INSTRUCTIONS: SELECT THE SINGLE BEST ANSWER FOR EACH QUESTION.
______ 1. Free radicals are produced within cells through all the following EXCEPT:
1. Sun tanning at the beach.
2. Endogenous, usually oxidative, reactions that occur during normal
metabolic processes.
3. After treatment with radiotherapy due to colon cancer.
4. Viral induced direct membrane injury.
5. Enzymatic metabolism of exogenous chemicals like CC14.
______ 2. All are True statements concerning chemical injury EXCEPT:
1. In mercuric chloride poisoning, mercury binds to sulfhydryl groups of
the cell membranes causing increased membrane permeability.
2. Cyanide directly inhibits mitochondrial enzymes.
3. CC14 -induced liver injury is both severe and extremely rapid in onset.
4. Most chemicals, particularly lipid soluble toxins, are converted to reactive
toxic metabolites, which then act on target cells.
5. Lysosomal based P-450 mixed function oxidase is critical in the metabolism
of toxins.
______ 3. All of the following are true statements about apoptosis EXCEPT:
1. The programmed destruction of cells during embryogenesis is a form of
apoptosis.
2. Endometrial cell breakdown during menstruation is a form of apoptosis.
3. By electron microscopy apoptosis is characterized by cellular swelling.
4. Histologically,in apoptosis the cytoplasm becomes intensely eosinophilic and
the nucleus becomes dense.
5. In contrast to necrosis, apoptosis does not elicit inflammation.
______ 4. All of the following are true statements concerning the cell cycle EXCEPT:
1. Continuously dividing cells go around the cell cycle from one mitosis to the
next.
2. G0 cells are permanently non-dividing cells.
3. Columnar epithelium of the small intestine is an example of labile or
continuously dividing cells.
4. Cardiac muscle cells are largely regarded as non-dividing cells.
5. A block in the cell cycle between the synthesis phase (s) and Gap 2 (G2)
phase leads to cellular hypertrophy.
______5. Ultrastructural features of coagulative necrosis include:
1. Mitrochondrial swelling.
2. Eosiniphilic cytoplasm.
3. Deeply basophilic nucleus.
4. Hyperchromatic cell membrane.
5. Shrunken endoplasmic reticulum.
______6. Which of the following is a feature of reversible cell injury?:
1. Cell membrane discontinuities.
2. Lipofuscin accumulation.
3. Fatty change.
4. It is detected clinically by minimal increase of lactic dehydrogenase in
plasma.
5. Karyorrhexis.
______7. The following statements about cellular aging are true EXCEPT:
1. It involves alteration in induction of heat-shock proteins.
2. Premature aging occurs in Werner's syndrome.
3. It can be enhanced by suntanning at the beach.
4. It is enhanced by the accumulation of lipofuscin.
5. Senescent cells have a decreased capacity for uptake of nutrients.
A 30-year old white male is diagnosed as having malignant teratoma of the testis with
metastatic spread to the hilar lymph nodes. As part of his treatment regimen, he is given
a course of systemic chemotheraphy aimed at killing the fast-growing population of tumor
cells.
______8. Which of the following normal organs/systems will be least likely to be affected
by the systemic chemotheraphy?
1. Hematopoietic system.
2. Gastrointestinal system.
3. Hair follicles.
4. Central Nervous system.
5. Genitourinary system.
______9. In question 8, the cells from the organ/system least likely to be affected by the
chemotherapy are examples of which of the following cell types:
1. Postmitotic cells.
2. Intermitotic cells.
3. Interphase cells.
4. Reverting postmitotic cells.
5. Non-mitotic cells.
______10. In tissues containing intermitiotic cells, injuries will heal by complete regeneration.
1. True
2. False
A 42-year old white male comes to you with a history of "heartburn" for 8 months. You
perform an endoscopic examination of his esophagus and gastroesophageal junction looking
for any abnormality. You see a white patch of epithelium located above the GE junction
and take a biopsy sample.
______11. The biopsy of the white patch reveals glandular epithelium with features suggesting
intestinal type differentiation (the esophagus is normally squamous). No
features suggesting a neoplastic process are present. Which of the following
processes describe what has taken place.
