Skin and Hematopathology

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Skin and Hematopathology
2014-02-03 12:55:18
Rubin Skin Hematopathology
Block 3
Rubin's Self Test for Skin and Hematopathology NOT Q&A questions
Show Answers:

  1. A 62-year-old male with abdominal pain and fatigue for a long time. Physical exam splenomegaly but without lymphadenopathy. After he development bacterial sepsis and die. During the autopsy the pathologist performs biopsy of bone marrow and shows atypical bone marrow and shows  atypical megakaryocytes and severe fibrosis. Which of the probably diagnosis in the following picture?

    A) Myelogenous Acute Leukemia
    B) Promyelocytic Chronic Leukemia
    C) Idiopathic Chronic Myelofibrosis
    D) Lymphocytic Chronic Myelofibrosis
    E) Myelogenous Chronic Leukemia
    Idiopathic Chronic Myelofibrosis
  2. A 40-year-old male presented third degree severe burns. In the hospital presents anemia thrombocytopenia and generalized purpura. Blood test shows increase fibrin. Which of the following probably diagnosis in the following picture?

    A) Acanthocytosis 
    B) Henoch-Schonlein Purpura
    C) Idiopathic Thrombocytopenia Purpura
    D) Microangiopathic Hemolytic Anemia
    E) Nocturnal Paroxystical Hemoglobulinuria
  3. A 46-year-old male presents ataxia. MRI shows cerebral infarctions. Blood test reveals 995,000 platelets. Bone marrow biopsy shows increase of megakaryocytes. Cytogenetic test are normal. Which of the following probably  diagnosis in the following picture?

    A) Chronic Myelogenous Leukemia
    B) Essential Thrombocytopenia
    C) Polycythemia Vera
    D) Myeloid Metaplasia w/ Myelofibrosis
    E) Thrombotic Thrombocytopenic Purpura

  4. Presented persistent cough with hemoptysis. Physical exam reveals right . Biopsy lymph node shows the following picture showing supraclavicular painless lymphadenopathy. Which of the following is the probable diagnosis?

    A) Acute Myelogenous Leukemia
    B) Burkitt Lymphoma
    C) Hodgkin Lymphoma
    D) Infectious Mononucleosis 
    E) Lymphoblastic Lymphoma

  5. A 55-year-old male paint with positive history of alcoholism present macrocytic anemia and thrombocytopenia. Blood test shows oval macrocytes and hyper-segmented neutrophils. Which of the following probably diagnosis in the following  picture?

    A) Chronic disease associated with anemia
    B) Folic acid deficiency
    C) G6PD deficiency
    D) Iron deficiency anemia
    E) Sickle cell anemia

  6. A 10-year-old boy is brought to the emergency room with pain joints. His mother refers that he has been suffering of joint and abdominal pains since very young. Past clinical history includes severe pneumococcal pulmonary infections. Lab reports show anemia, reticulocytosis, and thrombocytosis. A peripheral smear reveals abnormal erythrocytes (look at the picture) What is your diagnosis?

    A) Erythroblastosis Fetalis
    B) Hemolytic anemia
    C) Sickle cell anemia
    D) Microangiopathic hemolytic anemia
    E) G6PD deficiency

  7. A CBC shows pancytopenia, with moderate anemia (hemoglobin = 10.5 g/dL). Mild neutropenia and thrombocytopenia are noted. A bone marrow evaluation reveals erythroid hyperplasia with increased iron. A prussian blue-stain bone marrow aspirate is shown in the image. Which of the following is the appropriate diagnosis?

    A) Hairy cell leukemia
    B) Multiple myeloma
    C) Polycythemia Vera
    D) Promyelocytic Leukemia
    E) Myelodysplastic Syndrome

  8. A 4-year-old boy from Kenya presents with a 3 week history of a rapidly expanding jaw. The cells express surface IgM and are positive for common B-cell antigens (CD19,20,22) Which of the following is the appropriate diagnosis?

