A 52-year-old woman has experienced personality change and headaches over the past 3 months and is now developing a right hemiparesis. CT scan shows a mass in the left temporal lobe. Her condition deteriorates rapidly and she dies 7 months later. At autopsy, a large, hemorrhagic, necrotic tumor is identified in the left temporal lobe with extension to the right hemisphere. Microscopically there are highly pleomorphic cells with frequent mitoses. Serpentine areas of necrosis can be seen surrounded by masses of tumor cells. Which of the following is the most likely diagnosis?

(A) ependymoma

(B) glioblastoma multiforme

(C) medulloblastoma

(D) meningioma

(E) oligodendroglioma

A 46-year-old woman with a 30-year history of juvenile diabetes undergoes a left renal allograft for advanced diabetic nephropathy. The transplant is initially successful; however, 3 months later she develops an unproductive cough with associated arthralgia, malaise, diarrhea, and fever of 101.6°F. Upon hospital admission, she is found to be leukopenic. The patient continues to decompensate and dies 3 days following admission. A section of her right kidney taken at autopsy is shown in Figure 5-22. This figure indicates an infection with which of the following agents?

(A) cytomegalovirus

(B) Epstein-Barr virus

(C) Human immunodeficiency virus

(D) Pneumocystis carinii

(E) S. epidermidis

(F) Streptococcus pyogenes

A 43-year-old man complains of a 25-lbs weight gain over the past 2 years distributed mostly in the trunk and face. He also states that he has developed abdominal stretch marks and facial acne during the same time period. Physical examination reveals BP 160/100 mm Hg and pulse 90 per minute. Significant laboratory tests were fasting glucose 145 mg/dL and 24-hour urinary free cortisol greatly increased at 390 μg/d. The dexamethasone suppression test showed suppression of the urinary free cortisol at high but not low doses. Based upon this information, you would expect to find a hormonally-active tumor in which of the following sites?

(A) adrenal cortex

(B) adrenal medulla

(C) anterior pituitary

(D) posterior pituitary

A 23-year-old woman develops a sore throat, chills, headache, coryza, and a nonproductive cough. A chest x-ray reveals an indistinct, patchy interstitial infiltrate. She has an uneventful recovery within a few days without receiving therapy. Which of the following outcomes is most likely to occur in the region of the affected lung?

(A) healing by first intention

(B) metaplasia

(C) repair by scar formation

(D) resolution

(E) subacute inflammation

A 47-year-old man has had a cough that produces yellowish sputum for the past week. He is found to have a total WBC count of 16,300 per μL with a differential count of 75% segmented neutrophils, 11% band neutrophils, 9% lymphocytes, 4% monocytes, and 1% eosinophils. His temperature is 100°F and chest x-ray reveals a lesion in the right lower lobe that has a central cavity and an air-fluid level. Which of the following is the most likely diagnosis?

(A) bronchogenic carcinoma

(B) interstitial pneumonia

(C) lobar pneumonia

(D) pulmonary abscess

(E) pulmonary tuberculosis