MCQ Book Questions

Q60682. A 60-year-old woman presents with a large breast mass that she fi rst detected 3 months ago. Mammography reveals a well- circumscribed mass measuring 8 cm in diameter. A breast biopsy shows loose fi broconnective tissue with a sarcomatous stroma, abundant mitoses, and nodules and ridges lined by cuboidal epithelial cells. Which of the following is the appro- priate diagnosis?

Q60683. A 52-year-old woman presents with a 3-month history of a palpable breast mass. Physical examination confi rms a 1-cm nodule in the upper outer quadrant of the right breast. A biopsy reveals small cuboidal cells, with round nuclei and prominent nucleoli. The cells are arranged in single cell col- umns, between strands of connective tissue (shown in the image). Which of the following is the appropriate diagnosis?

Q60684. A 58-year-old woman has a screening mammography and is found to have a 4-cm circumscribed mass, without calcifi ca- tions, in her left breast. An excisional biopsy shows solid nests and sheets of highly pleomorphic cells, with many mitotic fi g- ures, surrounded by a dense infi ltrate of lymphocytes. Which of the following is the most likely diagnosis?

Q60685. An 18-year-old man moves from sea level to an elevation of 2,400 m to train as a skier. The increased requirement for oxy- gen delivery to tissues at the higher elevation stimulates the synthesis of a renal hormone (erythropoietin), which targets hematopoietic stem cells in the bone marrow. Erythropoietin promotes the survival of early erythroid progenitor cells pri- marily through which of the following mechanisms?

Q60686. A 6-year-old girl is brought into the emergency room after an automobile accident. Physical examination shows bleed- ing from multiple wounds, and a CBC reveals a normocytic, normochromic anemia. Which of the following indices is most helpful in defi ning this patient’s anemia as normocytic?

Q60687. A 60-year-old man presents with a 6-month history of increas- ing fatigue. Physical examination reveals marked pallor, and a CBC shows a macrocytic anemia. Which of the following is the most likely cause of anemia in this patient?

Q60688. A 43-year-old woman of Scandinavian descent complains of constant tiredness, light-headedness, and occasional palpitations and shortness of breath while ascending the stairs. Physical examination shows pallor of the oral mucosa and a raspberry-red tongue (glossitis). Neurologic examina- tion reveals paresthesias, numbness, decreased vibration sensation, and loss of deep tendon refl exes. The results of laboratory studies include hemoglobin of 7.2 g/dL, WBC of 4,500/mL, platelets of 140,000/mL, erythrocyte folate of 220 ng/mL, serum vitamin B12 of 40 pg/mL (normal >200 pg/mL), serum anti-intrinsic factor of 1:128, and serum anti–parietal cell antibody of 1:64. Examination of peripheral blood shows macrocytic anemia, with poikilocytosis of RBCs and hyperseg- mented neutrophils. Atrophic gastritis is diagnosed by gastric biopsy. Bone marrow examination in this patient will reveal which of the following pathologic fi ndings?

Q60689. Which of the following mechanisms of disease best describes the pathogenesis of anemia in the patient described in Question 4?

Q60690. A 30-year-old woman complains of recent easy fatigability, bruising, and recurrent throat infections. Physical examina- tion reveals numerous petechiae over her body and mouth. Abnormal laboratory fi ndings include hemoglobin of 6 g/dL, WBC of 1,500/mL, and platelets of 20,000/mL. The bone mar- row is hypocellular and displays increased fat. What is the appropriate diagnosis?

Q60691. The patient described in Question 9 is at increased risk for development of which of the following conditions?

Q60692. A 27-year-old pregnant woman comes to the obstetrician for a prenatal check-up. Routine laboratory testing reveals a mild normocytic anemia. The peripheral blood smear is shown in the image. Which of the following best explains the pathogen- esis of anemia seen in this patient?

Q60693. A 10-month-old boy of Arabic extraction is brought to the physician by his parents who complain that their child is fail- ing to thrive. Physical examination reveals splenomegaly and jaundice. A CBC shows a microcytic, hypochromic anemia (hemoglobin = 7.4 g/dL). Fetal hemoglobin accounts for most of the hemoglobin. A peripheral blood smear is shown in the image. Which of the following is the appropriate diagnosis?

Q60694. A 39-year-old woman presents with a 2-month history of upper abdominal pain, weakness, and fatigue. Physical exami- nation reveals marked pallor. Laboratory studies show micro- cytic, hypochromic anemia (hemoglobin = 8.5 g/dL) and mild thrombocytosis. Gastroscopy discloses a mucosal defect in the antrum measuring 1.5 cm in diameter. Which of the following best describes the pathogenesis of anemia in this patient?

Q60695. The patient described in Question 16 is at increased risk of developing which of the following conditions?

Q60696. A 10-year-old black girl is brought to the emergency room. She complains of severe pain in her chest, abdomen, and bones. Physical examination reveals jaundice and anemia. Her par- ents state that she has been anemic since birth. A CBC shows normocytic anemia with marked poikilocytosis. A peripheral blood smear is shown in the image. Hemoglobin electropho- resis demonstrates hemoglobin S. This child’s chest and bone pain is most likely caused by which of the following mecha- nisms?

Q60697. Over the next 6 years, the patient described in Question 18 develops multiple splenic infarcts. Which of the following is a common complication of autosplenectomy in this patient?

Q60698. A 24-year-old woman with sickle cell disease is seen in the emergency room for an acute upper respiratory tract infection. Laboratory fi ndings include a severe, normocytic anemia. The patient develops a rapid drop in the hemoglobin level. How- ever, the reticulocyte count is very low (<0.01%). This fi nding most likely refl ects which of the following conditions?

Q60699. Which of the following best describes the pathogenesis of splenomegaly seen in the patient described in Question 12?

Q60700. A 22-year-old woman from a large Italian family is screened for a familial blood disorder. The results of laboratory studies include a hemoglobin of 9.5 g/dL and a smear displaying mild microcytosis, hypochromia, and a few target cells. Hemoglo- bin electrophoresis shows a mild increase in hemoglobin A2 (7.5%). What is the appropriate diagnosis?

Q60701. A 28-year-old woman delivers a male neonate at 36 weeks of gestation. The mother has a history of poor prenatal care and several previous miscarriages. Examination of the neonate reveals marked pallor and generalized edema (anasarca), and the peripheral blood smear is shown in the image. The nucle- ated cells in this blood smear are which of the following?