Download PATHOLOGY WRITTEN AND PRACTICAL EXAM 1

PATHOLOGY WRITTEN EXAM I
1. All of the following are features of mitral valve prolapse syndrome EXCEPT:
A. predisposition to infective endocarditis
B. systolic click and murmur
C. myxomatous degeneration of valve leaflets
D. neovascularization and commissural fusion of valve leaflets
E. predisposition to spontaneous rupture of chordae tendineae
2. After binding to endothelium, leukocytes transmigrate across endothelial junctions.
The adhesion molecules involved in the transmigration phase are:
A. E selectin (ELAM-1) and sialyl-LeX glycoprotein
B. P selectin (GMP-40) and sialyl-LeX glycoprotein
C. LAM-1 ligands (glycoproteins) and L-selectin (LAM-1)
D. ICAM-1 (immunoglobulin) and LFA-1 (CD11a/CD18 integrins)
E. PECAM-1 (immunoglobulin) and CD31 (immunoglobulin)
3. Patients with which one of the following diseases are not likely to be positive for
antinuclear antibodies (ANA)?
A. Lupus
B. Scleroderma
C. Dermatomyositis
D. Wegeners granulomatosis
E. Sjogren syndrome
4. A key mechanism for the formation of lipid-laden foam cells in atherosclerotic plaques
is:
A. synthesis of high density lipoprotein (HDL) by smooth muscle cells
B. secretion of interferon gamma by T lymphocytes
C. production of C-reactive protein by endothelial cells f
D. uptake of oxidized low density lipoprotein (LDL) by macrophages /
E. synthesis of collagenous matrix by fibroblasts
5. A 26-year-old pregnant woman is found to have blood type O Rh negative. The baby's
father is O Rh positive, and the fetus is O Rh positive. This is the mother's third
pregnancy. Which of the following best describes the mechanism for destruction of the
baby's red blood cells?
A. Type I Hypersensitivity - Immediate hypersensitivity
B. Type II Hypersensitivity - Antibody mediated cytotoxicity
C. Type III Hypersensitivity - Immune complex deposition
D. Type IV Hypersensitivity - Delayed type
E. No concern since both the father and baby are Rh+
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6. All of the following participate in phagocytosis and destruction of bacteria by activated
neutrophils EXCEPT:
A. release of lysozyme and other lysosomal enzymes
B. production of superoxide and hypochloride radicals
C. attachment of bacteria to an Fc receptor and complement C3 receptor on the
leukocyte cell membrane
D. activation of NADPH oxidase and myeloperoxidase
E. cytokine-induced expression of VLA-4 and other integrins on the leukocyte cell
membrane.
7. The key compensatory mechanism in response to hemorrhage and most other causes
of shock is:
A. increase in venous filling pressure of the heart
B. renal sodium excretion
C. dilatation of peripheral venules
D. constriction of peripheral arterioles
E. bradycardia (showing of the heart rate)
8. A 35-year-old man previously in good health develops chest pain and shortness of
breath following an airplane trip from the Houston to Australia. Which of the following
most likely contributed to this patient's condition?
A. Viral pneumonia from exposure in recirculated air
B. Thromboembolus due to stasis of blood in deep leg vein
C. Air embolus from too rapid decompression
D. Fat emboli from bones of the extremities
E. Myocardial infarction from decreased oxygen at high altitude
9. A 60-year-old woman with a hepatocellular carcinoma is found to have a peripheral
blood erythrocytosis with an increased hemoglobin and hematocrit. The erythrocytosis
most likely is:
A. Immune response to a tumor
B. Tumor progression
C. Unrelated to her tumor
D. Paraneoplastic syndrome
E. Result of metastatic tumor to her bone marrow
10. A 6-year-old boy is found to have Burkitt lymphoma, an aggressive type of B cell
lymphoma. Analysis of the tumor demonstrates a growth fraction of 70%. Based on this
information, which of the following statements is most likely true regarding this tumor?
A. Since the tumor has likely been present for sometime, the presence of subclones is
not likely.
