Path 1 Block 1 Mock Exams.txt

A 45-year-old man dies suddenly and unexpectedly. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region. His right coronary was markedly narrowed. The microscopy of coronary reveals changes of atherosclerosis with thrombosis occluding lumen almost 80%.
What is the most likely trigger for thrombosis in this case?

A. Aspirin
B. Serotonin
C. Endothelial damage
D. Bradykinin
E. Cholesterol

A 60-year-old man has been treated in the hospital for acute abdomen for the past three weeks. He complained of a swollen right leg that he developed while in the hospital. It is tender on palpation. This condition is most likely to be the result of deep vein thrombosis (DVT) of right leg. What is the key factor that causes DVT?

A. Disruption of the lamilar flow of blood (margination of platelets)
B. Leukocytosis
C. Absence of fibrinogen
D. Use of aspirin
E. Thrombocytopenia

A 61-year-old man has the sudden onset of severe chest pain. Vital signs include T 37 C, P 101/minute, R 20/minute, and BP 80/40 mmHg. An electrocardiogram demonstrates changes that are consistent with myocardial ischemia involving the left lateral ventricular free wall. He is given thrombolytic therapy with tissue plasminogen activator (tPA) (reintroduction
of RBC’s). However his serum troponin and creatinine kinase (MB) is found to be
abnormally high. What type necrosis is likely occurred?

A. Liquefactive
B. Caseous
C. Coagulative
D. Hemorrhagic
E. Red infarct

What is the striking difference in cellular death by necrosis and apoptosis?

A. Absence of inflammation in necrosis
B. Presence of mononuclear cells in and around apoptotic bodies
C. Absence of Inflammatory response to apoptotic cell death
D. Abnormality of neutrophil in apoptosis
E. Lack of chemotaxis in necrosis

Chronic smoking induces cellular changes that may be precursor of malignancy in lung

A. Squamous metaplasia of respiratory epithelium
B. Hypertrophy of respiratory epithelium
C. Emphysema
D. Myeloid metaplasia
E. Bronchiectasis

A 49-year-old man with AIDS comes to the clinic with unexplained shortness of breath for the past month. His temperature is 37.0 C (98.6 F), blood pressure is 110/70 mm Hg, and respirations are 16/min. Physical examination
reveals diminished heart sounds, but is otherwise unremarkable. An electrocardiogram reveals normal sinus rhythm at a rate of 90/min and low voltages in all leads. The chest x-rays demonstrate normal lung and an enlarged
cardiac silhouette, and no pleural effusions. CT chest reveals enlarged heart. A therapeutic tap to the pericardium confirmed the pericardial effusion. The
protein content of pericardial fluid is 1.5 g/dL with very few cells. What type of fluid is this?

A. Exudate
B. Pus
C. Transudate
D. Lymphedema
E. Myxedema

Activation of endonucleases and proteoases in a programmed cell death leads to one of the following

A. Infiltration of neutrophils
B. Apoptotic body formation
C. Activation of caspases
D. Release of Cytochrome C
E. DNA repair

A 53-year-old man has experienced severe chest pain for the past 6 hours. On physical examination he is afebrile, but has tachycardia. Laboratory studies show a serum troponin I of 10 ng/mL. A coronary angiogram is
performed emergently and reveals >90% occlusion of the left anterior descending artery. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs?

A. Increased cellular permeability
B. Glycogen stores are depleted
C. Cytoplasmic sodium increases
D. Nuclei undergo karyorrhexis
E. Swelling of endoplasmic reticulum

A 64-year-old woman, a known insulin-dependent diabetic comes to the emergency department because of a non- healing ulcer in the right foot since 10 days. She is hypertensive. The ulcer has foul smelling discharge. She also has foot swelling and fever. Local examination of the right lower extremity shows swelling of the lower leg and foot with crepitus and a 3x2 cm ulcer at the base of the great toe with foul smelling serous brownish discharge. What is the most likely diagnosis that generally need surgical intervention.

A. Wet gangrene
B. Tuberculosis
C. Granulation tissue
D. Fungal infection
E. Apoptosis

A 57-year old woman comes to the emergency department because of a "very high fever." She has diabetes mellitus and hypertension. She has a central line (catheter) in her left subclavian vein. Her laboratory studies show a white blood cell count of 23,000/mm3 and a hematocrit of 31%. What is the complication that could be life threatening?

A. Bacteremia
B. Septic Shock
C. Hyperglycemia
D. Urinary Tract Infection
E. Hypovolemic shock

In chronic granulomatous disease (CGD) of childhood, one of the following is the cause for decreased immunity

A. Absent MPO
B. Defect in Integrin
C. Decreased NADPH oxidase
D. Defective degranulation
E. Neutrophilic vacoulation

Acute phase protein synthesized in liver is one of the following

A. C- reactive protein
B. IL-1
C. TNF
D. Histamine
E. Integrin

The important chemoattractant for neutrophils is one of the following.

A. IgG & C3b
B. IL-1
C. TNF
D. C5a & LT B4
E. Prostaglandin E2

A 3-year-old boy is brought to the office because of a 3-day history of fever and vomiting followed by watery diarrhea. The father tells you that the child is very lethargic and seems dehydrated. Your advice will be to prevent one of the causes of morbidity/mortality in such case.

