SELF ASSESSMENT EXAM A

DIRECTIONS: SEl,ECT THE ONE BEST ANSWER OR COMPLETION

1. Osteomalacia is associated with each of the following EXCEPT: A. Chronic renal insufficiency. B. Immobilization. C. Malabsorption states. D. Rickets. E. Vitamin D deficiency. 2. Which of the following alterations that can be seen in fibrocystic change of the breast is most associated with an increased risk of the development of carcinoma: A. Apocrine metaplasia. B. Cystic ductal dilation. C. Epithelial hyperplasia. D. Stromal fibrosis. 3. Of the following, the cell that is most likely to be damaged by ionizing radiation is: A. Fibroblast. B. Hepatocyte. C. Intestinal mucosal cell. D. Neuron. E. Pancreatic islet cE~I1. 4. Which of the following may show clinical symptoms related to low cardiac output: A. Dilated cardiomyopathy. B. Hypertrophic cardiomyopathy. C. Both. D. Neither. 5. The most accurate predictor of melanoma behavior is: A. Anatom:ic location. B. Degree of inflammatory reaction. C. Lesion thickness. D. Number of mitoses per square centimeter. E. Presence or absence of ulceration. 6. The MOST common type of thyroid carcinoma is: A. Anaplastic. B. Fo11icular. C. Hurthle ce11. D. Medullary. E. Papi11ary. 7. The MOST COMMON cause of is: A. Ectopic tubal pregnancy. B. . C. Gonorrheal . D. Ruptured luteal cyst.

194 8. Which of the following statements concerning Crohn's disease is TRUE: A. Always begins in the rectal area and extends proximally. B. Invariably associated with non-caseating granulomatous inflammation of the submucosal tissue. C. May produce symptoms of partial bowel obstruction due to stenosis and/or strictures of the bowel lumen. D. Patients are at high risk of developing colonic carcinoma. 9. Early diagnosis of pancreatic cancer is most likely if the tumor: A. Has metastasized to the brain. B. Has metastasized to the liver. C. Is located in the head of the pancreas. D. Is located in the tail of the pancreas. 10. The development of edema would be expected when there is: A. Decreased intravascular hydrostatic pressure. B. Increased oncotic pressure of blood. C. Both. D. Neither. 11. Reticulocytosis would be a feature of: A. Aplastic anemia. B. Autoimmune hemolytic anemia. C. Megaloblastic anemia. D. Sideroblastic anemia. 12. The primary vascular mechanism for the edema in acute inflammation: A. venous congestion. B. lymphatic obstruction. C. increased arterial flow. D. increased arterial pressure. E. increased vascular permeability. 13. The MOST malignant of testicular tumors is the: A. Choriocarcinoma. B. Embryonal carcinoma. C. Gonadal stromal tUDlor. D. Seminoma. 14. Which of the following features is most characteristic of a neoplasm: A. Autonomous growth. B. Increased vascularity. C. Large size. D. Necrosis. E. Rapid growth. 15. Traumatic skull fracture with tearing of the middle meningeal artery results in: A. Epidural hemorrhage. B. Hemorrhage in the base of the pons. C. Hemorrhage in the external capsule. D. Subarachnoid hemorrhage. E. Subdural hemorrhage.

