Repeated USMLE Questions Step 1 Review- 130- Pathology

by

Q- A 55-year-old man with a long history of alcohol use presents with abdominal distension. Physical exam reveals shifting dullness and spider angiomas on the chest. His lab results are: total bilirubin 3.2 mg/dL, albumin 2.1 g/dL, and an INR of 1.9.

Which of the following best explains the pathophysiology of his condition?

A- Autoimmune destruction of intrahepatic bile ducts

B- Deposition of α1-antitrypsin polymers in hepatocytes

C- Fibrosis and nodular regeneration disturbing hepatic architecture

D- Viral cytotoxicity with hepatocyte necrosis

C- Fibrosis and nodular regeneration disturbing hepatic architecture- Chronic alcohol use leads to cirrhosis, characterized by fibrosis and regenerative nodules that distort hepatic blood flow and function, resulting in portal hypertension and synthetic dysfunction.

 

Q- A 6-year-old boy presents with generalized edema and frothy urine. Lab results: urine protein 4+, serum albumin 1.8 g/dL, and elevated cholesterol. A renal biopsy shows normal glomeruli on light microscopy, but electron microscopy reveals effacement of podocyte foot processes.

What is the most likely diagnosis?

A- Focal segmental glomerulosclerosis

B- Membranous nephropathy

C- Minimal change disease

D- Post-streptococcal glomerulonephritis

C- Minimal change disease- Minimal change disease is the most common cause of nephrotic syndrome in children, with podocyte foot process effacement seen on electron microscopy and normal light microscopy. It responds dramatically to corticosteroids.

 

Q- A 72-year-old man with a 40-pack-year smoking history presents with hematuria and weight loss. CT shows a renal mass. Biopsy reveals polygonal cells with clear cytoplasm.

Which paraneoplastic syndrome is most commonly associated with this tumor?

A- Hypercalcemia due to PTHrP secretion

B- Hypoglycemia due to insulin-like factor secretion

C- Polycythemia due to excess erythropoietin

D- SIADH leading to hyponatremia

C- Polycythemia due to excess erythropoietin- Clear cell renal cell carcinoma, often linked with smoking, can produce erythropoietin, leading to paraneoplastic polycythemia. Cells appear with clear cytoplasm due to lipid and glycogen content.

 

More Repeated USMLE Questions Step 1

Check this Review Book for Step 1 

Leave a Comment