MODUL 2 Special pathomorphology
Text tests
1 All of the following statements correctly describe hereditary spherocytosis, EXCEPT:
A. *Red blood cells have the membrane-associated protein spectrin
B. A mutation in the ankyrin gene is present in most cases
C. Hemolytic crisis
D. An aplastic crisis
E. Splenectomy is invariably therapeutic
2 Features of megaloblastic anemias include all of the following, EXCEPT:
A. Hypersegmented neutrophils
B. *Lackof the membrane-associated protein spectrin
C. Increased intramedullary hemolysis
D. Increased extramedullary hemolysis
E. Pancytopenia
3 All of the following statements correctly describe aplastic anemia, EXCEPT:
A. Production of all hematopoietic bone marrow elements is reduced
B. Chemical \ drug exposure is the most common cause
C. Fanconi's anemia represents an inherited form of the disease
D. No underlying etiology is evident in E0% of cases
E. * Splenomegaly is a characteristic clinical finding
4 Multiple myeloma is associated with all of the following features, EXCEPT:
A. Hypercalcemia
B. Renal failure
C. Amyloidosis
D. * Increased susceptibility to viral infections
E. Rouleau formation on peripheral smear
5 Osmotic fragility is characteristic of the erythrocytes in which of the following diseases:
A. Fanconi's anemia
B. Sickle cell anemia
C. Glucose-6-phosphate dehydrogenase deficiency
D. * Hereditary spherocytosis
E. Pernicious anemia
6 Iron-deficiency anemia is commonly associated with all of the following factors, EXCEPT:
A. Colon cancer
B. *Polycythemia
C. Gastrectomy
D. Normal menses
E. Pregnancy
7 Polycythemia vera is a proliferative disorder of stem cells that:
A. Has an X-linked recessive mode of transmission
B. Is associated with high levels of erythropoietin
C. Produces abnormalities in the red cell series only
D. *Is rapidly fatal if untreated
E. Is compatible with a normal life span if treated
8 Increased blood viscosity (hyperviscosity syndrome) is major complication of all of the following disorders, EXCEPT:
A. Polycythemia vera
B. Immunoglobulin A myeloma
C. *"Hairy-cell" leukemia
D. Waldenstrom's macroglobulinemia
E. Heavy-chain disease
9 All of the following statements correctly describe nodular non- Hodgkin's lymphomas, EXCEPT:
A. They are often associated with a predictable chromosomal translocation
B. They have a better prognosis than diffuse lymphomas
C. They are characterized by cells with irregular nuclear contours
D. *They are commonly composed of neoplastic B cells
E. They are highly responsive to chemotherapy
10 All of the following features can be found in myeloid metaplasia with myelofibrosis, EXCEPT:
A. *Clonal proliferation of marrow fibroblasts
B. Giant platelets in the peripheral blood
C. Teardrop-shaped red cells in the peripheral blood
D. Elevated leukocyte alkaline phosphatase levels in the serum
E. Massive splenomegaly
11 Transformation to acute leukemia occurs as a complication of all of the following disorders, EXCEPT:
A. Paroxysmal nocturnal hemoglobinuria
B. Myeloid metaplasia with myelofibrosis
C. Aplastic anemia
D. *"Hairy-cell" leukemia
E. Polycythemia vera
12 Intermediate grade lymphomas include all of the following, EXCEPT:
A. Follicular, predominantly large-cell lymphoma
B. * Follicular, predominantly small cleaved cell lymphoma
C. Diffuse, small cleaved cell lymphoma
D. Diffuse, mixed small- and large-cell lymphoma
E. Diffuse large-cell lymphoma
13 Chronic myelogenous leukemia is characterized by all of the following features, EXCEPT:
A. Lack of alkaline phosphatase in circulating neutrophils
B. Extreme splenomegaly
C. Transition to acute leukemia
D. Philadelphia chromosomes in stem cells
E. * Transition to non-Hodgkin's lymphoma
14 Factor that provides for a definitive diagnosis of hemolytic anemia is which of the following:
A. Red blood cell antibodies
B. *Red blood cell destruction
C. Red blood cell enzyme deficiency
D. Bone marrow erythroid hyperplasia
E. Abnormal hemoglobin
