Pathological Basis of Disease 8th Edition By Kumar – Abbas -Test Bank

 

 

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Kumar: Robbins and Cotran Pathologic Basis of Disease, 8^th Edition

 

Chapter 03: Tissue Renewal, Repair and Regeneration

 

Test Bank

 

MULTIPLE CHOICE

 

1.    Fibrillin is important for the scaffolding and deposition of which other component of the extracellular matrix?

a.	Collagen type I
b.	Collagen type III
c.	Elastic fibers
d.	Fibronectin
e.	Laminin

 

ANS: C,  Fibrillin, a 350 kD glycoprotein, is part of the microfibrils that are important for the scaffolding and deposition of elastic fibers. A congenital defect of fibrillin, as seen in patients with Marfan syndrome, is associated with reduced elasticity of arteries and formation of aneurysms.

 

2.    Which growth factor is the most potent promotor of angiogenesis in the granulation tissue?

a.	Angiotensin
b.	Platelet-derived growth factor
c.	Tumor growth factor ß
d.	Vascular endothelial growth factor
e.	Epidermal growth factor

 

ANS: D, Vascular endothelial growth factor (VEGF) is the most important promotor of angiogenesis in the granulation tissue.

 

3.    A 20-year-old woman suffered extensive burns and developed large irregular scars over her hands. These scars limited the movement of her fingers, and she was unable to fully extend them. What are these lesions called?

a.	Contractures
b.	Desmoids
c.	Aggressive fibromatoses
d.	Keloids
e.	Wound dehiscences

 

ANS: A, Contractures are extensive scars overlying the joints that limit movements and cause permanent flexure.

 

Kumar: Robbins and Cotran Pathologic Basis of Disease, 8^th Edition

 

Chapter 04: Hemodynamic Disorders, Thromboembolic Disease, and Shock

 

Test Bank

 

MULTIPLE CHOICE

 

1.    A 60-year-old man had congestive heart failure and sodium retention. Pitting edema of the lower extremities in this patient is most likely associated with an increased blood level of

a.	albumin
b.	globulin
c.	aldosterone
d.	troponin
e.	plasminogen

 

ANS: C, Renal hypoperfusion due to heart failure leads to secondary hyperaldosteronism and consequent retention of sodium and water.

 

2.    A 60-year-old woman had a mastectomy for advanced cancer in her left breast, followed by chemotherapy and radiation therapy. She developed edema of the left arm. This edema is caused by

a.	obstruction of the lymph flow
b.	arterial thrombosis
c.	venous thrombosis
d.	spread of cancer into the soft tissue of the arm
e.	hypoalbuminemia secondary to liver injury caused by hepatic metastases

 

ANS: A, Arm edema following a mastectomy is a complication of breast cancer treatment caused by an obstruction of the lymphatics in the axilla. This obstruction of lymphatics is a consequence of radiation injury or scarring associated with surgery.

 

3.    A 63-year-old woman died 2 days after the onset of severe myocardial ischemia caused by coronary thrombosis. At autopsy, the lungs were heavy. Upon sectioning of the lungs, frothy fluid was seen oozing from the cut surface of the parenchyma. Which of the following is the most likely diagnosis?

a.	Pulmonary embolism
b.	Pulmonary infarction
c.	Pulmonary edema
d.	Atelectasis
e.	Lobar pneumonia

 

ANS: C, Lungs that are heavy and on cross section show oozing of frothy fluid are filled with edema fluid. In this case, edema developed due to left-sided heart failure.

 

4.    A 60-year-old man who had longstanding congestive heart failure complained of pain under the right costal margin. He died of worsening heart failure. At autopsy, the liver appeared enlarged and congested, showing a “nutmeg pattern” on cross section. Histologically this liver will show

a.	atrophy of bile ducts
b.	dilatation of bile ducts
c.	intralobular cholestasis
d.	centrolobular necrosis and loss of hepatocytes
e.	fibrosis of the Glisson capsule

 

ANS: D, Chronic passive congestion of the liver caused by heart failure leads to accumulation of blood in the terminal hepatic venule and the centrolobular sinusoids. Aggravation of the heart failure expands the blood-containing spaces, causing centrolobular liver cell necrosis.

