MCQ Book Questions

Q60782. A 10-year-old boy with a recent onset of diabetes mellitus dies following an automobile accident. Histologic examination of the child’s pancreas at autopsy is shown in the image. Injury to pancreatic islet cells in this patient was most likely mediated by which of the following mechanisms of disease?

Q60783. A 75-year-old woman with well-controlled diabetes complains of poor eyesight. A grayish-white opacifi cation of the lens is found during a comprehensive eye examination. Which of the following metabolic pathways is most likely involved in this lens abnormality?

Q60784. A 40-year-old diabetic woman complains of fl ank pain and fever. Her temperature is 38.7°C (103°F), respirations are 25 per minute, and blood pressure is 150/90 mm Hg. Urinalysis reveals pyuria with WBC casts. Which of the following features of diabetes is the most important contributing factor in the development of fl ank pain and fever in this patient?

Q60785. A 32-year-old woman with diabetes mellitus delivers a child after 38 weeks of gestation. Which of the following is the most likely abnormality that might be encountered in this child at birth?

Q60786. An obese woman (body mass index [BMI] = 32 kg/m2) presents for a routine physical examination. In reviewing your patient’s health status, you mention that obesity is associated with an increased incidence of which of the following diseases?

Q60787. A 65-year-old obese man (body mass index = 32 kg/m2) presents with a 2-year history of diffi culty walking. Physical examination reveals chronic ulcers in the lower extremities. Funduscopic examination reveals proliferative retinopathy. Which of the following best describes the pathogenesis of chronic ulcers on the legs of this patient?

Q60788. Thickening of small vessel basement membranes in the patient described in Question 7 is most likely related to abnormalities in which of the following cellular and biochemical processes?

Q60789. A 58-year-old man with a long-standing history of type 2 diabetes mellitus suffers a massive hemorrhagic stroke and expires. Examination of the pancreas shows hyalinization of many islets of Langerhans. Which of the following character- izes the material within the islets of Langerhans?

Q60790. A 57-year-old woman presents with a 1-year history of diarrhea, increasing fatigue, and weight loss. Physical examination rev- eals a large tongue and induration of the anterior abdominal wall. Laboratory tests are all within normal ranges. A D-xylose absorption test is abnormal, indicating small intestinal mal- absorption. A CT scan of the pelvis shows diffuse thickening of the rectal wall, retroperitoneum, and mesentery. Urinalysis documents proteinuria (0.5 g per day), without evidence of Bence-Jones protein. The plasma cell count in the bone mar- row biopsy is increased by 10%, but there is no evidence of multiple myeloma. Which of the following tests would be most useful for establishing a diagnosis of primary amyloidosis?

Q60791. Which of the following histochemical stains is most useful for identifying amyloid in a tissue biopsy taken from the patient described in Question 1?

Q60792. A biopsy taken from the rectum of the patient described in Questions 1 and 2 is appropriately stained and observed under polarizing light (shown in the image). Immunohistochemical assays show that this birefringent material contains kappa chains. This patient’s amyloidosis belongs to which of the following categories?

Q60793. A 74-year-old man with a history of progressive cognitive impairment dies from complications of congestive heart fail- ure. At the time of autopsy, his brain shows diffuse atrophy. Microscopic examination demonstrates numerous senile plaques and neurofi brillary tangles, as well as deposition of eosinophilic material in the walls of the cerebral vasculature. A section is stained with Congo red and examined under polarized light (shown in the image). The birefringent mate- rial is derived from which of the following proteins?

Q60794. A 56-year-old woman dies of a chronic neurodegenerative dis- ease. Autopsy reveals spongiform encephalopathy with brain amyloidosis. This patient’s amyloidosis most likely belongs to which of the following categories?

Q60795. The patient described in Question 4 asks for further informa- tion regarding her medical condition. You explain that “amy- loid” refers to a group of extracellular protein deposits that are best defi ned as which of the following?

Q60796. A 55-year-old man, who has smoked heavily for many years, presents with a 3-year history of persistent cough, frequent upper respiratory infections, and production of foul-smelling, mucopurulent sputum. An X-ray fi lm of the chest shows bron- chiectasis. Five years later, the patient complains of frequent diarrhea. A CT scan of the abdomen and pelvis shows diffuse thickening of the rectal wall, retroperitoneum, and mesen- tery. A rectal biopsy demonstrates amyloid that is most likely derived from which of the following serum proteins?

Q60797. For the patient described in Question 6, progressive cell and organ dysfunction will develop primarily as a result of which of the following biological processes?

Q60798. A 55-year-old man from China presents with a 3-month history of scales on his skin. Physical examination reveals numerous scaly, pigmented plaques, which rub off easily. Biopsy of a plaque shows anastomosing cords of mature and stratifi ed squamous epithelium, associated with small keratin cysts. This patient may have which of the following underlying conditions?

Q60799. An 18-year-old woman notes that one of her moles has increased in size and become darker. The patient has a family history of melanoma, and she is seen by her dermatologist regularly to “follow her moles.” Physical examination reveals numerous, 5 to 10 mm, darkly pigmented, variegated lesions distributed primarily on her trunk but also involving non–sun-exposed skin. This patient may harbor a germline mutation in a gene that regulates which of the following proteins?

Q60800. An 80-year-old farmer presents with a 1-cm, red, slightly raised plaque on his face. A biopsy of the lesion shows cytologic atypia and dyskeratosis limited to the basal layers of the stratum spon- giosum, as well as hyperkeratosis and parakeratosis. This lesion is a precursor for which of the following dermatologic diseases?

Q60801. A 45-year-old man presents with painful, purple nodules on the dorsal surface of his left hand that he fi rst noticed 9 months ago. A biopsy (shown in the image) discloses a poorly demar- cated lesion composed of atypical spindle-shaped neoplastic cells and extravasated red cells. Similar lesions are found in the lymph nodes and liver. Which of the following viruses is associated with the pathogenesis of these skin lesions?