MD2230E Fundamentals of Pathology

Final Exam Version 4

Closed questions – 0.4 point, Total: 20 points; True / False – 0.25 point, Total: 10 points;
Open questions ( Definition ) – 1 point, Total: 10 points.
Total score – 40 points.

Closed questions – 0.4 point, Total: 20 points

1. Neutrophils predominate during the:

A. first 5 to 7 days B. first month after the injury C. first 6 to 24 hours D. first year of injury

2. A 32-year-old man is involved in a vehicular accident and sustains fractures of the right femur
and tibia and the left humerus. The fractures are stabilized surgically. He is in stable condition
for 2 days, but then suddenly becomes severely dyspneic. Which of the following
complications from his injuries is the most likely cause of his sudden respiratory difficulty?:
A Cardiac tamponade B Fat embolism C Pulmonary edema D Pulmonary infarction E Right
hemothorax
3. All of the following are features of apoptosis EXCEPT:
A. Cell shrinkage B. Disorientation of cell membrane lipids C. Karyolysis D. No associated
inflammation E. Intact cellular components
4. Noso-comial infections are spread in
a. General population
b. In patients with AIDS
c. In patients with tuberculosis
d. In hospitalized patients
5. A 4 year girl has a broken arm. After her cast is removed 6 weeks later, her healing arm is
markedly smaller than her normal arm. The mechanism of atrophy in this case is:
A. Senile atrophy B. Pressure atrophy C. Loss of endocrine stimulation D. Denervation
atrophy E. Disuse atrophy

6. A 20-year-old woman undergoes cesarean section to deliver a term infant, and the lower
abdominal incision is sutured. The sutures are removed 1 week later. Which of the following
statements best describes the wound site at the time of suture removal?
A Collagen degradation exceeds synthesis B Granulation tissue is still present
C No more wound strength will be gained D Type IV collagen predominates
E Wound strength is 80% of normal tissue

7. A 26-year-old woman has a history of frequent nosebleeds and increased menstrual blood
flow. On physical examination, petechiae and purpura are present on the skin of her extremities.
Laboratory studies show normal partial thromboplastin time (PTT), prothrombin time (PT), and
platelet count, but decreased von Willebrand factor activity. This patient most likely has a
derangement in which of the following steps in hemostasis?
 A. Fibrin polymerization B. Platelet adhesion C. Platelet aggregation D. Prothrombin
generation E. Prothrombin inhibition F. Vasoconstriction

8. Abscess represents:
A. localized collections of pus B. Inflammation of lungs C. discharge from vagina D. all of the
above is correct

9. Lymphocytes: A. Produce inflammatory mediators B. Participate in cell-mediated immune

reactions C. Plasma cells produce antibody D. all of the above is correct

10. Type III hypersensitivity also known as: A. cytotoxic hypersensitivity B. immune complex
disease C. immediate or anaphylactic hypersensitivity D. all of the above is correct

11. What is pyknosis? A. Nuclear Condensation B. Nuclear Fragmentation C. Nuclear Dissolution

12. Which of the followings is the mechanism of edema in patients with congestive heart failure?
A. Decreased plasma oncotic pressure B. Endothelial damage
C. Increase hydrostatic pressure D. Increase vascular permeability
E. Lymphatic obstruction

13. Which of the following accurately defines cellular adaptation:

A. Development of a new, altered steady state B. Maintaining a steady state
C. Internally programmed cell death D. ATP depletion E. Accumulation of oxygen derived free
radicals

14. Reduced plasma oncotic pressure is the most important mechanism of edema in:
A. Congestive heart failure
B. Edema of leg affected by venous thrombosis
C. Edema of the arm in breast cancer patients
D. Nephritic syndrome
E. Brain trauma

15. Petechiae is best defined as:

A. Subcutaneous hemorrhage measuring 1-2 cm
B. Subcutaneous edema is associated with heart failure
C. Skin hemorrhages appearing as minute spots measuring 1-2 mm
D. Hemorrhage into the thoracic cavity
E. Bleeding inside the pericardial cavity

16. A 48-year-old male with a history of chronic alcoholism who is continuing to perform
adequately on the job will most often have which of the following findings in liver:
 Cholestasis B. Fatty change C. Hemochromatosis D. Coagulative necrosis E. Hypertrophy of
smooth endoplasmic reticulum

17. Which of the following in not considered an adaptive response:

A. Atrophy B. Hyperplasia C. Dysplasia D. Hypertrophy E. Metaplasia

18. Which type of shock is associated with low blood levels?

A. Hypovolemic shock B.Septic shock
A. Anaphylactic shock D. Cardiogenic shock

19. Perivascular cellular infiltrates, edema, cell destruction and granuloma formation are
pathologic lesions seen in which type of hypersensitivity reaction?
A. Type I B. Type II C. Type III D. Type IV

