Mt4l4 Elhm Pathology Course (Exam 1)

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Mt4l4 Elhm Pathology Course (Exam 1) - Quiz

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Questions and Answers
  • 1. 

    Which of the following factors participates in the Formation of inflammatory fluid exudate:

    • A.

      Increased intravascular osmotic pressure

    • B.

      Lncreased vascular permeability

    • C.

      Decreased osmotic pressure of the interstitial tissue

    • D.

      Vasoconstriction

    • E.

      All of the above

    Correct Answer
    B. Lncreased vascular permeability
    Explanation
    Increased vascular permeability is a factor that participates in the formation of inflammatory fluid exudate. When there is inflammation, the blood vessels in the affected area become more permeable, allowing fluid and proteins to leak out of the blood vessels and into the surrounding tissues. This increased permeability is caused by the release of inflammatory mediators, such as histamine, which cause the endothelial cells lining the blood vessels to contract and create gaps between them. This allows fluid and inflammatory cells to move from the bloodstream into the tissues, leading to the formation of inflammatory fluid exudate.

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  • 2. 

    Which oF the following is an effect of chemical mediators :

    • A.

      Increased vascular permeability

    • B.

      Chemolaxis

    • C.

      Fever

    • D.

      All of the above

    • E.

      None of the above

    Correct Answer
    D. All of the above
    Explanation
    Chemical mediators are substances released by cells in response to injury or inflammation. They play a crucial role in various physiological processes. Increased vascular permeability is one of the effects of chemical mediators, which allows immune cells and proteins to enter the affected site. Chemotaxis is another effect, where chemical mediators attract immune cells to the site of injury or infection. Fever is also an effect of chemical mediators, as they can act on the hypothalamus to increase body temperature. Therefore, all of the given options are correct effects of chemical mediators.

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  • 3. 

    Which of the following is true about vascular stasis in acute inflammation:

    • A.

      Lt is mainly induced by vasoconstriction.

    • B.

      Lt mainly occurs after emigration of leucocytes

    • C.

      Lt may lead to thrombosis

    • D.

      AII of the above

    • E.

      None of the above

    Correct Answer
    C. Lt may lead to thrombosis
    Explanation
    Vascular stasis in acute inflammation may lead to thrombosis. Thrombosis is the formation of a blood clot within a blood vessel, which can occur due to the sluggish blood flow caused by vascular stasis. This can further impede blood flow and potentially lead to complications such as tissue ischemia or infarction.

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  • 4. 

    Which of the following statements is true about the cellular phase of acute inflammation:

    • A.

      Opsonins play an important role in the process of pavementing

    • B.

      Neutrophils and monocytes emigrate at the same time.

    • C.

      Emigration of leucocytes is followed by Ieucopenia

    • D.

      Giant cells are formed by fusion of neutrophils

    • E.

      Bacilli are more chernotactic to macrophages while cocci mainly attract neutrophils

    Correct Answer
    E. Bacilli are more chernotactic to macrophages while cocci mainly attract neutrophils
    Explanation
    Bacilli are more chemotactic to macrophages while cocci mainly attract neutrophils. This means that bacilli, which are rod-shaped bacteria, have a greater ability to attract and stimulate the movement of macrophages towards them. On the other hand, cocci, which are spherical bacteria, primarily attract neutrophils. This difference in chemotaxis may be due to variations in the surface molecules or chemicals released by different types of bacteria, which can selectively attract specific types of immune cells.

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  • 5. 

    Which of the following is true about fibrin:

    • A.

      Deposition of fibrin in inflammatory conditions is known as fibrosis

    • B.

      Fibrin plays important functions in inflammation & repair

    • C.

      Cellulitis is characterized by excess fibrin deposition

    • D.

      All of the above

    • E.

      None of the abovE

    Correct Answer
    B. Fibrin plays important functions in inflammation & repair
    Explanation
    Fibrin plays important functions in inflammation and repair. Fibrin is a protein that is involved in the clotting process and forms a mesh-like structure to stop bleeding. In addition to its role in clot formation, fibrin also plays a crucial role in the inflammatory response and tissue repair. It acts as a scaffold for the migration of cells involved in tissue repair and helps in the formation of granulation tissue. Therefore, the statement that fibrin plays important functions in inflammation and repair is true.

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  • 6. 

    Which cf the following is true about chemotaxis:

    • A.

      This is diversion cf Ieucocytes out of the axial column of blood prior to their emigration

    • B.

