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PATHOLOGY

Instructions:

Choose the BEST answer

1. Acute myelogenous leukemia is:


a. most common in females
b. most common in adults over 60 years old
c. occasionally aleukemic
d. associated with massive splenomegaly
1. Answer: C
Robbins 6th ed pp. 677

MPL 0.25

2. Hodgkins lymphoma with the worst prognosis:


a. lymphocyte predominance
b. nodular sclerosis
c. mixed cellularity
d. lymphocyte depletion
2. Answer: D
Robbins 6th ed pp. 672

MPL 0.25

3. The
a.
b.
c.
d.
3.

most important difference between a benign reactive lymph node and lymphoma :
interstitial fibrosis
follicular hyperplasia
effacement of normal architecture
presence of plasma cells
Answer: C
Robbins 6th ed pp. 649
MPL 0.33

4. Plasma cells are characterized by


a. abundant surface immunoglobulins
b. Fc surface receptors
c. Abundant cytoplasm immunoglobulins
d. Complement surface receptors
4. Answer: C
Robbins 6th ed pp. 82

MPL 1

5. Paroxysmal hypertension is most typically associated with which of the following?


a. adrenal adenoma
b. thyroid adenoma
c. parathyroid adenoma
d. pheochromocytoma
5. Answer: D
Robbins 6th ed pp. 1166
MPL 1
6. The association of medullary carcinoma of the thyroid with pheochromocytoma with or without
parathyroid hyperplasia or adenoma is called:
a. Conns syndrome
b. Cushings syndrome
c. Sipples syndrome
d. Waterhouse-Friedricksens syndrome
6. Answer: C
Robbins 6th ed pp. 1167
MPL 0.25
7. Which of the following is the most common cause of Cushings syndrome
a. exogenous corticosteroids
b. adrenal cortical carcinoma
c. oat cell carcinoma of the lungs
d. basophilic adenoma of the pituitary
7. Answer: A
Robbins 6th ed pp. 1153
MPL 0.33
8. A destructive lesion in this area will result in diabetes insipidus:
a. mamillothalamic tract
b. adenohypophysis
c. subthalamic fasciculus
d. supraoptic and paraventricular hypothalamic nuclei
8. Answer: D
Robbins 6th ed pp. 1129
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9. Conns syndrome is primarily associated with an excess of :
a. glucocorticoids
b. mineralocorticoids
c. thyroid hormone
d. ADH
9. Answer: B
Robbins 6th ed pp. 1155
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10. Primary hyperaldosteronism is associated with:

a. hyponatremia
b. hypotension
c. elevation of plasma renin levels
d. hypokalemia
10. Answer: D
Robbins 6th ed pp. 1155

MPL 0.5

11. The single most frequent adrenal lesion producing primary hyperaldosteronism:
a. single unilateral adenoma
b. multiple unilateral adenomas
c. bilateral adenomas
d. carcinoma
11. Answer: A
Robbins 6th ed pp. 1155
MPL 0.25
12. Truncal obesity, easy bruising and osteoporosis is associated with:
a. craniopharyngioma
b. adrenal adenoma
c. thyroid adenoma
d. parathyroid adenoma
12. Answer: B
Robbins 6th ed pp. 1154-1155
MPL 1
13 Urinalysis results show proteinuria, red blood cells and casts, and 1-2 pus cells per HPO. These
findings are consistent with:
a. acute cystitis
b. acute pyelonephritis
c. chronic pyelonephritis
d. acute post-streptococcal glomerulonephritis
13. Answer: D
Robbins 6th ed pp. 950
MPL 1
14. Membranous glomerulopathy and poststreptococcal glomerulonephritis are similar in that they
both:
a. are self-limiting and transient renal diseases
b. are commonly associated with nephrotic syndrome
c. are most commonly seen in children
d. have glomerular immune complex deposits
14. Answer: D
Robbins 6th ed pp. 953
MPL 0.5
15. A patient with hemoptysis and renal failure has a renal biopsy which reveals crescentic
glomerulonephritis, with linear deposits of IgG and C3 on immunofluorescence. Diagnosis?
a. acute post-infectious glomerulonephritis
b. membranous nephropathy
c. Goodpastures syndrome
d. Minimal change disease
15. Answer: C
Robbins 6th ed pp. 951
MPL 1
16. The most characteristic feature of rapidly progressive glomerulonephritis:
a. crescent formation
b. hyaline nodules
c. subepithelial dense deposits
d. thickened capillary loops
16. Answer: A
Robbins 6th ed pp. 951
MPL 1
17. Benign nephrosclerosis is best defined as:
a. fibrinoid necrosis of afferent arterioles with ischemic atrophy of nephrons
b. hyalinization of afferent arterioles with ischemic atrophy of nephrons
c. diffuse thickening of glomerular capillary basement membrane leading to glomerulosclerosis
d. deposition of basement-like material within the glomerular mesangium leading to
glomerulosclerosis
17. Answer: B
Robbins 6th ed pp. 981-982
MPL 0.25
18. Ischemic acute tubular necrosis occurs most commonly in association with:
a. septic shock
b. ruptured aneurysm
c. carcinoma of the prostate
d. malignant hypertension
18. Answer: A
Robbins 6th ed pp. 969
MPL 1