20. What is type IV hypersensitivity is also known as?

A. Cell-mediated hypersensitivity B. Immediate hypersensitivity
C. Antibody-mediated hypersensitivity D. Immune complex hypersensitivity

21. Most immediate hypersensitivity reactions are mediated by which type of immunoglobulin?
A. Ig A B. IgD C. IgE D. IgG E. IgM

22. Rheumatoid arthritis is as example of which type of hypersensitivity reaction?

A. Immediate B. Antibody-mediated
C. Immune complex D. T-cell mediated

23. What is type I hypersensitivity is also known as?

A. Cell-mediated hypersensitivity B. Immediate hypersensitivity
C. Antibody mediated hypersensitivity D. Immune complex hypersensitivity

24. What is type II hypersensitivity is also known as?

A. Cell-mediated hypersensitivity B. Immediate hypersensitivity
C. Antibody mediated hypersensitivity D. Immune complex hypersensitivity

25. Which category of hypersensitivities is IgE-mediated? A. Type I B. Type II

C.Type III D.Type IV

26. Osteosarcoma is: A. Malignant smooth muscle tumor B. Benign smooth muscle tumor C.
Benign bone tumor D. Malignant bone tumor

27. Rhabdomyoma is: A. Malignant smooth muscle tumor B. Benign skeletal muscle tumor
B. Benign bone tumor D. Malignant bone tumor

28. Neoplasia is
A. Malignant smooth muscle tumor
B. Uncontrolled cell proliferation
C. Benign bone tumor
D. Malignant bone tumor
29. Which of the following is NOT characteristic of reversible cell injury?
A. Reduced oxidative phosphorylation B. ATP depletion C. Cellular shrinking
D. Changes in ion concentrations E. Water influx

30. Malignant tumor arising in mesenchymal tissue represents: A. Carcinoma B. Polyp C. Sarcoma
D. Chondroma

31. Which of the following describes hyperplasia?

A. Increase in the number of cells (mitosis) in an organ or tissue
B. Decrease in the number of cells (mitosis) in an organ or tissue
C. Increase in individual cell size in an organ or tissue
D. Decrease in individual cell size in an organ or tissue
E. Reversible change in which one adult cell is replaced by another adult cell type

32. Most forms of pathologic hyperplasia are caused by excessive hormonal stimulation or growth
factors acting on target cells. If a patient had hyperplasia of the endometrium, which of the
following is the most likely?
A. Increased risk of miscarriage
B. Decreased risk of miscarriage
C. Increased risk of endometrial cancer
D. Decreased risk of endometrial cancer
E. Increased risk of neurologic disease

33. Hepatitis C: A. is the single virus that is more often chronic than not (almost never detected
acutely); B. 85% or more of patients develop chronic hepatitis C. 20% of whom will develop
cirrhosis D. All of the above is correct

34. Which of the following describes metaplasia?

A. Increase in the number of cells (mitosis) in an organ or tissue
B. Decrease in the number of cells (mitosis) in an organ or tissue
C. Increase in individual cell size in an organ or tissue
D. Decrease in individual cell size in an organ or tissue
E. Reversible change in which one adult cell is replaced by another adult cell type

35. A deep vein thrombosis (DVT) causes edema by what mechanism:

A. Inflammation B. Lymphatic obstruction C. Reduced plasma colloid osmotic pressure
D. Sodium retention E. Increased hydrostatic pressure

36. Of the secondary (acquired) causes of thrombosis, which of the following is NOT considered
high risk? A. Prolonged bed rest B. Atrial fibrillation C. Prosthetic cardiac valves D. Cancer
E. Smoking
37. Patients who are in septic shock will have systemic and thus a(n) in peripheral
vascular resistance. These patients will also have decreased myocardialcontractility, although
their cardiac index (CI) may be normal (compensatory).
A. Vasodilation; Decrease
B. Vasodilation; Increase
C. Vasoconstriction; Decrease
D. Vasocontriction; Increase

38. In an experiment, antigen is used to induce an immediate (type I) hypersensitivity response.

Cytokines are secreted that are observed to stimulate IgE production by B cells, promote mast
cell growth, and recruit and activate eosinophils in this response. Which of the following cells
is most likely to be the source of these cytokines?
A CD4+ lymphocytes B Dendritic cells C Macrophages D Natural killer cells E Neutrophils

39. Which of the following is a sign of septic shock and NOT a sign of hypovolemic or cardiogenic
shock? A. Hypotension B. Weak, thready pulse C. Tachycardia D. Cool, clammy, cyanotic
skin E. Vasodilation

