Questions 1 - 6 - Match the numbered statement most closely associated with the lettered word or phase. Each lettered word or phrase may be used once, more than once, or not at all.
A. Histamine
B. Serotonin
C. Bradykinin
D. C5a
E. C3b
F. C-Reactive Protein (CRP)
______1. Chemotactic agent
______2. Derived from tryphophan
______3. Prime mediator of pain in acute inflammation
______4. Acute phase protein
______5. Opsonin
______6. Mediates the immediate transient phase of vascular permeability in
most types of tissue injury.
SELECT THE SINGLE BEST ANSWER:
______7. During acute inflammation, IL-1 and TNFa :
A. Upregulate endothelial cell ligands - ICAM-1, VCAM-1, and
ELAM-1
B. Cause fever
C. Cause neutrophil leukocytosis
D. All of the above
______8. Acute inflammation is a type of immune response.
A. True
B. False
______9. Lewis triple response includes:
A. Veal
B. Red line
C. Red flair
D. All of the above
E. None of the above
______10. Causes of chronic inflammation include:
A. Intracellular pathogens e.g. Mycobacteria, Brucellae,
viruses, etc.
B. Large extracellular pathogens like many fungi, parasites, etc.
C. Prolonged exposure to toxins such as absestos, silica, etc.
D. Autoimmune diseases such as rheumatoid arthritis, SLE, etc.
E. All of the above
______11. A 40-year old black woman was noted to have hilar adenopathy on chest roentgenogram as part of a routine physical exam. Otherwise, she was in good health. H & E stain of lymph node biopsy sections showed numerous pale-staining areas. Special stains for acid-fast and fungal organisms were negative as were cultures for mycobacterial and fungal pathogens. The most probable diagnosis is:
A. Chromoblastomycosis
B. San Joaquin Valley fever
C. Hansen's disease
D. Sarcoidosis
E. Tuberculosis
______12. Granuloma is:
A. Granular cell tumor
B. An inflammatory tumor
C. Granulation tissue
D. Always accompanied by presence of giant cells and new blood vessel
formation
______13. You should learn about Hansen's disease because:
A. It is one of the prototype examples of chronic inflammation.
B. Between 100 -200 cases per year are reported in the U.S.A.
C. It is endemic to several countries with more than 10 million cases known
world over.
D. All of the above
E. None of the above
______14. Which of the following is (are) most associated with the formation of a transudate?
A. Hydrostatic causes
B. Fluid with low specific gravity
C. Fluid that does not clot on standing
D. Little or no fibrinogen
E. All of the above
F. None of the above
______15. Which of the following is (are) most associated with an exudate?
A. Altered vasular permeability
B. Fluid with high specific gravity
C. Fluid that clots on standing
D. Presence of fibrinogen in the fluid
E. All of the above
F. None of the above
______16. The following features: monocytes, giant cells, fibroblasts and
lymphocytes are characteristic of:
A. Acute inflammation
B. Granulation tissue
C. Healing wound
D. Chronic inflammation
E. Suppuration
______17. Granulation tissue is characterized by:
A. Proliferation of new capillaries with fibroblasts and new collagen
formation
B. Proliferation of giant cells and fibroblasts
C. Proliferation of giant cells and lymphocytes
D. Proliferation of giant cells, plasma cells and lymphocytes
______18. Which type of inflammation is commonly characterized by collections
of dead and dying polymorphs, dead and dying bacteria, and necrosis of tissue, all of which form a turbid or thick fluid in tissues?
