Deck 4: Infections of Histological Importance

Question 1

A 54 year old man presented at the Emergency Department with severe chest pain.A chest x-ray revealed a markedly dilated ascending aorta.Before any further tests could be performed,the patient expired.At autopsy,a markedly dilated aorta was observed,with aortic dissection.The accompanying photomicrograph shows the pathology of the aorta.The letter "E" denotes elastic fibres,while "L" shows a lymphoplasmacytic infiltrate around small vessels in the adventitia.Which one of the following is the best explanation for the underlying cause of the patient's demise?

A)Atherosclerosis
B)Congenital elastin deficiency
C)Endarteritis obliterans
D)Marfan syndrome
E)Myocardial infarction

Answer 1

Endarteritis obliterans

Question 2

A 6 year old boy was brought to the Emergency Department by his mother because of increasing pain in the right lower abdomen.A diagnosis of appendicitis was made,and the appendix was removed laparoscopically.A representative section of the appendix is shown in the accompanying high power photomicrograph.Which one of the following is the best diagnosis of the cause of the boy's appendicitis?

A)Entamoeba histolytica
B)Enterobius vermicularis
C)Giardia lamblia
D)Schistosoma haematobium
E)Trichomonas vaginalis

Answer 2

Enterobius vermicularis

Question 3

In the accompanying low power photomicrograph of lung tissue from a patient with tuberculosis,the large cells labelled with an "L" are best known by which one of the following terms?

A)Amoeba cells
B)Astrocytes
C)Langhans' giant cells
D)Large cells
E)Large lymphocytes

Answer 3

Langhans' giant cells

Question 4

In the accompanying photomicrograph from a cervical (neck)lymph node,which of the following is the commonly used description for the purple bodies of filamentous Actinomyces organisms labelled "A"?

A)Actinomycetomas
B)Basophilic islands
C)Colourful colonies
D)Purple pods
E)Sulphur granules

Question 5

An otherwise well 24 year old woman was hiking in the mountains.She drank water from a mountain stream,but did not filter it.Two days later,she reported to an Emergency Department with intractable diarrhoea.An endoscopy biopsy of the small intestine was performed.A representative section is shown in the accompanying photomicrograph.Which one of the following infectious organisms is the most likely cause of these symptoms?

A)Candida albicans
B)Cytomegalovirus (CMV)
C)Entamoeba histolytica
D)Giardia lamblia
E)Trichomonas vaginalis

Question 6

In the accompanying photomicrograph from a cervical (neck)lymph node,what is the proper terminology for the eosinophilic,proteinaceous halo (seen at the tip of the arrows)around colonies of Actinomyces organisms (labelled "A")?

A)Coagulation
B)Necrosis
C)Splendori-Hoeppli phenomenon
D)Spock-Kirk continuum
E)Trilaminar membrane

Question 7

In the accompanying low power photomicrograph of lung from a patient with tuberculosis,the eosinophilic area labelled "CN" in the centre of the lesion depicted is best described by which one of the following words or statements?

A)Apoptosis
B)Caseous necrosis
C)Cottage cheese degeneration
D)Liquifactive necrosis
E)Suppurating granuloma

Question 8

The accompanying photomicrograph depicts a biopsy of uterine cervix tissue from a 24 year old woman with an abnormal Pap smear.Which one of the following viruses is directly involved in this infection of the squamous mucosa of the cervix?

A)Cytomegalovirus (CMV)
B)Human immunodeficiency virus (HIV)
C)Human papillomavirus (HPV)
D)Herpes simplex virus (HSV)
E)Measles virus

Question 9

The accompanying photomicrograph depicts an endoscopic biopsy of the oesophagus from a patient undergoing chemotherapy for gastric cancer.From the microscopic appearance of the syncytial cells (denoted with an "S"),which one of the following viruses is directly involved in this infection of the oesophagus?

A)Cytomegalovirus (CMV)
B)Human immunodeficiency virus (HIV)
C)Human papillomavirus (HPV)
D)Herpes simplex virus (HSV)
E)Measles virus

Question 10

The accompanying photomicrograph depicts an endoscopic biopsy of lung tissue from a patient undergoing chemotherapy for leukaemia.The arrows point to cells with viral inclusion bodies.Which one of the following viruses is directly involved in this case of viral pneumonitis?

