病理學（南開大學）知到章節(jié)答案智慧樹2023年

病理學（南開大學）知到章節(jié)測試答案智慧樹2023年最新緒論單元測試

Techniquesusedforcollectingbiopsysampleinclude:（

）

參考答案:

Alltheotheroptionsareincluded

第一章測試

A17-year-oldboyinfectedwithhepatitisAexperiencesmildnauseaforabout1weekanddevelopsverymildscleralicterus.Onphysicalexamination,hehasminimalrightupperquadranttenderness.LaboratoryfindingsincludeaserumASTof68U/L,ALT75U/L,andtotalbilirubin5.lmg/dL.Theincreaseinthispatient'sserumenzymelevelsmostlikelyresultsfromwhichofthefollowingchangesinthehepatocytes?

參考答案:

Defectsinthecellmembrane

Anexperimentanalyzescellsforenzymeactivityassociatedwithsustainedcellularproliferation.Whichofthefollowingcellsismostlikelytohavethehighesttelomeraseactivity?

參考答案:

Neurons

Inaclinicaltrial,achemotherapeuticagentisgiventopatientswithbreastcancermetastases.Samplesofthecancercellsareobtainedandassessedforthepresenceofdeathoftumorcellsbyapoptosis.Mutationalinactivationofwhichofthefollowingproductsismostlikelytorendertumorcellsresistanttotheeffectsofsuchanagent?

參考答案:

NF-kappaB

A22-year-oldwomanhasacongenitalanemiathathasrequiredmultipletransfusionsofRBCsformanyyears.Onphysicalexamination,shenowhasnosignificantfindings;however,liverfunctiontestsshowreducedserumalbumin.Whichofthefollowingfindingswouldmostlikelyappearinaliverbiopsyspecimen?

參考答案:

Hemosiderininhepatocytes

A69-year-oldmanhashaddifficultywithurination,includinghesitancyandfrequency,forthepast5years.Adigitalrectalexaminationrevealsthattheprostateglandispalpablyenlargedtoabouttwicenormalsize.Atransurethralresectionoftheprostateisperformed,andthemicroscopicappearanceoftheprostate“chips”obtainedisthatofnodulesofglandswithinterveningstroma.Whichofthefollowingpathologicprocesseshasmostlikelyoccurredintheprostate?

參考答案:

Hyperplasia

A33-year-oldwomanhashadincreasinglethargyanddecreasedurineoutputforthepastweek.Laboratorystudiesshowserumcreatininelevelof4.3mg/dLandureanitrogenlevelof40mg/dL.Arenalbiopsyisperformed,andthespecimenisexaminedusingelectronmicroscopy.Whichofthefollowingmorphologicchangesmostlikelysuggestsadiagnosisofacutetubularnecrosis?

參考答案:

Nuclearfragmentation

A63-year-oldmanhasa2-yearhistoryofworseningcongestiveheartfailure.Anechocardiogramshowsmitralstenosiswithleftatrialdilation.Athrombusispresentintheleftatrium.Onemonthlater,heexperiencesleftflankpainandnoteshematuria.LaboratorytestingshowselevatedserumAST.Whichofthefollowingpatternsoftissueinjuryismostlikelytobepresent?

參考答案:

Coagulativenecrosis

Onaroutinevisittothephysician,anotherwisehealthy51-year-oldmanhasabloodpressureof150/95mmHg.Ifthepatient'shypertensionremainsuntreatedforyears,Whichofthefollowingcellularchangesisunlikelytooccurinmyocardium?

參考答案:

Hemosiderosis;Metaplasia;Hyperplasia;Atrophy

Inanexperiment,cellsaresubjectedtoradiantenergyintheformofx-rays.Thisresultsincellinjurycausedbyhydrolysisofwater.Whichofthefollowingcellularenzymesdoesnotprotectcellsfromthisdamage?

參考答案:

Protease;Lactatedehydrogenase;Endonuclease;Phospholipase

A68-year-oldwomansuddenlylostconsciousnessand,onawakening1hourlater,shecouldnotspeakormoveherrightarmandleg.Twomonthslater,aheadCTscanshowedalargecysticareaintheleftparietallobe.Whichofthefollowingpathologicprocesseshasmostlikelyoccurredinthebrain?

