Download QUESTION ONE – CELL AND TISSUE DAMAGE

Page 1 of 13
MPF 1112
NOVEMBER 2007
QUESTION ONE – CELL AND TISSUE DAMAGE
Answer the multiple choice questions that follow. Write only the letter of your choice.
1.1 A 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-aortic region.
She is treated with a chemotherapeutic agent which results in the loss of individual neoplastic cells
through fragmentation of individual cell nuclei and cytoplasm. Over several weeks, the size of the
lymphoma decreases, as documented on abdominal CT scans. By which of the following mechanisms
has her neoplasm primarily responded to therapy?
a. Coagulative necrosis
b. Mitochondrial poisoning
c. Phagocytosis
d. Acute inflammation
e. Apoptosis
(1)
1.2 A 53-year-old man has experienced severe chest pain for the past 6 hours. On physical examination
he is afebrile, but has tachycardia. Laboratory studies show a serum troponin I of 10 ng/mL. A coronary
angiogram is performed emergently and reveals >90% occlusion of the left anterior descending artery. In
this setting, an irreversible injury to myocardial fibers will have occurred when which of the following
cellular changes occurs?
a. Glycogen stores are depleted
b. Cytoplasmic sodium increases
c. Nuclei undergo karyorrhexis
d. Intracellular pH diminishes
e. Blebs form on cell membranes
(1)
1.3 While in a home improvement center warehouse buying paint, a 35-year-old man hears "Look out
below!" and is then struck on the leg by a falling pallet rack, which strikes him on his left leg in the region
of his thigh. The skin is not broken. Within 2 days there is a 5 x 7 cm purple color to the site of injury.
Which of the following substances has most likely accumulated at the site of injury to produce a yellowbrown color 16 days after the injury?
Page 2 of 13
MPF 1112
NOVEMBER 2007
a. Lipofuscin
b. Bilirubin
c. Melanin
d. Hemosiderin
e. Glycogen
(1)
1.4 A 54-year-old man with a chronic cough has a squamous cell carcinoma diagnosed in his right lung.
While performing a pneumonectomy, the thoracic surgeon notes that the hilar lymph nodes are small,
0.5 to 1.0 cm in size, and jet black in color throughout. Which of the following is the most likely cause for
this appearance to the hilar nodes?
a. Anthracotic pigmentation
b. Lipochrome deposition
c. Accumulation of melanin
d. Hemosiderosis
e. Metastatic carcinoma
(1)
1.5 A 59-year-old woman had the loss of consciousness that persisted for over an hour. When she
became arousable, she could not speak and she could not move her right arm or leg. A cerebral
angiogram revealed an occlusion to her left middle cerebral artery. Months later, a computed
tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding
most likely demonstrates a lesion that is the consequence of resolution from which of the following
events?
a. Liquefactive necrosis
b. Atrophy
c. Coagulative necrosis
d. Caseous necrosis
e. Apoptosis
(1)
Page 3 of 13
MPF 1112
NOVEMBER 2007
1.6 A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She
continues breast feeding for almost a year with no difficulties and no complications. Which of the
following cellular processes that occurred in the breast during pregnancy allowed her to nurse the infant
for this period of time?
a. Stromal hypertrophy
b. Epithelial dysplasia
c. Steatocyte atrophy
d. Ductal epithelial metaplasia
e. Lobular hyperplasia
(1)
1.7 An 80-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small
(250 gm) and dark brown on sectioning. Microscopically, there is 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 of his heart?
a. Hemosiderin resulting from iron overload
b. Lipochrome from "wear and tear"
c. Glycogen resulting from a storage disease
d. Cholesterol as a consequence of atherosclerosis
e. Calcium deposition following necrosis
(1)
1.8 A 20-year-old woman had Goodpasture syndrome which progressed to chronic renal failure. She
was 165 cm tall and weighed 55 kg. She had blood pressure measurements in the range of 150/90 to
180/110 mm Hg, but she did not regularly take medications. Laboratory studies showed her blood urea
nitrogen was over 100 mg/dL. She required chronic dialysis. She died from heart failure. At autopsy, her
heart weighed 540 gm. The size of her heart is most likely to be the result of which of the following
processes involving the myocardial fibers?
a. Hypertrophy
b. Fatty infiltration
Page 4 of 13
MPF 1112
NOVEMBER 2007
c. Hyperplasia
d. Fatty degeneration
e. Edema
(1)
1.9 A study is performed involving the microscopic analysis of tissues obtained from surgical
procedures. Some of these tissues have the microscopic appearance of an increased cell size of
multiple cells within the tissue, due to an increase in the amount of cytoplasm, with nuclei remaining
uniform in size. Which of the following conditions is most likely to have resulted in this finding?
a. The uterine myometrium in pregnancy
b. The female breast at puberty
c. The liver following partial resection
d. The ovary following menopause
e. The cervix with chronic inflammation
(1)
1.10 A 48-year-old man has a history of chronic alcohol abuse. He is still able to perform his work at his
job. He has had no major illnesses. On physical examination, there are no significant findings.
