What is the underlying cause of pernicious anemia in untreated gastrectomy patients?
A lack of vitamin B12 (cobalamin) in the diet
B lack of intrinsic factor secreted by gastric parietal cells
C lack of folate (folic acid) in the diet
D inability to absorb dietary iron
E reduced circulating levels of erythropoietin
Answer
Primary afferents that convey sensory input from the bladder to the micturition center in the pons have cell bodies (i.e., somas) that reside within the:
a. pons
b. medulla
c. dorsal root ganglia of lumbar nerves
d. inferior vagal ganglion
e. parasympathetic ganglia located within the bladder wall
Answer
Cutting which of the following nerves would be expected to result in a diminished capacity for the detrusor muscle of the bladder to contract?
a. the pudendal nerve
b. lumbar splanchnic nerves that run to the inferior mesenteric ganglion
c. the hypogastric nerve.
d. pelvic splanchnic nerves that run to the bladder
e. both b and c
Answer
During a massive stimulation of the sympathetic-adrenal medulla system (i.e., a fight or flight response), all of the following responses would be expected EXCEPT:
a. in increase in heart rate
b. an increase in glucose metabolism
c. an increase in gastrointestinal motility and secretion
d. papillary dilation
e. airway dilation
Answer
Which of the following drugs or toxins will result in skeletal muscle paralysis? (E)
a. curare
b. succinlycholine
c. botulinum toxin
d. tetrodotoxin (TTX)
e. all of the above
Answer
A 24 year old man with an anterior lateral cystic neck mass is most apt to have a
A. Thyroglossal duct cyst
B. Brachial cleft cyst
C. Pleomorphic adenoma
D. Warthin tumor
Answer
Granulomas are characteristic of all EXCEPT:
A. Tuberculosis
B. Hypersensitivy pneumonitis
C. Histoplasmosis
D. Sarcoidosis
E. Asbestosis
Answer
A 67 year old man with a slowly worsening shortness of breath and a recent episode of hemoptysis. A non-smoker, he had been a deep coal miner for years. The chest radiographs show bilateral irregular areas of density in the upper lung lobes. An open lung biopsy reveals dense fibrosis and anthracosis in these areas; no malignancy is found. No necrosis is seen and no microorganism's are found. Your diagnosis:
A. Idiopathic interstitial fibrosis
B. Coal miner's pneumoconiosis with progressive massive fibrosis
C. Asbestosis
D. Silicosis
Answer
Pulmonary hypertension is LEAST likely in:
A. Patient with history of pulmonary emboli being treated for cancer by chemotherapy
B. Chronic bronchitis
C. Rheumatiod arthritis
D. Primary tuberculosis
Answer
The most likely cause of a pulmonary embolism:
A. Sudden death
B. Chronic cor pulmonale
C. Pulmonary infarction
D. Transient shortness of breath
E. No symptoms at all
Answer
The most common source of pulmonary emboli:
A. Hypogastric veins
B. Superior vena cava
C. Deep veins of the thigh
D. Axillary veins
E. Jugular veins
Answer
Patients with panacinar (panlobular) emphysema
A. Have diffuse interstitial lung fibrosis
B. May have related portal hypertension
C. Characteristically show mucus gland hyperplasia with an increase in the Reid index
D. Have medial hypertrophy of pulmonary arterial vessels by age 25
E. Have characteristic intra nuclear inclusions in pneumocytes
Answer
A 70 year old man presents slightly short of breath and afebrile. Multiple 1-2 cm nodules are found in the upper lobes of both lungs and mildly enlarged hilar lymph nodes are noted. Unfortunately, he is run down right outside your office by ( you guessed it) the Graham Service before you could talk to him further. The autpsy shows densely hyalinized fibrous with birefringent crystals and mild to moderate fibrosis which is most severe in the upper lobes of his lungs. No giant cells are seen and there is no necrosis. You guess that he retired from:
A. Pigeon breeding
B. Professional duck plucking
C. Quartz mining
D. Berrylium mining
E. Cotton farming
Answer
The most common cause of bacterial pneumonia
A. Pneumocystic carinii
B. Staphlococcus pneumonia
C. Escherichia coli
D. Streptococcus pneumonia
E. Pseudomonas aeroginosa
Answer
Dr. Slurpy, tired old pathologist, inhales his left lower bridge consisting of two teeth and completely obstructs his right lower lobe main bronchus. Wise but stubborn, he refuses surgical intervention for 2 weeks. By that time a right lower lobotomy is necessary. The LEAST likely pathological finding in light of the history:
A. Atelectasis
B. Emphysema
C. Empyema
D. Bronchiectasis
E. Broncopneumonia
Answer
A 45 year old man develops severe shortness of breath after an automobile accident. He is thought to have adult respiratory distress syndrome. The histological finding most characteristic of the first hours of the lesion:
A. Mucus plugs
B. Hemosiderin laden macrophages
C. Abscesses
D. Hyaline membranes
E. Multinucleated giant cells
Answer
The LEAST likely cause of adult respiratory distress syndrome:
A. Smoke inhalation
B. Right lower lobe mycoplasma pneumonia
C. Hemorrhagic shock
D. Disseminated intravascular coagulation
Answer
Mucus plugs are common findings in all EXCEPT:
A. Chronic bronchitis
B. Asthma
C. Panlobular emphysema
D. Cystic fibrosis
Answer
Pleuritis would be most likely in:
A. Lobar pneumonia
B. Early bronchopneumonia
C. Viral pneumonitis
D. Idiopathic pulmonary fibrosis
E. Sarcoidosis
Answer
