Systemic Pathology — MCQs

A 1-year-old infant is brought to the emergency department by his parents because of fever and rapid breathing for the past 2 days. He had a mild seizure on the way to the emergency department and developed altered sensorium. His mother states that the patient has had recurrent respiratory infections since birth. He was delivered vaginally at term and without complications. He is up to date on his vaccines and has met all developmental milestones. His temperature is 37.0°C (98.6°F), pulse rate is 200/min, and respirations are 50/min. He is lethargic, irritable, and crying excessively. Physical examination is notable for a small head, an elongated face, broad nose, low set ears, and cleft palate. Cardiopulmonary exam is remarkable for a parasternal thrill, grade IV pansystolic murmur, and crackles over both lung bases. Laboratory studies show hypocalcemia and lymphopenia. Blood cultures are drawn and broad-spectrum antibiotics are started, and the child is admitted to the pediatric intensive care unit. The intensivist suspects a genetic abnormality and a fluorescence in situ hybridization (FISH) analysis is ordered which shows 22q11.2 deletion. Despite maximal therapy, the infant succumbs to his illness. The parents of the child request an autopsy. Which of the following findings is the most likely to be present on autopsy?

A 48-year-old man comes to the emergency department because of a 2-hour history of severe left-sided colicky flank pain that radiates towards his groin. He has vomited twice. Last year, he was treated with ibuprofen for swelling and pain of his left toe. He drinks 4-5 beers most days of the week. Examination shows left costovertebral angle tenderness. An upright x-ray of the abdomen shows no abnormalities. A CT scan of the abdomen and pelvis shows an 9-mm stone in the proximal ureter on the left. Which of the following is most likely to be seen on urinalysis?

A 7-year-old girl is brought to the physician by her mother because of a 5-day history of fever, fatigue, and red spots on her body. Her temperature is 38.3°C (101.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. Physical examination shows pallor and petechiae over the trunk and lower extremities. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Peripheral blood smear shows normochromic, normocytic cells. A bone marrow aspirate shows hypocellularity. Which of the following is the most likely cause of this patient's findings?

A 25-year-old woman comes to the physician because of a 2-week history of episodic bleeding from the nose and gums and one episode of blood in her urine. She was treated with chloramphenicol 1 month ago for Rickettsia rickettsii infection. Her pulse is 130/min, respirations are 22/min, and blood pressure is 105/70 mm Hg. Examination shows mucosal pallor, scattered petechiae, and ecchymoses on the extremities. Laboratory studies show: Hemoglobin 6.3 g/dL Hematocrit 26% Leukocyte count 900/mm3 (30% neutrophils) Platelet count 50,000/mm3 The physician recommends a blood transfusion and informs her of the risks and benefits. Which of the following red blood cell preparations will most significantly reduce the risk of transfusion-related cytomegalovirus infection?

A 73-year-old man comes to the physician because of progressive fatigue and shortness of breath on exertion for 3 weeks. He has swelling of his legs. He has not had nausea or vomiting. His symptoms began shortly after he returned from a trip to Cambodia. He occasionally takes ibuprofen for chronic back pain. He has a history of arterial hypertension and osteoarthritis of both knees. He had an episode of pneumonia 4 months ago. His current medications include lisinopril and hydrochlorothiazide. He has no history of drinking or smoking. His temperature is 37°C (98.6°F), pulse is 101/min, and blood pressure is 135/76 mm Hg. Examination shows pitting edema of the upper and lower extremities. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 6,800/mm3 Platelet count 216,000/mm3 Serum Urea nitrogen 26 mg/dL Creatinine 2.9 mg/dL Albumin 1.6 g/dL Urine Blood negative Protein 4+ Glucose negative Renal biopsy with Congo red stain shows apple-green birefringence under polarized light. Further evaluation of this patient is most likely to show which of the following findings?

A 23-year-old African American man presents to the emergency department with severe pain. The patient, who is a construction worker, was at work when he suddenly experienced severe pain in his arms, legs, chest, and back. He has experienced this before and was treated 2 months ago for a similar concern. His temperature is 100°F (37.8°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tenderness to palpation of the patient's legs, chest, abdomen, and arms. Laboratory values are obtained and shown below. Hemoglobin: 10 g/dL Hematocrit: 30% Leukocyte count: 8,500/mm³ with normal differential Platelet count: 199,000/mm³ Reticulocyte count: 8% Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.9 mEq/L HCO3-: 25 mEq/L BUN: 23 mg/dL LDH: 327 U/L Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following is the most likely diagnosis?

A 33-year-old G2P2 woman presents with a history of fatigue and difficulty breathing upon exertion. She was not able to tolerate antenatal vitamin supplements due to nausea and constipation. Her vital signs include: temperature 37.0°C (98.6°F), blood pressure 112/64 mm Hg, and pulse 98/min. Physical examination reveals conjunctival pallor and spoon nails. Laboratory findings are significant for the following: Hemoglobin 9.1 g/dL Hematocrit 27.3% Mean corpuscular volume (MCV) 73 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell Red cell distribution width (RDW) 17.5% (ref: 11.5–14.5%) Serum ferritin 9 ng/mL Which of the following would most likely be seen on a peripheral blood smear in this patient?

A 35-year-old G4P1 woman presents for follow-up after her 3rd miscarriage. All 3 miscarriages occurred during the 2nd trimester. Past medical history is significant for systemic lupus erythematosus (SLE) and a deep vein thrombosis (DVT) in her right lower leg 3 years ago. Her current medication is hydroxychloroquine. The patient denies any tobacco, alcohol, and illicit substance use. Her vitals include: temperature 36.8℃ (98.2℉), blood pressure 114/76 mm Hg, pulse 84/min, respiration rate 12/min. Physical examination reveals a lacy, violaceous discoloration on her lower legs. Which of the following autoantibodies would this patient most likely test positive for?

Two weeks after undergoing allogeneic stem cell transplant for multiple myeloma, a 55-year-old man develops a severely pruritic rash, abdominal cramps, and profuse diarrhea. He appears lethargic. Physical examination shows yellow sclerae. There is a generalized maculopapular rash on his face, trunk, and lower extremities, and desquamation of both soles. His serum alanine aminotransferase is 115 U/L, serum aspartate aminotransferase is 97 U/L, and serum total bilirubin is 2.7 mg/dL. Which of the following is the most likely underlying cause of this patient's condition?

A 61-year-old woman comes to the physician for evaluation of numbness and a burning sensation in her feet for the past 5 months. She has type 2 diabetes mellitus and hypercholesterolemia. Her blood pressure is 119/82 mm Hg. Neurologic examination shows decreased sensation to pinprick, light touch, and vibration over the soles of both feet. There is a nontender ulcer on the plantar surface of her left foot. Pedal pulses are strong bilaterally. Her hemoglobin A1c concentration is 8.6%. Which of the following processes is most likely involved in the pathogenesis of this patient's current symptoms?