UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM I 1994-1995 INSTRUCTIONS For the multiple-choice items, including the pictures, fill in your answers on the answer sheet provided. For the completion items, put your answers on the exam sheet. Use ink if you have it. Your instructor will only review possible grading errors if there is no evidence of erasure. We have tried to write a fair test, but there will surely be problems with certain items. If you have a question, raise you hand and we'll talk about it QUIETLY (don't phonate!) during the exam. IF MEDICAL SCHOOL WERE EASY, YOUR DEGREE WOULD BE WORTHLESS. GOOD LUCK! [The first 35 items were GRIPE pool questions.] 36. We remember Rudolf Virchow LEAST for: A. being the founder of modern-day pathology B. his idea that all cells come from pre-existing cells C. his idea that all disease is disease of cells D. his idea that politics is a major cause of human disease * E. his focus on disease at the "whole person" level 37. During the 24 hours before the pathology exam, the wise student physician: A. brings out his or her seventh color of highlighter to complete the rainbow of scholarship B. complains there's never any time to preview the material before lectures C. looks at the videodisc pictures for the first time D. looks up the words he or she didn't look up the first three times through the material * E. says "I can't know it all, and I don't need to know it all" and gets a good night's sleep 38. All the following are endogenous antioxidants and/or free-radical removers EXCEPT A. ceruloplasmin B. glutathione * C. hydrogen peroxide D. superoxide dismutase E. vitamins C and E 39. Which is NOT a feature of apoptotic cell death? A. cutting of the DNA at regular intervals B. cross-linking of proteins in the cytoplasm C. destruction of the cytoskeleton * D. liquefaction of the apoptotic remnant E. pyknosis of the nucleus as in other forms of necrosis 40. The clinician tells the patient, "The pathologist called your biopsy pre-cancerous". That means the pathologist probably called it: A. a mass without anaplasia B. hyperplasia C. hypertrophy D. metaplasia * E. dysplasia 41. "Histotoxic hypoxia" results from A. bleeding to death from DIC B. carbon monoxide poisoning in a garage suicide C. drowning in Smithville Lake D. dying of a failing heart * E. eating cyanide bonbons 42. Gorbachev's birthmark is an example of a(n): A. atresia B. cyst * C. hamartoma D. choristoma E. metaplasia 43. An epithelialized track connecting the midportion of the jejunum and a point on the skin three cm left of the umbilicus is an example of a(n): A. autolysis B. choristoma C. cyst * D. fistula E. supernumerary structure 44. Microtubules fail to polymerize, and lysosomes fail to fuse with phagocytic vacuoles, in: A. Ataxia-telangiectasia * B. Chediak-Higashi syndrome C. DiGeorge syndrome D. Kartagener's syndrome E. Prader-Willi / Angelman syndromes 45. Which is NOT evidence of irreversible cell injury? *A. acute cell swelling ("cellular edema") B. calcium chunks in the mitochondria C. nuclear pyknosis D. rupture of the lysosomes E. all the above are evidence of irreversible injury 46. Which ion is blamed for "reperfusion injury"? * A. calcium B. magnesium C. phosphate D. potassium E. sodium 47. You're most likely to see caseous necrosis in A. calcified fat around a wounded pancreas B. gangrenous diabetic foot C. infarcted myocardium D. pus in a boil * E. tuberculous lung 48. The "acute phase reaction" in acute inflammation is a group of biochemical changes mediated by: A. dilatation of small blood vessels * B. factors released from macrophages C. histamine and complement components, among others D. neutrophil injury to tissue E. the increased erythrocyte sedimentation rate 49. What's the characteristic cell in tissue inflammation caused by worms? * A. eosinophil B. lymphocyte C. macrophage D. neutrophil E. plasma cell 50. Platelet-derived growth factor is best-known for * A. activating fibroblasts in wound healing B. activating the complement cascade C. aiding the maturation of granulomas D. causing epithelium to heal over breaks E. producing hemostasis in minor injuries 51. Which