Pathology Written Exam IV
1. A patient is said to have microcytic anemia if his:
A. Hematocrit and mean corpuscular hemoglobin concentration are low.
B. Hematocrit and mean corpuscular volume are low.
C. Mean corpuscular hemoglobin concentration is low.
D. Mean corpuscular volume is low.
E. Hematocrit and mean corpuscular hemoglobin are low.
2. An anemic patient can have a normal hematocrit if:
A. She is severely dehydrated.
B. She has chronic lung disease.
C. She is severely fluid-overloaded.
D. She has a hemoglobin variant with low oxygen affinity.
E. She has a hemoglobin variant with high oxygen affinity.
3. The body compensates for anemia by:
A. Directing more blood flow to the kidneys.
B. Directing less blood flow to the brain.
C. Decreasing the affinity between hemoglobin and oxygen.
D. Increasing the affinity between hemoglobin and oxygen.
E. Increasing the activity of Krebs cycle enzymes in the red cells.
4. In cases of severe anemia that develop over a long period of time, all the following
symptoms/signs are observed, EXCEPT:
A. Headache
B. Tinnitus
C. Orthostatic tachycardia.
D. Shortness of breath on exertion.
E. Easy fatiguability
5. Which physiologic compartment holds the greatest amount of iron?
A. Hemosiderin in the reticuloendothelial system
B. Transferrin in plasma
C. Ferritin in plasma
D. Hemoglobin in red cells
E. Myoglobin in skeletal muscle
6. The lab measurement referred to as the total iron binding capacity (TIBC) is a reflection
of which of the following?
A. Iron content of the red cells
B. Concentration of ferritin in plasma
C. Total body iron stores
D. Concentration of transferrin in plasma
E. Iron content of the plasma
7. When iron deficiency develops in a middle-aged man, what is the most likely cause?
A. Interference of iron absorption by excess alcohol intake
B. Loss of blood from a urinary tract lesion
C. Loss of iron due to chronic hemolysis
D. Poor diet due to depression
E. Loss of blood from an alimentary tract lesion
8. When iron deficiency develops in a 30-year-old woman who is not pregnant, the most
likely cause is:
A. Hemorrhoids
B. Bulimia
C. Menstrual blood loss
D. Cancer of the colon or rectum
E. Reflux esophagus
9. Any of the following can lead to vitamin B12 deficiency, EXCEPT:
A. Strict adherence to a vegan diet.
B. Immune-mediated destruction of gastric parietal cells.
C. Surgical removal of the stomach.
D. Inflammatory lesion of the proximal jejunum.
E. Inflammatory lesion of the terminal ileum.
10. Folate deficiency produces all the following, EXCEPT:
A. Nuclear/cytoplasmic asynchrony in red cell precursors.
B. Enlarged, oval-shaped red blood cells.
C. Ineffective erythropoiesis.
D. Demyelination of neurons.
E. Anemia.
11. In hemolytic anemia, which of the following is decreased?
A. Mean corpuscular volume
B. Mean corpuscular hemoglobin concentration
C. Serum haptoglobin concentration
D. Serum methemalbumin concentration
E. Reticulocyte count
12. Which of the following conditions causes hemolysis by direct physical trauma to the red cells?
A. Paroxysmal cold hemoglobinuria
B. Idiopathic thrombocytopenic purpura
C. Cold autoimmune hemolytic anemia
D. Warm autoimmune hemolytic anemia
E. Disseminated intravascular coagulopathy
13. Which of the following diseases is caused by an autosomal dominant gene?
A. Glucose-6-phosphate dehydrogenase deficiency
B. Hereditary spherocytosis
C. Pyruvate kinase deficiency
D. Hemoglobin M disease
E. None of the above
14. Hemoglobin C disease is characterized by which of the following clinical findings?
A. "Fish vertebrae"
B. Leg ulcers
C. Autosplenectomy
D. Hemolytic anemia
E. All of the above
15. Hemoglobin E disease is seen most frequently in patient populations native to or
originating from which region?
A. China
B. Japan
C. Sub-Saharan Africa
D. Southeast Asia
E. The Mediterranean
16. Structural hemoglobin variants that have abnormally high affinity for oxygen would be
expected to produce which clinical finding?
A. Heinz bodies
B. Intraerythrocytic crystals
C. Cyanosis
D. Hemolytic anemia
E. Polycythemia
17. In beta-thalassemia major, anemia is the result of:
A. Deficient hemoglobin A production
B. Ineffective erythropoiesis
C. Hemolysis
D. Relative folate deficiency
E. All of the above
18. Acute cutaneous graft-vs.-host disease is characterized by:
A. Blistering in severe cases
B. Typical occurance around 40 days post-transplantation
C. Clinical resemblance to scleroderma
D. Most frequently-affected population being renal transplant recipients
E. Reaction against histocompatibility antigens on donor cells
19. You perform a skin biopsy on a 5 year old girl who has a few 3mm umbilicated papules
on her face. What is the most likely diagnosis?
