Magalong Exam Flashcards
(252 cards)
1
Q
An adaptive mechanism which involves increase in the number of cells:
a. hyperplasia
b. induction
c. hypertrophy
d. metaplasia
A
a. hyperplasia
2
Q
An adaptive mechanism that results in a decrease of cytoplasmic volume and no. of organelles:
a. dysplasia
b. neoplasia
c. atrophy
d. agenesis
A
c. atrophy
Atrophy is reduced size of an organ or tissue resulting from a decrease in cell size and number. (Robbins 8th ed, Chapter 1, page 9)
A decrease in cell size entails a decrease in cytoplasmic volume and no. of organelles. Agenesis is failure of development of cells and tissues. Dysplasia and Neoplasia are not adaptive mechanisms, they are “new growths” that ultimately result in cancer.
3
Q
In this type of cellular adaptation, there’s a marked increase in number of autophagosomes accompanied by a decrease in number of myofilaments, ER, and mitochondria A. hypertrophy B. hyperplasia C. atrophy D. metaplasia
A
C. atrophy
A decrease in cell size entails a decrease in cytoplasmic volume and no. of organelles.
4
Q
A reversible change or alteration in adult cells characterized by variation in size, shape and orientation: A. metaplasia B. dysplasia C. hyperplasia D. atrophy
A
B. dysplasia
Dysplasia is the change of adult cells in terms of size, shape and orientation. Metaplasia is change in cell type, but the change is uniform.
5
Q
An adaptive mechanism which involves an increase in cell size and girth:
a. hyperplasia
b. hypertrophy
c. increase n/c ratio
d. none of the above
A
b. hypertrophy
Hypertrophy refers to an increase in the size of cells, resulting in an increase in size of the organ. (Robbins 8th ed, Chapter 1, page 6).
6
Q
An adaptive mechanism which involves transformation of multipotential stem cells into cells not native to the injured cell:
a. dysplasia
b. anaplasia
c. metaplasia
d. hyperplasia
A
c. metaplasia
Metaplasia is the result of a reprogramming of stem cells that are known to exist in normal tissues, or of undifferentiated mesenchymal cells present in connective tissue. In a metaplastic change, these precursor cells differentiate along a new pathway. (Robbins 8th ed, Chapter 1, page 11)
7
Q
Clinical example of metaplastic phenomenon:
a. cardiomegaly
b. endometrial involution
c. liver regeneration
d. reflux in esophagus
A
d. reflux in esophagus
Metaplasia is an adaptive mechanism wherein one differentiated cell type is replaced by another which is more able to withstand adverse environmental conditions. This phenomenon can occur with persistent gastric acid reflux, which causes the squamous epithelial cells of the lower esophagus to be replaced by intestine-like columnar cells.(a.k.a. Barret’s esophagus)
8
Q
Cardiomegaly is an example of what condition?
A
hypertrophy
9
Q
Endometrial involution is an example of what condition?
A
Atrophy
10
Q
Liver regeneration is an example of what condition
A
Hyperplasia
11
Q
Clinical example of a hyperplastic phenomenon:
a. Barret’s esophagus
b. prolapsed ectocervix
c. gastric adenocarcinoma
d. hypertension
A
b. prolapsed ectocervix
Hyperplasia is the increase in the number of cells in an organ or tissue, leading an increase in its mass. Excess hormonal stimulation (estrogen) in females can cause abnormal proliferation and keratinization of the squamous epithelium of the ectocervix leading to prolapse.
12
Q
Barret’s esophagus is an example of what condition?
A
Metaplasia
13
Q
Gastric adenocarcinoma is an example of what condition?
A
Neoplasia
14
Q
Hypertension is related to what condition?
A
Hypertrophy
Hemodynamic overload can stimulate an increase in the size of myocardial cells.
15
Q
Clinical example of hypertrophic phenomenon:
a. Barret’s esophagus
b. myocardial infarct
c. tuberculoma
d. hypertensive cardiomegaly
A
d. hypertensive cardiomegaly
Hypertrophy is an increase in the size of individual cells, and hence, the size of the organ itself. Hypertension can increase the mechanical load on the heart and stimulate the myocardial cells to become larger and synthesize more proteins.
16
Q
Myocardial infarct displays an example of what type of necrosis?
A
Coagulative
Although it can be remotely related to hypertrophy (Cardiomegaly -> Heart failure -> M.I.), the association is vague.
17
Q
Non-neoplastic but tumor-like mass resulting from the enlargement of a caseated tubercle
A
Tuberculoma
The web definition may suggest that it can be associated with hypertrophy,
18
Q
Clinical example of an atrophic phenomenon:
a. Alzheimer’s disease
b. endometrial hyperesteremia
c. tuberculoma
d. splenic infarct
A
a. Alzheimer’s disease
Atrophy is the reduce in the size of an organ or tissue resulting from a decrease in cell size or number, and can be caused by decreased workload, denervation, diminished blood supply, inadequate nutrition, loss of endocrine stimulation or pressure. Progressive atrophy of the frontal and parietal regions of the brain can be seen in Alzheimer’s disease.
19
Q
Endometrial hyperesteremia is an example of what condition?
A
hyperplasia
20
Q
Splenic infarct will display ____________ and may involve complications such as organ rupture, hemorrhage or abscess formation.
A
coagulative necrosis
21
Q
Common sequelae of metaplastic phenomenon:
a. pulmonary failure
b. adrenocortical carcinoma
c. endometrial carcinoma
d. gastric carcinoma
A
d. Gastric carcinoma
Metaplasia is brought upon by chronic cellular irritation. Gastric adenomas, 30% of which progress to carcinomas, often occur in a background of chronic gastritis and intestinal metaplasia [Robbins]. Pulmonary failure is more likely due to atrophy or hypertrophy. Hyperplasia usually happens in glandular epithelium in response to hormonal stimulation. Adrenocortical carcinoma and endometrial carcinoma are preceded by hyperplasia.
22
Q
Common sequelae of hypertrophy:
a. pulmonary failure
b. cardiac failure
c. hematopoietic failure
d. esophageal adenocarcinoma
A
b. cardiac failure
In the heart, the stimulus for hypertrophy is usually chronic hemodynamic overload, resulting from either hypertension or faulty valves… Whatever the exact mechanism of cardiac hypertrophy, it eventually reaches a limit beyond which enlargement of muscle mass is no longer able to compensate for the increased burden, and cardiac failure ensues. (Robbins, 8th ed, page 6-7)
23
Q
Fibrinoid necrosis can be expected in: A. Diabetes B. Plasmacytoma C. SLE D. Fibrinous peritonitis
A
C. SLE
Systemic lupus erythematosus, often abbreviated to SLE or lupus, is a chronic autoimmune connective tissue disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage. SLE most often harms the heart, joints, skin, lungs, blood vessels… (Wikipedia, 6/27/10)
Fibrinoid necrosis is a special form of necrosis usually seen in immune reactions involving blood vessels. This pattern of necrosis typically occurs when complexes of antigens and antibodies are deposited in the walls of arteries. (Robbins, 8th ed, p 16-17)
Fibrinoid necrosis is seen in autoimmune diseases, eg. SLE. (Cell Injury, Death, and Adaptation 2014 Trans)
24
Q
Liquefactive necrosis is expected in: A. Cerebral infarct B. Splenic infarction C. Myocardial infarction D. Hydrocephalous vacuole
A
A. Cerebral infarct
For unknown reasons, hypoxic death of cells within the central nervous system often manifests as liquefactive necrosis. (Robbins, 8th ed, p.15)
Also, the heart and the spleen are end organs with high protein content. Thus, it would show coagulative necrosis instead. “Seen in myocardial infarction and splenic infarction” (Cell Injury, Death, and Adaptation 2014 Trans)
Hydrocephalus vacuole is an accumulation of CSF in the brain, not connected with necrosis. (Wikipedia - Hydrocephalus) <- not sure
25
```
Gangrenous necrosis can be expected in:
A. diabetic foot
B. diabetic granuloma
C. diabetic neuropathy
D. mucocele of appendix
```
A. diabetic foot
Gangrenous necrosis is not a specific pattern of cell death, but the term is commonly used in clinical practice. It is usually applied to a limb, generally the lower leg that has lost its blood supply and has undergone necrosis. (Robbins, 8th ed, p. 15)
26
Bacterial infection superimposed on coagulative necrosis, seen in diabetic foot and can smell horrible. (Cell Injury, Death, and Adaptation 2014 Trans)
Dry gangrene
27
Hyperplasia of fibroblasts that have necrosed. Neuropathy is caused by injury to nerve cells, not necessarily necrosis.