A)Cytomegalovirus (CMV)
B)Human immunodeficiency virus (HIV)
C)Human papillomavirus (HPV)
D)Herpes simplex virus (HSV)
E)Measles virus

Question 11

A 60 year old male was treated with chemotherapy for leukaemia.He developed wedge-shaped infiltrates in his lungs,one of which was biopsied.A representative section is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Candida albicans pneumonitis
B)Cryptococcal pneumonia (Cryptococcus neoformans)
C)Cytomegalovirus (CMV)pneumonitis
D)Disseminated aspergillosis
E)Pneumocystis jirovecii pneumonitis

Question 12

The accompanying high power photomicrograph shows a biopsy of the buccal mucosa from an immunocompetent patient who had been taking broad spectrum antibiotics.Which one of the following is the best diagnosis?

A)Aspergillosis
B)Candida albicans
C)Cryptococcus neoformans
D)Herpes simplex virus
E)Pneumocystis jirovecii
F)Zygomycosis (Mucormycosis)

Question 13

The accompanying low power photomicrograph of skin is from a person with leprosy.The areas labelled "G" are granulomas.Which one of the following words or phrases best describes the type of leprosy represented?

A)Biblical
B)Complex
C)Simple
D)Lepromatous
E)Tuberculoid

Question 14

A 22 year old woman volunteered for a medical mission in Egypt.Before she returned to the United States,she wanted to swim in a tributary of the famous Nile River.This she did,but,after her return,she noted pain in the suprapubic area and bloody urine.A biopsy of the bladder was done,revealing the findings shown in the accompanying high power photomicrograph.The structure marked "SE" is virtually pathognomonic for the disorder,which is which one of the following infections?

A)Entamoeba histolytica
B)Giardia lamblia
C)Plasmodium falciparum
D)Schistosoma haematobium
E)Trichomonas vaginalis

Question 15

The accompanying high power photomicrograph of skin,showing a small dermal nerve (DN)is from a person with tuberculoid leprosy.The area labelled "G" is an associated granuloma.If an acid-fast stain were performed on this section,in an attempt to visualise the leprosy bacilli,which one of the following would you expect to see upon microscopic examination?

A)Few acid-fast organisms
B)Large numbers of acid-fast organisms
C)No organisms - acid-fast stains don't work for Mycobacterium leprae

Question 16

A 38 year old man had suffered from HIV for over a decade.The many side effects of his anti-retroviral therapy regimen depressed him,and he persuaded himself to stop taking the drugs.He was brought to the Emergency Department by his mother because he had become unresponsive.She related that he had complained of a severe headache just prior to losing consciousness.Unfortunately,he expired before any therapy or diagnostic tests could be performed.An autopsy was requested by his mother,and a representative section of the brain is shown in the accompanying high power photomicrograph,stained with the mucicarmine method (which stains mucin).Which one of the following is the best diagnosis?

A)Candida albicans meningitis
B)Cryptococcal meningitis (Cryptococcus neoformans)
C)Cytomegalovirus (CMV)meningitis
D)Disseminated aspergillosis
E)Pneumocystis jirovecii meningitis

Question 17

In the accompanying photomicrograph of colon,a fibrinous exudate (E)is seen erupting from the surface of the colonic mucosa.Which one of the following organisms characteristically causes such a microscopic picture?

A)Actinomyces israelii
B)Clostridium difficile
C)Mycobacterium tuberculosis
D)Staphylococcus aureus
E)Streptococcus pneumonia

Question 18

An otherwise well 43 year old man visited Mexico.He was well until he returned to the United States a few days later,whereupon he experienced bloody diarrhoea and crampy abdominal pain.Because of the possibility of parasitic infection,a colonic biopsy was performed.A representative section from the procedure is shown in the accompanying photomicrograph.Based upon the histopathologic findings,which one of the following is the best diagnosis?

A)Candida albicans
B)Cytomegalovirus (CMV)
C)Entamoeba histolytica
D)Giardia lamblia
E)Trichomonas vaginalis