Box________________________________
General Pathology (Path. 500)
Final Examination
Monday, December l7, l990
9:00 a.m. - 12:00 noon
(2) Read each question carefully. How it is asked could
be as important as what is asked.
(3) Suggested time allotments:
Part I: 1 hour
Parts II and III: 2 hours
Box_______________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
_______l. a. In comparison with young people, the bodies of older people
have more water and less fat.
b. The lipid peroxidation theory of aging is better supported by
experimental and clinical data than any other theory of aging.
c. Chemicals such as acetaminophen or bromobenzene produce
lipid peroxidation by means of activated oxygen species
formed by metabolism in the mixed-function oxidase system.
d. The brain is not subject to dystrophic calcification.
e. Although heavy metals comprise a heterogeneous group, their
cytotoxic effects are all mediated by the hydroxyl radical.
_______2. a. The accumulation of water in the cytoplasm in hydropic swell-
ing compresses the cisternae of the rough endoplasmic
reticulum, which therefore appear as thin, bilayered profiles
densely studded with ribosomes.
b. The separation of the fibrillar from the granular component
of the nucleolus is a sign of irreversible cell injury.
c. Atrophic cells have reduced energy requirements.
d. In adapting to injury, cells lose water and, therefore, a
reversibly injured cell is typically shrunken and smaller
than normal.
e. In contrast to cells in coagulative necrosis, cells in caseous
necrosis retain their outlines.
Name_____________________
Box______________________
Write the letter preceding the ONE best answer in the space provided next to each question.
_______3. Epithelioid cells in tubercles are derived from....
a. fibroblasts
b. lymphoblasts
c. alveolar epithelial cells
d. macrophages or monocytes
e. mesothelial cells
_______4. If a mammalian cell is in G1 phase....
a. it must undergo mitosis in order to survive
b. it generally will undergo mitosis within two hours
c. its RNA and protein content are, as a rule, rising in less
than three hours
d. it must enter S phase promptly
e. it ceases to glycosylate proteins
_______5. Homogeneous T-cell receptor gene rearrangements in lymphoma cells from a patient with malignant lymphoma indicate....
a. phenotypic identity
b. T-suppressor cell function
c. T-helper cell function
d. cytotoxic function of cells
e. monoclonal origin
_______6. The neoplastic cells in rapidly growing cancers....
a. are, as a rule, highly differentiated
b. often skip G1 phase when replicating
c. vary in rate of replication
d. are incapable of glycolysis
e. are likely to be highly synchronized for cell division
Name_________________________
Box___________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
_______7. Which of the following collagen types is found exclusively in basement membranes?
a. Type I
b. Type II
c. Type III
d. Type IV
e. Type V
_______8. Which one of the following is not true for proteoglycans?
a. They contain amino sugars.
b. They are negatively charged molecules.
c. They are highly hydrophilic.
d. Their distribution is tissue-specific.
e. They appear in healing wounds during late stages of scar
formation.
_______9. A healing wound reaches its maximal tensile strength....
a. at 2 weeks
b. at 6 weeks
c. at 3 months
d. at l year
e. over an unpredictable period of time
______l0. Which ONE of the following statements is TRUE?
a. Cancer cells always proliferate faster than their normal
counterparts.
b. Polypeptide growth factors implicated in neoplasia do not
act on normal cells.
c. Malignant tumors are invariably composed of homogeneous cell populations that are of monoclonal origin.
d. Spleen and skeletal muscle are frequently involved by
metastases of epithelial tumors because of their size and abundant blood supply.
e. RNA retroviruses may cause cancer either by integrating their oncogene into the cellular genome or by the activation
of pre-existing cellular proto-oncogenes.
Name__________________________
Box___________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
______11. The progressive and rapid growth of many neoplasms is an indication of....
a. marked shortening of the cell replication times as compared to normal cells
b. marked shortening of S phase
c. absence of G2 phase
d. number of completed cell replication cycles per unit of
time (e.g. month)
e. inability of host to mount immune responses
______12. The replicative pools of cells in a cancer are generally....
a. the most differentiated cancer cells
b. synchronized for replication by host factors
c. a numerical majority of the cancer cells
d. a numerical minority of the cancer cells
e. synchronized once they have metastasized
______13. Many sorts of dividing cancer cells are genetically unstable and undergo mutations that influence the subsequent clinical
behavior of cell sub-populations, usually in the direction of
greater malignancy. Such behavior of cancer cells is termed....
a. initiation
b. promotion
c. aggression
d. progression
e. resilience
Name_________________________
Box___________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
______14. A biopsy specimen from a uterine ectocervix was reported as
showing squamous cell carcinoma in situ. Which one of the
following would be out of line with that diagnosis?