Granuloma
28
```
Caseation necrosis can be expected in:
A. filariasis
B. sarcoidosis
C. histoplasma
D. scrofula
```
C. histoplasma
Histoplasmosis is a rare disease (imagine that) that resembles tuberculosis when chronic and is normally associated with caseation necrosis. It is caused by the fungi Histoplasma capsulatum that primarily affects the lungs with granulomas present in biopsies. Filariasis involves a worm. Sarcoidosis is typically marked with NON-caseating granulomas. Scrofula is caused by Myobacterium tuberculosis but is however, a skin disease. (Wikipedia: Caseous necrosis)
29
```
Caseation necrosis is commonly seen in
A. viral infection
B. mycobacterium infection
C. vascular disorders
D. autoimmune disorders
```
B. mycobacterium infection
Simplified version: Caseation necrosis is commonly caused by Myobacterium (TB) some fungi (histoplasmosis) or some foreign bodies.
30
```
Coagulation necrosis can be expected in:
A. pulmonary infarct
B. intestinal infarct
C. cerebral infarct
D. splenic infarct
```
D. splenic infarct
Coagulation necrosis occurs in end arterial organs (kidney, spleen, heart). Only D fits the description. (cell injury and death)
31
The pattern of necrosis in myocardial infarction is:
a. coagulation necrosis
b. fat necrosis
c. liquetactive necrosis
d. caseation necrosis
a. coagulation necrosis
Coagulation necrosis occurs in end arterial organs (kidney, spleen, heart). Only D fits the description. (cell injury and death)
32
Which of the following is true:
A. gangrene refers to tissue necrosis with or without infection
B. acute inflammation does not occur around necrotic tissues
C. apoptosis usually does not cause inflammation
D. The blood vessels surrounding acutely inflamed tissues usually show progressive dilation from the time of injury
C. apoptosis usually does not cause inflammation
Apoptosis involves the lack of inflammatory response. (cell injury and death)
33
```
Necrosis is a characteristic of chronic inflammation:
A. leptospirosis
B. gummatous inflammation
C. plasmacytosis
D. tuberculosis
```
D. tuberculosis
Probably D because TB can induce chronic inflammation and is associated with caseation necrosis.
Maybe B: Gummatous inflammation is mostly associated with spirochaetal infections which in turn results to syphilis. It later leads to necrosis. (Wikipedia: Gummatous necrosis)
A is out because leptospirosis leads to hemorrhaging and not inflammation.
C is out. There is no evidence that shows plasmacytosis causing necrosis.
34
```
A 40y.o. patient having a lymphoma involving the lymph nodes in the paraaortic areas. Treated with chemotherapy results to loss of individual neoplastic cells through fragmentation of individual nucleus and cytoplasm. Over the weeks, lymphoma decreased in size as documented by abdominal CT scan. By which of the following mechanisms did the neoplasm primarily respond to the therapy?
A. coagulative necrosis
B. phagocytosis
C. autolysis
D. apoptosis
```
D. apoptosis
Fragmentation of the nucleus and cytoplasm and decrease in cell size are morphologies of apoptosis.
Necrosis causes increased cell size then later explosion of the cell and its contents, causing inflammatory response to neighboring cells. Autolysis (autophagy) may undergo apoposis or necrosis. Phagocytosis engulf the defective cell as a whole or in parts, so the cell will not necessarily break into fragments
35
```
A 43y.o. man has complained of mild burning substernal or epigastric pain following meals for the past 3 years. Upper GI endoscopy was performed and biopsies were taken of an erythematous area of the lower esophageal mucosa 3cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies demonstrated the presence of columnar epithelium with goblet cells. Which of the ff. mucosal alteration is most likely represented by these findings?
A. agenesis
B. hypertrophy
C. adenocarcinoma
D. metaplasia
```
D. metaplasia
Glandular metaplasia of the esophagus
1. Due to chronic acid reflux
2. Esophagus now has a glandular epithelium, which is more tolerant to acid than stratified squamous epithelium
36
A 59y.o. woman lost consciousness for an hour. Upon arousal she was unable to speak or move her right arm and leg. Angiography showed an occlusion in her left cerebral artery. Months later, a CT scan revealed a 5cm cystic mass on her left parietal lobe. This is a result of the resolution of a previous:
A. liquefactive necrosis
B. Coagulation necrosis
C. Fat necrosis
D. None of the above
A. liquefactive necrosis
* Primary biochemical process is autolysis
* Occurs in tissues with high fluid content
* Seen in brain infarcts and abscesses
Coagulation necrosis happens in end arterial organs like heart and spleen. Fat necrosis happens exclusively in intestinal mesentery, being caused by the action of pancreatic juices to damage the mesentery
37
A 19-year old recently gave birth to her first child. She started breastfeeding and continued for 2 years. Which of the following cellular processes that occurred during pregnancy which allowed her to do this?
A. Stromal hypertrophy
B. Epithelial dysplasia
C. Ductal epithelial metaplasia
D. Lobular hyperplasia
D. Lobular hyperplasia
Hyperplasia usually is the response of glandular tissue (breast) to increased hormonal stimulation (prolactin). The stroma is not responsible for breastmilk production. Epithelial dysplasia may predispose the patient to breast cancer. Ductual epithelial metaplasia may be caused by chronic irritation, which is not the case in breastfeeding.
38
Increased hormonal stimulation may cause cells to undergo
A. Metaplasia
B. Hyperplasia
C. Dysplasia
D. atrophy
B. Hyperplasia
39
A 80 y/o man dies from complications of Alzheimer’s disease. At autopsy his heart is small (250g) and dark brown on sectioning. Microscopically there is a light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance in the heart?
a. hemosiderin from reabsorbed hemorrhages
b. lipochrome from “wear and tear”
c. dystrophic calcifications
d. carbon pigments from anthracosis
b. lipochrome from “wear and tear”
No complications relating to the heart was mentioned in the case. You can assume that the case looks for findings in the normal aging cardiac muscle.
Lipofuscin or “wear and tear ” lipochrome pigment is an insoluble brownish-yellow granular intracellular material that accumulates in tissues like heart, liver and brain as a function of aging and atrophy.
Hemosiderin may happen in muscle tissue in case of trauma (bruises) that is resorbed in short time. Dystrophic calcifications and carbon pigments will not appear brown in H &E. Carbon is usually limited to the respiratory tract with inhalation of carbon.
40
A 20- year old woman had Goodpasture syndrome which progressed to chronic renal failure. She was 165 cm tall, weighed 55kg and had a blood pressure of 150/90 – 180/110 but she did not take regular medications. Lab studies showed her BUN over 100 mg /dl. She required chronic dialysis. She died from heart failure. At autopsy her height weighed 540g. the size of the heart is the result of:
a. hypertrophy
b. amyloid infiltration
c. post-infarct myocyte hyperplasia
d. fatty change
a. hypertrophy
Renal failure would have led to an increase in hemodynamic load. In order to compensate, the heart would have hypertrophied (since its cells are nondividing) to the point of failure.