1. Hyperplasia
2. Hypertrophy
3. Metaplasia
4. Dysplasia
5. Inversion
______12. The patient from the previous question is at higher risk than the general population for
the development of a malignant process at this site.
1. True
2. False
A 57-year old black woman has a breast lump removed. The pathologic examination shows
that the lump contains invasive ductal carcinoma (malignant). The attending physician orders
a cell cycle analysis.
______13. Which of the following statements is CORRECT regarding the cell cycle analysis?
1. It is likely to show only G0G1 phase cells.
2. It is likely to show a substantial number of cells in S-phase.
3. The percentage of cells in G0G1 phase is the single best predictor of the
patient's prognosis.
4. Cells in the G0G1 phase are actively dividing.
5. Cells in S-phase refer to the resting (sleep) cells.
A 24-year old black male has been lifting weights for 2 years in hopes of winning a local
body building contest.
______14. Which of the following processes described what has been happening to his
muscles during this time?
1. Hyperplasia
2. Hypertrophy
3. Metaplasia
4. Inversion
5. Proplasia
______15. This individual will have more muscle cells when he competes in the contest than
he did before he began to lift weights.
1. True
2. False
______16. Following partial hepatectomy or other hepatic injury, there is an increase in:
1. Transforming Growth Factor Alpha (TGFa).
2. Transforming Growth Factor Beta (TGF[beta]).
3. Gene Expression of myc.
4. Gene Expression of ras.
5. All of the above.
______17. The disease condition due to abnormality of elastic tissue is:
1. Ehlers Danlos syndrome Type IV.
2. Ehlers Danlos syndrome Type VII.
3. Marfan's syndrome.
4. Curtis Laxa
5. Epidermolysis Bullosa
______18. Increased accumulation of extracellular matrix (ECM) proteins including fibronectin,
laminin and Type IV collagen occurs in:
1. Hereditary nephritis.
2. Marfan's syndrome.
3. Gout.
4. Diabetes mellitus.
5. All of the above.
______19. In response to organ necrosis, structural and functional regeneration is most likely
to occur in:
1. Brain
2. Heart
3. Lung
4. Kidney
5. Cartilage
______20. Deficiency of which of the following vitamins inhibits collagen synthesis?
1. Vitamin B1
2. Vitamin B6
3. Vitamin C
4. Vitamin E
5. Vitamin K
______21. Wound contraction is due, in part, to the presence of:
1. Endothelial cells
2. Plasma cells
3. Fibroblasts
4. Myofibroblasts
5. Tissue Mast Cells
______22. Collagenese is dependent for activation on the presence of:
1. Copper
2. Zinc
3. Magnesium
4. Iron
5. Calcium
______23. You are asked to evaluate a percutaneous liver biopsy performed to evaluate
abnormal liver enzyme values in a 52-year old man with a history of
alcohol abuse. On microscopic examination you observe numerous
clear cytoplasmic vacuoles in many hepatocytes. These vacuoles most
likely represent:
1. Cholesterolosis
2. Mucin
3. Triglycerides
4. Phospholipids
5. Intracellular edema
_____24. In the liver biopsy from the previous question, you identify a pigment which stains
blue with the Prussian Blue reaction. This pigment is:
1. Bile
2. Transferrin
3. Apoferritin
4. Hemosiderin
5. Heme
______25. At autopsy, sections of myocardium from an 87-year old man dying of
congestive heart failure demonstrate a perinuclear intracytoplasmic
pigment which is yellow-brown and finely granular. This pigment
most likely represents:
1. Hemosiderin
2. Carbon particles
3. Formalin pigment (an artefact)
4. Lipofuscin
5. Bile staining
______26. The pigment from the previous question represents:
1. A reversible change.
2. An irreversible change which does NOT affect cell function.
3. An irreversible change which DOES affect cell function.
4. A reversible change which sometimes affects cell function.
5. Perinuclear aggregation of prakeratin intermediate filaments.
______27. If the patient from queston 25 had primarily right-sided congestive heart failure, you
would expect to see:
1. Numerous "heart failure cells".
2. Pulmonary edema
3. Biventricular dilatation.
4. Pulmonary congestion.
5. Congestive hepatosplenomegaly.
______28. All of the following may result in metastatic calcification EXCEPT:
1. Parathyroid adenoma
2. Milk-alkali syndrome.
3. Pancreatitis
4. Renal failure.
5. Bony metastases.
______29. You have undertaken the study of patients with "cytoskeletal abnormalities".
Which of the following patients does not belong in your study?