A. Catarrhal inflammation
B. Phlegmonous inflammation
C. Cellulitis
D. Abscess formation
E. Granulomatous inflammation
______19. The predominant cell seen in an inflammatory response to staphylococcal infection is:
A. Lymphocyte
B. Monocyte
C. Eosinophil
D. Mast cell
E. Polymorphonuclear leukocyte
F. Plasma cell
______20. The predominant cell seen in inflammation resulting from viral
infection is:
A. Lymphocyte
B. Mast cell
C. Eosinophil
D. Polymorph
E. Plasma cell
______21. The predominant cell seen in an inflammatory response to protozoal
parasites is:
A. Lymphocyte
B. Polymorph
C. Eosinophil
D. Plasma cell
E. Mast cell
______22. Inflammation is best defined by which of the following statements?
A. A reaction of the microcirculation in tissue to injury.
B. A form of edema.
C. Chemotaxis of white cells to bacteria.
D. A form of abnormal cell growth.
E. Cellular changes resulting from injury.
______23. Mediators of vascular permeability are thought to achieve their effects by:
A. Increased intravascular hydrostatic pressure
B. Decreased intravascular hydrostatic pressure
C. Contraction of endothelial cells and venules
D. Dissolving capillary basement membrane
E. Binding serum albumin to tissue
______24. The following events are all part of the acute inflammatory response. If
placed in correct sequence, which would occur fourth?
A. Vascular dilatation
B. Local hemoconcentration and slowing of blood flow
C. Margination of white blood cells
D. Emigration of white blood cells
E. Increased vascular permeability
______25. Legally, death can be pronounced:
A. Only by the physician treating the patient
B. By any licensed health care professional
C. By the next of kin
D. By any licensed physician
______26. Brain death is the term used to indicate:
A. That respiration has ceased
B. That cardiac function has failed
C. That cortical functions are lost
D. That both cortical and brain stem functions are lost
______27. "Somatic death" implies that:
A. Autolysis has occurred
B. Necrosis has occurred
C. Both autolysis and necrosis have taken place
D. Neither autolysis nor necrosis has had to occur
______28. Procurement of organs for transplantation from cadaver donors depends on the fact that:
A. Antibiotics prevent infection in the donated organ
B. Rejection reactions are less severe against cadaver tissues than against
tissues from live-related donors
C. Autolysis occurs at different rates in different tissues
D. Long vascular segments are available on cadaver ogans
______29. All of the following forms of necrosis were named for their gross
characteristics except:
A. Caseous
B. Fibrinoid
C. Coagulative
D. Gummatous
E. Liquefactive
______30. Hemorrhagic pulmonary infarcts are basically examples of:
A. Caseous necrosis
B. Fibrinoid necrosis
C. Coagulative necrosis
D. Liquefactive necrosis
______31. Liquefactive necrosis is synonymous with abscess formation except in:
A. Heart
B. Kidney
C. Liver
D. Brain
E. Lung
______32. All of the following statements about apoptosis are true except:
A. Apoptosis is an energy-dependent process
B. Apoptosis appears to require protein synthesis
C. Apoptosis occurs as part of embryonic development
D. Apoptosis depends on activation of cytoplasmic actomyosin
______33. An early microscopical indicator of myocardial cell irreversible injury
is "contraction band necrosis." This appearance is most closely related to
changes in:
A. Intracellular K+
B. Intracellular fatty acid stores
C. Intracellular lysosomal hydrolases
D. Intracellular Ca++
______34. Cellular lipoprotein plasma membranes may be broken down by
intrinsic:
A. Pepsinogen
B. Acid phosphatase
C. Phospholipase
D. Trypsin
______35. Reperfusion injury appears to be mediated chiefly by:
A. Hemoglobin
B. Oxygen
C. Trypsin
D. Carbon dioxide
______36. Production of oxygen free radicals is mediated chiefly by:
A. Mitochondrial calcium binding
B. Calcium-induced proteolysis of endothelial xanthine dehydrogenase
C. Activation of lysosomal endonucleases
D. Superoxide dismutase
______37. Cholera causes massive loss of fluid and electrolytes from the intestinal
tract because cholera toxin:
A. Causes massive cellular necrosis in the gut
B. Poisons the NA+ - K+ pump of the basal lamina
C. Creates holes in the plasma membrane
D. Activates a cytoplasmic kinase system
______38. Accumulation of hepatic fat in CCl4 poisoning is the result of:
A. Decrease in synthesis of carrier protein for lipid secretion
B. Uncoupling of oxidative phosphorylation
C. Excessive mobilization of peripheral lipid stores
D. Excessive absorption of intestinal dietary fat
______39. Pompes disease (Glycogenosis Type II) is an example of a lysosomal
storage disease. Other examples of lysosomal storage diseases include all of