A. Hypovolemic shock
B. Fever
C. Cardiogenic shock
D. Loss of weight
E. Weight gain

A 21-year-old woman comes to the university health clinic complaining of a running nose, and mild fever. Her past medical history reveals that she suffers from similar attack of rhinitis whenever she visits farm? She has prescribed anti-allergic medication and nasal decongestant. What is the pathophysiology in this case?

A. Type IV hypersensitivity (delayed)
B. Autoimmune disorder
C. Innate immunity
D. Type I hypers ensitivity (immediate)
E. Adaptive immunity

A 49-year-old man with paraplegia see his physician for a yearly routine physical examination. His family history is significant for a father who died at age 58 from an acute myocardial infarction, and a brother with a history of angina. He does not smoke and drinks alcohol socially. His blood pressure is 135/96 mm Hg, and the remainder of his physical examination is unremarkable. An ECG is normal. A fasting cholesterol profile is performed which shows moderately increased cholesterol, triglyceride, LDL and decreased
HDL. The advice to this patient should be made concerning the following possible outcome:

A. Coagulative necrosis of heart
B. Ischemia of Kidney
C. Pale infarct of Spleen
D. Transient Ische mic Attack
E. pale infarct of spleen

A 76-year-old man comes to the clinic because of "urine problems". He tells you that he has "trouble with his urinary stream," that over the past month it has been progressively decreasing in force. He also has the urgency to urinate but can only pass a small amount of urine. He has started to leak urine. Yesterday, he ruined a new pair of pants and is visibly upset and embarrassed. Rectal examination reveals a moderately enlarged, smooth prostate. You explain to the patient that the most likely primary cause of his incontinence is benign prostatic enlargement. The changes at cellular level are:

A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Dystrophic calcification
E. Hypertrophy only

A 51-year-old man is admitted to the hospital because of alcoholic pancreatitis. The patient called 911 after experiencing 3 days of worsening abdominal pain. On arrival to the emergency room, he reported that he had been drinking approximately 1 quart of vodka per day for the past week. Admission laboratory tests revealed profoundly elevated amylase and lipase. An
abdominal CT demonstrated pancreatic stranding consistent with pancreatitis. What type of necrosis generally seen as complication of this condition?

A. Fat necrosis
B. Necrosis due to trauma
C. Wet Gangrene
D. Caseous necrosis
E. Ischemic necrosis

You are called to see a patient with end-stage liver disease secondary to hepatitis C obtained from injection drug abuse. He reports that he has experienced increasing abdominal girth for the last 2 weeks. He also notes that his urine output has been minimal for the last 3 days. Physical examination reveals scleral icterus, huge abdominal distention with bulging flanks. His lower extremities have 2+ edema. What is the most common cause for his abdominal distention?

A. Splenomegaly
B. Hepatomegaly
C. Peritonitis
D. Ascites
E. Renal hypertrophy

A 47- year-old man comes to the emergency department because he is "not feeling well and his abdomen is bloated and painful." He denies any previous medical history. He reports that he has had similar episodes in the past, which resolved spontaneously. This episode started 12 hours ago, when he started feeling discomfort and pain in the abdomen. He has not passed flatus since then. He is feeling nauseous. His abdomen is distended with fullness in the right upper quadrant and empty in the left lower quadrant. He has marked tenderness in the left lower quadrant. Rectal examination is positive for occult blood. His leukocyte count is 16,000/mm3. An abdominal x-ray shows a distended colonic loop pointing towards the left lower quadrant. Surgical intervention was used to treat the case. What type of cell death was being treated?

A. Anemic necrosis
B. Apoptosis
C. Atrophy
D. Appendicitis
E. Hemorrhagic necrosis

A 60-year-old woman develops severe chest pain over the past 6 hours. On physical examination she has tachycardia with hypotension. Laboratory studies show an elevated serum creatine kinase MB fraction. A coronary angiogram is performed emergently and reveals greater than 90% occlusion of the left circumflex artery. Which of the following cellular changes is most indicative of an irreversible injury to her myocardial fibers?

A. Glycogen depletion
B. Increased cytoplasmic sodium
C. Nuclear karyorrhexis
D. Diminished intracellular pH
E. Cell membrane blebbing

A 54-year-old man with a chronic cough has a squamous cell carcinoma diagnosed in his right lung. While performing a pneumonectomy, the thoracic surgeon notes that the hilar lymph nodes are small, 0.5 to 1.0 cm in size, and jet black in color throughout. Which of the following is the most likely cause for this appearance of the hilar nodes?

A. Accumulation of melanin
B. Anthracotic pigmentation
C. Hemosiderosis
D. Lipochrome deposition
E. Metastatic carcinoma

A 23-year-old female graduate student comes to a student clinic. She tells you that she is concerned about a breast lump that she found 2 days ago while showering. She is very worried as her 53-year-old maternal aunt was diagnosed with breast cancer 2 years ago. On breast examination, an approximately 2 cm mobile nodule is appreciated, which is slightly tender. The ultrasound reveals a cystic structure that gives a clear, straw-colored fluid on FNA. The cyst appears to be gone. The most appropriate next step in management is to

A. arrange for a breast biopsy under local anesthesia
B. obtain an official bilateral breast ultrasound
C. repeats the exam in 4-6 weeks
D. send the fluid for cytology
E. send the patient for a mammogram

A 43-year-old man has complained of mild burning substernal or epigastric pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass, no ulceration, and no hemorrhage noted. The biopsies demonstrate the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?