Amyloidosis is a consequence of renal failure but does not explain the size of the heart. Myocytes do not divide therefore it could not have been hyperplasia. Fatty change, while observable in the heart, the history suggests that the chronicity of the condition and ultimate heart failure makes hypertrophy more likely.
41
A 43-year-old man has complained of mild burning substernal pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies show the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?
a. dysplasia
b. hyperplasia
c. metaplasia
d. carcinoma
c. metaplasia
This is characteristic of Barrett’s esophagus where chronic gastric reflux turns the squamous lining of the esophagus into the more tolerant intestinal-like columnar epithelium: a metaplastic process.
42
A 26- year old man had destruction of the aortic valve by Staphylococcus aureus. Autopsy of the spleen reveals presence of tan to white wedge-shaped 1.5 x 3 cm lesion with base on capsule. What is the possible pathogenesis?
a. coagulation necrosis
b. gangrenous necrosis
c. lymphoreticular hyperplasia
d. sinusoidal hypertrophy
a. coagulation necrosis
43
What type of necrosis do organs with end-artery vasculature such as the spleen, kidney and heart display?
Coagulative pattern of necrosis.
44
Type of necrosis that often refers to the extremities
Gangrenous necrosis
45
```
Alcoholic injury to the liver causes accumulation of
A. triglycerides
B. lipofuscin
C. hemosiderin
D. melanin
```
A. triglycerides
46
What illness is characterized by decreased mitochondrial fatty acid beta-oxidation, increased endogenous fatty acid synthesis or enhanced delivery of fatty acids to the liver, and deficient incorporation or export of triglycerides as very low-density lipoprotein.
Fatty liver disease
47
```
Metastatic calcification is exemplified in:
A. Atherosclerosis
B. Hyperparathyroidism
C. Serocalcific TB
D. Fibrocalcific TB
```
B. Hyperparathyroidism
Metastatic calcification occurs in viable tissues characterized by high serum calcium levels (hypercalcemia) due to increased PTH secretion, destruction of bone tissues, vit. D disorder, or renal failure.
48
```
Carbon dust in tissues
A. Orthosia
B. Hematosia
C. Anthracosis
D. Cacoprosia
```
C. Anthracosis
Anthracosis happens when macrophages in connective tissues of the respiratory tract accumulate carbon.
49
Refers to focal accumulation of carbon pigment lader macrophages is the connective tissues of lung parenchyma
a. steatosis
b. xanthoma
c. cholesterolosis
d. anthracosis
d. anthracosis
50
```
In vasculitis involving autoimmune inflammatory diseases, the type of necrosis is
A. Caseation
B. Fibrinoid
C. Enzymatic fat
D. Coagulation
```
B. Fibrinoid
This occurs when complexes of antigens and antibodies (present in autoimmune diseases like SLE) are deposited in walls of arteries (bright pink in H&E).
51
Type of necrosis usually seen in immune reactions involving blood vessels.
Fibrinoid necrosis
This occurs when complexes of antigens and antibodies (present in autoimmune diseases like SLE) are deposited in walls of arteries (bright pink in H&E).
52
Type of necrosis that usually occurs in tuberculous infection
Caseous necrosis
53
Type of necrosis that occurs in fatty tissues due to lipases (acute pancreatitis).
Enzymatic fat necrosis
54
Type of necrosis that stems from ischemic injuries where the dead tissue architecture is preserved for some days; becomes an infarct when localized; ghost cells present.
Coagulation necrosis
55
```
Induction of smooth endoplasmic reticulum is associated with:
A. barbiturates use
B. epidermolysis bullosa
C. lipofuscin accumulation
D. α1-antitrypsin deficiency
```
A. barbiturates use
sER is responsible for detoxification/metabolism of drugs.
Although hypertrophy usually refers to increase in size of cells or tissues, sometimes a subcellular organelle may undergo selective hypertrophy. For instance, individuals treated with drugs such as barbiturates show hypertrophy of the smooth endoplamic reticulum (ER) in hepatocytes, which is an adaptive response that increases the amount of enzymes (cytochrome P-450 mixed function oxidases) available to detoxify the drugs. Over time, the patients respond less to the drug because of this adaptation.
56
```
The very first manifestation of cell injury is:
A. Vacuolar degeneration
B. Pyknosis
C. Cytoplasmic eosinophilia
D. Chromatin condensation
```
D. Chromatin condensation
57
The earliest ultramicroscopic change in reversible injury.
Chromatin condensation
58
Type of damage found in the later stages of irreversible injury
Vacuolar degeneration and pyknosis
59
```
The chalky deposits present during fat necrosis are due to...
A. Steatosis
B. Necrosis
C. Saponification
D. None of the Above
```
C. Saponification
In fat necrosis, the destruction of mesenteric fats attract calcium, then calcium reacts with existing fat through saponification, forming chalk deposits in the mesentery.
60
Cellular deposition of fat
Steatosis
61
```
This disorder is associated with increased Apoptosis and Cell Death
A. Breast Cancer
B. Prostate Cancer
C. Thymic Involution
D. AIDS
```
D. AIDS
HIV (human immunodeficiency virus) invades CD4+ T cells, and one might assume that it this infection by HIV that causes the great dying-off of these cells. However, that appears not to the main culprit. Fewer than 1 in 100,000 CD4+ T cells in the blood of AIDS patients are actually infected with the virus. So what kills so many uninfected CD4+ cells? The answer is clear: apoptosis.
62
Why is thymic involution not a disorder?
The atrophy and apoptosis involved in it are physiologic.
63
Why are breast cancer and prostate cancer neoplasias?
Their apoptotic mechanisms are already impaired by their cancerous states. Recall that cancer thrives with the dysfunctional p53 gene, the key regulator of apoptosis in the cell cycle.
64
```
Generalized atrophy occurs due to
A. Tumor pressure
B. Denervation
C. Ischemia
D. Aging
```
D. Aging
| The other choices result to localized atrophy
65
```
The major mechanism of apoptosis in humans
A. Mitochondrial pathway
B. Death-receptor pathway
C. Reduction-oxidation reaction
D. Peroxidase
```
A. Mitochondrial pathway
There are only two mechanisms of apoptosis in humans: mitochondrial (major) pathway and death receptor (minor) pathway)
66
```
The protein, when released from an organelle to the cytoplasm, causes apoptosis?
A. Fas ligand
B. TNF
C. cytochrome c
D. Bcl-2
```
C. cytochrome c
● When the permeability of the mitochondrial membrane increases, several proteins can activate caspase cascade leak out. One of these proteins is cytochrome c. (Robbins 7th ed)
67
Specific death ligands that induce death through the extrinsic pathway.
Fas ligand and TNF
68
Example of an anti-apoptotic protein.
Bcl-2
69
```
Free radicals are generated by:
A. Glutathione peroxidation
B. Oxidative protein modification
C. UV-radiation
D. DNA cross-linking
```
C. UV-radiation
UV radiation provides sufficient energy to split oxygen or water to superoxides, a very potent free radical.
Glutathione peroxidation is an antioxidant mechanism. Oxidative protein modification and DNA crosslinking are not related to free radical formation.
70
```
Localized area of coagulation necrosis
A. abscess
B. infarct
C. gangrene
D. pus
```
B. infarct
Infarct is the localized area of coagulation necrosis.
71
Localized area for liquefactive necrosis
Pus
72
Coagulation necrosis with or without pus or abscess common in extremities
Gangrene
73
```
Which of the following conditions predisposes to neoplastic formation?
A. Physiologic hypertrophy
B. Physiologic hyperplasia
C. Metaplasia
D. Atrophy
```
C. Metaplasia
Physiologic change normally do not precipitate cancer. They are orchestrated by changes in workload due to mechanical or hormonal (hormones, growth factor) causes.
