DAVAO MEDICAL SCHOOL FOUNDATION
College of Medicine
GENERAL PATHOLOGY
Chapter 1 CELLULAR ADAPTATIONS, CELL INJURY, AND CELL DEATH
QUESTIONS:
______1. Acetaminophen may be toxic under certain conditions, for example if taken in large amounts together with alcohol. It has been shown that the toxicity of acetaminophen is mediated by oxygen radicals, which are produced in large amounts and due to the depletion of an important scavenger molecule that normally inactivates hydrogen peroxide. Name that cytosolic scavenger of oxygen radicals.
A. Catalase
B. Iron
C. Oxidase
*D. Glutathione
______2. A patient with autoimmune hemolytic anemia was transfused with 24 blood units over a period of 3 years. He died of pneumonia. At the autopsy the liver was dark brown and contained increased amounts of Prussian blue positive pigment. Name this pigment.
*A. Hemosiderin
B. Carbon
C. Lipofuscin
D. Melanin
______3. A coal-miner suffered from chronic bronchitis and emphysema. At autopsy the lungs appeared black. The mediastinal lymph nodes were also black. Although you have no histologic slide, you can still make unequivocally the diagnosis of
A. Alkaptunuria
B. Ochronosis
C. Hemosiderosis
*D. Anthracosis
______4. At autopsy of a 60 year old man who died of myocardial infarction, histologically the heart demonstrated: loss of nuclei, loss of cell outlines, deeply eosinophilic staining of the cytoplasm and a loss of cross striation of cardiac myocytes. This heart shows signs of
*A. Coagulative necrosis
B. Fat necrosis
C. Caseous necrosis
D. Liquefactive necrosis
______5. A mediastinal lymph node of a patient who died of miliary tuberculosis was examined histologically. There were numerous granulomas, the central areas of which were composed of amorphous granular material. On gross examination these lymph nodes appear yellow-white, and are a typical example of
A. Coagulative necrosis
B. Fat necrosis
*C. Caseous necrosis
D. Liquefactive necrosis
______6. Following a fracture the leg was placed into a cast. Six weeks later the skeletal muscle cells appear angulated in histologic sections. These cells have reduced energy requirements. The muscles of the extremity are weak. Name the form of adaptation that occurred in this muscle.
A. Hypertrophy
B. Hyperplasia
*C. Atrophy
D. Metaplasia
______7. A chronic smoker presented to the hospital with relentless coughing. A bronchial biopsy was performed. It contained fragments of mature squamous epithelium with no evidence of nuclear atypia. This pathologic change is called
A. Hypertrophy
B. Hyperplasia
C. Atrophy
*D. Metaplasia
______8. Deposition of calcium salts in lymph nodes affected by tuberculosis is an example of a pathologic process called
A. Peroxidation
B. Lipolysis
C. Metastatic calcification
*D. Dystrophic calcification
______9. Multiple opacities in the cornea of a child given large amounts of vitamin D were found to contain deposits of calcium phosphate. This pathologic process is an example of
A. Peroxidation
B. Lipolysis
*C. Metastatic calcification
D. Dystrophic calcification
______10. A thrombus of the right coronary artery was lysed by infusion of plasminogen activator into the occluded coronary artery. A reperfusion injury was induced. Activated oxygen species that induced the injury was in part derived from the myocardial cells and in part from another source. Name that other source of oxygen radicals in this situation.
* A. Leukocytes
B. Thrombus
C. Plasminogen
D. Mitochondria
______11. Hydropic swelling of the cell is characterized by each of the following EXCEPT
A. increased number of cytoplasmic organelles
B. dilatation of cisternae of endoplasmic reticulum
C. impairment of cellular volume regulation
* D. influx of sodium into the cell
______12. Hypertrophic heart muscle cells contain increased amounts of
A. water in the sarcoplasmic reticulum
B. smooth endoplasmic reticulum
C. rough endoplasmic reticulum
* D. messenger RNA
______13. Erythroid hyperplasia of the bone marrow is often found in people who live
A. at sea level
* B. at extremely high altitude (10,000 feet)
C. in the equatorial jungles of Brasil
D. above the polar circle in Canada
Chapter 2 ACUTE AND CHRONIC INFLAMMATION
QUESTIONS:
______1. Formylated peptides derived from bacteria, leukotrienes derived from plasma membranes and complement fragments have in common that they all mediate a process important for formation of an exudate. This process is called
*A. Chemotaxis
B. Phagocytosis
C. Extravasation
D. Margination
______2. Which biogenic amine released from mast cells accounts for the increased vascular permeability at the site of inflammation?