A. Dysplasia
B. Hyperplasia
C. Carcinoma
D. Metaplasia
E. Ischemia

A 40-year-old female patient visit the medical clinic complaining of unusual vaginal discharge. She describes the discharge as nonfoul-smelling. She states that she has not been sexually active for several months however past history of several partner is well documented. She goes to a gynecologist who collect sample for Pap smear to rule out…

A. Hyperplastic cervical cells
B. Metaplastic change
C. Dysplastic change
D. Inflammatory smear
E. Gonorrhea

A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She continues breast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that occurred in the breast during pregnancy allowed her to nurse the infant for this period of time?

A. Epithelial dysplasia
B. Steatocyte atrophy
C. Ductal epithelial metaplasia
D. Lobular hyperplasia
E. Stromal hypertrophy

An inflammatory process that has continued for several months includes the transformation of tissue macrophages to epithelioid cells. There are also lymphocytes present. Over time, fibroblasts lay down collagen as the focus of inflammation heals. These events are most likely to occur as an inflammatory response to:

A. Immune complexes
B. EB virus
C. Mycobacterium leprae
D. Prothrombin
E. E. coli

A 26 year old male presents with enlarged cervical lymph nodes. A FNAC of the lymph node suggests tuberculous lymphadenitis. Which of the following cell is the hallmark of this granuloma?

A. Plasma cells
B. Eosinophils
C. Neutrophils
D. Epitheloid cells
E. Reactive lymphocytes

A 45-year-old woman is investigated for hypertension and is found to have enlargement of left kidney. The right kidney is very small and non-functional. The size change in the left kidney is an example of which of the following adaptive changes

A. Aplasia
B. Atrophy
C. Hyperplasia
D. Hypertrophy
E. Metaplasia

A 20-year-old man presents with multiple dark brownish black mole in the skin. Which of the following pigment accumulations is the cause for this finding?

A. Bilirubin
B. Hemosiderin
C. Lead
D. Melanin
E. Silver

A 20-year-old man has experienced painful urination for 4 days following spring break. A urethritis is suspected, and Neisseria gonorrheae is cultured on urine culture study. Numerous neutrophils are present in a smear of the exudate from the penile urethra. What is the most potent vasodilator that also increases vascular permeability?

A. TNF
B. IL
C. Histamine
D. Prostaglandin
E. Complement C5a

A 35-year-old woman has been taking acetylsalicylic acid (aspirin) for arthritis for the past 4 years. Her joint pain is temporarily reduced via this therapy. However, radiographs of her knees reveal continuing joint destruction with loss of articular cartilage and joint space narrowing. This pain reduction is most likely to be the result of diminishing which of the following inflammatory responses?

A. Blocking IL-1 release
B. Hageman factor inhibition
C. Blocking cyclooxegenase pathway of arachidonic acid
D. Blocking lipoxygenase pathway of arachidonic acid
E. Inhibition of chemotaxis of neutrophils by leukotrience B4

An inflammatory process that has continued for 3 months resulting in the collection of epithelioid cells and an outer mantle of lymphocytes. Over time, fibroblasts lay down collagen as the focus of inflammation heals. The epitheloid cells are diagnostic of granulomatous inflammation and are derived from one of the following cells.

A. Eosinophils
B. Basophils
C. Reactive Lymphocytes
D. Macrophage
E. IgG secreting Plasma cells

A 58-year-old woman with chronic obstructive pulmonary disease has a 60 pack year history of smoking. During the past month she has experienced worsening dyspnea. She is afebrile. A chest x-ray shows a prominent right heart border along with bilateral pleural effusions. Thoracentesis is performed and 500 mL of fluid is removed. Laboratory studies on the fluid show a cell count of 1 leukocyte/micro liter and protein of 0.7 g/dL. Which of the following conditions is most likely to cause her pleural effusions?

A. Pulmonary Tuberculosis
B. Mitral Stenosis
C. Mediastinal mass
D. Right heart failure
E. Lung malignancy

A 54-year-old man died due to Acute Coronary Syndrome. The medical history suggests that he has been a smoker for 30 yrs and was having a chronic cough. On autopsy, it was found that there is congestion and edema of the lung. His past history suggests multiple episodes of myocardial ischemia with clinical features of congestive cardiac failure. The histology of the lung reveals one of the following to confirm the chronic passive congestion of the lung.

A. Heart failure cell
B. Melanin deposition
C. Anthracoctic pigmentation
D. Hemochromatosis
E. Wear & tear pigments

A 56-year-old has not received any medical care nor seen a physician for years. He reports reduced exercise tolerance over the past 5 years. On occasion in the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. He is found to have a blood pressure of 155/95 mm Hg. His body mass index is 30. Laboratory findings include total serum cholesterol of 245 mg/dL with HDL cholesterol that is 22 mg/dL. The high lipid profile predisposes this patient to myocardial infarction due to one of the following factor that most likely initiates coronary artery thrombosis.