 

5.    Which form of hemorrhage is most typical of defective platelet function seen in uremia (end stage kidney failure)?

a.	Multiple petechiae
b.	Multiple ecchymoses
c.	Solitary ecchymoses
d.	Hematoma
e.	Hemarthrosis

 

ANS: A, Defective platelet function in uremia is typically associated with multiple petechiae in the skin and on mucosal surfaces.

 

6.    Which of the following substances is an anticoagulant secreted by endothelial cells?

a.	Von Willebrand factor
b.	Prothrombin
c.	Inhibitor of plasminogen activator
d.	Thrombomodulin
e.	Tissue factor

 

ANS: D, Thrombomodulin is an anticoagulant that acts by binding to thrombin and converting it from a procoagulant to an anticoagulant capable of activating protein C.

 

7.    Bernard-Soulier syndrome is a bleeding disorder caused by a defect of glycoprotein Ib (GpIb) on platelets. Platelets lacking GpIb cannot adhere to the wall of the damaged blood vessels, because GpIb is the receptor for which essential coagulation protein?

a.	Hageman factor (factor XII)
b.	Von Willebrand factor
c.	Fibrinogen
d.	Factor VIII
e.	Thrombin

 

ANS: B, GpIb, a platelet cell membrane glycoprotein, is the receptor for the von Willebrand factor (vWF), which mediates the adhesion of platelets to the damaged vascular wall. Congenital deficiency of GpIb, as seen in Bernard-Soulier syndrome, is similar to the deficiency of vWF in von Willebrand disease and results in a bleeding disorder.

 

8.    The most common form of congenital coagulopathy, factor V mutation (Leyden mutation), causes the altered coagulation factor V to be resistant to the action of which enzyme?

a.	Protein C
b.	Protein S
c.	Antithrombin III
d.	Plasmin
e.	Thrombin

 

ANS: A, Leyden mutation of factor V makes this factor resistant to the action protein C. Under normal circumstances, protein C inactivates factor V, and the mutation eliminates this very important anticoagulant control mechanism. As a result of these changes, there is uncontrollable activation of factor V, which promotes thrombosis.

 

9.    In the antiphospholipid syndrome of systemic lupus erythematosus, arterial thrombi occur most often in the arteries of the

a.	brain
b.	heart
c.	kidneys
d.	intestines
e.	bronchi

 

ANS: A, Antiphospholipid syndrome is characterized by widespread venous and arterial thrombi. Venous thrombi are found most often in the veins of the lower extremities, whereas the arterial thrombi are most often found in the cerebral arteries.

 

10.  Which of the following is the most common site for arteriolar thromboembolization?

a.	Brain
b.	Heart
c.	Kidneys
d.	Lower extremities
e.	Eyes

 

ANS: D, The lower extremities are the major site of arteriolar thromboemboli. This site is involved in 75% of all cases.

 

11.  A 30-year-old woman fractured her leg, and a few days later developed a diffuse petechial rash in the nondependent areas of the body. She was short of breath and had minor neurologic symptoms. Laboratory studies showed thrombocytopenia. These findings are most consistent with

a.	air embolism
b.	bone marrow embolism
c.	fat embolism
d.	talc embolism
e.	cholesterol crystal embolism

 

ANS: C, Rash in nondependent areas of the body following fracture of major bones, especially if associated with thrombocytopenia, is suggestive of fat embolism. Shortness of breath is indicative of pulmonary embolization, and neurologic symptoms suggest that the emboli have passed through the lungs and entered the cerebral vessels.

 

12.  Most cases of septic shock are caused by endotoxin-producing bacteria, which are classified as

a.	pyogenic
b.	gram-positive
c.	gram-negative
d.	encapsulated
e.	acid fast

 

ANS: C, Most cases of septic shock (70%) are caused by endotoxin-producing gram-negative bacteria. Endotoxins produced by gram-negative bacteria are lipopolysaccharides that bind to leukocytes, stimulating the release of cytokine, which in turn acts on vessels and other cells, propagating the development of shock.

