MCQ Book Questions

Q60942. A 65-year-old woman presents with a 3-week history of intractable headaches. Her vital signs and CBC are normal. Two weeks later, the patient develops left-sided hemiparesis. MRI reveals a large, necrotic tumor in the right hemisphere of the cerebrum, extending across the corpus callosum into the left hemisphere. A coronal section of the patient’s brain at autopsy is shown in the image. This tumor is most likely derived from which of the following cell types?

Q60943. A 20-year-old man complains of increasing diffi culty in hear- ing over the past several years. Physical examination confi rms bilateral sensorineural hearing defi cits. MRI discloses bilateral cerebellopontine angle tumors, consistent with schwannomas. This patient has a strong family history for benign tumors, including low-grade gliomas and meningiomas on his moth- er’s side of the family. Which of the following is the probable diagnosis?

Q60944. An 80-year-old woman wanders away from a nursing home and dies in a pedestrian-motor vehicle accident. A silver- stained section of her brain at autopsy reveals numerous lesions in the cerebral cortex (shown in the image). Which of the following terms best describes these pathologic fi ndings?

Q60945. A 26-year-old woman with a history of bitemporal hemianopsia and diabetes insipidus develops meningococcal infection and dies of septic shock. Examination of the brain at autopsy reveals a large cystic tumor mass replacing the midline struc- tures in the region of the hypothalamus (shown in the image). This tumor is derived from epithelial cells originating in which of the following embryonic structures?

Q60946. A 48-year-old man with AIDS is admitted to the hospital with a fever of 38.7°C (103°F), persistent cough, and diarrhea. His CD4 cell count is less than 500/μL. The patient is started on broad-spectrum antibiotics. He has also experienced a recent decline in cognitive function. He is at increased risk of devel- oping which of the following CNS neoplasms?

Q60947. A 14-year-old boy complains of a 4-month history of fatigue, abdominal pain, and yellowing of his eyes and skin. Physical examination shows tremor of both hands, lack of coordina- tion, and mild jaundice. An ophthalmic examination reveals Kayser-Fleischer rings. Degenerative changes are present in which of the following anatomic regions of the CNS in this patient?

Q60948. A 15-year-old boy who emigrated to the United States from Sudan presents with bilateral eye irritation and itching. Physi- cal examination reveals photophobia, conjunctivitis, and fi bro- vascular opacity in the superior cornea (shown in the image). Giemsa staining of a conjunctival scrape demonstrates cytoplas- mic inclusion bodies. What term describes the corneal lesion?

Q60949. A 29-year-old woman complains of nervousness and weak- ness of 6 months in duration. She says that she is increasingly intolerant of heat and frequently sweats. She has experienced a 9-kg (20-lb) weight loss over the past 2 months despite normal caloric intake and says that she frequently fi nds her heart racing. Physical examination reveals a symmetrically enlarged thyroid and exophthalmos. Which of the following best explains the pathogenesis of bilateral exophthalmos in this patient?

Q60950. A 56-year-old obese, diabetic woman (BMI = 32 kg/m2) complains of declining visual acuity. Funduscopic examina- tion shows peripheral retinal capillary microaneurysms, deep and superfi cial retinal hemorrhages, “waxy” hard exudates, areas of capillary closure, and vitreoretinal neovascularization. Urinalysis reveals 3+ proteinuria and 3+ glucosuria. Which of the following is the most important pathogenetic factor under- lying this patient’s retinopathy?

Q60951. A 65-year-old man complains of gradual loss of peripheral vision over the past 2 years. Ophthalmic examination shows elevated intraocular pressure. Funduscopic examination reveals “optic cupping.” Which of the following best explains the loss of visual fi eld sensitivity in this patient?

Q60952. The patient described in Question 4 has no underlying ocu- lar disease. Which of the following types of glaucoma is most likely present?

Q60953. A 28-year-old man consults his physician regarding his vision. He describes a 6-month history of increasing night blindness. Two of his maternal uncles have the same condition. Visual examination reveals a marked constriction of the patient’s peripheral visual fi eld. Funduscopic examination would likely show which of the following pathologic fi ndings?

Q60954. A 3-year-old child presents with a red and painful left eye. Ophthalmic examination reveals swelling of the eyelid and a purulent exudate. What is the proper name for this condition?

Q60955. A 54-year-old woman with rheumatoid arthritis presents with a 2-year history of dry eyes and dry mouth. Physical examina- tion confi rms xerostomia (dry mouth) and xerophthalmia (dry eyes) and reveals enlarged lacrimal glands bilaterally. Histo- logic examination of the lacrimal glands would likely show an infi ltrate of which of the following infl ammatory cell types?

Q60956. A 55-year-old obese woman (BMI = 34 kg/m2) with a his- tory of hypertension and hypercholesterolemia complains of nodular lesions on the nasal aspect of both of her eyelids. The lesions are yellow and nonpainful. Biopsy of a lesion would likely show an accumulation of which of the following cells?

Q60957. A 31-year-old woman complains of increased vaginal discharge of 3 months in duration. A cervical Pap smear is obtained. Two superfi cial squamous cells (shown in the image) display enlarged nuclei and perinuclear vacuoles (koilocytotic atypia). What is the appropriate diagnosis?

Q60958. A 33-year-old woman complains of vaginal spotting after intercourse. A cervical Pap smear is taken, and the results are shown in the image. A normal squamous epithelial cell is in the right upper corner. Which of the following is the most likely diagnosis?

Q60959. For the patient described in Question 2, which of the follow- ing cytologic features observed in the Pap smear would pro- vide the best evidence to substantiate a diagnosis of invasive squamous cell carcinoma?

Q60960. A 30-year-old woman presents for a routine physical exam- ination. A cervical Pap smear is taken. A cluster of multi- nucleated squamous cells is shown in the image. A normal superfi cial squamous cell is present at the top of the fi eld. This patient most likely has which of the following gyneco- logic diseases?

Q60961. A 36-year-old HIV-positive man presents with persistent dry cough, fatigue, and low-grade fever. Physical examination shows marked pallor and respiratory distress. An X-ray fi lm of the chest reveals diffuse, bilateral, interstitial infi ltrates. Bron- choalveolar lavage demonstrates a foamy alveolar cast com- posed of small cysts (shown in the image). What is the most likely diagnosis?