Exam 10: Pathology

A 21-year-old woman comes to the physician for evaluation of excess hair growth on her face. Menses occur irregularly at 45 to 65-day intervals. She is 159 cm (5 ft 3 in) tall and weighs 59 kg (130 lb); BMI is 23 kg/m2. Physical examination shows facial acne and growth of coarse dark hair on the face, chest, and lower back. Pelvic examination shows no abnormalities. Ultrasound examination of the pelvis reveals a normal uterus and ovaries.  Electrolytes are normal; other laboratory results are as follows: Which of the following enzyme reaction steps is most likely to be disrupted in this patient?

A 31-year-old man arrives at the office after experiencing progressive dyspnea for several months. According to the patient, shortness of breath improved initially with supine positioning, but it is now present even with recumbency and minimal exertion. He has had recurring nosebleeds since childhood but has no other medical conditions. The temperature is 36.7 degrees Celsius (98.1 degrees Fahrenheit), the blood pressure is 110/50 mm Hg, the pulse is 102/min, and the respirations are 20 per minute. On room air, oxygen saturation is 96 percent. An accentuated S2 over the upper left sternal border is discovered during a cardiac examination. Auscultation reveals that the lungs are clear. There is electronic clubbing. The results of the skin examination are depicted in the exhibit. Which of the following is the most likely underlying cause of this patient's dyspnea?

A 16-year-old boy was brought to the emergency department because of palpitations and lightheadedness that began 16 hours ago. He had been binge drinking the night before. After regaining consciousness, he was admitted for observation. His temperature is 37.1°C (98.8°F), pulse is 220/min, respirations are 20/min, and blood pressure is 92/54 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities.   An ECG shows a regular heart rate of 240/min with narrow QRS complexes and no identifiable P waves. . Which of the following is the most likely cause of this patient's hypotension?

A 60-year-old female presents to the clinic due to a headache for the previous months. The headache is on the right side only which is associated with tenderness upon hair combing. The patient reports pain and stiffness at the shoulders. Her husband says that she can not stand from the chair sometimes. Blood pressure is 145/80 mm Hg and pulse is 72/min. Her ESR and CRP were elevated. What is the most likely diagnosis?

A 71-year-old woman comes to the physician because of sudden loss of vision in her right eye for 15 minutes that morning, which subsided spontaneously. Over the past 4 months, she has had fatigue, a 4-kg (8.8-lb) weight loss, and has woken up on several occasions at night covered in sweat. She has had frequent headaches and pain in her jaw while chewing for the past 2 months. This patient's condition is most likely caused by:

A 50-year-old is being evaluated in the office due to renal stones. He states that his bowel habits change and feels constipated over the last month. He has no prior medical conditions and takes no medication. He has no family history of inherited disease. His physical examination is normal.  Laboratory results are as follows: Which of the following changes in bone structure is most likely associated with this patient's condition?

A 67-year-old man is brought to the physician because of increasing forgetfulness, unsteadiness, and falls over the past year. He reports that these symptoms seem to worsen with each fall. Initially, he could not remember directions to his home but now cannot remember recent conversations or appointments he has made. He often repeats questions that he asked shortly before. He has long-standing hypertension, coronary artery disease, and hypercholesterolemia. Current medications include aspirin, carvedilol, enalapril, and atorvastatin. Examination shows a bruise over the left temple and an unsteady gait. On mental status examination, he is oriented to person and place only. Short-term memory is impaired; he can recall 0 out of 5 objects after 10 minutes. Long-term memory is intact. Which of the following is the most likely diagnosis?

A 47-year-old woman is brought to the emergency department for the evaluation of fever, chest pain, and a cough productive of a moderate amount of greenish-yellow sputum for 2 days. She has hypertension, hypercholesterolemia, and type 2 diabetes mellitus. She smoked one pack of cigarettes daily for 20 years, but quit 5 years ago. Current medications include simvastatin, captopril, and metformin. Temperature is 39°C (102.2°F), pulse is 110/min, respirations are 33/min, and blood pressure is 143/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%.   Chest x-ray shows a dense infiltrate occupying the entire right lower lobe.  Which of the following most likely accounts for the color of this patient's sputum?

A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an acute myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully performed that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Cardiac troponin concentrations were elevated. Other laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion in leads II, III, and aVF. Physical examination shows raised jugular venous pressure, no heart murmurs, and clear lungs.  He rapidly loses consciousness and becomes pulseless, and the subsequent resuscitation attempt is ineffective.  Which of the following most likely contributed to this patient's death?

A 64-year-old guy visits his doctor with multiple lesions on his forehead. For most of his life, the patient has worked as a gardener. The snapshot below depicts the results of the physical examination. The lesions have a harsh gritty feel when touched. Atypical keratinocytes with hyperkeratosis and parakeratosis are discovered after a biopsy. Which of the following conditions is this patient most likely to acquire as a result of his lesions?