B. The percentage of cells in S phase is low compared to normal B lymphocytes.
C. The proliferative pool is small in this tumor.
D. This tumor is likely to be polyclonal in origin.
E. The tumor cells are more likely to respond to chemotherapy since there is a high
growth fraction.
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11. The first step in the pathogenesis of carbon tetrachloride (CCI4)-induced liver injury is:
A. increase in permeability of the cell membrane due to covalent binding of CCI4
B. CCI4-induced detachment of ribosomes from rough endoplasmic reticulum
C. CCI3.-induced triglyceride synthesis
D. CCI3.-induced calcium efflux
E. conversion of CCI4 to Cl and CCI3 radicals by smooth endoplasmic reticulum
Greatest risk for Cardiomyopathy of Pregnancy is:
A. Asian, nulliparous women under 30 years of age
B. Hispanic, nulliparous women older than 30 years of age
C. White, multiparous women under 30 years of age
D. Native American, nulliparous women older than 30 years of age
E. Black, multiparous women older than 30 years of age
13. A 36-year-old woman undergoes bone marrow transplantation (BMT) following
high-dose chemotherapy and total body radiation therapy for cancer. Two weeks after
BMT, she develops skin rash, diarrhea and jaundice. Which of the following
mechanisms is most likely involved in these symptoms?
A. Anaphylactic reaction to foreign antigens
B. Donor T and B cells are reacting to the recipient's tissue antigens
C. Excessive immunosuppression has resulted in opportunistic infections
D. Host immune system is rejecting the engrafted cells
E. Vasculitis caused by immune complex deposition
14. All of the following participate in ischemia-induced cell membrane damage leading to
oncositic necrosis EXCEPT:
A. peroxidation of membrane phospholipids due to effects of toxic oxygen radicals
B. loss of membrane phospholipid asymmetry due to redistribution of
phosphotidylserine to the outer membrane leaflet
C. increased membrane permeability due to incorporation of free fatty acids and other
lipid molecules
D. disruption of the membrane's cytoskeleton connections due to protease activation
E. phospholipid depletion due to phospholipase activation
15. All of the following are likely to precipitate angina pectoris EXCEPT:
A. coronary endothelial production of prostacyclin
B. exercise-induced tachycardia
C. coronary vasospasm
D. platelet aggregation on a coronary plaque
E. hemorrhage into a coronary plaque
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MATCHING: Match the carcinogen with the type of tumor with which it is associated.
Use each answer one time only.
16. Human papilloma virus
17. Polycyclic hydrocarbons from cigarette
smoke
18. Arsenic
19. Epstein Barr virus
20. Nitrosamines from smoked foods
A. Gastric cancer
B. Burkitt lymphoma
C. Skin cancer
D. Lung cancer
E. Cervical cancer
21. All of the following are important factors in granulomatous inflammation EXCEPT:
A. accumulation of epithelioid macrophages
B. activation-of cell-mediated immunity to inciting agent
C. continued presence of indigestible organisms or particles
D. accumulation of lymphocytes
E. brisk acute inflammatory reaction with abundant neutrophils
22. A 4-year-old boy becomes progressively short of breath at a birthday party and is taken
to the emergency room. History taken from the mother reveals that the child drank
punch at the party that contained orange juice, and that he is "very allergic" to citrus
fruit. His difficulty breathing started within five minutes of drinking the punch. Physical
examination demonstrates an extremely anxious child gasping for breath with swollen
lips and tongue. Which of the following mechanisms is most likely involved in this
case?
A. Immune complex deposition in vessels of the larynx and soft tissues in the neck
B. NK cell activation upon exposure to citrus antigens
C. T-cell cytotoxicity against antigens in citrus fruit
D. IgA binding to macrophages containing phagocytized citrus antigens
E. Mast cell activation by cross-linked IgE molecules specific to chemicals in citrus fruit
23. The role of hemodynamic forces in atherogenesis is manifest by all of the following
EXCEPT:
A. localization of lesions in areas of turbulent blood flow
B. propensity of plaque formation adjacent to the bifurcation of the common carotid
artery
C. propensity of plaque formation in the ventral thoracic aorta
D. propensity of plaque formation in the lower abdominal aorta
E. hypertension as a risk factor for atherosclerosis
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24. The most common cause of combined stenosis and incompetence (regurgitation) of
the mitral valve is:
A. infective endocarditis
B. redundant, floppy mitral valve
C. traumatic rupture of chordae tendineae
D. rheumatic heart disease
E. ischemia/infarction of a papillary muscle
25. Which of the following factors would be most likely to impede or limit the spread of a
malignant tumor?
