ࡱ> WYTUV5@ objbj22 XXgpppppppSSSS SCUUUUUUUU›ěěěěěě$1RTpUUUUUppUUVVVUFpUpU›VU›VVVڌ4 ppUU $JISU">0CL>ןVן|ppppןp$UUVUUUUU$$V PATHOLOGY MCQ Hypertrophy occurs after partial hepatectomy increases function of an organ exponentionally is triggered by mechanical and trophic chemicals occurs after dennervation is usually pathological All the following are features of apoptosis EXCEPT cell swelling chromatin condensation formation of cytoplasmic blebs lack of inflammation phagocytosis of apoptotic bodies Dystrophic calcification is formed only in coagulative necrosis does not occur on heart valves rarely causes dysfunction is rarely found on mitochondria is formed by crystalline calcium phosphate mineral Irreversible cell injury is characterised by dispertion of ribosomes cell swelling nuclear chromatin dumping lysosomal rupture cell membrane defects Metaplasia can be caused by vitamin B12 deficiency preserves mucus secretion in the respiratory tract is typically an irreversible process is the process that occurs in Barretts oesophagitis is an increase in the number and size of cells in a tissue Smooth endoplasmic reticulum is the site a cell steroid production is the site of cell protein synthesis is the site of cellular cytochrome oxidases Pinocytosis adds to the cell membrane involves the uptake of soluble macromolecules Examples of hyperplasia include glandular epithelium of pubertal breasts Ribosomes have 3 subunits have 30% DNA synthesise haemoglobin Which of the following is not associated with atrophy decreased smooth endoplasmic reticulum decreased rough endoplasmic reticulum decreased autophagic vacuoles In acute inflammation which event occurs first arteriolar dilatation arteriolar constriction oedema leucocyte migration blood flow stasis The first vascular response to injury is slowing of the circulation venular dilation recruitment of vascular beds capillary engorgement arteriolar vasoconstriction Leucocytes move into the tissues from the vasculature (extravasation ) by the action of actin and myosin predominantly as monocytes on the first day post injury in response to C3b in response to the Fc fragment of IgG largely in the arterioles Regarding chemical mediators of inflammation histamine is derived from plasma C3b is within macrophages The kinin system is activated in platelets Nitric oxide is preformed in leukocytes Seretonin is preformed in mast cells Chronic inflammation is always preceded by acute inflammation characterised by hyperemia, oedema and leukocyte infiltration most frequently results in resolution the factors underlying monocyte infiltration are the same as for acute inflammation In the triple response the reactive hyperemia is due to blushing excersise arteriolar dilation inflammatory mediators still present after sympathectomy Vascular hyperemia is caused by inflammatory mediators results in cyanosis results in oedema results in brown induration Platelets contain alpha and beta granules are biconcave discs contain a nucleus are found in the plasma at levels of 200-500 per microlitre are the main source of thrombin Macrophages may secrete histamine seretonin prostaglandins oxygen free radicals Which of the following cells cannot phagocytose neutrophils eosinophils macrophages T-cells The most common peripheral circulating lymphocyte is B-cell T-cell Granulocytes Oncogenes Dysplasia is a feature of mesenchymal cells inevitably progresses to cancer is characterised by cellular pleomorphism is the same as carcinoma in situ is not associated with architectural abnormalities Metastasis unequivocally prove malignancy is the most common presentation of melanoma is proven by lymph node enlargement adjacent to a tumor of breast is usually to supraclavicular nodes all of the above Mast cell may discharge independent of IgE release lysosymes Non-inflammatory oedema has a high protein content has a SG of greater than 1.012 is caused by low levels aldosterone is caused by elevated oncotic pressure is associated with elevated levels of ANP Metastatic calcification occurs in old lymph nodes gastric mucosa atherosclerotic vessels damaged heart valves Regarding chronic inflammation all of the following are true EXCEPT it can be caused by persistent infections it primarily involves tissue destruction it may contribute to the formation of atherosclerosis it involves mononuclear inflammatory cells it can be caused by exposure to toxic agents Macrophages are derived from monocytes T-cells B-cells Eosinophils Plasma cells White infarcts occur in small intestine oesophagus lung kidney sigmoid colon Concerning the repair of a well opposed, clean surgical incision dermal appendages destroyed by the incision usually recover new collagen begins to accumulate after the first week granulation tissue does not occur there is an initial inflammatory response 15% of original tissue strength is attained after 1 week Pulmonary congestion is associated with haemosiderin deposition in macrophages Regarding oedema infection does not cause pulmonary oedema hereditory angioneurotic oedema involves skin only facial oedema is a prominent component of anasacra