Laboratory studies show a serum albumin of 4.1 g/dL, ALT 40 U/L, AST 40 U/L, and total bilirubin 1.1
mg/dL. Which of the following microscopic findings in his liver is most likely to be present?
a. Cholestasis
b. Fatty change
c. Hemochromatosis
d. Hypertrophy of smooth endoplasmic reticulum
e. Coagulative necrosis
(1)
1.11 Define the following terms:
a. Histopathology
b. Aetiology
c. Pathogenesis
(1)
(1)
(1)
1.12 Describe the pathogenesis of an oesophageal pathology that is demonstrative of
metaplastic change.
(8)
Page 5 of 13
MPF 1112
NOVEMBER 2007
1.13 List four (4) potential causes of cell membrane damage in irreversible cell injury.
(4)
1.14 Match the cellular adaptation in column A with an appropriate cause in column B. Write only the
letter of your choice.
A
1.14.1 atrophy
1.14.2 hypertrophy
1.14.3 hyperplasia
1.14.4 metaplasia
1.14.5 dysplasia
B
a. myometrium during pregnancy
b. breast epithelium during puberty
c. neoplasm pressing on surrounding tissues
d. Vit. A deficiency
e. HPV type 6
(5)
1.15 Match the pattern of necrosis in column A with the most appropriate descriptor in column B. Write
only the letter of your choice.
A
B
1.15.1 Coagulative necrosis
a. Within the Ghon focus
1.15.2 Liquefactive necrosis
b. Acute pancreatitis
1.15.3 Caseous necrosis
c. Malignant hypertension
1.15.4 Fat necrosis
d. Stroke
1.15.5 Fibrinoid necrosis
e. Myocardial infarction
(5)
[35]
QUESTION TWO – INFLAMMATION
2.1 How does the normally non penetrable endothelial layer become leaky during acute inflammation?
List 5 mechanisms you know of.
(5)
2.2 Match the chemical mediator with the appropriate function. Write only the letter of your choice.
CHEMICAL MEDIATOR
1. LTC4
2. PGI2
3. TXA2
4. PGF2α
5. TNFα
FUNCTION
a. Inhibits platelet aggregation
b. Fever
c. Bronchospasm
d. Vasoconstriction
e. Potentiate edema
(5)
2.3 Define the following:
a. granulation tissue
(1)
Page 6 of 13
MPF 1112
NOVEMBER 2007
b. granuloma
(1)
c. exudate
(1)
d. chemotaxis
(1)
e. chronic inflammation
(1)
[15]
QUESTION THREE – HEALING
3.1 By means of a pencil sketch outline the “anatomy” of a granuloma.
(5)
3.2 List three tissue components involved in the generation of chemical mediators during tissue repair.
Name the tissue entity and the corresponding chemical mediator.
(6)
3.3 Define the following:
a. gliosis
b. fistula
c. empyema
d. Wallerian degeneration
(1)
(1)
(1)
(1)
[15]
QUESTION FOUR – INFECTION
4.1 By means of a table compare acute and subacute bacterial endocarditis using the following
parameters:
a. vegetations
b. clinical course
c. outcome
(4)
(4)
(2)
4.2 Match the causative agent in column A with the disease in column B. Write only the letter of your
choice.
A
4.2.1 staphylococcus aureus
4.2.2 treptococcus pyogenes
4.2.3 neisseria meningitides
4.2.4 cytomegalo virus
4.2.5 clostridium difficile
B
a. psuedomembranous colitis
b. pneumonia
c. cellulites
d. Osteomyelitis
e. massive adrenal haemorrhage
(5)
Page 7 of 13
MPF 1112
NOVEMBER 2007
4.3 A 9-year-old girl has complained of difficulty breathing for the past week. Her vital signs include T
37.9 C, P 80/minute, RR 25/minute, and BP 110/60 mm Hg. On physical examination, her lung fields are
clear to auscultation. Her heart rate is regular and no murmurs or gallops are heard. A chest radiograph
shows prominent hilar lymphadenopathy along with a 1 cm peripheral right lung nodule in the middle
lobe. No infiltrates or masses are present. A sputum gram stain shows normal flora and routine bacterial
culture reveals no pathogens. Which of the following conditions is she most likely to have?
