(2)--病理学期末考试题及答案

病理学期末考试试题一、单选题（20分）1. A 65-year-old man develops intense crushing substernal chest pain that is not relieved by nitroglycerin. The ECG shows ST-segment elevation and abnormal Q waves. His condition rapidly worsens and he dies 2 days later. At autopsy a2.5 cm2 necrotic area is found that involves the anterior left ventricle. What is the most likely cause of this patient's myocardial infarction?A．Fibrinoid necrosis of main trunk of left coronary arteryB．Severe stenosis of all three main branches of coronary artery without thrombosis C．Thrombosis of the anterior descending branch of the left coronary artery D．Complete occlusion of the left circumflex coronary arteryE．V asospasm of the right coronary artery2. A 60-year-old man has had hypertension for 20 years. His blood pressure has ranged from 150/95 mmHg to 220/110 mmHg. He has diabetes mellitus and has had signs of renal failure since last year.During the workup of her disease,a renal biopsy is performed. Which of the following vascular lesions is most likely to be found in the kidney of this patient?A. Dystrophic calcification in the tunica media of muscular arteriesB.The lumens of the afferent glomerular arterioles are narrowed by uniform, homogenous, pink deposits within the vessel wallsC. Fibrinoid necrosis of the intima and tunica media of vascular wall with infiltration of monocytes and neutrophilic granulocytesD. A concentric obliteration of arterioles by an increase in smooth muscle cells and protein deposition in a laminar configurationE. Chronic granulomatous inflammation with giant cells and breaks in the internal elastic lamina3. A 11-year-old girl manifests choreiform movements and begins to complain of pain in her knees and hips, particularly with movement 3 weeks after a bout of acute pharyngitis. She develops subcutaneous nodules over the skin of her arms and torso at the same time.A friction rub is heard on auscultation of the chest. Which of the following serum laboratory findings is most characteristic of the disease affecting this patient?A. Increased creatine kinase-MB fraction (CK-MB)B. Positive blood culture for Staphylococcus aureusC. High double-stranded DNA autoantibody titerD. Elevated anti-streptolysin O levelE. Elevated cholesterol level4. Which type of emphysema involves the entire acinus?A. Centriacinar emphysemaB. Panacinar emphysemaC. Interstitial emphysemaD. Periacinar emphysemaE. Irregular emphysema5. Which of the followings is not involved in emphysema lesions?A. Terminal bronchiolesB. AlveoliC. Alveolar tubeD. Respiratory bronchioleE. Alveolar sacs6. A 60-year-old woman develops a chronic cough with white foamy mucous sputum in autumn and winter each year, which continues for about three months each time. Which of the following pathologic conditions is not associated with these clinical findings?A. Fibroelastosis of the bronchial wallB. Hyperplasia of goblet cells in mucosal epitheliumC. Hypertrophy of mucous glandsD. Degeneration and atrophy of bronchial cartilageE. Squamous metaplasia of bronchial mucosa7. A 44-year-old man has been feeling fatigued for the past 4 months. He remembers that he had jaundice about 10 years ago, but that resolved 2 months later and he has been healthy since. On physical examination there are no remarkable findings. Laboratory studies show his hemoglobin is 14.0 g/dL. A chemistry panel reveals normal serum electrolytes, but he has a decreased level of total protein and albumin, an increased level of ALT and AST, as well as a slightly elevated level of total bilirubin and direct bilirubin.A liver biopsy is performed and microscopic examination shows disruption of the limiting plate of hepatocytes with extension of inflammation into the lobules from the triads. There is focal ballooning degeneration of hepatocytes. Which of the following laboratory test findings is most characteristic of his disease?A. Increased serum alpha fetoproteinB. Positive hepatitis B surface antibodyC. Positive hepatitis B surface antigenD. Positive hepatitis B core antigenE. Positive hepatitis A antigen8. A 55-year-old man has experienced severe epigastric pain, vomiting, and a 10-kg weight loss over the past3months.Physical examination reveals fixed left supraclavicular lymphadenopathy. Upper gastrointestinal endoscopy is done and confirms the present of a moderately differentiated adenocarcinoma. A palliative operation is performed to relieve his symptoms. A 6-cm ulcerative mass is located in the gastric antrum.The tumor has penetrated through the gastric wall, and is adherent to the transverse colon. The liver appears normal. There are numerous small white nodules on the serosal surface of intestine, spleen and peritoneum. Which of the following conditions may not have