Pathology Section 1 - Cellular Injury and Adaptation 1) Which of the following is NOT an anti-oxidant that detoxifies free radicals? a) caeruloplasmin b) superoxide dismutase c) catalase d) glutathione peroxidase e) iron-free fraction of apoferritin 2) Which of the following is NOT a cellular effect of free radicals? a) intracellular accumulation of haemosiderin b) random damage to DNA c) polymerisation of membranes d) random damage to RNA e) cell death 3) Regarding necrosis, which statement is INCORRECT? a) caseous necrosis exhibits both coagulation and liquefaction b) enzymic digestion is a feature of adrenal gland necrosis c) “dry” gangrene exhibits coagulative necrosis d) denaturation of proteins is a feature of myocardial necrosis e) bacterial lesions may exhibit liquefactive necrosis 4) Fatty change is NOT characteristic of which organ? a) liver b) heart c) pancreas d) skeletal muscle e) kidney
Transcript
Pathology
Section 1 - Cellular Injury and Adaptation
1) Which of the following is NOT an anti-oxidant that detoxifies free radicals?
a) caeruloplasminb) superoxide dismutasec) catalased) glutathione peroxidasee) iron-free fraction of apoferritin
2) Which of the following is NOT a cellular effect of free radicals?
a) intracellular accumulation of haemosiderinb) random damage to DNAc) polymerisation of membranesd) random damage to RNAe) cell death
3) Regarding necrosis, which statement is INCORRECT?
a) caseous necrosis exhibits both coagulation and liquefactionb) enzymic digestion is a feature of adrenal gland necrosisc) “dry” gangrene exhibits coagulative necrosisd) denaturation of proteins is a feature of myocardial necrosise) bacterial lesions may exhibit liquefactive necrosis
4) Fatty change is NOT characteristic of which organ?
a) liverb) heartc) pancreasd) skeletal musclee) kidney
5) Regarding pigments, which statement is INCORRECT?
a) melanin is not derived from haemoglobinb) homogentisic acid is a black pigment deposited in the skinc) haemosiderin represents aggregates of ferritin micellesd) lipofuscin damages cellular functionse) bilirubin contains no iron, despite being derived from haemoglobin
6) Intracellular dystrophic calcification initiates in which cellular organelle?
a) golgi apparatusb) mitochondriac) smooth endoplasmic reticulumd) membrane-bound vesiclese) lyposomes
7) Which of the following is NOT a mediator of cell injury and death?
a) oxygen derived free radicalsb) decrease in intracellular calciumc) loss of calcium homeostasisd) ATP depletione) deficiency in membrane permeability
8) Apoptosis is characterised by:
a) karyolysisb) swelling of organellesc) disruption of membrane integrityd) a mild inflammatory responsee) formation of cytoplasmic blebs
9) A hallmark of irreversible cellular injury is:
a) vacuolar degenerationb) mitochondrial swellingc) detachment of ribosomes from endoplasmic reticulumd) nucleolar dis-aggregatione) damage to plasma membranes
10) With regard to cellular injury, all of the following are reversible EXCEPT:
a) decreased ATPb) intracellular release of lysosomal enzymesc) decreased Na pump activityd) detachment of ribosomese) ER swelling
11) With regard to free radical-induced cellular injury:
a) this is not a mechanism of cellular damage associated with ischaemiab) this is a Ca++ dependent processc) it requires reperfusion of a previously ischaemic aread) free iron inhibits the process by acting as an anti-oxidante) free radicals are produced mainly by mitochondrial production of superoxide
12) In hypoxic cell injury, swelling of the cells occurs because:
a) intracytoplasmic liquids accumulateb) intracytoplasmic proteins accumulatec) intracytoplasmic glycogen increasesd) intracytoplasmic lipofuscin accumulatee) water enters the cell
13) In reversible cell injury, all of the following are true EXCEPT:
a) ATP depletion is responsible for acute cellular swellingb) it can cause myocardial cells to cease contraction within 60 secondsc) ATP is generated anaerobically from creatinine phosphated) mitochondrial swelling and degranulation of ER are the hallmarks of irreversible cellular
damagee) it is associated with myelin figures
14) Metaplasia:
a) is irreversibleb) is commonly a change from squamous to columnar epitheliumc) an example is the transformation of epithelial cells into chondroblasts to produce
cartilaged) retinoids may play a rolee) even if the stimuli is persistent, it is a benign lesion
15) Cytosolic calcium in cell injury:
a) only enters by active transportb) partially derives from mitochondriac) increases ATPd) inactivates phospholipase
e) inactivates protease
16) Metaplasia:
a) is usually a premalignant conditionb) is due to genetic reprogramming of cellsc) may be regulated by vitamin B12d) the most common type is from squamous to columnar epithelium e) is irreversible
17) In apoptosis:
a) it involves physiologic and pathologic stimulib) histologically it involves ATP depletionc) its DNA breakdown is random and diffused) its mechanism involves ATP depletione) it involves an inflammatory tissue reaction
18) Hyperplasia:
a) occurs after partial hepatectomyb) refers to an increase in the size of cellsc) is always a pathologic processd) often occurs in cardiac and skeletal musclee) usually progresses to cancerous proliferation
19) Metaplasia:
a) is an irreversible change in cell typeb) is most commonly a change from squamous to columnarc) does not occur in mesenchymal cellsd) may progress to cancer transformatione) is usually accompanied by hypertrophy
20) All of the following are important in the mechanism of cell injury EXCEPT:
a) O2 derived free radicalsb) defects in membrane permeabilityc) ATP depletiond) loss of cell volumee) loss of calcium homeostasis
21) Apoptosis is characterised by which one of the following?
