INSTRUCTIONS: SELECT THE SINGLE BEST ANSWER FOR EACH QUESTION.
1. Phagocytosis is enhanced by:
1. C1
2. Bradykinin
3. Lysozyme
4. Opsonin
5. Serotonin
2. A transudate differs from an exudate in its:
1. Protein concentration
2. Cellular content
3. Specific gravity
4. Cause
5. All of the above
3. In acute inflammation, as compared to chronic inflammation, there will be more:
1. Lymphocytes
2. Fibrosis
3. Plasma cells
4. Neutrophils
4. If the following events were put in sequence as they occur in an inflammatory reaction,
which would occur third?
1. Emigration of leukocytes
2. Phagocytosis and enzymatic digestion
3. Slowing of blood flow and red cell concentration
4. Vascular dilation and increased permeability
5. Migration of leukocytes directly toward a foreign substance or an injured tissue is called:
1. Diapedesis
2. Exudation
3. Emigration
4. Anaphylaxis
5. Chemotaxis
6. Which of the following events in acute inflammation occurs first?
1. Phagocytosis
2. Stasis
3. Margination
4. Emigration
5. Lymphadenitis
7. The acute inflammatory reaction would be LEAST affected by eliminating which of the
following?
1. Stasis
2. Vasoconstriction
3. Phagocytosis
4. Margination
5. Emigration
8. The tumor of inflammation is due predominantly to:
1. Arteriolar dilation
2. Venous dilation
3. Capillary dilation
4. Increased intracellular fluid
5. Increased extracellular fluid
9. Leukocytic emigration occurs primarily from:
1. Arteries
2. Arterioles
3. Capillaries
4. Venules
5. Veins
10. Each of the following events is prominent in acute inflammation EXCEPT:
1. Increased vascular leakage
2. Hyperemia
3. Collagen formation
4. Exudation
5. Edema
11. Characteristic morphological features of chronic granulomatous inflammation are:
1. Liquefaction necrosis, neutrophilic granulocyte infiltration and scattered multi-
nucleated giant cells
2. Aggregates of mononuclear phagocytes (with or without multinucleated giant cells and scattered lymphocytes)
3. Foci of caseous necrosis surrounded by neutrophilic granulocytes and multinucleated
giant cells
4. Aggregates of lymphocytes and plasma cells
12. Mediators of the acute inflammatory reaction in man include:
1. Clotting factor XII (Hageman)
2. Bradykinin
3. Histamine
4. C5a fraction of complement
5. All of the above
13. The most important complement-derived chemotactic factor for neutrophils is:
1. C1
2. C3a
3. C4
4. C5a
5. C5b67
14. Chemically, opsonins may be:
1. IgM
2. IgG
3. C1
4. C3b
15. Multinucleated giant cells of the foreign body type originate from:
1. Nuclear division of granulocytes
2. Atypical regeneration of epithelium
3. Megakaryocytes
4. Fusion or nuclear division of macrophages
5. Multiplication of nuclei in surrounding fibrocytes
16. Each of the following is true of neutrophils EXCEPT:
1. They phagocytose injurious agents
2. They reproduce and maintain a relatively constant number in foci of inflammation.
3. They usually degenerate rapidly in inflammation and their cell membrane ruptures
releasing their enzymes.