      Typhoid bacilli are strongly chemotactic to neutrophils.

    • C.

      Complement components are important chemotactic factors

    • D.

      AlI of the above

    • E.

      None of the above

    Correct Answer
    C. Complement components are important chemotactic factors
    Explanation
    Chemotaxis is the movement of cells in response to a chemical gradient. In this case, the correct answer states that complement components are important chemotactic factors. Complement components are proteins that are part of the immune system and play a role in inflammation and attracting immune cells to the site of infection or injury. Therefore, they can act as chemotactic factors, guiding immune cells to the appropriate location.

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  • 7. 

    Which of the following statements is true for neutrophils:

    • A.

      They are the first cells to emigrate in acute inflammation

    • B.

      They are the most predominant cells in chronic inflammation.

    • C.

      The most important chemotactic factors for neutrophiis are derived from bacilii.

    • D.

      They efficiently engulf foreign bodies

    • E.

      They can give rise to giant cells

    Correct Answer
    A. They are the first cells to emigrate in acute inflammation
    Explanation
    Neutrophils are the first cells to emigrate in acute inflammation. During an acute inflammatory response, neutrophils are rapidly recruited to the site of injury or infection. They are the first line of defense and play a crucial role in the initial stages of inflammation by migrating to the affected area and releasing various inflammatory mediators. Neutrophils are highly mobile and capable of phagocytosis, allowing them to efficiently engulf and destroy foreign bodies such as bacteria and other pathogens. Therefore, they are the first cells to arrive at the site of inflammation and initiate the immune response.

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  • 8. 

    Which of the following is not a feature of acute inflammation:

    • A.

      Persistent vasoconstriction

    • B.

      Vasodilatation

    • C.

      Lncreased vascular permeability

    • D.

      Emigration of leucocytes

    • E.

      Vascular stasis.

    Correct Answer
    A. Persistent vasoconstriction
    Explanation
    Persistent vasoconstriction is not a feature of acute inflammation. Acute inflammation is characterized by vasodilatation, increased vascular permeability, emigration of leukocytes, and vascular stasis. Vasoconstriction is more commonly associated with chronic inflammation or other physiological processes such as hypothermia or shock. In acute inflammation, vasodilatation occurs to increase blood flow to the affected area, allowing for the delivery of immune cells and nutrients.

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  • 9. 

    Which of the following is not a function of fibrin:

    • A.

      Opsonization

    • B.

      Sealing of bleeding vessels

    • C.

      Facilitation of movement of inflammatory cells

    • D.

      Localization of inflammatory fields

    • E.

      Facilitation of movement of fibroblasts during repair

    Correct Answer
    A. Opsonization
    Explanation
    Fibrin is a protein involved in the formation of blood clots. It plays several important roles in the body, including sealing of bleeding vessels, facilitation of movement of inflammatory cells, localization of inflammatory fields, and facilitation of movement of fibroblasts during repair. However, opsonization is not a function of fibrin. Opsonization refers to the process of coating pathogens or other foreign particles with molecules that enhance their recognition and uptake by immune cells. Fibrin does not directly participate in opsonization.

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  • 10. 

    Which of the following cells engulf fibrin:

    • A.

      Neutrophils

    • B.

      Eosinophils

    • C.

      Macrophages

    • D.

      Lymphocytes

    • E.

      Plasma cells

    Correct Answer
    C. Macrophages
    Explanation
    Macrophages are a type of white blood cell that play a crucial role in the immune system. They are known for their ability to engulf and digest foreign substances, such as bacteria, dead cells, and cellular debris. In the context of this question, macrophages are capable of engulfing fibrin, which is a protein involved in blood clotting. This ability allows macrophages to help remove fibrin during the healing process and maintain the balance of clot formation and dissolution in the body.

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  • 11. 

    Which of the following is true about activation of phospholipase C of phagocytic cells:

    • A.

      Lt provides the phagocytic cells with phospholipids

    • B.

      Lt provides the phagocytic cells with energy

    • C.

      Lt hydrolyses the release of calcium and enhances cell Mobility.

    • D.

      AIl of the above

    • E.

      None of the above.