 

Kumar: Robbins and Cotran Pathologic Basis of Disease, 8^th Edition

 

Chapter 15: The Lung

 

Test Bank

 

MULTIPLE CHOICE

 

1.    Which of the following lung diseases is classified as restrictive rather than obstructive?

a.	Asthma
b.	Chronic bronchitis
c.	Bronchiectasis
d.	Pneumoconiosis
e.	Emphysema

 

ANS: D, Pneumoconiosis is a restrictive lung disease, whereas the four other diseases listed here are obstructive lung diseases.

 

2.    Bronchospasms in patients with nonatopic asthma who have normal IgE blood levels are most often precipitated by

a.	bacteria
b.	viruses
c.	fungi
d.	aspirin
e.	exercise

 

ANS: B, Nonatopic asthma is most often precipitated by viruses, such as rhinoviruses or parainfluenza virus.

 

3.    Which bacterium is the most common cause of lobar pneumonia in chronic alcoholics?

a.	Haemophilus influenzae
b.	Staphylococcus aureus
c.	Streptococcus pneumoniae
d.	Pseudomonas aeruginosa
e.	Legionella pneumophila

 

ANS: C, Streptococcus pneumoniae, also known as pneumococcus, is the cause of lobar pneumonia in 95% of cases in persons who are chronic alcoholics.

 

4.    A 30-year-old man was found to have atypical pneumonia that was accompanied by elevation of cold agglutinin in the serum. Which of the following is the most likely cause of this pneumonia?

a.	Parainfluenza virus
b.	Influenza virus
c.	Chlamydia trachomatis
d.	Coxiella burnetii
e.	Mycoplasma pneumoniae

 

ANS: E, So-called primary atypical pneumonia (interstitial pneumonia) is most often caused by Mycoplasma pneumoniae. M. pneumoniae infection is associated with elevation of cold agglutinin in serum.

 

5.    Which of the following pathogens is the most common cause of pulmonary abscesses?

a.	Haemophilus influenzae
b.	Staphylococcus aureus
c.	Streptococcus pneumoniae
d.	Pseudomonas aeruginosa
e.	Escherichia coli

 

ANS: B, Among the five pathogens listed, Staphylococcus aureus is the most common cause of abscesses.

 

6.    In the bronchiectases of cystic fibrosis, bronchial plugging with mucus is often accompanied by infection with which of the following pathogens?

a.	Haemophilus influenzae
b.	Staphylococcus aureus
c.	Streptococcus pneumoniae
d.	Pseudomonas aeruginosa
e.	Legionella pneumophila

 

ANS: D, Pseudomonas aeruginosa has a tendency to grow in mucous plugs, and is a common pathogen isolated from the bronchiectases in patients who have cystic fibrosis.

 

7.    Pulmonary infection characterized by predominance of macrophages involving predominantly small bronchioli and sparing the large bronchioli is most typical of infection caused by

a.	Haemophilus influenzae
b.	Staphylococcus aureus
c.	Streptococcus pneumoniae
d.	Pseudomonas aeruginosa
e.	Legionella pneumophila

 

ANS: E, Legionella pneumophila affects primarily small bronchioli; thus, inflammations tend to organize and cause bronchiolar scarring. The exudate contains predominantly macrophages, which contain the pathogens, and less neutrophils.

 

8.    Hyaline membranes in the alveoli of lungs affected by acute respiratory distress syndrome (ARDS) are composed of

a.	surfactant
b.	eosinophils
c.	fibrin
d.	fungi
e.	collagen

 

ANS: C, Hyaline membranes are composed of fibrin and other plasma proteins.

 

9.    A retired man who had worked in the shipyards most of his life was found to have pleural plaques and mesothelioma. These pathologic changes are most likely a complication of which type of pneumoconiosis?

a.	Simple coal workers’ pneumoconiosis
b.	Progressive massive fibrosis
c.	Anthracosis
d.	Asbestosis
e.	Silicoanthracosis

 

ANS: D, Pleural plaques and mesothelioma are complications of asbestosis.