74
An adaptation of the cell to reduce its metabolism in times of scarce nutrients or oxygen.
Atrophy
75
Due to chronic irritation, and causes a change in the type of cell. Chronic irritation may cause DNA damage, favoring the formation of neoplasm
Metaplasia
76
Morphological characteristics of cellular aging?
A. Hemosiderin
B. Abnormal pleiomorphic vacuolated ribosomes
C. Abnormally lobed nucleus
D. Abnormally folded golgi
C. Abnormally lobed nucleus
77
Morphological alterations in cellular aging include:
1. Irregular and abnormal lobed nuclei
2. Pleomorphic vacuolated mitochondria
3. Decreased Endoplasmic Reticulum
4. Distorted Golgi apparatus
5. Accumulation of lipofuscin pigment
78
An iron-storage complex that is always found within cells (as opposed to circulating in blood) and appears to be a complex of ferritin, denatured ferritin and other material. Its presence is not confined to merely cellular aging.
Hemosiderin
79
In this solid tissue hypoxia-induced necrosis is due to autolysis rather than protein denaturation.
a. Kidney
b. Spleen
c. Brain
d. Liver
c. Brain
The brain, being an end-arterial organ is an exception, as infarcts cause liquefactive necrosis (a form of autolysis where exudates appear in the area of infarct)
80
Solid organ that undergoes autolysis
a. Brain
b. Lung
c. Kidney
d. Stomach
a. Brain
The brain, being an end-arterial organ is an exception, as infarcts cause liquefactive necrosis (a form of autolysis where exudates appear in the area of infarct)
81
```
In this organ, hypoxic death is due predominantly to antolysis rather than protein denaturation
A. lungs
B. GIT
C. Brain
D. Testis
```
C. Brain
The brain, being an end-arterial organ is an exception, as infarcts cause liquefactive necrosis (a form of autolysis where exudates appear in the area of infarct)
82
This type of necrosis has the following characteristics:
Primary biochemical process is autolysis
Occurs in tissues with high fluid content
Seen in brain infarcts and abscesses
Liquefactive Necrosis
83
Why is there no inflammation during apoptosis?
a. Rapid phagocytosis of apoptotic bodies
b. No enzymes in apoptotic bodies
c. No proteins inside apoptotic bodies
d. None of the choices
a. Rapid phagocytosis of apoptotic bodies
Once the budding has occurred, this extruded fragment will be an “apoptotic body.” These apoptotic bodies are membrane-bound and thus do not release cytoplasmic contents into the interstitium. Macrophages or other adjacent healthy cells subsequently engulf the apoptotic bodies. For these reasons, apoptosis does not incite an inflammatory reaction.
84
Free radicals damage the following
a. Mitochondria
b. Cell membrane
c. Both
d. Neither
b. Cell membrane
85
Irreversible nuclear change seen morphologically as fragmentation
a. Karyolysis
b. Pyknosis
c. Karyorrhexis
d. NOTA
c. Karyorrhexis
86
Nuclear change seen morphologically as condensation
Pyknosis
87
Nuclear change seen morphologically as fading or dissolving of nucleus
Karyolysis
88
The following involves dysrepair except
a. Apoptosis
b. Necrosis
c. Fibrosis
d. Cancer
a. Apoptosis
Apoptosis – physiologic and programmed cell death seen in embryogenesis, the epidermis and during menstruation. All others are pathologic
89
What describes an anemic infarct?
a. Common in organs with loose connective tissue
b. Wedge shaped
c. Common in liver
d. Common in lungs
b. Wedge shaped
90
White or pale infarcts caused by arterial occlusions, and are usually seen in the heart, kidney and spleen.
Anemic infarcts
91
Why are anemic infarcts called "white" or "pale" infarcts?
Lack of hemorrhaging and limited red blood cells accumulation, (compare to Hemorrhagic infarct).
92
```
City dwellers’ adaptation to air pollutants.
A. Squamous metaplasia
B. Glandular metaplasia
C. Osseous metaplasia
D. Bronchial mucous hyperplasia
```
A. Squamous metaplasia
The respiratory epithelium protects itself from chronic irritation due to air pollutants or cigarette smoke by converting its epithelium from simple ciliated columnar to stratified squamous epithelium
93
```
Changes in a chronic smoker
A. Squamous metaplasia
B. Glandular metaplasia
C. Osseous metaplasia
D. Bronchial mucous hyperplasia
```
A. Squamous metaplasia
94
Free readicals most commonly destroy the:
a) smooth ER
b) rough ER
c) nucleus
d) phospholipid bilayer membrane
d) phospholipid bilayer membrane
Of the three, the component attacked is the phospholipid bilayer membrane of the cell and its organelles. It is not specific to smooth ER, rough ER or nucleus.
The other molecular structures affected are proteins and enzymes and the DNA.
95
Which of the following is an example of an ultrastructure finding in reversible cell injury?
a) pyknosis
b) lysosomal rupture
c) blebbing
d) mitochondrial vacuolization
c) blebbing
96
Which of the following is an irreversible ultra structural change?
a. Lysosomal rupture
b. autophagy
c. chromatin clumping
d. endoplasmic reticulum swelling
a. Lysosomal rupture
97
The first manifestation of almost all cell injury
a. Fat accumulation
b. Dystrophic calcification
c. Hyaline
d. Cellular swelling
d. Cellular swelling
98
Pyknosis, mitochondrial vacuolization, and lysosomal rupture are associated with what condition?
Necrosis
99
An adaptation to digest organelles in times of nutrient scarcity.
Autophagy
100
May happen in reversible stages of cell injury
Swelling of ER and mitochondria
101
What’s the right sequence of cell change during injury/death?
a. Function retains until cell death
b. Function loss occurs RIGHT after cell death
c. Cell death precede all functional & histologic change
d. Ultrastructural changes antedate eosinophilic changes
d. Ultrastructural changes antedate eosinophilic changes
102
Sequence of events in cell injury and death
1. Cell function ceases
2. Biochemical alterations (cell death may happen here)
3. Ultrastructural alterations (electron microscope)
4. Light microscopic changes (eosinophilia)
5. Gross morphologic changes.
103
True of saponification in enzymatic fat necrosis:
a) Release of enzymes in hypercalcemic milieu
b) Release of fatty acids despite normal calcium levels
c) Neutrophile digestion and calcium deposition
d) None of the above
b) Release of fatty acids despite of normal calcium levels
In fat necrosis:
There is no hypercalcemia involved.
The chalk is formed with serum calcium directly reacting with fat released from enzymatic digestion of mesenteric fat.
Neutrophils are responsible for inflammatory reaction around the area of fat necrosis.
104
Preservation of cellular outline but with loss of cellular detail is due to:
a. Protein denaturation
b. autolysis
c. autophagy
d. infarction
a. Protein denaturation
In coagulative necrosis, the injury denatures not only the structural proteins but also enzymes, which blocks the proteolysis of dead cells. This preserves the outline of the dead cells.
105
A 35- year old woman developed icterus over the last week of her life. Lab studies show her to be hyperammonemia. She is found at autopsy to have 3500g liver with uniform, yellow, greasy cut surface. No necrosis of hepatocytes. Which of the following would cause the see condition in the patient?
a. galactosemia
b. hemochromatosis
c. TB
d. malnutrition
d. malnutrition
Malnutrition is often characterized by hepatomegaly and fatty change in the liver, as well as hyperammonemia as in kwashiorkor. While galactosemia could show the same symptoms, it is more likely to be complicated in infants and controlled in adults. Hemachromatosis is iron overload hence the liver will look brown and not yellow. TB would include signs of necrosis.
