Block 15 Step Pathology Prt 3

25 Questions | By Chachelly | Updated: Apr 27, 2023 | Attempts: 44

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1.

A 55-year-old plantation worker was referred to the dermatology clinic by his primary physician. He presented with a non-healing ulcer of 3 months duration on his right forearm. First a small pimple-like lesion had appeared at the site, which enlarged and became nodular, suppurated, and broke down forming an ulcer. He had 2 courses of antibiotics without any response. He did not remember having had any skin injury or prick at the site of the ulcer. Previous medical history was not significant. On examination, the ulcer on his forearm was about 15 mm in diameter, indurated with raised erythematous borders. Subcutaneous nodules were palpable and extended in a linear and ascending distribution on the right arm in the direction of the axilla. The local draining lymphatics were cord-like and palpable. Radiologically there was no evidence of bone involvement. Histopathological examination of biopsy from the ulcer showed granulomatous infiitration with many histiocytes and giant cells. Staining for mycobacteria was negative. Direct microscopic examination of tissue using 10% potassium hydroxide did not show fungal elements. Cultures were put up for bacterial and fungal pathogens. Tissue stained by Gomori's methanamine silver stain showed a few small oval and cigar shaped fungal elements measuring 3-5 microns. What is likely to be a characteristic of this fungus?
- A.
  
  Mycelial growth with non-septate hyphae
- B.
  
  Growth of yeast forms at 25°C
- C.
  
  Mycelial growth with septate hyphae at 37°C
- D.
  
  Thermal dimorphism
- E.
  
  Causes cutaneous mycosis
2.

Within 48 hours of consumption of raw oysters from a restaurant in North Carolina, 3 men in their 30s developed diarrhea and severe vomiting accompanied by headache, low grade fever, and chills. They recovered on administration of intravenous fluid. In a week's time all other adults and children in their households became sick with similar symptoms. Bacterial causes were excluded in the laboratory. A viral agent was considered as the cause of this outbreak of gastroenteritis. What is a likely characteristic of this virus?
- A.
  
  Enveloped virus, 70-80 nm size
- B.
  
  Genome contains double stranded RNA
- C.
  
  Replicates in the nucleus of the host cell
- D.
  
  Cultivable in vitro on HEp2 cells
- E.
  
  Can survive temperature as high as 60°C
- F.
  
  Only a single genotype has been identified
3.

A sexually active adolescent girl presented with fever, malaise, and painful vesiculoulcerative lesions of the genitalia of 3 days duration. Clinical diagnosis was suggestive of a viral infection. In the microbiology laboratory, material from the lesion was tested and found positive for a viral, antigen by direct fluorescent antibody (DFA) test. This etiological viral agent is likely to possess what characteristic?
- A.
  
  Grows only on human fibroblastic cells in vitro
- B.
  
  Is an RNA virus with a long replication cycle of >48 hours
- C.
  
  Remains latent in lymphoid tissues
- D.
  
  Produces cytoplasmic inclusions in infected celis
- E.
  
  Has glycoprotein G, an envelope protein that elicits type- specific antibodies
4.

A nosocomial outbreak of viral respiratory illness occurs in a pediatric ward during winter season. The causative viral agent is a recognized major respiratory pathogen of young children and infants. It is a paramyxovirus that does not have haemagglutination and neuraminidase activities. What is a feature of infection by this virus?
- A.
  
  Transmission can occur through contaminated fomites
- B.
  
  Infants having maternal antibodies are immune to the infection
- C.
  
  In adults the infection is always asymptomatic
- D.
  
  Responds to the antiviral agent Oseltamivir
- E.
  
  Immunoprophylaxis is the method of choice to control nosocomial spread
5.

An infant was born with manifestations of intrauterine retarded growth, jaundice, hepatosplenomegaly, microcephaly, thrombocytopenia, and retinitis. Urine and blood samples were collected and tested for agents causing congenital infections. Result of polymerase chain reaction test was diagnostic of infection by a virus that belongs to beta herpes viruses. Which of the following is a characteristic feature of the viral agent causing the congenital infection?
- A.
  
  Has a short replicative cycle of 12-18 hours
- B.
  
  Produces pocks on chorioallantoic membrane of chick embryo
- C.
  
