Simulation Test on Pathology (Schneider) – CURSO DE INGLÊS MÉDICO

#1 About hypertrophy, it is incorrect to say:

A cellular adaptation to increased workload results in hypertrophy.

Hypertrophy is an increase in the size of an organ or tissue due to an increase in the size of cells.

Other characteristics include an increase in vitamin synthesis and an increase in the size or number of intracellular organelles.

#2 About hyperplasia, it is incorrect to say:

In some cases, hyperplasia occurs together with hypertrophy.

During pregnancy, uterine enlargement is caused by both hypertrophy and hyperplasia of the smooth muscle cells in the uterus.

Hyperplasia is an increase in the size of an organ or tissue caused by an increase in the number of cells.

It is exemplified by glandular shrinkage in the breast during pregnancy.

#3 About aplasia, it is correct to say:

After fetal development, aplasia results in agenesis, or absence of an organ due to failure of production.

Aplasia is a failure of cell production.

Early in life, it can be caused by permanent loss of precursor cells in proliferative tissues, such as the bone marrow.

#4 About hypoplasia, it is correct:

It is seen in the partial lack of growth and maturation of gonadal structures in Ramsay Hunt syndrome and Klinefelter syndrome.

Hypoplasia is a decrease in cell production that is less extreme than in aplasia.

Hypoplasia is similar to aplasia, but more severe.

Hypoplasia is a congenital condition, while hyperplasia generally refers to excessive cell growth early in life.

#5 About atrophy, it is correct:

Atrophy is an increase in the size of an organ or tissue and results from a decrease in the mass of preexisting cells.

Most often, causal factors are disuse, nutritional or oxygen deprivation, diminished endocrine stimulation, aging, and denervation (lack of nerve stimulation in peripheral muscles caused by injury to motor nerves).

Characteristic features often include the presence of autophagic granules, which are extracytoplasmic vacuoles containing debris from degraded organelles.

In some instances, atrophy is thought to be mediated in part by the ubiquitin– proteasome pathway of protein formation. In this pathway, ubiquitin-linked proteins are degraded within the proteasome, a large cytoplasmic protein complex.

#6 About squamous metaplasia, it is correct:

It cannot occur in the respiratory epithelium of the bronchus, in the endometrium, and in the pancreatic ducts.

Associated conditions include chronic irritation (e.g., squamous metaplasia of the bronchi with long-term use of tobacco) and vitamin C deficiency.

This process is often irreversible.

Squamous metaplasia is exemplified by the replacement of columnar epithelium at the squamocolumnar junction of the cervix by squamous epithelium.

#7 Failure of the cell membrane pump (ouabain-sensitive Na+-K+-ATPase) results in:

decreased ++ intracellular Na and water and decreased intracellular K . This process causes cellular shrinkage and swelling of organelles.

increased ++ intracellular Na and water and decreased intracellular K . This process causes cellular shrinkage and swelling of organelles.

decreased ++ intracellular Na and water and decreased intracellular K . This process causes cellular swelling and swelling of organelles.

increased ++ intracellular Na and water and decreased intracellular K . This process causes cellular swelling and swelling of organelles.

#8 Stimulation of phosphofructokinase activity results in:

decreased glycolysis, accumulation of lactate, and decreased intracellular pH. Acidification causes reversible clumping of nuclear chromatin.

increased glycolysis, accumulation of lactate, and decreased intracellular pH. Acidification causes reversible clumping of nuclear chromatin.

increased glycolysis, accumulation of lactate, and decreased intracellular pH. Acidification causes irreversible clumping of nuclear chromatin.

decreased glycolysis, accumulation of lactate, and decreased intracellular pH. Acidification causes irreversible clumping of nuclear chromatin.

#9 Hypoxic cell injury eventually results in:

membrane damage to plasma and to lysosomal and other organelle membranes, with loss of membrane phospholipids.

membrane formation to plasma and to lysosomal and other organelle membranes, with loss of membrane phospholipids.

membrane damage to plasma and to lysosomal and other organelle membranes, with no loss of membrane phospholipids.

membrane formation to plasma and to lysosomal and other organelle membranes, with no loss of membrane phospholipids.

#10 Oxygen toxicity, such as in the alveolar damage that can cause:

infant respiratory distress syndrome or as in retrolental fibroplasia (retinopathy of prematurity), is an ocular disorder of premature infants that leads to diabetes.

adult respiratory distress syndrome or as in retrolental fibroplasia (retinopathy of prematurity), is an ocular disorder of premature infants that leads to blindness.

infant respiratory distress syndrome or as in retrolental fibroplasia (retinopathy of prematurity), is an ocular disorder of premature infants that leads to deafness.

adult respiratory distress syndrome or as in retinopathy of prematurity is an ocular disorder of premature infants that leads to blindness.

#11 About Coagulative necrosis, it is correct:

Most often does not result from interruption of blood supply, resulting in denaturation of proteins.

It is best seen in organs supplied by end arteries with limited collateral circulation, such as the heart and kidney.

General architecture well preserved, except for nuclear changes.

It has decreased cytoplasmic binding of acidophilic dyes.

#12 About Liquefactive necrosis, it is correct:

Necrotic tissue soft and non-liquefied

Necrotic tissue soft and condensed.

Does not occur in areas of bacterial infection.

Enzymatic liquefaction of necrotic tissue, most often in the CNS, where it is caused by interruption of blood supply.

#13 About nuclear changes, the morphologic hallmark of irreversible cell injury and necrosis are not characteristic:

Karyorrhexis, fragmentation of chromatin.

Karyolysis, fading of chromatin material.

