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EH 208
Your Name:
Pathophysiology of Human Disease
Spring 2005
Exam I
1.In ischemic cell injury, what is the first major biochemical consequence of decreased
oxygen? Starting at this point, outline a sequence of subsequent intracellular biochemical
changes that span from reversible to irreversible ischemic injury. Provide two examples
of how changes in intracellular calcium contribute.
2. For the role of free radicals in cell injury, provide: a) a definition of a free radical; b)
one example of how free radicals may be generated within cells; c) two examples of
reactions of free radicals which mediate cell injury (i.e., biochemical targets).
3. Provide short definitions of necrosis and apoptosis. Enter best matches for
biochemical events and morphologic results in table below :
Biochemical Event
Predominance of denaturation of
proteins
Predominance of degradation of
proteins
Synthesis & Activation of specific
endonucleases
Generalized enzyme activation
Causes:
Morphologic Result
A. DNA breakdown at
internucleosomal sites
B. Coagulative necrosis
C. Pus/Abscess
D. Random DNA breaks and
chromatin condensation
4. What are the three major components of acute inflammation? Name 3 of the major
signs of inflammation and state which of the three components causes these signs.
5.Summarize the steps involved in either (your choice) A) the recruitment of leukocytes
to sites of acute inflammation or B) the killing of microbes by polymorphonuclear
leukocytes, providing examples of specific molecules involved in the steps you identify.
6. Answer A or B: A) Match the mediator with these categories
MEDIATOR
ORIGIN:
superoxide anion
a. cell origin, preformed
leukotrienes :
b. cell origin, newly synthesized
C5a :
c. plasma, complement activation
Plasmin :
d. plasma, Hageman factor activation
histamine
nitric oxide
EH 208
Your Name:
Pathophysiology of Human Disease
Spring 2005
Exam I
B) Match the mediator with its major effect (answers can be used more than once or not
at all)
MEDIATOR
C5a
Causes:
a. vasodilation
interleukin 1
b. leukocyte chemotaxis
histamine
c. fever
bradykinin
d. pain
Free radicals
Neutrophil
lysosomal
enzymes
e. tissue damage
f. heartburn
7. What are the possible outcomes of acute inflammation? Pick one and identify factor(s)
that favor it over the other possibilities.
8. Match the major events in wound healing with their time course:
Event
Cellular connective tissue with
minimal leukocytes
Neutrophils at edge of incision
Influx of monocytes/macrophages
begins
Neovascularization maximal;
incisional space filled with
granulation tissue
Occurs at:
A. 72 hours
B. 24 hours
C. 3 months
D. 5 days
Match the event/problem in wound healing with mechanism:
Event
Occurs at:
Abdominal wound dehiscence after
A. Infection
coughing spell
Poor/delayed wound healing in
B. Contraction by myofibroblasts
malnutrition
Poor healing, persistent purulent
C. Mechanical stress when wound
exudate
tensile strength is still low
Gradual reduction of skin wound
D. Lack of vitamin C dependent
size
collagen modification
.
9. State three of the four major mechanisms for non-inflammatory edema. Define
transudate and exudate and state which one describes the fluid in an infected injury site.
EH 208
Pathophysiology of Human Disease
Spring 2005
Your Name:
Exam I
10. What are the three major influences that predispose to thrombus formation
(pathologic clotting)? Pick one and detail how it leads to thrombus formation, providing a
specific example
11. Identify the possible fate of thrombi, including at least one potentially fatal
complication.
12. Provide a definition of shock, state the three major types of shock, and provide a
specific example and outline the principle mechanism(s).
13. Describe one of the four major 'hypersensitivity' patterns of immune-mediated
disease, starting at the molecule(s) and finishing with the signs/symptoms the process
causes. Name a prototypical disease that illustrates the process.
14. Give an example of a primary or secondary immunodeficiency, identify the typical
problems (specific disease or sign/symptoms) associated with the disorder and explain
the pathogenesis.
EH 208
Your Name:
Pathophysiology of Human Disease
Spring 2005
Exam I
15. ANSWER A OR B: A) Identify three categories that describe how microorganisms
can cause injury to a host. Detail one of them, providing an example.
B) Name a specific bacterial exotoxin and provide an outline of its mechanism of action,
including the final clinical health effect:
16. Match the usual pattern of tissue reaction to infection with the organism
M. tuberculosis
Staphylococcal pneumonia
final pathway for multiple
types of infections
Viral mediated damage, e.g.
herpes
Clostridium perfringens
a. suppurative inflammation
b. granulomatous
inflammation
c. cytopathiccytoproliferative
inflammation
d. necrotizing inflammation
e. chronic inflammation and
scarring
Match the normal defense mechanism with the organ system where it operates:
mucociliary clearance
a. GI tract
acid secretions
b. Respiratory Tract
low pH and fatty acid
c. Urinary Tract
content of milieu
lytic enzymes and bile
d. Skin
detergents
frequent clearance by fluid
e. Brain
flow
dense keratinized layer as
f. biliary system
barrier
EH 208
Your Name:
Pathophysiology of Human Disease
Spring 2005
Exam I
17.Summarize the major criteria by which benign and malignant tumors are
distinguished.
18. Identify four classes of genes that are implicated in carcinogenesis. Name a specific
example for each class. Discuss one in detail (i.e., outline its mechanism)
19. ANSWER A OR B; A) Name the mechanisms by which protooncogenes can be
activated. Provide a specific example for one of your categories.
B) Summarize the steps required for a an epithelial tumor to metastasize
20. Match effects of tumors with most likely mechanism:
headache and seizures
a. invasion and impingement on local
structures
b. paraneoplastic secretion of
parathormone-like substance
c. direct endocrine production by tumor
hypoglycemia from insuling production by
pancreatic beta-cell adenoma
hemoptysis (coughing up blood) in lung
cancer
coma due to elevated blood calcium in lung d. metastasis (e.g. from a colon cancer)
cancer
pulmonary embolism
e. paraneoplastic hypercoaguable state
OPTIONAL:
21. Make up a question and answer it to illustrate your knowledge of a topic that has not
been covered in this exam.
22. Make up a question and answer it to illustrate your
knowledge of a topic that has not been covered in this exam.