40. Within 5 minutes after a bee sting, a 15-year-old girl sud¬denly has difficulty breathing, with
marked inspiratory stridor from laryngeal edema. She experiences marked urticaria and notes
swelling of the hand that was stung. Which of the following is the best pharmacologic agent to
treat her signs and symptoms? A. Cyclosporine B. Epinephrine C. Glucocorticoids
E. Methotrexate E. Penicillin

41. A 20-year-old man steps into an elevator full of people with influenza who are coughing and
sneezing. The influenza viral particles that he inhales attach to respiratory epithelium, and
viral infection reduces MHC class I molecules displayed on these epithelial cells. Which of the
following immune cells is most likely to rapidly destroy the virally infected cells?
A. CD4+ cell B. Dendritic cell C. Macrophage D. Natural killer cell E. Neutrophil

42. A 28-year-old woman with a 15-year history of recur¬rent thrombosis from a prothrombin
gene mutation develops septicemia after a urinary tract infection with Pseudomonas
aeruginosa. She develops multiple infarcts and organ failure over the next 2 weeks. Which of
the following organs is most likely to be spared from the effects of ischemic injury in this
woman? A. Brain B. Heart C. Kidney D. Liver E. Spleen

43. Excess lead causes

A. CNS defects in adults
B. Peripheral neuropathy in children
C. Precipitates with potassium in bones
D. All of the above is incorrect
E. All of the above is correct
 44. An 85-year-old man falls in the bathtub and strikes the back of his head. Over the next 24
hours, he becomes increasingly somnolent. A head CT scan shows an accumulation of fluid
beneath the dura, compressing the left cerebral hemi¬sphere. Which of the following terms
best describes this collection of fluid? A. Congestion B. Ecchymosis C. Hematoma
C. Petechiae E. Purpura

45. Malaria belong to

A. Hereditary transmitted diseases B. Vector-borne infectious diseases
C. Sexually transmitted diseases D. All of the above

46. A superficial puncture wound from a needle stick injury leads to a small amount of bleeding in
a healthy person. Seconds after this injury occurs, the bleeding stops. Which of the following
mechanisms is most likely to stop small arteriolar blood loss from this injury?
A. Fibrin polymerization B. Neutrophil chemotaxis C. Platelet aggregation
D. Protein C activation E. Vasoconstriction

47. 44-year-old man has a history of poorly controlled diabetes mellitus leading to coronary artery
disease. He now has decreasing cardiac output. An increase in which of the following
substances in his blood is most indicative of reversible cell injury from decreased perfusion of
multiple organs and tissues? A. Carbon dioxide B. Creatinine C. Lactate D. Glucose E. Troponin
I
48. An 11-year-old child falls and cuts his hand. The wound becomes infected. Bacteria extend
into the extracellular matrix around capillaries. In the inflammatory response to this infection,
which of the following cells removes the bacteria?
A. B lymphocyte B. Fibroblast C. Macrophage D. Mast cell E. T lymphocyte

49. 45-year-old woman who works while standing for long periods notices at the end of her 8-
hour shift that her lower legs and feet are swollen, although there was no swell¬ing at the
beginning of the day. There is no pain or erythema associated with this swelling. She is
otherwise healthy and takes no medications; laboratory testing reveals normal liver and renal
function. Which of the following mechanisms best explains this phenomenon?
A. Excessive free water intake B. Hypoalbuminemia C. Increased hydrostatic pressure
D. Lymphatic obstruction E. Secondary aldosteronism

50. Cardiac output is determined by:

a. kidney activity and smooth muscle contractility
b. heart rate and stroke volume
c. hyperacidity and hypertoxicity
d. All answer is correct
e. All answer is incorrect

True / False – 0.25 point, Total: 10 points

51. Angina pectoris is exertional chest pain due to inadequate perfusion: A. True B. False

52. Marfan Syndrome is represented skeletal abnormalities, ocular change, cardiovascular system
disorders: A. True B. False
53. Atresia describes the absence of an opening, usually of a hollow visceral organ or duct such as
intestines and bile ducts: A. True B. False
54. Digital clubbing is one of the clinical features of cystic fibrosis: A. True B. False

55. Mechanisms of hypertrophy in the heart involve signal transduction pathways, induction of
particular genes and increased synthesis of certain cellular proteins: A.True B. False
56. Increase in cytosolic Ca2+ can damage mitochondria: A. True B. False
57. The first reaction to vascular injury is vasodilation: A.True B. False
58. Type II hypersensitivity reactions can result in phagocytosis, lysis, inflammation or
dysregulated function (impaired or excessively stimulated) of target cells: A. True B. False
59. Heparin-like substances increases the adhesiveness of the blood vessel wall: a. true b. false
60. Xenobiotics are endogenous chemicals in the environment: A. True B. False
61. Lymphadenitis: inflammation of the lymph nodes: A. True B. False
62. In Barrett esophagus, metaplasia occurs as a result of refluxed gastric acid: A. True B. False
63. In a resting lymphocyte, B cells and T cells can be distinguished from each other via simple
blood smear: A. True B. False
64. Mechanisms of hypertrophy in the heart involve signal transduction pathways, induction of
particular genes and increased synthesis of certain cellular proteins. A. True B. False
65. Mesothelioma is bening tumor: A. true B. False
66. Hiatal hernia may lead to gastric mucosal ischemia, ulceration and bleeding: A. True B. False