1. A patient with herediatry spherocytosis.
2. A male patient with chronic pulmonary infections and infertility.
3. An Alzheimers disease patient.
4. A patient with chronic alcoholic liver disease.
5. A patient with Chediak-Higashi syndrome.
______30. You are treating a malnourished elderly patient for pneumonia and congestive
heart failure. The patient develops a symptomatic pleural effusion. The effusion
is drained, and a sample is submitted for evaluation. This fluid contains
numerous white blood cells and has a high specific gravity. The fluid is best
described as:
1. A transudate.
2. Pulmonary edema.
3. A hydrothorax.
4. An exudate.
5. A chylous effusion.
______31. The process named in the previous question reflects:
1. Increased central venous pressure.
2. Decreased plasma oncotic pressure.
3. Increased endothelial permeability.
4. Hydrostatic obstruction.
5. Lymphatic obstruction.
______32. The etiology of elephantiasis in patients with chronic Bancroftian filariasis is best
described as:
1. Localized hydrostatic effect.
2. Lymphatic obstruction
3. Extracellular volume expansion.
4. Reduced plasma oncotic pressure.
5. Impaired venous return.
______33. Clinical sequelae associated with pulmonary edema include all of the
following except:
1. Hypostatic pneumonia
2. Rales.
3. Hypotension.
4. Hypoxia
5. The "death rattle"
One evening while doing a 4th year elective in India, you are asked to evaluate a young patient
with suspected cholera. The patient has had massive diarrhea and vomiting for 1-2 days. On
physical exam, the patient has pale, cool skin and is afebrile. His pulse is 140, and his blood
pressure is normal. What is your initial assessment?
______34. 1. This patient can be sent home and told to keep himself hydrated.
2. You will admit the patient for IV hydration and call your preceptor in the
morning.
3. Regardless of what you do this patient is likely not to survive.
4. This patient may be in early shock, and you will call your preceptor immediately.
5. This patient may be in early shock. You will admit him and call your
preceptor in the morning.
______35. Of the following, which is the best definition of the clinical syndrome of SHOCK:
1. Inadequate delivery of oxygen and other nutrients to tissues.
2. An irreversible universally fatal condition.
3. Irreversible multiorgan failure.
4. The sequalae of untreated gram negative sepsis.
5. Circulatory collapse with widespread hypoperfusion.
______36. Which one of the following "pairs" is incorrect:
1. Burn patient:Pseudomonas aeruginosa.
2. Cystic fibrosis:Mycobacterium tuberculosis.
3. AIDS:Cryptosporidial enteritis.
4. Splenectomy:Streptococcus pneumonia.
_____37. All of the following disease states may be associated with qualitative neutrophilic
defects EXCEPT:
1. Diabetes mellitus.
2. Renal failure (uremia).
3. Multiple myeloma.
4. Chediak-Higashi syndrome.
______38. All of the following are typical infections in patients with neutropenia EXCEPT:
1. Cellulitis
2. Subcutaneous abscess formation.
3. Staphylococcal sepsis.
4. Toxoplasmosis encephalitis.
______39. A patient with pneumocystis pneumonia is most likely to suffer from which of the
following?
1. Severe neutropenia
2. Depressed cell mediated immunity.
3. Congenital antibody deficiency.
4. Immotile cilia syndrome.
______40. Intravenous drug abusers who are HIV negative are most at risk for which of these
infectious complications?
1. Urinary tract infection.
2. Staphylococcal endocarditis.
3. Otitis secondary to Hemophilus.
4. Giardia duodenitis
______41. Definitive identification of a particular microorganism must be made prior to
starting antibiotic therapy in an immunocompromised patient.