A. Bradykinin
B. Interferon
C. Tumor necrosis factor -alpha
*D. Histamine
______3. The arachidonic acid derivations produced through the lipoxygenase pathway in neutrophils, mast cells and macrophages in bronchial asthma, and known as slow reacting substances of anaphylaxis belong to the group of chemical substances known collectively as
A. Prostaglandin
* B. Leukotrienes
C. Lipoxin
D. Histamine
______4. Hageman factor activates kallikrein, which in turn produces a polypeptide that is an important plasma derived mediator of increased vascular permeability. Name this substance.
*A. Bradykinin
B. Interferon
C. Tumor necrosis factor -alpha
D. Histamine
______5. Name the group of plasma proteins that upon activation form intermediate complexes and fragments which act as vasoactive mediators of inflammation, prime phagocytic cells for a more active response to bacteria, and act as chemotactic factors.
A. Hageman factor
B. Kinins
*C. Complement
D. Kallikreins
______6. Which plasma protein if activated by a variety of stimuli can initiate the clotting cascade, the fibrinolytic pathway and kinin production?
*A. Hageman factor
B. Kinins
C. Complement
D. Kallikreins
______7. The process in which fragments of complement or IgG bind to bacteria facilitating phagocytosis is called
*A. Opsonization
B. Margination
C. Extravasation
D. Adhesion
______8. The adhesion of leukocytes to the endothelial cells in the early stages of inflammation is preceded by changes in the blood flow, most notably apportioning of leukocytes to the peripheral parts of the blood stream. This process is called
A. Opsonization
*B. Margination
C. Extravasation
D. Adhesion
______9. Which process representing an essential aspect of inflammation is mediated by cell surface glycoproteins known as LFA, ICAM-1, GMP-140? ______
A. Opsonization
B. Margination
C. Extravasation
*D. Adhesion
______10. Name the mobile cell in tissue that actively presents the antigen to lymphocytes and by secreting interleukins, regulates lymphocyte function.
A. Neutrophil
B. Natural killer cell
C. Langerhans cell
*D. Macrophage
Chapter 3 TISSUE RENEWAL AND REPAIR: REGENERATION, HEALING, AND
FIBROSIS
QUESTIONS:
______1. Name the glycoprotein that is deposited early in wound healing and is known for its binding sites for fibrin, fibrinogen, collagen, and other components of the extracellular matrix.
* A. Fibronectin
B. Laminin
C. Fibrillin
D. Collagen
______2. ) Name the tissue filling the bottom of a non-healing wound that consists histologically of capillaries, fibroblasts, collagen, and a variable number of inflammatory cells.
A. Collagen
B. Granuloma
*C. Granulation Tissue
D. Fibrin
______3. Name the cell that accounts for the primary contraction of the wound. This cell has features of both a fibroblast and a smooth muscle cell.
A. Collagen
* B. Myofibroblast
C. Fibroblast
D. Myoblast
______4. An exuberant (hypertrophic) scar developed after plastic surgery in a 20 year old Afro-American woman. This complication of wound healing is called
A. Hypertrophy
* B. Scar
C. Granulation tissue
D. Keloid
______5. Name the family of transmembrane proteins that interact with the cytoskeleton and the extracellular matrix.
A. Fibrillin
B. Collagen
C. Fibrin
* D. Integrin
______6. Renal proximal tubule cells are capable of repair after tubular necrosis unless there is destruction of the
A. Extracellular matrix
B. Basement membrane
C. Upper layer of the epithelium
* D. A & B are correct
______7. What is the name of the process characterized by a growth of newly formed blood vessels, stimulated by growth factors? ______(Angiogenesis (Granulation Tissue).)