4. They can cause tissue damage and thereby provoke further inflammation.
17. Which of the following cells is most abundant in an abscess?
1. Eosinophil
2. Lymphocyte
3. Macrophage
4. Neutrophil
5. Plasma cell
18. Polymorphonuclear leukocytes are by definition part of:
1. Granuloma
2. Granulation tissue
3. Both
4. Neither
19. Which of the following cells has the shortest life span?
1. Lymphocyte
2. Monocyte
3. Neutrophil
4. Giant cell
5. Epitheloid cell
20. Epitheloid cells are associated with:
1. Granulation tissue
2. Granuloma
3. Both
4. Neither
21. Which of the following circulating cells can actively phagocytose foreign material?
1. Neutrophils
2. Basophils
3. Monocytes
4. Lymphocytes
22. The epitheloid cells of a tubercle are derived from:
1. Langhans' giant cells
2. Lymphocytes
3. Capillary endothelial cells
4. Mononuclear phagocytes
5. Polymorphonuclear phagocytes
23. The most important cell in granuloma formation is the:
1. Plasma cell
2. Lymphocyte
3. Macrophage
4. Giant cell
5. Fibroblast
24. The presence of which cells in an inflamed area indicates a chronic reaction?
1. Lymphocytes
2. Plasma cells
3. Both
4. Neither
25. A granuloma is:
1. A small nodule of granulation tissue.
2. A tumor composed of granulocytes.
3. A small hard mass of fibroblasts and collagen.
4. A localized infiltrate of mononuclear phagocytes.
26. Fibrosis is associated with:
1. Acute inflammation
2. Chronic inflammation
3. Both
4. Neither
27. Which of the following is common to tuberculosis, leprosy and sarcoidosis?
1. Mycobacterial infection
2. Plasmacytic endarteritis
3. Pulmonary disease
4. Granulomatous inflammation
28. The appearance of which cells is useful in estimating the age of an inflammatory focus?
1. Mast cells
2. Fibroblasts
3. Both
4. Neither
29. A patient develops renal failure and requires hemodialysis. A rapidly acting agent is
needed to prevent coagulation in the dialysis machine during the procedure. The best
choice would be:
1. Warfarin
2. Heparin
3. Aspirin
4. Tissue plasminogen activator
30. During an evaluation for easy bruisability, a patient is found to have a prolonged bleeding
time. The most likely cause for this abnormality is:
1. Hemophilia A
2. von Willebrand Disease
3. Factor XII deficiency
4. Warfarin administration
31. A patient presents with acute deep vein thrombosis, and he has had two prior episodes in
the past. His mother and a maternal aunt have also suffered from venous thromboembolic
disease. Which of the following conditions is most likely?
1. Thrombocytopenia
2. Hemophilia A
3. Activated protein C resistance
4. Dysfibrinogenemia
32. In the process of platelet aggregation, what molecule serves as a bridge linking platelets?
1. Plasminogen
2. von Willebrand protein
3. Factor IX
4. Fibrinogen
33. Antithrombin III inactivates all of the following EXCEPT:
1. Thrombin
2. Factor Xa
3. Factor VIIIa
4. Factor XIa
34. Activated protein C inactivates which of the following:
1. Thrombin
2. Factor Xa
3. Factor VIIIa
4. Factor XIa
35. Endothelial cells are important in the physiologic regulation of fibrinolysis. All of the
following are functions of endothelial cells in regulating fibrinolysis EXCEPT:
1. Secretion of tissue plasminogen activator
2. Secretion of plasminogen activator inhibitor Type 1
3. Binding of urokinase-like plasminogen activator to surface receptor
4. Secretion of plasminogen
36. The enzyme that proteolytically cleaves and solubilizes fibrin resulting in fibrinolysis is
which of the followin?
1. Tissue plasminogen activator
2. Plasminogen
3. Plasmin
4. Thrombin
A 35 year old female is diagnosed as having cervical squamous carcinoma. At the time of
presentation, she is found to have metastatic spread to the pelvic lymph nodes. In addition
to surgical removal of the primary site and the pelvic lymph nodes, she is given systemic
chemotherapy aimed at killing any residual tumor cells outside of the pelvis.
37. Which of the following normal organs/systems will be most affected by the systemic
chemotherapy?
1. Gastrointestinal
2. Musculoskeletal
3. Respiratory
4. Central nervous
5. Endocrine
38. In question 37, the cells from the organ/system most likely to be affected by the chemo-
therapy 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
On taking the clinical history, the woman states that she had received a Pap smear every year
for the past 3 years and all had been reported to be within normal limits.
39. How often would you expect this unfortunate Pap smear false negative situation to
occur in the population having cervical cancer?
1. Less than 5%
2. 10%
3. 20% This question was dropped.
