1. Marked fatty change of the heart muscle cells, with all about equally involved, indicates



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1. Marked fatty change of the heart muscle cells, with all about equally involved, indicates:
A. anemia, but it must be very severe

B. cocaine abuse

* C. diphtheria

D. severe alcoholism

E. Tay-Sach's disease
2. Patients with alkaptonuria (ochronosis) are most troubled by
* A. arthritis / back pain

B. diabetes

C. heart failure / rhythm problems

D. liver failure

E. skin pigmentation
3. The "hyaline" in the hepatocytes of a problem drinker is composed largely of
A. amyloid

B. basement membrane

C. fibrin

D. immunoglobulin

* E. keratin
4. A trichrome stain imparts a rich, deep blue or blue-green color to
* A. collagen

B. mucin, whether epithelial or mesenchymal

C. skeletal muscle

D. smooth muscle

E. squamous epithelium
5. A patient with jaundice has markedly elevated levels of unconjugated bilirubin, but normal levels of conjugated bilirubin. You suspect:
A. anabolic steroid abuse

B. biliary tract obstruction

C. Dubin-Johnson

* D. hemolysis

E. melanosis coli
6. Striking "onion-skin" proliferation of the intima of blood vessels is most suggestive of
A. discoid lupus

B. polyarteritis nodosa, acute

C. polyarteritis nodosa, healed

* D. scleroderma

E. systemic lupus

7. Wegener's granulomatosis is caused by autoantibodies against


A. basement membrane

B. lymphocytes

C. fibrin

* D. neutrophils

E. smooth muscle
8. Finding which autoantibody will tell you that your patient really does have CREST?
* A. anti-centromere

B. anti-double stranded DNA

C. anti-histone

D. anti-neutrophil cytoplasmic antibody

E. anti-single stranded DNA
9. THREE PHOTOS. Diagnose this group of skin lesions.
A. actinic keratosis

* B. malignant melanoma

C. papular urticaria

D. seborrheic keratosis

E. squamous cell carcinoma
10. ONE PHOTO. Look closely. What kind of pigmented lesion?
A. basal cell carcinoma

B. blue nevus

* C. junctional nevus

D. lentigo maligna melanoma

E. seborrheic keratosis
11. ONE PHOTO. Peripheral blood smear. What's your diagnosis?
* A. acute leukemia

B. chronic granulocytic leukemia

C. chronic lymphocytic leukemia

D. infectious mononucleosis

E. plasma cell leukemia
12. TWO PHOTOS. What is this skin lesion?
A. basal cell carcinoma

B. contact dermatitis / eczema

C. dermatophyte (skin fungus)

D. malignant melanoma

* E. seborrheic keratosis
13. TWO PHOTOS. What is your diagnosis?
* A. actinic keratosis

B. basal cell carcinoma

C. discoid lupus

D. ringworm

E. seborrheic dermatitis
14. TWO PHOTOS. Skin lesions. What is the diagnosis?
A. contact dermatitis / eczema

* B. erythema multiforme

C. pityriasis rosea

D. psoriasis

E. systemic lupus
15. THREE PHOTOS. Diagnose these skin lesions.
A. contact dermatitis / eczema

B. impetigo

C. lichen planus

* D. psoriasis

E. systemic lupus
16. ONE PHOTO. What is the most likely diagnosis?
A. abetalipoproteinemia

B. extramedullary hematopoiesis

C. erythroblastosis fetalis (hemolytic disease of the newborn)

* D. hemoglobin C disease

E. hereditary spherocytosis
17. TWO PHOTOS. What is the cause of this man's ulcer?
* A. basal cell carcinoma

B. Behcet's syndrome

C. blastomycosis

D. malignant melanoma

E. squamous cell carcinoma
18. THREE PHOTOS. What is the diagnosis?
A. impetigo

B. lichen planus

C. psoriasis

* D. mycosis fungoides / Sezary's

E. toxic epidermal necrolysis
19. ONE PHOTO. Peripheral smear of circulating blood. What is the diagnosis?
A. acute myelogenous leukemia

* B. chronic granulocytic (myelogenous) leukemia

C. hairy cell leukemia

D. megaloblastic anemia

E. Pelger-Huet anomaly
20. TWO PHOTOS. What's the diagnosis?
A. amyloidosis

B. Kaposi's sarcoma

* C. polyarteritis nodosa

D. polymyositis / dermatomyositis

E. scleroderma
21. ONE PHOTO. Peripheral smear. What is the diagnosis?
A. hemoglobin C disease

B. leukoerythroblastic smear

* C. sickle cell anemia

D. spherocytosis

E. thalassemia
22. ONE PHOTO. Blistering skin disease. This is most consistent with:
A. Behcet's

B. bullous pemphigoid

C. dermatitis herpetiformis

* D. herpes simplex (herpes gladiatorum)

E. pemphigus vulgaris
23. TWO PHOTOS. Skin disease with IgG immunofluorescence. What is the diagnosis?
A. bullous pemphigoid

B. dermatitis herpetiformis

C. herpes zoster

* D. pemphigus

E. systemic lupus
24. ONE PHOTO. Heart. Which is most likely?
A. aspergillosis

B. candidiasis

C. meningococcemia

D. systemic herpes infection

* E. thrombotic thrombocytopenic purpura
25. ONE PHOTO. Peripheral smear. What is the diagnosis?
A. acute leukemia

B. chronic granulocytic leukemia

C. chronic lymphocytic leukemia

D. hairy cell leukemia

* E. infectious mononucleosis
26. TWO PHOTOS. Skin disease with IgA immunofluorescence. The epidermis is in the upper half of the photomicrograph, the dermis in the lower half.
A. bullous pemphigoid