A. Fibrosis
B. Extravasation
*C. Angiogenesis
D. Granulation
______8. Bursting of a wound is called ______(Dehiscence.)
A. Contracture
* B. Dehiscence
C. Keloid
D. 2nd intenetion
______9. Name a growth factor derived from platelets that are capable of inducing new growth of mesoderm-derived components (fibroblasts, etc.) in wounds. ______(Platelet-Derived Growth Factor.)
* A. Platelet derived growth factor
B. Platelet factor
C. Interferon
D. Platelet growth factor
______10. Each of the following are examples of atrophy EXCEPT
A skeletal muscle following transection of its nerve
B skeletal muscles following long term immobilization
C ovary following hypophysectomy
D endometrium following administration of estrogen
E brain of an 100 year old man
Chapter 5 GENETICS
QUESTIONS:
______1. Worried parents come to your office concerned about an increased risk of transmitting genetic disease to their offspring. You reassure them that there is no increased risk of having a second, afflicted child even if their first child is born with:
A. Cleft lip
B. Hydrops fetalis
C. Albinism
* D. Torch embryopathy
______2. Neonatal lymphedema, short stature, infertility, normal intelligence, and coarctation of the aorta are
characteristics typical of which genetic abnormality?
A. Trisomy 21
* B. Turner syndrome
C. Any autosomal aneuploidy
D. Cri du Chat syndrome
E. Fragile X syndrome
______3. Epicanthal fold, Brushfield spots, dysplastic ears, megacolon, congenital heart disease, and a simian crease are all clinical features of a numerical abnormality of chromosome number:
A. 11
B. 17
C. 18
* D. 21
______4. Cardiovascular disorders, particularly dissecting aortic aneurysm, are the most common cause of death in which autosomal dominant disorder?
A. Neurofibromatosis
B. Familial hypercholesterolemia
C. Erhler-Danlos syndrome
* D. Marfan syndrome
______5. Inherited as an autosomal dominant trait:
* A. Neurofibromatosis type I
B. Cystic fibrosis
C. Alcaptonuria
D. Neimann-Pick disease
E. Gaucher disease
______6. The inheritance pattern of cleft lip and cleft palate is:
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
* D. Multifactorial
______7. An exchange of fragments of chromatids between non-homologous chromosomes may occur during the first meiotic division. This chromosomal structural abnormality is called:
A. Deletion
B. Inversion
C. Nondisjunction
D. Segregation
* E. Translocation
Chapter 6 DISEASES OF IMMUNITY
QUESTIONS:
______1. A 30 year old woman with leukemia was irradiated and transfused with bone marrow cells of a related donor. She developed skin rash, diarrhea and jaundice. What is the name of this disease?
A. Hypersensitivity reaction
*B. Graft vs. host reaction
C. Immune deficiency reaction
D. AIDS
______2. A complex of genes on chromosome 6, the products of which are important in antigen presentation, and for mounting an immune reaction to transplanted foreign tissues.
* A. Major histocompatibility complex
B. T-cell receptor
C. CD3 proteins
D. Human leukocyte antibody
______3. A skin biopsy in a 30 year old woman with a skin rash showed deposits of IgG and complement along the basement membrane in a granular pattern. The patient had positive ANA antinuclear anti ds-DNA antibody, arthritis and glomerular inflammation. Name this disease. ______
A. Amyloidosis
B. AIDS
*C. Sytemic lupus erythematosus
D. Scleroderma
______4. A 40 year old female presents with “tight”, atrophic skin, dyspnea (shortness of breath), esophageal dysphagia, Raynaud’s phenomenon and kidney disease. Skin biopsy shows markedly condensed connective tissue. What autoimmune disease could account for this constellation of symptoms?
