Basic pathology MCQs

Published on October 26, 2014
Acute and Chronic inflammation MCQ
http://improvingedcare.org/2013/08/12/injury-inflammation-and-healing-mcqs/
Regarding acute inflammation
a) Initial vasoconstriction is the result of histamine and nitric oxide
b) Stasis occurs due to vasodilatation and the larger caliber of vessels
c) Increased permeability leads to protein depleted plasma leaking into the tissue
d) Initial formation of endothelial gaps lasts for only 15-30 minutes
e) Cytokines (IL-1 and TNF) are responsible for the early permeability
Histamine is involved in acute inflammatory responses and is released from mast cells. Which of the following statements is incorrect?
a) It is found in blood basophils, platelets and mast cells
b) It causes increased permeability of arterioles
c) It may be released by physical trauma
d) It causes constriction of large vessels
e) It acts on the microcirculation via H1 receptors
Regarding mediators of inflammation
a) TNF is a chemokine with chemoattractant properties
b) TNF contributes to cachexia of disease
c) TNF and IL-1 are produced mainly by activated leukocytes
d) The systemic acute phase response is induced by MIP-1 and RANTES chemokines
e) PAF causes vasodilation when expressed at high levels
Chronic inflammation is characterized by all of the below except
a) Tissue destruction
b) Angiogenesis
c) Infiltration with neutrophils
d) Fibrosis
e) Increased tissue concentration of lymphocytes
Complement
a) Proteins are usually stored in an active state in lysosomal molecules
b) Pathway is inhibited by C3 cleavage
c) C3 is the most abundant protein in the complement family
d) Activation by the classical pathway involves microbial surface antigens
e) Cobra venom activates the lectin pathway
INFLAMMATION
http://improvingedcare.org/2013/08/12/injury-inflammation-and-healing-mcqs/
1. In acute inflammation
a. A hallmark is reduced vascular permeability
b. Vasodilation is a late manifestation
c. Extravasation involves movement of leukocytes from interstitial tissue to the vessel lumen
d. Chemotaxis is migration of leukocytes along a chemical gradient
e. Selectins have a minor role
2. In acute inflammation which event occurs first
a. Arteriolar dilatation
b. Arteriolar constriction – vasodilatation follows transient arteriolar constriction lasting a few seconds
c. Oedema
d. Leucocyte migration
e. Blood flow stasis
3. The first vascular response to injury is
a. Slowing of the circulation
b. Venular dilation
c. Recruitment of vascular beds
d. Capillary engorgement
e. Arteriolar vasoconstriction – vasodilatation follows transient arteriolar constriction lasting a few seconds
4. leukocytes move into tissues from the vasculature (extravasation)
a. by the action of actin and myosin – correct
b.
predominantly as monocytes on the first day post injury – neutrophils
c. in response to C3b
d. in response to the Fc fragment of IgG
e.
 largely in the arterioles – in venules
5. Regarding chemical mediators of inflammation
a. Histamine is derived from plasma – and serotonin released from preformed stores from mast cells, basophils and platelets
b. C3b is within macrophages – synthesized in liver
c. The kinin system is activated in platelets – on platelets?
d. Nitric oxide is preformed in leukocytes – short half life, lasts seconds
e. Serotonin is preformed in mast cells – actually not in humans! It is preformed and in platelets and neuroendocrine cells
6. Chronic inflammation is
a.
Always preceded by acute inflammation – no, can result from low-grade persistent insult
b. Characterized by hyperaemia, oedema and leukocyte infiltration
c. Most frequently results in resolution
d. The factors underlying monocyte infiltration are the same as for acute inflammation
e. ?