195 16. The most distinctive structural defect in pulmonary emphysema is: A. Cellular infiltration of the walls of small airways. B. Dilatation and thickening of bronchial walls. C. Enlargement of air spaces and loss of alveolar septa. D. Increase in total mass of lung tissue. E. Loss of alveolar epithelium. 17. Necrosis of the renal papillae is MOST commonly seen in patients with which of the following diseases: A. Chronic glomerulonephritis. B. Chronic pyelonephritis. C. Diabetes mellitus. D. Lupus erythematosus. 18. The buildup of excessive amounts of collagen during wound healing is called: A. Contraction. B. Exuberant granulation. C. Keloid. D. Organization. E. Proud flesh. 19. A 40 year old woman who complains of a low-grade fever, malaise, and stiffness in her joints each morning most likely has which of the following diseases: A. Gout. B. Metastatic carcinoma. C. Osteoarthritis. D. Rheumatoid arthritis. E. Vi110nodular synovitis. 20. Which of the following clinical features is LEAST likely to indicate a malignancy of the breast: A. Alterations of breast contour. B. Edema of the skin. C. Nipple inversion. D. Skin dimpling. E. Tenderness to palpation. 21. Radiation is most likely to induce cell injury because of its effects on the: A. Cell membrane. B. DNA. C. Endoplasmic reticulum. D. Lysosomes. E. Mitochondria. 22. Manifestations of right-sided heart failure might include all of the following EXCEPT: A. Ascites. B. Hepatic congestion. C. Pulmonary edema. D. Splenomegaly. 23. Mycosis fungo ides is a lymphoma of which cell type: A. B-cel1. B. Langerhans cell. C. M~rckle cell. D. Null cell. E. T-cell.

196 24. Following the injection of TRF, thyrotropin (TSH) would NOT be expected to rise in a patient: A. Who is hyperthyroid. B. Who is hypothyroid. C. With a defect in thyroid hormone synthesis. D. With hypothalamic disease. 25. Which of the following is a masculinizing tumor of the ovary: A. Dysgerminoma. B. Granulosa cell tumor. C. Krukenberg tumor. D. Mucinous cystadenoma. E. Sertoli-Leydig cell tumor. 26. Which of the following would favor a diagnosis of ulcerative gastric carcinoma over a diagnosis of gastric peptic ulcer: A. Clean ulcer base. B. Indurated ulcer margins. C. Mucosal folds radiating from ulcer. D. All of the above. 27. Common complications of alcoholic cirrhosis of the liver include all of the following EXCEPT: A. Ascites. B. abnormalities. C. Cholelithiasis. D. Enlarged spleen. E. Jaundice. 28. Pooling of blood in capillary beds and venules due to impaired blood flow is known as: A. Congestion. B. Hyperemia. C. Hypovolemia. D. Shock. E. Vasoconstriction. 29. Which of the following typically causes a macrocytic anemia: A. Acute blood loss. B. Folate deficiency. C. Both. D. Neither. 30. Fluid exudation and neutrophil emigration in acute inflammation occur predominantly from: A. arteries. B. arterioles. C. capillaries. D. venules. E. veins. 31. Distant metastasis in prostatic carcinoma MOST COMMONLY involves: A. Adrenal. B. Bone. C. Brain. D. Liver. E. Lung .•

197 32. In most instances, metaplasia is the result of: A. Chronic irritation. B. Developmental defect. C. Immunologic reaction. D. Somatic mutation. E. Viral infection. 33. Infarcts of the brain which occur in the boundary zone between major arterial supplies are usually the result of: A. Atherosclerosis. B. Emboli. C. Hypotension. D. . 34. The lung cancer which most commonly produces and secretes hormone-like substances is: A. Adenocarcinoma. B. Larfe cell undifferentiated carcinoma. C. Sma I cell undifferentiated carcinoma. D. Squamous cell carcinoma. 35. The most common renal malignancy in childhood would be: A. Neuroblastoma. B. Renal cell carcinoma. C. Transitional cell carcinoma. D. Wilms' tumor. 36. The phenomenon of wound contraction may be: A. Advantageous in that it reduces the amount of scar tissue needed. B. Deleterious in that slows down the healing process. C. Both. D. Neither. 37. Of the following, the most common tumor that involves bone is: A. Chondrosarcoma. B. Giant-cell tumor. C. Metastatic tumor from an extraosseous site. D. Multiple myeloma. E. Osteogenic sarcoma. 38. Factors predisposing to the development of breast. cancer in women include each of the following EXCEPT: A. Fibrocystic change of the breast. B. Increasing age. C. Maternal history of breast cancer. D. Multiparity. E. Previous mastectomy for cancer. 39. Which of the following features characterizes irreversible cell injury: A. Cellular swelling. B. Cytoplasmic franulation. C. Mitochondria swelling. D. Nuclear pyknosis. E. Polysome disaggregation.