19. The most common appearance of nephrotic syndrome in adults is:

a.
b.
c.
d.

proliferative glomerulonephritis
membranous glomerulonephritis
rapidly progressive glomerulonephritis
wire-loops

19. Answer: B

Robbins 6th ed pp. 953

20. Nutmeg liver is a gross finding seen in:


a. petechial hemorrhages
b. viral hepatitis
c. alcoholism
d. chronic passive congestion
20. Answer: D
Robbins 6th ed pp. 116-117

MPL 0.25

MPL 1

21. Which of the following is associated with high levels of serum alkaline phosphatase?
a. hemolytic anemia
b. metastatic carcinoma to the liver
c. Dubin-Johnson syndrome
d. Gilberts syndrome
21. Answer: B
Robbins 6th ed pp. 891
MPL 1
22. The most common outcome in-patients with acute Hepatitis B is:
a. complete recovery without residual dysfunction
b. chronic persistent hepatitis
c. chronic active hepatitis
d. postnecrotic cirrhosis
22. Answer: A
Robbins 6th ed pp. 858
MPL 1
23. In a patient suspected of having viral hepatitis, which laboratory finding would indicate the most
severe and life threatening amount of liver damage?
a. prolonged prothrombin time
b. high serum bilirubin
c. high serum aspartate transaminases
d. high serum alkaline phosphatase
23. Answer: A
Robbins 6th ed pp. 867
MPL 1
24. The most important substance in the formation of gallstones is:
a. calcium
c. bile salts
b. bilirubin
d. lecithin
24. Answer: C
Robbins 6th ed pp. 894
MPL 0.25
25. Cirrhosis produces most of its clinical manifestations by means of:
a. hepatic necrosis leading to insufficient number of liver cells to sustain life
b. cancerous change in regenerating nodules
c. obstruction of large biliary passages
d. vascular derangements in the liver
25. Answer: D
Robbins 6th ed pp. 853
MPL 0.25
26. The major cause of portal hypertension is:
a. Intrahepatic
c. prehepatic
b. Posthepatic
d. cardiac
26. Answer: A
Robbins 6th ed pp. 855

MPL 1

27. The most common factor in the formation of esophageal varices is obstruction at the level of:
a. esophageal vein
b. hepatic vein
c. intrahepatic vessels
d. portal vein
27. Answer: C
Robbins 6th ed pp. 783
MPL 0.25
28. When a person dies suddenly from a heart attack the most likely event causing it will be:
a. aortic aneurysm
b. coronary artery embolism
c. congestive heart failure
d. arrhythmia
28. Answer: D
Robbins 6th ed pp. 562
MPL 1
29. Acute rheumatic heart disease is associated with:
a. arthritis
b. emboli to multiple organs

c. cardiac tamponade
d. right to left shunt
29. Answer: A
Robbins 6th ed pp. 572

MPL 0.5

30. The most frequent and clinically significant residual lesion of acute rheumatic fever is:
a. myocardial fibrosis
b. aortic stenosis
c. mitral stenosis
d. pericardial adhesion
30. Answer: D
Robbins 6th ed pp. 570-571
MPL 0.25
31. The absolute criterion of cardiomegaly:
a. increase in size
b. increase wall thickness
c. increase in weight
d. change in shape
31. Answer: C
Robbins 6th ed pp. 544