參考答案:

Liquefactivenecrosis

第二章測試

A60-year-oldwomandevelopedchestpainthatpersistedfor4hours.Aradiographicimagingprocedureshowedanapparentmyocardialinfarctioninvolvinga3×4cmareaoftheposteriorleftventricularfreewall.Laboratoryfindingsshowedserumcreatinekinaseof600U/L.Thepatientreceivedbothanti-arrhythmicandpressoragentstotreatthedecreasedcardiacoutputwhileinthehospital.Whichofthefollowingpathologicfindingswouldmostlikelybeseenintheleftventriclelmonthlater?

參考答案:

Fibrousscar

Anexperimentinfectsonegroupoftestanimalswithviralhepatitis.Twomonthslater,completerecoveryofthenormalliverarchitectureisobservedwhentheliversfromtheseanimalsareexaminedmicroscopically.Asecondtestgroupisinfectedwithbacterialorganisms,andafterthesameperiodoftime,fibrousscarsfromresolvingabscessesareseenmicroscopicallyinthelivers.Whichofthefollowingfactorsbestexplainsthedifferentoutcomesforthetwotestgroups?

參考答案:

Injurytotheconnectivetissueframework

A23-year-oldwomanreceivingcorticosteroidtherapyforanautoimmunediseasehasanabscessonherupperouterrightarm.Sheundergoesminorsurgerytoinciseanddraintheabscess,butthewoundhealspoorlyoverthenextmonth.Whichofthefollowingaspectsofwoundhealingismostlikelytobedeficientinthispatient?

參考答案:

Collagendeposition

Acesareansectionisperformedona20-year-oldwomantodeliveraterminfant,andthelowerabdominalincisionissutured.Thesuturesareremovedlweeklater.Whichofthefollowingstatementsbestdescribesthewoundsiteatthetimeofsutureremoval?

參考答案:

Granulationtissueisstillpresent

A40-year-oldmanunderwentlaparotomyforaperforatedsigmoidcolondiverticulum.Awoundinfectioncomplicatedthepostoperativecourse,andsurgicalwounddehiscenceoccurred.Primaryclosurewasnolongerpossible,andthewound"granulatedin."Sixweekslater,thewoundisonlyl0%ofitsoriginalsize.Whichofthefollowingprocessesbestaccountsfortheobserveddecreaseinwoundsizeoverthepast6weeks?

參考答案:

Myofibroblastcontraction

Inanexperimentinvolvingobservationsonwoundhealing,researchersnotedthatintracytoplasmiccytoskeletalelements,includingactin,interactwiththeextracellularmatrixtopromotecellattachmentandmigrationinwoundhealing.Whichofthefollowingsubstancesismostlikelyresponsibleforsuchinteractionbetweenthecytoskeletonandtheextracellularmatrix?

參考答案:

Integrin

Inanexperiment,releaseofepidermalgrowthfactorintoanareaofdenudedskincausesmitogenicstimulationoftheskinepithelialcells.Whichofthefollowingproteinsismostlikelytobeinvolvedintransducingthemitogenicsignalfromtheepidermalcellmembranetothenucleus?

參考答案:

RASproteins

Anexperimentanalyzesfactorsinvolvedinthecellcycleduringgrowthfactor-inducedcellularregenerationinatissueculture.CyclinBsynthesisisinduced;thecyclinBthenbindsandactivatescyclin-dependentkinase1(CDK1).Theactivekinaseproducedbythisprocessismostlikelytocontrolprogressioninwhichofthefollowingphasesofthecellcycle?

參考答案:

G2toM

Anexperimentisconductedinvolvingcellularaspectsofwoundhealing.Componentsoftheextracellularmatrixareanalyzedtodeterminetheirsitesofproductionandtheirbindingpatternstoothertissuecomponents.Whichofthefollowingmoleculessynthesizedbyfibroblastscanbestbindtocellularintegrinsandextracellularcollagenandattachepidermalbasalcellstobasementmembrane?

參考答案:

Fibronectin

Inanexperiment,surgicalincisionsaremadeinastudygroupoflaboratoryrats.Observationsaboutthewoundsarerecordedovera2-weekperiodusingavarietyofchemicalmediators.Whichofthefollowingstepsintheinflammatory-repairresponseisimpossibleaffectedbyneutralizationoftransforminggrowthfactor-β?