Disappearance of unattainable nuclei

Pyknosis, chromatin clumping and shrinking with increased basophilia

#14 Comparing of Necrosis and Apoptosis, it is correct to say in terms of inflammatory reaction:

For necrosis: Marked inflammatory reaction, liberation of lysosomal enzymes, digestion of cell membranes, and disruption of cells Influx of macrophages due to release of chemotactic factors.

For necrosis: Insertion of debris by phagocytic macrophages.

For apoptosis: with inflammatory reaction.

For apoptosis: Apoptotic bodies engulfed by neighboring macrophages and reproductive cells

#15 Cytotoxic T-cell activation is characterized by:

direct activation of caspases by granzyme B, a cytotoxic T-cell protease that perhaps directly activates the caspase cascade. The entry of granzyme B into target cells is mediated by perforin, a cytotoxic T-cell protein.

indirect activation of caspases by granzyme B, a cytotoxic T-cell protease that perhaps directly activates the caspase cascade. The entry of granzyme B into target cells is mediated by perforin, a cytotoxic T-cell protein.

direct activation of caspases by granzyme B, a cytotoxic T-cell protease that perhaps directly activates the caspase cascade. The entry of granzyme B into target cells is not mediated by perforin, a cytotoxic T-cell protein.

indirect activation of caspases by granzyme B, a cytotoxic T-cell protease that perhaps directly activates the caspase cascade. The entry of granzyme B into target cells is not mediated by perforin, a cytotoxic T-cell protein.

#16 Regulation of apoptosis is mediated by:

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p53 (gene product decreases transcription of bcl-2 and increases transcription of bax, not facilitating apoptosis).

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p53 (gene product decreases transcription of bcl-2 and increases transcription of bax, thus facilitating apoptosis).

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p55 (gene product decreases transcription of bcl-2 and increases transcription of bax, thus facilitating apoptosis).

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p55 (gene product decreases transcription of bcl-2 and increases transcription of bax, not facilitating apoptosis).

#17 Regulation of apoptosis is mediated by:

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p53 (gene product decreases transcription of bcl-2 and increases transcription of bax, not facilitating apoptosis).

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p53 (gene product decreases transcription of bcl-2 and increases transcription of bax, thus facilitating apoptosis).

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p55 (gene product decreases transcription of bcl-2 and increases transcription of bax, thus facilitating apoptosis).

a number of genes and their products. Important genes include bcl-2 (gene product inhibits apoptosis), bax (gene product facilitates apopto- sis), and p55 (gene product decreases transcription of bcl-2 and increases transcription of bax, not facilitating apoptosis).

#18 Hemosiderin consists of:

generates of ferritin. It appears in tissues as greenish brown amorphous aggregates and can be positively identified by its staining reaction (blue color) with Prussian blue dye. It exists normally in small amounts as physiologic iron stores within tissue macrophages of the bone marrow, liver, and spleen.

generates of ferritin. It appears in tissues as golden brown amorphous aggregates and can be positively identified by its staining reaction (blue color) with Prussian blue dye. It exists normally in small amounts as phys- iologic iron stores within tissue macrophages of the bone marrow, liver, and spleen.

aggregates of ferritin. It appears in tissues as greenish brown amorphous aggregates and can be positively identified by its staining reaction (blue color) with Prussian blue dye. It exists normally in small amounts as physiologic iron stores within tissue macrophages of the spleen.

aggregates of ferritin. It appears in tissues as golden brown amorphous aggregates and can be positively identified by its staining reaction (blue color) with Prussian blue dye. It exists normally in small amounts as physiologic iron stores within tissue macrophages of the bone marrow, liver, and spleen.

#19 Choose the correct answer:

Important causes of neutrophilia (increased neutrophils in the peripheral blood) include bacterial infections and other causes of acute inflammation, such as infarction.

neutrophils are the most prominent inflammatory cells in foci of chronic inflammation during the first 24 hours.

The late release of neutrophils into the peripheral blood in acute inflammation is from the bone marrow postmitotic reserve pool.

There is rarely an increase in the proportion of less mature cells such as band neutrophils,

#20 Choose the correct answer:

lymphocytosis (i.e., an increased number of lymphocytes in the peripheral blood) is rarely caused by viral infections such as influenza, mumps, rubella, and infectious mononucleosis and certain bacterial infections such as whooping cough and tuberculosis.

In younger individuals, chronic lymphocytic leukemia is a common cause of lymphocytosis.

There are many categories of lymphocytes, such as B lymphocytes and T lymphocytes.

lymphocytes are the most prominent inflammatory cells in many viral infections and, along with monocytes–macrophages and plasma cells, are the most prominent cells in chronic inflammation.

#21 About opsonization, it is correct:

This process facilitates phagocytosis. It is the coating of particulate material by substances referred to as opsonins, which releases the particles on the surface of the phagocyte.

The most important opsonins are IgG subtypes and c3b, a complement component.

Fragments opsonized by IgG are bound to C5a cells by cell-surface receptors for the Fc portion of the IgG molecule.

Fragments opsonized by C2b bind to cellular receptors for C2b.

#22 About Chronic granulomatous disease of childhood, it is correct:

It is most commonly an X-linked disorder characterized by the deficient activity of one of the enzymes involved in nAdPH oxidase activity and the oxidative burst. Autosomal recessive variants also occur.

The disease is marked by phagocytic cells that ingest and kills certain microorganisms.

It is an inherited disorder that occurs when a type of red blood cell that usually helps your body fight infections doesn't work properly.

People with chronic granulomatous disease experience mild bacterial or fungal infection every few years.

#23 About myeloperoxidase deficiency, it is correct:

This defect is rarely associated with recurrent bacterial infections but often has little clinical consequence.