    A) Plasmacytoma
    B) Small lymphocytic lymphoma
    C) Acute Myelogenous Leukemia
    D) Burkitt Lymphoma
    E) Reactive Follicular Hyperplasia

  9. Patient presents with splenomegaly, leukopenia and monocytopenia. Physical exam reveals hepatosplenomegaly and peripheral lymphadenopathy. A peripheral blood evaluation reveals cells with fried eggs appearance (look at the picture). Cytometry evaluation reported a CD19, 20 cells. What is the diagnosis in this case?

    A) Hairy cell leukemia
    B) Acute lymphoblastic leukemia
    C) Acute myelogenous leukemia
    D) Chronic myelogenous leukemia
    E) Chronic lymphocytic leukemia

  10. Patient presents with abundant scales located in the trunk and face. The mother and grandmother present with the same lesions. Biopsy of the skin reveals hyperkeratosis and thin stratum granulosum. which of the following probably  diagnosis according to the following picture?

    A) Acute Ezcematoid dermatitis
    B) Bullous Pemphigus
    C) Epidermolysis Bullosa
    D) Ichythosis Vulgaris
    E) Pemphigus Vulgaris

  11. In a routinely evaluation a 75-year-old man is found to have punched out lesions in the vertebral column. Serum examination is consistent with higher concentrations of M-protein. A bone marrow examination revealed abundant plasma cells with abundant basophilic cytoplasm and nuclear inclusions (look at the image). What is the most likely diagnosis?

    A) Hodgkin Lymphoma
    B) Non-Hodgkin Lymphoma
    C) Acute Lymphoblastic Leukemia
    D) Plasma Cell Myeloma
    E) Polycythemia Vera

  12. A 30-year old male with painless pigmentation and multiple lesions in the chest and the face of slowing growth. The image shows microscopic change in the skin. What is the probable diagnosis in the following picture?

    A) Intradermal Nevus
    B) Epidermal Cyst
    C) Keratosis seborrhea
    D) Impetigo
    E) Actinic Keratosis

  13. 63 year old male patient presents ulcerated lesion in eyelid. the image shows microscopic change in the skin. What is your diagnosis?

    A) Malignant Melanoma
    B) Basal Cell Carcinoma 
    C) Keratoacanthoma
    D) Hemangioma
    E) Kaposi Sarcoma

  14. A 59 year old man complains of having an itchy rash for the past few months. He said the lesions first appeared as red swollen plaques on his abdomen and flexor aspect of her forearms (Shown in the image). Physical examination reveals urticarial plaques, as well as large bullous on his abdomen and thighs (shown in the image). A skin biopsy  shows a positive direct immunoflourescence test for IgG antibasement membrane antibody. Which of the following is the appropriate diagnosis?

    A) Allergic Contact Dermatitis
    B) Bullous Pemphigoid
    C) Dermatitis Herpetiformis
    D) Epidermolysis Bullosa
    E) Pemphigoid Vulgaris

  15. A 42-year-old woman presents with a pigmented lesion on the posterior aspect of her right calf (shown int he image). An excisional biopsy demonstrates a superficial spreading types of melanoma. Which of the following histologic features has the most important prognostic  value in your evaluation of this patient?

    A) Degree of melanocytic atypia
    B) Degree of vascularity
    C) Depth of dermal invasion
    D) Extent of intraepidermal invasion by melanoma cells
    E) absence of variable melanin pigmentation

  16. A 20-year-old mean with multiple 2 to 4mm dome shaped flesh colored firm umbilicated papules on the trunk and anogenital region and not painful. The biopsy demonstrated a cup-like verrucous epidermal hyperplasia due to a poxvirus infection. What is the most accurate diagnosis?

    A) Herpes simplex
    B) Common wart
    C) Zoster
    D) Molluscum Contagiosum
    E) Roseola
  17. A 25-year-old woman presents with concern about a mole on her abdomen. The mole is small, round, symmetric, and dark-colored, and has sharply defined borders. It is diagnosed as a common mole. This lesion is properly termed a:

    A) Melanocytic nevus
    B) Blue nevus
    C) Spitz nevus
    D) Dysplastic Nevus
    E) Lentigo Maligna

  18. Soft, tan-colored, cauliflower-like lesion, Epidermal hyperplasia, hyperkeratosis koliocytosis refers to:

    A) Herpes infection
    B) Psoriasis
    C) Melasma
    D) Hairy Leukoplakia
    E) Verucae

  19. A 55-year-old man presents with a large, black-colored, asymmetric skin lesion with ill-defined borders on his face. He reports a family history of malignant melanoma. Which of the following clinical variants of malignant melanoma has the poorest prognosis?