A. Amyloidosis
B. AIDS
C. Sytemic lupus erythematosus
*D. Scleroderma
______5. A 40 year old man presents with hemoptysis, renal failure. He has antibodies to collagen type IV that react with glomerular basement membranes in a linear manner. Name this disease. ______
A. Systemic lupus erythematosus
B. Graft vs. host reaction
C. Serum sickness
*D. Goodpasture syndrome
______6. Name the mobile cell in tissue that actively presents the antigen to lymphocytes and by secreting interleukins, regulates lymphocyte function.
A. Lymphocyte
B. Plasma cell
*C. Macrophage
D. Neutrophils
______7. Each of the following represents a type II hypersensitivity (cytotoxic) reaction EXCEPT
A. Coomb's positive hemolytic anemia
B. myasthenia gravis
C. pemphigus vulgaris
* D. bronchial asthma
______8. A 28 year old female presents herself to your clinic complaining of a rash that worsens upon exposure to sunlight. She reports fatigue x 1 month and swollen, painful joints. Serology for anti-nuclear antibody and anti-double-stranded DNA are positive, in high titers. What is the best diagnosis?
A. dermatomyositis
B. graft vs. host reaction
C. rheumatoid arthritis
* D. type III hypersensitivity
______9. Severe myalgia (muscle pain), elevated CPK with MM isotype, and a rash involving the eyelids is characteristic of this disease.
* A. dermatomyositis
B. Goodpasture syndrome
C. graft vs. host reaction
D. mixed connective tissue disease
______10. A 40 year old female patient experiences a difficulty swallowing (due to esophageal fibrosis upon biopsy), myositis, and later in her course even develops arthritis. Anti-double-stranded DNA serology is negative, and serologic markers for dermatomyositis are not pathognomonic. A short course of corticosteroids seems to improve her condition somewhat. What is the best diagnosis?
A. dermatomyositis
B. Goodpasture syndrome
* C. mixed connective tissue disease
D. graft vs. host reaction
Chapter 7 NEOPLASIA
QUESTIONS:
______1. Each of the following statements concerning multi-stage carcinogenesis is CORRECT, EXCEPT
A. DNA damage is involved during initiation
B. requires a long time for tumors to evolve
C. occurs in animal models, but not in humans
D. involves multiple genetic events
* E. implicated in tumors of epithelial origin
______2. The following are common characteristics of metastatic cells EXCEPT
* A. often resemble primary tumor
B. spread by lymphatic vessels
C. vascular spread
D. invade basement membranes
E. incapable of degrading extracellular matrix
______3. Select the gene most likely associated with the condition. A 50 year old woman presents to her physician with fatigue, fever and splenomegaly. Blood work-up indicates granulocytic leukocytosis in peripheral blood (20,000/ul). Her physician diagnoses the patient as being in the early stages of chronic myelogenous leukemia.
A. Ki-ras oncogene
* B. c-src oncogene
C. BCR/abl oncogene
D. c-myc oncogene
______4. Select the gene most likely associated with the condition. A 2 cm mass is removed from a 45 year old woman's breast. Frozen sections are prepared and the diagnosis from the surgical pathologist is ductal adenocarcinoma, grade three. As the attending physician, you request that the pathologist perform immunohistochemistry staining for this oncogene product to assist you in predicting this woman's prognosis.
A. Ki-ras oncogene
B. c-src oncogene
* C. BCR/abl oncogene
D. c-myc oncogene
______5. Select the MOST LIKELY tumor suppressor gene to be implicated. A 42 year old woman patient visits her physician for a yearly examination and a 1 cm lump is detected in her left breast. An excisional biopsy is performed and the diagnosis is grade 2 adenocarcinoma. Further examination of the above patient's family history reveals that she has a mother and sister who both have had breast cancer diagnosed before menopause. It is likely that these women have inherited a germline mutation in this tumor suppressor gene.