參考答案:

Increaseinvascularpermeability

;Leukocyteextravasation;Chemotaxisoflymphocytes;Migrationofepithelialcells

第三章測試

A52-year-oldwomanwithnomajormedicalproblemstakesalongairplaneflightacrossthePacificOcean.UponarrivalatSydney'sKingsfordSmithairportfollowingtheflightfromLosAngeles,shecannotputhershoesbackon.Thereisnopainortenderness.Whichofthefollowingisthemostlikelyexplanationforthisphenomenon?

參考答案:

Venoushydrostaticpressurebecameincreased.

A56-year-oldmanhashadincreasingdifficultybreathingforthepastweek.Onphysicalexaminationhehasnofever.Auscultationofhischestrevealsdiminishedbreathsoundsanddullnesstopercussionbilaterally.Thereis2+pittingedemapresenttothelevelofhisthighs.Achestradiographrevealsbilateralpleuraleffusions.Whichofthefollowinglaboratorytestfindingsishemostlikelytohave?

參考答案:

Hypoalbuminemia

Astudyofatherogenesisisperformed.Thereisapropensityforatheromastoformatmusculararterialbranchpoints,suchasthecarotidandaorticbifurcations.Whichofthefollowingeventsinthearteriesattheselocationsismostlikelytoinitiateatherogenesis?

參考答案:

Endothelialdysfunction

A61-year-oldmanhasthesuddenonsetofseverechestpain.VitalsignsincludeT37°C,P102/minute,RR20/minute,andBP80/40mmHg.Anelectrocardiogramdemonstrateschangesthatareconsistentwithmyocardialischemiainvolvingtheleftlateralventricularfreewall.Heisgiventhrombolytictherapywithtissueplasminogenactivator(tPA)3hoursaftertheonsetofchestpain.Howeverhisserumcreatininekinaseisfoundtobe450U/L(elevated)3hoursafterthistherapy.Whichofthefollowingcellulareventshasmostlikelyoccurred?

參考答案:

Reperfusioninjury

Aclinicalstudyisperformedwithsubjectswhohavethrombocytopenia<10,000/microliter.Thesepatientsareobservedtohavedefectsincoagulationwithspontaneousbleedingcharacterizedbymultiplepetechiaeandpurpuraandstoolsamplespositiveforoccultblood.Whichofthefollowingcoagulationfunctionsismostlikelytoremainlargelyintactinthesepatients?

參考答案:

Conversionoffibrinogentofibrin

A70-year-oldmanseeksmedicalattentionbecauseofshortnessofbreathonminimalexertion.Aposteroanteriorchestradiographrevealsbluntingoftherightcostophrenicsulcusinterpretedasaright-sidedpleuraleffusion.Theaspiratedfluidisstrawcoloredandclear.Theproteinconcentrationislow,andthespecificgravityis1.011.Microscopicexaminationrevealsanoccasionalmesothelialcell.Whichofthefollowingisthemostlikelycauseoftheeffusion?

參考答案:

Leftventricularheartfailure

Twodaysfollowingacholecystectomy,a32-year-oldhospitalizedwomanhassuddenonsetofdyspnea,pleuralpain,andcoughproductiveoffrothy,blood-tingedsputum.Ventilation-perfusionscintigraphyindicatesaperfusiondefect.Ifitwerepossibletoexamineaportionoftheaffectedlung,whichofthefollowingwouldmostlikelyhavebeenfound?

參考答案:

Hemorrhagic(red)infarct

A36-year-oldmandiesduringcardiacsurgery.Hehadahistoryoflong-standingrheumaticheartdiseasewithmitralstenosis.Atautopsy,thepathologistreportsfindingsconsistentwithmitralstenosisandnotedthepresenceof‘heartfailurecells’.Thisfindingresultsfrom().

參考答案:

chronicpassivecongestionofthelungs

Duringalaboratoryexerciseoncoagulationtesting,a23-year-oldmedicalstudentisfoundtohaveaprolongedbleedingtime.Shehashadalonghistoryof‘easybleeding’withfrequentbleedingofthegums,epistaxis,cutaneousbleeding,andmenorrhagia.FurthertestingrevealedadeficiencyofvonWillebrandfactor.Whichofthefollowingthrombogenicprocessesinvolvingplateletsismostdirectlyimpaired?

