The Pathology Challenging Quiz

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| By Pavan Belagatti
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Pavan Belagatti
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  • 1/18 Questions

    A diabetic patient presents with macroalbuminuria that was once microalbuminuria. He also has hypertension and his GFR has decreased a lot. He has retinopathy. His kidney glomerular basement membrane is thickened and there appears to be sclerosing. What is a key feature of his syndrome.

    • Kimmelsteil-Wilson nodules
    • Haberden Nodes
    • Bouchard nodes
    • All of the above
    • B and c
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  • 2. 

    A patient presents with proteinuria, edema, and symptoms of renal insufficiency. There appears to be hyaline masses in the glomerulus of the kidney. Tests indicate that the organ has enlarged. The disease with the most similar presentation would be?

    • Diabetic Nephropathy

    • IgA Nephropathy

    • Osteomyelitis

    • Membranoproliferative glomerulonephritis

    • All of the above.

    Correct Answer
    A. Diabetic Nephropathy
    Explanation
    The given symptoms of proteinuria, edema, renal insufficiency, and enlarged kidney are characteristic of diabetic nephropathy. Diabetic nephropathy is a complication of diabetes that occurs due to damage to the kidneys' glomeruli. The presence of hyaline masses in the glomerulus further supports this diagnosis, as hyaline deposits are commonly seen in diabetic nephropathy. IgA nephropathy, osteomyelitis, and membranoproliferative glomerulonephritis do not typically present with the same combination of symptoms and findings as seen in this case. Therefore, the most similar disease in terms of presentation is diabetic nephropathy.

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  • 3. 

    A patient presents with malar rash, photosensitivity, oral ulcers, arthritis, and signs of nephritic syndrome. Upon examination of his kidney, there appears to be crescent formation. Test samples reveal antibodies against DNA, ANA, and snRNA. What is the pathogenic mechanism of the disease?

    • Immune complex mediated

    • Infection

    • Tumor

    • None of the above

    • All of the above

    Correct Answer
    A. Immune complex mediated
    Explanation
    The presence of antibodies against DNA, ANA, and snRNA suggests an autoimmune disease. The patient's symptoms, including malar rash, photosensitivity, oral ulcers, arthritis, and signs of nephritic syndrome, are consistent with systemic lupus erythematosus (SLE). In SLE, immune complexes form due to the binding of antibodies to self-antigens, leading to inflammation and tissue damage. The crescent formation observed in the kidney is a characteristic finding in lupus nephritis, which is caused by immune complex deposition in the glomeruli. Therefore, the pathogenic mechanism of the disease in this case is immune complex mediated.

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  • 4. 

    A 7 year old child presents with hypoalbuminemia, edema, hyperlipidemia, and proteinuria. The edema is in the periorbital region initially and eventually spreads to the rest of the body. The patient is given steroid therapy and the disease goes away. What is a key morphological feature of the patients disease?

    • Fusion of the foot processes

    • Destruction of the basement membrane

    • Destruction of the glomerulus

    • Hemosiderin laden macrophages in the kidney

    • None of the above

    Correct Answer
    A. Fusion of the foot processes
    Explanation
    The key morphological feature of the patient's disease is fusion of the foot processes. This is indicative of a condition called minimal change disease, which is a common cause of nephrotic syndrome in children. Fusion of the foot processes leads to increased permeability of the glomerular filtration barrier, resulting in hypoalbuminemia, edema, hyperlipidemia, and proteinuria. Steroid therapy is effective in treating minimal change disease, and the disease resolves with treatment.

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  • 5. 

    A 26 year old African American diagnosed with AIDS, and also a heroine abuser, presents with hypertension, microscopic hematuria, and renal insufficiency. The disease does not go away with steroid therapy. What is a key feature on immunofluorescence?