the following except:
A. Tay-Sachs disease (Sphingolipidosis)
B. Fabry's disease (Sulfatidosis)
C. Gaucher's disease (Sulfatidosis)
D. vonGierke's disease (Glycogenosis Type I)
______40. Amyloidosis is:
A. Biochemically uniform and morphologically diverse
B. Biochemically diverse and morphologically uniform
C. Biochemically uniform and morphologically uniform
D. Biochemically diverse and morphologically diverse
Characterize the following substances as either:
A. Procoagulant or B. Anticoagulant
41. von Willebrand factor______
42. Thrombomodulin______
43. Heparin______
44. Collagen______
45. Tissue factor______
A. Procoagulant or B. Anticoagulant
46. Protein C______
47. Protein S______
48. Prostaglandin I2______
49. Thromboxane A2____
50. Thrombin______
______51. The role of the "Contact Factors" XII (Hageman) and XI is illustrated by:
A. Occurrence of severe bleeding disorders in their absence
B. Occurrence of excessive thrombus formation with absence of factor XII
C. Occurrence of mild bleeding disorders in their absence
D. Occurrence of excessive thrombus formation with absence of factors XII
and XI
______52. Activation of the extrinsic clotting mechansim in Hemophilia A is
insufficient to control bleeding because:
A. Thromboplastin is deficient in Hemophilia A
B. Tissue Factor Pathway Inhibitor prevents adequate formation of [chi]a in
Hemophilia A
C. Antithrombin III is present in excessive amounts in Hemophilia A
D. Proteins C and S are present in excessive amounts in Hemophilia A
______53. Clinical deficiency of a single clotting factor is most likely due to:
A. Anticoagulant drug administration
B. Severe hepatic disease
C. Disseminated intravascular coagulation
D. Genetic defect
______54. Pulmonary embolization is least likely to be due to thrombosis of:
A. Deep leg veins
B. Inferior vena cava
C. Periprostatic venous plexus
D. Inferior mesenteric vein
______55. Aspirin in low dosage inhibits:
A. Platelet alpha granule release
B. Platelet dense granule release
C. Platelet thromboxane A2 synthesis
D. Platelet actomyosin contraction
______56. Administration of tissue plasminogen activator (tPA) is effective in
causing clot lysis because:
A. tPA activates antithrombin III-bound plasminogen
B. tPA activates fibrin-bound plasminogen
C. tPA activates free plasma plasminogen
D. tPA activates heparin-bound plasminogen
______57. Repair of necroses in the heart involves all of the following except:
A. Angiogenesis
B. Fibrosis
C. Regeneration
D. Compensatory hypertrophy
______58. Wound healing may be imparied in patients deficient in:
A. Manganese
B. Sulfur
C. Zinc
D. Copper
______59. Of the following growth factors, growth inhibition has been attributed
to:
A. Platelet - derived growth factor
B. Epidermal growth factor
C. Transforming growth factor - TGFa
D. Transforming growth factor - TGF[beta]
______60. Marfan's Syndrome appears to be due to defective:
A. Collagen
B. Laminin
C. Fibrillin
D. Elastin
______61. Amorphous appearance and lack of fibril formation is characteristic of
collagen Type:
A. I
B. II
C. III
D. IV
______62. Development of strength in a healing surgical wound is most closely
correlated to:
A. Mucopolysaccharide content of the wound
B. Collagen content of the wound
C. Fibrillin content of the wound
D. Laminin content of the wound
______63. Exuberant overgrowth of connective tissue in cutaneous wounds is
known as:
A. Ainhum
B. Keloid
C. Drusen
D. Ichthyosis
______64. All of the following are examples of a hyperplastic reaction except:
A. Lactational change in the breast of a pregnant person
B. Bone marrow cell proliferation in chronic hypoxia of a mountain dweller
C. Transformation of squamous to columnar epithelium in Barrett's
esophagus
D. Proliferation of thyroid epithelium in Graves disease
E. Granulation tissue formation following an incisional wound
______65. Which of the following statements regarding the cell cycle is correct:
A. Proliferating cell nuclear antigen is present in S phase cells
B. Cells in the GOG1 phase are tetraploid
C. The S (synthesis) phase consists of cells which are in mitosis
D. A DNA ploidy analysis of a tumor showing an abnormal DNA content
is diagnostic of malignancy
E. In a normal resting tissue, most cells are in the G2M phase
______66. All of the following are cytologic features typically associated with
dysplasia except:
A. Increased nucleus to cytoplasmic ratio
B. Hyperchromasia
C. Nuclear chromatin irregularities
D. Increased numbers of mitoses
E. Increases in number of mitochondria
______67. Which of the following tissue types is most likely to undergo
regeneration to normal after injury?
