Organ-specific histology Practice Questions

Question 1

An investigator is studying patients with acute decompensated congestive heart failure. He takes measurements of a hormone released from atrial myocytes, as well as serial measurements of left atrial and left ventricular pressures. The investigator observes a positive correlation between left atrial pressures and the serum level of this hormone. Which of the following is most likely the mechanism of action of this hormone?

Accepted Answer

Decreases sodium reabsorption at the collecting tubules

Answer

Increases potassium excretion at the collecting ducts

Answer

Constricts afferent renal arteriole

Answer

Decreases reabsorption of bicarbonate in the proximal convoluted tubules

Answer

Increases free water reabsorption from the distal tubules

Question 2

A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper abdominal quadrant. Abdominal ultrasound shows a 3-cm liver mass with poorly defined margins and coarse, irregular internal echoes. Lab results are shown:
Aspartate aminotransferase (AST) 90 U/L
Alanine aminotransferase (ALT) 50 U/L
Total bilirubin 2 mg/dL
Albumin 3 g/dL
Alkaline phosphatase 100 U/L
Alpha-fetoprotein 600 ng/mL
Which of the following is a feature of this patient's condition?

Accepted Answer

It arises from hepatocytes

Answer

It arises from the bile duct epithelium

Answer

Daughter cysts are usually present on abdominal ultrasound

Answer

Liver biopsy is required for diagnosis in a majority of patients

Answer

Doppler blood flow shows venous pattern

Question 3

A 65-year-old man with a 40-pack-year smoking history presents with hemoptysis and a persistent cough. Chest CT shows a 3.5 cm centrally located mass in the right main bronchus. Positron emission tomography confirms a malignant nodule. Bronchoscopy with transbronchial biopsy is performed and a specimen sample of the nodule is sent for frozen section analysis. The tissue sample is most likely to show which of the following tumor types?

Accepted Answer

Squamous cell carcinoma

Answer

Carcinoid tumor

Answer

Metastasis of colorectal cancer

Answer

Small cell lung carcinoma

Answer

Large cell carcinoma

Question 4

A 27-year-old woman presents to the emergency department complaining of a left-sided headache and right-sided blurry vision. She states that 2 weeks ago she developed dark urine and abdominal pain. She thought it was a urinary tract infection so she took trimethoprim-sulfamethoxazole that she had left over. She planned on going to her primary care physician today but then she developed headache and blurry vision so she came to the emergency department. The patient states she is otherwise healthy. Her family history is significant for a brother with sickle cell trait. On physical examination, there is mild abdominal tenderness, and the liver edge is felt 4 cm below the right costal margin. Labs are drawn as below:

Hemoglobin: 7.0 g/dL
Platelets: 149,000/mm^3
Reticulocyte count: 5.4%
Lactate dehydrogenase: 3128 U/L

Total bilirubin: 2.1 mg/dL
Indirect bilirubin: 1.4 mg/dL
Aspartate aminotransferase: 78 U/L
Alanine aminotransferase: 64 U/L

A peripheral smear shows polychromasia. A Doppler ultrasound of the liver shows decreased flow in the right hepatic vein. Magnetic resonance imaging of the brain is pending. Which of the following tests, if performed, would most likely identify the patient’s diagnosis?

Accepted Answer

Flow cytometry

Answer

Glucose-6-phosphate-dehydrogenase levels

Answer

Anti-histone antibodies

Answer

Bone marrow biopsy

Answer

Hemoglobin electrophoresis

Question 5

A 46-year-old man comes to the physician because of a 4-month history of progressively worsening fatigue and loss of appetite. Five years ago, he received a kidney transplant from a living family member. Current medications include sirolimus and mycophenolate. His blood pressure is 150/95 mm Hg. Laboratory studies show normocytic, normochromic anemia and a serum creatinine concentration of 3.1 mg/dL; his vital signs and laboratory studies were normal 6 months ago. Which of the following is the most likely underlying mechanism of this patient’s increase in creatinine concentration?

Accepted Answer

CD4+ T cell-mediated intimal smooth muscle proliferation

Answer

Drug-induced tubular vacuolization

Answer

CD8+ T cell-mediated parenchymal cell damage

Answer

Donor T cell-mediated epithelial cell damage

Answer

Donor endothelial cell damage by preformed host antibodies

Question 6

During identification of severely decomposed remains, which of the following methods provides the most reliable means of positive identification?

Accepted Answer

DNA analysis

Answer

Birthmarks

Answer

Facial features

Answer

Personal effects

Question 7

An investigator is studying the effects of an antihypertensive drug during pregnancy. Follow-up studies show that the drug can adversely affect differentiation of the ureteric bud into its direct derivatives in fetuses exposed during the first trimester. Which of the following structures is most likely to develop incorrectly in the affected fetus?

Accepted Answer

Collecting ducts

Answer

Proximal convoluted tubule

Answer

Loop of Henle

Answer

Bladder

Answer

Distal convoluted tubule

Question 8

A 23-year-old woman presents to her primary care physician with 3 days of fatigue and back pain after she started a drug for malaria prophylaxis. She says that her urine has also been darker over the same time period. Her past medical history is significant for allergies as well as a broken elbow that was treated in a cast 10 years ago. She does not take any medications, does not smoke, and drinks socially. Peripheral blood smear reveals both red blood cells with dark intracellular inclusions as well as abnormally shaped red blood cells. The immune cells responsible for the shape of these red blood cells are located in which of the following places?

Accepted Answer

Red pulp of the spleen

Answer

Lymph nodes

Answer

Bone marrow

Answer

White pulp of the spleen

Answer

Blood vessels

Question 9

A newborn is rushed to the neonatal ICU after becoming cyanotic shortly after birth. An ultrasound is performed which shows the aorta coming off the right ventricle and lying anterior to the pulmonary artery. The newborn is given prostaglandin E1 and surgery is planned to correct the anatomic defect. Which of the following developmental processes failed to occur in the newborn?

Accepted Answer

Failure of the aorticopulmonary septum to spiral

Answer

Failure of the membranous ventricular septum to fuse with the muscular interventricular septum

Answer

Failure of the septum primum to fuse with the septum secundum

Answer

Failure of the ductus venosus to close

Answer

Failure of the ductus arteriosus to close

Question 10

A 32-year-old woman presents with amenorrhea and galactorrhea. MRI shows a pituitary adenoma. Histological examination of the surgical specimen shows cells arranged in cords and nests with sinusoidal capillaries. Special staining reveals three distinct cell types: chromophobes (50%), acidophils (40%), and basophils (10%). Immunohistochemistry shows the tumor cells staining strongly for prolactin. Evaluate the relationship between normal pituitary architecture and tumor development to determine which cell type most likely gave rise to this neoplasm.

Accepted Answer

Lactotrophs (acidophils producing prolactin)

Answer

Somatotrophs (acidophils producing growth hormone)

Answer

Corticotrophs (basophils producing ACTH)

Answer

Gonadotrophs (basophils producing FSH/LH)

Answer

Chromophobes (null cells with no secretory granules)

Organ-specific histology

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Cardiovascular histology

Respiratory system histology

GI tract histology

Liver and gallbladder histology

Pancreas and salivary gland histology

Urinary system histology

Male reproductive histology

Female reproductive histology

Endocrine gland histology

Skin histology

Lymphoid tissue histology

Central and peripheral nervous system histology

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