* A. p53
B. Rb
C. Wilms tumor gene
D. APC gene
______6. The following are common characteristics of metastatic cells EXCEPT
* A. often resemble primary tumor
B. spread by lymphatic vessels
C. vascular spread
D. invade basement membranes
E. incapable of degrading extracellular matrix
______7. Which of the following statements regarding oncogenic DNA viruses is CORRECT?
A. transforming genes are homologous to c-oncs
B. play no role in human cancers
C. only one connected with human cancer is HTLV-1
* D. produce proteins capable of inactivating Rb and p53
E. cause cancer by insertional mutagenesis.
______8. Each of the following factors can contribute to weight loss in a cancer patient EXCEPT
A. anorexia
B. decreased food intake
* C. lowered metabolic rate
D. reduction of stored fat due to TNF
E. depression
______9. Select the most likely gene product. A nuclear protein which can induce apoptosis or alternatively can cause cell cycle arrest by turning on expression of cyclin inhibitors.
A. Ras p21
B. HER2/neu
* C. BCR/abl
D. PDGF
______10. Select the most likely gene product. A nuclear protein which controls cell cycle by regulating the entry into S phase by binding up essential transcription factors.
A. Ras p21
* B. HER2/neu
C. BCR/abl
D. PDGF
Chapter 9 ENVIRONMENTAL AND NUTRITIONAL PATHOLOGY
QUESTIONS:
______1. A patient with anorexia, dyspnea, a smooth sore tongue, numbness and tingling of feet, and mild paralysis of legs, was found to have megaloblastic anemia which was not reversed by folate therapy. What was the vitamin deficiency?
*A. Vitamin B12
B. Vitamin B1
C. Vitamin B6
D. Vitamin A
______2. An infant developed petechial hemorrhages 5 days following birth. Deficiency in what vitamin might have been contributory?
A. Vitamin A
B. Vitamin D
C. Vitamin E
*D. Vitamin K
______3. ) A chronic alcoholic developed signs and symptoms of beriberi (Wernicke encephalopathy, cardiac failure, sight loss, peripheral neuropathy, muscle wasting, edema). What was the vitamin deficiency?
A. Vitamin B12
*B. Vitamin B1
C. Vitamin B6
D. Vitamin A
______4. A patient presented with night blindness, keratomalacia, corneal ulceration and bronchopneumonia. What vitamin deficiency might be suspected?
*A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
______5. A woman was diagnosed as having diabetes, myocardial infarction and gallstones. She was suffering from the most common nutritional disorder in industrial counties. Name this disorder
A. Kwashiorkor
B. Marasmus
*C. Obesity
D. Beri-beri
______6. A patient presented with dermatitis, diarrhea and dementia. What is the most likely vitamin deficiency?
*A. Niacin
B. Pyridoxin
C. Ascorbic acid
D. Riboflavin
______7. A boy presented with irritability and ataxia, and was found to have hemolytic anemia, basophilic stippling of erythrocytes, and dark gray gingival pigmentation. Chronic poisoning with ______was diagnosed.
A. Chromium
B. Cobalt
C. Cadmium
*D. Lead
______8. A man was found semiconscious in his backyard beside a metal ladder, suffering from a burn on his hand and cardiac arrhythmias. What was probably the cause of his problem?
A. Heat stroke
*B. Electrical injury
C. Too much alcohol
D. High altitude illness
______9. A healthy adult running a marathon in the summer developed hot dry skin, cessation of sweating, lactic acidosis, hypocalcemia, and rhabdomyolysis. What is your diagnosis?______(Heat stroke.)
A. Heat cramps
B. Heat exhaustion
*C. Heat stroke
D. Hypothermia
______10. A boxer won his fight but received a black eye in the process. This lesion is best classified as
A. Laceration
*B. Contussion
C. Abrasion
D. Incision
______11. A severely depressed individual committed suicide by running his car engine in his closed garage. The cherry-red color of his tissues at autopsy is due to the presence of
*A. Carboxyhemoglobin
B. Nitrogen
C. Carbon monoxide
D. Hemoglobin
______12. A patient involved in a house fire was hospitalized with subepidermal bullae which eventually healed without skin grafts. These skin lesions represent
A. 1st degree burn
*B. 2nd degree burn
C. 3rd degree burn
D. 4th degree burn
______13. A boy, roller blading without knee and hand protection, fell and scraped his skin. Name this skin lesion.