a. loss of normal epithelial stratification
b. presence of bipolar mitoses
c. presence of anaplastic cells in the cervical epithelial cover
d. presence of anaplastic epithelial cells in the subepithelial
stroma
e. loss of normal polarity of cells in the cervical epithelial cover
______15. When cancer cells are grown in vitro, they generally display
behavior not associated with non-neoplastic cells growing
under similar circumstances. Which one of the following is
characteristic only of cancer cells?
a. absence of autophagy in cultured cells
b. confluent growth
c. loss of contact inhibition
d. altered shape of cells
e. altered size of cells
______l6. Which ONE of the following statements is FALSE about initiation
of cancer?
a. Most initiated cells never display neoplastic behavior.
b. Initiation precedes promotion.
c. Initiation confers growth autonomy upon cells.
d. Initiation of cells can result from point mutations.
e. Initiation of cells can result from frameshift mutations.
Name__________________________
Box___________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
______17. Which one of the following statements about carcinogenic
chemicals is FALSE?
a. Many are both initiators and promoters.
b. Some require no metabolic activation or conversion for
carcinogenicity.
c. Most are mutagens.
d. Some are metals.
e. They are generally not synergistic.
______18. Viewed statistically, the most significant factor in effecting cure
of any cancer is....
a. accurate staging
b. accurate grading
c. use of fine needle aspiration
d. early detection and diagnosis by whatever means
e. extensive screening of populations at risk
______19. Which one of the following statements is true?
a. Squamous metaplasia of the bronchial epithelium induced by
cigarette smoke is irreversible and, if untreated, progresses
to cancer.
b. Squamous metaplasia, in which one type of epithelium is con-
verted to another, is invariably beneficial, because it provides
the tissue with additional protection against adverse external
influences.
c. The term "dysplasia" denotes cytologic changes, primarily
reflected in the morphology of the nuclei, but does not include changes in the arrangement of cells within the tissue.
d. Endometrial thickening caused by the administration of
exogenous hormones is an example of hyperplasia.
e. The term "dysplasia" is applied to many different conditions
in all of which there is an increased risk of cancer.
Name__________________________
Box___________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
20 - 23 - Match each of the following carcinogenic chemicals (A) with one
statement under (B).
A B
_____20. Alkylating agents a. Their relation to nitrite food
additives has raised many
questions.
_____21. Polycyclic hydrocarbons b. Have pre-eminently served to
clarify many aspects of liver
cancer.
_____22. Azo Dyes c. Major atmospheric pollutants
_____23. Nitrosamines d. Used in treating cancer
24 - 28 - Complete the following table of corresponding benign and
malignant neoplasms.
BENIGN MALIGNANT
24. Hemangioma________________________________________
25. Chondrosarcoma
26. Leiomyoma__________________________________________
27. Epidermoid carcinoma
28. Cystadenoma________________________________________
Name________________________
Box__________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
______29. Which one of the following statements is true of inositol
triphosphate?
a. It stimulates protein kinase C activity by stimulating the
release of calcium from the endoplasmis reticulum.
b. Phosphodiesterase converts it back to inositol 1, 4, 5-tri-
phosphate.
c. Its production is stimulated by a cascade of phosphorylation
events.
d. It is active when associated with the plasma membrane.
______30. Which one of the following statements is true of oncogene
products in the cell nucleus?
a. They exert their effect through their DNA binding activities.
b. They are typically non-functional as proto-oncogenes.
c. They are synthesized in the nucleus and act in the cytoplasm.
d. They stimulate phosphorylation of the RB protein.
e. They must be activated by chromosomal rearrangement in
order to function.
______31. Which statement best describes anti-oncogene function?
a. They are normal cellular proteins which are activated by
the overexpression of deregulation of an oncogene.
b. They are cellular proteins which function in normal cellular
regulation.
c. Through direct binding with an oncogene protein they re-
store normal cellular functions.
d. Most cells lack these functions.
Name_________________________
Box___________________________
Write the letter preceding the ONE best answer in the space provided next to each question.
______32. Which of the following is NOT a form of antigen-specific
immunotherapy?
a. monoclonal antibodies carrying a toxin
b. interferon immunotherapy
c. adoptive immunotherapy
d. tumor cell vaccines
______33. Lymphocytes kill tumor cells by which one of the following
mechanisms?
a. adhesion of surfaces, cytokine transfer
b. cytokine release, membrane rupture
c. adhesion of surfaces, toxic granule transfer
d. cytokine release, phagocytosis
______34. Which of the following characteristics of tumor cells is critical
for active specific immunotherapy?
a. hyperdiploid (greater than 46 chromosomes)
b. production of IL-1 and/or IL-2
c. presence of HLA class III molecules
d. expression of tumor associated antigens
Name_________________________
Box___________________________
ANSWER: A if only item 1 is correct
B if only items 1 and 3 are correct
C if only item 2 is correct
D if only item 3 is correct
E if only items 2 and 4 are correct
F if all four (1, 2, 3, 4) items are correct
______35. Which of the following factors have a role in clearance of
particles from the broncho-alveolar airways?