10-minutes after the delivery of a 37-weeks gestation neonate, he is evaluated for decreased alertness. He is born to a 28-year-old primigravida woman. The mother did not have any complications during pregnancy, but the vacuum was used after finding recurrent late deceleration. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. Temperature is 37 C (98.6 F), the pulse is 180/min, and respirations are 42/min. Physical examination reveals a large fluctuant mass at the occiput passing toward the ears and extending over the neck. This patient's hemorrhage is most likely located between one of the following structures?

A 62-year-old woman comes to the physician because of a 3-month history of fatigue and weakness. Her blood pressure is 152/92 mm Hg. Examination shows lower extremity edema. The patient's fasting plasma glucose level is 160 mg/dL, although she has not been diagnosed previously with diabetes mellitus.  Serum triglyceride level is elevated, and the HDL level is low.  Which of the following additional findings would be most suggestive of increased insulin resistance in this patient?

A 20-year-old woman is brought to the emergency department because of severe muscle soreness, nausea, and darkened urine for 2 days. The patient recently joined the military and was participating in rigorous training exercises in hot weather earlier in the day. She appears healthy. Her temperature is 37.0°C (98.6°F), pulse is 64/min, and blood pressure is 110/70 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. There is diffuse muscle tenderness over the arms, legs, and back.  Laboratory results are as follows: Which of the following urine microscopy findings is most likely to be seen in this patient?

A 31-year-old man, who was hospitalized for substance-induced psychosis two days ago, has had episodic neck stiffness and pain for the past 8 hours. These episodes last for approximately 25 minutes and are accompanied by his neck rotating to the right. During the last episode, he was able to relieve the stiffness by lightly touching his jaw. He has received six doses of haloperidol for auditory hallucinations since his admission. His temperature is 37.3°C (99.1°F), pulse is 108/min, and blood pressure is 128/86 mm Hg. Examination shows a flexed neck rotated to the right. The neck is rigid with limited range of motion. The most likely cause of this patient's symptoms is antagonism of which of the following receptors?

A 55-year-old man whith a history of chronic kidney disease comes to the physician due to progressive fatigue, muscle cramps and weakness. His current medications include a vitamin D supplement.  While his blood pressure is being obtained, the patient develops carpal spasm.  Laboratory evaluation shows a blood urea nitrogen level of 115 mg/dL, serum creatinine level of 8 mg/dL, and serum calcium level of 6.5 mg/dL.  Which of the following is most likely contributing to this patient's carpal spasm?

A 51-year-old man comes to the emergency department because of fatigue, worsening abdominal discomfort, and progressive swelling of his legs for 3 months. The swelling is worse in the evenings. The patient does not smoke and drinks 2-3 beers each weekend. His temperature is 36.0°C (96.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulmonary examination shows no abnormalities. Abdominal examination shows a mildly distended abdomen with shifting dullness. The liver is palpated 2-3 cm below the right costal margin. When pressure is applied to the right upper quadrant, the patient's jugular veins become visibly distended for 15 seconds.. This patient's ascites most likely developed due to which of the following changes in portal capillary exchange parameters?

A 18-year-old male is examined because he has had lower extremities pain for three months. The discomfort is constant and is felt day and night. He has no history of leg trauma, a fever, or chills. The distal femur has an expansile lesion, as shown on imaging. Following a surgical resection, the specimen is displayed below. Mutations involving which of the following genes are most likely present in this patient?

A 23-year-old man comes to the physician because of intermittent history of episodic shortness of breath. The patient has no history of recent illness.  He had eczema as a child.  The patient has no other medical conditions and takes no medications.  Vital signs are within normal limits. Physical examination reveals scattered expiratory wheezes in both lungs.  Peak expiratory flow rate is decreased from baseline.  Sputum microscopy reveals eosinophilic, hexagonal, double-pointed crystals.  The sputum findings in this patient are a direct result of which of the following cytokines?

The patient received the proper treatment. 4 weeks later, she presented with occasional dizziness. Her symptoms occur usually while she combs her hair. She did not lose consciousness. She was evaluated for orthostatic hypotension, and the evaluation was normal. She has a normal ECG with a normal sinus rhythm. MR angiography shows delayed enhancement of the left vertebral artery, with retrograde flow. Which of the following arteries is most likely to be occluded based on these findings?

A 60-year-old woman is brought to the hospital due to progressive dyspnea. In the emergency room, patient was found unresponsivenss and despite cardiopulmonary resuscitation, she died. A photograph of the lung as seen at autopsy is shown below. Which of the following underlying histopathological changes are most likely to be seen within this patient's lungs?