    • IgG and C4 deposition

    • IgM and C3 deposition

    • IgM only

    • IgG only

    • None of the above

    Correct Answer
    A. IgM and C3 deposition
    Explanation
    In this case, the key feature on immunofluorescence is IgM and C3 deposition. This suggests that the patient has membranoproliferative glomerulonephritis (MPGN), which is commonly associated with infections such as hepatitis C and autoimmune diseases. The presence of IgM and C3 deposition indicates immune complex-mediated inflammation in the glomeruli, leading to renal dysfunction. This finding is consistent with the patient's clinical presentation of hypertension, microscopic hematuria, and renal insufficiency. Steroid therapy is ineffective in treating MPGN, further supporting the diagnosis.

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  • 6. 

    A black male that is diabetic, initially has no organ failure, and his arterioles seem to have undergone hyaline deposition. As time progresses, his diastolic blood pressure ends up being over 120, his organs start to fail, which proteinuria, nausea, vomiting, MI's, and blurry eyes. What is a key morphological feature of his conditions?

    • Fibrinoid necrosis and thrombus formation

    • Hyaline deposition continues

    • Atherosclerosis

    • Embolism formation

    • None of the above

    Correct Answer
    A. Fibrinoid necrosis and thrombus formation
    Explanation
    The key morphological feature of the black male's condition is fibrinoid necrosis and thrombus formation. This is indicated by the progression of his symptoms, including organ failure, proteinuria, nausea, vomiting, MI's, and blurry eyes. Fibrinoid necrosis refers to the deposition of fibrin-like material in the walls of blood vessels, often associated with immune complex deposition. Thrombus formation refers to the formation of blood clots within the blood vessels, which can further contribute to organ failure and other complications in this case.

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  • 7. 

    A patient presents with fever, flank pain, dysuria, costovertebral angle tenderness, papillary necrosis, pyonephrosis and perinephric abscess. Laboratory findings indicate elevated creatine and BUN levels. Laboratory findings will also reveal:

    • WBC casts

    • RBC casts

    • Granular casts

    • No casts

    • None of the above

    Correct Answer
    A. WBC casts
    Explanation
    The presence of WBC casts in the urine indicates inflammation and infection in the kidneys. In this case, the patient's symptoms such as fever, flank pain, dysuria, and costovertebral angle tenderness, along with the presence of papillary necrosis, pyonephrosis, and perinephric abscess, suggest a severe kidney infection. The elevated creatine and BUN levels further support the diagnosis of pyelonephritis. Therefore, the laboratory findings are likely to reveal WBC casts in the urine.

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  • 8. 

    A patient presents with symptoms of nephrotic syndrome. The disease is immune complex mediated and is known to create an increase in glomerular basement membrane size. IgG and C3 levels are deposited along the basement membrane. Which of the following would best describe the morphology of the disease?

    • Proliferation of new basement membrane between complexes

    • Spike and dome pattern

    • Infiltration of the area with lymphocytes

    • A and B

    • B only

    Correct Answer
    A. A and B
    Explanation
    The correct answer is A and B. In nephrotic syndrome, immune complexes are deposited along the glomerular basement membrane, leading to an increase in its size. This can result in the proliferation of new basement membrane between the complexes, as well as the formation of a spike and dome pattern. Therefore, both options A and B describe the morphology of the disease.

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  • 9. 

    A patient presents with hypertension, hematuria, flank pain, and nephrolithiasis. Examination of his kidney reveals many cysts. A common complication of his disease is:

    • Berry aneurysms

    • Pneumonia

    • Hemorrhages

    • Hypertension

    • None of the above

    Correct Answer
    A. Berry aneurysms
    Explanation
    Patients with hypertension, hematuria, flank pain, and nephrolithiasis, along with the presence of multiple cysts in the kidney, are likely to have a condition called autosomal dominant polycystic kidney disease (ADPKD). One of the common complications of ADPKD is the development of berry aneurysms. These aneurysms are small, balloon-like bulges that occur in the blood vessels of the brain. If they rupture, they can cause a potentially life-threatening condition called subarachnoid hemorrhage. Therefore, berry aneurysms are a significant concern in patients with ADPKD.

