USMLE Step 1 Pathophysiology Block 7

20 Questions | Total Attempts: 509

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USMLE Step 1 Pathophysiology Block 7

This is a block of 46 questions of MCQ type with images in some questions. Choose the best answer for each question and get explanation at the end of exam when you submit. Time permitted is 1 hour.


Questions and Answers
  • 1. 
    A peripheral blood smear shows normocytic, normochromic red blood cells. The other cell types are morphologically normal but reduced in number as well. Bone marrow biopsy in this patient would most likely show which of the following patterns?
    • A. 

      Hypocellular marrow filled with fat cells and fibrotic stroma

    • B. 

      Hypercellular marrow with megaloblastic hematopoiesis

    • C. 

      Hypergranular promyelocytes with multiple Auer rods

    • D. 

      Hypercellular marrow filled with numerous blast forms

  • 2. 
    A 17-year-old Caucasian female newly diagnosed with iron-deficiency anemia mentions that her menstrual bleeding lasts 7-8 days. She also notes occasional gingival bleeding. Her platelet count is normal. Further evaluation reveals that her platelets aggregate normally in response to ADP but poorly with addition of ristocetin. This abnormality is caused by a deficiency of:                                         
    • A. 

      Fibrinogen

    • B. 

      GP llb-llla receptors

    • C. 

      Von Willebrand factor

    • D. 

      Thromboxane A2

    • E. 

      Hageman's factor

  • 3. 
    A 50-year-old is started on warfarin therapy for new-onset atrial fibrillation. Thirty-six hours later, he develops a painful lesion on his arm. The lesion is shown beow. Which of the following is the most likely cause of this lesion?
    • A. 

      Vitamin K deficiency

    • B. 

      Protein C deficiency

    • C. 

      Anti thrombin III deficiency

    • D. 

      Autoimmune phenomena

    • E. 

      Allergic drug reaction

  • 4. 
    A mother brings her 12-year-old son to his pediatrician for evaluation of easy bruising. Physical examination is notable only for the presence of multiple bruises. There is no lymphadenopathy or hepatosplenomegaly. Laboratory studies show: Complete blood count Hemoglobin                 8.2 g/L Platelet count               80,000/mm3 Leukocyte count           2,100/mm3 Bone marrow biopsy reveals the following:What is the most likely diagnosis?
    • A. 

      Myelofibrosis

    • B. 

      Hairy cell leukemia

    • C. 

      Myelodysplasia syndrome

    • D. 

      Aplastic anemia

    • E. 

      Myelophthisic anemia

  • 5. 
    A 56-year-old smoker with recurrent hemoptysis presents to your office complaining of headaches. Physical examination reveals facial swelling, conjunctival edema and dilated vessels of the neck and upper trunk. Heart sounds are clear. This patient's condition is most likely caused by:
    • A. 

      Pericardial effusion

    • B. 

      Mediastinal mass

    • C. 

      Superior sulcus tumor

    • D. 

      Pleural effusion

    • E. 

      Autoimmune disease

  • 6. 
    A 48-year-old male who died in a motor vehicle accident is found to have a small fibrotic focus in the lower lobe of the right lung and a calcified lymph node in the right lung hilus. These autopsy findings are most consistent with which of the following?
    • A. 

      Primary exposure to M. tuberculosis

    • B. 

      Hematogenous dissemination of M tuberculosis

    • C. 

      Secondary M. tuberculosis infection

    • D. 

      Mycobacterial elimination from the body

    • E. 

      Poor immunity against mycobacterial infection

  • 7. 
    A 56-year-old African American female presents to the emergency room reporting a three day history of dysuria and back pain. On physical examination, she has a temperature of 39.2°C (102.6 F), a blood pressure of 70/40 mm Hg, a pulse of 130/min, and respirations of 26/min. She is confused and her skin is warm to the touch. Over the next few hours she becomes hypoxic. Which of the following lung findings is most likely to develop during her hospitalization?
    • A. 

      Wedge-shaped areas of hemorrhagic necrosis

    • B. 

      Fluid accumulation in the alveolar spaces

    • C. 

