Systemic Pathology — MCQs

A 72-year-old nursing home resident is complaining of pruritis. She is noted to have multiple, tense blisters on her trunk as well as the flexor surfaces of her extremities. The blisters have an erythematous base. You are unable to extend the blisters when you apply lateral traction. You suspect an autoimmune bullous dermatosis. Which of the following is the cause of the likely condition?

A 53-year-old woman presents to the emergency room with severe chest pain radiating to the back. She was diagnosed with acute aortic dissection. A few hours into the resuscitation, she was having oliguria. Laboratory findings show a serum creatinine level of 5.3 mg/dL. Which of the following casts are most likely to be seen on urinalysis?

A 9-year-old boy is brought to the emergency department by his parents with a 2-day history of weakness and joint pain. He was adopted 3 weeks ago from an international adoption agency and this is his first week in the United States. He says that he has been healthy and that he had an episode of sore throat shortly before his adoption. Physical exam reveals an ill-appearing boy with a fever, widespread flat red rash, and multiple subcutaneous nodules. The type of hypersensitivity seen in this patient's disease is also characteristic of which of the following diseases?

A 73-year-old man presents to his primary care doctor with his son who reports that his father has been acting strangely. He has started staring into space throughout the day and has a limited attention span. He has been found talking to people who are not present and has gotten lost while driving twice. He has occasional urinary incontinence. His past medical history is notable for a stroke 5 years ago with residual right arm weakness, diabetes, hypertension, and hyperlipidemia. He takes aspirin, glyburide, metformin, lisinopril, hydrochlorothiazide, and atorvastatin. On examination, he is oriented to person and place but thinks the year is 1989. He is inattentive throughout the exam. He takes short steps while walking. His movements are grossly slowed. A brain biopsy in this patient would most likely reveal which of the following?

A 4-year-old girl is brought to the physician because of increasing swelling around her eyes and over both her feet for the past 4 days. During this period, she has had frothy light yellow urine. Her vital signs are within normal limits. Physical examination shows periorbital edema and 2+ pitting edema of the lower legs and ankles. A urinalysis of this patient is most likely to show which of the following findings?

A 31-year-old woman presents to her primary care provider to discuss the results from a previous urine analysis. She has no new complaints and feels well. Past medical history is significant for systemic lupus erythematosus. She was diagnosed 5 years ago and takes hydroxychloroquine every day and prednisone when her condition flares. Her previous urine analysis shows elevated protein levels (4+) and blood (3+). The urine sediment contained red blood cells (6 RBCs/high-power field). The treating physician would like to perform a renal biopsy to rule out lupus nephritis. What type of hypersensitivity is suggestive of lupus nephritis?

A 65-year-old patient presents with rapidly progressive dementia, myoclonus, and ataxia over 3 months. Laboratory studies, including serum vitamin B12 (cyanocobalamin), thyroxine (T4), and thyroid-stimulating hormone concentrations, are within normal limits. A lumbar puncture is performed. Cerebrospinal fluid (CSF) analysis is most likely to show which of the following?

A 29-year-old GP10 woman at 24 weeks estimated gestational age presents for follow-up. Six weeks ago, a complete blood count showed a microcytic hypochromic anemia for which she was prescribed iron sulfate tablets. A repeat complete blood count today shows no improvement in her hemoglobin level. Past medical history is significant for her being Rh-positive with an Rh-negative partner. She emigrated to the United States with her husband 7 years ago and did not have regular medical care in her country. An abdominal ultrasound shows findings consistent with hydrops fetalis. Which of the following is the most likely etiology of the condition of her fetus?

A 25-year-old female with no significant past medical history presents to her primary care physician with several weeks of increased fatigue and decreased exercise tolerance. On physical exam, her skin and conjunctiva appear pale. The physician suspects some form of anemia and orders a complete blood panel, which is remarkable for hemoglobin 11.7 g/dl, MCV 79 fL, MCHC 38% (normal 31.1-34%), and reticulocyte index 3.6%. Peripheral blood smear shows red blood cells with a lack of central pallor. This patient would most likely develop which of the following conditions?

An otherwise healthy 42-year-old man undergoes routine investigations prior to blood donation. His complete blood count is shown: Hemoglobin 9.3 g/dL Mean corpuscular volume (MCV) 71 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell White blood cell count 8,200/mm3 Platelet count 317,000/mm3 Iron studies are shown: Serum iron 210 μg/dL Serum ferritin 310 ng/mL Total iron binding capacity (TIBC) 290 μg/dL Transferrin saturation 78% He occasionally drinks alcohol and denies smoking or use of illicit drugs. There is a family history of anemia including his brother and maternal uncle. Examination shows conjunctival pallor, but is otherwise unremarkable. Which of the following is the most likely diagnosis?