 

10.  Which is the most prevalent chronic occupational lung disease found worldwide?

a.	Complicated coal workers’ pneumoconiosis
b.	Asbestosis
c.	Berylliosis
d.	Silicosis
e.	Stannosis

 

ANS: D, Silicosis is the most prevalent pneumoconiosis encountered in the workplace worldwide. It develops after prolonged inhalation of silica crystals that are created during sandblasting, hard-rock mining, stone cutting, foundry work, and at other work sites.

 

11.  The inhalation of which substance is the most common cause of “humidifier” or “air-conditioner” lung?

a.	Thermophilic bacteria
b.	Cotton fibers
c.	Animal proteins
d.	Plant proteins
e.	Talc

 

ANS: A, Thermophilic bacteria that live in heated water reservoirs are the most common cause of hypersensitivity pneumonitis, called humidifier or air-conditioner lung.

 

12.  A primary lung cancer was found in the apex of the lung of a 78-year-old woman who never smoked Microscopically, the tumor was composed of mucus-secreting cuboidal cells arranged in gland-like structures. This tumor is most likely a(n)

a.	adenocarcinoma
b.	squamous cell carcinoma
c.	small cell carcinoma
d.	large cell carcinoma
e.	carcinoid tumor

 

ANS: A, This tumor is an adenocarcinoma. Adenocarcinomas are the most common form of cancer that occurs in peripheral parts of the lungs in nonsmokers.

 

13.  Which one of the following lung tumors has the best prognosis?

a.	Mesothelioma
b.	Squamous cell carcinoma
c.	Small cell carcinoma
d.	Large cell carcinoma
e.	Carcinoid tumor

 

ANS: E, Carcinoid tumors are low-grade malignant tumors and are the only consistently curable lung tumors. The 5- to 10-year survival rates are 50% to 95%, in contrast to all other lung cancers, which have a 5-year survival rate of less than 40%.

 

14.  This lung lesion was identified at the autopsy of a 40-year-old man infected with human immunodeficiency virus (HIV). It is illustrated here in a hematoxylin and eosin stained section and a silver methenamine impregnated section. This lesion is caused by a

 

 

a.	bacterium
b.	fungus
c.	virus
d.	protozoon
e.	nematode

 

ANS: B, This pneumonitis is caused by Pneumocystis carinii, a fungus that infects the lungs of AIDS patients. In the hematoxylin and eosin stained slides, there are alveoli filled with finely granular amorphous material. This material contains fungi that can be demonstrated as a black structure in the silver impregnated slide.

 

 

15.  This lung lesion was found at the autopsy of a 40-year-old man who suffered extensive burns to 50% of his body surface. These changes are most consistent with the diagnosis of

 

a.	atelectasis
b.	emphysema
c.	bronchiolitis obliterans-organizing pneumonia (BOOP)
d.	adult respiratory distress syndrome
e.	lobar pneumonia

 

ANS: D, This lung contains numerous hyaline membranes lining the alveoli and focal intraalveolar hemorrhages. These findings are typical of adult respiratory distress syndrome, which in this case was caused by burns.

 

16.  This lung lesion is diagnostic of

 

 

a.	anthracosis
b.	asbestosis
c.	silicosis
d.	bagassosis
e.	berylliosis

 

ANS: B, The brown structures seen in this slide represents asbestos bodies, which are typically seen in asbestosis.

 

 

Kumar: Robbins and Cotran Pathologic Basis of Disease, 8^th Edition

 

Chapter 29: The Eye

 

Test Bank

 

MULTIPLE CHOICE

 

1.    A 30-year-old African-American woman is diagnosed with granulomatous uveitis associated with hilar lymphadenopathy and pulmonary infiltrates. Bacteriologic studies show negative results. Which of the following is the most likely diagnosis?

a.	Rheumatoid arthritis
b.	Osteoarthritis
c.	Gout
d.	Sarcoidosis
e.	Cat-scratch disease

 

ANS: D, Granulomatous uveitis is a well-known complication of sarcoidosis, a granulomatous disease of unknown etiology. It most often affects middle-aged African-American women and presents with pulmonary lesions and hilar lymphadenopathy.