Systemic Pathology — MCQs

Six days after undergoing open reduction and internal fixation of a left-sided femur fracture that he sustained in a motor vehicle collision, a 67-year-old man has sudden-onset severe pain and paresthesia in his right arm. The operation and the immediate postoperative course were uneventful. Prior to hospitalization, he did not take any medications. He has smoked 1 pack of cigarettes daily for 25 years. His temperature is 37.3°C (99.2°F), pulse is 105/min and regular, respirations are 22/min, and blood pressure is 156/94 mm Hg. Physical examination of the right arm shows decreased brachial and radial pulses, and a capillary refill time of 6 seconds. The skin over the right arm is pale and cold to the touch. His left leg is casted. Preoperative laboratory studies were within the reference range. Current laboratory studies show: Hemoglobin 13.8 g/dL Leukocyte count 8,300/mm3 Platelet count 60,000/mm3 Serum Partial thromboplastin time, activated 55 sec Prothrombin time 14 seconds D-Dimer positive Arterial Doppler ultrasonography shows occlusion of the right brachial artery. Which of the following is the most likely explanation for this patient's current symptoms?

A 41-year-old man comes to the physician for generalized fatigue and weakness of his left hand for 4 weeks. During this period he also had multiple episodes of cramping abdominal pain and nausea. He works at a battery manufacturing plant. His temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure is 124/74 mm Hg. Examination shows pale conjunctivae and gingival hyperpigmentation. There is weakness when extending the left wrist against resistance. The brachioradialis reflex is 1+ on the left and 2+ on the right. The radial pulse is palpable bilaterally. The remainder of the examination shows no abnormalities. Further evaluation of this patient is most likely to show which of the following?

A 31-year-old woman presents with pruritic vesicles on the right side of her torso. She notes that the lesions appeared 2 days ago and have not improved. One day prior to their appearance, she says that she experienced a burning sensation in the affected area. The patient is afebrile and vital signs are within normal limits. Upon physical examination, there are painful vesicles noted that are localized to the right T10 skin dermatome. Which of the following complications is associated with this patient’s likely diagnosis?

A previously healthy 38-year-old woman is brought to the emergency department by her husband because of left-sided weakness. As she was getting dressed this morning, she was suddenly unable to button up her shirt. When she showed her husband, he noticed that she seemed confused. She has a 3-year history of diabetes mellitus, for which she takes metformin. She had a knee operation 2 days ago. Her temperature is 38.9°C (102°F), pulse is 98/min, respirations are 17/min, and blood pressure is 138/85 mm Hg. She is confused and oriented only to person. Neurologic examination shows diminished muscle strength on the left side. There are scattered petechiae over the chest, arms, and legs. Laboratory studies show: Hemoglobin 7.5 g/dL Leukocyte count 10,500/mm3 Platelet count 40,000/mm3 Prothrombin time 15 seconds Partial thromboplastin time 36 seconds Serum Bilirubin Total 3.5 mg/dL Direct 0.3 mg/dL Urea nitrogen 35 mg/dL Creatinine 2.5 mg/dL Lactate dehydrogenase 1074 U/L A peripheral smear shows numerous schistocytes. Further evaluation is most likely going to show which of the following findings?

A 36-year-old man presents to his primary care physician with increasing fatigue. He says that the fatigue started after he returned from vacation in South America 4 weeks ago and thinks that it may be related to an infection he got while abroad. He does not know the name of the infection but says that he went to a local clinic for treatment and was given an antibiotic. Since then, he has noticed that he is no longer able to perform his job as a contractor who renovates old homes because he feels short of breath after just a few minutes of work. Furthermore, he says that he has been experiencing prolonged nosebleeds that never occurred prior to this episode. He denies any neurologic symptoms. His past medical history is significant for alcoholic hepatitis secondary to alcohol abuse 3 years prior. Physical exam reveals conjunctival pallor as well as petechiae. Which of the following findings is associated with the most likely cause of this patient's symptoms?

A 16-year-old male presents to the emergency department with a hematoma after falling during gym class. He claims that he has a history of prolonged nosebleeds and bruising/bleeding after minor injuries. Physical exam is unrevealing other than the hematoma. Labs are obtained showing an increased bleeding time and an abnormal ristocetin cofactor assay. Coagulation assays reveal an increased partial thromboplastin time (PTT) but a normal prothrombin time (PT). The patient is given desmopressin and is asked to avoid aspirin. Which of the following findings is most likely directly involved in the etiology of this patient's presentation?

A 66-year-old man is admitted to the medical floor after being diagnosed with community-acquired pneumonia. He has been in good health except for the use of steroids for the past 6 months for ulcerative colitis. The patient is started on the empiric therapy with ceftriaxone for the management of pneumonia. After 10 days of treatment in the hospital, he becomes tachypneic with a decreased level of consciousness. He develops generalized pustular eruptions all over his trunk. The temperature is 40.8°C (105.4°F), and the white blood cell count is 19,000/mm3. The gram stain of an aspirate shows many budding yeasts and neutrophils. A culture of the skin specimen is positive for Candida albicans. The nitroblue tetrazolium test is normal. What is the most likely condition related to his signs and symptoms?

A 24-year-old healthy male presents to the emergency room complaining of severe abdominal pain. He reports that he was playing rugby for his college team when he was tackled on his left side by a member of the opposing team. He is currently experiencing severe left upper abdominal pain and left shoulder pain. A review of his medical record reveals that he was seen by his primary care physician two weeks ago for mononucleosis. His temperature is 99°F (37.2°C), blood pressure is 90/50 mmHg, pulse is 130/min, and respirations are 26/min. He becomes increasingly lethargic over the course of the examination. He demonstrates exquisite tenderness to palpation over the left 8th, 9th, and 10th ribs as well as rebound tenderness in the abdomen. He is eventually stabilized and undergoes definitive operative management. After this patient recovers, which of the following is most likely to be found on a peripheral blood smear in this patient?

A 25-year-old man comes to the physician for the evaluation of recurrent episodes of nosebleeds over the past 6 months. The nosebleeds occur spontaneously and stop after 10 minutes after pinching the nose at the nostrils. He has no history of serious illness except for prolonged bleeding following wisdom teeth extraction 2 years ago. He does not smoke or drink alcohol. He takes no medications. Vital signs are within normal limits. Examination of the nose shows no abnormalities. There are several bruises on the lower extremities. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 15 g/dL Leukocyte count 6,000/mm3 Platelet count 220,000/mm3 Bleeding time 9 minutes Prothrombin time 13 sec Partial thromboplastin time 55 sec Which of the following is the most likely diagnosis?

A mother brings her 6-year-old daughter in to the pediatrician’s clinic for a wellness visit. The mother has a history of von Willebrand’s disease (vWD) and is concerned that her daughter may be affected as well. The mother tells you that she has noticed that her daughter bruises very easily, and her bruises typically are visible for a longer period of time than those of her brother. She denies any personal history of blood clots in her past, but she says that her mother has had to be treated for pulmonary embolism in the recent past. Her birth history is significant for preeclampsia, preterm birth at 32 weeks, a NICU stay of two and a half weeks, and retinopathy of prematurity. She currently eats a diet full of green vegetables, fruits, and french fries. Her vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 106/54 mm Hg; heart rate, 111/min; and respiratory, rate 23/min. On physical examination, her pulses are bounding, complexion is pale, scattered bruises throughout all extremities that are specifically scattered around the knees and elbows. After ordering a coagulation panel, which of the following would one expect to see in the lab panel of a patient with vWD?