106
A 20-year old man is involved in a motor vehicle accident, which resulted in multiple blunt trauma with laceration to his lower extremities. The left femoral artery is lacerated and he incurs extensive blood loss and remains hypotensive for hours during transport to the emergency department. On admission hematocrit is 12%. Which of the following tissue is most likely to withstand impact of the events with least damage?
a. Skeletal muscle
b. Small intestine epithelium
c. Retina
d. Myocardium
a. Skeletal muscle
| Skeletal muscles are most tolerant to hypoxia, with vast glycogen stores and capacity for anaerobic respiration.
107
A 55- year old man has a 30 year history of poorly managed DM. His right foot had black discoloration and softness, with areas of yellow exudates. Upon amputation, what pathological process is expected?
a. enzymatic necrosis
b. gangrenous necrosis
c. coagulative necrosis
d. abscess formation
b. gangrenous necrosis
108
Coagulation necrosis with superimposed bacterial infection
Dry gangrene
109
Liquefactive necrosis with superimposed bacterial infection
Wet gangrene
110
A 45- year old man has traumatic injury to his forearms and incurs extensive blood loss. BP is 70/30. Which represents irreversible cell injury as a result of this injury?
a. cytoplasmic membrane blebbing
b. mitochondrial swelling
c. karyolysis
d. induction of ER
c. karyolysis
111
A 21-year old woman has a routine pap smear perform for a health screening exam. The pathology report indicates that some cells are found to cytologically have larger, more irregular nuclei. A follow- up cervical biopsy microscopically demonstrates disordered maturation of the squamous epithelium with hyper chromatic and peiomorphic nuclei extending nearly the full thickness of the epithelial surface. No inflammatory cells are present. Which of the following descriptive terms is best applied in these pap smear and biopsy findings?
a. dysplasia
b. metaplasia
c. anaplasia
d. hyperplasia
a. dysplasia
112
Characterized by a constellation of changes that include a loss in the uniformity of the individual cells as well as loss of architectural orientation.
Dysplasia
113
What is the most distinguishing feature of CPC of the liver?
a. Centrilobular necrosis
b. Hemosiderin laden macrophage
c. Presence of fat in hepatocytes
d. None of the above
a. Centrilobular necrosis
CPC of the liver:
o Right-sided heart failure => dilation of the central veins of the hepatic lobule => increased venous pressure is then transferred to the sinusoids => sinusoidal dilation and pressure atrophy of the centrilobular hepatocytes [leading to death of hepatocytes]
Gross: nutmeg liver
o Dark foci of centrilobular congestion surrounded by paler zones of unaffected peripheral portions of the lobules
114
Best describes inflammatory process:
a. If tissue injury is eliminated, inflammation resolves but normal tissue and physical function not restored
b. The affected area is walled off by collection of inflammatory cells. Destruction of tissue is caused by products of monocyte and forms abscess.
c. Failure to eliminate insult results in persistence of inflammatory response
d. Chronic Inflammation seldom leads to scar formation
c. Failure to eliminate insult results in persistence of inflammatory response
115
Which is not true of inflammation?
a. it involves multiple participants
b. it occurs in both living and non-living tissues
c. it involves multiple processes overlapping in a continuum
d. it may become harmful
b. it occurs in both living and non-living tissues
116
The chronic inflammatory response is not characterized by:
a. inflammation and prolonged during due to persistent of injurious agent
b. May develop as an insidious, low-grade subclinical process without history of a prior acute episode.
c. replacement of damaged tissues similar to that originally present
d. characterized by tissue infiltration with macrophages, lymphocytes and plasma cells or eosinophils.
c. replacement of damaged tissues similar to that originally present
(Damaged tissues are replaced by scar tissue)
117
Repair by fibrosis as opposed to healing by regeneration, is mainly characterized by:
a. replacement of injured tissue by parenchymal cells of the same type
b. replacement by connective tissue
c. starts as early as 24 hours
d. granulation tissue at 3-5 days.
b. replacement by connective tissue
118
In the process of Leukocyte Migration, transmigration is mainly characterized as:
a. initial rapid and loose adhesion
b. activation of leukocytes resulting in increased avidity
c. stable binding of integrins on activated leukocytes
d. directed migration of leukocytes
d. directed migration of leukocytes
119
In this process, the cytoskeletons of the leukocytes are reorganised in such a way that the leukocytes are spread out over the endothelial cells
Transmigration
120
Which of the following processes involves selectins?
a. Rolling
b. Adhesions
c. Transmigration
d. Chemotaxis
a. Rolling
121
Sequence of events in leukocyte inflammatory response
1. It first weakly attaches, or rolls over the endothelium, action mediated by selectins (Type E, P and L)
2. Attaches firmly to the endothelium through integrins
3. Transmigration towards the chemical gradient of the cytokines, in the process being activated, causing cytoskeleton changes, allowing it to creep through the gaps between endothelial cells towards the connective tissue stroma where inflammation is occuring
4. Through chemotaxis, it is guided toward the site of tissue injury.
122
Two processes in inflammation and repair: one requires the presence of neutrophils and edema while the other refers to fibrous tissue formation.
a. Acute Inflammation and Granulomatous Inflammation
b. Chronic Inflammation and Granulomatous Inflammation
c. Acute Inflammation and Granulation Tissue
d. Acute Inflammation and Fibrosis
d. Acute Inflammation and Fibrosis
123
In a wound with pus, the presence of neutrophils:
a. Is an indication of healing
b. Suggests that there is bacterial infection
c. Indicates that healing will progress more quickly
d. None of the above
c. Indicates that healing will progress more quickly
The presence of neutrophils indicate that the inflammatory response is active in the wound. Option (B) may also be correct because neutrophilia usually suggest bacterial infection in a chronic state.
124
Presence of fluid indicates:
a. suppurative inflammation
b. serous inflammation
c. granulomatous inflammation
d. chronic inflammation
b. serous inflammation
125
Type of inflammation that involves pus
suppurative inflammation
126
Type of inflammation that happens when the body cannot destroy the pathogen despite attempts to contain it (ie. TB)
Granulomatous inflammation
127
In order for an ulcer to progress:
a. Squamous cell metaplasia
b. Necrosis and acute inflammation must not stop
c. Fibrotic tissue must be removed
d. Formation of granulomatous tissue
b. Necrosis and acute inflammation must not stop
In ulcers, there is continuous necrosis and sloughing off of the necrosed tissue, as well as acute inflammation of the surrounding tissue. There is no fibrotic tissue involved. Since it happens near the surface, squamous cells necrose and slough off. Infection is not contained like in granuloma.
128
```
Gross examination of a heart showed pericarditis. The irregular masses of deeply eosinophilic acellular material at the surface of the pericardium on microscopic examination is:
A. fibrinous exudate
B. necrotic debris
C. thrombogenic material
D. granulomatous inflammation
```
A. fibrinous exudate
129
Examination of the pericardial tissue adjacent to this material are varying substances of granulation tissue and young fibrous tissue, which will eventually:
A. differentiate into pericardial adipose tissue
B. differentiate into fibrinous material and be cleared
C. undergo necrosis and removal
D. modified into dense fibrous tissue
D. modified into dense fibrous tissue
130
Develops when the vascular leaks are large or there is a local procoagulant stimulus (e.g., cancer cells) and is characteristic of inflammation in the lining of body cavities, such as the meninges, pericardium (Fig. 2–19A) and pleura.
Fibrinous exudate
131
```
Examination of inflamed tissue shows loose connective tissue with numerous small blood vessels and plump endothelial cells. This pathologic process is:
A. Granulomatous inflammation
B. Granulation tissue
C. Granulomatous fibrosis
D. Granulation inflammation
```
B. Granulation tissue
132
```
Based on the varied nature of inflammatory processes to different organisms, which etiology in addition should be considered when suppurative inflammation is characterized?