4. 30%
5. 50%
40. What would the answer be if she reported only having one negative Pap smear in the
prior 3 year period?
1. Less than 5%
2. 10%
3. 20% This question was dropped.
4. 30%
5. 50%
The following question is TRUE or FALSE:
41. In tissues containing reverting postmitotic cells, injuries will heal by a combination of
regeneration and repair.
1. True
2. False
42. An elderly patient having been diagnosed with Alzheimer's disease expires at home. He
is brought to the hospital for a postmortem examination. On viewing the patient's brain,
you find widened sulci and narrowed gyri on the cerebral cortex. Which of the following
processes has most likely occurred in this patient's brain?
1. Neoplasia
2. hyperplasia
3. Atrophy
4. Dysplasia
5. Hyperplasia
43. A 22 year old woman comes to the emergency room complaining of difficulty in
breathing and a worsening cough. Her medical history is significant for cystic fibrosis.
You diagnose probable pneumonia and suspect what microorganism?
1. Streptococcus
2. Pneumococcus
3. Pseudomonas
4. Aspergillus
44. Neutrophils (PMNs) are considered part of which arm of the body's defense system?
1. Local, innate
2. Systemic, innate
3. Humoral, acquired
4. Cellular, acquired
45. Patients with Kartagener's disease are susceptible to what form of opportunistic
disease?
1. Bronchiectasis
2. Lobar pneumonia
3. Hepatitis
4. Cystitis
46. The most immediate risk of infection in patients receiving chemotherapy follows reduction
in the quantity of circulating:
1. Antibody
2. Platelets
3. Neutrophils
4. T-cells
47. CMV pneumonitis in AIDS patients is almost always accompanied by:
1. Candidal pneumonia
2. Aspergillus pneumonia
3. Cryptococcus pneumonia
4. Pneumocystis pneumonia
48. Patients with isolated IgA deficiency are commonly:
1. Asymptomatic
2. Susceptible to staphyloccocal and streptococcal infections
3. Susceptible to pseudomonas infections
4. Susceptible to fungal and viral infections
49. Which of the following is NOT a light microscopic feature of lethally injured cells?
1. Cytoplasmic basophilia
2. Karyorrhexis
3. Karyolysis
4. Nuclear pyknosis
50. Which of the following is LEAST helpful in distinguishing post-mortem autolysis from necrosis?
1. Polymorphonuclear leukocyte infiltration
2. Karyorrhexis, karyolysis, and pyknosis
3. Zone of hyperemia
4. Localized wedge-shaped changes
51. The pattern of necrosis that is characterized by conversion of a single cell to an acidophilic body, usually with the loss of the nucleus but with preservation of its shape is termed:
1. Fibrinoid
2. Apoptotic
3. Liquifactive
4. Caseous
5. Gummatous
52. A well-developed infarct of the brain is associated with:
1. Coagulation necrosis
2. Enzymatic fat necrosis
3. Liquefaction necrosis
4. Gangrenous necrosis
5. Apoptosis
53. Which type of necrosis is most typically associated with pyogenic infection?
1. Fibrinoid
2. Enzymatic fat
3. Coagulation
4. Caseous
5. Liquefactive
54. The type of necrosis resulting from bacterial invasion of tissue dying from ischemia is called:
1. Caseous
2. Coagulative
3. Gangrenous
4. Gummatous
5. Septic
55. Anoxia can lead to each of the following changes in a cell EXCEPT:
1. Cloudy swelling
2. Nuclear pyknosis
3. Fatty change
4. Amyloid deposition
5. Cytoplasmic eosinophilia
56. Apoptosis is believed to have a key role in all of the following EXCEPT:
1. Developmental involution in the embryo
2. Regression of the lactating breast tissue after cessation of breast feeding
3. Cell death in tumors
4. Cell death due to hypoxia
5. Cell death in graft versus host disease
A 45 year old man who smokes and has elevated serum cholesterol experienced sudden onset of chest pain and shortness of breath while raking leaves. In the emergency department, an ECG (electrocardiogram) showed myocardial ischemia. Coronary angiography showed severe narrowing of his left anterior descending artery by atherosclerotic plaque. He underwent angioplasty (a procedure used to open the coronary artery lumen) and was admitted to the cardiac care unit. Over the next 36 hours, serial serum "cardiac" enzyme levels and ECGs were obtained. These indicated that the patient experienced myocardial ischemia but not a myocarial infarct.