* B. dermatitis herpetiformis

C. herpes virus infection

D. pemphigus

E. systemic lupus / discoid lupus
27. ONE PHOTO. Peripheral blood. Your best diagnosis, please?
A. acute myelogenous leukemia

B. chronic granulocytic leukemia

C. hairy cell leukemia

* D. Pelger-Huet anomaly

E. sepsis
28. ONE PHOTO. Opportunistic lung infection in AIDS. What is the organism?
A. candida

B. cryptococcus

C. coccidioidomycosis

* D. cytomegalovirus

E. pneumocystis
29. TWO PHOTOS. Skin lesion. What's the cause?
A. atopic eczema

B. contact dermatitis

* C. discoid lupus

D. lichen planus

E. psoriasis
30. ONE PHOTO. Peripheral blood. What's the diagnosis?
* A. acanthocytosis

B. sickle cell disease

C. spherocytosis

D. thalassemia

E. no pathology
31. ONE PHOTO. Rash on a student doctor. What is the diagnosis?
A. atopic dermatitis

B. contact dermatitis

* C. pityriasis rosea

D. psoriasis

E. zoster shingles
32. TWO PHOTOS. Lung lesions in AIDS. What is the infection?
A. candida

B. cryptococcus

C. cytomegalovirus

D. histoplasmosis

* E. pneumocystis
33. ONE PHOTO. Bone marrow biopsy. What is the diagnosis?
* A. aplastic anemia

B. chronic lymphocytic leukemia

C. parvo B19

D. plasma cell myeloma

E. tuberculosis or other granulomatous disease
34. ONE PHOTO. Patient has been under treatment for chronic granulocytic (myelogenous) leukemia. What do you see on smear?
* A. blast crisis

B. leukoerythroblastic smear

C. iatrogenic neutropenia

D. in remission

E. stable disease
35. TWO PHOTOS. Skin lesions. What is the diagnosis?
A. acral melanoma

B. contact dermatitis

* C. Kaposi's sarcoma

D. pyogenic granuloma

E. squamous cell carcinoma, neglected
36. TWO PHOTOS. Smear and section. What is the diagnosis?
A. acute myelogenous leukemia / chloroma

* B. Burkitt's lymphoma

C. immunoblastic lymphoma

D. Langerhans cell histiocytosis

E. plasma cell myeloma
BONUS ITEMS
37. THREE PHOTOS. Lymph node. What is your diagnosis?
[Hodgkin's is sufficient]

38. ONE PHOTO. Bone marrow, Prussian blue. The counterstain stains the nuclei red. What do we call this category of anemias?


[sideroblastic]

39. ONE PHOTO. Identify the nucleated cell in the center of the photo. Be as specific as you can, and give a brief explanation.


[leukemic myeloblast, Auer rod. "Blast" + rod both required.]

40. ONE PHOTO. Which subtype of Hodgkin's disease is this? Explain briefly.


[nodular sclerosing; either lacunar RS variants or nodular sclerosis is required also]
41. ONE PHOTO. Lung from a patient with HIV infection. The lumen in the center is one of the medium-sized air-passages. What is the diagnosis? Think and look carefully.
[lymphoma]

42. Explain briefly why people with protein C deficiency are especially prone to skin necrosis when treated with coumadin (coumarin).

[inhibits protein C production / infarct skin]
43. What's the eponym given to the illness in which patients make autoantibodies against both the small air spaces of the lung and the little filters in the kidney?
[Goodpasture's]

44. "Thorotrast", thorium dioxide, was used in the mid-1900's by physicians for what purpose?


[imaging scans is sufficient]

45. At autopsy of a 55 year old man who died in a bar fight, you discover large retroperitoneal lymph nodes which turn out to be normal except for large, sharply circumscribed globules of lipid up to 40 microns across. The man was successfully treated for Hodgkin's disease in the mid-1970's. Explain.


[lymphangiogram dye]
46. What is a lithopedion?
[dystrophic calcification of unborn child / calcified fetus]

47. What is rituximab? Your best answer please.


[antibody vs CD20 / B-cell lymphoma]
48. Patients with agnogenic myeloid metaplasia are likely to notice, first, that they feel full after eating only a little bit of food. Why?
[big spleen]
49. What is an "LE body"?
[nucleus eaten by a phagocyte; must mention both]

50. Why does the clot in a red top tube fail to retract in Glanzmann's "tired platelet" disease?


[platelets do not bind to fibrinogen]

51. Explain why blood group AB is the “universal donor” for plasma.


[no anti-A or anti-B]

52. An Rh-negative woman has suffered a third-trimester miscarriage. She has already been sensitized to anti-D, having delivered one healthy Rh-positive child and one with anti-D hemolytic disease of the newborn. All children have the same father. Do you administer RhoGam? Why or why not?


[do not, already sensitized]

53. Why and how do we do the “major crossmatch” prior to red cell transfusion?


[patient’s serum and donor red cells]

54. “Cryoprecipitate is given to correct clotting factor deficiency”, but it is a poor choice for hemophilia B. Explain.


[no factor IX]
Name: _______________________

36 points
UHS Pathology

Skin Blood and Lymph

2003-2004
INSTRUCTIONS:
You must hand in BOTH your exam book and your photo book along with your answer key. This exam has 54 questions.
We do not think you'll need a bathroom break. If you have a question, raise your hand. Do NOT phonate.
If you are in the first of two groups, do not leave until you are told to do so. Then leave the building as a group without stragglers.
These books will be returned to you, but we will retain the photo books. The key will be up as the last group is completing the exam.

Pathologist Karl Landsteiner worked out the basic blood groups in the early 1900’s.
GOOD LUCK!


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