A. Presence of receptors for endothelial cells on the surface of tumor cells.
B. Increased number of laminin receptors on the surface of tumor cells.
C. Coating of tumor cell emboli by platelets in the peripheral blood.
D. Increased production of collagenase by the tumor cells.
E. Increased number of NK and CD8+ T cells in the peripheral blood and infiltrating
the tumor.
26. Mechanisms involved in the kidney's role in blood pressure regulation include all of the
following EXCEPT:
A. renal prostaglandin production
B. changes in sodium reabsorption
C. renin release
D. renal effects of aldosterone
E. neurogenic regulation of vasomotor tone
27. A 58-year-old woman is treated for breast cancer with surgery and chemotherapy. She
appears to be disease free for five years, but then is found to have metastatic breast
cancer in her bones. Analysis of the primary tumor demonstrates mutations in ras and
her2-neu genes. Analysis of the metastatic tumor demonstrates mutations in ras,
her2-neu, P53, and fas genes. These findings involving genetic alterations suggest:
A. Homing of tumor cells
B. Differentiation of the tumor
C. Dedifferentiation of the tumor
D. Tumor progression
E. Malignant transformation
28. A functional pattern that presents as a systolic disorder is seen in:
A. Radiation fibrosis
B. Endomyocardial fibroelastosis
C. Friedreich's ataxia
D. Idiopathic hypertrophic subaortic stenosis
E. Infective myocarditis
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29. An occlusive vasculopathy with intimal proliferation causing Raynauds phenomenon,
pulmonary hypertension or renal failure is most characteristic of which one of the
following diseases?
A. Polymyositis
B. Polyarteritis nodosum
C. Scleroderma
D. Rheumatoid arthritis
E. None of the above
30. All of the following are typical of long-standing primary essential hypertension
EXCEPT:
A. hyaline arteriolosclerosis
B. rapidly progressive renal failure
C. arteriosclerosis of aorta
D. left ventricular hypertrophy
E. prevalence highest in black females
31. A key early step in initiation of the extrinsic pathway of apoptosis is:
A. translocation to the nucleus of the nuclear transcription factor, NF kappa B
B. formation of the apoptosome with caspase 9 activation
C. overexpression of the Bax protein
D. release of cytochrome c from the mitochondria
E. activation of the death domain of the tumor necrosis factor (TNF) receptor
32. A 20-year-old woman is evaluated for recurrent gastrointestinal infections and found to
have decreased serum IgA. Which of the following conditions is also associated with
this disorder?
A. Decreased number of peripheral blood CD4+ T cells
B. Increased number of peripheral blood NK cells
C. Enlarged lymph nodes
D. Anaphylactic response to blood products containing IgA
E. Small or absent thymus
33. All of the following are mechanisms of steatosis (fatty change) of the liver EXCEPT:
A. carbon tetrachloride-induced inhibition of synthesis of lipid acceptor proteins
B. increased load of fatty acids due to mobilization of fat from adipose tissue by
starvation
C. alcohol-induced functional defects in mitochondria and endoplasmic reticulum
D. diet-induced increase of cholesterol synthesis and lipoprotein production
E. hypoxia/ischemia-induced inhibition of fatty acid oxidation
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34. A 65-year-old man develops left-sided heart failure after a recent myocardial infarction.
Which of the following is most likely to be present in this patient?
A. Pulmonary edema
B. Renal vascular constriction
C. Bilateral jugular vein distention
D. Portal hypertension
E. Congestive hepatomegaly
35. A 60-year old woman complains of difficulty arising from chairs and combing her hair
because of weakness. Her exam shows 4/5 weakness in proximal muscles of arms and
legs. She also has a lilac (heliotype) colored rash on her eyelids and some skin
papules over her knuckles. What is the most appropriate diagnostic description?