57. Which of the following ultrastructural features would NOT be present in this patient's myocardium?
1. Small mitochondrial densities
2. Plasma membrane blebs
3. Disruption of the lysosomal membranes
4. Dissociation of polyribosomes
5. Mitochondrial swelling
The patient described in the preceding vignette is counseled to stop smoking, and begin a diet and exercise program aimed at reducing his serum cholesterol. Several weeks after discharge he experienced crushing chest pain and shortness of breath while out walking, and subsequently collapsed. Upon arrival in the emergency department, the ECG changes strongly supported a diagnosis of myocardial infarct.
58. Of the following ultrastructural features, which best distinguishes the patient's new myocardial injury from that in the previous vignette?
1. Myelin figures
2. Disruption of the plasma membrane
3. Swollen mitochondria
4. Detachment of ribosomes from rough endoplasmic reticulum
5. Dilation of endoplasmic reticulum
The patient in the previous vignette was admitted to the cardiac care unit and underwent coronary angiography which demonstrated occlusion of the left anterior descending artery, presumably by thrombus. Treatment with a thrombolytic agent was quickly instituted and resulted in lysis of the thrombus, with restoration of blood flow through the left anterior descending artery.
59. Which of the following biochemical events is NOT involved in the type of cellular injury which resulted from restoration of blood flow to this patient's ischemic myocardium?
1. Production of oxygen free radicals by neutrophils
2. Poisoning of the mitochondrial electron transport system
3. Inhibition of enzymes
4. Reactivation of ATP-dependent membrane pumps
5. Massive influx of calcium ions through the damaged membrane
60. All of the following statements are true of irreversible cell injury EXCEPT:
1. Nutritional and hormonal status play a role in determining susceptibility to irreversible cell injury.
2. The duration of ischemia required to induce irreversible injury varies with cell type.
3. Loss of plasma membrane integrity is a key event in irreversible cell injury.
4. Cell injury and death is a continuum of biochemical and structural events in which the "turning point" from reversible to irreversible cell injury is poorly understood.
5. Mitochondrial dysfunction resulting in ATP-depletion plays a minor role in irreversible cell injury.
61. Membrane damage in ischemic cell injury is related to all of the following biochemical events EXCEPT:
1. Increased intracellular calcium concentration
2. Inactivation of phospholipase
3. Decreased phospholipid synthesis
4. Lipid peroxidation
5. Enzymatic degradation of cytoskeletal proteins
62. Which statement about free radicals is FALSE?
1. Free radicals induce cell injury in a variety physical, chemical and infectious processes.
2. Peroxidation of membrane phospholipids is a key mechanism of injury.
3. Free radicals may undergo spontaneous decay.
4. Autocatalytic reactions play an important role in enhancing injury due to free radicals.
5. Endogenous antioxidants have only a minor role in the termination of free radical reactions .
63. The histologic hallmark of healing is:
1. Acute inflammatory infiltrate (neutrophils)
2. Dense mature scar
3. Granulation tissue
4. Fibrinous exudate
64. The major function of collagen in the extracellular matrix is:
1. Elastic recoil of tissue
2. Tensile strength
3. To mediate cell adhesion and migration
4. To initiate the process of healing
65. Which of the following is not a component of basement membranes:
1. Collagen Type IV
2. Laminin
3. Tissue fibronectin
4. Hyaluronic acid
66. Which of the following statements is NOT true:
1. Type I collagen is a fibrillar type of collagen.
2. Type III collagen is deposited in early stages of scar formation.
3. Integrin is a component of the extracellular matrix.
4. Integrins mediate cell-matrix interactions.
67. Which of the following statements about proteoglycans (glycosaminoglycans) is NOT
true:
1. They are components of the extracellular matrix.
2. They are positively charged.
3. They have hydrophylic properties.
4. They are tissure specific.
68. Which is a FALSE statement: The RGD sequence of amino acids:
1. Is present on elastic fibers.
2. Is recognized by cell integrins.
3. Is present in fibronectin.
4. Stands for Arginine, Glycine, Aspartate.
69. Which of the following statements about platelets is NOT true:
1. They release growth factors and chemotactants.
2. They synthesize collagen Type III.
3. They are part of a thrombus.
4. They are a component of blood clots.
70. The transformation zone of the cervix is the area within the female genital tract which is
most prone to the development of squamous neoplasia. Which of the following processes
is most likely to contribute to this high risk?
1. Hyperplasia of squamous mucosa
2. Atrophy of endocervical mucosa
3. Metaplasia of endocervical mucosa
4. Hypertrophy of squamous mucosa
5. Infection of chlamydia
71. "Nutmeg" liver" is a descriptive term for liver changes due to:
1. Petechial hemorrhages
2. Toxic hepatitis
3. Viral hapatitis
4. Chronic passive congestion
5. Active hyperemia
72. Widespread (rather than localized) edema is likely in:
1. Lymphatic obstruction
2. Capillary damage
3. Inflammation
4. Hypoalbuminemia
73. Transudates commonly result from:
1. Increased hydrostatic pressure
2. Altered osmotic pressure
3. Both
4. Neither
74. Causes of pulmonary edema include all the following except:
1. Acute myocardial infarction
2. Alcoholic cardiomyopathy
3. Left heart failure
4. Mitral valve stenosis
5. Pulmonic valve stenosis
75. Neurogenic, septic and cardiogenic shock are all characterized by:
1. Normal blood volume in early stages.
2. Need for blood transfusion.
3. Peripheral vasodilatation at onset.
4. Progression to irreversible shock.
76. At autopsy a patient was found to have hemosiderin-laden alveolar macrophages, "nutmeg"
liver, hydrothorax, and leg edema. The patient had:
1. Left heart failure
2. Right heart failure
3. Both
4. Neither
77. Disseminated intravascular coagulation is:
1. Characterized by massive pulmonary embolism
2. Initiated by platelet deficiency
3. Initiated by platelet excess
4. Characterized by both thrombosis and bleeding
5. Rarely life threatening
78. Vascular injury may induce:
1. Vasoconstriction
2. Platelet adhesion
3. Activation of the intrinsic coagulation system
4. Activation of the extrinsic coagulation system
5. All of the above
79. Factor VIII deficiency is associated with prolonged:
1. Bleeding time
2. Clotting time
3. Both
4. Neither
80. Which findings indicate chronic hemorrhage?
1. Hematocrit 20%, melena (tarry black stools), hypotension
2. Hematocrit 20%, occult fecal blood, iron deficiency anemia
3. Both
4. Neither
81. Qualitative platelet defects (thrombasthenia, thrombopathia) cause prolonged:
1. bleeding time
2. partial thromboplastin time
3. prothrombin time
4. thrombin time
82. A patient is brought to your office 30 minutes after cutting his foot with an ax. He claims to have lost "a bucket of blood". Which of the following, if obtained immediately, would be the LEAST helpful in determining the amount of blood lost?