a) cell swellingb) chromatin activationc) formation of cytoplasmic blebs and apoptotic bodiesd) exocytosis of apoptotic cells or bodiese) mild inflammation
22) Regarding hyperplasia, all of the following are true EXCEPT:
a) it is involved in growth of the female breast at pubertyb) it is responsible for hepatic regrowth following partial hepatectomyc) it is an important response of connective tissue cells in wound healingd) it is associated with certain viral infectionse) it does not predispose to malignant cell changes
23) Metaplasia is seen in all of the following EXCEPT:
a) respiratory epithelium of cigarette smokersb) vitamin A excessc) Barrett’s oesophagusd) epithelium of a pancreatic duct containing stonese) foci of cell injury
Section 1 Cellular Injury and Adaptation – Answers
1) The cardinal signs of acute inflammation include all of the following EXCEPT:
a) calorb) ruborc) dolurd) functio laesae) angiogenesis
2) Increased endothelial permeability can be caused by all of the following EXCEPT:
a) endothelial cell contractionb) endothelial cell retractionc) direct endothelial injuryd) leakage from old capillariese) proleolytic enzymes released from leukocytes
3) Which of the following chemical mediators is involved in acute inflammation?
a) anaphylatoxin C4ab) kallikreinc) fibrind) leukotriene A4e) PGG2
4) Regarding the action of specific complement components, which is INCORRECT?
a) C3a increases vascular permeabilityb) C5a is chemotactic to basophilsc) C3a is chemotactic to eosinophilsd) C3b is an opsonine) C5a increases vascular permeability
5) Which of the following is NOT a histological hallmark of chronic inflammation?
a) infiltration by plasma cellsb) proliferation of small blood vesselsc) increased connective tissued) proliferation of smooth muscle
e) infiltration by lymphocytes
6) Which of the following does NOT activate the classical complement pathway?
a) cobra venomb) IgM-antigen complexc) DNAd) IgG-antigen complexe) heparin
7) Which of the following produces a diffuse granulomatous reaction?
a) sarcoidosisb) lymphogranuloma venereumc) cat-scratch diseased) coccidioidomycosise) lepromatous leprosy
8) Which of the following would NOT be seen in the setting of granulomatous inflammation?
a) langerhans’ giant cellsb) acid-fast bacillic) epithelioid cellsd) granulomata up to 2mm in diametere) touton giant cells
9) Which complement component is present in greatest concentration in the blood?
a) C5b) factor Dc) C2d) C4e) C3
10) Which of the following is NOT a component of pus?
a) liquor purisb) neutrophilsc) parenchymal cell debrisd) macrophagese) lysosomal enzymes
11) What is the main structural component required for organised regeneration in a wound?
a) fibroblastsb) basement membranec) collagend) elastine) capillary loops
12) Which of the following is NOT a characteristic feature of “myofibroblasts”?
a) folded nucleusb) intracytoplasmic actinc) tight junctionsd) basement membrane formatione) they resemble smooth muscle cells
13) Which of the following is NOT a cell of the mononuclear phagocyte system?
a) hofbauer cellb) histiocytec) basket celld) mesangial celle) kupffer cell
14) Which of the following is NOT a general delaying factor in skin wound healing?
a) zinc deficiencyb) protein starvationc) copper deficiencyd) high temperaturee) vitamin C deficiency
15) Which of the following substances is NOT secreted by macrophages?
a) collagenaseb) hyaluronidasec) elastased) lysosome
e) interleukin-1
16) Which of the following is NOT a histologic feature of granulation tissue?
a) fibroblast proliferationb) macrophagesc) budding of pre-existing small blood vesselsd) oedemae) smooth muscle proliferation
17) Which of the following is NOT associated with macrophages?
a) expression of class 1 HLA antigensb) control of granulopoiesisc) anti-tumour activityd) control of erythropoiesise) defence against intracellular organisms
18) Regarding healing of skin wounds by primary intention, which statement is INCORRECT?
a) migrating epithelial cells divide within the woundb) fibroblasts invade the wound around day 3c) fibrin-rich haematoma forms initiallyd) final stage involves devascularisatione) type III collagen is the first to be laid down
19) Regarding increased vascular permeability in acute inflammation, which statement is INCORRECT?
a) delayed-prolonged response involves fluid leakage from venulesb) immediate-transient response is elicited by histaminec) immediate-sustained response involves fluid leakage from all vessels of the
microcirculationd) delayed-prolonged response is elicited by bacterial toxinse) immediate-transient response involves fluid leakage from capillaries
20) Regarding healing of skin wounds by secondary intention, which statement is INCORRECT?
a) wound contraction is the major difference to primary intentionb) epithelial cells migrate deep to granulation tissuec) fibroblasts resemble smooth muscle cellsd) wound fills with coagulum initially
e) regenerated epidermis sends short processes into underlying tissue
21) Regarding leucocytes, which function is NOT specifically impaired in diabetes mellitus?
a) phagocytosisb) chemotaxisc) adherenced) microbicidal activitye) migration
22) Which of the following is NOT a recognised complication of skin wound healing?