A. Fatty acids are damaging to endothelial cell
B. Fatty liver causing decreased fibrinogen
C. Splenomegaly
D. Use of aspirin
E. Hepatomegaly

A 22-year-old man develops marked right lower quadrant abdominal pain over the past day. On physical examination there is rebound tenderness on palpation over the right lower quadrant. Laparoscopic surgery is performed, and the appendix is swollen, erythematous, and partly covered by a yellowish exudate. It is removed, and a microscopic section shows infiltration with numerous neutrophils. What is molecule responsible for extravasations (transmigration) of neutrophils at the endothelial gaps?

A. VCAM
B. Selectin
C. ICAM
D. Integrin
E. PECAM-1 (CD31)

A clinical study is performed of patients with pharyngeal infections. The most typical clinical course averages 3 days from the time of onset until the patient sees the physician. Most of these patients experienced fever and chills. On physical examination, the most common finding is a pharyngeal purulent exudate. Which of the following types of cell is predominantly seen in this inflammation?

A. Mast cells
B. Basophils
C. Macrophages
D. Neutrophils
E. Lymphocytes

The acute inflammation is one of the means of defense by one of the following?

A. Adaptive immunity
B. Innate immunity
C. Autoimmunity
D. Hypersensitivity
E. Immune complexes

A 29-year-old man goes on a snorkeling trip to Looe Key Marine Sanctuary and later spends time on the beach at Bahia Honda State Park. The next day he has a darker complexion. His skin does not show warmth, erythema, or tenderness. His skin tone fades to its original appearance within a month. Which of the following substances contributes the most to the biochemical process leading to these skin changes?

A. Tyrosine
B. Melanocyte
C. Heme
D. Glycogen
E. Lipofuscin

A 55-year-old man has a history of hypercholesterolemia with coronary artery disease and suffered a myocardial infarction 2 years ago. He now presented with crushing substernal chest pain and died before any medical intervention. On autopsy, the thrombosed coronary artery is seen. What kind of necrosis that may cause?

A. Liquefactive necrosis
B. Hemorrhagic necrosis
C. Coagulative necrosis
D. Fat necrosis
E. Caseous necrosis

The following gross finding is seen in liver and diagnostic of the following:



A. Miliary tuberculosis
B. Cirrhosis
C. Hemochromiasis
D. Chronic Passive Congestion (nutmeg liver)
E. Fatty change

The hypertrophied left ventricle in 60 yrs old patient is due to:

A. Systemic Hypertension
B. Acute Coronary Syndrome
C. Liver cirrhosis
D. Deep vein thrombosis
E. Infective endocarditis

The pulmonary embolism is the result of one of the following.

A. Arterial thrombosis
B. Coronary thromboembolism
C. Venous thrombosis
D. Cerebral thromboembolism
E. Vegetation on mitral valves

The fatty change in this microscopic section can be confirmed by one of the following special stains.

A. Congo red
B. H & E staining
C. Oil red O stain
D. Prussian blue
E. Pap stain

A 45-year-old man dies suddenly and unexpectedly. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region. His right renal artery was markedly narrowed, resulting in focal ischemia and hemorrhage of the renal parenchyma. An elevation in which of the following substances in his blood is most likely to be associated with these findings?

A) Histamine
B) Serotonin
C) Renin
D) Bradykinin
E) Cholesterol

A 60-year-old man has been treated in the hospital for acute abdomen for the past three weeks. He complained of a swollen right leg that he developed while in the hospital. It is tender on palpation. This condition is most likely to be the result of which one of the following?

A) Left ventricular failure
B) Infarction
C) Mural thrombus
D) Deep vein thrombosis
E) Smoking

Chronic granulomatous inflammation as seen in the microscopic slide reveals caseating lesion. What is the type of giant cells.



A) Foreign body giant cells
B) Langhans giant cell
C) Multinucleated giant cells in Sarcoidosis
D) Epitheloid cells
E) None of the above

What is the striking difference in cellular death by necrosis and apoptosis?

A) Absence of inflammation in necrosis
B) Presence of mononuclear cells in and around apoptotic bodies
C) Absence of Inflammatory response to apoptotic cell death
D) Abnormality of neutrophil in apoptosis
E) Lack of chemotaxis in necrosis

Chronic smoking induces cellular changes that may be precursor of malignancy

A) Squamous metaplasia of respiratory epithelium
B) Atrophy of respiratory epithelium
C) Glandular metaplasia of the squamous epithelium
D) Myeloid metaplasia
E) None of the above

The hypertrophied left ventricle in 60 yrs old patient is due to



A) Systemic Hypertension
B) Acute Coronary Syndrome
C) Liver cirrhosis
D) Deep vein thrombosis
E) Infective endocarditis

Activation of endonucleases and proteoases in a programmed cell death leads to one of the
following

A) Infiltration of neutrophils
B) Apoptotic body formation
C) Activation of caspases
D) Release of Cytochrome C
E) DNA repair

Which one of the following venereal disease that are directly associated with cervical carcinoma

A) Syphilis
B) Gonorrhea
C) LGV
D) HPV infection
E) None of the above

A 57-year old woman comes to the emergency department because of a "very high fever." She has diabetes mellitus and hemodialysis-dependent renal failure. She also has hypertension. Her blood pressure is 170/90 mm Hg and temperature is 38.3 C (101.0 F). Her neck is supple without any specific meningismus. She has a Tesio catheter in her left subclavian vein. Her laboratory studies show a white blood cell count of 23,000/mm3 and a hematocrit of 31%. Her urinalysis is dipstick negative for white blood cells. What is the complication that could be life threatening.