15 A deficiency of the red cell membrane component spectrin causes which of the following diseases:
A. Pernicious anemia
B. * Hereditary spherocytosis
C. Sickle cell anemia
D. Thalassemia major E. Iron — deficiency anemia
E. -
16 Nonimmune hemolytic anemia occurs in patients with which of the following disease:
A. Systemic lupus erythematosus
B. * Malaria
C. Chronic lymphocytic leukemia
D. Hodgkin's disease
E. ALL
17 The disorder that most commonly causes iron deficiency anemia is which of the following:
A. Liver cirrhosis
B. Cardiomyopathy
C. * Peptic ulcer
D. Pancreatitis
E. Hemorrhagic stroke
18 The coagulation factor, reduced or absent in classical hemophilia is which of the following:
A. I
B. III
C. *VIII
D. X
E. XIII
19 The similarity between tha-lassemia major and thalassemia minor is which of the following:
A. Severity of anemia
B. Incidence of infection
C. Life span
D. * Familial occurrence
E. Homozygous form
20 Myelophthisic anemia can occur in patients with any of the following conditions, EXCEPT:
A. Miliary tuberculosis
B. Carcinomatosis
C. Myelofibrosis
D. Multiple myeloma
E. * Uremia
21 Patients with polycythemia vera show all of the following characteristic features, EXCEPT:
A. High platelet count (thrombocytosis)
B. High hematocrit
C. *High erythropoietin level
D. High mean age at presentation
E. Higher than average chance of stroke or myocardial infarction
22 All of the following etiologic associations with human acute leukemia have been proved valid, EXCEPT:
A. *Smoking
B. Irradiation
C. Antibiotics
D. Antineoplastic drugs
E. Benzene compounds
23 Transformation to acute leukemia may occur during the course of all of the following disorders, EXCEPT:
A. Polycythemia vera
B. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
D. *Hodgkin's disease
E. Myelofibrosis
24 Thrombocytopenia is commonly caused by all of the following factors, EXCEPT:
A. Folate deficiency
B. Myelofibrosis
C. * Chronic lymphocytic leukemia
D. Marked splenomegaly
E. Platelet sequestration
25 The diagnostic cell for Hodgkin's disease is which of the following:
A. Lymphocyte
B. "Foam cell"
C. *Reed-Sternberg cell
D. "Popcorncell"
E. Macrophage
26 Subtypes of Hodgkin's disease include all of the following, EXCEPT:
A. Nodular sclerosis
B. Mixed cellularity subtype
C. Lymphocyte predominance
D. * Nodular amyloidosis
E. Lymphocyte depletion
27 The diagnostic cell for multiple myeloma is which of the following:
A. T-lymphocyte
B. Eosinophile
C. Reed-Sternberg cell
D. * Plasma cell
E. "Popcorncell"
28 Multiple myeloma is characterized by the abnormal accumulation in tissues of which of the following substances:
A. Hyaline
B. Lipofuscin
C. * Amyloid
D. Hemosiderin
E. Melanin
29 Burkitt lymphoma is characterized by which of the following nistologic appearances:
A. *"Starrysky" appearance
B. Infiltration of plasma cells
C. Presence of " foam cells "
D. Presence of Reed-Sternberg cells
E. "Glassy " appearance of the cells
30 Mixed cellularity type of Hodgkin's disease is characterized by the presence of all of the following cells, EXCEPT:
A. Reed-Sternberg cells
B. Lymphocytes
C. Plasma cells
D. Macrophages
E. *"Heart failure " cells
31 Acute rheumatic carditis is characterized by all of the following, except:
A. Unremarkable gross appearance of the heart
B. The Aschoff bodies in myocardium
C. Diffuse nonspecific myocarditis
D. The Aschoff bodies in joints
E. *"Tigered effect" gross appearance
32 All of the following are stages of the atherosclerotic plaque development, except:
A. *Fibrinous plaque
B. Fibrous plaque
C. Fibrofatty plaque
D. Atheromatous plaque
E. Fibrolipid plaque
33 All of the following components can be found in the necrotic center of atheromatous plaque, except:
A. Cell debris
B. Cholesterol crystals
C. "Foam" cells
D. *Glycogen granules
E. Calcium crystals
34 All of the following factors may contribute to vasoconstriction, except:
A. *Acute coagulation factor
B. Behavioral factors
C. Neurogenic factors