is MOST LIKELY to produce directly an exudate rather than a transudate? * A. inflammation B. kidney failure C. left-sided heart failure D. liver failure E. plugged lymphatics 52. Non-replicating ("permanent") cells, as defined in the "Inflammation" unit, include * A. astrocytic glia B. endothelium of the spleen C. fibroblasts D. hepatocytes E. sweat glands 53. Which exhibits a "left shift"? Normal white count is around 5000- 10000. A. WBC 2000, 90% segmented neutrophils, no bands, the rest lymphocytes and monocytes B. WBC 5100, 52% segmented neutrophils, many with six or more lobes to their nuclei * C. WBC 9000, 52% segmented neutrophils, 32% bands D. WBC 11,000, 52% segmented neutrophils, 17% lymphocytes, 1% eosinophils, 1% basophils, 29% macrophages E. WBC 15,000, 98% segmented neutrophils, 1% lymphocytes, 1% monocytes 54. Which is LEAST LIKELY to mediate pain in acute inflammation? * A. arteriolar dilatation B. bradykinin C. nerve involvement and nerve regeneration D. prostaglandin E. the injury itself 55. Figuratively speaking, "chemokinesis" refers to the power of certain inflammatory mediators to make neutrophils A. better at killing their prey * B. dance about at random C. hungry D. run after their prey E. stick to the wall 56. IgG (classes 1 and 3) and C3b are famous as A. anaphylatoxins B. anti-thrombotic factors * C. opsonins D. "membrane attack complex" E. vascular permeability factors 57. A "keloid" is a type of: A. cancer B. cellular hyperplasia C. infarct * D. scar E. thrombus 58. Hereditary lack of protein C is a notorious cause of A. inability to clot the blood B. inability to fix complement C. inability of neutrophils to reach the invaders D. inability to kill many viruses * E. thrombosis 59. Which is LEAST LIKELY to cause edema? A. excessive loss of albumin from the plasma B. increased venous pressure behind a failing heart C. increased venous pressure below damaged leg vein valves D. lymphatic channels plugged by cancer * E. marked dilatation of arterioles 60. The edema of kidney failure or glomerular protein loss is most likely to appear first * A. around the eyes B. as ascites fluid in the abdomen C. in the ankles and feet D. in the genitals E. over the kidneys in the flanks 61. "Angioedema" with striking, episodic swelling of the soft tissues of the airway, may be due to hereditary deficiency of A. alpha-1 protease inhibitor B. antithrombin 3 * C. C1-esterase inhibitor D. mast-cell deconvertase E. tissue plasminogen activator 62. Norepinephrine increases blood pressure in shock primarily by A. decreasing oxygen requirement * B. decreasing tissue perfusion C. increasing cardiac output D. increasing circulatory volume E. producing positive mental images 63. Xanthoma cells are special A. epithelium B. lymphocytes * C. macrophages D. necrotic E. neutrophils 64. "Bantu beer" is a special health problem because of its high content of A. 2,4-dinitrophenol B. carbon C. copper * D. iron E. lipofuscin 65. Mallory's hyaline is composed primarily of: A. collagen B. fibrillin C. fibrin D. immunoglobulin * E. keratin 66. Most clinically-obvious enzyme deficiencies are inherited how? A. autosomal dominant * B. autosomal recessive C. chromosome deletions D. sex-linked E. none of the above 67. Northern blotting searches for A. carbohydrate B. DNA sequences C. lipid D. proteins * E. RNA sequences 68. Down's syndrome patients are LEAST LIKELY to exhibit A. Alzheimer's disease B. bad cardiac malformations C. fatal leukemia * D. massive hepatomegaly E. poor thyroid gland function 69. In the "storage diseases" such as Tay-Sachs, the substance accumulates within * A. lysosomes B. mitochondria C. nuclei D. rough endoplasmic reticulum E. smooth endoplasmic reticulum 70. Celiac sprue and dermatitis herpetiformis, mediated by sensitivity to the gluten in wheat, involve attacks by the body on its own: A. collagen B. dormant herpes virus C. elastin * D. reticulin E. T-helper cells 71. A novel approach to the treatment of autoimmune disease, which is finding considerable experimental support, is: * A. eating the autoantigen B. injecting retroviruses laced with the antigen C. interferon therapy to enhance immunity D. radical surgery to remove all cells with the antigen E. therapy with different colored lights 72. Which is deposited in the brain in Alzheimer's disease, as part of the essential pathology? * A. amyloid B. fibrin C. hemosiderin D. Mallory's hyaline E. prion 73. Raynaud's phenomenon is invariably present in patients with: A. graft-vs.