    Correct Answer
    C. Lt hydrolyses the release of calcium and enhances cell Mobility.
    Explanation
    Activation of phospholipase C in phagocytic cells leads to the hydrolysis of calcium release and enhances cell mobility. This enzyme plays a crucial role in cell signaling by cleaving phospholipids into inositol trisphosphate (IP3) and diacylglycerol (DAG), which in turn triggers the release of calcium from intracellular stores. The increase in calcium levels activates various signaling pathways, leading to enhanced cell mobility and other cellular responses. Therefore, the statement "lt hydrolyses the release of calcium and enhances cell Mobility" is true.

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  • 12. 

    Which of the following statements is true for hepatic steatosis :

    • A.

      May be caused by alcohol intake

    • B.

      May occur in cases of hepatitis C

    • C.

      May be followed by cirrhosis.

    • D.

      All of the above

    • E.

      None of the above

    Correct Answer
    D. All of the above
    Explanation
    Hepatic steatosis, also known as fatty liver disease, is a condition characterized by the accumulation of fat in the liver. It can be caused by various factors, including alcohol intake. Excessive alcohol consumption can lead to alcoholic fatty liver disease. Additionally, hepatic steatosis can occur in cases of hepatitis C, a viral infection that affects the liver. If left untreated, hepatic steatosis can progress to cirrhosis, a late stage of liver disease characterized by irreversible scarring. Therefore, all of the given statements are true for hepatic steatosis.

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  • 13. 

    The following are features of apoptosis except:

    • A.

      Lt is always caused by irritànts such as anoxia, bacteriai infections and alcohol.

    • B.

      Lt is characterized by fragmentation of nuclear DNA.

    • C.

      It is characterized by formation of cell membrane blebs.

    • D.

      Lt is characterized by transformation cf the affected cell into apoptotic bodies.

    • E.

      Phagocytosis of the apoptotic bodies is common.

    Correct Answer
    A. Lt is always caused by irritànts such as anoxia, bacteriai infections and alcohol.
    Explanation
    Apoptosis is a programmed cell death process that occurs naturally in the body. It is not always caused by irritants such as anoxia, bacterial infections, and alcohol. Apoptosis can be triggered by a variety of factors including DNA damage, cell stress, and developmental cues. The other options listed are all characteristics of apoptosis, including fragmentation of nuclear DNA, formation of cell membrane blebs, transformation of the affected cell into apoptotic bodies, and phagocytosis of the apoptotic bodies being common.

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  • 14. 

    Caseous necrosis is characterized by all of the following features except:

    • A.

      Cheese-like material

    • B.

      Commonly seen in tuberculous Iesions.

    • C.

      The structural outlines of the necrotic cells are preserved.

    • D.

      Lt represents partially iiquified coagulative necrosis.

    • E.

      Microscopically appears as amorphous eosinophilic granular debris.

    Correct Answer
    C. The structural outlines of the necrotic cells are preserved.
    Explanation
    Caseous necrosis is a type of necrosis characterized by the formation of a cheese-like material. It is commonly seen in tuberculous lesions. The microscopically appearance of caseous necrosis is amorphous eosinophilic granular debris. However, the structural outlines of the necrotic cells are not preserved in caseous necrosis.

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  • 15. 

    AII of the following changes can be seen in necrotic cells except::

    • A.

      Pyknosis

    • B.

      Karyorrhexis

    • C.

      Mitosis

    • D.

      Karyolysis

    • E.

      Cytomegaly

    Correct Answer
    C. Mitosis
    Explanation
    Mitosis is the process of cell division, which is not observed in necrotic cells. Necrosis is a form of cell death that occurs due to injury or disease, and it is characterized by changes such as pyknosis (shrinkage and condensation of the nucleus), karyorrhexis (fragmentation of the nucleus), and karyolysis (dissolution of the nucleus). Cytomegaly refers to an increase in cell size. Therefore, all the changes listed in the options can be seen in necrotic cells except for mitosis.

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  • 16. 

    Which of the following conditions is characterized by liquefactive necrosis

    • A.

      Lung infarction

    • B.

      Cerebral infarction

    • C.

      Pulmonary tuberculosis

    • D.

      AlI of the above

    • E.

      None of the above

    Correct Answer
    B. Cerebral infarction
    Explanation
    Liquefactive necrosis is a type of cell death characterized by the dissolution of dead tissue, resulting in the formation of a liquid-filled cavity. This process is commonly seen in cerebral infarction, which occurs when there is a blockage or reduction of blood flow to the brain, leading to tissue death. In this condition, the lack of oxygen and nutrients causes the affected brain tissue to undergo liquefactive necrosis, resulting in the formation of a fluid-filled cavity. Lung infarction and pulmonary tuberculosis are not typically associated with liquefactive necrosis.