a) cicatrisationb) proud fleshc) lipofuscin pigmentationd) epidermoid cyste) neoplasia
23) Which of the following is/are NOT released into extracellular space by leucocytes?
a) leukotrienesb) hydrogen peroxidec) thromboxanesd) superoxidee) prostaglandins
24) Which of the following is the MOST important cause of delayed skin wound healing?
a) foreign bodyb) continued traumac) poor blood supplyd) infectione) irritants
25) Which of the following chemical mediators does NOT induce leucocyte adhesion?
a) leukotriene B4b) C3ac) bacterial endotoxind) platelet activating factor
e) interleukin-1
26) Regarding the triple response, which statement is INCORRECT?
a) the red line is due to the axon reflexb) it is still present after total sympathectomyc) wheal occurs due to exudation of fluid through vascular wallsd) mediated by local histamine releasee) flare occurs due to arteriolar dilatation
27) Which of the following is NOT a local delaying factor in skin wound healing?
a) poor blood supplyb) neoplasiac) ionising radiationd) absence of ultraviolet radiatione) moist wound
28) Regarding fracture healing, which statement is INCORRECT?
a) lamellar bone precedes woven bone formationb) capillary loops invade from periosteumc) adjacent bone ends ‘decalcify’d) fat globules can excite a foreign body giant cell reactione) inadequate immobilisation may lead to cartilage formation
29) Which of the following is CORRECT?
a) myeloperoxidase activation leads to increased H2O2 productionb) opsonins are required for phagocytosisc) TNF is a powerful leukocyte activatord) protein kinase C activation leads to the oxidative burste) increased avidity of selectin binding is part of transmigration
30) Regarding leucocyte chemotaxis, which of the following is INCORRECT?
a) movement is mediated by phospholipase C activationb) migration occurs down a concentration gradientc) products of the cyclo-oxygenase pathway are important mediatorsd) IL-8 is the predominant chemotactic cytokinee) the leucocyte pseudopad contains actin and myosin
31) Regarding inflammatory vascular leakage, which is INCORRECT?
a) exudation is typicalb) endothelial cell contraction affects mainly capillariesc) leucocyte margination occurs as stasis developsd) angiogenesis causes oedema due to poorly differentiated endotheliume) lymph flow is increased in inflammation
1) All of the following concerning fatty streaks are correct EXCEPT:
a) they are composed of similar cells and substances to atheroma b) they decrease in an individual, as atheromatous lesions increasec) in the coronary arteries, they have the same distribution as atheromad) their incidence is increased by the same risk factors as atheromae) they are evident by adolescence only in the populations with high incidence of
atherosclerosis in later life
2) Necrosis is characterised by:
a) cellular shrinkageb) chromatin condensationc) cytoplasmic condensationd) liquefaction of muscle in the absence of bacterial infectione) cytoplasmic vacuolation
3) The vessel MOST intensely involved by atherosclerotic plaques is:
a) the abdominal aortab) the coronary arteryc) the internal carotid arteryd) the popliteal arterye) the middle cerebral artery
4) Which of the following is the LEAST significant risk factor for atherosclerosis?
a) obesityb) hypercholesterolaemiac) hypertensiond) diabetese) cigarette smoking
5) A major risk factor that predisposes towards atherosclerosis is:
a) male genderb) diabetesc) obesityd) a family history of premature atherosclerosise) physical inactivity
6) Atheroma predominantly affects:
a) the intimab) the mediac) the adventitiad) the media and adventitiae) the whole arterial wall
7) Which is NOT a feature of atheromatous plaques?
a) it mainly involves the muscular and elastic arteriesb) lesions tend to be covered with a fibrous cap of smooth muscle cellsc) the edges (“shoulder”) contain macrophages and T cellsd) the core is a necrotic mass of cholesterol and other lipids with foam cellse) it mainly occurs within the tunica media
8) After the abdominal aorta, in general, which site is the most heavily affected by atheroma?
a) the descending thoracic aortab) the coronary arteriesc) the popliteal arteryd) the internal carotid arterye) the vessels of the circle of Willis
9) The hyperlipidaemic contribution to the pathogenesis of atheroma is thought to occur via:
a) the atheroma macrophages uptaking lipid via LDL receptorsb) the hyper viscosity secondary to hyperlipidaemiac) the oxidation of lipids within the atheromad) the thrombogenic nature of lipidse) the apolipoprotein B-48
10) With regard to ischaemic necrosis:
a) liquefaction is the most common morphological processb) changes seen in the central nervous system represent the typical morphological patternc) gene activity plays a significant roled) ATP depletion plays a pivotal rolee) chromatin condensations are characteristics
11) Regarding infarctions:
a) venous thromboemboli lodge in the pulmonary vein causing infarctionb) 85% of infarcts are caused by thromboembolic eventsc) twisting or compression of vessels to an organ is a common cause of infarctiond) haemorrhagic infarcts occur in solid organse) the usual cytologic appearance is that of ischaemic coagulative necrosis
12) Which of the following causes of ischaemia does NOT result in small vessel damage?