hepatic cirrhosis is the most common cause of hypoprotenemia hypoprotenemia is the most common cause of systemic oedema With respect to wound healing neutrophils proliferate at the wound margins at the same time as epitheleal proliferation occurs Which occurs first in fracture healing neutrophil invasion procallus formation woven bone ossification lamellar bone ossification collagen deposition Subchondral necrosis is rarely idiopathic associated with diving injuries rarely involves ischaemia In bone fracture healing woven bone forms in the periosteum of the medullary cavity osteoblasts lay down woven bone over the procallous to repair the fracture line PTH acts directly on osteoclasts to increase absorption Haematoma at the fracture site plays little role in the development of procallous Inadequate immobilisation aids the formation of normal callous In healing by primary intention there is a large tissue defect the tissue defect cannot be reconstituted it involves excessive granulation tissue an epitheleal spur forms on the first day The process of blood coagulation involves prothrombin activator converting fibrinogen to fibrin alpha 2 macroglobulin the action of antithrombin 3 to promote clotting the action of plasmin on fibrin the removal of peptides from each fibrinogen molecule DIC is associated with thrombocytosis a bleeding diathesis presentation in a patient with malignancy With respect to the clotting cascade the alternative pathway is stimulated by Ag-Ab interaction C3bBb inhibits the final common pathway As As C5a initiates arachadonic acid metabolite release from neutrophils With regard to embolism arterial emboli most often lodge in the viscera pulmonary emboli are rarely multiple amniotic fluid emboli are associated with the highest mortality all emboli consist of either gas or solid intravascular mass most pulmonary emboli produce signs of respiratory distress Regarding the veins of the lower limb thrombosis in the superficial veins is a common source of emboli phlegmasia alba dolens is associated with iliofemoral vein thrombosis dermatitis is a common consequence of Buergers disease varicosity development has no genetic component 20% of venous thrombi commence in superficial veins Post mortem features of clot include adherence to vascular walls absence of red cells in supernatant lines of Zahn Air embolism is fatal as air is non-compressible so does not leave the heart 200 ml is the lethal dose Amniotic fluid embolism is associated with a greater than 80 % mortality Fat embolism syndrome is assocoated with mortality of greater than 20 % petechial rash, non-thrombocytopenic T lymphocytes contain CD3 proteins are the basis for type 2 hypersensitivity differentiate into antibody producing plasma cells are capable of cytotoxic activity are activated in the presence of soluble antigens In transplant rejection the hyperacute rejection is cell mediated prevented largely by cross-matching blood controlled by immunosuppressive drugs All the following are type 1 hypersensitivity primary mast cell mediators EXCEPT histamine tryptase heparin platelet activating factor eosinophil chemotactic factor Type 2 hypersensitivity involve cell mediated immune responses explain the tuberculin skin test involve IgE on mast cells explain many transfusion reactions include serum sickness as an example A man with type B blood has the commonest blood type cannot have a child with type O blood cannot have a child with type AB blood cannot have a child with type A blood none of the above Passive immunity is achieved by administering live virus attenuated virus adsorbed toxin activated T-cells all of the above The majority of AIDS cases are reported from homosexual males IV drug abusers Haemophilliacs Heterosexual contact Recipients of blood products The following are opportunistic AIDS infections EXCEPT PCP Atyoical mycobacterium CMV Mycoplasma pneumonia HIV is associated with polyclonal hypergammaglobulinemia Staph aureus has enterotoxins which stimulate emetic receptors in the abdominal viscera has a lipase which degrades lipids on the skin surface has a capsule that allows it to attach to artificial materials has receptors on its surface which allow binding to host endothelial cells all of the above Staph aureus can cause all of the following EXCEPT food poisoning osteomyelitis carbuncles scarlet fever scalded skin syndrome Which of the following is NOT a DNA virus HSV HBV HIV EBV VZV With respect to streptococcal infection may result in glomerulonephritis 3 weeks post infection Non-thrombocytopenic purpura is associated with aplastic anemia SLE Meningococcemia HIV EBV With hepatitis B infection HbeAg is associated with viral replication In hepatitis B Anti-HBs appears soon after HbsAg Infection does not play a role in hepatocellular carcinoma HbsAg appears soon after overt disease The majority of cases of persistent infection result in cirrhosis Acute infection causes sub-clinical disease in 65% of cases Hepatitis C is acquired by faecal-oral transmission has its highest prevelance in heamodialysis patients transmission by sexual contact is at a high