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74 Cards in this Set
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What variation in findins will you notice in pt w/chronic granulomatous disease w/ Staph aures or Streptococci ? think about catalase positive function
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since NADPH oxidase is ineffective the "oxygen burst" function will be ineffective
staph aures is catalase + so it will continue to cause problems for the individual infected due to its capacity to evade and attempt destruction via pahgolysosome on the other hand Strep infection is catalase - so it will still generate peroxide in pt phagolysosome (the missing component) good for the patient because this will allow them to fight off the bacteria as HOCl will be produced with the help of the strep infection |
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What are common examples of infections that often lead to complete resolution?
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hepatic A infeciton
mucosal ulcerations (stomach and colon) remember it must be a labile cell taht can continue to divide such as GI, skin, or bone marrow |
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What affect does G- enotoxemia produce in the lungs?
a. primary (endotoxic shock) b. secondary (ARDS) c. secondary (anaphylaxis) d. primary (inflammation) |
secondary effect due to endotoxic shock (primary)
the increase in neutrophile adhension cells leads to neurtopenia throughout the body b/c all the neutrophiles are being occupied (lining in pulmonary capillaries --> degenerative enzymes and free radicals the increase in vessel permeability allow entry of neutrophiles int alveoli (secondary response) leading to ARDS |
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what is one function of corticosteroids in relation to inflammation?
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anti-inflammatory as CS interfere with synthesis of adhesion molecules resulting in neutrophile leukocytosis (reduced # neutros heading toward the site of infection)
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which are important opsonizing agents?
a. C5a and IgM b. C3b and IgG c. C3a and IgG d. C2 and IgM |
C3b and IgG
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What is a key factor that determines resolution ?
a. type of infection b. involvement of vasodilators c. regeneration capacity of tissue d. degree of hypoxia |
regeneration capacity of parencymal tissue involved (more importantly if the BM is intact)
labile GI, skin, bone marrow stable: liver, kidney, smooth muscle Go --> G1 permanent: sk. muscle, cardiac muscle, and neurons --> SCAR!! |
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When does fibronectin become useful?
a. resolution b. acute inflammation c. vascularity d. chemotaxis |
during resolution or cellular repair
derived from macrophages, fibroblast, and endothelial cells function as chemotaxis (fibro & macro) opsonize promote angiogenesis 'glue' fibrin and fibronectin (collagen) incerase tensile strenght of wounds |
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what cell is mainly involved in chronic inflammation?
a. mast b. neutorphile c. macrophage d. eosinophile |
macrophage
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what components are released via the macrophage?
a. IL-3 and TNF beta b. IL-1 and IL-8 c. IL-4 and IL-5 d. IL 12 |
IL-1, IL-8 TNF-alpha (IL 6 and IL-12)
IL-3 and TNF beta (Tcell) IL-4 and IL-5 (Th2) IL -12 (Bcell) |
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What is released via Tcells?
a. TNF beta and IL-3 b. IL-3 and TNF beta c. IL-1 and IL-8 d. IL-4 and IL-5 |
TNF - beta and IL-3
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What is released via Th1 cells and what organisms do they target?
a. IL-3 and TNF beta b. IL-1 and IL-8 c. IL-4 and IL-5 d. histamine |
intracellular bacteria
TNF beta and IL -3 used to enhance macrophage phagocytic activity |
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what is released via Th2 cells and what organisms do they target?
a. IL-3 and TNF beta b. IL-1 and IL-8 c. IL-4 and IL-5 d. histamine |
extracellular bacteria (helmith)
IL -4 (IgE) and IL -5 (IgA) |
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what is the primary VASODILATORS released via mast cells ?
a. thromboxane A2 and leukotrienes b. histamine and 5HT c. histamine and NO d. histamine and bradykinin |
histamine and 5HT MajOr VASODILATORS!!
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what major immunoglobulin is invloved in acute inflammation?