MPL 1

32. Myocardial disease gradually producing 4-chamber dilatation:


a. viral myocarditis
b. hypertrophic cardiomyopathy
c. congestive cardiomyopathy
d. restrictive cardiomyopathy
32. Answer: C
Robbins 6th ed pp. 579-581
MPL 1
33. Necrotizing infection caused by highly virulent organisms seeding a normal valve:
a. rheumatic heart disease
b. SLE endocarditis
c. acute infective endocarditis
d. marantic Endocarditis
33. Answer: C
Robbins 6th ed pp. 572-573
MPL 1
34. The most common cause of intestinal obstruction is:
a. adhesions
b. volvulus
c. neoplasm
d. hernia
34. Answer: A
Robbins 6th ed pp. 825 (table)

MPL 1

35. A two-week old boy has projectile vomiting. The most likely diagnosis is :
a. pyloric stenosis
b. esophageal atresia
c. annular pancreas
d. incomplete rotation of the gut
35. Answer: A
Robbins 6th ed pp. 789
MPL 0.25
36. An endoscopic gastric biopsy finding of intestinal type epithelia is most likely due to:
a. chronic gastritis
b. congenital heterotopia
c. precancerous dysplasia
d. metastatic carcinoma
36. Answer: A
Robbins 6th ed pp. 790
MPL 0.25
37. Most characteristic of right sided colon cancer compared to left-sided cancer:
a. anemia
b. associated with polyposis
c. bowel obstruction
d. diarrhea
37. Answer: A
Robbins 6th ed pp. 834
MPL 0.33

38. Acute erosive gastritis is characterized by:


a. superficial and multiple gastric mucosal ulceration
b. pus in the gastric mucosa
c. deep ulcer with scarred base
d. frequent association with gastric cancer

38. Answer: A

Robbins 6th ed pp. 789-790

39. The most common site of chronic gastric peptic ulcer:


a. lesser curvature at the antral-body junction
b. anterior wall of the duodenal verge
c. greater curvature at the mid-antrum
d. esophago-gastric junction
39. Answer: A
Robbins 6th ed pp. 795
40. The definitive finding in acute appendicitis:
a. obstruction of the lumen by a fecalith
b. mucus inspissation in the lumen
c. neutrophils in the muscularis
d. serosal congestion and margination of polys
40. Answer: C
Robbins 6th ed pp. 839

MPL 0.25

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41. Morphologic appearance favoring benign rather than malignant gastric ulcer:
a. large ulcer
b. heaped up margin
c. antral location
d. folds radiating from the ulcer
41. Answer: C
Robbins 6th ed pp. 795
MPL 0.25
42. Most frequently found neoplasm in the appendix:
a. adenoma
b. polyp
c. carcinoid
d. adenocarcinoma
42. Answer: C
Robbins 6th ed pp. 840
43. The most common malignant soft tissue tumor:
a. rhabdomyosarcoma
b. malignant fibrous histiocytoma
c. leiomyosarcoma
d. liposarcoma
43. Answer: D
Robbins 6th ed pp. 1261

MPL 1

MPL 0.25

44. Brown tumors of bone is associated with:


a. hyperparathyroidism
b. trauma
c. metastatic carcinoma
d. vitamin deficiency
44. Answer: A
Robbins 6th ed pp. 1228

MPL 1

45. The most frequent site of compression fracture is:


a. femur
b. radio-ulnar area
c. clavicle
d. vertebrae
45. Answer: D
Robbins 6th ed pp. 1229-1231