1. mucociliary "escalator"
2. cough reflex
3. rate of respiration
4. macrophages
______36. Coalworkers' pneumoconiosis may, if complicated, give rise to....
1. large (> 2 cm) black scars in the lungs
2. cavitation of lungs
3. "rheumatoid" lesions in the lungs
4. cor pulmonale
______37. The most frequent hallmarks of pulmonary asbestosis are....
1. patchy alveolar fibrosis in periphery of upper lobes
2. diffuse interstitial fibrosis in the periphery of lower lobes
3. presence of uncoated chrysotile fibers in alveolar air spaces
4. ferruginous bodies with cores of asbestos in areas of diffuse
interstitial fibrosis
______38. Silicosis of the lungs....
1. carries an increased risk of lung cancer
2. carries an increased risk of pulmonary tuberculosis
3. carries an increased risk of cancer of the larynx
4. may be complicated by the development of Caplan's
syndrome
Name_________________________
Box___________________________
ANSWER: A if only item 1 is correct
B if only items 1 and 3 are correct
C if only item 2 is correct
D if only item 3 is correct
E if only items 2 and 4 are correct
F if all four (1, 2, 3, 4) items are correct
______39. The use of cocaine or its derivative "crack" in relatively high
doses often leads to....
1. ventricular arrhythmias
2. necrosis of cardiac myocytes
3. contraction bands in cardiac myocytes
4. pulmonary edema
40 - 44 - Write the ONE best answer in the space provided next to each question.
______40. In a contact sensitivity reaction to poison ivy (rhus), what
happens first?
a. monocytes become activated by direct contact with rhus oils
b. natural killer cells respond to antigen-antibody complexes
localized to the skin
c. T-cells bearing antigen receptors specific for rhus antigens
are activated by contact with antigen
d. blood monocytes are recruited to the skin by cytokines
released by T-cells
______41. In which of the types of hypersensitivy reaction is the target
cell actually destroyed directly by a lymphocyte?
a. Type I (anaphylactic)
b. Type II (cytotoxic)
c. Type III (immune complex)
d. Type IV (cell-mediated)
e. none of the above
Name_________________________
Box___________________________
40 - 44 - Write the ONE best answer in the space provided next to each
question.
______42. In the formation of a granuloma as part of a Type IV (cell-
mediated) immune response, which is the first event to occur
in the usual sequence of events?
a. recognition of antigen by specific T-cell clones
b. activation of monocytes to form "epithelioid cells"
c. formation of giant cells
d. recruitment of monocytes by T-cells
______43. Anti-nuclear antibodies....
1. are specific for SLE (systemic lupus)
2. are never found in normal individuals
3. bind to unknown antigens in the nucleus
4. are a broad group of antibodies reacting to various mostly
known nuclear structures, a fact which is of practical
diagnostic usefulness in certain diseases
______44. Serum sickness usually occurs 7 - l0 days after injection of the
foreign protein because....
1. T-cells require that much time to recruit monocytes to site
of antigenic contact
2. neutrophils and monocytes require at least 1 week to respond
to deposition of complement in vessels and other tissues
3. of the necessity to generate cytotoxic T-cells
4. the disease develops after formation of antibody to the foreign
protein, which requires this long for a primary response
Name_________________________
Box___________________________
Part I
INSTRUCTIONS: Use only the space provided on this page for your answer. Nothing on the backs will be graded. Answers must be in ink (pen). Illegible answers will not be graded.
1. An apparently healthy 17-year old male begins to have repeated
episodes of pulmonary thromboembolism. Briefly, outline a general plan by which you would investigate the patient's problem.
Box__________________________
INSTRUCTIONS: Use only the space provided on this page for your answer. Nothing on the backs will be graded. Answers must be in ink (pen). Illegible answers will not be graded.
2. Compare and contrast the gross and microscopic appearance of necrosis in a non-tuberculous bacterial abscess and in tuberculous caseation in lung.
A. Non-tuberculous:
B. Tuberculous:
C. Briefly, differentiate the pathogenesis of the two forms of necrosis.
Box___________________________
INSTRUCTIONS: Use only the space provided on the this page for your answer. Nothing on the backs will be graded. Answers must be in ink (pen). Illegible answers will not be graded.