參考答案:

Adhesion

Fluidisaspiratedfromthegrosslydistendedabdomenofa47-year-oldchronicalcoholicman.Thefluidisstrawcoloredandclearandisfoundtohaveaproteincontent(largelyalbumin)of2.5g/dL.Whichofthefollowingisnotthemaincauseofthepatient'sfluidaccumulation?

參考答案:

Decreasedsodiumretention;Increasedcapillarypermeability;Inflammatoryexudation;Blockageoflymphatics

第四章測試

A22-year-oldmandevelopsmarkedrightlowerquadrantabdominalpainoverthepastday.Onphysicalexaminationthereisreboundtendernessonpalpationovertherightlowerquadrant.Laparoscopicsurgeryisperformed,andtheappendixisswollen,erythematous,andpartlycoveredbyayellowishexudate.Itisremoved,andamicroscopicsectionshowsinfiltrationwithnumerousneutrophils.Thepainexperiencedbythispatientispredominantlytheresultofwhichofthefollowingtwochemicalmediators?

參考答案:

Prostaglandinandbradykinin

A45-year-oldmanhasbeenworkinghardalldaylongcarryingloadsofbrickstobuildawall.Hetakesanon-steroidalanti-inflammatorydrug(ibuprofen).Whichofthefollowingprocessesisthisdrugmostlikelytodiminishinhisarms?

參考答案:

Pain

Withinminutesfollowingabeesting,a37-year-oldmandevelopsmarkedrespiratorystridorwithdyspneaandwheezing.Healsodevelopsswellinganderythemaseeninhisarmsandlegs.Aninjectionofepinephrinehelpstoreversetheseeventsandherecoverswithinminutes.Whichofthefollowingchemicalmediatorsismostimportantinthepathogenesisofthisman'scondition?

參考答案:

Histamine

Inanexperiment,lymphaticchannelsareobservedinnormalsofttissuepreparations.Staphylococcusaureusorganismsareinnoculatedintothetissuesandtheimmunologicresponseisobservedoverthenext24hours.Whichofthefollowingfunctionsismostlikelytobeservedbytheselymphaticstoproduceaspecificimmuneresponsetotheseorganisms?

參考答案:

Transportantigenpresentingcells

A65-year-oldwomanhashadafeverforthepastday.Onphysicalexaminationhertemperatureis39°Candbloodpressure90/50mmHgwithheartrateof106/minute.LaboratorystudiesshowaWBCcountof12,510/microliterandWBCdifferentialcountof78segs,8bands,11lymphs,and3monos.AbloodcultureispositiveforEscherichiacoli.Hercentralvenouspressurefallsmarkedly.Shegoesintohypovolemicshockasaresultofthewidespreadinappropriatereleaseofachemicalmediatorderivedfrommacrophages.Shedevelopsmultipleorganfailure.Whichofthefollowingmediatorsismostlikelytoproducethesefindings?

參考答案:

Nitricoxide

A56-year-oldmanhashadincreasingdyspneafor6years.Hehasnocoughorfever.Hehadchronicexposuretoinhalationofsilicadustformanyyearsinhisjob.Achestx-raynowshowsincreasedinterstitialmarkingsandparenchymal1to3cmsolidnodules.Hispulmonaryproblemsaremostlikelytobemediatedthroughwhichofthefollowinginflammatoryprocesses?

參考答案:

Macrophageelaborationofcytokines

A40-year-oldwomanhadlaparoscopicsurgery3monthsago.Nowshehasasmall0.5cmnodulebeneaththeskinattheincisionsitethatwassutured.Whichofthefollowingcelltypesismostlikelytobemostcharacteristicoftheinflammatoryresponseinthissituation?

參考答案:

Giantcell

A43-year-oldwomanhashadachroniccoughwithfeverandweightlossforthepastmonth.Achestradiographrevealsmultiplenodulesfrom1to4cminsize,someofwhichdemonstratecavitationintheupperlobes.Asputumsamplerevealsthepresenceofacidfastbacilli.Whichofthefollowingcellsisthemostimportantinthedevelopmentofherlunglesions?

參考答案:

Macrophage

Aroutinecompletebloodcountperformedona22-year-oldmedicalstudentrevealsanabnormalityinthedifferentialleukocytecount.Shehasbeencomplainingoffrequentsneezingand‘watery’eyesduringthepastseveralweeksandreportsthatshefrequentlyhadsuchepisodesinthespringandsummer.