1. True
2. False
______42. The absolute neutrophil count does not correlate well with the risk of bacterial
infection in bone marrow transplant patients.
1. True
2. False
______43. The majority of pulmonary thromboemboli arise:
1. In situ in the lungs.
2. From inferior vena caval thrombi.
3. From hepatic vein thrombi.
4. From deep leg vein thrombi.
5. From pelvic vein thrombi.
______44. 48 hours after sustaining multiple fractures in a motor vehicle accident, a 24-year
old man began to have respiratory distress, cyanosis, petechial rash and
delirium. The most likely diagnosis is:
1. Air embolism.
2. Septic shock.
3. Hemorrhagic shock.
4. Fat embolism.
5. Osteocalcific embolism.
______45. Venous infarcts in solid organs differ from arterial infarcts by virtue of the
fact that venous infarcts are characterized by:
1. Intense edema and hemorrhage.
2. Minimal to absent ischemia
3. Liquefactive necrosis.
4. Absence of hemosiderin pigment.
5. None of the above.
______46. Hemorrhagic arterial infarction occurs most commonly in:
1. Kidney
2. Spleen
3. Brain
4. Heart
5. Lung
______47. A "bland" infarct is:
1. One that forms because of insufficient calcium in the blood.
2. One that is formed as a result of pure platelet thrombosis.
3. One that does not exhibit bacterial infection.
4. One that is pale rather than hemorrhagic.
5. One that has no clinical effect on the patient.
______48. Clinically significant bleeding commonly occurs in patients with deficiencies of all
the following except:
1. Factor I (Fibrinogen)
2. Factor II (Prothrombin)
3. Factor VIII (Antihemophiliac globulin)
4. Factor X (Stuart factor)
5. Factor XII (Hageman factor)
______49. Paradoxical embolism refers to one that:
1. Develops in a patient receiving anticoagulants.
2. Develops in the venous circulation and causes arterial occulsion.
3. Develops in a patient with thrombocytopenia.
4. Develops in a patient with thrombocytosis.
5. Develops from a left ventricular mural thrombus following myocardial
infarction.
______50. Pulmonary emboli (thromboemboli) may cause:
1. Sudden death.
2. Pulmonary infarction.
3. Centrally located pulmonary hemorrhage.
4. Pulmonary hypertension.
5. All of the above.
6. All but one of the choices 1 - 4.
______51. The presence of Tissue Factor Pathway Inhibitor (TFPI) helps to explain occurrence
of bleeding after injury in:
1. Hageman Factor Deficiency
2. Thrombocytopenia
3. Protein C deficiency
4. Hemophilia A
5. Thrombomodulin deficiency
______52. vonWillebrand factor (vWF) plays a role in blood clotting by:
1. Ability to attach platelets to endothelium.
2. Ability to attach platelets to collagen.
3. Blocking the effect of Protein C.
4. Blocking the effect of Anti-Thrombin III.
5. Blocking tissue plasminogen activator.
______53. Anti-phospholipid antibodies (anticardiolipin antibodies) are being recognized with
increasing frequency in patients with:
1. Thrombocytopenia
2. Thrombocytosis
3. Increased postoperative bleeding.
4. Increased venous and arterial thromboses.
5. Disseminated intravascular coagulation (DIC)
______54. Congenital absence of thromboplastin is:
1. Associated with a mild bleeding disorder.
2. Associated with a severe bleeding disorder.
3. Associated with platelet dysfunction.
4. Detected by abnormal clotting time.
5. Not known to occur.
______55. A patient develops multiple cerebral emboli. The least likely source of these is:
1. Left atrial appendage.
2. Left ventricular wall.
3. Aortic valve.
4. Mitral valve.
5. Tricuspid valve.
______56. Disseminated Intravascular Coagulation (DIC) is characterized by:
1. Thrombocytopenia - hyperfibrinoginemia
2. Thrombocytopenia - hypofibrinogenemia
3. Thrombocytosis - hypoprothrombinemia
4. Thrombocytosis - hyperprothrombinemia
5. None of the above.
For each of the cell types listed below, (questions 57 - 61), choose the most closely associated surface marker: Each marker may be used once, more than once, or not at all.