198 40. A 62 year old insulin dependant diabetic with a past history of myocardial infarction suddenly develops acute abdominal pain and bloody diarrhea followed by ileus and abdominal rigidity. Exploratory laparotomy would most likely reveal which of the following: A. Bleeding duodenal peptic ulcer. B. Encroacnment of mesenteric fat over the serosal surfaces of the bowel. C. Thrombosis of the portal vein. D. Thrombotic occlusion of proximal superior mesenteric artery. 41. The characteristic cutaneous immune deposits in systemic lupus erythematosus are seen in the: A. Dermal blood vessels. B. Dermal papillae. C. Epidermal basement membrane zone. D. Epidermal intercellular spaces. 42. A localized, destructive lesion of the posterior pituitary would most likely affect which of the following serum values: A. Calcium. B. Creatinine. C. Glucose. D. Potassium. E. Sodium. 43. Metastatic, mucin-producing, signet-ring cancer cells in the ovary most frequently come from: A. Astrocytoma. B. Endometrial carcinoma. C. Gastrointestinal carcinoma. D. Histiocytic lymphoma. E. Malignant melanoma. 44. Adenocarcinoma of the esophagus would most likely arise in the: A. Distal esophagus. B. Mid esophagus. C. Proximal esophagus. D. Equal distribution between all three of the above. 45. Of the following, hepatocellular carcinoma is most often associated with: A. Biliary atresia. B. Chronic pancreatitis. C. Gallstones. D. Hepatic cirrhosis. 46. Hypovolemic shock would be most likely to develop in patients with: A. Bee stings. B. Cardiac failure. C. Extensive burns. D. Head trauma. E. Septicemia. 47. Renal failure is characteristically associated with: A. Acute myelogenous leukemia. B. Chronic lymphatic leukemia C. Hodgkin's disease. D. Multiple myeloma. E. NodulaF lymphoma.

199 48. All of the following cell types are found in acute and/or chronic inflammatory reactions EXCEPT: A. Lymphocytes. B. Macrophages. C. Megakaryocytes. D. Plasma cells. E. Polymorphonuclear leukocytes. 49. Metastatic spread of a prostatic adenocarcinoma would be most likely to occur through the: A. Arterial system. B. Lymphatic system. C. Peritoneal cavity. D. Venous system. 50. Which of the following is a benign neoplasm of epithelial origin: A. Astrocytoma. B. Chondroma. C. Lipoma. D. Melanoma. E. Papilloma. 51. Which of the following intracranial neoplasms has the highest incidence in adults: A. Ependymoma. B. Ganglioglioma. C. Glioblastoma multiforme. D. Neuroblastoma. E. Oligodendroglioma. 52. A decrease in surfactant activity is the underlying problem in patients with: A. Alpha-1-antitrypsin deficiency. B. Asbestosis. C. Asthma. D. Bronchiectasis. E. Respiratory distress of the newborn. 53. The disease most likely to cause nephrotic syndrome in a child is: A. Focal sclerosis. B. Lipoid nephrosis. C. Membranous glomerulonephritis. D. Membranoproliferative glomerulonephritis. 54. Each of the following cell types are capable of regeneration EXCEPT: A. Astrocyte. B. Cardiac muscle. C. Fibroblast. D. Hepatocyte. E. Keratinocyte. 55. Generation of free radicals is the major mechanism of cell injury in: A. Ischemia. B. Oxygen toxicity. C. Both. D. Neither.