A. bacterial infection
B. viral infection
C.fungal infection
D. rickettsial infection
```
A. bacterial infection
133
These cells show up in bacterial infection
Neutrophils
| pus is a collection of dead leukocytes, mostly neutrophils, released in suppuration
134
These cells show up in viral infection
Lymphocytes
135
These cells show up in parasitic infection
Eosinophils
136
```
A liver showed multinodular aggregation of macrophages with numerous cytoplasm. What do these nodules represent?
A. foci of granulomatous inflammation
B. fibrosis (i.e. scarring)
C. regenerating or healing hepatocytes
D. masses of chronic inflammation
```
A. foci of granulomatous inflammation
137
A focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells.
Granuloma
In the usual hematoxylin and eosin–stained tissue sections, the epithelioid cells have a pale pink granular cytoplasm with indistinct cell boundaries, often appearing to merge into one another.
138
A type of chronic inflammation characterized by activated macrophage with a modified epithelial like (epitheloid) appearance.
a. Granulomatous inflammation
b. Suppurative inflammation
c. Serous inflammation
d. Purulent inflammation
a. Granulomatous inflammation
139
Frequently, epithelioid cells fuse to form _____ in the periphery or sometimes in the center of granulomas. These _____ may attain diameters of 40 to 50 μm.
Giant cells
140
These cells have a large mass of cytoplasm containing 20 or more small nuclei arranged peripherally (Fig. 2–27). (Robbins, p 73-74)
Langhans-type giant cell
141
These cells have a large mass of cytoplasm containing 20 or more small nuclei arranged haphazardly (Fig. 2–27). (Robbins, p 73-74)
Foreign body–type giant cell
142
The repair of necrosis in the kidney is very different than that in the skin because of
A. different growth factors at the two sites
B. different proliferative capacity of cells
C. different nutritional status of the organs
D. different cell-to-cell communication
B. different proliferative capacity of cells
143
```
Histologic abnormality of a hypertophic scar in a skin specimen presents as:
A. chronic inflammation
B. granulation tissue
C.excess normal looking dermis
D. dermal collagen thick bands
```
D. dermal collagen thick bands
144
```
A 26 year old male with a long history of drug abuse died after developing progressive pulmonary failure with unproductive cough. The drug market is known to have drugs that were cut (diluted) with contaminants (i.e. Talc & White powder). Upon histological examination, granulomatous inflammation was found. The etiologic agent caused this pattern of injury because it was:
A. Infectious
B. Immunogenic
C. Toxic
D. Nondegradable
```
D. Nondegradable
Talc and white powder are inert foreign bodies that are difficult to eliminate by the body. Usually, macrophages try to ingest these materials, making these foreign bodies in the center of a granuloma (foreign body granuloma).
Infectious and immunogenic agents are another kind of granuloma, called immune granuloma.
145
```
In a case of viral myocarditis, the myocardium showed small clusters of lymphocytes on infected myocytes. The major pathologic process in the heart is:
A. acute inflammation
B. chronic inflammation
C. granulation tissue
D. granulomatous inflammation
```
B. chronic inflammation
Formation of clusters of lymphocytes refer to formation of tertiary lymphatic organs in areas near the injury. It is a hallmark of chronic inflammation.
146
In this type of inflammation, lymphocytes do not form clusters, as if they have already colonized the tissue.
Acute inflammation by viral myocarditis
147
Type of tissue that signals the start of scarring
Granulation tissue
148
T/F: Virus rarely develop into granulomatous inflammation
True
149
Myocardial infiltrates of mononuclear leukocytes are characteristic of:
A. acute viral myocarditis but not chronic viral myocarditis
B. chronic viral myocarditis but not acute viral myocarditis
C. neither chronic viral myocarditis or acute viral myocarditis
D. both chronic viral myocarditis or acute viral myocarditis
B. chronic viral myocarditis but not acute viral myocarditis
150
Acute inflammation is mediated by
Granulocytes
151
Chronic inflammation is mediated by
Mononuclear cells (monocytes, lymphocytes)
152
In bacterial killing/degradation, what is the main process?
a. Reactive oxygen species in lysosomes
b. Bactericidal permeability activity
c. Lysozymes
d. Lactoferrin
a. Reactive oxygen species in lysosomes
153
In acute inflammation, the main mechanism of killing performed by neutrophils is...
Phagocytosis followed by release of ROS in the phagosome by lysosomes.
154
Performed by membrane attack complex of the complement system
Bactericidal permeability
155
Tightly-controlled minor mechanisms that act and also affect nearby tissues.
Lysozymes and lactoferrin
156
The cytokines most important in directly producing the systemic inflammation in disease
a. IL-1 and IL-2
b. IL-1 and TNF
c. IL-1 and PDGF
d. TNF and PDGF
b. IL-1 and TNF
157
Endogenous pyrogens that cause fever
IL-1 and TNF
158
Which of the ff. is a “cell-derived inflammatory mediator”?
a. coagulation cascade: fibrin framework
b. bradykinin: pain
c. histamine: vasodilation
d. C3b: phagocytosis
c. histamine: vasodilation
159
Two kinds of inflammatory mediators
Cell derived and plasma derived.
160
Released by basophils and mast cells to induce vasodilation
Histamine
161
Produced by the liver and are classified under plasma derived mediators.
Coagulation proteins, kinins, and complement proteins
162
Which of the ff. events is mediated by histamine?
a. endothelial cell contraction
b. endothelial cell detachment
c. leukocytes adhere to endothelium and increase ROS leakage into endothelium
d. increased transcytosis
a. endothelial cell contraction
163
This factor induces angiogenesis and increases vascular permeability
a. FGF
b. VEGF
c. PDGF
d. TGF-b
b. VEGF
164
What does PDGF induce?
Angiogenesis and fibroblast reproduction
165
This factor induces chemotaxis and endothelial proliferation
a. FGF
b. VEGF
c. PDGF
d. TGF-b
a. FGF
166
TGF-b is not involved in:
a. neutrophil migration
b. monocyte chemotaxis
c. fibroblast migration
d. fibroblast proliferation
a. neutrophil migration
167
Type of collagen predominant in late, healing wounds
a. I
b. II
c. III
d. IV
c. III
168
Complete regeneration will most likely happen in which of the ff:
a. chronic inflammation w/ high proliferative capacity
b. chronic inflammation w/ low proliferative capacity
c. acute inflammation w/ ECM destruction
d. acute inflammation w/o ECM destruction
d. acute inflammation w/o ECM destruction
169
Which of the ff is a characteristic of secondary intention?
a. less intense inflammatory reaction
b. wound with extensive tissue loss
c. larger area of wound defect
d. smaller cells of granulation tissue
c. larger area of wound defect
170
What is CORRECT regarding acute inflammation?
A. It is triggered by histamine
B. It is a rapid response specific to the nature of the injury
C. It releases an exudate consisting of fibrin, eosinophils, and fluids.
D. None of the above
A. It is triggered by histamine
171
Which of the following is correct regarding chronic inflammation?
A. It always follows acute inflammation.
B. The key inflammatory cell is the macrophage.
C. IL-2 secreted by CD4+ T helper lymphocytes activates macrophages.
D. Transforming growth factor alpha triggers scarring.
B. The key inflammatory cell is the macrophage.
172
Which of the following is correct regarding granulomatous inflammation?
A. defined by the presence of granulomas
B. epithelial histiocytes are so called because they begin to express epithelial proteins like cytokeratins
C. it is a definitive characteristic of pyogenic granuloma
D. it is a definitive characteristic of tuberculosis
A. defined by the presence of granulomas
173
```
A 24-year-old man experienced painful urination 4 days following his bachelor party. A urethritis is suspected and Neisseria gonorrhea is cultured. What is the chemical mediator that causes pain?