1. A history of fainting after the hemorrhage
2. The presence of postural hypotension
3. A blood volume determination
4. Hemoglobin and hematocrit determinations
5. Examination for skin pallor.
83. Platelets have each of the following functions in hemostasis and thrombosis EXCEPT:
1. Activation of thrombin to cause fibrin formation
2. Adherence to damaged vessel walls
3. Clot retraction
4. Formation of hemostatic plugs in damaged capillaries
5. Release of plasminogen activator.
84. Amyloidosis is usually diagnosed by:
1. Serum amyloid levels
2. Biopsy
3. Both
4. Neither
85. Amyloidosis is associated with:
1. Tuberculosis
2. Multiple myeloma
3. Chronic osteomyelitis
4. Rheumatoid arthritis
5. All of the above
86. Which of the following pigments stains postively with the commonly used Prussian blue stain for iron?
1. Hematin
2. Bile
3. Hematoidin
4. Hemosiderin
5. Lipofuscin
87. In a condition called "brown atrophy of the heart", which is found in elderly patients, the brownish discoloration is produced by an increase in perinuclear, membrane-bound particles containing the pigment:
1. Hematin
2. Bile
3. Hematoidin
4. Hemosiderin
5. Lipofuscin
88. All of the following pigments are related to hemoglobin EXCEPT:
1. Hemosiderin
2. Porphyrins
3. Bilirubin
4. Melanin
89. Metastatic calcification is NOT characteristically
1. Associated with hypercalcemia
2. Found in brain, liver, and bone
3. A systemic condition
4. Found in living tissues
5. Found in kidneys, stomach, and lungs
90. Dystrophic calcification is associated with:
1. Necrosis
2. Altered calcium metabolism
3. Both
4. Neither
SLIDE QUESTIONS
91. This slide depicts a mucicarmine stain from a lung tissue specimen in a transplant recipient.
The opportunistic agent is most likely:
1. Cytomegalovirus
2. Cryptosporidium parvum
3. Cryptococcus neoformans
4. Toxoplasma gondii
92. This slide depicts an H & E stain from a lung tissue specimen in a transplant recipient.
The opportunistic agent is most likely:
1. Cytomegalovirus
2. Cryptosporidium parvum
3. Cryptococcus neoformans
4. Toxoplasma gondii
Questions 93 and 94 refer to the same patient.
93. A 57 year old man has a history of hypertension. He come to the hospital complaining of crushing chest pain and a myocardial infarction is diagnosed. Microscopic hematuria is an incidental finding on urinalysis. He dies of cardiac arrhythmia. At autopsy, the gross appearence of his kidney is caused by:
1. Liquefactive necrosis
2. Coagulative necrosis
3. Caseous necrosis
4. Enzymatic fat necrosis
5. Gummatous necrosis
94. This is the microscopic appearance of the kidney from the previous question. The etiologic agent is most likely:
1. Ascending infection by pyogenic bacteria
2. Hematogenous infection by pyogenic bacteria
3. Partial digestion by proteases
4. Emboli of atherosclerotic debris
5. Hematogenous infection by Mycobacteria
Questions 95-98 all refer to the same patient.
95. An elderly man is found collapsed in the street. His breath smells of alcohol. In the emergency room he is found to have grossly bloody stool. The appearence of his rectal mucosa is most consistent with:
1. Ulcerative colitis
2. Amebic ulceration
3. Varicose veins
4. Pinworm infestation
5. Pseudomembranous colitis
96. This is the histologic appearence his liver. The pathogenesis of his bloody stool is related to:
1. Portal hypertension
2. Decreased hepatic synthesis of clotting factors
3. Both
4. Neither
97. The patient dies. This is the histologic appearence of his kidneys. The pathogenesis of this change is related to:
1. Alcohol-induced microtubular degeneration
2. Hypoxic damage to tubular cells
3. Concurrent viral infection
4. Fatty metamorphosis
98. Structures such as this are found in his lungs. The pathogenesis is related to:
1. Aspiration of Pneumococci
2. Opportunistic infection with Coccidioidomycosis
3. Primary Tuberculosis
4. Recurrent Tuberculosis
5. Aspiration of food particles
Questions 99 and 100 refer to the same patient.
99. A middle-aged woman comes to her doctor complaining of swelling of one leg. She collapses on the elevator while going to radiology. This is the histologic appearence of her lung. If she had had her chest radiograph it would have shown:
1. Multiple nodular densities
2. One or more subpleural densities
3. Dense pulmonary arteries
4. Dense pulmonary veins
5. A hilar mass density
100. This is another finding from her lung. It indicates she has had a previous:
1. Granulomatous infection
2. Aspiration pneumonia
3. Pulmonary infarction
4. Pulmonary embolism
5. Episode of left heart failure
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