Histology Questions Usmle 2017 u5q2k

A 34 year old woman presents to her general physician with nonspecific fever of five days' duration. She says that there are swollen "bumps" in her right axillary region which are painful. She complains of fatigue, low-grade fever, and some stomach pain. Physical exam reveals tender right axillary lymphadenopathy. She also has a minor laceration on her right forearm that her cat gave her a week ago. She its to a 5 kg weight loss, but says she is not hungry. What findings are likely to be prominent if a biopsy was performed of a right axillary lymph node? A. Prominent germinal centers B. Effacement of the nodal architecture C. Proliferation of cytotoxic CD8 T cells D. Atypical lymphocytes E. Numerous band cells e correct answer is E This patient is most likely suffering from "cat-scratch disease", a bacterial infection caused by Bartonella henselae. This unilateral lymphadenopathy on the side of the scratch combined with nonspecific constitutional symptoms is characteristic of the disease. The patient thus likely has expansion of germinal centers, which are aggregates of B cells that can occur upon antigen presentation. Effacement of nodal architecture is characteristic of lymphoma, especially Hodgkin lymphoma in a female patient of this age. Proliferation of cytotoxic CD8 T cells can occur during a delayed hypersensitivity reaction to antigens such as tuberculosis. Atypical lymphocytes are characteristic to infection with Ebstein-Barr Virus or

cytomegalovirus. Numerous band cells are more common in acute septic infections such as thos

2. A 41-year-old woman with no significant medical history presents complaining of fatigue and lightheadedness. Physical exam is notable for conjunctival pallor, bilateral brisk patellar reflexes, slightly ataxic gait, and impaired position and vibration sense in the feet bilaterally. Her hematocrit is 23%. Serologic studies are positive for anti-parietal cell antibodies. What would you expect to see on peripheral blood smear? A. Burr cells B. Hypersegmented neutrophils C. Howell-Jolly bodies D. Schistocytes E. Spur cells Good Work The correct answer is B This patient has pernicious anemia, autoimmune attack on parietal cells causing decreased production of intrinsic factor and resultant vitamin B12 deficiency. B12 deficiency causes a megaloblastic anemia (with hypersegmented neutrophils on blood smear), stomatitis, glossitis, and subacute combined degeneration of peripheral nerves and spinal cord (which can cause ataxia, hyperreflexia, and impaired position/vibration sense). Burr cells (A) and spur cells (E) are types of poikilocytes - burr cells suggest renal disease and spur cells (acanthocytes) suggest liver disease or lipid abnormalities. Howell-Jolly bodies (C) are clusters of DNA within RBC cytoplasm indicative of asplenia or hyposplenia. Schistocytes (D) are

fragmented red blood cells that are seen in microangiopathic diseases such as disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS). 3.

A 45 year-old man with a history of alcoholism develops pancreatitis. What

pathologic changes would likely be seen in this patient's pancreas? A. Eosinophilic deposits in vascular walls B. Granulomatous inflammation with some preservation of tissue architecture C. Liquefied necrotic tissue D. Necrotic fat cells, calcium soap formation, and lipid-laden macrophages E. Tissue architecture well-preserved, with nuclear changes

The correct answer is D Check It!

Enzymatic fat necrosis is seen in pancreatitis, and is characterized histologically by necrotic fat cells, calcium soap formation, and lipid-laden macrophages. The two most frequent causes of pancreatitis are gallstones and alcohol. Eosinophilic deposits in vascular walls is representative of fibrinoid necrosis. Granulomatous inflammation with some preservation of tissue architecture is representative of caseous necrosis. Liquefied necrotic tissue is representative of liquefactive necrosis. Tissue architecture well-preserved, with nuclear changes is representative of coagulative necrosis.

4. A 45-year-old man cannot leave home without antacids because he has had severe heartburn with every meal for 10 years. Which of the following is likely to be seen on biopsy of his lower esophagus? A. Columnar metaplasia B. Hyperplasia C. Hypertrophy D. Normal esophageal epithelium E. Squamous metaplasia The correct answer is A Barrett's esophagus is a complication of gastro-esophageal reflux disease (GERD). The lower 2/3 of the esophagus is composed of stratified squamous epithelium. With repeated exposure to caustic gastic acid, tissue in the lower esophagus is replaced with columnar glandular epithelium with goblet cells resembling glandular cells of the intestines that secrete mucin. This process is called metaplasia, in this case columnar. Hyperplasia is an increase in the number of cells in a tissue region, such as endometrial hyperplasia. Hypertrophy describes enlargement of existing cells, such as in hypertrophic cardiomyopathy. Squamous metaplasia would not occur in the esophagus, where epithelium is normally squamous. Squamous metaplasia can occur in the bladder, cervix, or lungs.