  Causes latent infection in sensory ganglia
- D.
  
  Shows antigenic cross reaction with varicella-zoster virus
- E.
  
  Grows only on human fibroblastic cell culture
6.

A 20-year-old pregnant female presents to your office at 21-weeks gestation with symptoms and signs of preeclampsia. Her symptoms have been present for the past 2 days. Previous to that she had flu-like symptoms and a rash around her body and facial area (still present on her cheeks). Serum was collected for viral titers of the suspected agent causing the symptoms. Intrauterine fetal demise was detected by ultrasonogram. Labor was induced, and a stillborn male fetus was delivered. The viral IgM titers were positive, as suspected. What is the virus that caused the symptoms and eventual fetal demise?
- A.
  
  Herpes simplex type 1
- B.
  
  Herpes simplex type 2
- C.
  
  Epstein-Barr virus
- D.
  
  Cytornegalovirus
- E.
  
  Varicelia-zoster
- F.
  
  Parvo virus B19
7.

A 32-year-old man presents to a dermatologist because of a severe mucocutaneous rash that involves most of his body, including his palms and soles. Questioning reveals that he is a merchant marine who several months previously had an encounter with a prostitute in Southeast Asia, What is the most likely causative agent of this rash?
- A.
  
  Herpes simplex I
- B.
  
  Herpes simplex II
- C.
  
  HIV
- D.
  
  Neisseria gonorrhoeae
- E.
  
  Treponema pallidum
8.

A 40-year-old male presents with a non-healing ulcer in the face. He had noticed a pearly white nodule sometime back, which ruptured and formed the ulcer. However, the ulcer never healed. Microscopically, the biopsy taken from the ulcer shows an island of basaloid cells, with a palisading of the cells at the periphery. The cells have a hyperchromatic nucleus with little poorly defined cytoplasm. What is the most likely diagnosis?
- A.
  
  Squamous cell carcinoma
- B.
  
  Basal cell carcinoma
- C.
  
  Merkel cell carcinoma
- D.
  
  Seborrheic keratosis
- E.
  
  Keratoacanthoma
9.

A 50-year-old German female presents with multiple tiny swellings on the dorsum of her left hand. On examination, there are 3 flesh colored dome shaped swellings measuring between 0.5 to 1 cms. Close examination reveals keratin plugs in the swelling. Microscopically, the biopsy taken from the swelling shows a keratin-filled crater with tongues of epithelium growing downwards. The epithelium shows cytological atypia and abrupt keratinization. What is the most likely diagnosis?
- A.
  
  Squamous cell carcinoma
- B.
  
  Basal cell carcinoma
- C.
  
  Merkel cell carcinoma
- D.
  
  Seborrheic keratosis
- E.
  
  Keratoacanthoma
10.

A 60-year-old female presents with a swelling in the forehead. The swelling measures 2 cms in diameter and has been gradually increasing in size. On examination, the swelling is flat, tan brown in color, and the surface appears granular. Microscopically, the excised swelling shows an exophytic growth from the skin with a sharp demarcation from the adjacent skin. The tumor is composed of sheets of basaloid cells with keratin filled horn cysts. What is the most likely diagnosis in this case?
- A.
  
  Squamous cell carcinoma
- B.
  
  Basal cell carcinoma
- C.
  
  Merkel cell carcinoma
- D.
  
  Seborrheic keratosis
- E.
  
  Keratoacanthoma
11.

A patient comes to see you for a growth on his forearm. He has had it for 7 years and is concerned that it may be enlarging. You observe a well circumscribed, pink, slightly pigmented, raised nodule about 1 centimeter in diameter. The center appears slightly ulcerated. What is the most likely diagnosis?
- A.
  
  Melanoma
- B.
  
  Molluscum Contagiosurn
- C.
  
  Squamous Cell Carcinoma
- D.
  
  Basal Cell Carcinoma
- E.
  
  Lipoma
12.

A 65-year-old Caucasian woman presents to the primary care physician with a rapidly expanding lesion noted on her right leg over the course of the past few weeks. The patient states that there was no preexisting lesion. The patient also states that the lesion began bleeding after minor scratching 2 days ago. Examination demonstrates a blue-black, 2cm dome shaped nodule in the proximal aspect of the patient's right leg. Vital signs are within normal limits. A picture of the lesion is shown above. What is the most likely subtype of this patient's melanoma?
- A.
  