13) Which of the following is NOT true concerning cerebral infarction?
a) cerebral infarction is primarily due to atherosclerosisb) the lower end of the basilar artery is a common site of involvement in cerebral infarctionc) cerebral infarction is commonly associated with goutd) carotid arterial thrombus is the most frequent source of thrombotic materiale) anticoagulation is contraindicated in haemorrhagic infarcts
14) Cerebral infarction is characterised by all of the following EXCEPT:
a) it is undetectable under 6 hoursb) the prolonged presence of macrophagesc) pronounced oedema at 24 hoursd) discolouration and softening at 12 hourse) cyst formation
15) Which is NOT a complication of atheroma?
a) occlusionb) thrombosisc) aneurysmd) fistulae) embolism
16) Which of the following is TRUE of atheromatous plaques?
a) they do not impinge on the lumen of the vesselb) they are more likely to occur in the internal carotid arteries compared to the popliteal
arteriesc) they tend to involve the arterial wall circumferentiallyd) they contain foam cells derived from smooth muscle cellse) they show evidence of neovascularisation
17) The associated fluid released with infarction is usually:
a) fibrinous exudateb) transudate with high potassium contentc) neutrophil rich exudated) the same consistency as lymphatic fluide) transudate with low potassium content
18) Monckeberg’s arteriosclerosis is characterised by all of the following pathological features EXCEPT:
a) calcification within tunica mediab) co-existent atheromac) inflammatory cell infiltrated) unaffected intima and adventitiae) bone and marrow formation
19) Atherosclerosis:
a) is a disease of elastic arteriesb) the basic lesion is plaque within the mediac) begins in early 20s d) causes approximately 35% of all deathse) causes ischaemic injury through small vessel occlusion
20) Which of the following is NOT true of infarction?
a) infarction is commonly due to thrombotic or embolic occlusionsb) few infarcts are due to venous occlusionc) haemorrhagic infarcts are usually encountered with venous occlusionsd) haemorrhagic infarcts may occur in the braine) the small intestine is an uncommon site for haemorrhagic infarcts
21) Which of the following is NOT a commonly recognised feature of infarction?
a) raised ESRb) raised c-reactive proteinc) eosinophiliad) fevere) neutrophilia
22) Which of the following is placed INCORRECTLY in the sequence of the formation of the atheromatous plaque?
a) endothelial cells exhibit increased permeability to plasma constituentsb) monocytes and platelets adhere to the endotheliumc) monocytes enter the intimad) monocytes release chemotactic factors to induce smooth muscle cell migratione) monocytes accumulate lipid to form foam cells
23) All are determinants of infarction EXCEPT:
a) availability of alternative blood supplyb) rate of occlusion developmentc) the sex of the tissue/organ ownerd) formation of collateral circulatione) the tissue type
24) Which of the following processes is NOT a recognised complication of atheromatous plaques?
a) intraplaque haemorrhageb) metastatic calcificationc) aneurismal dilationd) thrombosise) ulceration and micro embolus formation
25) Which cell type is MOST susceptible to ischaemic necrosis?
a) neuronb) hepatocytec) skeletal muscled) cardiac musclee) renal tubular epithelium
26) “Red” infarcts are more common in which of the following?
a) the heartb) the small intestinec) the spleend) the kidneye) none of the above
27) Which of the following statements regarding infarction is INCORRECT?
a) an infarct is an area of ischaemic necrosis within a tissue or an organb) nearly all infarcts result from thrombotic or embolic occlusionc) vascular occlusion does not always produce infarctiond) venous thrombosis cannot cause infarctione) trapping of a viscus under a peritoneal adhesion may cause infarction
28) Which of the following is NOT associated with an increased risk of atherosclerosis?
a) pre-menopausal femaleb) familial predispositionc) hypertensiond) high intake of omega-3 fatty acidse) diabetes
29) Which of these is NOT true regarding the consequences of myocardial infarction?
a) some regeneration of dead tissue by cellular replicationb) hypertrophy of viable tissue to compensatec) irreversible injury occurs after 40 minutesd) granulation tissue forms from day 7 and this may potentially lead to ventricular rupturee) there is a neutrophilic infiltration into necrotic tissue from 12 hours post infarct
30) Which of the following statements is INCORRECT?
a) chylomicions have the lowest densityb) VLDL transport triglyceridesc) LDL transports endogenous cholesterol to body cellsd) HDL functions primarily in the transport of exogenous cholesterole) high serum levels of HDL are related to low risk of IHD
31) Which of the following is a major determinant of the development of an infarct?
a) the nature of the vascular supplyb) the rate of development of the occlusionc) the vulnerability of the tissue to hypoxiad) the oxygen carrying capacity of the bloode) all of the above
32) Regarding atherosclerosis, which of the following is TRUE?
a) fatty streaks cause disturbance in blood flowb) fatty streaks appear in aortas of all children older than one yearc) atheromatous plaques are composed of a luminal surface of foam cellsd) coronary artery lesions are often mainly fatty atheromae) the lipid in a plaque is primarily triglyceride
33) Morphological changes of cell necrosis include:
a) intact endoplasmic reticulumb) no mitochondrial swellingc) karyolysis of nucleusd) formation of nuclear chromatin clumpse) intact lysosomes
34) Which of the following statements about necrosis is NOT true?