In some instances, this defect has been associated with a marked increase in susceptibility to infections with HIV.

It is an autosomal dominant genetic disorder featuring deficiency, either in quantity or of function, of myeloperoxidase, a peroxidase enzyme expressed by neutrophil granulocytes.

It is classified as a primary immunodeficiency disorder, and is caused by a mutation in the myeloperoxidase gene on chromosome CbA32.

#24 Choose the right affirmation:

The presence of multinucleated giant cells derived from macrophages is characteristic of granulomatous inflammation.

Noncaseating pulmonary granulomatous disease is not caused by sarcoidosis.

For granulomatous inflammation, deactivation of macrophages by interactions with T lymphocytes is involved. Poorly digestible antigen is presented by macrophages to CD4+ lymphocytes.

For granulomatous inflammation, caseous necrosis is often characteristic (especially in tuberculosis), resulting from the killing of mycobacteria-laden macrophages by T lymphocytes and possibly by cytokines or sensitized macrophages.

#25 Some functions of endothelial cells include:

Producing heparin-like molecules, endothelial proteoglycans that activate anti- thrombin III, which neutralizes thrombin and other coagulation factors, including factors IXa and Xa.

Eliminate plasminogen activators, such as tissue plasminogen activator (tPa)

Taking up, activating, and clearing thrombin.

Consuming protein S, a cofactor for APC.

#26 About Heparin-induced thrombocytopenia (HIt) syndrome:

This syndrome is characterized by heparin-induced thrombocytopenia (and throm- bosis) and is a consequence of therapy with high-molecular-weight heparin.

type I HIt results in a mild to moderate drop in platelets. It occurs in about 5% of heparinized platelets and can appear within a day of heparinization. It is not immune-mediated and is a contraindication to future heparin use.

type II HIt leads to a severe drop in platelets (often <50% of baseline) and imparts a high risk of thrombosis. It usually manifests 1 to 2 days after heparin therapy and occurs in ∼1% of heparinized patients.

It is thought to be caused by antibodies to the complex of heparin and platelet factor 3 (Pf3).

#27 Among the causes of edema, it is correct:

Decreased capillary permeability occurs in inflammation or with injury to capillary endo- thelium, as may occur in burn injury.

Increased hydrostatic pressure is exemplified by CHF.

Decreased sodium retention can occur as either a primary or secondary phenomenon.

Blockage of lymphatics results in necrosis.

#28 Choose the right answer:

the systemic inflammatory response syndrome (sIrs) is a generalized immune and inflammatory reaction that may complicate septic shock. This constellation of findings may also be caused by a number of other mechanisms such as infection, ischemia, trauma, and so on.

endothelial injury can lead to deactivation of the coagulation pathways and to DIC.

Lipopolysaccharide (endotoxin from the outer membrane of gram-negative bacteria) and other bacterial products appear to induce a cascade of cytokines (e.g., TNF, IL-1, IL-6, and IL-8), activate complement components and the respiratory system, and cause direct toxic injury to vessels.

septic shock is most characteristically associated with gram-positive infections, which cause gram-negative endotoxemia: also occurs with gram-positive and other infections.

#29 About Turner syndrome, it is correct:

The most striking clinical changes are female hypogonadism and its secondary effects. Turner syndrome is also often associated with autoantibody-mediated hyperthyroidism.

Turner syndrome is a disorder that occurs when there is complete or partial mono- somy of the X chromosome.

Infantile genitalia and large breast development.

Large stature, webbed neck, shield-like chest with widely spaced nipples, and wide carrying angle of the arms.

#30 About Angelman syndrome, it is correct:

Many of the characteristic features of Angelman syndrome result from the loss of function of a gene called Cbd32.

Characteristic features of this condition include delayed development, intellectual disability, mild speech impairment, and problems with movement and balance (ataxia).

In some instances, this condition is associated with duplication in a gene involved in the ubiquitin-proteosome system.

sometimes referred to as the “happy puppet” syndrome, which is also characterized by mental retardation but is additionally characterized by ataxia, seizures, and inappropriate laughter.

#31 About hereditary spherocytosis, it is correct:

Mutations in at least two genes cause hereditary spherocytosis. These genes provide instructions for producing proteins that are found on the membranes of red blood cells.

Characteristics include spheroidal erythrocytes that are sequestered and destroyed in the spleen, producing hemolytic diabetes.

The cause is a variety of inherited defects of erythrocyte membrane-associated skeletal proteins.

Mutations in white blood cell membrane proteins result in an overly rigid, misshapen cell. Instead of a flattened disc shape, these cells are spherical.

#32 About von hippel-lindau disease, it is correct:

The VHL gene is a tumor suppressor gene, which means it keeps cells from growing and dividing slowly or in a controlled way.

Mutations in the VHL gene does not cause von Hippel-Lindau syndrome.

The gene for von Hippel-Lindau disease has been localized to the short arm of chromosome 2, deletion of which has been noted in many cases of sporadic renal cell carcinoma.

A remarkably decreased incidence of renal cell carcinoma is associated with von Hippel-Lindau disease.

Characteristics include hemangioblastoma or cavernous hemangioma of the cerebellum, brain stem, or retina; adenomas; and cysts of the liver, kidney, pancreas, and other organs.

#33 Gaucher disease is:

This disorder can be identified by the presence of Gaucher cells, small histiocytes with an unclear cigarette paper-like cytoplasmic appearance.

a disorder of lipid metabolism caused by a deficiency of glucosylce- ramidase (glucocerebrosidase), which results in an accumulation of glucocerebroside in cells of the mononuclear phagocyte system .