5. A 46 year-old white male with a family history of esophageal adenocarcinoma presents complaining of heartburn. On endoscopy, a crescent-shaped area of erythematous mucosa is seen that extends above the

gastroesophageal junction. A biopsy of this area of mucosa is taken. What histological features will most likely be seen on H&E stain? A. Columnar epithelium with goblet cells B. Columnar epithelium with parietal cells C. Keratinized squamous epithelium D. Non-keratinized squamous epithelium E. Transitional epithelium The correct answer is A This erythematous mucosa is likely Barrett's esophagus, or metaplasia of the normal squamous epithelium of the distal esophagus to columnar epithelium. This usually occurs in the setting of gastroesophageal reflux. Barrett's is considered pre-malignant for esophageal adenocarcinoma, but not for squamous cell carcinoma. Goblet cells are mucous-secreting cells that will easily be seen in Barrett's on H&E stain. Parietal cells are not associated with the development of Barrett's furthermore, they would not easily be seen on H&E stain. Transitional epithelium is seen in the urinary tract. 6, BASIC SCIENCE: HISTOLOGY A 65 year-old man with no past medical history presents for his annual checkup. He notes some increased dyspnea on exertion along with an overall lethargic feeling for the past few months. Physical exam is normal with the exception of a heme-occult positive stool test, and he is subsequently found to have elevated liver function tests. Which of the following is true? A. A peripheral blood smear will show microcytic erythrocytes B. A CEA level will be at least twice the upper limit of normal C. A peripheral blood smear would show polymorphonuclear cells with more than five lobes of the nucleus

D. A biopsy of the primary lesion will show signet-ring cells E. A CEA level will be undetectable BASIC SCIENCE: HISTOLOGY A 65 year-old man with no past medical history presents for his annual checkup. He notes some increased dyspnea on exertion along with an overall lethargic feeling for the past few months. Physical exam is normal with the exception of a heme-occult positive stool test, and he is subsequently found to have elevated liver function tests. Which of the following is true? A. A peripheral blood smear will show microcytic erythrocytes B. A CEA level will be at least twice the upper limit of normal C. A peripheral blood smear would show polymorphonuclear cells with more than five lobes of the nucleus D. A biopsy of the primary lesion will show signet-ring cells E. A CEA level will be undetectable

8.

A 65-year-old man presents with worsening symptoms of difficulty rising

from a chair, shuffling gait, drooling, tremor at rest, and constipation. Which of the following is the most likely finding on examination of tissue if a brain biopsy was performed? A. Amyloid neuritic plaques in neocortex B. Atypical lymphocytes C. Eosinophilic sphere-shaped inclusions in cytoplasm

D. Neurofibrillary tangles within neurons E. Protein aggregations and intranuclear inclusions

Check It!

The correct answer is C - eosinophilic sphere-shaped inclusions in cytoplasm. These are Lewy bodies and they are the pathological hallmark of Parkinson's disease along with degeneration of dopaminergic neurons of the substantia nigra. It is important to first recognize that this patient's symptoms are seen in Parkinson's disease. The other histological findings are seen in other neurological diseases. Amyloid neuritic plaques and neurofibrillary tangles are seen in Alzheimer's disease. Atypical lymphocytes may be seen in a viral encephalitis secondary to Epstein Barr Virus infection. Protein aggregations and intranuclear inclusions are findings in Huntington's Chorea. 10. A five-month old infant is brought to your office with a distressed mother. She complains that he bruises easily when on his back and arms when he is laid in his crib every night. She thinks his ts feel "loose" and that when she picks him up she is afraid that she may dislocate his shoulders. On exam his arms feature ecchymoses and cigarette-paper-like stretch marks on the skin. Which of the following is the likely defect causing this infant's presentation? A. Deficiency of sphingomyelinase B. Dynein arm defect C. Faulty collagen synthesis and misfolding

D. Fibrillin gene mutation E. Glycogen accumulation in muscle tissue The correct answer is C This infant is exhibiting a classical form of Ehlers-Danlos syndrome, characterized by hyperextensible ts and skin under physiologic loading, and a tendency to bleed, due to a defect in collagen synthesis and folding. Sphingomyelinase deficiency is associated with Niemann-Pick disease. A dynein arm defect resulting in immotile cilia is found in Kartagener's syndrome. The autosomal dominant fibrillin gene mutation is found Marfan's disease. Glycogen accumulation in the muscle tissue of infants and toddlers can be verified microscopically in McArdle's disease, a disorder of glycogen storage. 11.