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IgM
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What major components are involved in adhesion and chemotaxis of neutorphiles during acute inflammation?
a. C3a and TNF gamma b. C5a, LTB4, and IL-8 c. C3a, IL -2, and TNF gamma d. C5a, IgG and histamine |
C5a, LTB4 (adhesion), and IL-8 (chemotaxis)
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what is the only granulocyte that carries the MPO mechanism (oxygen burst)?
a. basophile b. macrophage c. neutorphile d. eosinophile |
neutrophile remember it is the first responder in acute inflammation
MPO!!! |
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what is increased in keloid formation?
a. collagen III b. fibrin c. collagen I d. pus |
collagen III as a result of the process of wound healing there is NO collagen I
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what is the function of Ito cells produced in the liver?
a. mucus secretion b. Vit A storage c. produce vitC d. detoxify drugs |
vit A storage
as a result of defective extracellular matrix and an increase in IL-1 and TNF --> collagen synthesis |
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how can you differentiate an ischemic or drug induced acute tubular necrosis (kidney)?
a. collagen production b. necrosis c. BM intact d. no changes both the same |
in an ischemic episode damage to BM will result in lack of scaffolding; while in a drug induced there is no damage to BM (intact) leading to continued cell proliferation
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what defines a left-shift during acute inflammation?
a. increase in segs b. increase in bands c. increase in MGP's d. decrease in bands d. |
increase >10% bands (immature neutrophiles released via BM)
you will also see an increase in toxic granulation due to MPO "oxygen burst" |
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What vital co-factor deficiency can lead to aortic aneurysm in wound healing?
a. Calcium b. copper c. iron d. vit A |
copper (lysl oxidase)
necessary for cross-linking of collagen fibrils |
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What causes 2nd intention wound to take longer to heal?
a. pus b. increased granulation tissue c. lack proper suturing d. lack of oxygen |
increased granulation tissue due to myofibroblast; remember you will also notice wound contration
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What would deficiency in VitC result in poor wound healing?
a. anemia b. scurvy c. open wound d. infection |
scurvy due to weak collagen as a result of poor VitC
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How long will it take for a wound to gain 80% of max. tensile strength, via first intention?
a. 3 days b. one month c. 3 months d. one year |
3 MONTHS
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What is NOT a cause of arteriole spasms?
a. COLD b. STRESS c. meds d. Cocaine e. none of the above |
all are common causes of arteriole spasms
cold, stress, meds, and COCAINE!! |
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5. A 65 yo man has a ruptured abdominal aortic aneurysm and is in hypovolemic shock. Which of the following is a reversible cellular event that is most likely to occur in the straight portion of the proximal tubular cells of the kidneys?
A. Ca2+ moving into the cytosol B. Cytochrome c diffusing out of the mitochondria C. Intracellular pH increasing D. Na+ and H20 moving into the cytosol E. Phospholipase damaging the cell membrane |
D; A ruptured abdominal aortic aneurysm leading to hypovolemic shock is your clue that renal ischemia is taking place. Na+ and H20 move into cells causes cellular swelling. This occurs because decreased ATP production decreases Na+/K+ pump activity. Anaerobic glycolysis causes a decrease in intracellular pH due to production of lactic acid. Ca2+ moving into the cell causes release of enzymes (phospholipase, endo/exonucleases) which damage cellular proteins and the cellular membrane. Movement of Ca2+ into the cell also represents the first IRREVERSIBLE cellular event.
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A 58 yo man with a 15 year history of alcohol abuse complains of RUQ tenderness. Physical exam reveals tender hepatomegaly. Serum AST and ALT are increased with AST levels about twice as high as ALT levels. The photo shows a section of the liver take on biopsy.
A. Decreased hydrolyisis of fat in adipose cells B. Decreased synthesis of fatty acids C. Decreased synthesis of VLDL (very low density lipoprotein) D. Increased synthesis of glycerol 3- phosphate E. Increased beta oxidation of fatty acids |
D; alcohol metabolism increases NADH levels. The result is a shutdown in fatty acid B-oxidation along with activation of glycolysis, which will increase glycerol 3-phosphate production. Glycerol 3-phosphate is a substrate for trigycleride syntheis. The combination results in a build up of fat in the liver. (Remember, adipose cells are the white/clear circles without nuclei whereas swollen cells are the white/clear circles with nuclei.)