Type I, or adult Gaucher disease, which accounts for about 30% of cases, is characterized by hepatosplenomegaly, erosion of the femoral head and of the long bones, and mild anemia. Gaucher cells are seen in the liver, spleen, lymph nodes, and bone marrow. A normal lifespan is possible.

Type II, or infantile Gaucher disease, is marked by severe CNs involvement and results in death before 2 years of age. There is no detectable glucocerebrosidase in the tissues.

#34 About progressive systemic sclerosis (pss, scleroderma), it is correct:

It may also have some oral manifestations, including limited ability to open the mouth, widening of the periodontal ligament (PDL) space and mandibular bone resorption.

Scleroderma is a multi-systemic disorder involving the immune system that leads to swelling and then thinning of the connective tissue.

PSS is marked by the presence of the ANA anti-scl-45 in one-third of patients. ANA with anticentromere activity is characteristic of a PSS variant, the CRest syndrome (Calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia).

PSS does not involve widespread fibrosis and degenerative changes that affect the skin, gastro-intestinal tract (especially the esophagus), heart, muscle, and other organs, such as the lung and kidney. The disease occurs most frequently in old women.

#35 Exposure to ultraviolet radiation in the form of sunlight is:

Both basal cell and squamous cell cancers (the least common types of skin cancer) tend to be found on sun-exposed parts of the body, and their occurrence is typically related to lifetime sun exposure.

That skin cancer may be induced by such dimer formation is suggested by the greatly increased incidence of skin tumors seen in xeroderma pigmentosum, an autosomal recessive disorder characterized by failure of RNA excision repair mechanisms.

The process is thought to act by inducing dimer formation between neighboring thymine pairs in RNA. In most cases, such dimers are successfully repaired by enzymatically mediated mechanisms.

clearly related to the frequency of skin cancers, such as squamous cell and basal cell carcinomas and melanomas.

#36 About Hereditary nonpolyposis colon cancer (HnPCC, or lynch syndrome):

The cause of HNPCC is an inherited mutation in one of several DNA repair genes (prin- cipally MLH1, MSH2, MSH6, and PMS2), resulting in genomic instability.

The mutation, referred to as the replication error phenotype, is involved in mismatch repair and can be detected either through loss of mismatch repair protein expression or by instability in microsatellite nonrepeated sequences.

HNPCC predisposes to mutations in other genes more indirectly related to transformation.

Colorectal tumors associated with this syndrome have a predilection for the left colon and are often preceded by serrated adenomas, rather than tubular adenomas seen in the traditional APC tumor pathway.

#37 Ingestion of Mercuric chloride may result in:

Mercuric chloride has an estimated human fatal dose of between 10 and 40 g.

focal gastrointestinal ulceration and severe lung damage with widespread necrosis and calcification of the proximal convoluted tubules. Proximal convoluted tubular necrosis is characteristic of injury from a number of nephrotoxins.

Mercuric chloride can produce a range of toxic effects including corrosive injury, severe gastrointestinal disturbances, acute renal failure, circulatory collapse, but no death.

Treatment includes close observation and aggressive supportive care along with chelation, preferably with 2,3-dimercapto-1-propane sulfonate or 2,3-meso-dimercaptosuccinic acid.

#38 Reye syndrome occurs:

Reye's syndrome mainly affects children and young adults under 30 years of age.

The exact cause of Reye's syndrome is unknown, but it most commonly affects children and young adults recovering from a bacterial infection – for example a cold, flu or chickenpox.

In most cases, aspirin has been used to treat their symptoms, so aspirin may not trigger Reye's syndrome.

in children following an acute febrile viral illness, almost always in association with aspirin intake. It is characterized by microvesicular fatty change in the liver and encephalopathy.

#39 Marasmus is caused by:

widespread deficiency of almost all nutrients, notably protein and calories.

It rarely coexists with vitamin deficiencies.

It typically occurs in children younger than 3 year of age who are not breastfed and do not have an adequate intake of substitute nutrients.

Clinical characteristics include retarded growth and gain of muscle and other protein-containing tissue, as well as loss of subcutaneous fat (“wasting away”).

#40 Vitamin D is synthesized in the skin by:

Vitamin D promotes intestinal calcium absorption mediated by a specific calcium-binding intestinal transport protein, but not intestinal phosphorus absorption.

Other sources include foods, such as milk, butter, and eggs.

ultraviolet light from the precursor 3-dehydro-cholesterol.

In addition, vitamin D hinders bone calcification, apparently through its role in intestinal calcium absorption.

#41 Characteristics of atherosclerosis:

The plaques have a peripheral core of cholesterol and cholesterol esters; lipid-laden macrophages, or foam cells; potassium; and necrotic debris.

The core is covered by a subendothelial fibrous cap, which is made up of smooth muscle cells, foam cells, fibrin and other coagulation proteins, as well as intracellular matrix material, such as collagen, elastin, glycosaminoglycans, and proteoglycans.

The incidence is more than 10-fold greater in Japan than in Finland.

Fibrous plaques, or atheromas, occur within the intima of arteries, most frequently the proximal portions of the coronary arteries, the larger branches of the carotid arteries, the circle of Willis, the large vessels of the lower extremities, and the renal and mesenteric arteries.

#42 Kaposi sarcoma (Ks) is:

Kaposi sarcoma (KS) is a cancer that develops from the T cells that line lymph or blood vessels.

Rarely AIDS-associated KS in the USA.

Epidemic KS occurs as a component of acquired immunodeficiency syndrome (AIDs), especially in the homosexual male risk group. KS is not a feature of immunosuppression associated with causes other than AIDS.