rate exposure confers effective immunity to subsequent infection causes chronic hepatitis at a higher rate than hepatitis B With hepatitis C infection Associated with sexual transmission primarily More than 50 % become chronic Transmission increases in pregnancy With hepatitis E infection it is transmitted primarily parenterally it accounts for a greater than 20 % mortality in pregnant mothers Clostridium species are all spore producing C.tetani produces an endotoxin which causes muscle spasm Vaccination against C.tetani has not significantly reduced the incidence of tetanus C.botulinum toxin blocks seretonin and dopamine receptors C.perfringens causes wound infections 10 days post operatively All the following infections are associated with splenomegaly EXCEPT leprosy toxoplasmosis tuberculosis typhoid fever CMV Bacterial endotoxin is exemplified by streptokinase si the cause of the severe form of diptheria is the cause of gas gangrene induces the production of TNF is the outer cell wall of gram positive bacteria In aseptic meningitis the glucose in the CSF is raised the most commonly identified agent is an enterovirus there is a more fulminant course than bacterial meningitis there is no brain swelling microscopically there is a large infiltration of leukocytes In infectious disease bacterial endotoxin is inner cell wall mucoprotein exotoxin molecular mechanisms are mostly unknown microbes propagating in the gut lumen are accessible to IgA antibodies macrophages in bronchi play a major role in protecting the lungs from infection bacterial adhesins which bind bacteria to host cells have a broad range of host cell specificity In malaria plasmodium vivax causes severe anemia parasites mature in red blood cells innoculated sporozites immediately invade the spleen plasmodium falciparum initially causes hepatomegaly cerebral malaria is caused by parasites invading grey matter Ricketsial infection principally affects the endothelium Which of the following tissues is the most susceptible to radiation injury GI mucosa CNS Lymph and haemopoetic Bone Lungs With electrical injury death is always due to thermal burn dry skin is a good electrical conductor ampage of the current is important all body tissues conduct electricity Which of the following is an anti-oxidant vitamin D vitamin B12 vitamin E vitamin K vitamin B6 Which deficiency causes diarrohea, dermatitis and dementia pyridoxine vitamin A riboflavin vitamin B1 niacin Decreased levels of B12 are associated with all the following EXCEPT autoimmune gastritis crohns disease subacute combined degeneration of the cord Regarding Iron which of the following is INCORRECT absorption is increased by vitamin C most is found in myoglobin most is absorbed in the duodenum women have smaller iron stores than men transferrin is usually 33% saturated Which is true of the pituitary gland anteriorLHbasophils posteriorvasopressinbasophils anteriorGHbasophils Pituitary adenoma may cause graves disease hypothyroidism acromegaly Which is true of the pituitary posteriorprolactinacidophils posteriorvasopressinbasophils anteriorLHbasophils The type of emphysema associated with smoking is panacinar centriacinar distal acinar irregular none of the above Squamous cell lung carcinoma has a 5 year survival rate of 60% is most commonly associated with smokers is commonest peripherally is commonest in females Intrinsic asthma is commonly triggered by viral infections TB pathogenicity is due to Lobar pneumonia is more common in the young and the elderly involves morphological changes of red to grey hepatisation not usually associated with a productive cough is associated with immunosuppression rarely caused by streptococcus Chronic bronchitis is characterised by smooth muscle hypertrophy leucocyte infiltration mucus gland hypertrophy increased size of goblet cells All the following cause compressive atelectasis EXCEPT pneumothorax asthma CCF Peritonitis Pleural effusion Which is not true of bronchogenic cysts they may become dysplastic they occasionally cause pneumothorax they have an epithelial layer they may contain mucus they are often associated with bronchioles Chronic bronchitis major morphological change involves leukocyte infiltration decreased goblet cell number smooth muscle hypertrophy increased mucosal gland depth ( REID index) In males the relative risk of cigarette smoking causing a cancer is highest for lung larynx oesophagus pancreas lip, oral, and pharynx Cessation in cigarette smoking causes a prompt reduction in the risk of lung cancer stroke cancer of the bladder MI COPD Regarding bronchogenic carcinoma it most often arises around the hilum of the lung distant spread occurs solely by lymphatic spread metastasis are most common to the liver small cell carcinoma is the most common type surgical resection is often effective for small cell carcinoma In emphysema a deficiency of alpha 1 antitrypsin is protective centriacinar destruction leads to obstructive overinflation the proteaseantiprotease mechanism is the most plausible explanation of the disease smokers have an increased number of macrophages in the