a) it is due to the progressive degradative action of enzymes on the lethally injured cellb) it may be due to autolysis or heterolysisc) necrotic cells show increased eosinophiliad) nuclear changes also occure) apoptosis is a more common pattern of cell death
35) Necrosis differs from apoptosis because:
a) it involves single cells at timesb) there is presence of chromatin condensationc) it may be a physiological event when cells aged) it stimulates an inflammatory responsee) it involves gene activation and programmed release of endonuclease
36) Liquefaction necrosis is characteristic of hypoxic death of cells within the:
a) heartb) liverc) braind) kidneye) spleen
37) Risk factors for the development of atherosclerosis include all of the following EXCEPT:
a) cigarette smokingb) diabetesc) female genderd) hypertensione) hyperlipidaemia
38) Major risk factors of atherosclerosis include all of the following EXCEPT:
a) diabetesb) cigarette smokingc) obesityd) hyperlipidaemiae) hypertension
a) C3a is a chemotactic to most leucocytesb) the alternate pathway is activated by Ag-Ab complexc) C5a stimulates arachidonic acid mechanismd) C3b Bb is responsible for negative feedback on C3 convertasee) C5a is involved in membrane lysis
2) During phagocytosis:
a) opsonisation involves the coating of a micro-organism with C5bb) bacterial killing is largely independent of oxygenc) acid hydrolases degrade the bacteria within the phagolysosomed) myeloperoxidase requires Ca2+ for activatione) major basic proteins are cytotoxic to many bacteria
3) Glycosylation end products:
a) inhibit lipid oxidationb) activate nitric oxidec) bind to AgE receptors on monocytesd) inactivate cytokinese) decrease vascular permeability
4) With regards to chemical mediators in inflammation, which is NOT true?
a) vasoactive amines are important in vasodilation and increased vascular permeabilityb) complement components C3 and C5 are key factorsc) interleukin-1, tumour necrosis factor and prostaglandins are involved with production of
feverd) leukotrienes formed via the cyclo-oxygenase pathway are potent in chemotaxis and in
increasing vascular permeabilitye) activated Hageman factor (Factor XII) initiates clotting, fibrinolytic and kinin systems
5) A preformed mediator of inflammation is:
a) prostaglandinb) histaminec) leukotriened) nitric oxidee) platelet activating factor
7) With regard to chemical mediators of inflammation:
a) they are derived solely from plasmab) leukotrienes are performed mediatorsc) nitric oxide results in vasodilationd) the source of serotonin is leucocytee) histamine results in vascular leakage
8) Regarding burns:
a) full thickness burns only heal with skin graftingb) neurogenic shock can follow hypovolaemic shockc) dominant invading organisms include resistant proteus strains and staphylococcid) excess fluid loss may be of the order of 0.4ml/kg/percentage of burne) partial thickness burns are characterised by preservation of dermal appendages
9) Regarding physical injuries, which is INCORRECT?
a) an abrasion is a scrape in which superficial epidermal cells are torn offb) a laceration is an irregular tear in the skin produced by overstretchingc) an incision is made with a sharp cutting objectd) a contusion is caused by a blunt force which disrupts the continuity of the tissuee) with gunshot wounds, exit wounds are more irregular than entry wounds due to the
wobbling trajectory of the bullet
10) With regard to extracellular fluids, which one of the following is INCORRECT?
a) an exudate has a high protein concentration and has a specific gravity >1.020b) exudates occur mainly in inflammatory responsesc) a transudate has a low protein concentration and has a specific gravity <1.012d) transudates occur when vascular permeability is alterede) transudates are essentially an ultrafiltrate of plasma
11) With regard to histamine, which one of the following is INCORRECT?
a) it dilates capillariesb) it increases capillary permeabilityc) it induces the expression of endothelial adhesion moleculesd) it is a polypeptidee) it can causes endothelial contraction
12) With regard to the acute inflammatory response, which one of the following is INCORRECT?
a) stasis is the result of vasoconstriction of the venulesb) leucocytic margination in blood vessels is mainly due to stasisc) exudate formation is due in part to a fall in colloid oncotic pressured) exudate formation is due in part to an increase in arteriolar and venular hydrostatic
13) With regard to apoptosis, which of the following is INCORRECT?
a) it may be regarded as a normal physiological processb) it is characterised by chromatin condensationc) it often elicits a strong inflammatory responsed) it is the process by which ovaries atrophy in post-menopausal womene) it is characterised by cell shrinkage
14) With regard to the acute inflammatory response, which is the MOST common mechanism of vascular leakage?
a) endothelial cell contractionb) junctional retractionc) direct injuryd) leucocyte-dependent leakage
e) regenerating endothelium
15) With regard to the development of wound strength following a laceration:
a) one week after repair, the wound strength is approximately 50% of unwounded skinb) increased wound strength occurs as a result of stronger inter-epithelial cell junctionsc) collagen synthesis ceases to be an important factor after the first 4 weeksd) peak wound strength may plateau at 70-80% of unwounded skine) structural modification of collagen fibres (eg cross linking) is important for early recovery
of tensile strength
16) With regard to the acute inflammatory response, which of the following is INCORRECT?
a) chemotactic agents increase intercellular Ca2+ concentration in leucocytesb) phagocytosis of bacteria by leucocytes may occur without opsonisationc) complement receptors 1, 2 & 3 on leucocytes bind mainly to C5b component d) Fc gamma R is a receptor on leucocytes that binds the Fc fragment of IgGe) bacterial killing is mainly by oxygen-dependent mechanisms
17) With regard to the role of complement in the acute inflammatory response, which of the following is INCORRECT?