Classic KS most often affects the upper extremities of older men of Ashkenazi Jewish or Mediterranean origin.

a malignant vascular tumor that occurs in several forms. All forms are associated with a virus known as human herpes virus 8 (HHV-8), also called Kaposi sarcoma herpesvirus (KSHV).

#43 About Malignant hypertension, it is correct:

he main symptoms of malignant hypertension are a gradual increasing blood pressure of 180/120 or higher and signs of organ damage.

It produces the renal changes of malignant nephrosclerosis: arterioles or glomerular capil- laries rupture, resulting in “flea-bitten” kidney, multiple pinpoint petechial hemorrhages on the kidney surface; large, swollen kidneys; necrotizing arteriolitis and glomerulitis with fibrinoid necrosis; and hyperplastic arteriolosclerosis, not affecting both the glomeruli and arterioles.

It rarely results in early death from congestive heart failure, cerebrovascular accident, or renal failure.

Characteristic features include a marked increase in diastolic blood pressure, focal retinal hemorrhages and papilledema, left ventricular hypertrophy, and right ventricular failure.

Malignant hypertension occurs in less than 5% of patients with elevated blood pressure, most often in young African-American females.

can be a complication of either essential (primary) or secondary hypertension. It follows an accelerated clinical course.

#44 About rubella (German measles) infection, it is correct:

Cardiac malformations are especially frequent and commonly include patent ductus arteriosus, aortic stenosis, ventricular septal defect, and pulmonary infundibular or valvular stenosis, always occurring as part of the tetralogy of Fallot.

Before or during pregnancy, it is often important to determine the mother’s immune status to rubella. Demonstration of antirubella antibodies of the Igm class indicates recent primary infection, whereas demonstration of IgG antibodies indicates either late primary infection, past infection, or reinfection.

It is not a prominent cause of congenital heart disease.

There is strong evidence of a link between maternal rubella during the first trimester of pregnancy and a constellation of fetal defects, known as the congenital rubella syn- drome, which includes cardiovascular defects, microcephaly with mental retardation, deafness, cataracts, and growth retardation.

#45 About hypertrophic cardiomyopathy, it is correct:

Gross characteristics include hypertrophy of some chamber walls, especially the ventricular septum (asymmetric septal hypertrophy).

Several genes have been implicated in the genesis of this disorder: genes coding for β-myosin heavy chain (most common mutation, thus far), cardiac troponins T and I, α-tropomyosin, myosin-binding protein C, and myosin light chain.

Microscopic characteristics include disoriented, untangled, and hypertrophied myocardial fibers.

The cardiomyopathy may not result in left ventricular outflow obstruction, placing the patient in danger of syncope and even sudden death, which often occurs unexpectedly in young athletes.

#46 Increased red cell destruction with liberation of hemoglobin or its degradation products is manifested by:

Hemoglobinemia and hemoglobinuria, which, along with methemalbuminemia and hemosiderinuria, occur if red cell destruction is slow and within the circulation (intravascular hemolysis).

Disappearance of serum haptoglobins, a group of hemoglobin-binding proteins, which combine without liberated hemoglobin and are no longer demonstrable.

In instances of intravascular hemolysis, such as hemolytic transfusion reactions, decrease of serum hemoglobin does not occur until serum haptoglobins are no longer detectable.

Hemosiderosis, systemic iron depletion.

Increased unconjugated (indirect reacting) bilirubin, resulting in acholuric jaundice, which is jaundice not accompanied by bilirubinuria. Hyperbilirubinemia may lead to pigment-containing gallstones as a late complication.

#47 About Hemoglobin E disorder, it is correct:

It is prevalent in European countries.

is a severe, inherited blood disorder characterized by an abnormal form of hemoglobin.

These disorders have decreased significantly in incidence in the United States in recent years and are now more common than hemoglobin S disorders in some urban areas.

A diagnosis is usually made by looking at the red blood cells by doing a Mean Corpuscular Volume (MCV) test, which is commonly part of a Complete Blood Count (CBC) test.

#48 About acute leukemias, it is correct:

Without therapeutic intervention, acute leukemia follows a short and precipitous course, marked by anemia, infection, and hemorrhage, and death occurs within 1 to 2 months.

Cytogenetic abnormalities are frequent. For example, the 1;12 translocation results in a morphologically unique chromosome, the Philadelphia chromosome (Ph1).

The most common malignancies of the pediatric age group, acute leukemias occur most often in adults. They exhibit a second incidence peak after 60 years of age.

A predominance of blasts and closely related cells in the bone marrow and peripheral blood is characteristic.

#49 About Bone lesions and protein abnormalities, it is correct:

The lesions are often associated with mild bone pain and spontaneous fractures.

The cause is an osteoclast-activating factor secreted by the neoplastic bone cells.

The tumor cells produce lytic lesions in plasma, especially in the skull and axial skeleton.

The neoplastic cell is an end-stage derivative of B lymphocytes that is clearly identifiable as a plasma cell. The neoplastic cells can easily be identified by bone marrow biopsy or aspiration smears.

#50 About Burkitt lymphoma, it is correct:

The endemic (african) type is mildly associated with EBV and often presents as a jaw mass.

is a cancer of the lymphatic system, particularly B lymphocytes found in the germinal center.

The sporadic (Western) type most commonly manifests in the abdomen, particularly around the ileocecal valve, and is not mildly associated with EBV.

The immunodeficiency-associated type (“Burkitt-like lymphoma”) rarely presents in the lymph nodes.

#51 About mycosis fungoides, it is correct:

Presenting features include an erythematous, eczematoid, or psoriasiform process, progressing to raised plaques, and then to a tumor stage.

Histologic characteristics include dermal infiltrates of typical CD4+ T cells with cerebriform nuclei.