A. Hematopoietic precursor cells
B. Skeletal muscle
C. Central neurons
D. Hepatocytes
E. Cartilage
______68. TRUE or FALSE - Skeletal muscle enlargement in weight training
occurs because of an increase in muscle cell number.
______69. Which of the following statements regarding reverting postmitotic
cells is true:
A. They continually divide during adult life
B. Injuries heal incompletely with scar and regeneration
C. Central nervous system neurons are such cells
D. They undergo dysplasia when injured
E. Metaplasia commonly occurs when stimulated
______70. A patient enters the hospital following a nuclear accident at a local
power plant. He has been exposed to large doses of whole body irradiation.
Based on your knowledge of organ system susceptibility to injury, which of
the following systems would be the most likely to suffer acute damage:
A. Central nervous system
B. Gastrointestinal system
C. Musculoskeletal system
D. Cardiovascular system
E. Urinary tract system
______71. A patient presents to you with numerous pinpoint hemorrhages
involving skin and mucous membranes. This finding represents:
A. Purpura
B. Red cell diapedesis
C. Petechiae
D. Ecchymases
E. Capillary hemangiomatosis
______72. The organs most vulnerable to hypoxia and metabolic insult include
all of the following except:
A. Kidneys
B. Brain
C. Heart
D. Thyroid
E. Lung
______73. The term "heart failure cells" refers to these pigmented cells:
A. Hepatocytes with centralobular necrosis
B. Intra-alveolar macrophages with fine gray-black pigment
C. Intra-alveolar macrophages with coarse golden pigment
D. Hepatocytes with coarse golden pigment
E. Pigmented myocardium
______74. A protein-poor ultrafiltrate of blood plasma is known as a(n):
A. Exudate
B. Hydrothorax
C. Transudate
D. Effusion
E. Chylothorax
______75. Which ion or solute primarily determines the volume of the extra-
cellular fluid compartment:
A. Albumin
B. Na+
C. Cl-
D. K+
E. Total protein
______76. Examples of edema secondary to an imbalance in hydrostatic pressure
include all of the following except:
A. Congestive heart failure
B. Cirrhosis
C. Venous obstruction
D. Malnutrition
E. Constrictive pericarditis
______77. All of the following clinical settings are examples of alterations in cell
mediated immunity except:
A. AIDS
B. transplantation
C. immotile cilia syndrome
D. lymphoma
E. chemotherapy for malignancy
______78. A patient with a history of Hodgkin's disease treated with chemo-
therapy is most at risk for the following infections except:
A. Herpesvirus
B. Pneumocystis pneumonia
C. Cryptococcus
D. Pseudomonas aeruginosa
E. Mycobacterium tuberculosis
______79. A young adult patient presents with a history of repeated bacterial
infections. You are concerned about ruling out the following risk factors
except:
A. IV drug user
B. chronic skin disorder
C. neutropenia (decreased WBC)
D. splenectomy
E. DiGeorge syndrome (thymic hypoplasia)
______80. A patient presents with history of chronic diarrhea. A duodenal biopsy
shows infection with Cryptosporidium and numerous Cytomegalovirus
(CMV) inclusions. Your leading clinical suspicion is:
A. previous splenectomy
B. immotile cilia syndrome
C. AIDS
D. Chediak-Higashi syndrome