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7. At which of the following times will necrotic changes following myocardial infarction first be visible by LM?
A. 20 minutes B. 3 hours C. 4-12 hours D. 3 days E. 5-7 days |
C; 20 minutes is way too short of a time to see any changes; 3-7 days is way too long to see any changes (these are time frames for complications); microscopic changes of coagulation necrosis are generally visible 12-24 hours after infarction.
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A 6-year old child hás a history of recurrent infections with pyogenic bactéria, including Staph aureus and Strep pneumo. The infections are accompanied by neutrophilic leukocytosis. Microscopic examination of a biopsy specimen obtained from an área of soft tissue necrosis shows microbial organisms but very few neutrophils. An analysis of neutrophil funciton shows a defect in rolling. This child’s increased susceptibility to infection is most likely cause by a defect in which of the following molecules?
a. Selectins b. Integrins c. Leukotriene B4 d. Complement C3b e. NADPH Oxidase |
a selectins
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A 15-year old African-american girl develops a nodular, tumor-like scar on her right ear lobe after ear piercing. Which of the following factors is responsible for the development of this complication?
a. Contracture b. Excessive collagen synthesis c. Exuberant fibroblast proliferation d. Exuberant granulation e. Foreign bodies f. Infection g. Remodeling |
b. excessive collagen III synthesis
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A 56-year old woman dies in a hospital where she is being evaluated for shortness of breath, ankle edema, and mild hepatomegaly. Because of the gross appearance of the liver at necropsy, which is seen in the photograph below, which of the following abnormalities is likely to be present?
a. A pulmonary saddle embolus b. Right heart failure c. Portal vein thrombosis d. Biliary cirrhosis e. Splenic amyloidosis |
b RHF
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A 59-year old man presents with increasing shortness of breath and problems sleeping. He has a long history of poorly controlled hypertension. Physical examination finds distention of his neck veins, crepitant rales in both lower lungs, and bilateral edema of his feet. A chest x-ray reveals his heart to be dialated and enlarged. Which of the following is the basic defect that caused these clinical signs?
a. Decreased peripheral resistance caused low-output cardiac failure b. Decreased viscosity of blood caused decreased diastolic filling of his heart c. Increased afterload caused systolic dysfunction of his heart d. Increased contractility of cardiac muscle caused high-output cardiac failure e. Increased preload caused diastolic dysfunction of his heart |
c. increased afterload caused systolic dysfunction of his heart
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On sectioning of an organ from a 60-year-old man at the time of autopsy, a focal, wedge-shaped area that is firm is accompanied by extensive hemorrhage, giving it a red appearance. The lesion has a base on the surface of the organ. In which of the following situations will this lesion most likely occur?
a. Lung with pulmonary thromboembolism b. Heart with coronary thrombosis c. Liver with hypovolemic shock d. Kidney with septic embolus e. Spleen with embolized mural thrombus f. Brain with cerebral arterial aneurysm |
a. Lung with pulmonary thromboembolism
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A 45-year old woman with a history of breast cancer and bilateral masectomy complains of shortness of breath. Radiographic evaluation reveals a right-sided pleural effusion. The fluid is tapped. Analysis of the fluid reveals a high triglyceride level relative to the serum; effusion cholesterol levels however, are reduced when compared to the serum. Effusion cytology does not reveal any malignant cells. Bacterial culture is negative. What is the most likely etiology of the effusion?