A. Briefly, describe microscopic changes you would find at autopsy in bone marrow, spleen, and lymph nodes.
B. Briefly, describe possible microscopic, pathological changes in parenchymal organs such as heart, lungs and kidneys.
Box___________________________
Answer: A if items 1, 2, 3, are correct
B if items 1 and 3 are correct
C if items 2 and 4 are correct
D if item 4 is correct
E if all four (1, 2, 3, 4) items are correct
_______1. The body's main response(s) to an obligate extracellular
pathogen include:
1. Acute exudative response
2. Granulomatous response if the pathogen is very large
3. Antibody-mediated immune response
4. Cell-mediated immune response
_______2. Pathogens which are typically spread through the
mother's blood to the placenta and fetus include:
l. Toxoplasma gondii
2. Group B beta-hemolytic Streptococci
3. Cytomegalovirus
4. Gardnerella vaginalis
_______3. Which of the following are examples of virulence
factors?
1. Meningococcal exotoxin
2. Staphylococcal coagulase
3. Pneumococcal exotoxin
4. Mycobacterial cording factor
Box___________________________
B if items 1 and 3 are correct
C if items 2 and 4 are correct
D if item 4 is correct
E if all four (1, 2, 3, 4) items are correct
_______4. Route(s) of body invasion which occur(s) with viruses,
protozoa, and bacteria, but not with fungi include:
1. Transcutaneous
2. Respiratory
3. Gastrointestinal
4. Transplacental
_______5. Lyme disease is caused by a spirochete (Borrelia burg-
dorferi) spread by an insect vector. Since it is caused by
a spirochete, one would expect the disease to have:
1. A primary lesion at the inoculation site
2. A secondary phase with symptoms related to systemic
spread
3. Stillbirths caused by maternal infection
4. A tertiary phase long after the initial infection
_______6. Opportunistic infections are....
1. Caused by organisms which are not normally invasive
2. Infrequent in a hospitalized population
3. Vary according to the type of abnormal defenses
4. Only knock once
_______7. Corynebacterium diphtheriae....
1. Causes a tracheal inflammatory pseudomembrane
2. Produces toxin only when infected by a bacteriophage
3. Toxin causes myocarditis and neuritis
4. Causes tracheal perforation
Name_________________________
Box___________________________
Answer: A if items 1, 2, 3, are correct
B if items 1 and 3 are correct
C if items 2 and 4 are correct
D if item 4 is correct
E if all four (1, 2, 3, 4) items are correct
_______8. In syphilis....
1. Neutrophilic and eosinophilic inflammation are
characteristic
2. The causative organism can't be cultured in vitro.
3. Granulomas are part of the secondary stage
4. Production of antibodies is effective against re-
infection
_______9. Members of the genus Clostridium produce....
1. Enterotoxins
2. Hemolysins
3. Neurotoxins
4. Endotoxins
______10. Coccidioidomycosis....
1. Causes infiltration by neutrophils
2. Does not cause granulomatous inflammation
3. May mimic tuberculosis in x-ray images
4. Is primarily an enteric infection
Box___________________________
B if items 1 and 3 are correct
C if items 2 and 4 are correct
D if item 4 is correct
E if all four (1, 2, 3, 4) items are correct
______11. Miliary tuberculosis....
1. Is characterized by granulomas without necrosis
2. Can be seen in many parts of the body
3. Is widely disseminated throughout the lungs
4. Is named for the high prevalence in army camps
______12. Patients with A.I.D.S. tend to have infections by....
1. Pyogenic bacteria
2. Herpes group viruses
3. Enteric bacteria
4. Enteric protozoa
______13. Parts coded in a virus's genome include....
1. Capsid
2. Nucleic acid polymerase
3. Envelope proteins
4. Envelope lipids
______14. Mechanisms by which organisms avoid or survive
phagocytosis include....
1. Enzymes to produce peroxide
2. Carbohydrate-rich capsules
3. Hemagglutinins
4. Waxy cell walls
Name_________________________
Box___________________________
Answer: A if items 1, 2, 3, are correct
B if items 1 and 3 are correct
C if items 2 and 4 are correct
D if item 4 is correct
E if all four (1, 2, 3, 4) items are correct
______15. Lobar pneumonia is caused by all of the following
except:
1. Legionella pneumophila
2. Streptococcus pneumoniae
3. Klebsiella pneumoniae
4. Bordetella pertussis
______16. Entamoeba histolytica can....
1. Have an asymptomatic carrier state
2. Invade the liver via portal vessels
3. Phagocytize red blood cells
4. Cause liquefactive necrosis of bowel mucosa
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