參考答案:

null

第五章測試

Whichoneofthefollowingitemsismosthelpfulindistinguishingpoorlydifferentiatedcarcinomafromsarcoma?

參考答案:

Reticulumfiberstain

ThepatientsurvivalratewithstageT4N1M1neoplam5yearsfromthetimeofdiagnosisislessthan50%,regardlessoftherapy.Whichofthefollowingclinicalfindingsismostlikelytobecharacteristicofthisgroupofpatients?

參考答案:

Cachexia

Ahealthy22-year-oldwomanundergoesaroutinephysicalexamination.Adiscrete,firm,rubbery,movablemassisfoundintheleftbreast.Shehasnoaxillarylymphadenopathy.Theskinoverlyingthebreastandthenippleappearnormal.Whichofthefollowingneoplasmsismostlikelytobepresentinthiswoman?

參考答案:

Fibroadenoma

62-year-oldmanhascomplainedofpainonurinationforthepastweek.Heisafebrile.Oncystoscopy,aslightlyerythematous1cmdiameterareaisseenonthebladdermucosa.Thisareaisbiopsiedandonmicroscopicexaminationshowscellswithmarkedhyperchromatismandincreasednuclear/cytoplasmicratioinvolvingthefullthicknessoftheepithelium.However,thesechangesareconfinedtotheepitheliumabovethebasementmembrane.Whichofthefollowingtermsbestdescribesthesebiopsyfindings?

參考答案:

Carcinomainsitu

A60-year-oldmanwhohasa90packyearhistoryofcigarettesmokinghashadachroniccoughforthepast10years.Hehasbeguntoloseweight(3kg)duringthepastyear.Noabnormalfindingsarenotedonphysicalexamination.Hehasachestradiographthatrevealsarighthilarmass.Asputumcytologyshowsatypical,hyperchromaticsquamouscells.Whatisthemostcommoninitialpathwayformetastasesfromthislesion?

參考答案:

Lymphatics

Allneoplasmsarecollectivelyreferredtoascancers.

參考答案:

錯

Papillomaisabenignneoplasmthatmostoftenarisesfromsurfaceepithelium.

參考答案:

對

Poorlydifferentiatedsquamouscellcarcinomasformintercellularbridgesandpinkkeratinizedcytoplasm.

參考答案:

錯

Paraneoplasticsyndromescanbeexplainedbytheanatomicdistributionofthetumor.

參考答案:

錯

Biopsyofsentinellymphnodesisoftenusedtoassessthepresenceorabsenceofmetastaticlesionsinthelymphnodes.

參考答案:

對

第六章測試

50-year?old?man?has?blood?pressure?of?150/90?mm?Hg（normalblood?pressure?is?120/90?mm?Hg）.?If?this?person?remains?untreated?for?years,which?of?the?following?alterations?will?be?seen?in?the?myocardium?

參考答案:

Hypertrophy

A65-year-oldmanwasfoundtohavea5-cmpulsatilemassinhisabdomenduringaroutinephysicalexamination.Angiographyrevealsamarkeddilationinhisaortadistaltotherenalarteries.Whichofthefollowingisthemostlikelycauseofthisaneurysm?

參考答案:

Atherosclerosis

40.A65-year-oldmandevelopsintensecrushingsubsternal,chestpainthatisnotrelievedbynitroglycerin.TheECGshowsST-segmentelevationandabnormalQwaves.Hisconditionrapidlyworsensandhedies2dayslater.Atautopsya2.5cm2necroticareaisfoundthatinvolvestheanteriorleftventricle.Whatisthemostlikelycauseofthispatient'smyocardialinfarction?

參考答案:

Thrombosisoftheanteriordescendingbranchoftheleftcoronaryartery

A57-year-oldmanhashadbloodpressuremeasurementsintherangeof160/95to180/110mmHgformanyyears.Hehastakennomedications.Arenalscanrevealskidneysofnormalsizeforage.Thesefindingswithbenignnephrosclerosisaremostlikelytooccurwithwhichofthefollowingvascularchanges?

參考答案:

Hyalinearteriolosclerosis

A51-year-oldmanhasthesuddenonsetofsubsternalchestpainwhichradiatestohisleftarmandneck.Hebecomeslight-headedanddiaphoreticoverthenext8hours.Hegoestotheemergencyroom.Onexaminationheisafebrilebuthasaheartrateof96/minutewithanirregularrhythm.LaboratorystudiesshowanincreasedserumtroponinI.Whichofthefollowingfeatureswouldbemostprominentbyhistopathologicexaminationofhismyocardiumatthispointintime?