a. Congestive heart failure b. Damage to the thoracic duct c. Decreased oncotic pressure d. Fungal infection e. Upward tracking abdominal ascites |
b. damage to thoracic duct
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17 year old boy has 12 irregular brown 3 to 5 cm macules scattered over his skin. He also has multiple dermal skin nodules. The appearance of his hand is shown here. Which of the following characteristics is most representative of his genetic disorder:
a. Expression of the defect is extremely uniform among affected individuals b. Heterzygous females rarely express the full phenotypic change c. Complete penetrance is virtually always observed d. The onset of the disorder is most frequently seen in infancy e. A family history of affected parents may not be present |
autosomal dominant: delayed onset, non-penetrance, variable expressivity, new mutaitons, affect structural and regulatory proteins (50% chance to pass on) may not notice family hx
e. A family history of affected parents may not be present |
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A 7-month-old infant has failure to thrive, with vomiting and diarrhea noted since 1 month of age. Developmental neurologic milestones are not being met. A physical examination reveals hepatomegaly. The eyes show cataract formation in the crystalline lenses. The baby dies of fulminant Escherichia coli septicemia at 8 months of age. Which of the following congenital abnormalities is most likely to produce these findings?
a. Von Gierke’s disease b. Marfan’s syndrome c. Galactosemia d. Congenial rubella e. Phenylketonuria |
c. galactosemia
low galactose 1P uridyl transferase leading to an accumulation of galcitol (eyes CATARACTS) also common symptoms include jaundice, diarrhea, vomit, enlarge liver; IRREVERSIBLE brain damage |
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25-year-old woman has a workup for infertility. She has never experienced menarche. On physical examination she is short, with a broad chest and a webbed neck. She has normal intelligence. A blood sample is obtained for chromosome analysis. Which of the following karyotypes is she most likely to have?
a. 47, XXX b. 45, X c. 46, XX d. 47, XXY e. 46, XX/ 47, XXY f. 47, XX, +18 |
b. XO
webbed neck!! |
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16 year old girl is found to have pancytopenia along with a pathologic fracture of the right tibia. A bone marrow biopsy is performed. From the microscopic appearance of the marrow smear shown here, her most likely underlying disease process has resulted from a deficiency of which of the following enzymes:
a. Sphingomyelinase b. Glaactose-1-uridyl transferase c. Glucose-6-phosphatase d. Glucocerebrosidase e. Hexosaminidase A |
D. gluco-cerebrosidase (Gaucher cells)
pathololgical fracture and pancytoenia are secondary to BM infliltration wrinkled tissue paper cytoplams Beta-glucocerbrosidase --> gcsidase accumulation in brain, liver, spleen and BM |
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25-year-old mother notes that her 18 month old child is not keeping up with the normal growth curve for the past 5 months. She has noted that her child has not been feeding well over that time. The baby's abdomen seems larger than it should be. On physical examination, there is a left upper quadrant mass. Which of the following is the most likely diagnosis in this child?
a. Recessive polycystic kidney disease b. Cystic fibrosis c. Galactosemia d. Neuroblastoma e. Cystic hygroma |
d. neuroblastoma -- malignant tumor most commonly found in adrenal medulla (LUQ mass) seen in kids <5y/o associated with N-MYC oncogene
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20-year-old woman has had a 6 month history of symmetrical, proximal muscle weakness. She has 4/5 motor strength in all extremities. A deltoid biopsy shows a neutrophilic infiltrate with focal necrosis of the muscle fibers. Her antinuclear antibody test is negative, but she has histidyl-tRNA synthetase (Jo-1) antibody in her serum. Which of the following additional laboratory test findings would be most likely be present in this patient?
a. Heart failure b. Malabsorption c. Peripheral neuropathy d. Skin rash e. Renal failure |
D; The presentation is of Polymyositis. The presence of a skin rash often accompanies this presentation and would also lead to the official diagnosis of dermatomyositis
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5. An appropriate, useful type I hypersensitivity response of the immune system, accompanied by eosinophilia, would most likely be directed against which of the following?
a. Amyloid protein b. Spirochetes c. Neoplasms d. Inhaled dusts e. Liver flukes |
e liver flukes
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8. A 40-year-old woman has had increasing difficulty swallowing for over the past year. She also notes that it is more difficult to use the keyboard of her computer because she finds in hard to move her fingers, though the joints are not painful. She has lost the facial wrinkles that she was beginning to develop in middle age. A skin biopsy is performed and shows extensive dermal fibrosis but almost no inflammatory cell infiltrates. These findings are most typical for which of the following conditions?
a. Mixed connective tissue disease b. Discoid lupus erythematosus c. CREST syndrome d. Dermatomyositis e. Amyloidosis |
C; CREST syndrome is the slightly less severe form of Progressive Systemic Sclerosis (Scleroderma). The difference between the two is the presence/absence of internal organ damage. In both syndromes, collagen builds up inappropriately leading to fibrosis.