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  • 17. 

    Which of the following statements is true for dystrophic calcification :

    • A.

      It is due to hypercalcemia

    • B.

      Lt affects healthy tissues

    • C.

      Lt can be seen in tubeculosis.

    • D.

      Lt cormmonly occurs in teeth and bone

    • E.

      Lt is more common in arterial lhan venous thrombi

    Correct Answer
    C. Lt can be seen in tubeculosis.
    Explanation
    Dystrophic calcification refers to the deposition of calcium in damaged or necrotic tissues. It occurs as a result of tissue injury or inflammation, rather than hypercalcemia. Tuberculosis is a chronic infectious disease that can cause tissue damage, and therefore, dystrophic calcification can be seen in tuberculosis. The other statements are not true for dystrophic calcification.

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  • 18. 

    Which of the following statements is true for metastatic calcification

    • A.

      Lt may occur in cases of hyperparathyroidism.

    • B.

      It is seen in metastatic tumors.

    • C.

      Calcified thrombi represent a type of metastatic calcitication

    • D.

      All of the above

    • E.

      None of the above

    Correct Answer
    A. Lt may occur in cases of hyperparathyroidism.
    Explanation
    Metastatic calcification refers to the deposition of calcium in normal tissues due to hypercalcemia. Hyperparathyroidism is a condition characterized by excessive production of parathyroid hormone, which can lead to elevated calcium levels in the blood. Therefore, it is true that metastatic calcification may occur in cases of hyperparathyroidism. The other statements, such as it being seen in metastatic tumors or calcified thrombi representing a type of metastatic calcification, are not mentioned in the question and cannot be assumed to be true.

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  • 19. 

    Which of the following statements is not true tor amyloidosis:

    • A.

      Amyloid is predominantly a fibril protein.

    • B.

      Macrophages may play an important role in systemic amyloidosis

    • C.

      Sudan lll and osmic acid can specifically stain amyloid

    • D.

      Amyloid is mainly deposited within the walls of small blood vessels

    • E.

      Amyloidosis may Iead to Addison's disease.

    Correct Answer
    C. Sudan lll and osmic acid can specifically stain amyloid
  • 20. 

    The following are causes of systemic amyloidosis except:

    • A.

      Acute suppurations

    • B.

      Tuberculosis

    • C.

      Ulcerative colitis.

    • D.

      Rheumatoid arthritis

    • E.

      Mlultiple myeloma.

    Correct Answer
    A. Acute suppurations
    Explanation
    Systemic amyloidosis is a condition characterized by the deposition of abnormal protein called amyloid in various organs and tissues throughout the body. The causes of systemic amyloidosis include chronic inflammatory diseases like tuberculosis, ulcerative colitis, and rheumatoid arthritis, as well as plasma cell disorders like multiple myeloma. However, acute suppurations, which refer to localized infections with pus formation, are not a known cause of systemic amyloidosis. Therefore, acute suppurations are the exception among the given options.

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  • 21. 

    Which of the following types of amyloid affection produces the most serious effects:

    • A.

      Amyloid sago spleen

    • B.

      Hepatic amyloidosis

    • C.

      Renal amyloidosis

    • D.

      Amyloid diffuse spleen

    • E.

      Cutaneous amyloidosis

    Correct Answer
    C. Renal amyloidosis
    Explanation
    Renal amyloidosis produces the most serious effects compared to the other types of amyloid affection listed. This is because renal amyloidosis involves the deposition of amyloid protein in the kidneys, leading to progressive damage and dysfunction of the kidneys. This can result in severe complications such as kidney failure, proteinuria (excessive protein in the urine), and hypertension. The impairment of kidney function can have significant systemic effects on other organs and body systems, making renal amyloidosis a more serious condition compared to the other types mentioned.

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  • 22. 

    In all of the following conditions the amyloid fibril protein is AA except:

    • A.

      Ulcerative colitis

    • B.

      Multiple myeloma

    • C.

      Tuberculosis

    • D.

      Chronic Iung abscess

    • E.

      Hodgkin's disoase.

    Correct Answer
    B. Multiple myeloma
    Explanation
    The correct answer is Multiple myeloma. In multiple myeloma, the amyloid fibril protein is not AA, but rather composed of immunoglobulin light chains (AL) or fragments of immunoglobulin heavy chains (AH). In the other conditions listed, such as ulcerative colitis, tuberculosis, chronic lung abscess, and Hodgkin's disease, the amyloid fibril protein is AA, which is derived from the acute-phase reactant serum amyloid A protein (SAA).

