217 PathologyExamination Tips

A 25-year-old woman palpates a left breast "lump" on self-examination. Her nurse practitioner palpates an ill-defined mass. There is no pain or tenderness. No axillary lymphadenopathy is noted. Fine needle aspiration is performed and cytologic examination shows cells that appear benign. The lesion persists, and 6 months later another biopsy is taken and shows ductal epithelial proliferation with ductal apocrine metaplasia, stromal fibrosis, and sclerosing adenosis. Which of the following is the most likely diagnosis?

A. Infiltrating ductal carcinoma

B. Ductal carcinoma in situ

C. Fibrocystic changes

D. Lobular carcinoma in situ

Decreased airway radius occurs in chronic bronchitis due to all the following except:

A. Increased elastic recoil

B. Excessive amounts of sputum

C. Airway scarring

D. Inflammation

A 35-year-old woman has noted a palpably firm, irregular mass in her right breast for the past 3 months. On physical examination there is no tenderness or swelling. By mammography there is an irregular 2 cm density that contains scattered microcalcifications. Biopsy of this mass reveals extensive fat necrosis. Which of the following is the most likely cause for this breast lesion?

A. Trauma

B. Prolactinoma

C. Pregnancy

D. Lobular carcinoma in situ

Air trapping associated with chronic obstructive diseases results in an increase in which of the following components of pulmonary function testing?

A. Residual volume

B. Forced expiratory volume in one second (FEV1)

C. Vital capacity

D. Expiratory reserve volume

A 52-year-old woman feels a lump in her right breast on self-examination and goes to her physician. On physical examination the 4 cm mass is not freely movable and feels quite hard. A fine needle aspirate is performed and cytologic examination shows cells are present consistent with carcinoma. Which of the following features of this carcinoma is most likely to suggest a worse prognosis?

A. Axillary lymph node metastases

B. Presence of an in-situ component

C. Family history of breast carcinoma

D. Estrogen receptor positivity

Clinical findings of prolonged hypoxemia in long-standing cystic fibrosis include:

A. Cough

B. Frequent respiratory infections

C. Clubbing of the fingers

D. Crackles in the lungs

A 41-year-old woman has felt a large breast lump that has increased slowly in size for the past 3 years. On physical examination there is a 9 cm firm, movable mass present in her left breast. The overlying skin appears normal; there is no axillary lymphadenopathy. The mass is excised and grossly appears soft and fleshy. On microscopic examination this mass has a lymphoid stroma with little fibrosis surrounding sheets of large vesicular cells with frequent mitoses. Which of the following is the most likely diagnosis?

A. Medullary carcinoma

B. Colloid carcinoma

C. Infiltrating ductal carcinoma

D. Lobular carcinoma

Extrinsic / allergic asthma:

A. Is mediated by IgG

B. Presents with different signs and symptoms than intrinsic asthma

C. Is due to an antigen-antibody reaction on IgE-bearing mast cells

D. Often is precipitated by exercise

A 45-year-old woman feels a "lump" in her left breast. Her physician palpates a 2 cm irregular area in the upper outer quadrant. A biopsy is performed and microscopic examination shows no evidence for carcinoma. Which of the following microscopic findings in this biopsy is most likely to suggest an increased risk for subsequent development of breast carcinoma?

A. Galactocele

B. Sclerosing adenosis

C. Apocrine metaplasia

D. Atypical hyperplasia

Pathophysiologic differences between emphysema and chronic bronchitis include the fact that:

A. Emphysema is characterized by hypersecretion of goblet and mucus cells

B. Chronic bronchitis commonly results in polycythemia to compensate for persistent hypoxemia

C. Chronic bronchitis produces destruction of alveolar walls

D. Emphysema is due to chronic inflammation resulting in fibrotic airwways

25yr HIV-positive presents w/ low grade fever, nonproductive cough, increasing shortness of breath. Routine histologic sections from transbronchial biopsy reveal foamy frothy eosinophilic material within alveoli. Silver stains reveal presence of numerous cup-shaped organisms with central dark spots. Which of the following is the most likely diagnosis?

A. Atypical pneumonia

B. Organizing pneumonia

C. Paragonimus pneumonia

D. Pneumocystis pneumonia

Signs or symptoms of tracheobronchial obstruction include all of the following except:

A. Stridor

B. Wheezing

C. Sternal retractions

D. Crackles

A 20-year-old woman notes a mass in her left breast after following the directions for breast self-examination provided by her health clinic. Her physician palpates a firm, 1 to 2 cm mass. There is no nipple discharge and no pain. No axillary adenopathy is present. The overlying skin of the breast appears normal. Her left breast is slightly larger than the right, a condition she says has been present since puberty. Her urine pregnancy test is negative. Mammography confirms the presence of a rounded density, which has no microcalcifications, and reveals no lesions of the opposite breast. Which of the following is the most likely diagnosis?

A. Focus of fat necrosis

B. Fibroadenoma

C. Intraductal papilloma

D. Infiltrating ductal carcinoma

Arterial blood gases for a patient with mild to moderate emphysema would reflect:

A. Severe hypoxemia

B. Increased PaCO2

C. Near-normal PaO2 and normal to low PaCO2

D. Respiratory failure

A 26 yr woman present w/ acute onset of fever, malaise, headache, muscle pain, dry hacking nonproductive cough. Laboratory evaluation finds presence of cold agglutins in her serum, mainly immunoglobulin M (IgM) anti- I cold agglutinins. Which histologic changes would most likely be present in the lung parenchyma of this individual?