    A) Lentigo Maligna Melanoma
    B) Superficial Spreading Melanoma
    C) Nodular Melanoma
    D) Acral-lentiginous melanoma

  20. Used as a treatment. Which of the following is your diagnosis?

    A) Pemphigus Vulgaris
    B) Bullous Pemphigoid
    C) Lichen Planus
    D) Psoriasis
    E) Actinic Keratosis

  21. A 4-year-old male presents severe hemorrhage after trauma to the knee. Blood test shows decrease factor IX and normal factor VIII. Which of the following is the probably diagnosis?

    A) Hemophilia A
    B) Hemophilia B
    C) Henoch-Schonlein Purpura
    D) Idiopathic Thrombocytopenic Purpura
    E) Von Willebrand Disease
  22. 72-year old woman who has suffered chronic hypertension for more than 20 years is seen in consult because of signs and symptoms suggestive of anemia. She has been non-compliant with her antihypertensive medication and is currently in renal failure. What type of anemia is most likely to be found on a peripheral smear of her blood?

    A) Microcytic Normochromic
    B) Normocytic Normochromic
    C) Megaloblastic
    D) Microcytic Hypochromic
  23. A 52-year-old woman seeks medical attention because of “worsening of my reflux problem.” Physical examination is unremarkable except for epigastric tenderness. On endoscopy the physician observes a mass in the stomach from which he excises a sample for biopsy. The biopsy report indicates a lymphoid ma??? with the presence of expanded marginal zone lymphocytes surrounding and infiltrating B-cell follicles and invasion of the granular epithelium. This woman would benefit the most from which of the following treatments?

    A) Cytotoxic agents
    B) Radiotherapy
    C) Antibiotic therapy
    D) Surgery
  24. A 66 year old patient has been experiencing, dizziness and weakness for about a month. He shows his physician a CBC, which was done approximately 2 days before. It reveals the following information: HgB 11g/dL, Hct 30%, RBC count 3.0x10/uL, reticulocyte count is within normal limits. MCV 75um3, RDW increased. Which is the most likely diagnosis?

    A) Anemia due to Thalassemia
    B) Anemia due to iron deficiency
    C) Anemia due to enzymatic defect
    D) Megaloblastic Anemia
  25. Which of the following is true about vitamin B12?

    A) Deficiency states develop rapidly
    B) Homocysteine levels are diminished
    C) It is absorbed in the ileum
    D) It is absorbed in the proximal jejunum
  26. A 59-year-old man seeks medical attention because of fever, fatigue, anorexia, and abdominal pain. Laboratory exams shows moderate anemia, leukocytosis, with granulocytes in different stages of maturation. A biopsy report of his bore marrow shows hypercellularity with general effacement of the marrow space because of invasion predominantly myeloid cells. On physical examination hepatosplenomegaly is described. Which of the following is the most likely diagnosis?

    A) Acute Myeloid Leukemia
    B) CML chronic phase
    C) Adult T cell leukemia Lymphoma
  27. A 5-year-old child develops the sudden onset of bloody diarrhea, vomiting of blood, hematuria, and renal failure following a flulike gastrointestinal illness. The blood urea nitrogen BUN level is markedly increased, but fibrin degradation products and blood clotting times are within normal limits. A peripheral blood smear reveals pokilocytes, schistocytes, and decrease in the number of platelets. No fever or neurologic symptoms are present. Which is the most likely diagnosis for this patient?