  Nodular
- B.
  
  Lentigo maligna
- C.
  
  Amelaocytic
- D.
  
  Acral-lentigous
13.

A 45-year-old woman presents to her physician with complaints of shoulder weakness over the course of the past few months. The patient notes that she is extremely frustrated as she is having difficulty raising her arms over her shoulders. Furthermore, the patient reports a new onset skin rash around her eyes. Vital signs are T 99.8 F, BP 128/78mm Hg, P 88/m in, R 14/min. Examination demonstrates profound bilateral weakness noted in her upper extremities graded at 3/5, normal reflexes, and normal pain sensation. A purplish discoloration in her periorbital region is also noted. What is associated with the patient's disease?
- A.
  
  Celiac disease
- B.
  
  Lung cancer
- C.
  
  Polyrnyalgia rheumatica
- D.
  
  Myasthenia gravis
- E.
  
  Gulllain-Barre Syndrome
14.

Your patient is a 25-year-old woman complaining of skin depigmentation. Symptoms started about a year ago with whitening patches of skin on her hands that spread to the other parts of her body so that now she has additional depigmented patches on her elbows, neck, upper eyelids, chin, and around her lips. She tried antifungal therapy for several weeks with no effect. She feels stigmatized by her appearance. If examination with Wood's lamp confirms your preliminary diagnosis, what else will you look for?
- A.
  
  Bacterial skin infection
- B.
  
  Hashimoto's thyroiditis
- C.
  
  Viral skin infection
- D.
  
  Local trauma
- E.
  
  Additional salting the foods
15.

A 12-year-old boy has numerous freckles and depigmented areas on his face and hands. Closer examination reveals numerous basal cell carcinomas on his face. This child also has a long history of photophobia and currently has severe conjunctivitis. The most likely diagnosis of this disease is xeroderma pigmentosum. Ultraviolet light induces which change in DNA?
- A.
  
  Excision of pyrimidines
- B.
  
  Formation of thymine dimers
- C.
  
  Substitution of purines for pyrimidines
- D.
  
  Frame shift mutations
- E.
  
  Nonsense mutations
16.

A 55-year-old white female has a long history of red lesions with silvery scales on her knees and elbow. She has scaly lesions on her scalp as well. She denies having any itching associated with the lesions. A skin biopsy is done because of another condition that she has developed. The pathologist comments that there is retention of the nuclei in the stratum corneum. What is the correct term for this phenomenon?
- A.
  
  Hyperkeratosis
- B.
  
  Acanthosis
- C.
  
  Spongiosis
- D.
  
  Parakeratosis
- E.
  
  Keratosis
17.

A 3-year-old boy is brought to the pediatrician with a 6-day history of symptoms of an itchy, red wound on the right knee. The mother ignored it initially, assuming that the boy got injured while playing in the street. However, the wound did not heal and seemed to worsen. On examination, the child is afebrile. There are a few intact vesicles and a few ruptured vesicles covered with honey-colored crusts on the right knee. You send a swab from one of the lesions, and Staphylococcus aureus is detected. What is the diagnosis.
- A.
  
  Carbuncle
- B.
  
  Cellulitis
- C.
  
  Furuncle
- D.
  
  Impetigo
- E.
  
  Necrotizing Fasciitis
18.

A 3-year-old boy is brought to the pediatrician with a 6-day history of symptoms of an itchy, red wound on the right knee. The mother ignored it initially, assuming that the boy got injured while playing in the street. However, the wound did not heal and seemed to worsen. On examination, the child is afebrile. There are a few intact vesicles and a few ruptured vesicles covered with honey-colored crusts on the right knee. You send a swab from one of the lesions, and Staphylococcus aureus is detected. 'What treatment will you prescribe
- A.
  
  Antibiotic ointment
- B.
  
  Steroid ointment
- C.
  
  Emollient cream
- D.
  
  Oral antibiotics
- E.
  
  Oral steroids
19.

A 20-year-old white college student comes in with a complaint of hypopigmented patches which appeared gradually during the summer. He reports no history of unprotected sex. Scaling on scratching is present, but no pruritus. On examination he has hypopigmented patches over the face and chest but no vesicles or pustules. What is the most likely condition?
- A.
  