A pathologist is performing an autopsy on the brain of a 42-year-old

woman who died in the same way her father and grandmother had which included a prolonged course of dementia, uncontrolled limb movements, and mood changes. What is the pathologist most likely to find on autopsy? A. Cortical amyloid plaques B. Light colored susbtantia nigra C. Multiple ischemic lesions D. Shrunken head of the caudate E. Vacuoles and gliosis

The correct answer is D The age, genetic pattern and symptoms in the vignette suggest that the patient described likely suffered from Huntington's disease. The pathological findings characteristic of Huntington's include a shrunken head of the caudate (choice D) and dilated ventricles. Cortical amyloid plaques (Choice A) are typical findings of Alzheimer's disease, but would be unlikely in a 42 year old and does not follow a clear genetic pattern. Light colored susbtantia nigra (choice B) are classic findings in Parkinson's disease, where a loss of dopaminergic neurons occurs. Parkinson's is unlikely to cause dementia in such a young patient. Multiple ischemic lesions (Choice C) are characteristic of multi-infarct dementia, which would be unusual in a woman of 42. Vacuoles and gliosis (choice E) are typical findings in Creutzfeldt-Jakob Disease, which is generally not a genetic disease. 12. A pathologist receives a normal specimen resected from a patient's gastrointestinal tract. Under the microscope, she sees that the mucosa contains columnar cells lacking villi. There are many straight and long tubular glands. This specimen most likely originates from which portion of the GI tract? A. Esophagus B. Large intestine C. Pharynx

D. Small Intestine E. Stomach he correct answer is B The large intestine (choice B) contains the cecum and the colon. Its mucosa is composed of columnar cells lacking villi, and contains openings which give way to tubular glands known as the crypts of Lieberkuhn. The mucosa of the esophagus (choice A) is composed of thick, stratified, squamous, nonkeratinized epithelium. The pharynx (choice C) contains stratified, squamous epithelium, as well as ciliated, pseudostratified, columnar epithelium. Intestinal villi are the hallmark of the small intestine (choice D). They are composed of outgrowths of the mucous membrane into the lumen. Crypts of Lieberkuhn are also found in the small intestine. The stomach (choice E) mucosa contain simple, columnar cells, but lacks the crypts of Lieberkuhn.

13.

A physician-scientist is conducting an experiment in which she tries to

stimulate growth of cartilage in vitro. She wishes to use a substance to stimulate histogenesis. Which substance would be best suited to her purposes based on its stimulation of cartilage growth in vivo? A. Cortisone B. Estrogen

C. Thyroxine D. Vitamin A E. Vitamin D The correct answer is C Cartilage growth is stimulated by thyroxine (Choice C), testosterone and growth hormone. It is inhibited by estrogen (Choice B) and cortisone (Choice A). Vitamin A (Choice D) and Vitamin D (Choice E) are involved in bone mineralization. 14. An infant is born prematurely at 32 weeks in respiratory distress. A chest X-ray shows signs of neonatal respiratory distress syndrome (RDS) and the infant is treated with exogenous surfactant. Which of the following types of pulmonary cells makes surfactant? A. Type I alveolar cells B. Type II alveolar cells C. Capillary endothelial cells D. Clara cells E. Pseudocolumnar ciliated cells Surfactant is made by type II alveolar cells and stored in lamellar bodies within these cells. They start developing after 24 weeks gestation, which is one of the major reasons birth before 24 weeks is not compatible with life. Type I alveolar cells make up the majority of the alveolar surface. Capillary

endothelial cells secrete angiotensin-converting enzyme (ACE). Clara cells are mostly found in the primary bronchioles and contain P450 enzymes to detoxify harmful chemicals in the lungs. Pseudocolumnar ciliated cells line the trachea, creating a "muco-ciliary escalator" to expel toxins/dust in the upper airways.

1. An otherwise healthy Kenyan man is prescribed trimethoprimsulfamethoxazole for a urinary tract infection. He presents to the emergency department with jaundice, fatigue, and confusion. Which of the following might you see in the RBCs of a peripheral smear? 2. A. Heinz bodies B. Howell-Jolly bodies C. Basophilic stippling D. Auer rods E. Reed-sternberg bodies The correct answer is A G6PD deficiency is often asymptomatic until faced with an oxidative challenge, such as the drug TMP-SMX. It usually occurs in people of central African, Middle-Eastern, or Western Asian origin. The classic finding in RBCs is Heinz bodies (Answer A), which are collections of denatured hemoglobin. Howell-Jolly bodies are nuclear remnants in RBCs that remain due to failure of splenic sequestration in Sickle-cell disease. Basophilic stippling represents RNA collections that are most classically associated with lead poisoning. Auer rods are clumps of granular material diagnostic of acute myeloid leukemia (AML). Reed-sternberg bodies are the "owl-eyes" pathognomonic for Hodgkin's lymphoma.

In young infants as well as geriatrics patients, "bandemia" (increased band

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cells) is a sign of acute bacterial infection. When a band cells differentiates, which of the following types of cells is a possible mature cell type it can become? A. Erythrocyte B. Lymphocyte C. Neutrophil D. Monocyte E. Platelet he correct answer is C Myeloblasts differentiate into promyelocytes, myelocytes, metamyelocytes, then band cells, and finally branch into neutrophils, eosinophils and basophils. These types of cells are all known as granulocytes. Lymphoblasts differentiate into B cell and T cell lymphocytes, as well as natural killer cells. Monoblasts differentiate into monocytes. Megakaryoblasts turn into megakaryocytes, which produce platelets. 17.