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  • 23. 

    Which of the following is true about amyloid deposited within m medullary carcinoma of thyroid:

    • A.

      The amyloid protein is secreted by macrophages within the thyroid gland.

    • B.

      The amyloid protein is produced by tumor cells .

    • C.

      Lt may be accompanied by renal or hepatic amyloidosis.

    • D.

      The amyloid protein is AL

    • E.

      None of the above

    Correct Answer
    B. The amyloid protein is produced by tumor cells .
    Explanation
    The correct answer is "the amyloid protein is produced by tumor cells." In medullary carcinoma of the thyroid, the tumor cells themselves produce the amyloid protein. This is in contrast to other types of amyloidosis where the protein may be secreted by macrophages or other cells within the affected organ. Medullary carcinoma of the thyroid can also be associated with systemic amyloidosis involving the kidneys or liver.

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  • 24. 

    Which of the following conditions associated with abnormal melanin deposition :

    • A.

      Neurofibromatosis

    • B.

      Brown atrophy of the heart

    • C.

      Melanosis coli

    • D.

      Leukoderma

    • E.

      All of the above

    Correct Answer
    A. Neurofibromatosis
    Explanation
    Neurofibromatosis is a condition associated with abnormal melanin deposition. It is a genetic disorder that causes tumors to form on nerve tissue. These tumors can develop anywhere in the nervous system, including the skin, leading to abnormal melanin deposition and the appearance of pigmented spots or patches on the skin.

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  • 25. 

    If the following features of the acute inflammatory reaction were placed in chronological order which would come fourth as regard vascular phase ?

    • A.

      Arteriolar contraction

    • B.

      Blood flow slows.

    • C.

      Dilatation of arterioles.

    • D.

      Emigration of leucocytes from blood vessels.

    • E.

      Protein rich fluid escapes from blood vessels.

    Correct Answer
    B. Blood flow slows.
    Explanation
    In the vascular phase of the acute inflammatory reaction, the first step is arteriolar contraction, which helps to reduce blood flow to the affected area. This is followed by the dilatation of arterioles, which allows increased blood flow to the area. The third step is the emigration of leucocytes from blood vessels, where white blood cells exit the blood vessels and migrate to the site of inflammation. Finally, protein-rich fluid escapes from blood vessels, leading to swelling and edema. Therefore, the correct answer is "Blood flow slows," as it occurs before the emigration of leucocytes and the escape of protein-rich fluid.

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  • 26. 

    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 (normal level 0 - 0.4) . A coronary angiogram is performed emergently and reveals >90% occlusion of the left anterior descending artery. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs?

    • A.

      Glycogen stores are depleted

    • B.

      Cytoplasmic sodium increases

    • C.

      Nuclei undergo karyorrhexis

    • D.

      Intracellular pH diminishes

    • E.

      Blebs form on cell membranes

    Correct Answer
    C. Nuclei undergo karyorrhexis
    Explanation
    In the given scenario, the patient is experiencing severe chest pain for the past 6 hours, which suggests myocardial infarction. The elevated troponin I level indicates myocardial damage. The coronary angiogram reveals >90% occlusion of the left anterior descending artery, indicating a significant blockage in the blood supply to the heart. Irreversible injury to myocardial fibers occurs when nuclei undergo karyorrhexis, which is the fragmentation of the nucleus due to DNA degradation. This is a characteristic cellular change seen in irreversible cell death or necrosis.

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  • 27. 

    *** 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 (كل الرغي اللي فات معناه انه اتخبط ف رجله وده المهم), which strikes him on his left leg in the region of his thigh. The skin is not broken. Within 2 days there is a 5 x 7 cm purple color to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown color at the site of injury 16 days later?

    • A.

      Lipofuscin

    • B.

      Bilirubin

    • C.

      Melanin

    • D.

      Hemosiderin

    • E.

      Glycogen

    Correct Answer
    D. Hemosiderin
    Explanation
    The most likely substance that has accumulated at the site of injury to produce a yellow-brown color 16 days later is hemosiderin. Hemosiderin is a yellow-brown pigment that is formed when red blood cells break down and release iron, which then accumulates in tissues. In this case, the injury caused bleeding in the region of the thigh, leading to the accumulation of hemosiderin. Over time, the hemosiderin deposits can cause discoloration of the skin, resulting in the yellow-brown color observed.