  Leprosy
- B.
  
  Tinea versicolor
- C.
  
  Tirea cruris
- D.
  
  Vitiligo
- E.
  
  Tinea capitis
20.

A 44-year-old woman is in your office presenting with a strong urge to urinate often and a burning sensation when she urinates. You prescribe ciprofloxacin which you explain inhibits a specific bacterial enzyme involved in DNA replication. This bacterial enzyme performs the same function during DNA replication as which of the following eukaryotic enzymes?
- A.
  
  DNA polymerase
- B.
  
  Topoisomerase
- C.
  
  Helicase
- D.
  
  Primase
- E.
  
  DNA ligase
21.

A 30-year-old Asian woman presents to the hospital complaining of a 1-week history of foul smelling vaginal discharge. On examination, you note the vagina is not inflamed, but there is a grayish discharge that gives off a fishy smell when mixed with potassium Hydroxide. What is the causative organism?
- A.
  
  Candida albicans
- B.
  
  Gardnerella vaginalis
- C.
  
  Haemophylus ducrey
- D.
  
  Varicella-zoster virus
- E.
  
  Staph aureus
22.

A 30-year-old Asian woman presents to the hospital complaining of a painful ulcer on her vulva. On examination, you note a very tender purulent ulcer with undermined edges and suppurative inguinal lymphadenopathy. What is the causative organism?
- A.
  
  Treponema pallidum
- B.
  
  Candida albicans
- C.
  
  Trichomonas vaginalis
- D.
  
  Haemophileis ducreyi
- E.
  
  Varicella-zoster virus
- F.
  
  Staphylococcus aureus
23.

A 45-year-old woman becomes very ill. She develops a high fever, severe headache, cough, and muscle aches. She is quite upset about missing work, as she owns her own pet store (specializing in exotic birds), and has no employees to cover for her in her absence. She tries to work for a day despite her illness, but is unable to. The next day, she sees her family doctor. On physical examination, she is found to be febrile. Her doctor suspects an infection based on her occupational history and her physicaf examination. What is the classification of the infectious agent?
- A.
  
  Chlamydia
- B.
  
  Rickettsia
- C.
  
  Mycobacteria
- D.
  
  Spriochete
- E.
  
  Gram-neg rod
24.

A 17-year-old young man presents complaining of severe itching and scaling of the groin area. The rash involves the anterior aspects of the thigh and the scrotum. A skin scraping is collected for fungal culture. The patient is diagnosed with jock itch and giver topical fungal cream to treat the infection. A fungus grows out within 10 days. The surface of the colony has a brownish yellow to olive gray of khaki color. The surface is lumpy and sparse. The reverse is orange to brownish with a thin yellow border. Microscopica[ly, the hyphae are septate with no microconidia. The macroconidia are smooth, occur as thin and thick walled, have a club shape with rounded ends, contain 2-6 cells, and are found singly or in characteristic clusters. What kind of mold is causing his infection?
- A.
  
  Microsporum canis varicanis
- B.
  
  Trichophyton mentagrophytes
- C.
  
  Trichophyton tonsurans
- D.
  
  Trichophyton schoenleini
- E.
  
  Epidermophyton floccosurn
25.

A recently married 22-year-old Indian woman attended OBG clinic for complaints of severe vulval and vaginal pruritus and purulent vaginal discharge of 7 days duration. She was having dysuria and dyspareunia. Examination showed frothy yellowish mucopurulent vaginal discharge with an offensive odor. Vaginal mucosa appeared inflamed and cervical erosion was also observed. Vaginal secretion was collected and microscopy of wet film done immediately. Oval pear- shaped organisms about the size of white blood cells with wobbling rotatory motility were observed among inflammatory cells. Gram stain was negative for Candida and Clue cells. Based on the diagnosis, the patient and her husband were treated with metronidazole. What is a characteristic of the microbial agent causing symptoms in this patient.
- A.
  
  Infective form is trophozoite
- B.
  
  Produces cystic form under unfavorable conditions
- C.
  
  Motility is due to presence of cilia
- D.
  
  Undulating membrane extends full length of the parasite
- E.
  
  Ideal pH for growth is 3.8 to 4