11. In chronic inflammation:
a. The most important cells are lymphocytes – are present, but macrophages more important
b. Mast cells are not involved – plasma cells are (?Mast cells)
c. Is always associated with tissue damage – associated with mononuclear cells (Macrophages), tissue destruction and attempts at healing (angiogenesis and fibrosis)
d. The most important cells are neutrophils – monocytes -> macrophages
e. Caseous necrosis is only seen in tuberculosis – characteristic of, not indicative
13. Leukotrienes play a role in all of the following EXCEPT:
a. Chemotaxis
b. Vasoconstriction
c. Platelet aggreagation – don’t cause this
d. Bronchospasm – more potent than histamine
e. Increased permeability
15. A preformed mediator of inflammation is:
a. Prostaglandin
b. Histamine
c. Leukotriene
d. Nitric oxide
e. Platelet activating factor
16. Interleukin 1 causes:
a. Neutropenia
b. Decreased sleep
c. Decreased prostaglandin synthesis
d. Increased collagen synthesis – Vascular endothelium and leukocytes -> inflammation
Fibroblasts (promote proliferation and collagen synthesis) -> repair, Fever, Anorexia, Lethargy, Neutrophilia, Corticotrophin and corticosteroid release
e. Decreased leukocyte adherence
17. With regard to the acute inflammatory response, which is the most common mechanism of vascular leakage?
a. Endothelial cell contraction
b. Junctional retraction
c. Direct injury
d. Leukocyte-dependent leakage
e. Regeneration indothelium
18. With regard to the role of complement in the acute inflammatory response, which is INCORRECT?
a. C5a is a powerful chemotactic agent for neutrophils, monocytes and eosinophils
b. C5a increases leukocyte adhesion to endothelium by activating leukocytes
c. C3a and C5a are called anaphylatoxins because they cause mast cell degranulation
d. C3a activated the lipooxygenase pathway in leukocytes – C5a does…
e. C3 and C5 can be activated in inflammatory exudates by lysosomal enzymes
19. Granulomatous inflammation
a. May sometimes be a component of the acute inflammatory response
b. Indicates the presence of tuberculosis
c. Consists in part of microscopic aggregates of transformed lymphocytes
d. Is always associated with the presence of giant cells – often, especially if older
e. May result from non-immune mechanisms – foreign body granuloma
20. In acute inflammation, all of the following are true EXCEPT:
a. There is contraction of endothelial cells
b. There is a mononuclear infiltrate – this seems true, neutrophils first 6-24, then monocytes 24-48
c. There is induction of adhesion molecules on endothelium
d. There is production of arachadonic acid metabolites
e. Cytokines induce a systemic acute phase response
23. Which is not chemotactic?
a. Histamine – just causes vasodilatation, increased permeability (and endothelial activation)
b. C5a – powerful
c. Leukotriene B4 – main leukotriene
d. Bacterial polypeptides – true
e. Cytokines – definitiely
24. The alternative pathway of complement activation can be triggered by:
a. IgG antigen-antibody complexes
b. Properdin
c. Microbial surfaces
d. Lysosomal proteases
e. C5-9 Membrane attack complex
25. Which factor ties together activation of the clotting cascade, kinins and the fibrinolytic system?
a. Stuart Factor
b. Prothrombin
c. Plasminogen
d. Factor XII – aka Hageman factor -> XIIa:
1. induces the intrinsic pathway, 
2. prekallikrein -> kallikein
i. autocatalytic loop-> XII
ii. HMWK – > bradykinin (dilation/permeability)
iii. C5->C5a
3. pasminogen -> plasmin (fibrinolytic), plasmin also C3->C3a
e. Kallikrein
36. Regarding acute inflammation:
a. Occurs in apoptosis
b. Increased vascular permeability resulting in increased colloid osmotic pressure and reduced hytdrostatic pressure
c. Leukocyte migration through blood vessels is required by binding to selectin and integrin receptors
d. Causes venule dilation but not arteriole dilation
e.
Typically produces transudate – normally exudate
transudate /tran·su·date/ (tran´su-dāt) a fluid substance that has passed through a membrane or has beenextruded from a tissue; in contrast to an exudate, it is of high fluidity and has a low content of protein, cells, or solidmaterials derived from cells.