a) C5a is a powerful, chemotactic agent for neutrophils, monocytes and eosinophilsb) C5a increases leucocyte adhesion to endothelium by activating leucocytesc) C3a and C5a are call anaphylatoxins because they cause mast cell degranulationd) C3a activates the lipoxygenase pathway in leucocytese) C3 and C5 can be activated in inflammatory exudate by lysosomal enzymes
18) Removal of sutures from a wound at day 7 coincides with a wound strength of:
a) 1% of unwounded skin strengthb) 10% of unwounded skin strengthc) 50% of unwounded skin strengthd) 75% of unwounded skin strengthe) 100% of unwounded skin strength
19) With regard to the human acute inflammatory response, which of the following is INCORRECT?
a) mast cells release serotoninb) IL-1 and IL-8 may cause mast cell degranulationc) platelet-activating factor increases leucocyte chemotaxis and activationd) nitric oxide has anti-microbial properties in addition to being a vasodilator
e) IL-8 increases leucocyte chemotaxis and activation
20) The role of selectins in inflammation is:
a) to assist adhesion of leucocytes to vascular endotheliumb) to be a chemotactic agent for leucocytesc) to increase vascular permeability by endothelial cell retractiond) to allow leucocytes to break down basement membranee) they have no role in inflammation
21) With regard to the kinin system, which is NOT true?
a) it is directly triggered by contact (surface) activation of Hageman factorb) kallikrein converts high MW kininogen into bradykininc) kallikrein is an inhibitor of Hageman factor providing a negative feedback loopd) kallikrein has chemotactic activitye) kallikrein directly converts C5 to C5a
22) Zinc is important for healing because:
a) it is a cofactor in the enzymatic modification of collagen and chainsb) it is a cofactor in the cross-linking of collagen and chainsc) it directly stimulates fibroblasts to synthesise collagend) it is required for activity of metalloproteinases which enable remodellinge) none of the above are true
23) With regard to the role of nitric oxide as an inflammatory mediator:
a) it has important platelet aggregating effectsb) it acts only on cells in close proximity to its releasec) it acts as an antioxidantd) it is a primary chemotactant for macrophagese) it is responsible for activating macrophages
24) Histamine release from mast cells is activated by all of the following EXCEPT:
a) kallikreinb) complement fragments C3a and C5ac) cytokines IL-1 and IL-8d) physical injurye) immune reactions
25) With regard to eicosanoids in the acute inflammatory response, which of the following is INCORRECT?
a) 5-lipoxgenase is the predominant arachidonic acid enzyme in neutrophilsb) leukotriene B4 and 5-HETE are chemotacticc) the leukotrienes C4, D4 and E4 are potent vasodilatorsd) thromboxane A2 causes vasoconstriction and promotes platelet aggregatione) leukotriene B4 causes aggregation and adhesion of leucocytes to venules
26) With regard to nitric oxide as a mediator of acute inflammation, which of the following is INCORRECT?
a) endothelial nitric oxide synthase is activated by an increase in cytoplasmic calciumb) macrophage nitric oxide synthase is activated by cytokines, especially IFN-gammac) nitric oxide promotes platelet aggregationd) uncontrolled production in septic shock leads to massive vasodilatione) it has antimicrobial activates
27) Which of the following antioxidants is a powerful hydrogen peroxide detoxifier?
a) ceruloplasminb) transferrinc) superoxide dismutased) catalasee) none of the above
28) In an inflammatory response, neutrophils release molecules that have all the following effects EXCEPT:
a) chemotaxis for monocytesb) chemotaxis for lymphocytesc) degranulation of mast cellsd) increased vascular permeability independent of histamine releasee) connective tissue digestion
29) Mediators of increased vascular permeability in acute inflammatory responses include all the following EXCEPT:
a) leukotriene E4b) complement C5b67c) leukotriene C4d) bradykinin
e) PAE
30) Neutrophil lysosomal granules contain:
a) clotting factorsb) cytokines IL-1 and TNFc) myeloperoxidasesd) nitric oxidee) complement components including properdin
31) Granulomatous inflammation:
a) may sometimes be a component of the acute inflammatory responseb) indicates the presence of tuberculosisc) consists, in part, of microscopic aggregates of transformed lymphocytesd) is always associated with the presence of giant cellse) may result from non-immune mechanisms
32) In normal wound healing:
a) the epidermal regeneration is from de-differentiation of cells in the stratum corneumb) there is a larger degree of wound contraction in healing by secondary intention than is
seen in healing by primary intentionc) the tensile strength of the wound after 1 month is approximately 85% of the strength of
unwounded skind) new basement membrane is synthesised by fibroblastse) neovascularisation is maximal at about day 10 in healing by primary intention
33) Which of the following is INCORRECT with regard to the complement system?
a) properidin factors B and D are required for activation via the alternative pathwayb) fixation of C1 to the Fc portion of an antibody triggers the classical pathway of
complement activationc) MAC is the only active product of complement activationd) C5a is a powerful chemotactic agente) C3b can opsonise bacteria
34) Which of the following is INCORRECT regarding arachidonic acid metabolites?
a) platelets can synthesise thromboxane A2b) endothelial cells can synthesise thromboxane A2c) thromboxane A2 spontaneously degenerates thereby limiting its actiond) aspirin inhibits prostacyclin productione) leukotriene B4 is a powerful chemotactic agent
35) Which of the following is CORRECT?
a) histamine vasodilates large arteriesb) bradykinin inhibits the action of Hageman factorc) serotonin has similar actions to histamined) leukotriene B4 causes vasospasme) interleukin-1 inhibits the release of neutrophils from bone marrow
36) With regard to a healing wound, which is CORRECT?