D. Increased release of vasoconstric-tive agents
E. Increased sensitivity of vascular smooth muscles to constricting agent
35 Aschoff giant cells are large mesenchymal cells and are believed to be derived from which of the following:
A. *Macrophages
B. Fibroblasts
C. Lymphocytes
D. Eosinophils
E. Erythrocytes
36 Atherosclerosis commonly affects the arteries supplying all of the following organs, except:
A. *Upper extremities
B. Lower extremities
C. Heart
D. Brain
E. Kidney
37 Blood vessels affected in atherosclerosis are which of the following:
A. Aorta only
B. *Aorta and large arteries
C. Large arteries and large veins
D. Large veins
E. Aorta and arterioli
38 Blood vessels affected in systemic hypertension are which of the folowing:
A. *Arterioli
B. Aorta and large arteries only
C. Aorta only
D. Large arteries and large veins
E. Venules
39 Changes in the aging heart are all of the following, except:
A. Decreased left ventricular cavity size
B. Epicardial coronary artery tortuosity
C. Decreased subepicardial fat
D. Brown atrophy of myocardium
E. *Increased number of inflammatory cells in myocardium
40 Cholesterol-laden macrophages and smooth muscle cells in atheromatous plaque are also referred to as:
A. Giant cells
B. "Popcorn" -cells
C. Epithelioid cells
D. Vacuolated cells
E. *"Foam" cells
41 Coronary artery supplying blood to the anterior part of the inter-ventricular septum is which of the following:
A. Left main coronary artery
B. Left anterior descending artery
C. *Right coronary artery
D. Left circumflex coronary artery
E. Proximal marginal coronary artery
42 Etiologically and pathogenetically, rheumatic fever and rheumatic heart disease are characterized by all of the following, except:
A. Initial attack of illness some weeks after streptococcal infection
B. Elevated serum titers of antibodies to streptolysin and hyaluronidase
C. Sterile tissue lesions not resulting from direct bacterial invasion
D. Recurrent acute illness following the streptococcal infection
E. *Decreased serum protein levels
43 Fibrosis bridging across the valvular commissures and calcification in chronic rheumatic heart disease cause which of the following:
A. *Fish mouth or buttonhole stenosis
B. "Tigered effect"
C. Fibrofatty atheromas
D. Starry sky appearance
44 Heart lesions in acute rheumatic fever are called as which of the following:
A. Tuberculoma
B. *Aschoff bodies
C. Foreign bodies
D. Gumma
E. Mitral stenosis
45 Infective endocarditis is characterized by all of the following, except:
A. Microbic invasion into the heart valves
B. Destructive vegetation formation
C. Mural thrombosis
D. Destruction of the underlying cardiac tissues
E. *Amyloid mass deposition
46 Coronary artery suppying blood to the posterior portion of the interventricular septum is which of the following:
A. Left main coronary artery
B. Left anterior descending artery
C. *Right coronary artery
D. Left circumflex coronary artery
E. Proximal marginal coronary artery
47 Material accumulated in macrophages and smooth muscle cells in atherosclerotic plaque is which of the following:
A. Glycogen
B. Lipohyaline
C. Triglycerides
D. *Cholesterol or cholesterol esters
E. Lipoproteids
48 Material deposited in arteriolar walls in systemic hypertension is which of the following:
A. Amyloid
B. Glycogen
C. Cholesterol or cholesterol esters
D. Lipoprotein
E. *Hyaline
49 Microscopically, chronic rheumatic heart disease is characterized by all of the following, except:
A. Diffuse fibrosis of leaflets
B. Neovascularization of leaflets
C. *Acute purulent inflammation
D. Destruction of original leaflet architecture
E. Aschoff bodies in perivascular connective tissue
50 Microscopically, most cases of acute myocarditis are characterized by all of th following, except:
A. Nonspecific inflammatory infiltrate
B. Variable amount of interstitial edema
C. Variable degree of myofiber degeneration
D. *Marked fibrosis of interstitium
E. Variable degree of myofiber necrosis