MPL 1

46. Rheumatoid arthritis usually has its origin in:


a. ball and socket joints
b. lumbo-sacral joints
c. small peripheral joints
d. major weight-bearing joints
46. Answer: C
Robbins 6th ed pp. 1251

MPL 1

47. Most common primary malignant bone tumor in 15-25 years of age:
a. chondrosarcoma
b. osteosarcoma
c. Ewings sarcoma
d. Chondroblastoma
47. Answer: B
Robbins 6th ed pp. 1236
MPL 1

48. The most likely malignant bone tumor in a 65 yo man is:


a. Giant cell tumor
b. Osteosarcoma
c. Metastatic prostatic cancer
d. Multiple myeloma
48. Answer: C
Robbins 6th ed pp. 1245

MPL 1

49. The most common primary type of bronchogenic carcinoma is:


a. metastatic carcinoma
b. adenocarcinoma
c. squamous cell carcinoma
d. small cell carcinoma
49. Answer: C
Robbins 6th ed pp. 743-744
MPL 1
50. The source of surfactant is believed to be:
a. Type I pneumocyte
b. Type II pneumocyte
c. Mast cell
d. Alveolar mcrophage
50. Answer: B
Robbins 6th ed pp. 471

MPL 0.33

51. The single most characteristic feature of bronchiectasis is:


a. excessive mucus secretion
b. immotile cilia
c. dilatation of bronchi
d. alpha-1 antitrypsin deficiency
51. Answer: C
Robbins 6th ed pp. 716
MPL 1
52. Non-communicating hydrocephalus means obstruction:
a. between ventricles and subarachnoid space
b. at the cisterna ambiens
c. at the arachnoid granulations
d. at the vein of Galen
52. Answer: B
Robbins 6th ed pp. 1298-1299

MPL 0.33

53. The most common cause of bacterial meningitis in a patient <2 months old is:
a. Escherichia coli
b. Hemophilus influenza
c. Streptococcus pneumoniae
d. Neisseria meningitides
53. Answer: A
Robbins 6th ed pp. 1314
MPL 1
54. The most important and consistent site for histologic lesion in parkinsonism is:
a. caudate nucleus
b. substantia nigra
c. red nucleus
d. putamen
54. Answer: B
Robbins 6th ed pp. 1334
MPL 1
55. Increased hormonal stimulation may cause cells to undergo:
a. atrophy
c. hyperplasia
b. metaplasia
d. dysplasia
55. Answer: C
Robbins 6th ed pp. 32-33
MPL 1
56. A reversible change or alteration in adult cells characterized by variation in size, shape and
organization:
a. metaplasia
c. dysplasia
b. hyperplasia
d. atrophy
56. Answer: C
Robbins 6th ed pp. 466
MPL 1

57. Type of cellular adaptation where there is marked increase in the number of autophagosomes
accompanied by decrease in the number of mitochondria, myofilaments, ad endoplasmic reticulum:
a. hypertrophy
c. hyperplasia
b. atrophy
d. metaplasia
57. Answer: B
Robbins 6th ed pp. 36
MPL 1
58. The most common cause of hypoxic injury is;
a. ischemia

b. depletion of oxygen-carrying capacity of blood


c. poisoning of the oxidative enzymes within the cells
d. thrombosis
58. Answer: A
Robbins 6th ed pp. 4