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A 42-year-old man has lost 7 kg over the past two years. During that time he has had pain and swelling around the small joints of his hands and feet. He has had a series of upper respiratory tract infections, with organisms including Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa cultured. He has a chronic diarrhea. A stool specimen is found to have Giardia lamblia cysts. Laboratory studies show a hemoglobin of 8.8 g/dL with a reticulocyte count of 3.2%. His serum urea nitrogen is 19 mg/dL with creatinine 1.0 mg/dL. His antinuclear antibody test is negative. Quantitative serum immunoglobulins show IgA 70 mg/dL, IgG 303 mg/dL, and IgM 64 mg/dL. By flow cytometry there are normal numbers of T cells and slightly reduced numbers of B cells. Which of the following conditions is most likely to be present in this man?
a. HIV infection b. Polymyositis c. Bruton agammaglobinemia d. Common variable immunodeficiency e. Diabetes mellitus |
d. common variable immunodeficiency
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10. A 4 year old girl recently underwent a bone marrow transplant in efforts to treat leukemia. She now presents to the hospital with fever and the skin discoloration seen in the image below. Routine blood tests show elevated AST and ALT. What is the mechanism of the girl’s pathology? figure of rash all over body
a. Her own T cells are attacking the donor bone marrow cells b. Donor B cells are producing antibodies against her c. There is no association between her current state and the transplant d. Donor T cells are attacking cells in her body |
D; This is graft vs. host disease in which donor T cells attack the recipient.
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12. A 48 year old female has xerostomia that seems to plague her constantly regardless of fluid intake or the weather outside. She also reports that though she had never had a cavity before, she was recently to the dentist and required fillings for 4 new cavities. A biopsy of the inner lip is performed and has the microscopic findings shown here. Which of the following serologic tests is most likely to be positive:
figure of glands a. Anti-Smith b. Anti-centromere c. Jo-1 d. Scl-70 e. SS-A |
E; This is Sjogren’s Syndrome. The image shows lymphocytes infiltrating glandular epithelium (ie. Salivary gland which would lead to this woman’s dry mouth).
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A 50-year-old man has felt vague abdominal discomfort for the past 4 months. On physical examination he has no lymphadenopathy, and no abdominal masses or organomegaly can be palpated. Bowel sounds are present. An abdominal CT scan shows a 20 cm retroperitoneal soft tissue mass obscuring the left psoas muscle. A stool specimen tested for occult blood is negative. Which of the following neoplasms is this man most likely to have?
a. Melanoma b. Hamartoma c. Adenocarcinoma d. Lymphoma e. Liposarcoma |
e. sarcomas are BIG and bad; RETROPERITONEUM is typical location
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A 52-year-old woman feels a lump in her right breast and goes to her physician. On physical examination there is a 3 cm right breast mass fixed to the chest. This mass is biopsied and on microscopic examination shows nests of cells with marked hyperchromatism and pleomorphism. These cells are estrogen receptor positive. Flow cytometry is performed. Compared with surrounding non-neoplastic stromal cells, the neoplastic cells are more likely to be in which of the following phases of the cell cycle?
a. G0 b. G1 c. S d. G2 e. M |
c. a high S-phase as well as aneupoidy (hyperchromatism indicative of active DNA synthesis)
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a neoplasm of epithelial origin?
a. adenoma b. carcinoma c. sarcoma d. lipoma |
carcinoma and can include skin, esophagus, lip and tongue
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a neoplasm of stromal origin?
a. adenoma b. carcinoma c. sarcoma d. lipoma |
sarcoma and can include tissue of orgin
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malignant cancer of lymphoid (outside BM)?
a. lymphsarcoma b. lymphcarcinoma c. lymphoma d. lymphadenoma |
lymphoma
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malignant neoplasm of blood cell origin?