67. A 28-year-old man has had hemoptysis and hematuria for the past 2 days. On physical
examination, his temperature is 36.8° C, pulse is 87/min, respirations are 19/min, and blood
pressure is 150/90 mm Hg. Laboratory studies show creatinine of 3.8 mg/dL and urea nitrogen
of 35 mg/dL. Urinalysis shows 4+ hematuria, 2+ proteinuria, and no glucose. A renal biopsy
specimen examined microscopically shows glomerular damage and linear
immunofluorescence with labeled complement C3 and anti-IgG antibody. Is it correct that anti–
basement membrane - autoantibodies has the greatest specificity for this patient’s condition? :
A. True B. False
68. Essential hypertension represents 5% of cases and is a complex, multifactorial disorder,
involving both environmental influences and genetic polymorphisms: a. true b. false
69. Aneurysms are congenital (in all cases) dilations of the heart or blood vessels that involve the
entire wall thickness: a. true b. false
70. 76 year-old woman with metastatic breast cancer to bone, has abnormal calcium deposits
diffusely within her lung depicted on chest x-ray. This is an example of dystrophic type of
pathologic calcification?: a. true b. false
71. The two most common pathogenic mechanisms of vasculitis are immune-mediated
inflammation and direct vascular invasion by infectious pathogens: a. true f. false
72. Steatosis refers to the accumulation of which of Lipofuscin in cells: a. True b. false

73. Down Syndrome is manifested in trisomy 18: A. True B. Flase

 74. Fragile X syndrome results from loss of FMR1 gene function and is characterized by mental
retardation, macro orchidism, and abnormal facial features: A. True B. False
75. The system catalyzes reactions that either detoxify xenobiotics or activate xenobiotics into
active compounds that cause cellular repair: A. True B. False
76. Acute poisoning by CO is marked by a characteristic generalized cherryred color of the skin
and mucous membranes: A. True B. False
77. Vasculitis represented in small blood vessels inflammation: A. True B. False
78. Chronic alcoholism is a major risk factor for cancers of the oral cavity, larynx, and esophagus:
A. True B. False
79. Myocardial ischemia leads to loss of myocyte function within 1 to 2 hours but causes necrosis
only after 1 to 2 days: a. true b. false

80. A 45-year-old man with chronic renal failure received a kidney transplant from his brother 36
months ago. For the next 30 months, he had only minor episodes of rejection that were
controlled with immunosuppressive therapy. During the past 6 months, he has had increasing
serum creatinine and urea nitrogen levels. On physical examination, he is afebrile. Microscopic
examination of a urinalysis specimen shows no WBCs. A renal scan shows that the allograft is
reduced in size with reduced blood flow. Doctor said that vascular intimal immunologic injury
is reprecented in this clinical case? A. True B. False
81. Cytogenetic disorders Involving sex chromosomes from 45,X to 49,XXXXY: Klinefelter
syndrome, Turner syndrome: A. True B. False
82. Dysplasia is a term that literally means “absence of organ “ : A. True B. False
83. Lymphangiosarcoma is benign tumor derived from lymph vessels: A. True B. False
84. More than one neoplastic cell type derived from more than one germ layer represents
hemangiomas: A. True B. False
85. Metastasis is defined by the spread of a tumor to sites that are physically discontinuous with
the primary tumor, and unequivocally marks a tumor as malignant, as by definition benign
neoplasms do not metastasize: A. True B. False
86. Benign tumor often invade surrounding normal tissue: A. True B. Flase
87. Benign tumors resemble the tissue of origin and are well differentiated; malignant tumors are
less well differentiated or completely undifferentiated (anaplastic): A. True B. False
88. Tumors have no capacity to proliferate without external stimuli, usually as a consequence of
oncogene activation: A. True B. Flase
89. Proto-oncogenes – are normal cellular genes whose products promote cell proliferation: A.
True B. False
90. Most of the systemic lesions are caused by immune complexes (type I hypersensitivity): A.
True B. Flase

Open questions (Definition ) – 1 point, Total: 10 points

91. Define what is hemoptysis

92. Define what is opportunistic infection
93. Define icterus
94. Define hypersensitivity type IV
95. What is steatosis?
96. Define cyanosis
97. List heavy metals – most commonly associated with toxic effects in humans
98. List routs – how can be spread metastasis?
99. List morphologic patterns of necrosis
100. Define apoptosis