MPL 1

59. The sum of all morphologic changes following cell death:


a. necrosis
c. autolysis
b. heterolysis
d. autophagy
59. Answer: A
Robbins 6th ed pp. 2
MPL 1
60. The characteristic cellular infiltrate in the early phase of acute inflammation:
a. lymphocyte
c. plasma cells
b. neutrophils
d. eosinophil
60. Answer: B
Robbins 6th ed pp. 51
MPL 1
61. The immediate transient phase of vascular permeability in most types of tissue injury is mediated
by:
a. histamine
c. complement
b. prostaglandins
d. bradykinin
61. Answer: A
Robbins 6th ed pp. 66
MPL 0.5
62. The characteristic cell of a granuloma:
a. Langhans type giant cell
c. lymphocyte
b. epithelioid cell
d. plasma cell
62. Answer: B
Robbins 6th ed pp. 83-84
Answer: MPL 1
63. The essential features of a granulation tissue:
a. fibroblasts and inflammatory cells
c. edema & inflammatory cell
b. small blood vessels and fibroblasts
d. inflammatory cells & vessels
63. Answer: B
Robbins 6th ed pp. 102-103
MPL 0.5
64. Acute pancreatitis:
a. coagulation necrosis
c. liquefaction necrosis
b. caseation necrosis
d. enzymatic fat necrosis
64. Answer: D
Robbins 6th ed pp. 17-18
MPL 1
65. Acute inflammation is characterized by the following:
A. relatively long duration
B. proliferation blood vessels and connective tissue
65. Answer: D
Robbins 6th ed pp. 51

C. emigration of macrophages
D. exudation
MPL 1

66. The most common mechanism of vascular leakage elicited by free oxygen radicals:
A. endothelial contraction
C. leukocyte-dependent leakage
B. direct endothelial cell injury
D. regeneration of endothelial cell
th
66. Answer: B
Robbins 6 ed pp. 55 / 76
MPL 0.25
67. Leukocyte adhesion, chemotaxis and activation are important inflammatory mediator processes
performed by complement factor:
A. C7a
C. C5a
B. C6a
D. C1a
67. Answer: C
Robbins 6th ed pp. 61
MPL 0.33
68.

Oxygen-derived free radicals are implicated in:


A. endothelial cell damage
B. release of histamine
68. Answer: A
Robbins 6th ed pp. 76

C. tissue regeneration
D. prostaglandin release
MPL 0.5

69. This inflammatory infiltrate is the prima donna of chronic inflammation because of the great
number of biologically active substances it releases:
A. lymphocytes
C. neutrophils
B. macrophage
D. plasma cells
69. Answer: B
Robbins 6th ed pp. 79
MPL 1
70. Adaptation has happen:
a. if the cell undergoes necrosis
c. ..is replaced by another cell type
b. loses its genetic apparatus
d. undergoes dystrophic calcification
70. Answer: C
Robbins 6th ed pp. 36-37
MPL 1
71. Characteristics of benign tumors:
a. invasive

c. immortal

b. cohesive
71. Answer: B

Robbins 6th ed pp. 270

d. escape from regulatory control


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72. The most reliable feature of malignancy:


a. metastasis
c. rate of growth
b. differentiation
d. invasion
72. Answer: A
Robbins 6th ed pp. 268
MPL 1
73. The most common route of metastasis of a carcinoma:
a. contiguity
c. hematogenous
b. lymphatic
d. iatrogenic
73. Answer: B
Robbins 6th ed pp. 269
MPL 1
74. The most important prognostic factor for malignancy:
a. stage
c. invasion
b. grade
d. localization
74. Answer: A
Robbins 6th ed pp. 321-322
MPL 1
75. A 25-year-old man with a history of intravenous drug use has had one bout of Pneumocystis carinii
pneumonia which was successfully treated a year ago. He now has a WBC count of 3600/microliter
with differential count of 78 segs, 3 bands, 5 lymphs, and 14 monos. He has recently developed
painful, progressive visual loss involving both eyes. Which of the following infections is he most likely
to have:
A. Klebsiella pneumoniae
C. Mycobacterium tuberculosis
B. Staphylococcus aures
D. Cytomegalovirus
75. Answer: D
Robbins 6th ed pp. 1319
MPL 0.25
76. A 65-year-old previously healthy woman has had a non-productive cough increasing in severity
over the last 10 days. She has a temperature of 38.0 C. A chest radiograph shows faint interstitial
infiltrates but no areas of consolidation. A CBC reveals a WBC count of 8900/microliter with differential
count of 60 segs, 3 bands, 25 lymphs, and 12 monos. A sputum gram stain reveals a few gram
positive cocci, gram negative cocci, and Candida with few neutrophils. Her condition gradually
improves over the next week. Which of the following infectious agents is most likely responsible for her
illness:
A. Klebsiella pneumoniae
C. Mycobacterium tuberculosis
B. Staphylococcus aures
D. Influenza A virus
76. Answer: D
Robbins 6th ed pp.348
MPL 0.25
77. A 39-year-old man had an acute febrile illness with fever, pharyngitis, lymphadenopathy, and
malaise following a trip to a city known for its commercial sex workers. In how many years would you
predict that his peripheral blood CD4 lymphocyte count will drop below 200/microliter:
A. one
C. ten
B. five
D. fifteen
77. Answer: C
Robbins 6th ed pp.246-248
MPL 0.25
78. A 20-year-old commercial sex worker has lower abdominal pain of 24 hours duration. There is no
previous history of pain. She is febrile, her total WBC is 29,000/mm3 with 85% neutrophils. She has a
markedly tender lower abdomen on palpation. Laparotomy reveals a distended, fluid-filled reddened
left fallopian tube that is about to rupture. The tube is removed. A culture of the fluid from the tube is
most likely to grow:
A.
TB bacilli
C.
AIDS virus
B.
Neisseria gonorrhea
D.
Human Papilloma virus
78. Answer: B
Robbins 6th ed pp.362
MPL 0.25
79. A 10-year-old child has a severe watery diarrhea that causes her to become severely dehydrated
over the past two days. The persistent activation of adenylate cyclase by GTP leads to excessive
intestinal fluid loss. Which of the following organisms is most likely to produce a toxin that has this
effect:
A. Eschericia coli
C. Vibrio cholera
B. Entamoeba histolytica
D. Salmonella enteritidis
79. Answer: C
Robbins 6th ed pp.808
MPL 0.5

80. An 18-year-old man is plowing a field on a hillside. He discovers a deep, penetrating puncture
wound to his foot. He walks home and washes the soil off the wound site and puts a bandage over it. A
week later the wound is healing, and the leg is not swollen, but he begins to experience generalized
muscle spasms, with stiffness and pain in his shoulders and back. He has difficulty with eating and