a. Hypersensitivity pneumonitis
b. Mycobacterium tuberculosis infection
c. Bronchial carcinoid tumor
d. Infective endocarditis
e. Goodpasture syndrome
(1)
4.4 Describe three (3) patterns of change that viral infected cells undergo.
(6)
4.5 List three peripheral blood changes associated with infection.
(3)
[25]
QUESTION FIVE – IMMUNITY
5.1 A 15-year-old healthy girl with no major medical problems says that she breaks out with blotchy
areas of erythema that are pruritic over the skin of her arms, legs, and trunk within an hour every time
she eats seafood, followed by diarrhea. These problems abate within a few hours, and physical
examination reveals no abnormal findings. Which of the following immunologic abnormalities is she most
likely to have?
a. Localized anaphylaxis
b. Cell-mediated hypersensitivity
c. Release of complement C3b
d. Hypergammaglobulinemia
e. Immune complex deposition
(1)
Page 8 of 13
MPF 1112
NOVEMBER 2007
5.2 An appropriate, useful type I hypersensitivity response of the immune system, accompanied by
eosinophilia, would most likely be directed against which of the following?
a. Amyloid protein
b. Spirochetes
c. Neoplasms
d. Inhaled dusts
e. Liver flukes
(1)
5.3 Twelve hours after going on a hike through dense foliage, a 40-year-old man notices a slightly raised
and tender irregular reddish rash on one forearm that was not covered by clothing. This rash gradually
increases in intensity for 2 days and then fades after two weeks. Which of the following forms of
hypersensitivity is most likely demonstrated in this patient?
a. Type I hypersensitivity
b. Type II hypersensitivity
c. Type III hypersensitivity
d. Type IV hypersensitivity
(1)
5.4 A 48-year-old man has had a chronic cough with fever for 2 months. On physical examination his
temperature is 37.9 C. A chest radiograph reveals a diffuse bilateral reticulonodular pattern. A
transbronchial biopsy is performed. On microscopic examination of the biopsy there are focal areas of
inflammation containing epithelioid macrophages, Langhans giant cells, and lymphocytes. These
findings are most typical for which of the following immunologic responses?
a. Type I hypersensitivity
b. Type II hypersensitivity
c. Graft versus host disease
d. Polyclonal B-cell activation
e. Type IV hypersensitivity
(1)
Page 9 of 13
MPF 1112
NOVEMBER 2007
5.5 A 27-year-old woman is given intravenous penicillin to treat infective endocarditis. Within minutes of
starting this therapy, she begins to have severe difficulty breathing with respiratory stridor and
tachypnea. She suddenly develops an erythematous skin rash over most of her body. Her symptoms are
most likely to be produced by release of which of the following chemical mediators?
a. Interleukin 1
b. Bradykinin
c. Complement C5a
d. Histamine
e. Thromboxane
(1)
5.6 Discuss the process of antigen presentation.
(5)
5.7 Match the correct function with the following chemical mediators:
A
1. IL-2
2. IL-5
3. IL-1
4. TNFα (alpha)
5. IFNα (alpha)
6. IFNβ (beta)
7. IFNγ (gamma)
B
a. Macrophage activation
b. NK cell activation
c. T cell activation
d. Eosinophil activation
e. Induces a leucocytosis
f. Stimulates release of acute phase proteins
g. Increased MHC Class 1 expression
(7)
5.8 Briefly contrast Graves’ disease with myasthenia gravis.
(4)
5.9 Name the four (4) types of hypersensitivity reactions and provide an example of each.
(8x½=4)
[25]
QUESTION 6 – NEOPLASIA
6.1 A 45-year-old healthy woman has a routine check of her health status. She has no chest pain,
cough, or fever. A chest x-ray taken and shows a peripheral 2.5 cm diameter "coin lesion" in the right
mid-lung field. Which of the following biologic characteristics best distinguishes this lesion as a
neoplasm, rather than a granuloma?
a. Recurrence following excision
Page 10 of 13
MPF 1112
NOVEMBER 2007
b. Rapid increase in size
c. Sensitivity to radiation or chemotherapy
d. Uncontrolled (autonomous) growth
e. Necrosis
(1)
6.2 A study is performed to analyze characteristics of malignant neoplasms in biopsy specimens. The
biopsies were performed on patients who had palpable mass lesions on digital rectal examination. Of the
following microscopic findings, which is most likely to indicate that the neoplasm is malignant?
a. Pleomorphism
b. Atypia
c. Invasion
d. Increased nuclear/cytoplasmic ratio
e. Necrosis
(1)
6.3 A child is born with a single functional allele of a tumor suppressor gene. At the age of five the
remaining normal allele is lost through a point mutation. As a result, the ability to continue the transition
from G1 to the S phase of cell cycle is lost. Which of the following neoplasms is most likely to arise via
this mechanism?
a. Infiltrating ductal carcinoma of breast
b. Small cell anaplastic carcinoma of the lung
c. Retinoblastoma of eye
d. Cerebral astrocytoma
e. Chronic myeloid leukemia
(1)
6.4 A 22-year-old woman goes to her physician for a routine examination. A palpable nodule is found in
the right lobe of her thyroid gland. No lymphadenopathy is noted. A chest x-ray shows no masses. A fine
needle aspirate of the nodule is performed and cytologic examination reveals cells present consistent
Page 11 of 13
MPF 1112
NOVEMBER 2007
with a papillary carcinoma of the thyroid. There are no other family members affected by this disorder.