參考答案:

CoagulativeNecrosis

Peripheralarterydiseasedevelopsifplaquedepositsblockbloodflowtothearteriesthatsupplythearms,pelvis,orlegs.

參考答案:

對

Grossfeatureofhypertensiveheartdiseaseisleftventricalhypertrophy.

參考答案:

對

Familyhistory,age,geneticabnormalities,anddiet,theseareallcalledconstitutionalriskfactor.

參考答案:

錯

Myocardialruptureismostcommon10-14daysafterinfarction.

參考答案:

錯

Fattystreaksarecomposedofsmoothmusclecells.

參考答案:

錯

第七章測試

Anasymptomatic10-year-oldchildwithachestradiographshowingasubpleuralnoduleintherightmid-lungfieldandenlargedmediastinallymphnodesprobablyhas:

參考答案:

Primarytuberculosis

Ifapersonquitssmoking,he/shecanexpecttobenefitfromallofthefollowingEXCEPT:

參考答案:

Reversalofemphysematouschanges

WhichofthefollowingfindingsisLEASTlikelytobediagnosedbybronchoalveolarlavage(BAL)ina45-year-oldmalewithfeverandcough:

參考答案:

Pulmonaryhamartoma

WhichofthefollowingpatientsisLEASTlikelytohavedevelopedanobstructivelungdisease:

參考答案:

A50-year-oldmalewhoworksindemolitionofoldbuildings

Pulmonaryatherosclerosisismostoftenassociatedwithwhichofthefollowing:

參考答案:

Corpulmonale

Lobarpneumoniaischaracterizedbyapatchydistributioninvolvingoneormorelobes,withaninflammatoryinfiltrateextendingfromthebronchiolesintotheadjacentalveoli.

參考答案:

錯

Panacinaremphysemaisthemostcommontypeofemphysema.

參考答案:

錯

Theclinicaldefinitionofchronicbronchitisisaproductivecoughthatoccursduringatleasttwoconsecutivemonthsoveratleastthreeconsecutiveyears.

參考答案:

錯

Smallcellanaplasticcarcinomasarerarelyresectedbecauseofearlymetastasis.

參考答案:

對

Adenocarcinomasareoftenresectablebecausetheyareperipheralinlocation.

參考答案:

對

第八章測試

Atthetimeofbiopsy,chronicatrophicgastritisofautoimmuneetiology(typeA)canbeassociatedwitheachofthefollowingfindingsexcept：

參考答案:

Helicobacterinfection

Pre-neoplasticconditionsofthegastrointestinaltractincludeallofthefollowingexcept:

參考答案:

Diverticulitis

Aperirectalfistulaismostlikelytooccurinwhichofthefollowingpatients:

參考答案:

A27-year-oldmalewithCrohn'sdisease

A45-year-oldmaleisfoundatautopsytohavea2500gmliver(normalupto1800gm)thatmicroscopicallyshowsmosthepatocytestobefilledwithlargelipiddroplets.Theprobableetiologyis:

參考答案:

Chronicalcoholism

A54-year-oldAsianmalewhoishepatitisBsurfaceantigenpositivehasafirm,nodularliver.Allofthefollowingfindingscanoccurascomplicationsofthisconditionexcept:

參考答案:

Hepaticinfarction

Chronicgastritisischaracterizedbychronicmucosalinflammationandatrophyofthemucosalglands.

參考答案:

對

Mostoften,thegastriculceroccursatornearthegreatercurvature,intheantralandprepyloricregions.

參考答案:

錯

ThetumorcellsofKrukenbergtumorsoftencontainabundantmucin.

參考答案:

對

ThetransmissionofhepatitisAvirusisviaparenteral,sexual,andverticalroutes.

參考答案:

錯

HBVandHCVarethemostcommonviralcausesofpostnecroticcirrhosis.

參考答案:

對

第九章測試

A35-year-oldmanisawakenedatnightbecauseofseverelowerabdominalpainthatradiatestothegroin.Thepainisveryintenseandcomesinwaves.Thenextmorning,henoticesbloodinhisurine.Onexamination,therearenoremarkablefindings.Whichofthefollowingisthemostlikelydiagnosis?