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  • 10. 

    A patient presents with hematuria, proteinuria on urinanalysis, edema and recurrent episodes of gross hematuria. C3 levels are low and examination of the basement membrane reveals thickening of the glomerular loop or tram-tracking. He is diagnosed with the rare form of the disease. Electron dense deposition is most commonly seen in:

    • The subepithelial area

    • Glomerular basement membrane

    • Mesangium

    • The loops of henle

    • None of the above

    Correct Answer
    A. The subepithelial area
    Explanation
    In this rare form of the disease, the electron dense deposition is most commonly seen in the subepithelial area. This is indicated by the thickening of the glomerular loop or tram-tracking observed in the examination of the basement membrane. The presence of hematuria, proteinuria, and edema suggests glomerular involvement, and the low C3 levels further support the diagnosis. The deposition of electron dense material in the subepithelial area is consistent with the findings in this patient.

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  • 11. 

    A patient presents with hypotension, low urine output, uremic signs like pericaridal friction rub, asterxis and confusion. Laboratory findings indicate elevated serum creatinine and BUN levels, hyperkalemia, hyperphosphatemia, and metabolic acidosis. Urinary findings would indicate:

    • Muddy brown granular casts

    • Epithelial cell casts

    • Rbc casts

    • A and B

    • A and C

    Correct Answer
    A. A and B
    Explanation
    The presence of hypotension, low urine output, uremic signs, elevated serum creatinine and BUN levels, hyperkalemia, hyperphosphatemia, and metabolic acidosis suggests acute renal failure. In acute tubular necrosis (ATN), which is a common cause of acute renal failure, there is damage to the renal tubules leading to the release of cellular debris into the urine. Muddy brown granular casts are characteristic of ATN, indicating the presence of renal tubular cell debris. Epithelial cell casts are also indicative of tubular injury. Therefore, the urinary findings in this patient would include both muddy brown granular casts and epithelial cell casts (A and B).

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  • 12. 

    A child after a strep infection, presents 10 days later with hypertension, hematuria, edema, and sometime oliguria. There appears to be elevated titers of anti-streptolysin O anitbodies. What is a key morphological feature of his disease?

    • Spike and dome appearance

    • Humps

    • Deposition of IgG and C3

    • Deposition of IgM and C3

    • B and C

    Correct Answer
    A. B and C
    Explanation
    The key morphological feature of the child's disease is the deposition of IgG and C3, as well as humps. This suggests that the child is likely experiencing post-streptococcal glomerulonephritis (PSGN), which is characterized by the immune complexes of IgG and C3 depositing in the glomeruli of the kidney. The humps refer to the appearance of these immune complexes under electron microscopy, forming a characteristic hump-like structure. This deposition of immune complexes leads to inflammation and damage to the glomeruli, resulting in the symptoms of hypertension, hematuria, edema, and oliguria.

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  • 13. 

    A 60 year old male comes to your office and upon examination, there appears to be a mass on his kidney. He has hematuria and flank pain. The tumor arises from and is associated with_ in the non sporadic form:

    • Ductal cells, Von Hippel lindau

    • Glomerulus, NF2

    • Adrenal medulla, polycystic kidney disease

    • Ductal cells, NF1

    • None of the above

    Correct Answer
    A. Ductal cells, Von Hippel lindau
    Explanation
    The correct answer is ductal cells, Von Hippel lindau. Von Hippel-Lindau (VHL) disease is a genetic disorder that can cause the development of tumors in various organs, including the kidneys. In this case, the mass on the patient's kidney is likely a result of VHL disease affecting the ductal cells. The presence of hematuria and flank pain further supports this diagnosis. The other options, such as glomerulus and adrenal medulla, are not associated with VHL disease.

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  • 14. 

    A 25 year old Asian male is notices to have gross hematuria. Upon returning, there appears to be no great symptoms, however, after taking a sample of the urine, there appears to microscopic hematuria, hence hematuria between recurrences. The patient has cirrhosis and fatty stools, indicating some sort of malabsorption syndrome. He sometimes has arthritis. What is deposited in the mesangial matrix?