      Atheromatous deposits in the pulmonary arteries

    • D. 

      Thick mucous plugs in bronchi and bronchioles

    • E. 

      Scattered non-caseating granulomas

  • 8. 
    A 32-year-old Caucasian male is hospitalized after sustaining multiple long bone fractures in a motor vehicle accident. He now develops shortness of breath, confusion, and petechiae to the upper chest. The patient dies despite resuscitation efforts. A section of his lung tissue is shown on the slide below.A stain giving a dense black reaction was used to demonstrate. What is the black stained material as described?
    • A. 

      Fibrin

    • B. 

      Surfactant

    • C. 

      Fat

    • D. 

      Iron

    • E. 

      Platelets

  • 9. 
    A 65-year-old male dies in the hospital of an overwhelming pulmonary infection. Autopsy shows a right lower lung lobe that is pale, firm and airless. Histologically, the alveoli are filled with exudate containing neutrophils, fibrin and some fragmented red blood cells. This patient died during which phase of his disease?
    • A. 

      Congestion

    • B. 

      Red hepatization

    • C. 

      Gray hepatization

    • D. 

      Resolution

    • E. 

      Organization

  • 10. 
    A 65-year-old male presents to your office with a non-healing ulcer on his right foot. His past medical history is significant for recurrent high blood glucose readings for the last several years, but the patient has failed to comply with appropriate treatment. Physical examination is significantfor bilateral symmetric decrease in vibration sensation over the feet and ankles. Which of the following is most likely to be associated with this patient's condition?
    • A. 

      Pancreatic islet infiltration with leukocytes

    • B. 

      Pancreatic islet amyloid deposition

    • C. 

      Circulating anti-islet cell antibodies

    • D. 

      Strong linkage with HLA class II gene makeup

    • E. 

      Episodic ketoacidosis that requires insulin therapy

  • 11. 
    A 39-year-old Caucasian female presents to your office with a palpable nodularity in the right breast. Pathologically, the lesion is composed of ducts distended by pleomorphic cells with prominent central necrosis. The lesion does not extend beyond the ductal basal membrane. Which of the following is the most likely diagnosis in this patient?
    • A. 

      Paget disease

    • B. 

      Comedocarcinoma

    • C. 

      Medullary carcinoma

    • D. 

      Sclerosing adenosis

    • E. 

      Mammary duct ectasia

  • 12. 
    A 40-year-old male is diagnosed with refractory peptic ulceration and diarrhea. Fasting gastrin levels are markedly elevated. You suspect a multi-organ disease and are worried about other associated conditions. This patient's family history should be most scrutinized for which of the following?
    • A. 

      Multiple endocrine neoplasia type 1

    • B. 

      Multiple endocrine neoplasia type 2 A

    • C. 

      Multiple endocrine neoplasia type 2 B

    • D. 

      Von Hippel-Lindau syndrome

    • E. 

      Retinoblastoma and osteosarcoma

  • 13. 
    A 50-year-old male presents to the emergency room with a sudden severe headache, double vision, and bitemporal hemianopsia. He says that he's had decreased libido and mild headaches for a few months. As you are presenting to your attending, he develops cardiovascular collapse and dies, despite aggressive resuscitation. Autopsy will most likely reveal which of the following?
    • A. 

      Rupture of berry aneurysm

    • B. 

      Pituitary hemorrhage

    • C. 

      Pulmonary embolism

    • D. 

      Ischemic necrosis of pituitary

    • E. 

      Acute congestive glaucoma

  • 14. 
    A 46-year-old female presents to your office with persistent diarrhea, weight loss and abdominal pain. Her diarrhea started several months ago and has not responded to antibiotics. The diarrhea does not remit with fasting. An upper gastrointestinal series revealed postbulbal duodenal and jejunal ulcers. Which of the following hormones is most likely to be elevated in this patient?
    • A. 

      Gastrin

    • B. 

      Insulin

    • C. 

      Glucagon

    • D. 

      VIP

    • E. 