200 56. Elevated serum levels of which of the following is NOT associated with the development of clinically significant atherosclerosis: A. Alpha lipoproteins. B. Beta lipoproteins. C. Low density lipoproteins. D. Pre-beta lipoproteins. 57. Most of the human papilloma viruses (HPV) associated with human malignant tumors are strains related to: A. Epidermodysplasia. B. Flat warts. C. Immunosuppression. D. Sexual transmission. 58. Secondary hyperparathyroidism will characteristically show: A. Elevated serum calcium. B. Elevated serum PTH. C. Both. D. Neither. 59. Each of the following is characteristic of carcinoma of the vulva EXCEPT: A. Affects post-menopausal age group. B. May be preceded by . C. Majority are derived from subcutaneous sweat glands. D. Regional node metastases often present at time of diagnosis. 60. The MOST common type of polyp of the colon and rectum is: A. Adenomatous polyp. B. Juvenile adenoma. C. Pseudopolyp. D. Villous adenoma. 61. Total functional regeneration of acutely injured liver is dependent upon the degree of injury to: A. Bile ducts. B. Central veins. C. Hepatocytes. D. Portal veins. E. Reticular framework. 62. Which of the following has the LEAST influence on slowing hemorrhage from venules: A. Blood . B. Direct pressure on bleeding site. C. Formation of plugs. D. Vasoconstriction. 63. Massive splenomegaly would be most likely to accompany which of the following: A. Acute lymphoblastic leukemia. B. Chronic myelogenous leukemia. C. Multiple myeloma. D. Hodgkin's disease. E. Sickle cell anemia.

201 64. The most characteristic cell of the acute inflammatory response is the: A. Giant cell. B. Lymphocyte. C. Monocyte. D. Plasma cell. E. Polymorphonuclear leukocyte. 65. Which of the following disorders would be LEAST likely to present as gross hematuria in a 46 year old male: A. Adult polycystic disease. B. Carcinoma of the urinary bladder. C. Renal calculi. D. Renal cell carcinoma. E. Wilms' tumor. 66. A malignant neoplasm of connective tissue origin is a/an: A. Adenoma. B. Carcinoma. C. Hamartoma. D. Sarcoma. E. Teratoma. 67. Which of the following microscopic findings is LEAST suggestive of Alzheimer's disease: A. Granulovacuolar degeneration. B. Increased neuronal lipofuscin pigmentation. C. Neurofibrillary tangles. D. Senile plaques. 68. The MOST frequent cause of symptomatic pulmonary edema is: A. Anaphylaxis. B. Infection. C. Left heart failure. D. Shock. 69. Intermittent severe flank pain which radiates to the groin would be the dominant symptom of: A. Acute pyelonephritis. B. Papillary necrosis. C. Renal infarct. D. Ureter obstructed by calculus. 70. Which one-of the following is LEAST likely to regenerate: A. hepatocytes. B. axons. C. bone. D. cardiac muscle. E. renal tubular epithelium.

202 SELF ASSESSMENT EXAM A

ANSWER KEY

1. B 11. B 21. B 31. B 41. C 51. C 61. E 2. C 12. E 22. C 32. A 42. E 52. E 62. D 3. C 13. A 23. E 33. C 43. C 53. B 63. B 4. C 14. A 24. A 34. C 44. A 54. B 64. E 5. C 15. A 25. E 35. D 45. D 55. B 65. E 6. E 16. C 26. B 36. A 46. C 56. A 66. D 7. A 17. C 27. C 37. C 47. D 57. D 67. B