A. Prostaglandin
B. Hageman factor
C. Bradykinin
D. Leukotriene B4
```
A. Prostaglandin or C. Bradykinin
174
A potent chemotactic agent and activator of neutrophils, causing aggregation and adhesion of the cells to venular endothelium, generation of ROS, and release of lysosomal enzymes (Robbins, p59)
Leukotriene B4
175
Initiates four systems involved in the inflammatory response:
(1) the kinin system, which produces vasoactive kinins;
(2) the clotting system, which induces formation of thrombin, which has inflammatory properties;
(3) the fibrinolytic system, which produces plasmin and degrades fibrin to produce fibrinopeptides, which induce infl ammation; and
(4) the complement system, which produces anaphylatoxins and other mediators. Some of the products of this initiation—particularly kallikrein—can, by feedback, activate this factor, resulting in amplification of the reaction (Robbins p66)
Activated Hageman factor (factor XIIa)
176
```
Neutrophils are attracted to the site of inflammation through which of the following mediators?
A. TNF and IL-1
B. ß-Catenin and L-Carnatin
C. Selectin and Magnolia
D. PGE1 and Thromboxane
```
A. TNF and IL-1
177
Induce endothelial expression of ligands for integrins, which causes firm attachment of neutrophils to the endothelium for its transmigration towards the site of injury.
TNF and IL-1
178
```
A 36 year old woman undergoes a laparoscopic procedure for her ovarian cysts. A 12 cm scar is left on the abdominal wall. How long before the original tensile strength is restored?
A. One month
B. Three months
C. Six months
D. One year
```
D. One year
179
The most common mechanism facilitating increased vascular permeability
A. Endothelial injury
B. leukocyte – mediated endothelial injury
C. Gaps due to endothelial contraction
D. increased transcytosis
C. Gaps due to endothelial contraction
180
What is the common cause of increase vascular permeability?
a. Endothelial injury
b. Leukocyte mediated injury
c. Increase in interendothelial space
d. increased transcytosis
c. Increase in interendothelial space
181
Caused by VEGF and is contributory to increased vascular permeability to water and solutes
Transcytosis
182
```
Sources of histamine and serotonin is/are
A. mast cells
B. Basophils
C. platelet
D. AOTA
```
D. AOTA
183
```
Which of the following generates prostaglandin and thromboxanes
A. lipoxygenase
B. cycloxygenase
C. kinins
D. complement
```
B. cycloxygenase
184
Generates leukotrienes
Lipoxygenase
185
Generate mediators
Kinins
186
Produced by the liver and are cleaved to perform cascade of inflammatory responses to pathogens
Complement proteins
187
Which is/are true about acute inflammation?
A. In chemotaxis, the injurious agent goes to the phagocytic cell for phagocytes to digest.
B. In activation of phagocytic cell, secretions are not only confined to phagosome but also leaks out to the extracellular matrix
C. Leukocyte adhesion consists of migration, rolling, and adhesion
D. B and C are true
D. B and C are true
188
Cell in charge of hunting the injurious agent with the aid of opsonins and chemokines. Overstimulation of this cell will also cause damage to neighboring normal cells by its ROS.
Phagocytic cell
189
```
Protein C, fibronectin and amyloid proteins are examples of
A. chemokines
B. acute phase proteins
C. cytokines
D. complement
```
B. acute phase proteins
190
Plasma proteins that are mostly synthesized in the liver and whose plasma concentrations may increase several hundred-fold as part of the response to inflammatory stimuli
Acute-phase proteins
191
Three of the best-known examples of acute-phase proteins
C-reactive protein (CRP)
Fibrinogen
Serum amyloid A (SAA) protein.
192
Leukemoid reaction occurs when:
A. leukocyte count reaches 15,000-20,000 cells/uL
B. leukocyte count reaches 40,000 – 100,000 cells/uL
C. leukocyte count drops 5,000 – 10,000 cells/uL
D. leukocyte count drops 1,000 – 5,000 cell/uL
B. leukocyte count reaches 40,000 – 100,000 cells/uL
193
Leukocyte count reflected as a common symptom of inflammation
15,000-20,000 cells/uL
194
Which statement is correct?
a) In acute inflammation, the major players are mononuclear inflammatory cells
b) The most common cause of leukocyte defect is bone marrow suppression
c) The chemical mediators of inflammation does not have the potential to have harmful effects
d) Kinin, clotting, fibrinolytic, and complement cascades are interellated systems that are activated by factor V
b) The most common cause of leukocyte defect is bone marrow suppression
195
```
Effects of tumor necrosis factor include
A. increase fibroblast proliferation
B. decrease acute phase proteins
C. increase anticoagulant activity
D. decrease cytokine secretion
```
A. increase fibroblast proliferation
196
True of Nitric Oxide
A. pleiomorphic of vasodilation
B. aka endothelium-derived relaxation factor
C. inhibits platelet aggregation and adhesion
D. all of the above
B. aka endothelium-derived relaxation factor
197
The following is true about nitric oxide
a. Promotes vasodilation
b. Also known as your endothelial derived relaxation factor
c. Inhibits platelet adhesion and aggregation
d. AOTA
d. AOTA
198
```
Outcome/s of acute inflammation
A. resolution
B. abscess formation
C. chronic inflammation
D. all of the above
```
D. all of the above
| Since A and C are correct, All of the above.
199
Which of the following organs is normally involved in low-level proliferation but is capable of rapid replication upon stimulation?
a. Skeletal muscle
b. liver
c. bone marrow
d. neurons
b. liver
200
```
A cell producing substances that affect target cells in close proximity:
A. Autocrine
B. Endocrine
C. Paracrine
D. Eccrine
```
C. Paracrine
201
```
This allows ECM to sketch and recoil
A. Fibrillin
B. Colllagen
C. Elastin
D. Cartilage
```
C. Elastin
202
```
True of collagen?
A. Type 1: predominant in skin & bones
B. has at least 5 types
C. type 2: in basement membrane
D. Enzymatic activity Vitamin E
```
A. Type 1: predominant in skin & bones
203
```
Vessel function in adult tissues is:
A. vasculogenesis
B. angiogenesis
C. neovascularisation
D. Both B and C
```
D. Both B and C
204
```
True of granulation tissue
A. hallmark of healing
B. proliferating blood vessels
C. pink, soft, granular, loose ECM
D. All of the above
```
D. All of the above
205
```
Characterized by wound contraction in which the size of the wound is markedly decreased by the action of myofibroblast
A. healing by first intention
B. healing by second intention
C. fibrosis
D. scar formation
```
B. healing by second intention
206
```
When the same type of tissue replaces the injured one
A. replacement
B. regeneration
C. hyperplasia
D. None of the above
```
B. regeneration
207
```
Gives ECM turgor resistance to compression
A. hyaluronan
B. Laminin
C. Fibrillin
D. None of the above
```
A. hyaluronan
208
Which statement is correct?
A. Acute inflammation is typified by infiltration of mononuclear lymphocytes
B. Chronic inflammation can occur without prior acute inflammation
C. Abscess formation is part of fibrinous inflammation
D. Suppurous inflammation produces transudates
B. Chronic inflammation can occur without prior acute inflammation
209
Typified by Infiltration of tissues by neutrophils
Acute inflammation
210
Often follows acute inflammation, however, it may also be the initial or the only detected response to some agents or in certain diseases such as viral infections and hypersensitivity reactions
Chronic inflammation
211
Occurs when neutrophils dominate the composition and material is liquefied to form pus
Suppurative or purulent inflammation
212
T/F: Suppurous inflammation produces transdates
False. Pus is an exudate, not a transudate
213
Tuberculosis granuloma consists of
a. Granular debris
b. Neutrophilic infiltrates
c. Eosinophilic infiltrates
d. Basophilic calcium deposits
b. Neutrophilic infiltrates or d. Basophilic calcium deposits
214
Most of the caseating material in TB infections is derived from
a. Lysis of macrophage
b. Karyorrhexis of acute inflammatory cells
c. Pus
d. Liquefaction necrosis
a. Lysis of macrophage
| The dead and dying macrophages form the caseated material.