A) Bacteremia
B) Septic Shock
C) Hyperglycemia
D) Urinary Tract Infection
E) Hypovolemic shock

In chronic granulomatous disease (CGD) of childhood, one of the following is the cause for decreased immunity

A) Absent MPO
B) Defect in Integrin
C) Decreased NADPH oxidase
D) Defective degranulation
E) None of the above

Acute phase protein synthesized in liver is one of the following

A) C- reactive protein
B) IL-1
C) TNF
D) Histamine
E) Integrin

The important chemoattractant for neutrophils is one of the following.

A) IgG & C3b
B) IL-1
C) TNF
D) C5a & LT B4
E) Prostaglandin E2

A 3-year-old boy is brought to the office because of a 3-day history of fever and vomiting followed by watery diarrhea. The father tells you that the child is very lethargic and seems dehydrated. He attends daycare 5 days a week and 4 other children have had similar symptoms over the past month. The patient appears moderately dehydrated.

Your advice will be to prevent one of the cause of morbidity/mortality in such case.

A) Hypovolemic shock
B) Fever
C) Cardiogenic shock
D) Loss of weight
E) Non of the above

23 yrs old women has breast fed her new born baby until 2 years. Which of the following changes during pregnancy made that breast feeding possible?

A) Epithelial metaplasia
B) Weight gain
C) Lobular Hyperplasia
D) Stromal hypertrophy
E) Good nutrition

A 55-year-old man has a history of hypercholesterolemia with coronary artery
disease and suffered a myocardial infarction 2 years ago. He now presented with crushing substernal chest pain and died before any medical intervention. On autopsy, the thrombosed coronary artery is seen as shown in the picture? What kind of necrosis that may cause?



A) Liquefactive necrosis
B) Hemorrhagic necrosis
C) Coagulative necrosis
D) Fat necrosis
E) Caseous necrosis

A 76-year-old man comes to the clinic because of "urine problems". He tells you that he has "trouble with his urinary stream," that over the past month it has been progressively decreasing in force. He also has the urgency to urinate and he finds himself running to the bathroom, but can only pass a small amount of urine. The trips to the bathroom have increased in frequency over the past couple of days and he has started to leak urine. The leakage is only in small amounts, but can occur at any time. Yesterday, he ruined a new pair of pants and is visibly upset and embarrassed. Rectal examination reveals a moderately enlarged, smooth prostate. Urine dipstick in the office is negative for glucose, RBC, WBC, and nitrites. You explain to the patient that the most likely primary cause of his incontinence is benign prostatic enlargement. The changes at cellular level are:

A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Dystrophic calcification
E) Hypertrophy only

A 67-year-old woman with peripheral vascular disease, bilateral leg claudication, and hypertension comes to the clinic because of nausea and severe, diffuse abdominal pain that she rates as 7/10 in intensity for the past 2 days. The pain is related to meals, particularly lunch. She has smoked a pack of cigarettes per day for the past 30 years. The patient has a temperature of 36.1 C/(97 F) with a pulse of 80/min and a blood pressure of 120/80 mm Hg. Abdominal examination demonstrates normal bowel sounds, no tenderness, and no hepatosplenomegaly. Laboratory studies reveal a leukocyte count of 4,000/mm3 and a hematocrit of 47%. You should be immediately suspicious of

A) Acute Appendicitis
B) Acute Pancreatitis
C) Acute Cholecystitis
D) Mesenteric Ischemia
E) Ulcerative colitis

A 63-year-old woman with type 2 diabetes comes to the office after 5 episodes of vaginal bleeding over the past 3 months. There is no discharge accompanying the bleeding. The patient has been postmenopausal for 12 years and has never experienced any bleeding since then. Her past medical history is significant for anxiety disorder, depression, hypertension, and gout. The patient refuses to give a sexual history. Her blood pressure is 140/90 mm Hg, pulse is 80/min, and her weight is 136 kg (300 lbs). You are concerned about her vaginal bleeding and perform the following:

A) Excisional biopsy of endometrium
B) USG of lower abdomen
C) X-ray lower abdomen
D) Coagulation profile
E) Serum Beta HCG

A 55 year old diabetic woman who died 48 hours after being hospitalized for chest pain is presented for autopsy. The left ventricular myocardium has an extensive area of coagulative necrosis and the left anterior descending coronary artery, supplying the affected area, is occluded by a soft yellow plaque. What is the cardiac marker from the following?