swallowing, with painful stiff jaw and facial muscles. Which of the following organisms is most likely
responsible for these findings :
A. Clostridium tetani
C. Staphylococcus aureus
B. Clostridium perfringens
D. Streptococcus pneumoniae
80. Answer: A
Robbins 6th ed pp.368-369
MPL 1
81. A 41-year-old man has a chronic cough and recently experienced an episode of hemoptysis. A
chest radiograph shows a cavitary 4 cm nodule in the right upper lung. There are a few adjacent
smaller nodules with calcifications. The best diagnosis is:
A. AIDS with cytomegalovirus
C. Bronchopneumonia with
pseudomonas
B. Secondary tuberculosis
D. peripheral organizing pulmonary thromboembolus
81. Answer: C
Robbins 6th ed pp.376-377
MPL 0.25
82. A 40-year-old man has had a productive cough with yellowish sputum for several days. A complete
blood count shows that he has a total WBC count of 15,700/microliter with differential count of 73
segs, 10 bands, 12 lymphs, and 5 monos. He has a fever of 38.9 C. A chest radiograph reveals a
nodule in the left upper lobe that has a central cavity with an air-fluid level. Which of the following
findings is most likely to be present in his sputum|:
A. +2 acid fast bacilli
C. 4+ gram positive cocci
B.
atypical squamous cells
D. hemosiderin-laden macrophages
82. Answer: C
Robbins 6th ed pp.367 / 722
MPL 0.33
83. A 78-year-old woman has a history of Alzheimer's disease. She dies after an illness lasting only a
two-day history of fever and cough productive of copious amounts of yellowish sputum. Her vital signs
on admission included blood pressure 110/75 mm Hg, pulse 105, respirations 26, and temperature
38.1 C. She had dullness to percussion at the right lung base. The microscopic findings from the right
lower lobe at autopsy include numerous neutrophils within the alveolar spaces, with minimal
destruction of alveolar walls. What was the most likely infectious cause for her pulmonary disease:
A.
Influenza A virus
C. streptococcus pneumoniae
B. Mycobacterium tuberculosis
D. Cytomegalovirus
83. Answer: C
Robbins 6th ed pp.719
MPL 0.33
84. A 22-year-old woman has experienced episodes of myalgias, pleural effusions, pericarditis, and
arthralgias without joint deformity over the course of several years. She has continued working at her
job. A CBC reveals a mild normocytic anemia. The best laboratory screening test to begin the workup
for her condition would be a(an):
A. CD4 lymphocyte count
C. antinuclear antibody test
B. Blood culture
D. creatine phosphokinase
84. Answer: C
Robbins 6th ed pp.216-217
MPL 0.25
85. A male infant was born at term. No congenital anomalies were noted at birth. A year later he now
has failure to thrive and has been getting one bacterial pneumonia after another with both Hemophilus
influenzae and Streptococcus pneumoniae cultured from his sputum. You should most strongly suspect
that he has which of the following diseases
A. Di George Syndrome
C. EBV infection
B. Selective IgA deficiency
D. X-inked agammaglobulinemia
th
85. Answer: D
Robbins 6 ed pp.232-233
MPL 0.25
86. An appropriate, useful type I hypersensitivity response of the immune system, accompanied by
eosinophilia, would be directed against:
A. amyloid protein
C. neoplasms
B. pinworm infection
D. inhaled dusts
86. Answer: B
Robbins 6th ed pp.82
MPL 1
87. A 54-year-old woman is found to have a blood pressure of 170/110 mm Hg. Her fingers become
cold and painful upon exposure to cold. She has mild dyspnea, but no wheezing. The antinuclear
antibody test is positive with a titer of 1:256 and a nucleolar pattern. Her serum urea nitrogen is 15
mg/dL with creatinine of 1.1 mg/dL. These findings most strongly suggest that she has which of the
following autoimmune diseases:
A. discoid lupus erythematosus
C. polymyositis-dermatomyositis
B. progressive systemic sclerosis
D. rheumatoid arthritis
87. Answer: B
Robbins 6th ed pp.226-229
MPL 0.25
88. Several hours after going on a hike through dense foliage, a 40-year-old man notices a slightly
raised and tender irregular reddish rash on one forearm that was not covered by clothing. This rash
gradually increases in intensity for a couple of days and then fades after two weeks. The rash is most
indicative of:
A. Type I
C. Type III
B. Type II
D. Type IV