      Somatostatin

  • 15. 
    A 34-year-old Caucasian female presents to your office complaining of mood swings, difficulty concentrating, and a hand tremor that started only recently. She also admits to having discomfort in her neck. The discomfort radiates to her ears, particularly on swallowing. She ignored the neck and ear discomfort at first because she thought they might be related to flu-like symptoms that she had few weeks ago. Her blood pressure is 140/80 mmHg, and heart rate is 105/min. You proceed with a thyroid scan which shows a diffuse decrease in radioactive iodine uptake. Erythrocyte sedimentation rate (ESR) is 105 mm/Hr. Which of the following pathological changes in the thyroid gland is most consistent with the clinical scenario described?
    • A. 

      Follicular hyperplasia with tall cells forming intrafollicular papillary projections

    • B. 

      Mononuclear, parenchymal infiltration with well-developed germinal centers

    • C. 

      Mixed, cellular infiltration with occasional multinucleate giant cells

    • D. 

      Extensive stromal fibrosis extending beyond the thyroid capsule

    • E. 

      Branching papillary structures with interspersed calcified bodies

  • 16. 
    A 44-year-old Caucasian male comes to your office complaining of increased fatigability, trouble sleeping, and heart palpitations. He has lost ten pounds over the last three months. His past medical history is non-contributory. He admits that he is "under a lot of pressure" at his job, but can not think of any precipitating factors for his insomnia. Laboratory tests reveal a decreased serum TSH concentration. Which of the following would most likely indicate the cause of this patient's condition?
    • A. 

      Atrial fibrillation

    • B. 

      Tremor of the outstretched hands

    • C. 

      Skin infiltration of the lower legs

    • D. 

      Increased serum alkaline phosphatase

    • E. 

      Heat intolerance

  • 17. 
    A 40-year-old female who has been having episodic headaches is admitted to a local hospital for hypertensive emergency. Evaluation shows increased urinary metanephrines. Hyperactivity of which of the following structures is most likely responsible for this patient's symptoms?
    • A. 

      Chromaffin cells of the adrenal medulla

    • B. 

      Zona glomerulosa of the adrenals

    • C. 

      Zonafasciculata of the adrenals

    • D. 

      Zona reticulata of the adrenals

    • E. 

      Juxtaglomerular cells of the kidney

  • 18. 
    A neonate who weighs 4.5 kg (9 lb, 15 oz.) is found to be hypoglycemic. His mother was treated with insulin during the pregnancy after being diagnosed with gestational diabetes The mother has a history of depression and drug abuse in the past, but she denies "using" for the past few years. VV&ich of the following is the most likely cause of this neonate's hypoglycemia?
    • A. 

      Placental transfer of insulin

    • B. 

      Diffuse hyperplasia of the islets

    • C. 

      Hypothyroidism

    • D. 

      Glycogen storage disease

    • E. 

      IGF-2 producing fibrosarcoma

  • 19. 
    A 32-year-old Caucasian male comes to your office complaining of visual problems. He has had several "near-misses" in his car lately, being nearly hit by cars coming from both the right and the left. He also admits to having headaches that respond to acetaminophen. Which of the following hormones is most likely elevated in this patient?
    • A. 

      Growth hormone

    • B. 

      Adrenocortical-stimulating hormone

    • C. 

      Thyroid-stimulating hormone

    • D. 

      Prolactin

    • E. 

      Follicle-stimulating hormone

  • 20. 
    A 55-year-old African-American male is found to have abnormal serum chemistries during routine laboratory testing. His only other medical problem is hypertension, for which he is being treated with pharmacologic therapy, accompanied by weight reduction and low salt intake. His lab studies are as follows: Chemistry panel Serum sodium 134 mEq/L Serum potassium 3.8 mEq/L Blood urea nitrogen (BUN) 18 mg/dL Serum creatinine 0.8 mg/dL Calcium 11.0 mg/dL Blood glucose 98 mg/dL Parathyroid hormone decreased Which of the following is the most likely cause of his symptoms?
    • A. 

      Primary hyperparathyroidism

    • B. 

      Medication

    • C. 

      Hypothyroidism

    • D. 

      Secondary hyperparathyroidism

    • E. 

      Familial hypocalciuric hypercalcemia

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