A. Polymyositis
B. Lupus erythematosus
C. Dermatomyositis with high likelihood of underlying malignancy
D. Dermatomyositis with low likelihood of underlying malignancy
E. None of the above
36. A 34-year-old HIV seropositive man is seen at a community clinic. Which of the
following findings is a criterion for the diagnosis of AIDS?
A. Peripheral blood CD4+ T cell count less than 200/mm3
B. Hypergammaglobulinemia
C. Enlarged lymph nodes
D. Localized skin rash
E. Ten pound unintentional weight loss
37. The factor that favors resolution of inflammation with restitution of normal structure is:
A. abundant granulation tissue formation
B. persistence of injurious agent
C. tissue containing stable or labile parenchymal cells
D. connective tissue framework destroyed
E. extensive necrosis of parenchymal cells
38. Rheumatoid nodules may occur in which of the following organs?
A. Lungs
B. Myocardium
C. Cardiac values
D. Eye
E. All of the above
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39. A newborn male infant has marked hypocalcemia and severe congenital heart defects.
Which of the following is also likely to be present in this patient?
A. Spinal bifida
B. Enlarged adrenal glands
C. Absent thymus gland
D. Decreased immunoglobulins
E. Cleft palate
40. A characteristic feature of pure (isolated) left ventricular failure is:
A. ankle edema
B. distended neck veins
C. hepatomegaly
D. pulmonary congestion and edema
E. pericardial effusion
MATCHING: For each numbered item (column 1), choose the letter of the most closely
related item in column 2. Each answer can be used once, more than once, or not at
all.
COLUMN I
COLUMN 2
41. Complement C5a
42. Bradykinin
43. Interleukin-6
44. Nitric oxide
45. Thromboxane A2
A. pain
B. chemotaxis and leukocyte activation
C. vasodilatation and bacterial killing
D. production inhibited by aspirin and
indomethacin
E. fever
46. All of the following are causes of aortic stenosis or left ventricular outflow tract
obstruction EXCEPT:
A. fibrosis of a congenitally bicuspid valve
B. hypertrophic cardiomyopathy
C. valvular calcification in the elderly
D. dissecting aneurysm involving the aortic root
E. rheumatic heart disease
47. A 25-year-old pregnant woman reports that she has not felt fetal movement in about a
week. On examination, there are no fetal heart sounds, and ultrasound studies show
no fetal heart beating and no other movement. She is hospitalized and soon after
develops oozing from IV and blood venopuncture sites, decreased renal output, and
hypotension. Laboratory studies indicate disseminated intravascular coagulation.
Which of the following would most likely be seen in this patient?
A. Fat emboli in the brain and lungs
B. Fibrosis of blood vessel walls with narrowing of the lumen
C. Large pulmonary thromboemboli
D. Numerous small thrombi in capillaries
E. Increased intravascular volume
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MATCHING: For each numbered item (column 1), choose the letter of the most closely
related item in column 2. Each answer can be used once, more than once, or not at
all.
COLUMN 1
COLUMN 2
48. Cystic lesion in brain of a patient with
an occluded carotid artery
49. Dry, pale, yellow-gray wedge-shaped
zone in renal cortex of a patient with
an occluded renal artery
50. Opaque, chalky-white deposits in
omentum of a patient with a ruptured
gastric ulcer
51. Black, dry skin of the foot of a patient
with severe iliofemoral atherosclerosis
52. Soft, friable, yellow-gray pasty foci in
lungs of a patient with a positive
tuberculin skin test
A. caseous necrosis
B. liquefaction necrosis
C. gangrenous necrosis
D. enzymatic fat necrosis
E. coagulation necrosis
53. A 45-year-old man is to receive a renal transplant from a cadaver. During the surgery,
as soon as the renal artery of the transplanted kidney is anastomosed with the
recipient's blood vessels, the kidney becomes red and edematous and fails to produce
urine. The transplanted kidney never functions and must be removed. Which of the
following mechanisms is most likely involved in this type of rejection?