參考答案:

Ureterallithiasis

A3-year-oldpreviouslyhealthyboyhasbecomeincreasinglylethargicforthepast3weeks.Onphysicalexamination,histemperature36.9℃，pulse80/min,respirations15/min,andbloodpressure140/90mmHg.Periorbitaledemaispresent.Urinalysisshows4+proteinuria,andnoblood,ketones,orglucose.Whichofthefollowingisthebestinformationtogivetheboy'sparentsabouthisdisease?

參考答案:

Corticosteroidtherapyshouldalleviatethisproblem

A25-year-oldmanhasa5-yearhistoryofceliacsprue.Severaldaysafteramildupperrespiratoryinfection,hebeginspassingdarkred-brownurine.Thedarkurinepersistsforthenext3daysandthenbecomesclearandyellow,onlytobecomered-brownagainlmonthlater.Therearenoremarkablefindingsonphysicalexamination.UrinalysisshowsapHof6.5,specificgravity1.018,3+hematuria,l+proteinuria,andnoglucoseorketones.MicroscopicexaminationoftheurineshowsRBCsandnoWBCs,casts,orcrystals.A24-hoururineproteinlevelis200mg.Arenalbiopsyspecimenfromtheglomeruliofthispatientismostlikelytoshowwhichofthefollowingalterations?

參考答案:

MesangiallgAstainingbyimmunofluorescence

A7-year-oldboyisrecoveringfromimpetigo.Physicalexaminationshowsafewhoney-coloredcrustsonhisface.Thecrustsareremoved,andacultureofthelesionsgrowsgroupAStreptococcuspyogenes.Heistreatedwithacourseofantibiotics.Oneweeklater,hedevelopsmalaisewithnauseaandaslightfeverandpassesdarkbrownurine.Laboratorystudiesshowaserumanti-streptolysinO(ASO)titerofl:1024.Whichofthefollowingisthemostlikelyoutcome?

參考答案:

Completerecoverywithouttreatment

A15-year-oldboyhasbeenpassingdark-coloredurineforthepastmonth.Onphysicalexamination,hehasbilateralsensorineuralheartinglossandcornealerosins.UrinalysisshowsapHof6.5,specificgravity1.015,1+hematuria,1+proteinuria,andnoketones,glucose,orleukocytes.Theserumcreatininelevelis2.5mg/dL,andtheureanitrogenlevelis24mg/dL.Arenalbiopsyspecimenshowstubularepithelialfoamcellsbylightmicroscopy.Byelectronmicroscopy,theglomerularbasementmembraneshowsareasofattenuation,withsplittingandlaminationoflaminadensainotherthickenedareas.Whichofthefollowingisthemostlikelydiagnosis?

參考答案:

Alportsyndrome

Aftereatingacheeseburger,Frenchfries,andIcecreamfordinneronenight,a6-year-oldgirldevelopsnausea,mildabdominalcramping,andaslightfever.Threedayslater,herparentsnoticethatsheispassingdarkstoolsanddarkurineandappearsfatiguedandweak.Onphysicalexamination,shehasatemperatureof37.9,pulse88/min,respirations18/min,andbloodpressure140/90mmHg.Scatteredpetechiaearepresent℃ontheextremities.Laboratoryfindingsshowaserumcreatininelevelof2.2mg/dLandureanitrogenlevelof20mg/dL.UrinalysisshowsapHof6,specificgravity1.016,2+hematuria,andnoproteinorglucose.Arenalbiopsyspecimenshowssmallthrombiwithinglomerularcapillaryloops.Whichofthefollowingdiseasesismostlikelytoproducethesefindings?

參考答案:

Hemolytic-uremicsyndrome

A26-year-oldmanisinvolvedinamotorvehicleaccidentandsustainsacutebloodloss.Heishypotensiveforseveralhoursbeforeparamedicalpersonnelarrive.Theystabilizethebleedingandtransporthimtoahospital,wherehereceivesatransfusionof3unitsofpackedRBCs.Overthenextweek,theserumureanitrogenlevelincreasesto48md/dL,theserumcreatininelevelincreasesto5mg/dL,andtheurineoutputdecreases.Heundergoeshemodialysisforthenext2weeksandthendevelopsmarkedpolyuria,withurineoutp