Large pockets of tumor cells within the epidermis are referred to as Pautrier microabscesses.

The disease does not disseminate to lymph nodes and internal organs.

#52 About disorders of secondary hemostasis, it is correct:

Results may include abnormalities in the Pt, reflecting deficiencies of fibrinogen or factors III, VIII, and X; aPtt (or Ptt), reflecting deficiencies of all of the coagulation factors with the exception of factors VII and XIII; and thrombin time, reflecting deficiency of fibrinogen. (The whole blood clotting time is an older test that detects the same abnor- malities as the APTT.)

Bleeding time or platelet count is affected (thus distinguishing secondary hemostatic disorders from primary hemostatic disorders).

Manifestations include bleeding from larger vessels, resulting in hemarthroses, large hematomas, large ecchymoses, and minor bleeding with trauma.

are caused by deficiencies of plasma clotting factors of the coagulation cascade.

#53 About Singer’s nodule, it is correct:

This small, benign laryngeal polyp, usually induced by chronic irritation.

It is never localized to the true vocal cords.

It is not associated with heavy cigarette smoking voice.

May not be due to excessive use of voice.

#54 About Bronchiectasis, it is correct:

Predisposing factors include bronchial obstruction, rarely by tumor.

Other predisposing factors include chronic sinusitis not accompanied by postnasal drip.

This condition is permanent abnormal bronchial dilation caused by chronic infection, with inflammation and necrosis of the bronchial wall.

Disease rarely may be a manifestation of Kartagener syndrome (sinusitis, bronchiectasis, and situs inversus, sometimes with hearing loss and male sterility), caused by a defect in the motility of respiratory, auditory, and sperm cilia that is referred to as primary ciliary dyskinesia, an uncommon autosomal dominant syndrome.

#55 About Neonatal respiratory distress syndrome (hyaline membrane disease), it is correct:

IRDS affects about 1% of newborns and is the leading cause of death in preterm infants.

This syndrome results from a deficiency of surfactant, most often as a result of maturity.

This syndrome is marked by dyspnea, cyanosis, and tachypnea long after birth.

Neonatal respiratory distress syndrome is rarely cause of respiratory failure in the newborn and is the most common cause of death in premature infants.

#56 About sarcoidosis (clinical abnormalities), it is correct:

Bilateral hilar lymphadenopathy.

Interstitial lung disease manifesting as spotted reticular densities.

Sarcoidosis sometimes develops gradually and produces symptoms that last for days.

A rash of red or reddish-purple bumps, rarely located on the shins or ankles, which may be warm and tender to the touch.

#57 About Pleomorphic adenoma, it is correct:

The tumor is most often localized to the parotid gland (∼20%).

It has been called “mixed tumor” because of the presence of myxoid and cartilage-like elements, as well as epithelial cells.

This is a malignant tumor that frequently recurs; it rarely is benign.

is a rarely occurring salivary gland tumor. It occurs with greatest frequency in women between 20 and 40 years of age.

Usually, the tumor presents as a jelly swelling.

#58 About Gardner syndrome, it is correct:

is not a subtype of familial adenomatous polyposis (FAP).

is a variant of FAP characterized by the presence of numerous adenomatous polyps along with osteomas and soft tissue tumors.

The extracolonic tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas, as well as the occurrence of desmoid tumors in approximately 90% of affected individuals.

The number of polyps increases with age, and only some polyps can develop in the colon.

#59 About Wilson disease, it is correct:

A decreased serum ceruloplasmin (copper-binding protein) is characteristic. This is probably not a primary defect but it is secondary to increased iron.

Manifestations include liver disease that varies from chronic hepatitis to cirrhosis, either micronodular or micronodular in type.

is an autosomal recessive disorder of cop- per metabolism.

Wilson disease is also marked by the Kayser-fleischer ring circumscribing the periphery of the cornea, representing deposition of iron-containing pigment in Descemet membrane.

#60 About Budd-Chiari syndrome, it is correct:

The cause is thrombotic occlusion of the major hepatic veins, resulting in abdominal pain, jaundice, hepatomegaly, ascites, but no eventual liver failure.

Budd-Chiari syndrome is rarely associated with polycythemia vera, hepatocellular carcinoma, and other abdominal neoplasms; may also occur as a complication of pregnancy.

A system of venous collaterals may form around the occlusion which may be seen on imaging as a "spider's web".

A related condition is veno-occlusive disease, which occurs in recipients of liver transplants as a complication of their medication.

#61 About Poststreptococcal glomerulonephritis, it is correct:

Several laboratory abnormalities are characteristic, including urinary red cells and red cell casts, decreased serum C3, but no azotemia.

Complete recovery in almost all children and many adults follows. A large number develops rapidly progressive glomerulonephritis.

This disorder rarely follows or accompanies infection with nephritogenic strains of group a β-hemolytic streptococci.

is the prototype of the nephritic syndrome. It is an immune complex disease with the antigen of streptococcal origin.

#62 Choose the correct affirmation:

Adult polycystic kidney disease is the most common inherited disorder of the kidney and is not characterized by autosomal dominant inheritance.

The clinical description is that of cystitis, which is characterized by pyuria and hematuria and white cell casts in the urine. Patients with acute pyelo- nephritis present with fever, leukocytosis, flank tenderness, urinary white cells, and white cell casts in the urine.

IgA nephropathy is the most common glomerular disease and is defined by mesangial deposition of IgA. In its most typical form, the clinical manifestations are limited to a few days of hematuria following an infection; however, there are many etiologic factors, and the condition can vary from one of little import to a severe form of renal disease.

