Systemic Pathology — MCQs

A 35-year-old man comes to the physician because of progressive swelling of his legs over the past 2 months. During this period, the patient has had an unintentional 5-kg (11-lb) weight gain. He also reports frequent numbness of the tips of his fingers and cramping in his back and leg muscles. He has a history of HIV infection treated with combined antiretroviral therapy. The patient immigrated to the US from Nigeria 3 years ago. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure 150/90 mm Hg. Physical examination shows 3+ periorbital and lower extremity edema bilaterally. Sensation to pinprick and light touch is decreased around the mouth and along the fingers. Laboratory studies show: Serum Albumin 2.5 g/dL Total cholesterol 270 mg/dL HIV antibody positive Urine Blood negative Protein +4 RBC 1-2/hpf RBC casts negative A kidney biopsy is most likely to show which of the following findings under light microscopy?

A 71-year-old male with worsening memory, behavior changes, and disorientation over the span of several years was admitted to the hospital for signs of severe pneumonia. He passes away after failed antibiotic therapy. Which of the following findings would most likely be identified on autopsy?

A 46-year-old man is admitted to the hospital with a 3-day history of productive cough with purulent sputum and fever with chills. On the second day of admission, he develops bloody vomiting, altered mental status, and multiple red spots all over the body. He is oriented only to self. His temperature is 39.3°C (102.7°F), pulse is 110/min, respirations are 26/min, and blood pressure is 86/50 mm Hg. Physical examination shows ecchymoses on both lower extremities. Crackles are heard at the right lung base. Laboratory studies show a platelet count of 45,000/mm3, with a prothrombin time of 44 sec and partial thromboplastin time of 62 sec. D-dimer concentrations are elevated. Which of the following is the most likely cause of this patient's ecchymoses?

A 66-year-old man is brought to the clinic with a history of recurrent falls. He has been slow in his movements and walks clumsily. He denies fever, vision problems, limb weakness, numbness, abnormal sensation in his limbs, trauma, or inability to pass urine. The past medical history is unremarkable, and he only takes calcium and vitamin D supplements. The vital signs include: blood pressure 128/72 mm Hg, heart rate 85/min, respiratory rate 16/min, and temperature 36.9°C (98.4°F). He is awake, alert, and oriented to time, place, and person. His eye movements are normal. There is a tremor in his hands bilaterally, more in the left-hand which decreases with voluntary movements. The muscle tone in all 4 limbs is increased with normal deep tendon reflexes. He walks with a stooped posture and takes small steps with decreased arm swinging movements. During walking, he has difficulty in taking the first few steps and also in changing directions. The speech is slow and monotonous. His mini-mental state examination (MMSE) score is 26/30. What is the most likely pathophysiology of the patient’s condition?

A 76-year-old man presents with progressive fatigue, shortness of breath, and brownish discoloration of the urine for the past 5 weeks. Past medical history is significant for aortic valve replacement surgery 2 years ago. His vital signs include: temperature 36.7°C (98.0°F), blood pressure 130/85 mm Hg, pulse 87/min. Physical examination reveals generalized pallor. Skin appears jaundiced. Laboratory findings are significant for the following: Hemoglobin 9.7 g/dL Reticulocyte count 8% Indirect bilirubin 4 mg/dL Lactate dehydrogenase 250 U/L Direct antiglobulin test Negative Which of the following would most likely be found on a peripheral blood smear in this patient?

A 15-year-old African-American male with a BMI of 22 is brought to his physician by his mother to address concerns about a change in his dietary habits. The patient's mother notes that he is constantly hungry and thirsty, despite his eating and drinking water in excess. She also reports an increase in his use of the bathroom. The physician begins explaining that her son's symptoms are likely due to which of the following?

A 28-year-old man seeks evaluation at a medical office for facial swelling and blood in his urine during the last 3 days. He claims that he has had weakness, malaise, and low-grade fevers for the past 3 months. On physical examination, the blood pressure is 160/96 mm Hg and he has periorbital edema bilaterally. The lab testing is significant for leukocytosis, elevated blood urea nitrogen, and elevated serum creatinine. Urinalysis shows gross hematuria, proteinuria, and red blood cell casts. You suspect that this patient has Goodpasture’s disease and decide to order additional tests to confirm the diagnosis. Antibodies to which of the following would most likely be present in this patient if your suspicion is correct?

A 44-year-old female presents to her primary care physician complaining of fatigue. She reports a four-month history of increasing fatigue accompanied by occasional constipation. She also reports a 15-pound weight gain over the same time period. She is otherwise healthy and takes no medications. She has never been pregnant. On physical examination, her skin is dry and cracked. Patellar reflexes are 1+ bilaterally. Laboratory analysis reveals an elevated serum TSH and decreased serum and free T4. Her blood is positive for the presence of specific antibodies. A biopsy of this patient’s thyroid gland would most likely reveal which of the following?

A 53-year-old woman seeks medical care for superficial erosions and blisters over the skin of her head and trunk. She also has significant involvement of her buccal mucosa, which has made eating difficult. A year earlier, she developed tender sores on the oral mucosa and soft palate of her mouth, which was initially treated as herpes simplex stomatitis. Her condition worsened despite treatment, resulting in the development of eroded areas over her trunk and extremities, with a 10 kg weight loss. Upon further questioning, she denies itching, but she notes that the top layer of her skin could be easily removed when firm horizontal pressure was applied. What is the most likely diagnosis for this patient’s condition?

A 4-month-old boy with a history of multiple infections presents with muscle stiffness. On physical exam, he is found to have carpopedal spasm as well as a heart murmur. Based on your clinical suspicion you decide to obtain a chest X-ray which shows a diminished shadow in the mediastinum. A mutation in which of the following chromosomes is the most likely cause of this patient's presentation?