A. Eosinopils within walls of capillaries

B. Lymphocytes within walls of alveoli

C. Microthrombi within lumen of capillaries.

D. Neutrophils within lumen of alveoli

Which of the following assesment findings is indicative of an asthma attack?

A. Wheezing

B. Thin, watery mucus production

C. Nonproductive cough

D. Fever

A study of postpartum women is performed. Some of them developed a palpable "lump" in one or both breasts postpartum. The lump appeared following cessation of breast feeding and persisted for more than one month, Many of these lumps regressed following fine needle aspiration. Which of the following breast lesions is most likely to fulfill these criteria?

A. Papilloma

B. Fat necrosis

C. Galactocele

D. Ductal epithelial hyperplasia

A classic clinical finding when a patient has epiglottitis is:

A. Pain and difficulty swallowing

B. Pain with inspiration

C. Unequal thoracic expansion

D. Earaches

A 31-yr woman presents 2 A&E w/ Acute onset of malaise, fever, & productive cough. CXT shows consolidation of R lower lobe along with air bronchograms and Gram stain of her sputum shows a predominance of Gram-positive lancet-shaped cocci in pairs & chains.Which of the following is the most likely causative agent of this individual's infectious disease?

A. H. influenza

B. Klebsiella pneumonia

C. Pseudomonas aerogenosa

D. Streptococcus pneumonae

Bronchoiolitis, commonly seen in infants due to respiratory syncytial virus, is characterised by:

A. Airway inflammation and mucus formation

B. Athrophy of smooth muscle of the airway

C. Oncreased compliance of lung tissue

D. Thin secretions from the nose

A 52-year-old woman has felt a lump in her breast for the past 2 months. On physical examination a firm 2 to 3 cm mass is palpable in the upper outer quadrant of her right breast. There are no palpable axillary nodes. A lumpectomy with axillary node dissection is performed. The breast lesion is found to have positive immunohistochemical staining for HER2/neu (c-erb B2). Staining for estrogen and progesterone receptors is negative. Which of the following treatment options is most likely to be efficacious in this woman?

A. Letrozole

B. Tamoxifen

C. Trastuzumab

D. Prednisone

Croup is a syndrome, a collection of signs and symptoms that may be due to several etiologic factors. The most characteristic finding croup is:

A. Earaches

B. Barking cough with respiratory stridor

C. Enlarged lymph nodes in the neck

D. Marked fever

A 47-year-old woman undergoes routine mammographic screening and there are multiple small areas of increased density, though a single distinctive mass lesion is not detectable either by palpation or by mammography. A fine needle aspiration biopsy of an abnormal density reveals cells suspicious for a malignancy. An excisional breast biopsy yields a diagnosis of lobular carcinoma in situ of the breast. Which of the following is the most likely finding associated with this woman's carcinoma?

A. No residual carcinoma

B. Opposite breast involvement

C. Absent family history of breast cancer

D. Concomitant Paget disease of the nipple

Acute and chronic bronchitis differ in which of the following ways?

A. Chronic bronchitis is caused by repeated infections

B. Acute bronchitis is not associated with increased mucus production

C. Acute bronchitis produces arterial blood gas changes reflecting significant hypoxemia

D. Chronic bronchitis results in airway changes that are irreversible

A 20-year-old woman gives birth to a term girl infant following an uncomplicated pregnancy. She breast feeds the infant. Six weeks later, her left breast becomes painful and slightly swollen. On physical examination there is a tender 3 cm mass in the left breast beneath a nipple that shows several painful fissures. Which of the following pathologic findings is most likely to be present in this breast?

A. Infiltrating ductal carcinoma

B. Staphylococcus aureus infection

C. Sclerosing adenosis

D. Fat necrosis

Which of the following statements regarding cystic fibrosis is correct?

A. It is caused by a bacterial infection

B. It can be prevented by a vaccine

C. It is associated with a generic defect in chloride transport

D. It affects only the pulmonary system

A 49-year-old woman notes increasing size to her right breast over the past year. This breast is not painful, but the heaviness causes some discomfort. On physical examination the overlying skin and nipple appear normal. There is no nipple discharge. There is no axillary lymphadenopathy. Mammography reveals a solid 12- cm circumscribed mass. The mass is biopsied, and on microscopic examination shows a cellular stromal component along with an epithelial component. Which of the following is the most likely diagnosis?

A. Fibroadenoma

B. Sclerosing adenosis

C. Medullary carcinoma

D. Phyllodes tumor

A 65 yr woman complains of itching and scaliness of breast nipple. A 1-cm palpable mass is felt underlying the skin. A biopsy confirms Paget disease. Which of the following is likely to be an association?

A. Infiltrating ductal carcinoma

B. Lobular carcinoma in situ

C. Invasive lobar carcinoma

D. Intraductal papilloma

High-dose oxygen therapy must be used cautiously in patients with chronic bronchitis because:

A. V/Q changes can result in further elevations in partial pressure of carbon dioxide in arterial blood (PaCO2)

B. Pulmonary vasoconstriction will worsen, increasing the work of the right heart

C. Respiratory smooth muscle constriction will result in increased air trapping

D. Peripheral chemoreceptors will be depressed, and the patient will stop breathing

Pursed-lip breathing is commonly used by patients with emphysema because it:

A. Increases the pressure gradient for gas exchange

B. Helps strengthen accessory respiratory muscles

C. Decreases small airway collapse during expiration

D. Prolongs inspiration to allow gas to reach distal air sacs

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