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Respiratory & Renal Pathology — Step 1 practice questions
50 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. These two systems are examined together because acid-base links them.
Sample questions
Sample question 1
A young child presents with a large, painless, unilateral abdominal mass. Which of the following is the most likely diagnosis?
Explanations
A. Simple constipation
Constipation does not typically present as a distinct, large, palpable abdominal mass in this classic manner.
B. Simple viral gastroenteritis
Viral gastroenteritis does not cause a palpable abdominal mass.
C. Wilms tumor (nephroblastoma) · correct
Wilms tumor (nephroblastoma) is the most common renal malignancy in children, classically presenting as a large, painless, unilateral abdominal mass, often discovered incidentally by a caregiver.
D. Normal abdominal anatomy
A large palpable abdominal mass represents an abnormal finding requiring evaluation, not normal anatomy.
E. Adult-type renal cell carcinoma
Adult-type renal cell carcinoma is rare in young children; Wilms tumor is the classic pediatric renal malignancy instead.
Sample question 2
A 55-year-old man has painless gross hematuria, flank pain, and a left-sided varicocele that does not decompress when he lies down. Which of the following best explains the varicocele?
Explanations
A. Left renal vein compression from tumor invasion, obstructing gonadal vein drainage · correct
Renal cell carcinoma can invade the left renal vein (which the left gonadal vein drains into at a right angle), obstructing gonadal venous outflow and causing a left-sided varicocele that fails to decompress in the supine position — a classic exam finding for RCC.
B. Reactive lymphadenopathy compressing the spermatic cord
While lymphadenopathy can occur, the classic testable mechanism for this specific finding is direct venous obstruction.
C. Direct extension of tumor into the testis
RCC does not typically directly extend into the testis to cause this finding.
D. Increased testosterone production from the tumor
RCC is not classically associated with androgen overproduction.
E. Bilateral venous congestion from heart failure
A unilateral, non-decompressing varicocele localizes to a structural venous obstruction, not systemic heart failure.
Sample question 3
Pleural fluid analysis shows a pleural-to-serum protein ratio of 0.7 and a pleural-to-serum LDH ratio of 0.8. Which of the following does this indicate?
Explanations
A. Hemothorax
Hemothorax is identified by hematocrit comparison.
B. A transudative effusion from heart failure or cirrhosis
Transudates fall below all three thresholds.
C. Chylothorax
Chylothorax is identified by triglyceride content and milky appearance.
D. An exudative effusion, indicating increased capillary permeability or impaired lymphatic drainage from infection, malignancy, or inflammation · correct
LIGHT criteria classify an effusion as EXUDATIVE if any one is met: pleural-to-serum PROTEIN ratio above 0.5, pleural-to-serum LDH ratio above 0.6, or pleural LDH above two-thirds the upper limit of normal serum LDH. Exudates reflect increased capillary PERMEABILITY or impaired lymphatic drainage — pneumonia, malignancy, tuberculosis, pulmonary embolism, and inflammatory disease — and warrant further evaluation. TRANSUDATES result from altered hydrostatic or oncotic pressures in heart failure, cirrhosis, or nephrotic syndrome, and are managed by treating the underlying condition.
E. A normal pleural fluid composition
Normal pleural space contains only a few milliliters of fluid.
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