A. Fibrosis of the vessel walls with loss of the renal tubules and glomeruli
B. T cell activation upon exposure to antigens in the transplanted kidney with
subsequent formation of IgG against the foreign antigens
C. NK activation with nonspecific cytotoxicity against the transplanted tissue antigens
D. Lack of immunosuppression prior to surgery
E. Localized Arthus reaction caused by preexisting antibodies in the recipient against
HLA or ABO antigens in the donor kidney
54. The synthetic graft considered to posses many of the properties of the ideal prosthesis,
except its porosity may increase blood loss in heparinized patients, is:
A. Polyurethane grafts
B. Porous silicone grafts
C. Dacron grafts
D. Teflon grafts
E. Textured silicone grafts
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55.
A 60-year-old woman presents to the Emergency Center with a one day history of
worsening shortness of breath and dull, aching substernal chest pain. She gives a
history of long-standing hypertension and poor compliance with medication. Physical
examination reveals tachycardia, blood pressure of 170/115 mmHg, pulmonary
congestion, and hepatomegaly. Chest x-ray reveals cardiomegaly, prominent
pulmonary vasculature, and bilateral pleural effusions. EKG shows ST segment
depressions and T wave flattening in leads II, III, AVF, and V2-6. She is started on
anti-hypertensive medication. Serum marker studeies are as follows:
(CK- creatine kinase; LD- lactic dehydrogenase; Tr - troponin)
Total CK
CK-MB
MB-Index
Total LD
LD-1
LD-1 %
TrT
Reference
12-191 U/L
0-10 ng/ml
0-2.5
83-200 U/L
30-80 U/L
0-40%
0-0.1 ng/ml
Admission
120
1
0.8
600
100
17
0.06
12 hrs later
90
2
2.2
500
90
18
0.04
24 hrs later
70
1
1.4
300
50
16
0.04
The correct diagnosis is:
A. pulmonary infarct due to a pulmonary thromboembolus
B. hepatic congestion due to congestive heart failure
C. acute anterior transmural myocardial infarct
D. acute inferoposterior subendocardial myocardial infarct
E. renal infarct due to a thrombosed renal artery
56. A 60-year-old man has a segment of colon removed for colon cancer. Which of the
following would be part of the staging for this patient's tumor? Evaluation of:
A. Nuclear-to-cytoplasmic (N/C) ratio of tumor cells
B. Number of mitoses within tumor cells
C. Pleomorphism of tumor cells
D. Regional lymph nodes with metastatic tumor
E. Differentiation of tumor cells
57. A 10-year-old boy complains of itching around his ankles. On examination, there is an
erythematous eruption (red rash) of the skin covered by his socks. When prompted,
the boy's mother remembers that she recently changed laundry detergent. The rash
began a couple of days after wearing socks washed in the new detergent. Which of the
following mechanisms most likely explains this reaction?
A. Type IV Hypersensitivity (delayed type): Foreign antigen is processed and
presented on surface of macrophages; CD4+ T cells recognize foreign antigens,
become activated and produce cytokines, leading to localized inflammation
B. Type II Hypersensitivity (antibody dependent cytotoxicity): B cells are activated,
differentiate into plasma cells, and produce antibodies against antigens in the
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detergent
C. Type III Hypersensitivity (immune complex): Immune complexes become deposited
in vessels in the exposed area leading to vasculitis
D. Type, I Hypersensitivity (immediate): IgE is bound to mast cells which degranulate
upon exposure to the antigen a second time
58. Mediators involved in the formation of granulation tissue and fibrosis involve all of the
following EXCEPT:
A. transforming growth factor beta (TGFB)
B. basic fibroblast growth factor (bFGF)
C. platelet derived growth factor (PDGF)
D. vascular endothelial growth factor (VEGF)
E. monocyte chemotactic protein-1 (MCP-1)
59. All of the following are true of sudden cardiac death prior to hospitalization EXCEPT:
A. ischemia-induced ventricular fibrillation is a common mechanism
B. coronary atherosclerosis is frequently present
C. recent myocardia infarction is rarely evident
D. old myocardial scars are often present
E. occlusive coronary thrombosis is often present
60. All of the following represent mechanisms for hypertrophic enlargement of
parenchymal cells EXCEPT:
A. increased formation of autophagic vacules in response to hypoxic damage of
organelles
B. increased numbers of mitochondria in response to increased metabolic demand
C. increased numbers of myofilaments in response to increased muscle workload
D. increased amounts of smooth endoplasmic reticulum in response to certain drugs
(e.g., phenobarbital)
E. increased numbers of ribosomes and rough endoplasmic reticulum in response to
demand for increased protein synthesis
MATCHING: From the following heart muscle and myocardial dysfunction indicate the
appropriate functional pattern (Note: patterns can be used more than once) Match the
following types of pericardial effusion:
61. A complication of increase in
extracellular fluid volume as with
congestive heart failure or nephrotic
syndrome.