bronchi elastase activity is unaffected by oxygen free radicals In chronic bronchitis the hallmark is hypersecretion of mucus in the large airways there is a marked increase in goblet cells in the main bronchi infection is a primary cause cigarette smoke stimulates alveolar leukocytes dysplasia of the epitheleum leads to emphysema In bronchial asthma extrinsic asthma is initiated by diverse non-immune mechanisms sub-epitheleal vagal receptors in respiratory mucosa are insensitive to irritants IgG plays a role Bronchial wall smooth muscle is atrophic Primary mediators include eosinophilic and neutrophilic chemotactic factors In bacterial pneumonia patchy consolidation of the lung is the dominant feature of bronchopneumonia a lobar distribution is a function of anatomical variations Klebsiella pneumonia is a common virulent agent Alveolar clearance of bacteria is achieved by lymphocytes The nasopharynx is inconsequential in defending the lung against infection Smoking is associated with all the following diseases EXCEPT spontaneous abortion atherosclerosis bladder carcinoma chronic liver disease Smoking is associated with particle deposition in alveolar macrophages In pulmonary tuberculosis the Ghon complex is a parenchymal peri-hilar lesion bacilli establish themselves in sites of low oxygen tension liquefactive necrosis precedes granuloma formation Langhans cells occur in coalescent granulomas Primary TB causes more damage to lungs than secondary TB The commonest site of primary TB lesion in lung is apex base hilum lower zone of upper lobe peripherally Regarding the changes to myocardium after MI pallor at 24 hours wavy fibres are found centrally decreased contractility after 5 minutes liquefactive necrosis is typical sarcoplasm is resorbed by leukocytes In compensated cardiac hypertrophy changes include diffuse fibrosis hyperplasia decreased sarcomeres increased capillary density increased capillary/myocyte ratio In atherosclerosis the cells at the centre of the plaque are macrophages foam cells leukocytes smooth muscle cells All of the following are major risk factors for atherosclerosis EXCEPT obesity hyperlipidemia smoking hypertension diabetes Endocarditis in IV drug abusers typically involves the mitral valve is caused by candida albicans does not cause fever has a better prognosis than other types of endocarditis is caused by staph aureus The commonest cause of fungal endocarditis is actinomycosis as as candida blatomycosis With regard to MI gross necrotic changes are present within 3-5 hours irreversible cell injury occurs in less than 10 minutes fibrotic scarring is completed in less than 2 weeks death occurs in 20 % of cases in less than 2 hours is most commonly caused by occlusion of the left circumflex coronary artery Septic shock may cause all of the following EXCEPT myocardial depression vasoconstriction DIC ARF ARDS Regarding pericarditis constrictive pericarditis only rarely follows suppurative pericarditis primary pericarditis is usually bacterial in origin serous pericarditis may be due to ureamia haemorrhagic pericarditis is most commonly due to Klebsiella infection fibrinous pericarditis is due to TB until proven otherwise Shock results in decreased capillary hydrostatic pressure Patient who has a normal blood pressure post MI must have increased cardiac output increased systolic filling pressure increased right atrial pressure Acute endocarditis has a less than 20 % mortality is caused by virulent micro-organisms 30 % is caused bacteria Congestive cardiac failure may be caused by vitamin A deficiency niacin deficiency vitamin D deficiency thiamine deficiency vitamin C deficiency Following myocardial infarction ATP is down to 50% at 10 minutes Irreversible cell injury occurs within 5 minutes ATP depletion begins at 2 minutes Microvascular injury occurs within 30 minutes Wavy fibres are present within 20 minutes Thromboctopenia occurs commonly in HIV causes spontaneous bleeding at levels of less than 90,000/mm occurs with hyposplenism is related to platelet survival in paroxysmal nocturnal haemoglobinuria is not associated with megaloblastic anaemia A young man presents with central chest pain presumed to be associated with vasoconstriction. The most likely cause of the pain is local hypoxia decreased ATP increased CO2 catecholamines acting on alpha 1 receptors acetylcholine stimulation An adult male with an ejection fraction of 80 % could be due to myocardial ischaemia arrhythmia thiamine deficiency Which risk factors have the greatest association with atherosclerosis hypertension, diabetes, smoking , hyperlipidemia hypertension, male, family history hypertension, obesity, sedentary lifestyle hypertension, female, OCP age, family history, sex Central pathophysiological feature of shock hypotension decreased blood volume cellular hypoxia at a tissue level infection cardiac failure Malignant hypertension 75 % recover with no loss of renal function is associated with abnormal renin levels affects 1 to 5 % of sufferers The cause of fluid retention peripherally with congestive cardiac failure is increased renin increased GFR