EXUDATE – contains protein
37. Mononuclear phagocytes
a. Are the predominant cells in three day old wounds
b. Are common in liver, spleen and pancreas
c. Produce fibroblast growth factor
d. Secrete interferon-g
e. Have a half-life of one day
http://improvingedcare.org/2013/08/12/injury-inflammation-and-healing-mcqs/
CELL INJURY
1. Cell injury
a. Is characterized by increased oxidative phosphorylation – decreased -> anaerobic glycolysis
b. Results in efflux of calcium from the cell – influx and release of mitochondrial
c. May result in free radical induced damage – may result from, or cause it…
d. May be increased by enzymes such as catalase – catalase is free radical scavenger H2O2 -> H2O and O2
e. Results in increased membrane phospholipid – loss of
2. Tissue
a. Hypertrophy is characterized by increased numbers of cells
b. Hyperplasia is characterized by increased size of cells
c. Necrosis is always pathological – true
d. Response to injury may involve apoptosis, which is never a normal response
e. Reperfusion after ischaemia never results in full cell recovery
3. Hypertrophy
a. occurs after partial hepatectomy – hyperplasia
b. increases function of an organ exponentially
c. is triggered by mechanical and trophic chemicals – true
d. occurs after denervation – atrophy
e. is usually pathological
4. All of the following are features of apoptosis EXCEPT:
a. Cell swelling – shrinkage
b. Chromatin condensation
c. Formation of cytoplasmic blebs
d. Lack of inflammation
e. Phagocytosis of apoptotic bodies
5. Dystrophic calcification
a. Is formed only in coagulative necrosis – occurs is atheroscleosis, damaged heart valves and areas of necrosis (coagulative, liquefactive and caeseous)
b. Does not occur on heart valves
c. Rarely dauses dysfunction
d. Is rarely found on mitochondria – initiation of intracellular calcification occurs in mitochondrial of dead or dying cells
e. Is formed by crystalline calcium phosphate mineral – similar to bone hydroxyapatite
6. Irreversible cell injury is characterized by
a. Dispersion of ribosomes
b. Cell swelling
c. Nuclear chromatin clumping
d. Lysosomal rupture
e. Cell membrane defects – characterized by mitochondrial dysfunction and profound disturbances in membrane function
7. Metaplasia
a. Can be caused by vitamin B12 deficiency – Vit A (retinoic acid)
b. Preserves mucus secretion in the respiratory tract – will affect b/c loss of mucous production and ciliary action
c. Is typically an irreversible process
d. Is the process that occurs in Barrett’s oesophagitis – sqaumous -> columnar
e. Is an increase in the number and size of cells in a tissue
8. …..no question
9. no question
10. Metaplasia
a. Involves the formation of malignant cells in a tissue – predisposes
b. Of the respiratory tract often involves the replacement of squamous cells with columnar cells – columnar with squamous
c. Is a reversible change in which one mature cell type is replaced by another mature cell type – correct
d. Of the oesophagus, is normally a change from columnar to squamous cell types – squamous -> columnar in Barrett’s, hence normally glandular cancers
e. Is due to changed gene expression in mature cell types to produce a different mature cell type – the mature cells don’t change, stem or undifferential cells undergo reprogramming
11. The most important factor in irreversible cell injury is
a. ATP depletion
b. Decreased protein synthesis
c. Decreased pH
d. Membrane damage – profound membrane dysfunction is a hallmark
e. Loss of intracellular K+
12. no question
13. Hyperplasia
a. Results in a reversible change to another cell type – metaplasia
b. May be a precursor to malignancy – true, it is the “fertile soil”
c. Is defined as an increase in cell size – hypertophy
d. May occur due to increased functional demand in striated muscle – vast majority is hypertrophy
e. Persists when the stimulus is removed
14. In reversible cell injury, all are true except
a. ATP depletion is responsible for acute cellular swelling – correct, via failure of NA+/K+ ATPase pump and metabolic products of anaerobic gycloyisis
b. Can cause myocardial cells to cease contraction within 60 seconds
c. ATP is generated anaerobically from creatine phosphate