62. Secondary to lymphatic obstruction by
tumor or infection.
Associated with chest trauma
(accidental or following CPR).
64. Bleeding directly into the pericardial
Cavity
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A. Serous pericaridal effusion
B. Chylous effusion
C. Serosanguineous pericardial effusion
D. Hemopericardium
E. Cardiac tamponade
65. Rapid accumulation of pericardial fluid,
which restricts filling of the heart.
66. The feature shared in common by fatty streaks and fibrous (atheromatous) plaques is:
A. vascularization from vasa vasorum
B. subendothelial fibrous capsule
C. abundant extracellular cholesterol crystals
D. central necrosis
E. potential for regression with risk factor modification
67. Which one of the following cytokines is a major regulator of inflammation and joint
damage in rheumatoid arthritis and a successful target of recent new therapies?
A. TNF alpha
B. IL-2
C. TGF beta
D. IL-6
E. None of the above
MATCHING: Match the name of a tumor with the corresponding description. Use each
answer one time only.
68. Rhabdomyosarcoma
69. Gastric adenocarcinoma
70. Fibroadenoma of the breast
71. Teratoma
72. Lipoma of the leg
A. Benign tumor of adipose tissue
B. Malignant tumor of striated muscle
C. Benign tumor composed of connective
tissue and glands
D. Malignant tumor of glands
E. Tumor composed of cells derived from
more than one germ cell layer
73. The cause of cell swelling in early hypoxic/ischemic injury is:
A. inhibition of the Na+, K+ ATPase
B. increased influx of potassium ions
C. activation of carnitine palmitoyl transferase
D. activation of calcium-dependent endonucleases
E. elevated intracellular pH
74. Acute transmural myocardial infarction is associated with all of the following EXCEPT:
A. persistent ST-segment and T wave depression on electrocardiogram
B. fibrinous pericarditis
C. external rupture in about 5% of cases
D. occlusive coronary thrombosis
E. coronary plaque erosion or rupture
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75. A patient presents with a heart tumor and a clinical syndrome of mitral obstruction,
embolization, and febrile illness most likely has:
A. Leiomyoma
B. Fibroma
C. Rhabdomyoma
D. Myxoma
E. Lipoma
76. Aneurysms of medium sized arteries are most characteristic of which one of the
following diseases?
A. Lupus erythematosus
B. Wegeners granulomatosis
C. Polyarteritis nodosum
D. Scleroderma
E. None of the above
77. A 56-year-old man suffers a myocardial infarction due to thrombosis of a coronary
artery. Which of the following factors would be most likely to contribute to this
thrombosis?