8. C 18. C 28. A 38. D 48. C 58. B 68. C

9. C 19. D 29. B 39. D 49. B 59. C 69. D

10. D 20. E 30. D 40. D 50. E 60. A 70. D

203 SELF ASSESSMENT EXAM B

DIRECTIONS: SELECT mE ONE BEST ANSWER OR COMPLETION

1. Inadequate mineralization of bone matrix is characteristic of: A. Achondroplasia. B. Hypoparathyroidism. C. Osteogenesis imperfecta. D. Osteoporosis. E. Rickets. 2. A 22-year-old woman presents with a discrete upper/outer quadrant breast mass. The most likely diagnosis is: A. Fat necrosis. B. Fibroadenoma. C. Fibrocystic change. D. Infiltrating ductal carcinoma. E. Intraductal papilloma. 3. Quantitatively, which of the following serum proteins is present in the greatest concentration in a healthy individual: A. Albumin. B. Beta lipoproteins. C. Gammaglobulins. D. Haptoglobin. 4. Complications of cystitis include each of the following EXCEPT: A. Acute pyelonephritis. B. Cystitis cystica. C. Formation of bladder stones. D. Transitional cell carcinoma. 5. Pleural mesotheliomas are most closely associated with: A. Anthracosis. B. Asbestosis. C. Berylliosis. D. Silicosis. E. Smoking. 6. Of the following, the cerebrospinal fluid finding most consistent with acute bacterial meningitis is: A. Increased glucose. B. Increased lymphocyte count. C. Increased protein. D. Xanthochromia 7. An elderly male presents with a 3-month history of severe throbbing pain and tenderness over the temple. The most likely diagnosis is: A. Giant cell arteritis. B. Raynaud IS di.sease. C. Rheumatoid arteritis. D. Syphilitic arteritis. E. Thromboangiitis obliterans.

204 8. After activation, each of the following chemical mediators of inflammation often proceeds in a cascade EXCEPT: A. Arachidonic acid. B. Complement. C. Fibrinopeptides. D. Kinin. E. Neutral proteases. 9. Factor VIII deficiency is associated with prolonged: A. Bleeding time. B. Clotting time. C. Both. D. Neither. 10. Massive pulmonary thromboemboli cause sudden death because of: A. Acute cor pulmonale with arrhythmias. B. Acute pulmonary infarction. C. Asphyxia. D. Cerebral anoxia. E. Massive . 11. Primary biliary cirrhosis is typically associated with each of the following EXCEPT: A. Alcohol abuse. B. Hyperlipidemia. C. Jaundice. D. Middle-aged women. E. Pruritus. 12. Hirschsprung's disease is characterized by absence of ganglion cells in the: A. Adrenal medulla. B. Body of the stomach. C. Distal esophagus. D. Rectum. E. Ureters. 13. Each of the following statements concerning squamous cell carcinoma of the uterine is true EXCEPT: A. It begins at the cervical/endocervical squamo-columnar junction. B. It is associated with human papilloma virus infection. C. It is usually preceded by dysplastic epithelial changes. D. It shows early, widespread metastases. 14. Which of the following tumors would be most likely associated with abdominal stria, easy bruising, and osteoporosis are associated with: A. Adrenal adenoma. B. Craniopharyngioma. C. Parathyroid adenoma. D. Pheochromocytoma. E. Thyroid adenoma. 15. Which of the following is most characteristic of polyarteritis nodosa: A. Cutaneous rash. B. Hypothyroidism. C. Jaundice. D. Necrotizing arteritis. E. Urtic8,J"ia.

205 16. A myocardial infarct which is grossly detectable, yellow to gray in color, and microscopically contains necrotic debris and macrophages but little evidence of granulation tissue is probably: A. 1 hour old. B. 12 hours old. C. 1 day old. D. 1 week old. E. 1 month old. 17. Light microscopic examination of a pulmonary infarct would reveal: A. Caseous necrosis. B. Coagulation necrosis. C. Enzymatic fat necrosis. D. Gangrenous necrosis. E. Liquefaction necrosis. 18. Liver cells are an example of: A. Alternate cells. B. Labile cells. C. Permanent cells. D. Stable cells. 19. A 24 year old female presents to the emergency room with a three day history of fever, malaise, and dysuria. Physical examination reveals costo-vertebral angle tenderness. BUN and creatinine levels are normal.UA shows a few red blood cells, white blood cell casts, and bacteria. The most likely diagnosis would be: A. Acute pyelonephritis. B. Chronic pyelonephritis. C. Goodpasture's syndrome. D. Necrotizing papillitis. 20. Which of the following is associated with an increased incidence of cancer: A. Anthracosis. B. Asbestosis. C. Berylliosis. D. Siderosis. E. Silicosis. 21. In an axonal reaction, degeneration and disintegration of the myelin sheath and axon cylinder is called: A. Axonal dystrophy. B. Central chromatolysis. C. Clasmatodendrosis. D. Gliosis. E. Wallerian degeneration. 22. Which of the following terms would best describe the presence of squamous epithelium lining the renal pelvis: A. Desmoplasia. B. Dysplasia. C. Ectopia. D. Hyperplasia. E. Metaplasia.