    A) Autoimmune Thrombocytopenic purpura 
    B) Disseminated Intravascular Coagulopathy
    C) Hemolytic Uremic Syndrome
    D) Isoimmune Thrombocytopenic purpura
    E) Thrombotic Thrombocytopenic Purpur
  28. Patient comes to doctor because of jaundice, abdominal pain and chronic ulcers on his lower extremities. A lab exam reveals a normocytic anemia with polyychromasia, reticulocytosis, and increased osmotic fragility of the RBC. A biopsy of the bone marrow is reported to have erythroid hyperplasia. Physical examination reveals splenomegaly and pain to palpation in the right upper quadrant. Which microorganism is most likely involved in this process?

    A) H. pylori
    B) Human Papilloma Virus
    C) Parvovirus B19
    D) HTLV-1
    E) EBV
  29. 63-year-old man is seen in consult because of unaccounted weight loss of more than 15 points in one month, fever, and fatigue. On physical exam the physician describes a generalized painless lymphadenopathy. A biopsy of one of the lymph nodes reveals neoplastic follicles, which are present in high density, and found in a back-to-back arrangement with very little intervening paracortex. Which of the following is the most likely diagnosis?

    A) Follicular lymphoma
    B) Mantle Cell lymphoma
    C) Hodgkin lymphoma
    D) MALT lymphoma
  30. Patient presents with weight loss, and low grade fever, which occurs predominantly at night. On physical examination the physician describes non-tender peripheral adenopathy involving a group of lymph nodes in the cervical region. Biopsy of the lymph nodes reveals an inflammatory cell milieu consisting of small lymphocytes (mostly T cells), plasma cell bland histiocytes and eosinophils along with RS cells. Which of the following lymphocytic markers are expressed in the RS cells?

    A) CD30
    B) CD22
    C) CD12
    D) CD10
    E) CD2
  31. Which is the most common cause of death in patients with hemophilia A?

    A) Intestinal obstruction intestinal
    B) Bleeding into the cerebrum
    C) Degenerative articular disease
    D) Priapism
    E) HTLV infection
  32. Which of the following Purpuras is most common during menstruation?

    A) Purpura simplex
    B) Senile Purpura
    C) Scurvy
    D) Henoch-Schonlein Pupura
    E) Rendu-Osler Weber Syndrome
  33. Which of the following is a vascular pathology due to immune damage to blood vessel wall?

    A) Rendu-Osler-Weber Syndrome
    B) Henoch-Schonlein Purpura
    C) Ehlers-Danlos Syndrome
    D) Scurvy
    E) Senile Purpura
  34. A camp counsellor, because of severe pain, brings a 14-year-old girl to the emergency department. She knows that she has a “chronic disease” but is not exactly sure what it is. Physical examination shows a 2-cm ulcer on her lower leg that appears to extend to the bone. An x-ray of her lower leg is normal. Technetium radionuclide scan of her leg shows increased uptake. Cultures of the wound grow Salmonella. A peripheral blood smear shows Howell-Jolly bodies. Which of the following the most likely underlying condition?

    A) Alpha-thalassemia
    B) Beta-thalassemia
    C) G6PD deficiency
    D) Hereditary spherocytosis
    E) Sickle cell anemia
  35. A 6-year-old is brought to the emergency department by her father because of a nosebleed “that just wont stop.” The father says that they have “tilted her head back” and applied ice packs for several hours, but nothing has worked. She has been well except for a runny nose and a sore throat from a viral infection some 12 days ago. Physical examination shows epistaxis and diffuse ecchymoses and petechiae. A bone marrow biopsy shows increased number of megakaryocytes with immature forms. Which is the patient’s most likely diagnosis?

    A) Acute ITP
    B) Chronic ITP
    C) TTP
    D) Henoch-Schonlein Purpura
    E) Bernard-Soulier Syndrome
  36. 9-year-old black girl is brought to the emergency room. She complains of severe pain in her chest, abdomen, and bones. Physical examination reveals jaundice and anemia. Her parents state that she has been anemic since birth. A CBC shows normocytic anemia with marked poikilocytosis. A peripheral blood smear is shown in the image. Hemoglobin electrophoresis demonstrates hemoglobin S. This child’s chest and bone pain is most likely caused by which of the following mechanisms?