A. Laminar blood flow in the coronary artery
B. Decreased number of red blood cells with decreased hemoglobin
C. Endothelial injury with exposure of subendothelial collagen
D. Increased velocity of blood flow in the coronary artery
E. Stasis of blood flow in the coronary artery
A patient presenting with a positive immunofluorescence to a perinuclear antineutrophil
cytoplasmic auto-antibodies (ANCA) and segmental, fibrinoid necrosis of medium-sized
or small arteries most likely has:
A. Giant cell (Temporal) arteritis
B. Polyarteritis nodosa
C. Wegener's granulomatosis
D. Takayasu's arteritis
E. Kawasaki disease
79. A 55-year-old man comes to your office for a pre-employment examination. He gives a
history of frequent fatigue and occasional shortness of breath. He admits to smoking
one pack of cigarettes a day. You find he is obese and has a blood pressure of 160/95
mmHg. You obtain a fasting blood lipid study with the following results: total
cholesterol - 300 mg/dI, high density lipoprotein cholesterol - 35 mg/dL, triglycerides –
90 mg/dl. The best advice you can give the patient is:
A. your LDL cholesterol is 247 mg/dI; modify your lifestyle and diet to reduce your
cardiovascular risk, then we will consider adding a statin drug
B. your LDL cholesterol is 265 mg/dI; you have homozygous familial
hypercholesterolemia and must have a liver transplant
C. your LDL choleserol is high but your HDL cholesterol of 35 giving you a normal LDL
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to HDL ratio
D. your lipid values are a little out of line but you can continue to eat, drink, and be
merry
E. your LDL cholesterol is 125 mg/dI; you have little risk of cardiovascular disease
80. In women with lupus, the presence of antiphospholipids antibodies places them at high
risk for all of the following EXCEPT:
A. Stroke
B. Deep venous thrombosis
C. Fetal miscarriages
D. Fetal congenital heart block
E. All of the above
81. Cardiomegaly is generally seen in:
A. Congestive cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Obliterative cardiomyopathy
D. A and C
E. All of the above
82. All of the following are involved in chemotaxis and activation of leukocytes EXCEPT:
A. activation of phospholipase C
B. stimulation by bradykinin
C. activation of protein kinase C
D. increase in intracellular calcium
E. hydrolysis of phosphatidyl-inositol biphosphate to diacylglycerol and inositol
triphosphate
83. A 60-year-old man presents to the Emergency Center with an acute onset of severe
substernal chest pain which radiates into the left shoulder and neck. The EKG shows
prominent ST segment elevation and T wave inversion in leads II, III and AVF.
Physical examination reveals tachycardia, blood pressure of 100/60 mmHg, pericardial
friction rub, pulmonary congestion, and hepatomegaly. Serum marker studies are as
follows:
(CK - creatine kinase; LD - lactic dehydrogenase; Tr - troponin)
Total CK
CK-MB
MB-Index
Total LD
LD-1
LD-1 %
TrT
Reference
12-191 U/L
0-10 ng/ml
0-2.5
83-200 U/L
30-80 U/L
0-40%
0-0.1 ng/ml
Admission
280
5
1.7
200
40
20
1.5
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12 hrs
1900
160
8.4
320
80
25
2.0
later 24 hrs later
1000
50
5.0
700
300
36
3.0
The correct diagnosis is:
A. acute anterior subendocardial myocardial infarct
B. hepatic congestion due to congestive heart failure
C. acute inferoposterior transmural myocardial infarct
D. pulmonary infarct due to a pulmonary thromboembolus
E. renal infarct due to a thrombosed renal artery
84. The inflammation-induced increase in vascular permeability that starts immediately and
is sustained for several hours (immediate sustained response) is characterized by the
following feature:
A. selective involvement of venules and sparing of arterioles and capillaries
B. mediated by cytokine-induced separation of intercellular junctions of endothelial
cells
C. effective blockage by antihistamines
D. direct damage and necrosis of endothelial cells
E. leads to formation of a transudate with specific gravity less than 1.012
85. The characteristic feature of apoptosis is:
A. prominent cell membrane lipid peroxidation by toxic oxygen radicals
B. loss of cell calcium due to increased cell membrane permeability
C. neutrophilic inflammation aimed at the apoptotic cells
D. nuclear condensation due to cleavage of DNA into double-stranded fragments
E. early swelling of involved cells
86. A 30-year-old woman complains of thickening of the skin over her shins (pretibial
myxedema) and protrusion of her eyes (exophthalmos). Further evaluation confirms
Grave's disease. Which of the following mechanisms is most likely involved in this
disorder?