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  • 28. 

    *** A 50-year-old woman with a history of unstable angina suffers an acute myocardial infarction. Thrombolytic therapy with tissue plasminogen activator (tPA) is administered to restore coronary blood flow. In spite of this therapy, the degree of myocardial fiber injury may increase because of which of the following cellular abnormalities?

    • A.

      Cytoskeletal intermediate filament loss

    • B.

      Decreased intracellular pH from anaerobic glycolysis

    • C.

      Increased free radicals

    • D.

      Reduced protein synthesis

    Correct Answer
    C. Increased free radicals
    Explanation
    Thrombolytic therapy with tPA aims to restore coronary blood flow by dissolving the blood clot causing the myocardial infarction. However, during the process of reperfusion, an increased amount of free radicals can be produced. Free radicals are highly reactive molecules that can cause damage to cellular structures, including the myocardial fibers. Therefore, despite the therapy, the degree of myocardial fiber injury may increase due to the increased free radicals generated during reperfusion.

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  • 29. 

    ** A 43-year-old man has complained of mild burning substernal pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies show the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?

    • A.

      Dysplasia

    • B.

      Hyperplasia

    • C.

      Carcinoma

    • D.

      Metaplasia

    Correct Answer
    D. Metaplasia
    Explanation
    The presence of columnar epithelium with goblet cells in the biopsies suggests metaplasia. Metaplasia is a reversible change in which one adult cell type is replaced by another adult cell type that is better suited to withstand the new environment. In this case, the columnar epithelium with goblet cells indicates a change from the normal squamous epithelium of the esophagus to a more gastric-like epithelium. This is a common finding in gastroesophageal reflux disease (GERD) and is known as Barrett's esophagus. Dysplasia, hyperplasia, and carcinoma are not indicated by the findings described.

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  • 30. 

    *** A 59-year-old woman had the loss of consciousness that persisted for over an hour. When she becomes arousable, she cannot speak nor move her right arm or leg. A cerebral angiogram revealed an occlusion to her left middle cerebral artery. Months later, a computed tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding is most likely the consequence of resolution from which of the following cellular events?

    • A.

      Liquefactive necrosis

    • B.

      Atrophy

    • C.

      Coagulative necrosis

    • D.

      Apoptosis

    Correct Answer
    A. Liquefactive necrosis
    Explanation
    The CT finding of a large cystic area in the left parietal lobe cortex is most likely the consequence of resolution from liquefactive necrosis. Liquefactive necrosis is characterized by the dissolution of dead cells and the formation of a liquid-filled cavity. In this case, the occlusion of the left middle cerebral artery likely caused ischemia and subsequent necrosis of brain tissue, leading to liquefactive necrosis and the formation of the cystic area seen on the CT scan.

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  • 31. 

    ** A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She continues breast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that began in the breast during pregnancy allowed her to nurse the infant for this period of time?

    • A.

      Stromal hypertrophy

    • B.

      Epithelial dysplasia

    • C.

      Steatocyte atrophy

    • D.

      Lobular hyperplasia

    Correct Answer
    D. Lobular hyperplasia
    Explanation
    During pregnancy, the breast undergoes changes to prepare for breastfeeding. One of these changes is lobular hyperplasia, which refers to an increase in the number and size of the lobules in the breast. Lobules are the structures responsible for producing milk. This increase in lobules allows for increased milk production and storage, which enables the woman to breastfeed her infant for an extended period of time without difficulties or complications.

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  • 32. 

    ** An 80-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small (250 gm) and dark brown on sectioning. Microscopically, there is light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance of his heart?

    • A.

      Hemosiderin from iron overload

    • B.

      Lipochrome from 'wear and tear

    • C.

      Glycogen from a storage disease

    • D.

      Cholesterol from atherosclerosis

    Correct Answer
    B. Lipochrome from 'wear and tear
    Explanation
    Lipochrome is a yellow-brown pigment that accumulates in cells as a result of normal aging and wear and tear. It is commonly seen in the heart of older individuals and is responsible for the dark brown appearance on sectioning. This pigment is not associated with any specific disease process and is considered a normal finding in aging hearts. The other options, such as hemosiderin from iron overload, glycogen from a storage disease, and cholesterol from atherosclerosis, are not relevant to this case as they do not produce the characteristic appearance described.