She works as a secretary for an accounting firm part time and is earning a college degree. Which of the
following findings would you consider most relevant in her past history to indicate a risk factor for this
neoplasm?
a. Chronic alcoholism
b. Radiation therapy in childhood
c. Ataxia telangiectasia
d. Blunt trauma from a fall
e. Exposure to arsenic compounds
(1)
6.5 A 50-year-old man has felt vague abdominal discomfort for the past 4 months. On physical
examination he has no lymphadenopathy, and no abdominal masses or organomegaly can be palpated.
Bowel sounds are present. An abdominal CT scan shows a 20 cm retroperitoneal soft tissue mass
obscuring the left psoas muscle. A stool specimen tested for occult blood is negative. Which of the
following neoplasms is this man most likely to have?
a. Melanoma
b. Hamartoma
c. Adenocarcinoma
d. Lymphoma
e. Liposarcoma
(1)
6.6 A clinical study is performed of oncogenesis in human neoplasms. It is observed that some
neoplasms appear to develop from viral oncogenesis, with serologic confirmation of past viral infection.
Which of the following neoplasms is most likely to arise in this manner?
a. Retinoblastoma
b. Small cell anaplastic carcinoma of lung
c. T-cell leukemia
d. Prostatic adenocarcinoma
Page 12 of 13
MPF 1112
e. Hepatic angiosarcoma
NOVEMBER 2007
(1)
6.7 A 29-year-old woman with a history of multiple sexual partners over the last 15 years has a routine
physical examination with no abnormal findings. On pelvic examination, the cervix shows no
abnormalities, but a Pap smear is taken and dysplastic cells are reported to be present. A cervical
biopsy is performed and shows microscopic features of a minimal dysplasia (CIN 1) involving the
cervical squamous epithelium. Which of the following is the most appropriate statement to make to the
patient regarding these findings?
a. No further treatment is indicated
b. Antibiotic therapy will be necessary
c. You probably have widespread metastases
d. Complete excision of the lesion is required
e. You have inherited a BRCA-1 mutation
(1)
6.8 A 60-year-old man who has a 90 pack year history of cigarette smoking has had a chronic cough for
the past 10 years. He has begun to lose weight (3 kg) during the past year. No abnormal findings are
noted on physical examination. He has a chest radiograph that reveals a right hilar mass. A sputum
cytology shows atypical, hyperchromatic squamous cells. What is the most common initial pathway of
spread of this lesion?
a. Bloodstream
b. Pleural cavity
c. Contiguous spread to chest wall
d. Lymphatics
e. Bronchi
(1)
6.9 A 35-year-old woman had a firm nodule palpable on the dome of the uterus six years ago recorded
on routine physical examination. The nodule has slowly increased in size and now appears to be about
twice the size it was when first discovered. She remains asymptomatic. Which of the following
neoplasms is she most likely to have?
Page 13 of 13
MPF 1112
NOVEMBER 2007
a. Adenocarcinoma
b. Leiomyosarcoma
c. Hematoma
d. Leiomyoma
e. Metastasis
(1)
6.10 A 70-year-old healthy man is found to have a palpable firm nodule in the prostate gland on digital
rectal examination. His serum prostate specific antigen (PSA) is 19 ng/mL. The microscopic appearance
seen on biopsy of the prostate will probably be most consistent with which of the following conditions?
a. Chronic prostatitis
b. Adenocarcinoma
c. Infarction
d. Leiomyoma
e. Rhabdomyosarcoma
(1)
6.11 By means of a table compare the histology of benign and malignant tumours.
(10)
6.12 Provide the names for the following neoplasms:
6.12.1 A benign tumour of renal epithelium.
6.12.2 A malignant tumour of striated muscle.
6.12.3 A benign tumour of blood vessels.
6.12.4 A malignant tumour of neuroectodermal origin.
6.12.5 A benign tumour of mesothelium.
6.12.6 A malignant tumour of liver cells.
(1)
(1)
(1)
(1)
(1)
(1)
6.13 What are the basic mechanisms of cancer cell invasion?
(3)
6.14 List the possible routes of malignant tumour spread.
(6)
[150]