MCQ Book Questions

Q60822. A 45-year-old woman presents with a 1-year history of dry mouth and eyes. Physical examination reveals bilateral enlarge- ment of the parotid glands. A biopsy (shown in the image) discloses infi ltrates of lymphocytes forming focal germinal centers. Which of the following best describes changes that would be expected in this patient’s parotid glands, late in the course of her disease?

Q60823. A 16-year-old girl presents with a sore throat of 4 months in duration. She describes feeling a lump in her throat. Physical examination reveals a 1-cm cystic lesion at the base of the tongue. This developmental lesion most likely arises as a rem- nant of which of the following anatomic structures?

Q60824. A 4-year-old boy from Uganda presents for pre-school physi- cal examination. His parents indicate that hearing loss in his right ear developed 3 years ago following an acute illness. If this child’s hearing loss was caused by a viral infection, which of the following was the most likely etiology?

Q60825. An 82-year-old man presents with painless swelling below the right ear that has been growing slowly for about a year. Physical examination confi rms a cystic lesion. Fine-needle aspiration returns scanty brown fl uid, which microscopically consists of a mixture of lymphoid cells and epithelial cells with abundant granular eosinophilic cytoplasm. A biopsy of the mass is shown in the image. Which of the following is the most likely diagnosis?

Q60826. A 64-year-old man presents with sores on the gums. Oral examination shows multiple, gingival abscesses adjacent to the teeth and excessive mobility of several teeth. Which of the following is the most likely diagnosis?

Q60827. A 2-year-old girl was withdrawn from a day care center for excessive irritability. On physical examination, she has mul- tiple, small superfi cial ulcers of the oral mucosa. The ulcer- ations heal spontaneously over the next 5 days. Which of the following is the most likely diagnosis?

Q60828. A 6-year-old boy presents with a painful sore in his mouth. Physical examination reveals a small, elevated, and focally ulcerated red-purple gingival lesion. A soft red mass mea- suring 1 cm in diameter is surgically removed. Histologic examination discloses highly vascular granulation tissue, with marked acute and chronic infl ammation. What is the most likely diagnosis?

Q60829. A 60-year-old man, who is a chronic alcoholic, is referred by a homeless shelter for facial ulcers. On physical examina- tion, there are large ulcerations in the mouth and facial tissues with focal exposure of bone. A culture grows Borrelia vincentii. Which of the following is the most likely diagnosis?

Q60830. A 60-year-old woman presents with a 5-month history of “sinus pressure.” A 2-cm fi rm lesion is identifi ed in the right lateral nasal wall. A CT scan reveals involvement of the adjacent para- nasal sinus. A biopsy (shown in the image) displays epithelial nests protruding into the submucosa with uniform cellular pro- liferation and no atypia. Which of the following etiologic agents is most likely associated with the development of this lesion?

Q60831. A 33-year-old woman presents with a painful gingival lesion. Oral examination shows a 1-cm swelling on the lower right gingiva. A biopsy is taken (shown in the image). Which of the following is the most likely diagnosis?

Q60832. A 26-year-old football player complains of persistent nasal blockage, runny nose, and headache. Multiple nasal polyps are identifi ed and resected (shown in the image). Histological examination of the polyps shows that they are benign. Which of the following is the most likely cause of polyps in this patient?

Q60833. A 50-year-old woman presents with a slowly enlarging, painful mass at the angle of the right jaw. A biopsy of the mass is shown in the image. Which of the following is the most likely diagnosis?

Q60834. A 34-year-old man complains of hearing loss. He has had mul- tiple bouts of ear infections over the last 20 years and was recently diagnosed with chronic suppurative otitis media. Which of the following is the most likely complication of this condition in this patient?

Q60835. A 40-year-old man presents with a 2-month history of a pain- less lump in his left jaw. A radiograph of the mandible shows a 2-cm multilocular lesion with smooth cyst-like appearance, smooth periphery, expansion of the bone, and thinning of the cortex. A biopsy of the mass is shown in the image. This patient’s ameloblastoma is thought to arise from which of the following cells or structures?

Q60836. An 8-year-old boy presents with a 3-day history of fever and sore throat. His temperature is 38°C (101°F), pulse is 88 per minute, and respirations are 33 per minute. On physical examination, the tonsils are enlarged, boggy, and coated with a purulent exudate. A tonsillar swab is most likely to grow which of the following microorganisms?

Q60837. A 70-year-old woman complains of gradual hearing loss. Which of the following conditions is the most likely cause of conducting hearing loss in this patient?

Q60838. A 24-year-old man presents with right ear pain that he has had for 3 days. He recently returned from a scuba diving trip to the Caribbean. The patient is afebrile. Otoscopic examination reveals a bulging, right tympanic membrane. What is the most likely diagnosis?

Q60839. A 33-year-old man from China presents with a lump in his neck. Physical examination reveals painless, anterior cervi- cal adenopathy. A large necrotizing mass is identifi ed in the posterior nasopharynx, with obstruction of both eustachian tubes. A biopsy of the mass reveals sheets of malignant cells with large nuclei (shown in the image). Which of the follow- ing pathogens has been associated with the development of this patient’s neoplasm?

Q60840. A 30-year-old man with dwarfi sm is admitted to the hospital for hip replacement due to severe osteoarthritis. He has short arms and legs and a relatively large head. His parents do not show signs of this congenital disease. This patient most likely has a spontaneous mutation in the gene encoding which of the following proteins?

Q60841. A 2-year-old boy is treated for recurrent fractures of his long bones. Physical examination reveals blue sclerae, loose joints, abnormal teeth, and poor hearing. Molecular diagnostic stud- ies will most likely demonstrate a mutation in the gene encod- ing which of the following proteins?