206 23. The organism most frequently responsible for acute bacterial endocarditis is: A. Beta hemolytic streptococcus. B. Diplococci pneumoniae. C. Hemophilus influenzae. D. Staphylococcus aureus. E. Streptococcus viridans. 24. The benefit of the acute inflammatory response ion include: A. Localization or walling off of site of damage. B. Removal of dead cells and debris. C. Preparation of area for repair .. D. Laying foundation for hypersensitivity. 25. Which of the following non-Hodgkin's lymphomas has the best prognosis: A. Follicular small cleaved cell (nodular poorly differentiated). B. Large cell immunoblastic (diffuse histiocytic). C. Lymphoblastic. D. Small non-cleaved cell (diffuse undifferentiated). 26. Infarcts tend to be hemorrhagic when they occur in the: A. Heart. B. Intestine. C. Kidney. D. Pancreas. E. Spleen.

27. The pathogenic factor which appears to be responsible for the maj~rity of instances of cholelithiasis is: A. Acute cholecystitis. B. Autoantibodies to bile. C. Hemolysis. D. High fat diet. E. Supersaturation of bile with cholesterol 28. Diverticulosis of the colon: A.. Increases in incidence with age. B. Is a necessary precursor to the development of hemorrhoids. C. Is complicated by diverticulitis in over half of the cases. D. Is inherited as an autosomal dominant trait. E. Predisposes to carcinoma of the colon. 29. Causes of include each of the following EXCEPT: A. Cervical dysplasia. B. Chronic salpingitis. C. Endometriosis. D. Leiomyomas. E. Polycystic ovary disease. 30. A patient with Addison's disease is likely to exhibit all of the following EXCEPT: A. Adrenal atrophy. B. Central obesity. C. Hyperpigmentation of skin. D. Hypotension.

207 31. After activation, each of the following chemical mediators of inflammation often proceeds in a cascade EXCEPT: A. Arachidonic acid. B. Complement. C. Fibrinopeptides. D. Kinin. E. Neutral proteases. 32. Each of the following is a feature of Tetralogy of Fallot EXCEPT: A. Atrial septal defect. B. Pulmonary stenosis. C. Right ventricular hypertrophy. D. Ventricular septal defect. 33. Coagulation necrosis: A. Grossly appears soft with ill-defined borders. B. Is characteristic of granulomatous inflammation. C. Is often associated with ischemia. D. Results from lysosomal digestion of tissue. 34. The greatest enlargement of the spleen is usually found in which of the following diseases: A. Acute granulocytic leukemia. B. Acute lymphocytic leukemia. C. Chronic granulocytic leukemia. D. Hodgkin's disease. E. Multiple myeloma. 35. The tensile strength of a healing wound appears to be primarily a function of: A. Collagen deposition. B. Dystrophic calcification. C. Exuberant granulation tissue. D. Inflammatory infiltrate. E. Vascular proliferation. 36. On radiologic exam, small scarred kidneys which show blunting of the pyramids would be most consistent with: A. Chronic pyelonephritis. B. Membranoproliferative glomerulonephritis. C. Renal cell carcinoma. D. Renal infarction. 37. Each of the following could be considered an obstructive disease EXCEPT: A. Bronchial asthma. B. Chronic bronchitis. C. Mucoviscidosis. D. Pulmonary emphysema. E. Pulmonary fibrosis. 38. In the brain, which of the following cells are most sensitive to anoxic damage: A. Astrocytes. B. Ependyma. C. Oligodendroglia. D. Microglia. E. Neurons.