    • IgA

    • C3

    • IgM C3

    • A and B

    • None of the above

    Correct Answer
    A. A and B
    Explanation
    The patient's symptoms of gross hematuria, microscopic hematuria, cirrhosis, fatty stools, and arthritis suggest that he may have IgA nephropathy, also known as Berger's disease. IgA is deposited in the mesangial matrix in this condition, leading to inflammation and damage to the kidneys. Therefore, the correct answer is A and B (IgA).

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  • 15. 

    A patient with a history of gout experiences abrupt onset of flank pain extending to the groin, nausea, vomiting, and microscopic hematuria. All of the following are related to his condition except:

    • Renal colic

    • UTI

    • Calcium oxalate

    • Increased fluid intake

    • All are related

    Correct Answer
    A. All are related
    Explanation
    The patient's symptoms and history of gout suggest that he may be experiencing a kidney stone (renal colic). Flank pain extending to the groin, nausea, vomiting, and microscopic hematuria are commonly associated with kidney stones. UTI can also be related to kidney stones as the presence of a stone can lead to urinary tract infections. Calcium oxalate is a type of kidney stone that can form in individuals with a history of gout. Increased fluid intake is often recommended to help flush out kidney stones. Therefore, all of the options provided are related to the patient's condition.

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  • 16. 

    Obstructive uropathy will cause dilation of renal pelvises and calyses also known as -

    Correct Answer
    hydronephrosis
    gallstone disease
    pyelonephritis
    Explanation
    Obstructive uropathy refers to a condition where there is a blockage in the urinary system, preventing the normal flow of urine. This blockage can cause the dilation of the renal pelvises and calyses, leading to a condition known as hydronephrosis. Hydronephrosis is characterized by the accumulation of urine in the kidneys, which can cause pain and potential damage to the kidneys if left untreated. While gallstone disease and pyelonephritis are both conditions that can affect the urinary system, they are not specifically associated with the dilation of renal pelvises and calyses seen in obstructive uropathy.

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  • 17. 

    Rapidly progressive glomerulonephritis is a group of disorders associated with severe oliguria and death from renal failure within weeks and is commonly associated with _ formation

    Correct Answer
    crescent
    nodule
    membrane
    immune complex
    Explanation
    Rapidly progressive glomerulonephritis is a condition characterized by severe oliguria and death from renal failure within weeks. It is commonly associated with the formation of crescent-shaped lesions in the glomeruli. These crescents are composed of immune complexes, inflammatory cells, and fibrin. The presence of crescents indicates a severe and rapidly progressing form of glomerulonephritis, which can lead to rapid deterioration of kidney function and ultimately death if not treated promptly. Other terms mentioned in the answer choices, such as nodule, membrane, and immune complex, may also be associated with glomerulonephritis, but the formation of crescents is the most specific and defining characteristic of rapidly progressive glomerulonephritis.

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  • 18. 

    A patient presents with fever and rash and has been on NSAIDs. Upon taking a renal biopsy, his kidney shows inflammatory infiltration of lymphocytes and _

    Correct Answer
    eosinophils
    neutrophils
    osteoclasts
    Explanation
    The patient's presentation of fever and rash, along with the use of NSAIDs, suggests a possible drug-induced hypersensitivity reaction. The renal biopsy findings of inflammatory infiltration of lymphocytes and eosinophils are consistent with an allergic or hypersensitivity response. Neutrophils are also present, which indicates an acute inflammatory process. The presence of osteoclasts suggests bone resorption, which may be related to the underlying inflammatory condition. Therefore, all three cell types - eosinophils, neutrophils, and osteoclasts - are seen in the renal biopsy, supporting a diagnosis of drug-induced hypersensitivity reaction with associated inflammation and bone involvement.

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Sep 07, 2012
    Quiz Created by
    Pavan Belagatti
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