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Multisystem Pathology — Step 1 practice questions
33 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Pathology questions in this section combine two things the exam tests separately elsewhere. Pathology is the largest discipline on Step 1. This section covers what does not sit in one organ: shock, sepsis, poisoning, nutritional deficiency, and the genetic syndromes that touch several systems at once.
Sample questions
Sample question 1
A patient has central obesity, moon facies, easy bruising, and purple abdominal striae. Which of the following is the most common overall cause of this presentation?
Explanations
A. Adrenal carcinoma
Adrenal carcinoma is a rare cause of Cushing syndrome.
B. Exogenous corticosteroid use · correct
Exogenous corticosteroid use (for various medical conditions) is the most common cause of Cushing syndrome overall, when considering all causes together.
C. Ectopic ACTH from small cell lung cancer
Ectopic ACTH is an important but less common cause overall compared to exogenous steroid use.
D. Adrenal adenoma
Adrenal adenoma is a less common endogenous cause compared to exogenous steroid use as the overall most common cause.
E. Pituitary ACTH-secreting adenoma
A pituitary adenoma (Cushing DISEASE specifically) is a significant cause of endogenous Cushing syndrome but not the single most common cause OVERALL when exogenous causes are considered.
Sample question 2
A patient with Marfan syndrome undergoes regular echocardiographic monitoring. Which of the following is the primary reason for this surveillance?
Explanations
A. No cardiac monitoring is needed in Marfan syndrome
Cardiac (specifically aortic) monitoring is a critical, life-saving component of Marfan syndrome management.
B. To monitor for coronary artery disease exclusively
While cardiovascular disease matters generally, the SPECIFIC, classically emphasized surveillance concern in Marfan syndrome is aortic root dilation, not primarily coronary artery disease.
C. To monitor for aortic root dilation and dissection risk · correct
Marfan syndrome (from fibrillin-1 defects weakening the aortic wall) carries a significant risk of progressive aortic root dilation and potentially life-threatening aortic dissection; regular echocardiographic monitoring is essential to track aortic root size and guide timing of prophylactic surgical repair.
D. To monitor for pulmonic stenosis exclusively
Pulmonic stenosis is not the primary Marfan-associated cardiac concern requiring surveillance.
E. To monitor for congenital heart block
Congenital heart block is not the primary Marfan-associated cardiac concern.
Sample question 3
A patient with multiple myeloma develops restrictive cardiomyopathy and macroglossia. Congo red staining of a fat pad biopsy shows apple-green birefringence. Which type of amyloid is responsible?
Explanations
A. AL amyloid derived from immunoglobulin light chains · correct
AL amyloid is derived from monoclonal immunoglobulin light chains, associated with plasma cell dyscrasias like multiple myeloma, and classically causes cardiac (restrictive cardiomyopathy) and macroglossia findings.
B. AA amyloid
AA amyloid is associated with chronic inflammatory conditions, not plasma cell dyscrasias like multiple myeloma.
C. Transthyretin amyloid
Transthyretin amyloid is associated with familial or senile systemic amyloidosis, not myeloma.
D. Islet amyloid polypeptide
Islet amyloid polypeptide is associated with type 2 diabetes (pancreatic islet amyloid), unrelated to myeloma.
E. Beta-2 microglobulin amyloid
Beta-2 microglobulin amyloid is associated with long-term dialysis.
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