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  • 33. 

    *** A 17-year-old adolescent receives whole body radiation as part of a preparatory regimen for bone marrow transplantation to treat acute lymphocytic leukemia. Which of the following cells and tissues in the body is most likely to remain unaltered by the effects of this therapeutic radiation?

    • A.

      Ovarian follicles

    • B.

      Small intestinal epithelium

    • C.

      Erythropoietic cells of bone marrow

    • D.

      Spermatogonia of testicular tubules

    • E.

      Neurons of cerebral cortex

    Correct Answer
    E. Neurons of cerebral cortex
    Explanation
    The neurons of the cerebral cortex are most likely to remain unaltered by the effects of therapeutic radiation because they are post-mitotic cells, meaning they do not divide and replicate like other cells in the body. Therefore, they are less susceptible to the damaging effects of radiation compared to actively dividing cells such as ovarian follicles, small intestinal epithelium, erythropoietic cells of bone marrow, and spermatogonia of testicular tubules.

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  • 34. 

    *** A 79-year-old man has a large myocardial infarction involving much of the left ventricular free wall. He develops congestive heart failure (CHF) with decreased cardiac output. Now, a year later, his CHF is worsening. Which of the following laboratory tests on serum would best indicate poor peripheral tissue perfusion in this patient?

    • A.

      Elevated troponin I

    • B.

      Increased sodium

    • C.

      Elevated lactate

    • D.

      Increased hematocrit

    Correct Answer
    C. Elevated lactate
    Explanation
    Elevated lactate would best indicate poor peripheral tissue perfusion in this patient. Lactate is produced when there is inadequate oxygen supply to the tissues, leading to anaerobic metabolism. In the context of congestive heart failure with decreased cardiac output, there is reduced blood flow to the peripheral tissues, resulting in tissue hypoperfusion. This lack of oxygen supply leads to the production of lactate. Therefore, an elevated lactate level would be indicative of poor peripheral tissue perfusion in this patient.

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  • 35. 

    *** A 22-year-old woman has a congenital anemia. She has required multiple transfusions of red blood cells for many years. She now has no significant findings on physical examination. Laboratory studies now show a serum AST of 74 U/L (normal 0-40) and ALT 75 U/L (normal 0-50) with albumin 3.6 g/dL (normal 3.5-5.5). Which of the following microscopic findings would most likely appear in a liver biopsy?

    • A.

      Steatosis in hepatocytes

    • B.

      Bilirubin in canaliculi

    • C.

      Hemosiderin in hepatocytes

    • D.

      Glycogen in hepatocytes

    • E.

      Amyloid in portal triads

    Correct Answer
    C. Hemosiderin in hepatocytes
    Explanation
    The presence of hemosiderin in hepatocytes is most likely to appear in a liver biopsy of a patient with a congenital anemia who has received multiple transfusions of red blood cells. Hemosiderin is an iron storage complex that accumulates in cells when there is excessive breakdown of red blood cells or impaired iron metabolism. In this case, the patient's anemia and transfusions suggest a chronic condition that could lead to iron overload and deposition of hemosiderin in the liver. This finding is consistent with the elevated serum AST and ALT levels, indicating liver injury or inflammation.

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  • 36. 

    * A 40-year-old woman has the sudden onset of severe abdominal pain. On physical examination she has diffuse tenderness in all abdominal quadrants, with marked guarding and muscular rigidity. She has laboratory findings that include serum AST of 43 U/L, ALT of 30 U/L, LDH 630 U/L (HIGH) , and lipase 415 U/L (HIGH). An abdominal CT scan reveals peritoneal fluid collections and decreased attenuation along with enlargement of the pancreas. Which of the following cellular changes is most likely to accompany these findings?

    • A.

      Coagulative necrosis

    • B.

      Dry gangrene

    • C.

      Fat necrosis

    • D.

      Liquefactive necrosis

    Correct Answer
    C. Fat necrosis
    Explanation
    The given scenario suggests acute pancreatitis, which is characterized by severe abdominal pain, diffuse tenderness, and laboratory findings such as elevated lipase levels. The presence of peritoneal fluid collections, decreased attenuation, and enlargement of the pancreas on CT scan are consistent with pancreatitis. In pancreatitis, the release of pancreatic enzymes leads to autodigestion of adipose tissue, resulting in fat necrosis. This occurs due to the breakdown of triglycerides into free fatty acids, which then combine with calcium to form soaps. These soaps appear as chalky white deposits in the peripancreatic tissue, giving a characteristic appearance of fat necrosis.