208 39. A teratoma is most likely to arise in whi.ch of the following locations: A. Breast. B. Kidney. C. Lung. D. Ovary. E. Prostate. 40. During a pre-employment physical exam, a 35 year old female was found to have a peripherally located "coin lesion" on chest X-ray. This would most likely represent a/an: A. Abscess. B. Carcinoma. C. Granuloma. D. Hamartoma. E. Infarct. 41. A granulomatous inflammatory response is diagnostic of: A. Alcoholism. B. Bacterial dise.ase. C. Fungal disease. D. Tuberculosis. E. None of the above. 42. Reed-Sternberg cells are characteristic of which of the following diseases: A. Cat scratch disease. B. Chronic lymphocytic leukemia. C. Histiocrtosis X. D. Hodgkin s disease. E. Thymoma 43. The most frequent site of venous thrombosis is the: A. brain. B. kidney. C. leg. D. liver. E. lung. 44. Morphologic features of viral hepatitis include each of the following EXCEPT: A. Ballooning degeneration of hepatocytes. B. Focal necrosis of hepatocytes. C. Hypertrophy and hyperplasia of Kupffer cells. D. Microabscesses. E. Periportal inflammation. 45. Which of the following disorders would be most likely to present with hematemesis: A. Achalasia. B. Hiatal hernia. C. Mallory~Weiss syndrome. D. Plummer-Vinson syndrome. E. Zenker's diverticulum. 46. Characteristic features of polycystic ovary disease include each of the following EXCEPT: A. . B. Bilateral ovarian enlargement. C. Hirsutism. D. Obesity. E. Ovarian "chocolate" cysts.

209 47. Which of the following tumors is most likely to be associated with essential hypertension: A. Adrenal adenoma. B. Parathyroid adenoma. c. Pheochromocytoma. D. Pituitary adenoma. E. Thyroid adenoma. 48. Tobacco smoking is closely associated with the development of: A. Buerger's disease. B. Giant cell arteritis. C. Polyarteritis nodosa. D. Raynaud's disease. E. Wegener's granulomatosis. 49. In which of the following clinical settings might you expect acute cor pulmonale to most likely arise: A. A patient with a two year history of stable angina. B. A patient with an 85 pack-year smoking history and chronic bronchitis. C. A patient with kyphoscoliosis due to childhood polio. D. An overweight patient in bed recovering from surgery for cervical cancer. 50. Of the following, dystrophic calcification would be most closely associated with: A. Hyperphosphatemia. B. Necrotic tissue. C. Osteoporosis. D. Parathyroid hyperplasia. E. Renal calcium excretion. 51. Huntington's chorea is characterized by: A. Atrophy of the caudate nucleus. B. Degeneration of upper motor neurons. C. Demyelination of posterior spinocerebellar tract. D. Depigmentation of substantia nigra. E. Necrosis of Purkinje cells. 52. Osteogenic sarcoma is known to be a complication of: A. Bone trauma. B. Osteitis deformans (Paget's disease). C. Osteoarthritis. D. Osteogenesis imperfecta. E. Multiple myeloma. 53. As a scar matures, it becomes: A. Less vascular. B. More cellular. C. Both. D. Neither. 54. Which of the following is LEAST likely to be seen in the renal biopsy of an individual who has had non-insulin dependent diabetes mellitus for 15 years:

A. Diffuse glomerular sclerosis. B. Hyaline arteriolosclerosis. C. Nodular mesangial sclerosis. D. TPickening of the glomerular capillary basement membranes.