A) Albumin
B) CK-MB
C) Globulin
D) Prothrombin
E) Fibrinogen

A 40 year old black male noticed a raised disfiguring skin nodule over the previously healed scar. A biopsy was done and the microscopic picture is given below. This finding is seen in one of the following situation.



A) Overgrowth of granulation tissue
B) Repeated wound at the same place
C) Keloid
D) Delayed healing
E) Infected wound

A 26 year old male presents with enlarged cervical lymph nodes. A FNAC of the lymph node suggests tuberculous lymphadenitis. Which of the following cell is the hallmark of this granuloma.

A) Plasma cells
B) Eosinophils
C) Neutrophils
D) Epitheloid cells
E) Reactive lymphocytes

A 45-year-old woman is investigated for
hypertension and is found to have enlargement of left kidney. The right kidney is very small and non-functional. The size change in the left kidney is an example of which of the following adaptive changes

(A) Aplasia
(B) Atrophy
(C) Hvperplasia
(D) Hypertrophy
(E) Metaplasia

A 20-year-old man presents with multiple dark brownish black mole in the skin. Which of the following accumulations underlies these findings?

(A) Bilirubin
(B) Hemosiderin
(C) Lead
(D) Melanin
(E) Silver

The autopsy finding as revealed in the picture of a case of acute abdomen who died before arrival to the hospital emergency is one of the following type of necrosis.



A) Anemic infarct
B) Fat necrosis
C) Hemorrhagic necrosis
D) Dry gangrene
E) None of the above

The pulmonary embolism is the result of one of the following.



A) Arterial thrombosis
B) Coronary thromboembolism
C) Venous thrombosis
D) Cerebral thromboembolism
E) Vegetation on mitral valves

After two weeks in the hospital following a fall in which she incurred a fracture of her left femoral trochanter, a 76-year-old woman now has a left leg that is swollen, particularly her lower leg below the knee. She experiences pain on movement of this leg, and there is tenderness to palpation. What complication is she suffering from?

A. Gangrenous necrosis of foot
B. DIC
C. Venous stasis [DVT]
D. Soft tissue malignancy
E. Cellulitis

The gross sectional finding of the cellular death is a result of one of the following



A) Dry gangrene
B) Liquefactive necrosis
C) Fat necrosis
D) Arterial infarct
E) Venous infarct

A 40-year-old, chronically ill man from a Vietnamese village presents with painful sores around his mouth. Physical examination reveals prominent fissures at the angles of his mouth. Cheilosis in this patient is most likely caused by a deficiency of which of the following vitamins?

A. A
B. B1 (thiamine)
C. B2 (riboflavin)
D. B12
E. C

An obese woman (body mass index [BMI] = 32 kg/m2) presents for a routine physical examination. In reviewing your patient's health status, you mention that obesity is associated with an increased incidence of which of the following diseases?

A. Cardiomyopathy
B. Cervical carcinoma
C. Chronic obstructive pulmonary disease
D. Degenerative joint disease
E. Diabetes mellitus type I

A starving, 4-year-old, African boy presents with apathy, generalized edema, and an enlarged fatty liver. The physician notes that, despite generalized growth failure, subcutaneous fat is preserved. What is the appropriate diagnosis?

A. Beri-beri
B. Kwashiorkor
C. Marasmus
D. Pellagra
E. Scurvy

A 47-year-old man presents with a 6-week history of increasing fatigue and dark-colored stools. Complete blood count shows hemoglobin of 8.6 g/dL and microcytic, hypochromic RBCs. Upper gastrointestinal endoscopy reveals a peptic ulcer along the lesser curvature of the stomach. This patient's anemia is most likely caused by deficiency of which of the following?

A. Folic acid
B Iron
C. Thiamine
D. Vitamin B12
E. Zinc

A 40-year-old, malnourished woman presents with a 6-month history of night blindness. Physical examination reveals keratomalacia and corneal ulceration. Which of the following vitamin deficiencies would be suspected in this patient?

A. A
B. B2 (riboflavin)
C. C
D. E
E. Folic acid

A homeless man, who is a chronic alcoholic, is brought to the hospital in a wasted state. He is noted to have a peripheral neuropathy, difficulty balancing, and dementia. He dies suddenly of an arrhythmia, and at autopsy, lesions are found in the mamillary bodies and the vicinity of the third ventricle. The vitamin deficiency associated with these signs and symptoms is which of the following?

A. B1 (thiamine)
B. B12
C. D
D. Niacin
E. Pyridoxine

A 45-year-old woman with longstanding Crohn disease and severe fat malabsorption experiences a fracture of the femoral neck after a minor contusion. This woman most likely has a deficiency of which of the following vitamins?

A. B1 (thiamine)
B. C
C. D
D. K
E. Niacin

A 15-year-old African boy has a history of tooth loss, gingivitis, skin hemorrhages, multiple infections, and poor wound healing. Physical examination shows that the child is in the 20th percentile for height and 10th percentile for weight. This patient most likely has which of the following underlying conditions?

A. Beri-beri
B. Impetigo
C. Kwashiorkor
D. Pellagra
E. Scurvy

Which of the following is more often associated with bulimia nervosa than with anorexia nervosa.