a) the skin has 40% of its tensile strength one week after injuryb) the skin has 10% of its tensile strength one week after injuryc) oxygen and halide radicals inactivate metalloproteases in a healing woundd) nutritional status has no effect on wound healinge) cross linking of collagen fibres does not contribute to wound strength
37) Regarding interleukin-1, which is INCORRECT:
a) it can stimulate the release of neutrophils from the post mitotic reserve pool in bone marrow
b) it can suppress appetitec) it can induce slow wave sleepd) it can induce production of acute phase proteins by the livere) it inhibits the release of interleukin-6 to stimulate the thermoregulatory centres
a) complement systemb) kinin systemc) fibrinolytic systemd) coagulation systeme) all of the above
2) With regard to the leucocyte extravasation of the acute inflammatory response, which of the following is INCORRECT?
a) ELAM-1 is a selectin found on endotheliumb) E-& P- selectins bind to oligosaccharides found on neutrophils and monocytesc) L-selectin is found on neutrophils, monocytes and lymphocytesd) ICAM-1 belongs to the immunoglobulin family molecules and is found on leucocytese) VCAM-1 binds to integrins
3) With regard to cellular injury, all the following are reversible EXCEPT:
a) decreased ATPb) intracellular release of lysosomal enzymesc) decreased NA pump activityd) detachment of ribosomese) ER swelling
4) A patient presents with a greater muscle mass in one lower limb than the other. Possible explanations include all of the following EXCEPT:
a) muscular hyperplasia in the larger limbb) muscular atrophy in the small limbc) ischaemia of the smaller limbd) damage to motor nerves of the smaller limbe) hypertrophy of muscles in the larger limb
5) With regard to free radical induced cellular injury:
a) this is not a mechanism of cellular damage associated with ischaemiab) this is a Ca++ dependent processc) it requires reperfusion of a previously ischaemic aread) free iron inhibits the process by acting as an anti-oxidante) free radicals are produced mainly by mitochondrial production of superoxide
6) Coagulative necrosis:
a) results from necrosis, in which cellular enzymatic digestion predominates over denaturation
b) is characterised by a marked leucocytic infiltratec) is uncommon after myocardial infarctiond) usually occurs after irreversible ischaemic cellular damagee) is not usually seen in association with caseous necrosis
7) In hypoxic cell injury, swelling of the cells occurs because:
a) intracytoplasmic liquids accumulateb) intracytoplasmic proteins accumulatec) intracytoplasmic glycogen increasesd) intracytoplasmic lipofuscin accumulatee) water enters the cell
8) Which of the four statements is CORRECT?
a) complement can only be activated by IgM and IgGb) leukotrienes can cause bronchodilationc) activation of the complement pathway leads to the formation of the membrane attack
complexd) defence mechanisms are harmless to maminalian cells
9) With regard to phagocytosis by neutrophils, which of the following is INCORRECT?
a) the main metabolites active against bacteria are oxygen radicalsb) bacteria can only be ingested if they are opsonisedc) halides are formed by myelperoxidased) lysosomes contain lysosymese) none of the above – all are correct
Section 5
Inflammation and Healing and Necrosis - Answers
1) E2) D3) B4) A5) C6) D7) E8) C9) B
Section 6
1) In apoptosis, which of the following is FALSE?
a) councilman body formation is an example of apoptosisb) seen in pathological and physiological conditionsc) cellular shrinkage is a preletrial changed) causes acute inflammatory responsee) characterised by chromatin condensation and fragmentation
2) The following are seen in reversible cell injury EXCEPT:
a) myelin figuresb) swelling of ERc) swelling of mitochondriad) appearance of large amorphous flocculent densities in mitochondrial matrixe) loss of microvilli and membrane blebs
3) All of the following are free radical scavengers EXCEPT:
a) catalaseb) superoxide dismutasec) vitamin Cd) vitamin Ee) zinc
4) Liquefaction necrosis:
a) does not occur in the brainb) occurs in TB granulomasc) maintains cellular outline after the necrosisd) does not usually occur in bacterial infectione) usually makes cells to become viscous mass after the necrosis
5) Which of the following does not cause free radical damage?
a) NOb) fenton reactionsc) oxidation-reduction in mitochondriad) glutathione peroxidase
e) ultraviolet radiation
6) Acetaminophen toxicity is derived by:
a) sulphationb) glucorinidationc) reductiond) oxidatione) oxygenation
7) Which of the following is a tell-tale sign of free radical damage?
a) lipofuscin granulesb) carbon particlesc) haemosiderind) melanine) iron particles
8) Which is true regarding dystrophic calcification?
a) calcification occurs in viable tissueb) there is normal Ca+2 homeostasisc) does not interfere with cellular functiond) not associated with coagulation necrosise) Ca+2 is deposited as Ca+2/NH4
+/Mg+2 triphosphate
9) Preservation of cellular outline is seen in which of the following necrosis?
a) liquefactionb) coagulativec) fat necrosisd) caseous necrosise) apoptosis
10) Liquefaction necrosis is seen in all of the following EXCEPT:
a) hypoxic brain injuryb) Klebsiella pneumoniac) staphylococcus pneumoniad) fungal infections
e) myocardial infarction
11) All of the following have anti-thrombotic properties EXCEPT:
a) adenosine diphosphataseb) thrombomodulinc) protein Cd) NOe) ADp
12) Causes of oedema include the following EXCEPT:
a) high salt intakeb) protein-calorie malnutritionc) acute inflammationd) increased lymphatic outflowe) post streptococcal glomerulonephritis
a) hypoxia and ischaemia impinge on ATP generationb) ischaemia is more damaging than hypoxiac) irreversible myocardial injury occurs within 20-60 minutes of hypoxiad) glycolytic pathway is uninterrupted in early hypoxiae) toxicity of clostridium perfringens relates to destruction of cell membrane by
phospholipase
2) Which is false?