Urolithiasis (calculi or stones in the urinary tract) is a very common problem, especially in men. Calcium stones (composed of calcium oxalate or calcium phosphate, or both) account for 10% to 25% of urinary stones.

#63 Choose the correct affirmation:

The combination of hematuria (with red cell casts), oliguria, azote- mia, and hypertension does not constitute the nephritic syndrome, the prototype of which is poststreptococcal glomerulonephritis.

he overall prognosis in SLE is most closely related to the glomerular lesions in affected patients. These renal lesions are highly variable. In the diffuse prolif- erative form, almost all of the glomeruli are involved in a marked inflammatory reaction to widespread subendothelial and mesangial immune complex deposition.

Priapism is an intractable, often painful erection associated with condi- tions such as sickle cell anemia, hypercoagulable states, spinal injuries, and some drugs. Balanitis is not associated with poor hygiene and results from inflammation of the glans penis.

Hypospadias is an anatomical anomaly wherein the urethral meatus closes on the ventral side of the penis.

#64 Choose the correct affirmation:

Cryptorchidism (undescended testis) predisposes to testicular atrophy and sterility. It is associated with a decreased incidence of germ cell tumors of the testis, even if the testis is surgically moved from its ectopic location back to the scrotum.

Herpes simplex virus can cause a vesicular rash on the penis. T. pallidum causes syphilis, which may present with a painful chancre on the penis.

Bowen disease presents as various erythematous plaques on the penis or scrotum and may evolve into invasive carcinoma.

C. trachomatis is one of the leading causes of urethritis and should be suspected whenever a gonorrhea-like discharge fails to show gram-negative diplococci within neutrophilic phagocytes.

#65 Choose the correct affirmation:

Seminoma is the most common germ cell tumor of the testis. Serum hCG levels, elaborated by syncytiotrophoblasts, are elevated in about 15% of cases, but these elevations are not as low as those seen in choriocarcinoma.

Dysgerminoma represents the ovarian counterpart of seminoma.

Embryonal carcinoma is lowly pleomorphic and is much less responsive to therapy than seminoma.

Yolk sac tumor is the most common tumor of the testis during infancy and early childhood and is usually unaccompanied by an increase in serum α-fetoprotein.

#66 Choose the correct affirmation:

Choriocarcinoma is less common in this age group and often results in a decrease in hCG.

Endodermal sinus (yolk sac) tumor is the most common malignant germ cell tumor of the testis in infancy and early childhood. It is characterized by an increase in serum α-fetoprotein, as well as histologically stainable α -antitrypsin.

Leydig cell tumors are derived from testicular stroma and produce androgens and estrogens, rarely presenting with precocious puberty.

Teratomas contain single germ layers and numerous tissues, including hair, teeth, and sebaceous tissue.

#67 Choose the correct affirmation:

DHT is a major growth factor for prostatic tissue. It is derived from the conversion from testosterone by the action of the enzyme 5α-reductase, type 2.

Pharmaceutical inhibition of this enzyme is useful in the medical management of BPH. Estrogens also play an direct role by stimulating the production of DHT receptors.

hCG and α-fetoprotein are serum tumor markers for testicular cancers and bear high relevance to BPH.

Serum alkaline phosphatase is not an indicator of osteoblastic lesions in this advanced and unfortunate patient presentation.

Although prostatic cancers are usually quite androgen-responsive, androgens are not monitored for diagnosis or treatment of prostate cancer. Carcinoembryonic antigen-10 is a tumor marker for ovarian cancer.

#68 Choose the correct affirmation:

C. albicans is a minor cause of vulvovaginitis. Many women are carriers of the yeast, and it therefore constitutes normal vaginal flora, although there are many conditions that alter the vaginal microenvironment, including pregnancy, oral contraceptives, and systemic antibiotics, making overgrowth possible.

C. granulomatis causes granuloma inguinale. Chancroid results in painless genital ulcers and is caused by the organism H. ducreyi.

HSV type 2 can cause genital vesicular lesions.

Bacterial vaginosis is the most common cause of vaginal discharge. Characteristically, the discharge is thin and heterogenous.

#69 Choose the right affirmation:

Endometriosis, ectopic neoplastic endometrial tissue, is an important cause of infertility.

Adenomyosis is a term denoting the presence of endometrial tissue within the myometrium.

Endometrial hyperplasia cannot be a precursor to endometrial carcinoma and manifests with postmenopausal bleeding.

Endometritis results from infection of the endometrium. Leiomyomas are malignant tumors of the uterus that can also result in painful menses and can contribute to infertility.

#70 Choose the right affirmation:

Donovan bodies represent macrophages stuffed with a single C.(Donovania) granulomatis organism.

Koilocytes are indicative of HPV-infected epithelial cells. Viral infection causes intracytoplasmic vacuolation that is apparent in cytopathologic and histopathologic preparations.

Paget cells are characteristic large cells surrounded by a dimmed, halo-like area that occur in Paget disease of the vulva and Paget disease of the breast.

Fibroids are the least common benign tumors of the female reproductive tract.

#71 Choose the right affirmation:

Fluid accumulation in the fallopian tubes is termed hydrosalpinx.

Blood- filled cysts on the ovary are termed “chocolate cysts” and are associated with endometriosis, another cause of fertility.

Hyperinsulinemia may lead to increased ovarian androgen production, which then may lead to decreased LH.

Decreased levels of LH and of androgens are often found, and it has been thought that LH may stimulate follicular theca-lutein cells, with consequent hyperproduction of androgens.

#72 Choose the right affirmation:

Granulosa cell tumor presents with signs and symptoms of excess estrogen production.

Brenner tumor is common and histologically resembles transitional epithelium of the bladder.