88. Answer: D
Robbins 6th ed pp.204-206
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89. The second pregnancy of a 23-year-old woman appears uncomplicated until ultrasound
performed at 19 weeks shows hydrops fetalis. The fetal organ development is consistent for 19 weeks,
and no congenital anomalies are noted. Her first pregnancy was uncomplicated and resulted in the
birth of a normal girl at term. The current pregnancy yields a baby born prematurely at 32 weeks
gestation with marked icterus. The baby is also markedly anemic, and an exchange transfusion is
performed. Which of the following immunologic mechanisms best explains these findings
A. anti-receptor antibody
C. immune complex formation
B. complement-mediated cell destruction
D. delayed type
hypersentsitivity
89. Answer: B
Robbins 6th ed pp.199-201
MPL 0.25
90. A man in his mid-30's presents with malar skin rash, polyarthritis with swelling and warmth of his
hands, and sensitization to cold. On physical examination he has generalized lymphadenopathy and
pale conjunctivae. Laboratory findings include a hemoglobin of 9.5 g/dL, total WBC count of
2100/microliter, total serum protein 8.8 g/dL, albumin 3.6 g/dL, creatinine 1.1 mg/dL, and creatine
kinase of 468 U/L. His antinuclear antibody test is positive at 1:256. The best additional serologic test
to help determine his underlying disease process is:
A. Anti-centromere
C. Rheumatoid Factor
B. Anti-RNP
D. Serum C1q complement level
90. Answer: B
Robbins 6th ed pp.218
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91. Several weeks following a pharyngitis in which the throat culture grew group A hemolytic
streptococcus, a child is noted to have hematuria on urinalysis. An immunofluorescence staining
pattern in a renal biopsy shows granular deposition of IgG and complement around glomerular
capillary loops. Which of the following immune hypersensitivity mechanisms is most likely responsible
for this pattern of findings
A. Type I
C. Type III
B. Type II
D. Type IV
91. Answer: C
Robbins 6th ed pp.204-226
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92. A 48-year-old man has a chronic cough with fever that have persisted for several months. The
chest radiograph reveals a diffuse reticulonodular pattern. Microscopically on transbronchial biopsy
there are focal areas of inflammation containing epitheloid macrophages, Langhan's giant cells, and
lymphocytes. These findings are most typical for which of the following immunologic responses:
A. Type I
C. Type III
B. Type II
D. Type IV
92. Answer: D
Robbins 6th ed pp.204-226
MPL 0.25
93. A 31-year-old woman with chest pain for the past week has a chest radiograph that shows modest
bilateral pleural effusions. On chest CT scan, the pleural effusions, as well as a pericardial effusion, are
observed. A thoracentesis on the left yields clear fluid with a low protein and cell count. She is found to
have an anti-double stranded DNA titer of 1:512. If she is later found to have a serum urea nitrogen
that is 55 mg/dL, it will probably be the result of which of the following pathologic processes
A. atherosclerosis
C. amyloid deposition
B. glomerular immune deposits
D. Anti-glomerular basement membrane
93. Answer: B
Robbins 6th ed pp.216-225
MPL 0.25
94. A 5 cm well-encapsulated mass was excised from the breast of a 21-year-old woman.
Histologically, the mass was composed of elongated, ductlike structures surrounded by
loose, fibrous connective tissue. Diagnosis
A. fibroadenoma
B. intraductal papilloma
C Pagets disease
D. Phyllodes tumor
94. Answer: A
Robbins 6th ed pp. 1102-1103
MPL 0.25
95. An 18-year-old medical student complains of poor concentration and easy fatigability. She
had heavy menstrual bleeding but was otherwise healthy. Examination of the blood showed
a microcytic, hypochromic erythrocytes. Diagnosis?
A. aplastic anemia
B. sickle cell anemia
C. thalassemia
D. iron deficiency anemia
95. Answer: B
Robbins 6th ed pp. 627-630
MPL 1
96. A 30-year-old man known to be a heavy smoker developed gangrene of the leg, which had
to be amputated. Intraluminal thrombi associated with microabscesses in the wall of
medium sized arteries were found in the resected leg. Diagnosis?
A. Henoch-Sholein purpura
B. Syphilis

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C. Polyarteritis nodosa
D. Buerger disease
96. Answer: D
Robbins 6th ed pp.523

MPL 1

97. Ocular muscle weakness and general fatigability were found in a 38-year-old woman who
also had antibodies to acetylcholine receptors. Diagnosis?
A. Graves disease
B. Polymyositis
C. Myasthenia gravis
D. Wiscott-Aldrich syndrome
97. Answer: C
Robbins 6th ed pp.1289
MPL 1
98. Congenital aplasia of the thymus and parathyroid glands was discovered in a neonate that
developed spastic contraction on the second postpartum day. Diagnosis?
A. Goodpasture syndrome
B. DiGeorge syndrome
C. Isolated IgA deficiency
D. Brutons agammaglobulinemia
98. Answer: B
Robbins 6th ed pp.235
MPL 1
99. Hemorrhagic cutaneous nodules in a male homosexual with AIDS. Diagnosis?
A. hemangioma
B. lentigo maligna
C. neurofibroma
D. Kaposi sarcoma
99. Answer: D
Robbins 6th ed pp535
MPL 0.33
100. Short female with web neck and amenorrhea. Her karyotype was 45,X. Diagnosis?
A. Turner syndrome
B. Klinefelter syndrome
C. Down syndrome
D. Fragile-X syndrome
Answer: A
Robbins 6th ed pp.174-176
MPL 0.33

11