A. Significant weight loss
B. Metabolic alkalosis
C. Distorted body image
D. Secondary amenorrhea
E. Osteoporosis

A clinical or laboratory finding that is more frequently associated with marasmus than with kwashiorkor is

A. Decreased muscle mass and subcutaneous fat
B. Pitting edema
C. Fatty liver
D. Hypoalbuminemia
E. Diarrhea

Which of the following clinical or laboratory abnormalities represents a water soluble vitamin deficiency rather than a fat soluble vitamin deficiency?

A. Nyctolopia
B. Squamous metaplasia
C. Hypocalcemia
D. Rickets
E. Ringed sideroblast

A 25 year old woman has not had her period for the last 8 months. She is 5’ 2” and weighs 90 pounds. A urine pregnancy test is negative. She states that she has been trying to lose weight for her upcoming wedding. You order a battery of tests and give the patient an intramuscular injection of progesterone. Ten days later the patient returns to your office and reports that she had no withdrawal bleeding. Laboratory tests reveal the following: serum prolactin is normal, serum FSH and LH are low, serum TSH is normal, serum estradiol is low and serum Cortisol is increased. Based on these findings you strongly suspect the patient has ….

A. Primary ovarian disease
B. Hypoputitarism
C. Secondary hypothyroidism
D. Anorexia Nervosa
E. Cushings syndrome

Which of the signs or symptoms characterize a fat soluble rather than a water soluble vitamin deficiency?

A. Perifollicular hemorrhage
B. Bone pain and tetany
C. Peripheral neuropathy
D. Ophthalmoplegia, confusion and ataxia
E. Hyperpigmentation in sun exposed areas

Which of the signs or symptoms are more predominantly found in marasmus than kwashiorkor?

A. Hepatomegaly
B. Pitting edema
C. Flaky paint dermatitis
D. Broom stick extremities

Pellagra will most likely develop in a patient:

A. Who is taking isoniazid
B. Whose diet primarily consists of corn
C. Who is a pure vegan
D. Who is taking nicotinic acid to lower lipids
E. With maldigestion secondary to chronic pancreatitis

Which of the following laboratory test abnormalities would you most expect in a patient with morbid obesity?

A Increased serum TSH
B. Increased 24-h urine for free cortisol
C. Increased fasting glucose
D. Increased 24-h urine for 17 ketosteroids
E. Increased serum prolactin

Which of the following vitamin deficiencies would you expect in a child maintained on unfortified goat’s milk?

A. Ascorbic acid
B. Thiamine
C. Niacin
D. Pyridoxine
E. Riboflavin

A 65 year old woman complains of bleeding gums after brushing her teeth, easy bruising and pain in her legs when walking. Her platelet count is normal. The pathogenesis of her disease is most closely related to

A. A deficiency of ATP
B. A cofactor deficiency in collagenase
C. Lack of hydroxylation of lysine and proline
D. A cofactor deficiency in lysyl oxidase
E. Platelet dysfunction

A 24-year-old woman, who is a food faddist, eats only corn-based foods. She presents with dermatitis, diarrhea, and dementia. This patient most likely suffers from which of the following conditions?

A. Beri-beri
B. Impetigo
C. Kwashiorkor
D. Marasmus
E. Pellagra

A 68-year-old man goes to the physician for a routine health maintenance examination. Physical examination of the oral cavity shows that the right buccal mucosa has some discrete white patches with a leathery surface. The lesions are spread over an area of 0.7 x 2.5 cm. A biopsy sample from one of the lesions shows squamous epithelial acanthosis with marked hyperkeratosis. Which of the following risk factors is most likely to cause these lesions?

A. Eating chili peppers
B. Chewing spearmint gum
C. French kissing
D. Chewing tobacco
E. HIV infection

Cigarette smoking has wide spread adverse health effect. The ischemic heart disease is one of the important consequences of the smoking. Which of the following is the major component of the tobacco smoke that predisposes the person to ischemic heart disease by damaging the endothelium of coronary arteries and hypoxia of the heart?

A. Chemical irritant like ammonia
B. Nicotine
C. Tar
D. Carbon monoxide
E. Polycyclic hydrocarbons

The cancer patients who have intractable nausea as a result of chemotherapy have used a drug that has been classified as drugs of abuse in parts of the world. Which is most likely to have this beneficial effect for cancer patient?

A. Cocaine
B. LSD
C. Marijuana
D. Heroin
E. Ecstasy

In cocaine abuse, the addictive euphoric effect is caused by the persistence of neurotransmitter dopamine in CNS. This is caused by one of the following action of cocaine?

A. Increased secretion of dopamine
B. Dopamine metabolised to active ingredient
C. Blocks the reuptake of dopamine [increase D2]
D. Increased secretion of serotinin
E. Activates the serotonin

A 5-year-old boy is seen by physician for his sleepiness. He is very tired and does not play with friends. On examination, he has pale skin and mucous membranes. His CBC report shows decreased hemoglobin with RBCs showing basophilic stippling. Which of the following is the most likely diagnosis?

A. Arsenic poisoning
B. Lead poisoning
C. Carbon monoxide poisoning
D. Cyanide poisoning
E. Mercury poisoning

To determine the exposure to cigarette a metabolite of nicotine is detected in the urine samples. Which of the following is that metabolite?