E. cystic fibrosis
______81. A patient with cystic fibrosis is most likely at risk for the following
infection:
A. toxoplasmosis
B. aspergillosis
C. Pseudomonas pneumonia
D. Streptococcus pneumonia
E. cellulitis due to Strep. pyogenes
______82. Clinical examples of patients with depressed humoral (e.g., antibody
mediated) immunity include all of the following except:
A. multiple myeloma
B. chronic lymphocytic leukemia
C. Chediak-Higashi syndrome
D. X-linked (Bruton's) agammaglobulinemia
______83. All of the following clinical settings are risk factors for opportunistic
infections except:
A. patients with severe burns
B. IV drug users
C. severe neutropenia due to chemotherapy
D. AIDS
E. recent tooth extraction
ANSWER:
A if 1, 2, and 3 are correct
B if 1 and 3 are correct
C if 2 and 4 are correct
D if 4 is correct
E if all are correct
______84. Cardinal signs of inflammation include:
1. Tumor
2. Color
3. Dolor
4. Rubbor
______85. Lymphoid cells in the granuloma exhibit the surface phenotype of:
1. CD4
2. CD34
3. CD8
4. CD54
SELECT THE SINGLE BEST ANSWER:
"Mr. L.M., a 73 year old married man, was admitted to SMH via ambulance from a nearby community. He had been found slumped over his desk in his office.... On admission to the Emergency Department, he was sweating and cyanotic. Very soon after arrival, he stopped breathing and had no detectable blood pressure or pulse. He was intubated and oxygen was administered, cardiopulmonary resuscitation was instituted, and intravenous fluids containing pressor agents were administered. Despite vigorous therapeutic efforts, the patient did not respond. His ECG showed ventricular fibrillation and then progressively decreasing voltage to a flat line. He was pronounced dead one hour after admission."
______86. This slide is from his right lung. The central structure:
A. Probably originally formed in a deep vein of his leg.
B. Is the cause of his death.
C. Is a cellular reaction to an inhaled irritant.
D. Is a cellular reaction to an acid-fast bacillus.
______87. This is in his left lung. The striated structure probably originally formed:
A. In a deep vein of his leg.
B. In the pulmonary artery.
C. After his death.
D. As a cellular reaction to an inhaled irritant.
______88. This is taken from the "apical wedge-shaped scar in left lung." It represents the results of a previous episode of:
A. The process illustrated in question 86.
B. The process illustrated in question 87.
C. Pneumonia.
D. Tuberculosis.
______89. His liver's "cut surface was yellow and greasy." This condition could be caused by:
A. Halogen free radicals.
B. Derangement of lipoprotein synthesis.
C. Increased mobilization of peripheral fat stores.
D. All of the above.
"A 48 year old woman presented with bilateral carpal tunnel syndrome and underwent bilateral surgical release procedures.... Seven months after her presentation...she was admitted to a community hospital with a chief complaint of dyspnea on exertion. The physical examination on admission showed jugular venous distention, basilar rales, and pedal edema.... The results of gingival and rectal biopsies were positive for amyloid.... A bone marrow biopsy revealed a diffuse plasmacytosis."
