1. A 3 yr old girl is found to have a grade 4/6, loud, harsh, high-pitched holosystoclic murmur that radiates over the precordium and a palpable thrill at the Lt. sternal border. Which of the following defects is most likely in this pt?
A. aortic regurgitation
B. aortic stenosis
C. atrial septal defect
D. coarctation of the aorta
E. mitral regurgitation
F. mitral stenosis
G. patent ductus arteriosus
H. pulmonic stenosis
I. tricuspid regurgitation
J. ventricular septal defect
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answer is J: tricuspid regurg and VSD are similar but VSD is associated with a louder murmur and palpable thrill as seen in this case. (also i don't think tricuspid issues are particularly common in young children like with the VSD but I'm not as sure on that).
2. A 39 yr old woman with end stage renal dz caused by systemic lupus erythematosus undergoes kidney transplantation from a living, unrelated donor. Despite aggressive immunosuppressive therapy, the transplant is rejected after 6 months. Analysis of a biopsy specimen of the transplant shows numerous infiltrating CD8+ T lymphocytes. Which of the following is the most likely cause of rejection of the transplant in this pt?
A. antibody synthesis
B. complement activation
C. direct cytotoxicity
D. histamine release
E. nitric oxide production
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Not as sure on this one, I haven't reviewed this recently but I would say C with the CD8 T cells
3. A 9 yr old girl is brought to the emergency dept by her father b/c of severe pain in her Rt. shoulder after a fall 1 hour ago. Physical exam shows pain on movement of the Rt shoulder and a tender Rt. clavicle. An x-ray of the shoulder shows a nondisplaced fracture of the Rt. clavicle. Which of the following structures of the clavicle will most likely assist in producing new bone to heal this fracture?
A. epiphysis
B. haversian canal
C. lamella
D. periosteum
E. volkmann canal
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Also not as sure on this but I think it would be D. The periosteum as it is generally involved in bone healing and has the precursor cells etc.
4. A 35 yr old man comes to the physician for a routine exam. He has a 5 yr hx of recurrent episodes of genital herpes treated with acyclovir. He says, "I've been taking the medication, but I still occasionally get lesions. When will I be cured?" The phsyiain informs him that herpes simplex is a lifelong infection, with no cure at the present time. Which of the following best explains the longevity of the herpes simplex virus?
A. continual replication in dendritic cells
B. continual replication in epithelial cells of the skin
C. continual replication in sacral root ganglia
D. continual replication in T lymphocytes
E. establishment of a latent infection in B lymphocytes
F. establishment of a latent infection in circulating immune cells.
G. establishment of a latent infection in epithelial cells of the skin
H. establishment of a latent infection in sensory nerve cells
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Answer is H, when the disease is not presenting and such it is latent, during latency there is no replication occurring. this happens with herpes in the Sensory nerve cells.
5. A 40 yr old man is brought to the emergency dept after being involved in a motor vehicle collision. He is pronounced dead on arrival. He had a hx of fever, headache, chills, and pain in the Rt. upper quadrant of the abdomen 5 days ago. During autopsy, histologic exam of a liver section shows disruption of the normal hepatic lobule. Small shrunken hepatocytes with intense eosinophilic cyotoplasm, fragmented unclear chromatin, and cytoplasmic bleb formations are noted. Which of the following processes is most likely occurring in the hepatocytes described?
A. apoptosis
B. atrophy
C. caseous necrosis
D. coagulation necrosis
E. dysplasia
F. fatty change
G. heterophagy
H. liquefaction necrosis
I. metaplasia
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The answer is, I believe, A. Keys are the fragmented unclear chromatin, cytoplasmic blebs (big time this one), small shrunken cells. http://www.pathologystudent.com/?p=5770 has some nice quick down and dirty descriptions here.
6. A 9 yr old boy is brought to the emergency dept b/c of fever, chest pain, and migratory joint pain of his shoulders, hips, and knees for 2 days. Four weeks ago, he had a febrile pharyngitis, which resolved 2 weeks later w/o treatment. His temp is 39C. The lungs are clear to auscultation. A pericardial friction rub and quiet heart sounds are heard. Throat cultures do not grow any pathogens. Lab testing shows increased antibody titers to streptolysin O. The greatest risk for death at this time is from which of the following?
A. aortic stenosis
B. embolism
C. miatral insufficiency
D. myocarditis
E. septic shock
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I believe the answer is D. Rheumatic fever can cause myocarditis and this can happen with pericarditis. Keys to this are the pericardial friction rub and quiet heart sounds (pericarditis). Missing this dx is catastrophic hence greatest risk of death.