a) cyanide inactivates cytochrome oxidase in mitochondriab) effects of cyanide are those of hypoxiac) mitochondrial permeability transition is reversible, at any staged) oxidative phosphorylation produces toxic by-productse) glycolysis reduces pH within cells
3) Which is false?
a) myocardial cells cause contracting within 1 minute of coronary blockageb) dystrophic calcification occurs with normal serum Ca2+ levelc) metastatic calcification occurs with normal serum Ca2+ leveld) intracellular Ca2+ causes release and activation of lysosomal enzymese) membrane damage is a central feature of cell injury
4) Which is false?
a) coronary destruction causes cell death, visible by light microscope in one hourb) oxidative stress is caused by imbalance of free radicals and scarringc) cell injury results in increased cellular Ca2+ in cytoplasmd) detachment of ribosomes from RER shows reversible cell injurye) mitochondrial cytochrome C is a trigger of apoptosis
Section 7
Cell Injury - Answers
1 C2 C3 C4 A
Section 8
1) In apoptosis there is:
a) a cell swellingb) coagulation of cytoplasmic proteinsc) chromatin condensation and fragmentationd) early loss of cell membrane integritye) influx of neutrophils
2) Regarding cellular injury:
a) hypoxia injures tissues faster than ischaemiab) mitochondrial damage results in blocking of channels in the inner mitochondrial
membranec) Na-K-ATPase pump failure results in rising intracellular K+ levelsd) detachment of ribosomes is one indicator of irreversible injurye) cell death due to reperfusion is by necrosis or apoptosis
3) Which is NOT a sign of reversible injury?
a) blebbing distortion of microvillib) mitochondrial swellingc) reduced basophiliad) dilation of the endoplasmic reticulume) mitochondrial density formation
4) Regarding hypertrophy:
a) increased cell size is partially due to cellular swellingb) it is pathological not physiologicalc) size changes, but not the phenotype of the celld) it does not occur in cells capable of divisione) there are both mechanical and trophic triggers
5) Regarding pathologic calcification:
a) metastatic calcification occurs in nonviable tissueb) there are three general typesc) an internal alkaline compartment in tissue predisposes them to metastatic calcificationd) calcific valvular disease usually occurs in the setting of hypercalcaemiae) dystrophic calcification is intracellular not extracellular.
6) Regarding cellular ageing, which is NOT true?
a) telomeres progressively lengthen with increasing cell divisionb) oxidative phosphorylation by mitochondria is reducedc) advanced glycation end products play a roled) restriction of caloric intake lowers levels of oxidative damagee) clockgenes control the rate and timing of ageing.
7) The following are stimulants of apoptosis:
a) ischaemic injuryb) hypoxic stressc) cytotoxic T cellular actiond) mitochondrial permeability transition phasee) loss of membrane phospholipase
8) Lysosomes contain all but one of the following:
a) collagenaseb) acid phosphatasec) glucuronidased) capsasee) ribonuclease
9) Histamine does all but one of the following:
a) dilates arteriolesb) increases vascular permeability of capillariesc) constricts arteriesd) dilates and increases permeability of vesselse) acts on the microcirculation via H1 receptors
10) Complement:
a) acts through the alternate pathway, triggered by fixation of C1 to antibody (IgG or IgM)b) the system contains 10 component proteins which are found in plasma and XXXXX in a
cascade reactionc) may be activated by collectives in the lectin pathwayd) C5a deactivates the hypoxygenase pathway of arachidonic acide) is not influenced by the clotting cascade
11) Regarding platelets:
a) adhesion to the extracellular matrix is via vWFb) dense bodies contain factor Vc) the primary haemostatic plug involves platelet contractiond) TXA2 inhibits platelet aggregatione) calcium is not secreted
12) Regarding the coagulation cascade:
a) prolonged APTT indicates a defective extrinsic pathwayb) intrinsic and extrinsic pathways converge with the activation of factor Vc) thromboplastin inhibits thrombin formationd) calcium is involved in the intrinsic, not the extrinsic pathwaye) protein C inactivates factors Va and VIIIa
13) Regarding chemotaxis:
a) locomotion is down a chemical gradientb) involves C3a
c) it is activated by IL-8d) involves phospholipase C levelse) bacterial products have no effect
14) Regarding kallikrein, which is NOT true?
a) it activates Hageman factorb) it is activated by Hageman factorc) it is chemotacticd) it activates C3e) it causes neutrophil aggregation
15) TNF does NOT stimulate:
a) haemodynamic effects of shockb) cytokine secretionc) coagulationd) neutropeniae) fibroblast proliferation
16) Which is an azurophil granule of a neutrophil?
a) myeloperoxidaseb) lysozymec) alkaline phosphatased) type IV collagenasee) lactoferrin
17) In wound healing by first intention:
a) neovacularisation is maximal at 10 daysb) fibroblasts deposit basement membrane components c) collagen fibrils begin to bridge the incision on day 2d) vascular channels regress in week 2e) wound strength is 50% at seven days