occurred in this patient’s tumor?A. Local invasionB. Lymphatic spreadC. Hematogenous spreadD. Seeding within abdominal cavityE. Perforation9. One week after a mild flu like illness, a 9-year-old boy has an episode of hematuria that subsides within 2 days. One month later, he tells his parents that his urine is red again. On physical examination, there are no significant findings. Urinalysis shows l+ proteinuria, l+ hematuria, and no ketones, glucose, or urobilinogen. The serum urea nitrogen level is 36 mg/dL and the creatinine level is 32 mg/dL. A renal biopsy specimen shows diffuse mesangial proliferation and electron-dense deposits in the mesangium. Which of the following mechanisms is most likely to produce these findings?A. Deposition of immune complexes containing IgAB. Formation of antibodies against type IV collagenC. Virus-mediated injury to the glomeruliD. Cytokine-mediated injury to the capillariesE. Congenital defects in the structure of glomerular basement membranes10. A 3-year-old girl is brought to the clinic by her parents who are very concerned about her.Physical examination is remarkable for extremity edema.Urinalysis shows significant proteinuria, but no red cells or casts. Electron microscopy performed on a kidney biopsy would be most likely to show which of the following findings?A. Subepithelial spikesB. Subendothelial depositsC．Mesangial depositsD．Fusion of epithelial foot processesE．Dense deposits11. A 60-year-old man develops low back pain, and radiologic investigation reveals multiple osteoblastic lesions of the lumbar vertebrae. A hard, irregular nodule on the posterior surface of the prostate is found on rectal examination. Plasma levels of prostatic specific antigen (PSA) are markedly increased. Which of the following is the most likely diagnosis?A．Prostatic hyperplasiaB. Multiple myelomaC. Prostatic intraepithelial neoplasia (PIN)D．Chronic prostatitisE．Prostatic adenocarcinoma12. An 18-year-old woman has had pelvic discomfort for several months. On pelvic examination, there is a 10-cm right adnexal mass. Upon surgical resection, the mass is solid and white,with small areas of necrosis.Microscopically,it contains mostly primitive mesenchymal cells along with some cartilage,muscle,and foci of neuroepithelial differentiation. Which of the following is the most likely diagnosis? A．Brenner tumorB. DysgerminomaC. Granulosa cell tumorD．Immature teratomaE．Leiomyosarcoma13. The most common histologic type of cancer in cervix is aA．Squamous carcinomaB．Mucinous carcinomaC．Papillary carcinomaD．LymphomaE．Leiomyosarcoma14. Which of the following lymphomas is a mature T-cell lymphoma?A．T lymphoblastic leukemia/lymphomaB．Mycosis fungoidesC. Mantle cell lymphomaD．Follicular lymphomaE．Burkitt lymphoma15. The microscopic appearance of a neoplasm in the jaw bones of an 8-year-old boy shows a “starry sky” pattern. The tumor cells express CD19, CD20 and CD10. Genetic examination shows t(8;14)(q24;q32).Which of the following is the most likely diagnosis?A．Burkitt lymphomaB．Diffuse large B-cell lymphomaC．Eosinophilic granulomaD．Mycosis fungoidesE．Follicular lymphoma16. Which of the following regarding follicular lymphoma is incorrect?A. Originates from marginal zone cellsB. Usually has a nodal patternC. It is an indolent neoplasmD. Can transform into a diffuse large B-cell lymphomaE. May occur primarily in the skin, GI tract, breast and testis17. Which of the following secretes calcitonin?A. Follicular carcinomaB. Papillary carcinomaC. Medullary carcinomaD. Squamous cell carcinomaE. Undifferentiated carcinoma18. An 8-month-old infant is being evaluated for growth and mental retardation. Physical examination reveals this small infant with dry,rough skin,a protuberant abdomen, periorbital edema, a flattened, broad nose, and a large, protuberant tongue. Which of thefollowing disorders is the most likely cause of this infant's signs and symptoms?A. Graves' diseaseB. CretinismC. Toxic multinodular goiterD. Toxic adenomaE. Struma ovary19. A 65-year-old man presents with tremors at rest and muscular rigidity. Physical examination reveals the patient has a "masklike" face. In this patient, from which one of the following sites would biopsies most likely reveal intracytoplasmic eosinophilic inclusions within neurons?A. Basal gangliaB. Caudate nucleusC. HippocampusD. MidbrainE. Substantia nigra20. Which of the following is the major component of senile plaque?A. neurofilamentsB. microtubule proteinC. β-amyloid substanceD. glial filament acid proteinE. S-100 protein二、名词解释 （20分）1. Atherosclerosis 6. Cervical intraepithelial neoplasia CIN2. Silicosis7. Reed-Sternberg cell3. COPD8. Red neuron4. Viral hepatitis9. Teratoma5. Pseudolobule10. Caseous pneumonia三、简答题 （40分）1. 何谓肺心病？简述其病因及发病机制。