51 Microscopycally the vegetations of subacute infective endocarditis are characterized by all of the following, except:
A. Fibrosis
B. Microbic body calcifications
C. Chronic inflammatory infiltrate
D. *Granuloma formation
E. Granulation tissue at vegetation's bases
52 Nonembolic complications of infective endocarditis include all of the following, except;
A. Valvular insufficiency or stenosis with cardiac failure
B. Myocardial ring abscess
C. Suppurative pericarditis
D. Endocarditis of artificial valves
E. *Acute myocardial infarction
53 Nonbacterial thrombotic endocarditis is characterized by all of the following, except:
A. Mitral and/or aortic valve involvement
B. *Tricuspid valve involvement
C. Small (A to E mm), sterile vegetations
D. Vegetations along the line of valve closure
E. Systemic emboli development
54 On gross examination, the kidneys in systemic chronic hypertension are characterized by all of the following features, except:
A. Reduced in size and weight
B. Fine granularity on cortical surface
C. Grain leather-like cortical surface
D. *Hemorrhages on cortical surface
E. Narrowed cortical surface on section
55 Resulting from left-sided heart failure are all of these pathologic changes, except:
A. Brown induration of the lung
B. Hypoxic encephalopathy
C. Pulmonary edema
D. Prerenal azotemia
E. *Secondary amyloidosis
56 Secondary hypertension may be caused by all of the following diseases, except:
A. Acute glomerulonephritis
B. *Lobar pneumonia
C. Gushing's syndrome
D. Pheochromocytoma
E. Coarctation of aorta
57 Symptoms of cardiac dysfunction include all of the following, except:
A. Failure of the pump itself
B. *Disorders of blood coagulation
C. Obstruction of blood flow
D. Regurgitant blood flow
E. Disorders of cardiac conduction
58 Systemic emboli in infective endocarditis may occur because of all of the following, except:
A. Involvement of aortic and mitral valves
B. Severe valvular damage
C. Numerous amount of vegetations
D. Friable nature of vegetations
E. *Chronic heart insufficiency
59 Systemic embolism in infective endocarditis may cause infarcts in all of the following organs, except:
A. Brain
B. Kidneys
C. Heart
D. *Lungs
E. Spleen
60 The Anitschkow cells are characterized by all of the following, except:
A. Abundant amorphophilic cytoplasm
B. Central round-to-ovoid nucleus
C. Central disposed chromatin (caterpillar cells)
D. Monocytic cytogenesis
E. *B-lymphocytic cytogenesis
61 The antihypertensive substances produced in the kidney are all of the following, except:
A. Prostaglandines
B. Urinary kallikrein-kinin system
C. Platelet-activating factor
D. Nitric oxide
E. *Thromboxane
62 The Aschoff bodies consist of all of the following, except:
A. Lymphocytes (primarily T cells)
B. Anitschkow cells
C. *"Foam cells"
D. Fibrinoid degeneration
E. Plasma cells
63 The cardinal anatomic changes of the mitral (or tricuspid) valve in chronic rheumatic heart disease are all of the following, except:
A. *Leaflet softening
B. Leaflet thickening
C. Commisural fusion
D. Shortening and thickening of the tendinous cords
E. Fusion of the tendinous cords
64 The cells accumulating cholesterol or cholesterol esters in atherosclerotic plaque are which of the following:
A. Neutrophils
B. Lymphocytes and macrophages
C. *Macrophages and smooth muscle cells
D. Mesenchymal cells
E. Giant cells.
65 The chronic endothelial injury in atherosclerosis may be caused by all of the following factors, except:
A. Hyperlipidemia
B. Hypertension
C. Smoking
D. *Genetic defects
E. Immune reactions
66 The chronic endothelial injury in atherosclerosis includes all pathologic processes, except:
A. Increased endothelial permeability
B. Adhesion of blood monocytes to the endothelium
C. Adhesion of platelets to the intima
D. Insudation of lipoproteins into the vessel wall
E. *Regeneration of endothelial cells
67 The clinical consequences of valvular dysfunction depend on all of the following, except;
A. Valve involved
B. Sex of the patient