215
True of collagen, except? [1 pts.]
a. Type 1: predominant in skin & bones
b. Has at least 40 types
c. Type 4: in basement membrane
d. Enzymatic activity provided by Vitamin A
d. Enzymatic activity provided by Vitamin A
216
The hallmark of tissue repair
Granulation tissue formation
217
A 40-year-old man underwent laparotomy for a perforated sigmoid colon diverticulum. A wound infection complicated the postoperative course, and surgical wound dehiscence occurred. Primary closure was no longer possible, and the wound “granulated in.” Six weeks later, the wound is only 10% of its original size. Which of the following processes best accounts for the observed decrease in wound size over the past 6 weeks?
a. Increase in synthesis of collagen
b. Myofibroblast contraction
c. Inhibition of metalloproteinases
d. Resolution of subcutaneous edema
e. Elaboration of adhesive glycoproteins
b. Myofibroblast contraction
218
The ability of the skin to hold water 1000 times its weight is granted by which of the following glycoprotein?
Hyaluronic acid
219
This factor induces fibrogenesis and inhibits endothelial proliferation
TGF-B
220
Type of collagen predominant in early stages of healing wounds
Type III
221
An 18-year-old man lacerated his left hand and required sutures. The sutures were removed 1 week later. Wound healing continued, but the site became disfigured by a prominent raised, nodular scar that developed over the next 2 months. Which of the following terms best describes the process that occurred during this 2-month period?
Keloid formation
222
In an experiment involving observations on wound healing, researchers noted that intracytoplasmic cytoskeletal elements, including actin, interact with the extracellular matrix to promote cell attachment and migration in wound healing. Which of the following substances is most likely responsible for such interaction between the cytoskeleton and the extracellular matrix?
Integrin
223
A 21-year-old woman sustains multiple injuries, including fractures of the right femur and tibia and the left humerus, in a motor vehicle collision. She is admitted to the hospital, and the fractures are stabilized surgically. Soon after admission to the hospital, she is in stable condition. She suddenly becomes severely dyspneic, however, 2 days later. Which of the following complications is the most likely cause of this sudden respiratory difficulty?
Fat embolism
224
A 55-year-old woman has had discomfort and swelling of the left leg for the past week. On physical examination, the leg is slightly difficult to move, but on palpation, there is no pain. A venogram shows thrombosis of deep left leg veins. Which of the following mechanisms is most likely to cause this condition?
Immobilization
225
A 66-year-old woman comes to the emergency department 30 minutes after the onset of chest pain that radiates to her neck and left arm. She is diaphoretic and hypotensive; the serum troponin I level is elevated. Thrombolytic therapy is begun. Which of the following drugs is most likely to be administered?
Tissue plasminogen activator
226
A 49-year-old man is in stable condition after an infarction of the anterior left ventricular wall. He receives therapy with anti-arrhythmic and pressor agents. He was rushed to ER due to severe breathlessness 3 years later, and an echocardiogram shows a markedly decreased ejection fraction. He dies 2 weeks later. At autopsy, which of the following microscopic changes is most likely to be present in the lungs?
Fibrosis of alveolar walls with hemosiderin-laden macrophages in alveoli
227
A 29-year-old woman has a history of frequent nosebleeds and increased menstrual flow. On physical examination, petechiae and purpura are present on the skin of her extremities. Laboratory studies show normal partial thromboplastin time, prothrombin time, and platelet count, and decreased von Willebrand factor activity. This patient most likely has a derangement in which of the following steps in hemostasis?
Platelet adhesion
228
A 76-year-old woman is hospitalized after falling and fracturing her left femoral trochanter. Two weeks later, the left leg is swollen, particularly below the knee. She experiences pain on movement of the leg; on palpation, there is tenderness. Which of the following complications is most important for the physician to watch out for?
Pulmonary thromboembolism
229
A 45-year-old woman who works as a bank teller notices at the end of her 8-hour shift that her lower legs and feet are swollen, although there was no swelling at the beginning of the day. There is no pain or erythema associated with this swelling. The woman is otherwise healthy and takes no medications; laboratory testing reveals normal liver and renal function. Which of the following mechanisms best explains this phenomenon?
Increased hydrostatic pressure
230
A 78-year-old woman falls in the bathtub and strikes the back of her head. Over the next 24 hours, she becomes increasingly somnolent. A head CT scan shows an accumulation of fluid beneath the dura, compressing the left cerebral hemisphere. Which of the following terms best describes this collection of fluid?
Hematoma
231
A 28-year-old woman with a 15-year history of recurrent thrombosis from a prothrombin gene mutation develops septicemia after a urinary tract infection with Pseudomonas aeruginosa. Despite aggressive therapy, she dies of multiple organ failure. At autopsy, which of the following organs is most likely to be spared from the effects of ischemic injury?
Liver
232
A 61-year-old woman has had a fever and felt faint for the past 2 days. On physical examination, her temperature is 38.4°C, pulse is 101/min, respirations are 17/min, and blood pressure is 85/40 mm Hg. She has marked peripheral vasodilation. The serum lactic acid level is 6.8 mg/dL. She later died of shock. What kind of shock did the woman most likely suffered from?
Septic
233
A 59-year-old obese woman with a history of diabetes mellitus had a myocardial infarction 3 months ago. She is now taking a low dose of aspirin to reduce the risk of arterial thrombosis. On which of the following steps in hemostasis does aspirin have its greatest effect?
Aggregation of platelets
234
A 23-year-old woman with an uncomplicated pregnancy develops sudden dyspnea with cyanosis and hypotension during routine vaginal delivery of a term infant. She has a generalized seizure and becomes comatose. Her condition does not improve over the next 2 days. Which of the following findings is most likely to be present in the peripheral pulmonary arteries?
Amniotic fluid
235
Most important cells in hemostasis
Endothelial cells
236
True of anemic infarcts
wedge-shaped
237
A thrombus, compared to a post mortem clot,
has Lines of Zahn, seen microscopically
238
In platelet aggregation, platelet to vWF adhesion is mediated by what receptors?
Glycoprotein 1b receptor
239
A deficiency of Glycoprotein 2b/3a receptor results to what condition?
Glanzmann Thrombasthenia
240
The primary hemostastic plug is cemented by
fibrin
241
Human’s initial response to injury
Vasoconstriction
242
The common denominator in shock regardless of the underlying cause
systemic hypoperfusion
243
What characteristics differentiate a thrombus from a thromboembolus?
The thrombus is adherent to the vessel wall
244
The extravasation of blood due to vascular injury is called
hemorrhage
245
Mechanism of edema in a child with kwashiorkor.
Decrease in albumin/protein synthesis
246
What activates factor X during the activation of the extrinsic coagulation cascade?
Factor II, prothrombin
247
What activates factor X during the activation of the intrinsic coagulation cascade?
Factor IV, Calcium
Factor VIII
Factor IX, Christmas Factor
248
Describe TGF-b
It is the most important fibrogenic mediator
249
What term refers to an increase in the number of the cells in an organ or tissue, usually resulting in increased mass of the organ or tissue?
Hyperplasia (Robbins 8th ed, Chapter 1, page 8)
250
Primary producers of histamine in an inflammatory response
Mast cells
251
Action of alcohol on liver
Alcohol disturbs metabolic functions of the liver by increasing lipid synthesis.
252
This material is seen in an aging liver.
Lipofuscin