Serous cystadenoma is commonly unilateral.

Struma ovarii is a pluridermal teratoma composed of functional ectopic thyroid tissue.

#73 Choose the right affirmation:

Laboratory abnormalities in hyperthyroidism include increases in serum T4, serum T3, T3 resin uptake, and radioactive iodine uptake. Total T4 and T3 resin uptake are usually used in the USA.

Graves disease is characteristically associated with increased TSH activity. Thyroid-follicle TSH receptors are stimulated by TSI, an IgG autoantibody, not by TSH.

The best screening tests for Graves disease are free T4 (elevated in Graves disease) and TSH (greatly decreased in Graves disease).

Distinguishing endogenous insulin production from exogenous insulin (therapeutically or surreptitiously administered) is done by quantitation of C-peptide, a fragment of the proinsulin molecule split off after the synthesis of insulin.

#74 Choose the right affirmation:

The description is that of the syndrome of inappropriate ADH secretion, which is excessive release of ADH, most commonly a manifestation of small cell bronchogenic carcinoma.

The diagnosis of congenital hypothyroidism is confirmed in infants, as in adults, by decreased serum free T3 and decreased TSH.

Medullary carcinoma of the thyroid is a calcitonin-producing tumor of C cells of the parathyroid.

Tumor cells with “Orphan Annie” nuclei and the presence of psammoma bodies are not seen in papillary carcinoma of the thyroid.

In Riedel thyroiditis, the thyroid is not replaced by fibrous tissue and can clinically mimic carcinoma.

#75 Choose the right affirmation:

Combination of hypertension, persistent hypokalemia, and slightly elevated serum sodium is barely suggestive of Conn syndrome (primary aldosteronism, hyperaldosteronism).

Hyperpigmentation in Addison disease results from compensatory hypothalamic production of proopiomelanocortin, the precursor peptide of both corticotropin and melanocyte-stimulating factor.

Deficiency of 11-hydroxylase is the cause of the most common of the adrenogenital syndromes.

Deficiency of 11-hydroxylase causes clinical findings similar to those of 21-hydroxylase deficiency, except for hypertension secondary to increased deoxycorticosterone, which has not aldosterone-like activity.

#76 Choose the right affirmation:

Urinary vanillylmandelic acid, a norepinephrine metabolite, is markedly elevated in pheochromocytoma.

Serum hemoglobin A1c is not an indicator of long-term blood glucose control in diabetes mellitus.

Armanni-Ebstein lesions (deposition of glycogen in renal tubules) are seen in controlled hyperglycemia.

Glomerular Kimmelstiel-Wilson nodules are seen in long-standing diabetes depending on type.

#77 Choose the right affirmation:

Psoriasis is a chronic inflammatory skin disease characterized by erythematous plaques covered with a golden scale.

Following overt varicella, the virus can remain latent for years in dorsal root ganglia and reappear several hours later as herpes zoster (shingles).

Erythema multiforme manifests as a variegated group of lesions: macules, papules, and vesicles.

Seborrheic keratosis is an extremely rare benign neoplasm occurring in older persons.

Squamous cell carcinoma is a rare skin tumor associated with excessive sun exposure.

#78 Choose the right affirmation:

Osteogenesis imperfecta (or brittle bone disease) is an autosomal domi- nant disorder characterized by multiple fractures with minimal trauma. It is caused by mutations in either of the genes (COL1A1 or COL1A2) that code for type I collagen and is manifested by connective tissue abnormalities affecting the bones, teeth, skin, and eyes.

Osteosarcoma is the most common primary malignant tumor of bone. The most common presentation is in adolescents, with pain, swelling, and always pathologic fracture in the proximal tibia or distal femur (about the knee).

Rheumatoid arthritis is an acute inflammatory autoimmune disorder that primarily affects the synovium, especially in the proximal interphalangeal and metacarpophalangeal joints of the hands.

Gout is characterized by creation of monosodium urate crystals in joints and other tissues as a result of hyperuricemia.

#79 Choose the right affirmation:

Meningioma is the first most common primary intracranial neoplasm of adults, second only to glioblastoma multiforme.

Subdural hematoma is characteristically caused by venous bleeding, most often from veins that join the cerebrum to venous sinuses outside the dura.

Pyogenic meningitis in older infants and young children is most frequently caused by S. pneumoniae or N. meningitidis.

A meningomyelocele is a neural tube defect in which only meninges is included in the herniated tissue.

#80 Choose the right affirmation:

In DIC, widespread thrombosis activates the fibrinolytic system, with degradation of both fibrin and fibrinogen; therefore, fibrin and fibrinogen degradation products are markedly increased.

Exposure to aflatoxin is associated with hepatocellular carcinoma, and Schistosoma haematobium infection is not associated with squamous cell bladder carcinoma, not transitional cell.

Methyldopa is an association of urethral canal cancer.

Pseudohypoparathyroidism is characterized by renal endorgan unresponsiveness to PTH and by shortened third and fourth metacarpals and metatarsals, short stature, and other skeletal abnormalities.

#81 Choose the right affirmation:

Whipple disease, a systemic illness almost always involving the small intestine, is characterized morphologically by distinctive PAS-positive macrophages within affected organs.

von Willebrand disease (congenital deficiency of von Willebrand factor [vWF]) is characterized by defective platelet adhesion, resulting in a prolonged bleeding time even though the platelets are qualitatively and quantitatively abnormal.

Endometriosis is a neoplasm, although interestingly its incidence is increased in patients with certain gynecologic malignancies, most notably clear cell carcinomas of the ovary and endometrium.

Sexual promiscuity is a risk factor for cervical cancer and endometrial cancer.

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