d. Mitochondrial swelling and degranulation of ER are the hallmarks of irreversible cellular damage – these occur as result of decreased ATP, but are reversible
e. Is associated with myelin figures – true
15. no question
16. no question
17. no question
18. Metastatic calcification
a. causes widespread tissue damage – usually
b. occurs with normal calcium levels – elevated
c. can be caused by systemic sarcoidosis – true, Vit D related
d. occurs in hypothyroidism – hyperparathyroidism
e. is caused by drinking large quantities of milk
19. With regard to apoptosis, which of the following is INCORRECT
a. It may be regarded as a normal physiological process
b. It is characterized by chromatin condensation
c. It often elicits a strong inflammatory response – usually does not
d. It is the process by which ovaries atrophy in post menopausal women
e. It is characterized by cell shrinkage
20. With regard to cellular injury, all of the following are reversible EXCEPT
a. Decreased ATP
b. Intracellular release of lysosomal enzymes – irreversible
c. Decreased Na pump activity
d. Detachment of ribosomes
e. ER swelling
21. Metaplasia is seen in all of the following except
a. Respiratory epithelium of cigarette smokers
b. Vitamin A excess – it occurs from deficiency, excess -> cell swelling and rupture
c. Barrett’s oesophagitis
d. Epithelium of a pancreatic duct containing stones
e. Foci of cell injury – connective tissue metaplasia?
22. Regarding atrophy, all are correct EXCEPT
a. Persistance of residual bodies
b. Decreased myofilaments
c. Decreased rough endoplasmic reticulum
d. Decreased autophagic vacuoles – increased because cell autophages for survival
e. Deceased smooth endoplasmic reticulum
23. no question
24. no question
25. Dystrophic calcification
a. Occurs in normal cells and tissues
b. Occurs in sarcoidosis – vit D increase -> metastatic calcification
c. Occurs in multiple myeloma
d. Often causes organ dysfunction – can be a source of significant pathology
e. ?
26. An example of hypertrophy is
a. The pubertal breast
b. The pregnant uterus
c. Post partial hepatectomy
d. ?
e. ?
27. Fatty change occurs in all of the following EXCEPT:
a. Heart
b. Liver
c. Skeletal muscle
d. Spleen
e. Kidney
33. Apoptosis
a. involves transfer of cytochrome C from the cytosol to the mitochondria – out from mitochondria
b. involves DNA fragmentation – cleaves into 180 – 200 base pair fragments (ladder pattern on EP)
c. is mediated by caspase inactivation – activation
d
. is suppressed by Fas-Fas ligand interaction – is activated by
e.
is activated by Bcl-2 – Bcl-2 and BCL-x are to main anti-apoptotic proteins
35. Which is incorrect regarding necrosis?
a. Autolysis may follow owing to denaturation of protein – ?
b. Heterolysis is digestion by lysosomal enzymes of immigrant leukocytes
c. Dystrophic calcification is seen particularly in necrotic fat cells -> calcium soaps
d. Coagulation necrosis is the most common pattern of necrosis
e. Liquefaction necrosis occurs when autolysis and heterolysis prevail over protein denaturation
CELLULAR INJURY/ADAPTATION/DEATH
http://units.georgetown.edu/gumc/educ/pathlab_manual/quiz/quiz_ci.htm
1. Which of the following accurately defines cellular adaptation:
Development of a new, altered steady state
Maintaining a steady state
Internally programmed cell death
ATP depletion
Accumulation of oxygen derived free radicals
2. Which of the following in not considered an adaptive response:
Atrophy
Hyperplasia
Dysplasia
Hypertrophy
Metaplasia
Metaplasia – replacement of one cell type to another.
Dysplasia- is abnormal cells lacking differentiation.
and dysplastic cells result from lack of differentiation into mature cells.
they don’t mature completely.
To help you remember, think about dysplasia as already cancer in situ, meaning that the cells are all screwed up,lacking differentiation and going berserk, its irreversible, not benign.
In metaplasia, its just a change of tissue, like for example a change from columnar epithelium to gastric, or the most common metaplasia is in the cervix, where there is a physiologic change of cell type in the transitional zone of the cervix. (In a Pap test, you might read metaplasia, and its normal, its benign, but if dysplasia is present, then something is wrong).