A. Cotinine
B. Dioxin
C. Formaldehyde
D. Nitrosamine
E. Hydrazine

A 8-year-old boy falls while running around. The skin of his left arm and knee scrape along the rough pavement, and the top layer of epidermis get removed. Which of the following best describes this injury?

A. Deep Incision
B. Contusion
C. Abrasion
D. Sharp cut
E. Superficial burn

A case of heroin addict was examined by his physician. He was icteric and was diagnosed as having mass in his liver. His serological studies reveal HBs Ag (HBV) positive. What has most likely caused present clinical feature.

A. Infection
B. Heroin overdose
C. Thrombophlebitis
D. Hepatotoxicity
E. None of the above

A 30-year-old man is brought to the emergency room in an obtunded condition. He is afebrile. Laboratory studies show AST 1876 U/L, ALT 2056 U/L, lipase 30 U/L, and calcium 8.5 mg/dL. He dies a day later. The autopsy was performed. The histology of the liver shows extensive necrosis of liver cells. Ingestion of which of the following substances is the most likely cause for these findings?

A. Vitamin B12
B. Aspirin
C. Alcohol
D. Acetaminophen
E. Lead

A 30 years old man walks 10 km distance in 40 degree Celsius heat, ignoring the warning sign about carrying plenty of water. He collapses and is brought to the emergency department. His core body temperature is 42 degree Celsius. His skin is dry. Which of the following is the most likely diagnosis?

A. Heat cramp
B. Heat Stroke
C. ARDS
D. Heat Exhaustion

A 25-year-old man was bare foot and accidentally touches the wire of a 220 volt with his left hand. The current traveled from left arm to right leg. Which of the following is most likely to be the major life-threatening problem associated with this event?

A. Burn to his left arm
B. Ventricular fibrillation
C. Pulmonary edema
D. Increased core body temperature
E. Thromboembolism

A 29-year-old woman comes to the physician for a periodic health maintenance examination. She has no specific complaints. She drinks alcohol “socially” and smokes about a pack of cigarettes per day. She exercises regularly; takes 1,500 mg of calcium a day, and eats a low fat diet. She wants to know if she can get a prescription for oral contraceptive pills (OCPs).
Which of the following is the most appropriate response on the part of the
physician?

A. “in your case, OCPs will increase your risk of developing endometrial cancer.”
B. “In your case, OCPs may increase you
risk of developing thromboemboli and deep venous thrombi.”
C. “OCPs are a good way to lower your risk for cervical cancer.”
D. “OCPs are not a good idea in your case because they will increase your risk for
ovarian cancer”
E. “OCPs are not a good idea in your case because they will increase your risk for osteoporosis.”

A 50-year-old man has been diagnosed as cirrhosis of liver. His medical history reveals that he has been chronic alcoholic and tobacco smoker for last 20 years. Which one of the following is the commonest cause of death with alcohol consumption?

A. Driving with alcohol intoxication
B. Cirrhosis of liver
C. Hepatocellular carcinoma
D. Hepatorenal syndrome
E. Hepatic failure

The non-ionizing radiation like ultraviolet
causes damage to DNA, activates the oncogene and inactivates the tumor
suppressor gene like p53. The most common cancer attributed to ultraviolet radiation is one of the following.

A. Actinic keratosis
B. Colonic adenocarcinoma
C. Lymphoma
D. Basal cell carcinoma
E. Small cell carcinoma of lung

A 30-year-old woman has been brought to the emergency with burn injury. The history suggests that there has been an accident in the kitchen giving variable degree of burn of both upper and lower limbs. The superficial burn was painful however deep burn was painless. What is the reason that deep burns were
painless?

A. Loss of nerve ending in dermis
B. Lack of neurotransmitter
C. Presence of inflammation
D. Blister formation
E. Fibrosis

A 25-year-old man with infertility is diagnosed with Kartagener syndrome. He has also been particularly susceptible to recurrent pulmonary infections and bronchiectasis. Which of the following cellular functions is most likely disrupted in this patient?

A. Chloride transport
B. Formation of phagolysosomes
C. Motility of cilia
D. Oxidative burst
E. Synthesis of IgA

Cigarette smoking is most likely to assume a pivotal role in the pathogenesis of?

A. Idiopathic pulmonary fibrosis
B. Cor pulmonale
C. Mesothelioma
D. Hypersensitivity pneumonitis
E. Tuberculosis
F. Silicosis
G. Asbestosis

A 35-year-old roofer presents to his primary care physician complaining of dyspnea and chronic dry cough. Chest x-ray reveals interstitial lung fibrosis and calcified parietal pleural plaques. The most likely diagnosis is

A. Anthracosis
B. Asbestosis
C. Berylliosis
D. Brucellosis
E. silicosis

A 30 years old man walks 10 km distance in 40 degree Celsius heat, ignoring the warning sign about carrying plenty of water. He collapses and is brought to the emergency department. His core body temperature is 42 degree Celsius. His skin is dry. Which of the following is the most likely diagnosis?

A. Heat cramp
B. Heat Stroke
C. ARDS
D. Heat Exhaustion