increased angiotensin 2 increased aldosterone Rheumatic carditis is associated with Curschmann spirals Ito cells Aschoff bodies Nutmeg cells Reed-sternberg cells Bradykinin causes smooth muscle dilatation kallikrein causes prohormone degredation to produce bradykinin Diabetes is associated with carbuncles mucormycosis all of the above Pathogenesis of type 1 diabetes is associated with decreased insulin sensitivity abnormal glucokinase activity no antibodies found at diagnosis auto-immune insulitis twin concordance greater than 70 % Which of the following is characteristic of type 11 diabetes early insulinitis not affected by pregnancy decreased peripheral receptor sensitivity less than 50 % concordance in twins 90 % of patients displaying antibodies to insulin receptors within 1 year of diagnosis Type 11 diabetes is characterised by onset in early adulthood 50 % concordance in twins severe beta cell depletion islet cell antibodies normal or increased blood insulin levels In type 1 diabetes associated organ-specific auto-immune disorders are common a genetic susceptibility is not supported by evidence Finnish children have a 70 fold increase compared with Korean children Influenza and varicella viruses are suspected as initiators of the disease Children who ingest cows milk early in life may have a lower incidence Regarding pancreatitis the second most common cause is infectious agents trypsin is implicated as an activator of the kinin system the chronic form is usually due to gallstones duct obstruction is not the mechanism in alcoholic pancreatitis elastase is the only pancreatic enzyme that acts to limit pancreatitis In acute pancreatitis fat necrosis occurs in other intra-abdominal fatty deposits trauma is the precipitating cause in 30 % of cases alcohol is directly toxic to the Islets of Langerhans Kallikrein converts trypsin to activate the complement system Erythromycin has been implicated in severe cases With regards to jaundice Conjugated bilirubin causes kernicterus in adults Unconjugated bilirubin does not colour sclera Unconjugated bilirubin is tightly bound to albumin Unconjugated bilirubin produces bilirubin in urine Conjugated bilirubin is tightly bound to albumin In cirrhosis fibrosis is confined to the delicate bands around central veins nodularity is uncommon vascular architecture is preserved the Ito cell is a major source of excess collagen the left lobe of the liver is most affected Cirrhosis is associated with reorganised liver vasculature with scarring Oesophageal varices occur in one third of all cirrhosis patients account for more than 50 % of episodes of haematemesis are most often associated with hepatitis C cirrhosis have a 40 % mortality during the first episode of rupture lie primarily in the middle portion of the oesophagus Concerning acute tubular necrosis cephalosporins are not a causative agent nephrotoxic causes are associated with a poor prognosis casts are found in the loop of Henle rhabdomyolysis is not a cause ischaemic tubular necrosis is uncommon after haemorrhagic shock Regarding acute tubular necrosis it is associated with hyperkalemia not hypokalemia in recovery non-oliguric has a better recovery it is associated with ischaemic cortical cells 80 % are associated with anuria Ischaemic tubular necrosis is associated with maintenance stage with polyuria predominantly proximal necrosis intact basement membranes tubular cast obstruction distal necrosis only Hypertensive renal disease 60 % of renovascular hypertension is due to fibromuscular hyperplasia malignant hypertension only arises if previous hypertension onion skinning correlates with degree of renal failure The morphology of renal failure includes Regarding the hepatorenal syndrome it is irreversible one loses the ability to concentrate urine urine has a high sodium concentration the urine is hyperosmolar the favoured theory of its generation involves increased renal blood flow Urolithiasis presence of hypercalcemia implies renal insufficiency a patient with leukemia is likely to make cystine calculi calcium is the major component of 35% of calculi struvite stones are made up of magnesium-ammonium-phosphate the commonest cause of calcium oxalate stones is hypercalciuria In pyelonephritis 85 % of infections are caused by G-ve bacteria uretral obstruction makes haematogenous infection less likely uretral obstruction allows bacteria to ascend the ureter into the pelvis infection is less likely during pregnancy papillary necrosis and perinephric abscess are common seqelae Cushing syndrome is associated with osteoporosis general obesity hypotension Macrocytic anaemia is associated with all the following except Hyperthyroidism Neoplasm Folate and B12 deficiency Pregnancy EBV Myositis ossificans Morphologically resembles osteosarcoma Resembles the repair process following a muscle tear Internal carcinoma is associated with which of the following skin disorders acanthosis nigricans Hypothyroidism is associated with all of the following EXCEPT cretinism decreased hair growth cold intolerance Which of the 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