a. lymphoma b. retinoblastoma c. leukemia d. blastoma |
leukemia
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cancer of male germ cell origin?
a. testoma b. adenoma c. seminoma d. vasoma |
seminoma
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a malignant neoplasm of melanocyte origin?
a. melanoma b. lymphoma c. chondroma d. meladenoma |
melanoma
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a malignant neoplasm of primitive origin?
a. blastoma b. neoplasm c. melanoma d. glioma |
blastoma
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a benign or malignant neoplasm of glial origin?
a. blastoma b. glioma c. melanoma d. leukemia |
glioma
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a malignant neoplasm of 3 germ layer origin?
a. seminoma b. leukemia c. glioma d. teratoma |
teratoma
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what would you name a malignant tumor of low-grade neuroenodcrine?
a. carcinoid b. pheochromocytoma c. adenoma d. blastoma |
carcinoid
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what kind of tumor is pheochromocytoma?
a. neuroendocrine b. melanocyte c. blood cell origin d. adrenal medulla |
adrenal medulla
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what is the name of a malignant tumor of plasma cells?
a. adenocarcinoma b. squamous cell carcinoma c. multiple myeloma d. pheochromoctytoma |
multiple myeloma
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what is a common HIV vascular tumor?
a. Wilm's sarcoma b. Kaposi's sarcoma c. Hodgkins disease d. multiple myeloma |
Kaposi's sarcoma
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Ewings is what kind of sarcoma?
a. bone marrow b. pediatric bone c. plasma cell d. renal |
pediatric bone
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Wilm's tumor is ?
a. bone marrow b. pediatric bone c. plasma cell d. renal |
renal
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Hodgkin's disease is what kind of tumor?
a. brain b. lymphoma c. phenochromocytoma d. teratoma |
lymphoma
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a lung nodule of smooth muscle is commonly referred to as?
a. hematoma b. atheroma c. sarcoma d. harmartoma |
harmatoma -- disorganized growth of tissue native to the organ
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If there are nodules of pancreas in the wall of the stomach this is often referred to as:
a. hematoma b. harmatoma c. glaucoma d. choristoma |
choristoma -- growth of tissue not native to the organ
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what are common features of a poorly differentiated tumor (anaplastic)?
a. variable nuclear size b. nuclear hyperchromatism c. maintains cell polarity d. a and b |
variable nuclear size
nuclear hyperchromatism loss cell polarity increased to normal mitosis necrosis tendancy |
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what can be a precursor lesion of cancer in epithelial cells?
a. anaplastic b. blastoma c. dysplasia d. sarcoma |
dysplasia
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common distant effects of cancer EXCEPT
a. metastasis b. cachexia c. ascites d. paraneoplastic syndromes e. neuropathy |
all except neurophathy
metastasis, cachexia (muscle wasting), ascites, paraneoplastic |
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what is the most commn parneoplastic effects due to malignant cancers?
a. endocrine like effects b. hypercalcemia c. neuromuscular effects d. thrombic effects |
hypercalcemia
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carcinoma growth patterns vary from sarcomas in all EXCEPT:
a. invasive/infliltrate b. denophytic/polypoid c. ulcerate d. diffuse e. metastosize via blood stream |
metastosize via blood stream this is seen is sarcomas
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Sarcomas are commonly
a. ulcerating b. diffuse c. bulky and deep seeded d. ulcerating |
bulky and deep seeded
defined necrotic metastosize via blood stream |
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what oncogene mutation is common in 20-40% of cancers?
a. Ras oncogene b. cyladase oncogene c. caspase oncogen d. none of the above |
ras oncogene this activates teh MAP kinase pathway leading to cell cycle progression
MUTATED in common number of cancers |
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what common clyclins result in cell cycle stimulation?
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CDK4 binds to cyclin dependent kinase
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what is the single most common mutation in human cancer?
a. CDK4 b. cyclin kinase D c. p53 d. bcl2 |
p53
if p53 is intact, chemotherapy and radiation work better (cells undergo apoptosis) |