A. dermatophyte infection
B. scabies
C. condyloma acuminatum
D. molluscum contagiosum
E. seborrheic dermatitis
20. You are taking call for one of your colleagues who is out of town. One of his
50-year-old patients calls you to say that he has broken out in a rash on his hands that
resembles a "bulls-eye". What is the first thing you ask him?
A. Does it itch?
B. Have you been previously diagnosed with pemphigus vulgaris?
C. Did you recently undergo arterial catheterization?
D. Are you taking any medications?
E. Did this happen after you went out in the sun?
21. You perform a skin biopsy on a 25-year-old woman with a blistering condition. The
routine pathology report says "Subepidermal blister with neutrophilic microabscesses in
the dermal papillae". The immunofluorescence report says "Granular deposition of IgA
at the epidermal-dermal junction". What is the most likely diagnosis?
A. Bullous pemphigoid
B. Dermatitis herpetiformis
C. Porphyria cutanea tarda
D. Pemphigoid gestationis
E. Epidermolysis bullosa acquisita
22. Blisters are LEAST likely to occur in which location?
A. Just above the stratum basalis
B. Beneath the dermis
C. Just beneath the stratum basalis
D. Beneath the stratum corneum
E. Within the stratum spinosum
23. What are you trying to preserve by submitting skin biopsies to pathology in Michel's media?
A. parasites
B. bacterial toxins
C. immunoglobulins
D. drugs
E. cholesterol emboli
24. Your renal failure patient visits his grandson in the newborn nursery. Not long
thereafter, he develops fever and his skin becomes bri ht , followed by formation of
large flaccid bullae which easily rupture. Several babies in the nursery also develop
the same condition. Which statement is true?
A. Culture of his skin lesions will be positive for Staphylococcus aureus
B. This condition may clinically resemble toxic epidermal necrolysis
C. He has a better prognosis than the babies in the nursery
D. Your patient can be managed at home with steroids
E. If a biopsy is performed, the cleft will be located in a subepidermal location
25. Which of the following is uncharacteristic of smallpox?
A. Lesions on the same area of the body in different stages of development
B. Involvement of palms and soles
C. Lesions which feel like "pellets" under the skin
D. Infectious scabs
E. Significant febrile prodrome
26. Mothers of Infants with ABO hemolytic disease of the newborn are usually of which
blood group?
A. AB
B. Equally likely among ABO groups
C. O
D. A
E. B
27. Which factor(s) contributing to hemolytic disease of the newborn are removed during
exchange transfusion?
A. Antibody
B. Antigen, antibody and bilirubin
C. Antigen
D. Antigen and antibody
E. Antigen and bilirubin
28. In the ABO blood group, mating of which two phenotypes can produce offspring with
each of the four common blood types?
A. ABandB
B. A and B
C. AB and AB
D. AB and O
E. AB and A.
29. The majority of acute hemolytic transfusion reactions are caused by:
A. Undetected antibody in the patient recipient
B. Clerical or managerial error
C. Leukocyte/platelet antibodies
D. Massive transfusion
E. Undetected antibody in the donor blood unit
30. A 28 year old gravida 2 para 0 is seen for the first time at 28 weeks gestation. She has
an anti D titer of 1:128. Management may include all of the following EXCEPT:
A. Rh Immune globulin
B. Intrauterine transfusion
C. Percutaneous umbilical blood sampling(PUBS)
D. Ultrasound
E. Amniocentesis
31. If a group A, Rh positive patient requires fresh frozen plasma (FFP) but no group A
FFP is available, the substitute product of choice would be:
A. Group AB FFP
B. Group B FFP
C. Group O FFP
D. Group A red blood cells
E. None of the above
32. Which infectious agent can be transmitted by WBCs present in a blood component?
A. Treponema pallidum
B. Hepatitis B virus (HBV)
C. Hepatitis C virus (HCV)
D. Plasmodium vivax
E. Cytomegalovirus (CMV)
33. Mrs G. is a pleasant 68 year old female with severe coronary artery disease and
anemia due to myelodysplastic syndrome. Her hemoglobin is 6.0g/dL, and you would
like to transfuse her with red blood cells to increase her hemoglobin to 10g/dL. How
many units of red blood cells should you order from the blood bank?