A. Vasculitis with fibrinoid necrosis
B. Destruction of thyroid tissue by CD8+ T suppressor cells
C. Chronic stimulation of thyroid epithelium by autoantibodies against TSH receptors
D. Nonspecific cytotoxicity against thyroid epithelium by NK lymphocytes
E. Destruction of thyroid tissue by immune complex deposition
87. All of the following are true of the evolution of acute myocardial infarction EXCEPT:
A. reperfusion after two hours results in net salvage of myocardium
B. can be diagnosed by elevated blood levels of proteins leaked from damaged
muscle cells
C. often is associated with an elevated white blood cell count
D. irreversible injury and necrosis begins in the subendocardium
E. peak incidence of rupture occurs at 3 weeks after onset
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88. The factor that favors healing by primary union (first intention) is:
A. extensive granulation tissue formation
B. persistence of foreign bodies in wound
C. effective neutrophilic response to remove bacteria and tissue debris
D. delayed cleaning and delayed opposition of wound edges
E. extensive tissue necrosis
Matching: From the following vascular changes indicate the appropriate etiology. For
this matching question each answer may be used only once.
89. An arteritis of children and infants that
involves large, medium and small
arteries and is associated with
mucocutaneous lymph node
syndrome.
A. Wegener's granulomatosis
B. Kawasaki disease
C. Syphilitic arteritis
D. Thromboangitis obliterans
E. Thrombophlebitis migrans
90. Characterized by transient venous
inflammation, which migrates from one
area of the body to another and
associated with carcinomas of the
bronchus, pancreas, or colon.
91. A positive cytoplasmic
immunofluorescence to antineutrophil
cytoplasmic auto-antibodies (C-ANCA)
and necrotizing inflammation of
medium-sized or small arteries.
92. An occlusive peripheral vascular
disease that occurs almost exclusively
in males under 35 years of age and is
exacerbated by smoking
93. Characterized by an aortitis and
aneurysm formation (most severe in
ascending aorta).
94. The characteristic feature of subacute infective endocarditis is:
A. typically involves previously diseased valve
B. intravenous drug abuse is a common predisposing factor
C. patient often presents as severely ill with septic clinical picture
D. typically caused by highly virulent organisms, such as Staphylococcus aureus
E. infected emboli usually produce purulent abscesses in multiple organs
- 16 -
MATCHING: For each numbered item (Column 1), choose the most closely related
item in column 2. Each answer can be used once, more than once, or not all.
COLUMN 1
COLUMN 2
95. Strong genetic predisposition (90%
A. Type I (insulin dependent) diabetes
concordance in identical twins)
mellitus (IDDM)
96. Insulitis due to autoimmune attack of
B. Type II (non-insulin dependent)
pancreatic beta cells
diabetes mellitus (NIDDM)
97. Strong predisposition to ketoacidosis if C. both
untreated
D. Neither
98. Relative insulin deficiency linked to
insulin resistance
99. Increased prevalence of premature
atherosclerotic disease
100. All of the following are features of acute rheumatic fever EXCEPT:
A. acute cardiac dilatation
B. fibrinous pericarditis
C. streptococcal bacteremia
D. perivascular granulomatous lesions in myocardium
E. migratory polyarthritis
- 17 -
- 18 -
Answers
1. D
2. E
3. D
4. D
5. B
6. E
7. D
8. B
9. D
10. E
11. E
12. E
13. B
14. B
15. A
16. E
17. D
18. C
19. B
20. A
21. E
22. E
23. C
24. D
25. E
26. E
27. D
28. E
29. C
30. B
31. E
32. D
33. D
34. A
35. C
36. A
37. C
38. E
39. C
40. D
41. B
42. A
43. E
44. C
45. D
46. D
47. D
48. B
49. E
50. D
51. C
52. A
53. E
54. C
55. B
56. D
57. A
58. A
59. C
60. A
61. A
62. B
63. C
64. E
65. D
66. E
67. A
68. B
- 19 -
69. D
70. C
71. E
72. A
73. A
74. A
75. D
76. C
77. C
78. B
79. A
80. D
81. E
82. B
83. C
84. D
85. D
86. C
87. E
88. C
89. B
90. E
91. A
92. D
93. C
94. A
95. B
96. A
97. A
98. B
99. C
100. C