    A) Amylodosis
    B) Ischemia
    C) Infection
    D) Coagulopathy
    E) Vasculitis

  37. 10 year old boy from Northern Europe presents with chronic fatigue. Physical examination reveals slight jaundice and splenomegaly. The results of laboratory studies include hemoglobin 11.7g/dL, hematocrit 32%, total bilirubin of 2.6 mg/dL, and conjugated bilirubin of 0.8 mg/dL. The peripheral blood smear is shown in the image. The osmotic fragility of the patient’s RBC are increased, but the Coombs test is negative. Defects in which of the following are involved in the pathogenesis of this disorder?

    A) DNA synthesis
    B) Erythrocyte cytoskeleton
    C) Erythrocyte maturation
    D) G6PD
    E) Hemoglobin synthesis

  38. A 25-year-old, previous healthy man of turkey origin develops moderate to severe hemolytic anemia. The previous evening he had celebrated a Saint’s day with a feast of beans and pasta. Urinalysis shows fr?? hemoglobin, and the direct Coombs test is negative. Supravital staining of the blood smear demonstrates numerous membrane bound inclusions (Heinz bodies) with erythrocytes. Which of the following is the most likely diagnosis?

    A) G6PD deficiency
    B) Paroxysmal Nocturnal Hemoglobulinuria
    C) Sickle cell anemia
    D) B-thalassemia minor
    E) Warm antibody autoimmune hemolytic anemia
  39. A 33-year-old man is brought into the emergency room after an automobile accident. Physical examination shows bleeding from multiple wounds, and a CBC reveals normocytic normochromic anemia. Which of the following indices is most helpful in defining this patient’s anemia as normocytic?

    A) Hemoglobin
    B) Hematocrit
    C) Mean corpuscular volume
    D) Mean corpuscular hemoglobin concentration
  40. A 65-year-old woman complains of pain in her back, fatigue and occasional confusion. She admits to polyuria and polydipsia. An X-ray examination reveals numerous lytic lesions in the lumbar vertebral bodies. Laboratory studies disclose hypoalbuminemia, mild anemia, and thrombocytopenia. A monoclonal IgG peak is demonstrated by serum electrophoresis. Urinalysis shows 4+ proteinuria. A bone marrow biopsy discloses foci of plasma cells, which account for 19% of all hematopoietic cells. What is the appropriate diagnosis?
    A) Acute Lymphoblastic Lymphoma
    B) Chronic Lymphocytic Leukemia
    C) Extramedullary plasmacytoma
    D) Waldenstrom macroglobulinemia
    E) Multiple myeloma
  41. A 52-year-old male presents with multiple tense bullae that involve his skin but not his oral mucosa. Physical examination finds that none of the bullae have ruptured, and the 

    A) Pemphigus Vulgaris
    B) Bullous Pemphigoid
    C) Dermatitis Herpetifromis
    D) Psoriasis
    E) Lichen planus
  42. A 28-year-old worker male frequently in contact with dust and soil materials, complains about a dermatosis in the neck and upper lumbs, referes that have been identified 3 months ago and characterized by pruritic lesions. Physical exam reveals slightly descamative and diffuse plaques. What is the diagnosis to this case?

    A) Seborrheic Dermatitis
    B) Psoriasis
    C) Contact Dermatitis due to allergic reaction
    D) Chronic Lichen
  43. Related to the last question, Which hypersensitive reaction is related to this situation?

    A) Type I
    B) Type V
    C) Type III
    D) Type IV
  44. A 45-year-old male with long lasting lesions in the scalp,elbow and knees. Physical exam reveals large scaly erythematous plaques, in the extensor cutaneous surfaces. Histopathologic findings reveal thickened epidermis with hyperkeratosis and parakeratosis. What is the diagnostic in this case?

    A) Lichen planus
    B) Atopic dermatitis
    C) Psoriasis
    D) Circunscrit Neurodermatitis
  45. Female 2 years old with dermatoses affecting face (perinasal area), 2 days of evolution, with mild itching. On examination boards background with lacerated crusted erythematosus, of variable shape and size, looking like "cigarette burns." We would be facing:

    A) Contagious Impetigo 
    B) Leishmaniasis 
    C) Contact dermatitis 
    D) None of the above