-host disease B. lupus C. polymyositis-dermatomyositis * D. scleroderma E. Sjogren's 74. Boys who lack CD40 have trouble switching from IgM production to IgG production, and are said to suffer from A. ataxia-telangiectasia B. DiGeorge's C. Bruton's disease * D. common variable immunodeficiency E. Wiskott-Aldrich 75. Which was the first human disease to be cured by gene therapy? * A. adenosine-deaminase deficiency B. Chediak-Higashi C. cystic fibrosis D. Gaucher's disease E. X-linked SCID 76. ONE KODACHROME. Joel works out so that his muscles will undergo: A. apoptosis B. dysplasia C. hyperplasia * D. hypertrophy E. metaplasia 77. ONE KODACHROME. This old cerebral infarct exhibits which type of necrosis? A. caseation B. coagulation C. enzymatic fat D. fibrinoid * E. liquefaction 78. ONE KODACHROME. The cells in the center of this picture are * A. anaplastic cancer cells B. eosinophils C. epithelioid macrophages D. lymphocytes E. neutrophils 79. ONE KODACHROME. This Hurler's baby cannot break down A. ceramide trihexose B. ganglioside C. glucocerebroside * D. mucopolysaccharide E. sphingomyelin 80. ONE KODACHROME. The body habitus is A. adrenal hyperplasia with virilization B. Klinefelter's XXY C. male XX D. Supermale XYY * E. Turner's XO 81. ONE KODACHROME. It's a(n) A. abscess B. carcinoma in situ (dysplasia) * C. granuloma D. hemorrhage E. infarct 82. ONE KODACHROME. Which type of circulating white cell? A. eosinophil B. neutrophil * C. lymphocyte D. macrophage E. plasma cell 83. ONE KODACHROME. Albinism usually results from a problem with the metabolism of A. glycine B. leucine C. proline D. tryptophan * E. tyrosine 84. ONE KODACHROME. The principal protein providing strength for this pseudomembrane is A. albumin B. collagen C. Clostridium difficile toxin * D. fibrin E. hemoglobin 85. TWO KODACHROMES. Heart. It demonstrates a(n): A. abscess * B. acute infarct C. granuloma D. healed infarct / scar E. hemorrhage 86. TWO KODACHROMES. It's a(n) * A. abscess B. granuloma C. infarct / gangrene D. hemorrhage E. scleroderma lesion 87. ONE KODACHROME. This beautiful demonstration of 2i)mosis fungi within pulmonary macrophages was made using what stain? A. H&E B. PAS/dPAS C. histoplasmosis-green-and-everything-else-black stain * D. methenamine silver E. trichrome 88. ONE KODACHROME. Hepatocytes. They exhibit: A. apoptosis * B. fatty change C. fatty ingrowth ("stromal infiltration of fat") D. infarction E. no abnormality 89. ONE KODACHROME. Heart. The brown pigment is A. alkapton B. hemosiderin * C. lipofuscin D. malaria pigment E. melanin 90. TWO KODACHROMES. These thrombi are both: * A. ante-mortem B. post-mortem C. A & B D. neither A nor B E. C & D 91. ONE KODACHROME. Kidney. The hyaline globules are A. amyloid B. fibrin C. immunoglobulin D. Mallory's hyaline * E. resorbed protein 92. ONE KODACHROME. Coronary artery. It exhibits (a): A. dystrophic calcification B. fibrinoid necrosis C. fresh thrombus D. granuloma formation * E. recanalized thrombus 93. ONE KODACHROME. Right ventricle. It exhibits A. fatty change, probably due to diphtheria B. fatty change, probably due to profound anemia * C. fatty ingrowth ("stromal infiltration of fat") D. fibrosis E. fresh infarction and necrosis 94. TWO KODACHROMES. Autopsy surprise. What's the lethal lesion in the heart? A. abscess B. calcification C. granuloma D. storage disease * E. subendocardial infarct 95. ONE KODACHROME. The liver exhibits A. abscess formation * B. congestion C. granulomas D. hemorrhage E. infarction 96. ONE KODACHROME. This pulmonary edema is LEAST LIKELY to result from A. alveolar injury by a war gas B. cirrhosis with lack of albumin C. early pneumonia (lung inflammation) D. pulmonary lymphatics plugged by cancer * E. right ventricular failure (right heart failure) 97. THREE KODACHROMES. This "Patau's" child has * A. trisomy 13 B. trisomy 18 C. trisomy 23 D. uniparental disomy E. 5p- 98. ONE KODACHROME. This is pancreas and peri-pancreatic fat, exhibiting the result of old A. abscess formation B. cyst formation * C. enzymatic fat necrosis D. metaplasia E. tuberculosis 99. TWO KODACHROMES. This lesion from lung is probably a(n): A. acute inflammation (pneumonia) B. cancer, you can tell by the anaplasia C. hemorrhage without infarction, as in Goodpasture's disease * D. infarct E. syphilitic lesion, you can tell by the plasma cells 100. ONE KODACHROME. This kidney lesion is a(n): A. abscess B. calcification, probably dystrophic C. calcification, probably metastatic D. granuloma * E. infarct BONUS ITEMS: 101. What class of chemical substances stains PINK with hematoxylin and eosin? [proteins; accept basic amino acids] 102. "That's just a theory". What is a theory? [idea that explains a large number of disparate facts] [and has shown powerful predictive value] [and has not been falsified by any known fact.] [Credit if you're in the ballpark] 103. What do we mean by a "forme fruste" of a disease? [very mild version but with the same pathogenesis] 104. What's a supernumerary nipple? [an extra one in a reasonable place] 105. What's the difference between a diverticulum and a pseudodiverticulum? [diverticulum includes outpouching of wall] [pseudodiverticulum outpouches through wall] 106. What's the term we use for the condition, common in cancer and AIDS, in which muscle wastes in preference to fat? [cachexia] 107. "Chronic granulomatous disease of childhood" is a dread hereditary illness. What's the underlying problem? [neutrophils can't kill staph / make H2O2] 108. What is granulation tissue? [immature scar / organizing fibrin / healing connective tissue] [if you define "granuloma", shame on you] 109. Why do venipuncture sites tend to re-open in disseminated intravascular coagulation? [plasmin] 110. Suppose a Prader-Willi male, the product of nondisjunction bearing two maternal chromosome 15's, were to be fertile, and wish to bear a child with a normal woman. What are the chances of one of their children having Prader-Willi syndrome, and what are the chances of one of their children having Angelman syndrome? [risk of neither, the chromosomes themselves are normal] 111. As the terms are used nowadays, Hrthle cells, oncocytes, Ashkenazy cells, and oxyphil cells are all the same things. What are they? [packed tight with mitochondria] 112. What is pseudo-autosomal inheritance? [on homologous region of X and Y] 113. A 24 year old woman comes to you and mentions that she has never menstruated. She has normal breast development, and a normal vulva and vagina. Mention any one finding that you could obtain in your own primary-care office that would tip you off that this is testicular feminization. (NOTE: Here and elsewhere, if I ask for "one", and you give me a list, I'll grade your weakest single answer.) [no pubic/axillary hair; feel groin testes; no uterus] 114. Patients with hereditary C2 deficiency get a disease which closely resembles the much more familiar idiopathic: [lupus] 115. Amyloid H, which causes the infamous arthropathy of hemodialysis patients, is -leated from what molecule? [beta-two microglobulin] 116. What's the generic term for the family of hereditary connective tissue problems in which the joints, skin, and/or arteries are so hyperextensible that problems result? [Ehlers-Danlos] 117. What's the common, popular name for the infamous anti-cardiolipin autoantibodies that is currently strongly suspected of causing thrombosis, abortion, false-positive syphilis tests, and even schizophrenia in surviving pregnancies? ["lupus anticoagulant"] 118. What is pus? [polys plus necrosis is good enough] 119. Comment on Hippocrates's motto "First do no harm" (i.e., the most important principle of medicine is to avoid producing iatrogenic disease) as it applies to today's practice of medicine. [no longer applicable; we have therapies that actually work] [to improve duration and quality of life despite side-effects] [and risks] 120. Why is this man smiling? [he's a toothless albino banjo player, +1 for any correct answer]