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  • 37. 

    ** A 38-year-old man incurs a traumatic blow to his upper left arm. He continues to have pain and tenderness even after 3 months have passed. A plain film radiograph reveals a 4 cm circumscribed mass in the soft tissue adjacent to the humerus. The mass contains areas of brightness on the x-ray. Over the next year this process gradually resolves. Which of the following terms best describes this process?

    • A.

      Dysplasia

    • B.

      Hyperplasia

    • C.

      Neoplasia

    • D.

      Metaplasia

    Correct Answer
    D. Metaplasia
    Explanation
    The correct answer is "Metaplasia". Metaplasia refers to the process in which one type of mature cell is replaced by another type of mature cell. In this case, the traumatic blow to the upper left arm caused the formation of a circumscribed mass in the soft tissue adjacent to the humerus. The areas of brightness on the x-ray indicate that the mass contains abnormal tissue. Over time, the abnormal tissue gradually resolves, indicating a change in cell type, which is characteristic of metaplasia.

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  • 38. 

    * A 48-year-old man has a history of chronic alcohol abuse. He is still able to perform work at his job. He has had no major illnesses. On physical examination, there are no significant findings. Laboratory studies show a serum albumin of 4.1 g/dL, ALT 40 U/L, AST 40 U/L, and total bilirubin 1.1 mg/dL. Which of the following microscopic findings in his liver is most likely to be present?

    • A.

      Cholestasis

    • B.

      Fatty change

    • C.

      Hemochromatosis

    • D.

      Coagulative necrosis

    Correct Answer
    B. Fatty change
    Explanation
    Based on the given information, the 48-year-old man has a history of chronic alcohol abuse but is still able to perform work at his job and has no major illnesses. On physical examination, there are no significant findings. Laboratory studies show normal liver enzymes (ALT and AST) and a slightly elevated total bilirubin. The most likely microscopic finding in his liver is fatty change, also known as hepatic steatosis. Chronic alcohol abuse can lead to the accumulation of fat in the liver cells, causing fatty change. This is supported by the normal liver enzymes and the absence of significant findings on physical examination.

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  • 39. 

    * A 30-year-old woman is claiming in a civil lawsuit قضية دفاع مدني that her husband has abused her for the past year. A workup by her physician reveals a 2 cm left breast mass. There is no lymphadenopathy. No skin lesions are seen, other than a bruise to her upper arm. An excisional biopsy of the breast mass is performed. On microscopic examination, the biopsy shows fat necrosis. This biopsy result is most consistent with which of the following etiologies?

    • A.

      Physiologic atrophy

    • B.

      Breast trauma

    • C.

      Radiation injury

    • D.

      Hypoxic injury

    Correct Answer
    B. Breast trauma
    Explanation
    The biopsy result of fat necrosis is most consistent with breast trauma. Fat necrosis is a condition where the fat tissue in the breast undergoes cell death due to injury or trauma. In this case, the woman's claim of abuse and the presence of a bruise on her upper arm suggest that she has experienced physical trauma, which could have led to fat necrosis in her breast.

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  • 40. 

    **** A 35-year-old woman has had headaches and abdominal pain worsening for 3 months. There are no remarkable physical examination findings. On radionucleide scanning of the neck, she is found to have a mass involving one of her parathyroid glands. An abdominal CT scan suggests extensive nephrocalcinosis along with urinary tract calculi. Which of the following laboratory test findings is most likely to accompany her disease?

    • A.

      CO2 of 30 mmol/L

    • B.

      Phosphorus of 2.2 mg/dL

    • C.

      Uric acid of 15.1 mg/dL

    • D.

      Sodium of 121 mmol/L

    • E.

      Calcium of 4.5 mg/dL

    Correct Answer
    B. Phosphorus of 2.2 mg/dL
    Explanation
    The patient's symptoms of headaches, abdominal pain, and the presence of a mass involving one of the parathyroid glands suggest the possibility of hyperparathyroidism. Nephrocalcinosis and urinary tract calculi are common complications of hyperparathyroidism. In hyperparathyroidism, there is increased production of parathyroid hormone (PTH), which leads to increased reabsorption of calcium in the kidneys and increased excretion of phosphorus. Therefore, the most likely laboratory finding in this case would be a low phosphorus level, as indicated by a phosphorus level of 2.2 mg/dL.

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