A. 1 unit of RBC
B. 5 units of RBC
C. 6 units of RBC
D. 4 units of RBC
E. 2 units of RBC
34. An infant is born to an Rh negative mother with anti D. The father is Rh positive. The
mother did not receive antenatal care during this pregnancy. Your attending asks you
to order the necessary laboratory tests on the baby. All of the following are appropriate
EXCEPT:
A. Direct antiglobulin test (DAT)
B. Serum bilirubin levels
C. Hemoglobin and Hematocrit
D. ABO and Rh type
E. Coagulation profile (PT/PTT)
35. In the case above, the blood bank resident tells you she is going to make sure that the
units of blood for this baby will be gamma irradiated. This is to prevent:
A. Delayed hemolytic transfusion reaction.
B. Transfusion related graft versus host disease
C. febrile non hemolytic transfusion reaction
D. Transfusion related acute lung injury
E. Allergic reactions to infused plasma proteins
36. All of the following are indications for the transfusion of plasma EXCEPT:
A. A 54 year old female with sepsis and disseminated intravascular coagulopathy
B. A 75 year old female on wafarin who presents with retroperitoneal hemorrhage
C. A 36 year trauma victim who is relatively stable with IV normal saline
D. A 66 year old male with chronic liver disease and gastrointestinal bleeding
E. A 24 year old female with congenital factor V deficiency
37. Which of the following statements is TRUE?
A. Osteopetrosis is a common disorder due to osteoclast dysfunction.
B. Osteomalacia, like rickets, has severe skeletal deformities at sites of rapid growth.
C. Paget's disease has an increased risk of associated skin lesions.
D. The autosomal dominant form of osteogenesis imperfecta is compatible with life.
E. Achondroplasia is the most common lethal form of dwarfism.
38. Which of the following statements is TRUE concerning avascular necrosis:
A. Microscopic findings are dead osteocytes in lacunae with necrotic overlying
cartilage.
B. It is a common condition.
C. It can usually be prevented.
D. It occurs only in the epiphysis.
E. It is most often due to thrombosis or embolism as in decompression sickness.
39. Which of the following statements is FALSE?
A. Osteomyelitis is the inflammation of bone and bone marrow.
B. Most osteomyelitis is caused by pyogenic bacteria and mycobacteria.
C. The "involucrum" refers to the inflammatory reaction with release of toxins and
destructive enzymes.
D. The location of the inflammation varies with age.
E. The "sequestrum" is the area of bone necrosis.
40. Which statement is TRUE regarding osteoarthritis?
A. It is seen mostly in males.
B. It may have extra-articular manifestations.
C. It is the most common type of joint disease.
D. It is usually seen in younger individuals.
E. Autoimmunity plays a key role, but the cause is unknown.
41. Tumors of adipose tissue:
A. When malignant, always behave in a low-grade fashion.
B. When malignant, will always be obviously sarcomatous histologically.
C. If malignant will have the lipoblast as a common type of cell.
D. Are more likely to be malignant in the subcutaneous tissue.
E. Are found commonly in children.
42. Which statement about synovial sarcoma is FALSE?
A. Simple excision is curative with 100% survival at 10 years.
B. It often has a biphasic pattern of epithelial gland formations with spindle cell
sarcoma component.
C. It occurs in the lower extremities, shoulder and elbow.
D. The tumor grows close to joints but rarely involves the synovium.
E. This tumor affects teenagers and young adults.
MATCHING: For each numbered item (Column 1), choose the letter of the most closely related item in column 2. Each answer may be used once, more than once, or not at all.
COLUMN I COLUMN 2
43. Achondroplasia A. Deficiencies in Type I collagen
44. Paget's Disease resulting in too little bone.
45. Osteomalacia B. Disease of growth plate with no
46. Osteogenesis Imperfecta changes in longevity, intelligence or
47. Rickets reproductive status.
C. Osteoclastic bone resorption followed
by excessive disordered bone
formation.
D. Characterized by defect in matrix
mineralization, most often related to
lack of vitamin D or disturbance
in its metabolism.
E. "Marble bone disease" due to
osteoclast dysfunction.
MATCHING: For each numbered item (Column 1), choose the letter of the most closely related item in column 2. Each answer may be used once, more than once, or not at all.
COLUMN I COLUMN 2
48. Salmonella osteomyelitis A. The cause of the majority of pyogenic
49. Group B strep osteomyelitis osteomyelitis.
50. Staph. aureus osteomyelitis B. Elderly patients with peripheral
51. E. Coli and Pseudomonas vascular disease
osteomyelitis C. IV drug abusers
D. Sickle cell disease
E. Neonates
MATCHING: For each numbered item (Column 1), choose the letter of the most closely related item in column 2. Each answer may be used once, more than once, or not at all.
COLUMN 1 COLUMN 2
52. Anklyosing spondylitis A. Systemic onset, teenagers
53. Reiter's syndrome B. Aging or "wear and tear"
54. Rheumatoid arthritis C. "Bamboo spine"
55. Osteoarthritis D. Arthritis, urethritis, conjunctivitis
56. Still's disease E. Pannus formation and subcutaneous
nodules
MATCHING: For each numbered item (Column 1), choose the letter of the most closely related item in column 2. Each answer may be used once, more than once, or not at all.