210 55. In which of the following would an interstitial inflammatory infiltrate be most striking: A. Bronchopneumonia. B. Fungal pneumonia. C. Lobar pneumonia. D. Viral pneumonia. 56. In the central nervous system, myelin formation and maintenance is a function of: A. Astrocytes. B. hons. C. Microglia. D. Neuron. E. Oligodendroglia. 57. A fibroadenoma of the breast is an example of: A. Anaplasia. B. Dysplasia. C. Hyperplasia. D. Metaplasia. E. Neoplasia. 58. Of the following, the most life-threatening complication of ulcerative colitis would be: A. Enterocutaneous fistulas. B. Hemorrhage. C. Peritoneal adhesions. D. Stenosis of ileo-cecal valve. E. Toxic megacolon. 59. The first blood cells to aggregate at the site of injury usually are: A. Lymphocytes. B. Macrophages. C. Plasma cells. D. Polymorphonuclear leukocytes. 60. Which of the following is characteristic of acute lymphocytic leukemia: A. Cytoplasmic auer rods. B. Hepatosplenomegaly. C. High incidence in children. D. Lymphadenopathy. E. Philadelphia chromosome. 61. Predisposing factors for thrombosis include all of the following EXCEPT: A. Anemia. B. Atherosclerosis. C. High serum protein levels. D. Thrombocytosis. E. Venous obstruction. 62. The typical outcome of hepatitis A is: A. Chronic active hepatitis. B. Chronic persistent hepatitis. C. Hepatic cirrhosis. D. Massive hepatic necrosis. E. Resolution.

211 63. In contrast to carcinoma of the right colon, carcinoma of the left colon tends to: A. Be annular and obstruct the colon earlier. B. Be clinically silent or asymptomatic. C. Cause anemia and anorexia. D. Produce steatorrhea. 64. Which of the following is embryologically related to the paramesonephric duct: A. Gartner's duct. B. Mesonephric duct. C. Mullerian duct. D. Vitelline duct. E. Wolffian duct. 65. Each of the following neoplasms are associated with the multiple endocrine neoplasia (~mN) syndromes EXCEPT: A. Islet cell adenoma. B. Medullary thyroid carcinoma. C. Neuroblastoma. D. Pheochromocytoma. E. Pituitary adenoma. 66. The most frequently identified neoplasm in the lung is: A. Adenocarcinoma. B. Bronchioloalveolar carcinoma. C. Squamous carcinoma. D. Undifferentiated carcinoma. E. Metastatic carcinoma. 67. Which heart valve is most commonly affected in rheumatic heart disease: A. Aortic valve. B. Mitral valve. C. Pulmonary valve. D. Tricuspid valve. 68. In hypoxic cell injury, cellular swelling occurs because of: A. Active reabsorption of interstitial water. B. Osmotic influx of water due to increased cellular glycogen. C. Both. D. Neither. 69. The MOST common cause of sudden death from myocardial infarction is: A. Angina pectoris. B. Arrhythmia. C. Cardiac tamponade. D. Cardiogenic shock. E. Ventricular aneurysm. 70. The primary cartilage change in osteoarthritis is characterized by: A. Degeneration. B. Dysplasia. C. Hyperplasia. D. Inflammation. E. Regeneration.

212 SELF ASSESSMENT EXAM B

ANSWER KEY

1. D 11. A 21. E 31. E 41. E 51. A 61. A 2. B 12. D 22. E 32. A 42. D 52. B 62. E 3. A 13. D 23. D 33. A 43. C 53. A 63. A 4. D 14. A 24. A 34. C 44. D 54. C 64. C 5. B 15. D 25. A 35. A 45. C 55. D 65. C 6. C 16. D 26. B 36. A 46. E 56. E 66. E 7. A 17. B 27. E 37. E 47. C 57. E 67. B 8. E 18. D 28. A 38. E 48. A 58. E 68. D 9. B 19. A 29. A 39. D 49. D 59. D 69. B 10. A 20. B 30. B 40. C 50. B 60. C 70. A

213