______90. This slide is an H&E section of the lung. The eosinophilic material in the blood vessel and alveolar walls could be described as:
A. Caseous
B. Fibrinous
C. Fibrous
D. Hyaline
______91. (Same slide) The presence of amyloid in the lung:
A. Caused decreased compliance due to parenchymal deposits.
B. Caused pulmonary hypertension due to vascular occlusion.
C. Caused dyspnea due to airway obstruction.
D. A and B
E. B and C
______92. This slide is a congo red stain of the myocardium. The darker staining of amyloid is caused by:
A. Covalent bonding to the alpha-helix of the protein.
B. Layering of the dye around the alpha-helix of the protein.
C. Intercalation of the dye between layers of the beta-pleated-sheet of the protein.
D. Hydrogen bonding to the protein.
______93. (Same slide) Myocardial dysfunction in this patient is caused by:
A. Ischemia due to vascular deposits.
B. Atrophy due to interstitial deposits.
C. Right ventricular failure due to pulmonary hypertension.
D. All of the above.
"A 20 year old man presented to the emergency room after one day of malaise, nausea, and vomiting that progressed to myalgias, arthralgias, and rash. Vital signs included blood pressure of 60 mmHg systolic, a pulse of 150/min, a respiratory rate of 50/min, and a temperature of 38deg.C. Administration of 5 L of intravenous fluid raised his blood pressure to greater than 100 mmHg systolic. However, he then developed marked respiratory distress, and results of a physical examination were consistent with pulmonary edema."
______94. This is the patient's lung. There is alveolar hemorrhage and desquamation of alveolar pneumocytes. These findings are the result of:
A. Pulmonary toxicity from bacterial endotoxins
B. Disseminated intravascular coagulation
C. Shock
D. A and B
E. B and C
______95. His adrenal gland has hemorrhagic necrosis, typical of the Waterhouse-Friderichsen syndrome. This is caused by adrenal susceptibility to:
A. Ischemia
B. Venous thrombosis
C. Atrophy
D. None of the above
______96. The heart has pericardial hemorrhages. Hemorrhages are present in many other sites such as adrenals, lungs, skin. These hemorrhages are accompanied by:
A. Decreased platelet counts
B. Decreased clotting factors
C. Abnormal arterioles
D. A and B
E. B and C
"This 3 year 9 month old black male presented to SMH for the first time at age 15 months with a painful, swollen left foot. Other problems at that time included: conjunctivitis, a pustular skin rash, cervical and inguinal lymphadenopathy, and hypochromic microcytic anemia (Hb 11, Hct 33). Open bone biopsy of the tibia diagnosed chronic osteomyelitis with Serratia marcescens. Skin and eye cultures grew Staphylococcus aureus. He was treated with nafcillin, gentamicin, and Septra. His reticulocyte count rose to 9.5% on iron therapy....He was admitted to SMH on 12/6/82. Right middle and lower lobe and left lower lobe pneumonia was seen on chest X-ray, but did not respond to amikacin and nafcillin. Cardiomegaly and hepatosplenomegaly were present. Echocardiogram on 12/15 diagnosed right ventricular hypertrophy. An open lung biopsy contained granulomata, containing fungi which were consistent with Aspergillus fumigatus by morphology and direct fluorescent antibody testing."
______97. This slide shows the patient's neutrophils containing opsonized beads with nitroblue tetrazolium dye. The lack of a blue color to the beads indicates failure of neutrophil:
A. Locomotion
B. Binding
C. Phagocytosis
D. Respiratory burst
______98. The gross appearence of the left lung includes a cavity (lower left corner) and multiple yellow nodules. The nodules have been likened to:
A. Millet seeds
B. Nutmeg
C. Strawberry seeds
D. Cheese
______99. The microscopic features of the nodules include neutrophils and multinucleated giant cells. The giant cells are present because:
A. Aspergillus is chemotactic for monocytes.
B. Neutrophils cannot kill Aspergillus
C. Giant cells are phagocytizing dead fungi
D. Neutrophils secrete TNFß
______100. This is a Gomori methenamine silver stain of a portion of pulmonary artery. Aspergillus stains black. This lesion might be associated with:
A. Sudden death
B. Pulmonary hypertension
C. Septic infarction
D. Systemic emboli
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