Sugar and Spice
Sticks and Stones
Hot and Heavy
Lumps and Bumps
Humours and Whiskey
100
A 3-year-old male child comes in because his parents have noticed delay in reaching his developmental milestones. Upon exam, he has coarse facial features, upper airway obstruction and clouded corneas. What disease do you suspect?
Hurler Syndrome
100
This pattern of necrosis is most often seen with ischemic damage.
Coagulative necrosis
100
Name the neutrophil chemotactic factors.
C5a, Il-8, LTB4, Bacterial products
100
You see a 74 y.o. male for a return visit after his labs came back with a PSA of 10 ng/ml (normal is <4 ng/ml). Upon further history, he does say that he has noticed his chronic lower back pain has gotten worse over the past 6 months and has been worse at night. You order an X-ray of the spine. What do you expect to see?
Osteoblastic lesions
100
What histologic finding can be found both in atherosclerosis and Neimann-Pick disease?
Foam cells I.e. lipid laden macrophages
200
Cirrhosis. Fibrous septae and regenerative nodules
200
A 55 y.o. male, s/p PCI for a LAD occlusion 1 week ago, develops sudden onset hypotension, lethargy, and crushing substernal chest pain. He could not be resuscitated. His heart tissue is shown on autopsy. What was the most likely etiology of his presentation?
Free wall rupture
200
During the process of neutrophil rolling, P-selectin on the endothelial cell surface binds to what protein expressed on neutrophils?
Sialyl Lewis X
200
What is the main differentiating factor between cervical intraepithelial neoplasia grade 3 (CIN III I.e. carcinoma in situ) and cervical squamous cell carcinoma?
Invasion past the basement membrane
200
A 58 y.o. male presents to the clinic with a 4 month history of excessive fatigue, back and hip pain, and constipation. Significant hepatomegaly is noted on physical exam. A liver biopsy shows the following.
What cell type is most likely responsible for this abnormal accumulation?
Plasma cells
300
A 28-year-old woman is brought to the physician because of progressive difficulty walking, slowed speech, and a tremor for the past 5 months. Her grandfather died of bleeding esophageal varices at the age of 42 years. She does not drink alcohol. She is alert and oriented but has a flat affect. Her speech is slurred and monotonous. Examination shows a broad-based gait and a low-frequency tremor of her left hand. Abdominal examination shows hepatosplenomegaly. A photograph of the patient's left eye is shown.
What abnormal lab value are you likely to see in this patient?
A low ceruloplasmin
300
These are the nuclear signs (3) of irreversible cell injury.
Pyknosis, karyolysis, karyorrhexis
300
A 17 y.o. male presents to the ED with a 6 hours history of periumbilical pain, nausea, and anorexia. Urgent surgery is performed. What findings are seen on histology of the resected tissue?
Neutrophils infiltrating the muscularis externa of the appendix
300
A 68 y.o. female with an insignificant past medical history and an unknown family history presents for her annual checkup. As her primary care provider, you notice that she looks quite thin and weak compared to her baseline. She unintentionally lost 30 pounds since last year and mentions seeing occasional blood in her stool. Colonoscopy shows colorectal adenocarcinoma, and follow-up CT shows metastases to the liver. Her physical exam findings are mediated by which cytokine?
TNF-alpha
300
This characteristic immunohistochemistry stain pattern is caused by what immunologic process? Be specific.
Antibody to alpha 3 chain of type IV collagen
400
This physical exam finding is present in mucopolysaccharidoses, but not in glycogen storage diseases.
Splenomegaly
400
A 47 y.o. female with a long standing history of alcohol use disorder presents to the ED with acute onset epigastric pain, nausea, and fever. What electrolyte abnormality would you expect to see with this condition?
Low calcium
400
A 61 y.o. female comes into the office with complains of gnawing epigastric pain that worsens after eating. Recent history is significant for a herniated L3-L4 disc 2 months ago, for which she has been taking 1200mg of ibuprofen a day. Inhibition of what cytokine is responsible for her condition?
Prostaglandins
400
A 68 y.o. male with a 40 pack year smoking history comes in for a follow-up after a CXR noted an incidental lung nodule. Biopsy of the nodule shows the following.
What would you expect his PTH levels to be?
Low
400
A man with chronic asthma is treated with inhaled corticosteroids. What two inflammatory responses would be subdued in this patient but not in a man of the same age that is taking NSAIDs for post-operative knee pain?
Bronchoconstriction and neutrophil chemotaxis
500
This enzyme is deficient in Pompe disease.
lysosomal a-1,4-glucosidase
500
This cellular process is often characterized by cytochrome c mediated intracellular proteolysis and is inhibited by the expression of Bcl2. The same pathway can be activated externally by which process?
Fas/Fas ligand
500
A 33 y.o. female newly diagnosed with HIV is hospitalized for high fever, fatigue, shortness of breath. Bronchiolar lavage shows the following. Infiltration with which cell would be unusual in this case?
Neutrophils
500
A 55 y.o. G0P0 female is evaluated for treatment regarding a recently discovered breast nodule. She has a maternal aunt with a history of breast cancer. Biopsy shows invasive ductal carcinoma, with moderate differentiation, numerous mitotic bodies. The decision is made to perform a lumpectomy with sentinel lymph node biopsy, which shows a 4cm x 2cm x 3cm breast mass with negative node involvement. Immunohistochemistry shows the mass to be ER+/PR+/Her2Neu-. What is the most important prognostic factor for this patient?
Lymph node involvement, i.e. stage
500
A 25 y.o. female with long standing severe asthma treated with inhaled corticosteroids presents for her annual PCP appointment. What genetic defect could lead to a similar finding on CBC to this patient?
Leukocyte Adhesion Deficiency; CD18 subunit of integrins
600
Individuals with hemochromatosis are at increased risk of these infections.
Iron loving bacteria - Vibrio vulnificus, Listeria monocytogenes, and Yersinia pestis
600
A 30 y.o. male comes into the Emergency Department with a chief complaint of hemoptysis, night sweats, and fever of two weeks duration. The following is seen on lung biopsy. 
Which immune cell type and associated cytokine is directly responsible for the observed pathologic process?
Th1 and IFN-gamma
600
A 45 y.o. male presents with several days of worsening chest pain, dyspnea, and a cough productive of yellow sputum. He is febrile. White cell count is notable for a left shift. A bronchial lavage was performed, H&E is shown. The organism responsible for this infection is also involved in what other pathology we’ve studied?
Right sided endocarditis
600
A 22 y.o. male with no significant past medical history and a family history significant for a father with a brain cancer, comes to the office with hematuria and back pain. He assures you he does not smoke. What abnormal CBC finding would you expect to find in this patient and why?
High hemoglobin, high EPO d/t overexpression of HIF-1 d/t VHL gene mutation
600
A biopsy of the temporal artery of a 59 y.o. female with new onset headaches and intermittent vision loss is shown. The cell type responsible for the formation of this lesion is dysfunctional in what genetic condition?
Chronic granulomatous disease