3. The enlarged uterus of a pregnant woman is an example of which adaptive behavior?
Dysplasia
Metaplasia
Hyperplasia
Hypertrophy
Atrophy
4. Mechanisms of hypertrophy in the heart involve signal transduction pathways, induction of particular genes and increased synthesis of certain cellular proteins.
TrueFalse
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:
Senile atrophy
Pressure atrophy
Loss of endocrine stimulation
Denervation atrophy
Disuse atrophy
6. All of the following are features of apoptosis EXCEPT:
Cell shrinkage
Disorientation of cell membrane lipids
Karyolysis
No associated inflammation
Intact cellular components
Karyolysis: the dissolution of a cell nucleus. It occurs normally, both as a form of necrobiosis and during the generation of new cells through mitosis and meiosis.
Karyolysis (Greek karyon = kernel, seed or nucleus, and lýsis from lýein, to separate) is the complete dissolution of the chromatin of a dying cell due to the enzymatic degradation by endonucleases. The whole cell will eventually stain uniformly with eosin after karyolysis. It is usually preceded by karyorrhexis and occurs mainly as a result of necrosis, while in apoptosis after karyorrhexis the nucleus usually dissolves into apoptotic bodies.[1]
Which one of the following cellular changes is reversible?
a- Karyorrhexis
b- Pyknosis
c- Karyolysis
d- Swelling of endoplasmic reticulum
Answer: D. Swelling of the endoplasmic reticulum from increased cell water, one of the earliest ultrastructural changes observed in injured cells, is reversible. In contrast, karyorrhexis, pyknosis, and karyolysis are all nuclear signs of cell death and represent irreversible changes.
7. Stimuli causing cellular injury do so by which of the following mechanisms:
ATP depletion
Loss of mitochondrial membrane potential
Oxidative stress
Loss of membrane permeability
All of the above
9. Steatosis refers to the accumulation of which of the following in cells?
Thin filamentsTriglycerides
Keratin filaments
Glycogen
Lipofuscin
steatosis (also called fatty change, fatty degeneration or adipose degeneration) is the process describing the abnormal retention of lipid
10. A 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 what type of pathologic calcification?
DystrophicMetastatic
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 the next 2 months, the lymphoma decreases in size, 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
Apoptosis
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
Nuclei undergo karyorrhexis
D Intracellular pH diminishes
E Blebs form on cell membrane
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 colour to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown colour at the site of injury 16 days later?
A Lipofuscin
B Bilirubin
C Melanin
Hemosiderin
E Glycogen
True or False?
Metaplasia occurs in Chronic smoker’s squamous bronchial epithelium
True , In normal healthy person trachea and bronchus lined by columnar ciliated epithelium , due to chronic smoking columnar ciliated epithelium is replaced by squamous epithelium –
In hypertrophy:
Size of organ increases
True
Number of cells increase
False
Size of cells increases
True
Occurs in cells which have limited capacity to divide
True
E
Only pathological
False , hypertrophy can be physiological or pathological
Hyperplasia:
Number of cells increases
Hint:
True
occurs in cardiac muscle
Hint:
False, has limited capacity to divide
Occurs in skeletal muscle
Hint:
False, has limited capacity to divide
Involved in wood healing
Hint:
True
Papillomavirus results skin warts form hyperplasia
Hint:
True
Hyperplasia (from ancient Greek ὑπέρ huper, “over” + πλάσις plasis, “formation”), or hypergenesis, means an increase in the number of cells or a proliferation of cells. It may result in the gross enlargement of an organ and the term is sometimes confused with benign neoplasia or benign tumor.
Hyperplasia is a common preneoplastic response to stimulus. Microscopically, cells resemble normal cells but are increased in numbers. Sometimes cells may also be increased in size (hypertrophy).[1] Hyperplasia is different from hypertrophy in that theadaptive cell change in hypertrophy is an increase in the size of cells, whereas hyperplasia involves an increase in the number
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