1. CD4+ cells
2. CD56+ cells
3. CD20+ cells
4. CD8+ cells
5. CD62E+ cells
6. CD15+ cells
______57. B lymphocytes
______58. Cytotoxic T cells
______59. Endothelial cells
______60. NK cells
______61. Helper T cells
For each of the following phenomena associated with inflammation or immunity, questions 62 - 66, choose the most closely associated effector molecule or antigen from the list. Each molecule or marker may be used once, more than once, or not at all.
1. Leukotriene B4
2. C3a/C5a
3. IL-5
4. IL-4
5. CD54
6. CD5
______62. Increased vascular permeability
______63. Cellular adhesion
______64. Chemotaxis
______65. Parasitic infestations
______66. Differentiation of B lymphocytes into plasma cells
______67. Acute inflammation is a form of immunity?
1. True
2. False
Match the following precursor molecules for questions 68 - 71. Each precursor molecule may be used once, more than once, or not at all.
1. Histidine
2. Fatty acids
3. Polypeptides
4. Histones
______68 Cytokines
______69. Histamine
______70. Prostaglandins
______71. Leukotrenes
______72. Identification of multinucleated giant cells is imperative (a sine qua non) for the
diagnosis of a granuloma.
1. True
2. False
______73. Fluid removed from the peritoneal cavity has the following characteristics: high
specific gravity, clots spontaneously on standing, turbid and yellow in color,
contains fibrinogen. Which of the following does this most fully represent?
1. A transudate due to high portal vein pressure.
2. A transudate due to right heart failure.
3. An exudate due to peritoneal inflammation.
4. Fluid associated with starvation or protein loss.
______74. Pain associated with acute inflammation is thought to be due to:
1. Pressure effects of exudate fluid.
2. Histamine
3. Serotonin
4. Kinins
5. All of the above.
6. None of the above.
______75. Which of the following are complications of acute inflammation?
1. Suppuration
2. Abscess formation
3. Scar formation
4. Organization with adhesions between mesothelial surfaces
5. All of the above.
6. None of the above.
______76. Which of the following events in acute inflammation occurs first?
1. Phagocytosis
2. Stasis
3. Margination of leukocytes
4. Emigration of leukocytes
5. Lymphadenitis
______77. The immediate transient phase of vascular permeability in most types of tissue
injury is mediated by:
1. Complement
2. Hageman factor
3. Anaphylatoxin
4. Histamine
5. Serum albumin
______78. The role of complement in acute inflammation is mostly associated with:
1. Initiation of the early increase in vascular permeability.
2. Formation of anaphylatoxin from C3 and C5.
3. Stimulation of granulation tissue formation.
4. Release of histamine from mast cells.
For each of the following statements, choose the form of necrosis or cell injury which is most closely associated. Each kind of injury may be used once, more than once, or not at all.
1. Coagulative necrosis
2. Liquefactive necrosis
3. Caseous necrosis
4. Gummatous necrosis
5. Enzymatic fat necrosis
6. Apoptosis
7. Reversible cell injury
8. Autolysis
______79. This is caused by acute pancreatitis.
______80. This is caused by infection by Treponema pallidum.
______81. This is caused by interruption of blood supply.
______82. This is part of normal G.I. tract cell turnover.
______83. This is a form of acute inflammation.
______84. This was named for its gross resemblance to cheese.
______85. This was named for its gross resemblance to cooked meat.
______86. A 40-year old black woman was noted to have hilar adenopathy on chest x-ray as part of a routine physical exam. Otherwise, she was in good health. The slide portrays the hilar lymph node biopsy findings. Notably, special stains for acid-fast and fungal organisms were negative as were cultures for mycobacterial and fungal pathogens. This scenario represents a case of:
1. Chromoblastomycosis
2. Schistosomiasis
3. Hansen's disease, lepromatous type
4. Sarcoidosis
5. Acquired immunodeficiency
6. Pulmonary tuberculosis
______87. This slide portrays the morphologic spectrum of a cell type which is associated
with:
1. Viral infections
2. Bordelella pertussis ("whooping cough")
3. Acquired Immunodeficiency Syndrome
4. None of the above.
5. All of the above.
______88. This cell is:
1. Loaded with bactericidal enzymes.
2. A depot of preformed vascular mediators.
3. Highly phagocytic.
4. A bulwark against parasitic infestations.
5. Discovered by Paul Ehrlich.
______89. This patient represents a case of deficiency of:
1. C5b
2. C3a
3. CD18
4. CD38
5. CD19
This slide (which relates to questions 90 and 91) shows a low-power photomicrograph from a 52-year old man following a coronary artery occlusion. The infiltrating cells are reminiscent of polymorphonuclear leukocytes.
______90. The most likely age of the lesion depicted is:
1. One hour after coronary occlusion.
2. Two hours after coronary occlusion.
3. Three months after coronary occlusion.
4. Six months after coronary occlusion.
______91. Which of the following can occur?
1. Slight fever
2. Transient rise in WBC count.
3. Both
4. Neither
______92. A 25 year old white male medical student goes out to unwind with his friends the
evening after his pathology midterm. This slide represents the histologic
appearence of his liver the next morning. The pale stained areas represent
cells with:
1. Decreased alcohol oxidation.
2. Increased triglyceride synthesis.
3. Decreased glycogen degradation.
4. Increased fatty acid absorption
5. Decreased mucopolysaccharide degradation.
______93. An 87 year old woman with a past history of multiple heart attacks comes to the emergency room with difficulty breathing. You hear loud rales. Her ankles are swollen and her liver is enlarged. She dies with pink foamy material around her lips. The histologic appearence of her lung is caused by:
1. Inhalation of a pathogenic bacterium.
2. Aspiration of food.
3. Inhalation of a virus.
4. Right heart failure.
5. Left heart failure.
______94. A patient with a similar history and physical findings dies under similar circumstances. The DIFFERENCE in histologic appearences of this person's lung is caused by.
1. Inhalation of a virus instead of a bacterium.
2. Failure of a different ventricle of the heart.
3. The same pathogenesis but a longer time course.
4. The same pathogenesis but a shorter time course.
______95. A 59 year old man has a history of 10 years of hypertension, poorly controlled by medication. He dies suddenly. His heart weight is increased. His hear has:
1. Increased number of cells.
2. Increased size of cells.
3. Increased interstitial collagen.
4. Increased cellular glycogen stores.
5. Increased intestitial elastin.
______96. A 42 year old male taxicab driver comes to you complaining of perianal swelling and pain. You treat him with minor surgery and send the excised tissue to Pathology. This slide shows:
1. Acute inflammation.
2. Chronic inflammation.
3. Acute congestion.
4. Chronic congestion.
5. Acute thrombosis.
6. Organizing thrombosis.
______97. A 34 year old alcoholic man has a chronic cough. He dies with massive hemoptysis. At autopsy, multiple cavitary lung lesions are noted. This slide is from the edge of one of these cavities. The prediminant cell types present include all of the following EXCEPT:
1. Macrophages
2. Plasma cells
3. Lymphocytes
4. Neutrophils
5. Fibroblasts.
______98. This is from a lung biopsy from a 31 year old HIV positive woman. The large cells represent:
1. Macrophages phagocytizing infected cells.
2. Macrophages phagocytizing lymphocytes.
3. Macrophages producing virions.
4. Epithelial cells producing virions.
5. Epithelial cells with disordered microfilaments.
______99. This is a lung slide from an elderly man who had total opacification of his left lung lower lobe on chest radiograph. Sputum culture grew Streptococcus pneumoniae ("Pneumococcus"). If he had survived, this would probably have healed by:
1. Resolution
2. Involution
3. Organization
4. Scarring
5. Granulation.
______100. The 25 year old medical student we first met in question 92, goes on to lead a moderately productive life until he dies suddenly at age 47 of acute gastrointestinal hemorrhage. This is a slide of his liver. The hemorrhage was mostly caused by:
1. Alcohol related platelet dysfunction.
2. Increased portal venous pressure.
3. Fatty liver.
4. Pericentral fibrosis.
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