2004 Primary Exam Workshop
2004 Primary Exam Workshop
Pathology MCQs
1. In pulmonary oedema:
a) fluid accumulation occurs due to decreased hydrostatic pressure
b) due to gastric aspiration, microvascular injury is the underlying mechanism
c) due to high altitude, the primary mechanism is due to haemodynamic changes
d) haemosiderin accumulates in the alveolar epithelial cells
e) Brown induration is the acute histological change
2. In hepatitis B infection:
a) anti Hbe appears before anti Hbc
b) lack of anti HbeAB formation is a poor prognostic sign
c) the causative organism is a RNA virus
d) chronic infection is distinguished from drug induced hepatitis by increased granuloma formation
e) Coinfection with hepatitis E leads to chronic hepatitis
3. Acute pancreatitis:
a) is a recognised sequelae in about 15% of patients with gallstones
b) can be caused by use of sulfonamides
c) is an idiopathic condition in 40% of cases
d) can lead to symptomatic hypercalcaemia
e) is a common cause of secondary diabetes mellitus
4. Characteristic histologic findings of asthma include:
a) thinning of the basement membrane of the bronchial epithelium
b) oedema and an inflammatory infiltrate in the bronchial walls with a prominence of plasma cells
c) an increase in size of the submucosal glands
d) atrophy of the bronchial wall muscle
e) undistended lungs because of occlusion of bronchioles
5. Regarding the pathogenesis of COPD:
a) macrophage elastase function is inhibited by (1-antitrypsin
b) cigarette smoking activates the classic complement pathway
c) microbiologic infections initiate the changes
d) smokers have decreased numbers of neutrophils in their alveoli
e) chronic bronchitis is up to 10 times more common in heavy smokers
6. Hyperbaric oxygen therapy:
a) is useful in the treatment of clostridial infection
b) is not effective for leprosy
c) is usually administered at 5-6 atmospheres
d) prevents the formation of oxygen free radicals
e) can be administered in sealed negative pressure isolation rooms
7. Regarding bacterial pneumonia:
a) lobar pneumonia is most often caused by staphylococci
b) coliform bacteria are unlikely to cause bronchopneumonia
c) particles larger than 10mm are deposited in terminal airways of alveoli
d) lobar distribution is an indication of the virulence of the organism
e) during resolution, the transudate is digested by enzymes
8. Bilirubin:
a) is excreted in urine as urobilinogen
b) levels are decreased in pernicious anaemia
c) conjugation is impaired in Dubin Johnson Syndrome
d) is formed from globin molecules
e) is elevated in Gilbert Syndrome in predominantly the unconjugated form
9. Renal stones:
a) are unilateral in about 60% of patients
b) formation is enhanced by a deficiency of inhibitors of crystal formation in urine
c) are least commonly composed of magnesium ammonium phosphate
d) can be formed by urea splitting organisms such as Proteus and Klebsiella
e) formed of calcium are radiolucent
10. In regards to gallstones:
a) cholesterol stones arise exclusively in the gallbladder and consist of 50-100% of cholesterol
b) about 1% of black stones are radio-opaque
c) there are no hereditary factors involved
d) in the west, about 80% are crystalline cholesterol monohydrase and 50% are cholesterol stones
e) rapid weight reduction is not a risk factor for gallstone formation
11. Regarding cirrhosis of the liver, which of the following is FALSE?
a) it is an important cause of death in the western world
b) the most important cause is alcoholic liver disease
c) it is often complicated by hepatocellular carcinoma
d) it causes osteoporosis
e) it causes reversible fibrosis of the liver
12. Regarding thyroid disease:
a) thyrotoxicosis reflects excessive leakage of hormone out of a non-hyperactive gland
b) secondary hyperthyroidism may be due to a thyroid gland abnormality
c) a common cause for hyperthyroidism is iodide-induced hyperthyroidism
d) TSH levels are a reliable indicator of thyroid function caused by hypothalmic and primary pituitary disease
e) secondary hypothyroidism accounts for the vast majority of causes of hypothyroidism
13. Regarding embolism:
a) introduction to the circulation of > 100ml of air is usually required to cause a clinical effect
b) fat embolism syndrome is characterised by a maculopapular rash
c) most pulmonary emboli produce clinical signs and symptoms
d) obstruction of medium sized pulmonary arteries usually causes pulmonary infarction
e) multiple pulmonary emboli over time may result in left heart failure
14. Healing by first intention involves:
a) an initial infiltration of macrophages
b) the growth of abundant granulation tissue from the edge of the wound
c) the infiltrate of neutrophils into the clot within 24 hours
d) the formation of a scar within one week
e) the appearance of granulation tissue within 48 hours
15. Osteoporosis:
a) always involves the entire skeleton
b) is associated with decreased IL-1 level
c) can be reliably detected on radiographs with 20% bone loss
d) is associated with anticoagulant use
e) may be caused by vitamin A deficiency
16. Gram negative bacilli:
a) have a single phospholipid bilayer
b) include bacteroides species
c) haemophilus influenzae species are 95% encapsulated
d) stain dark purple using antibody probes
e) are identified as the major causative organism in most pyogenic wound infections
17. Regarding Cushing syndrome:
a) it is called Cushing disease if it is caused by a primary pituitary lesion with decreased ACTH production
b) the basic lesion is in the adrenal and pituitary glands
c) diffuse atrophy in the adrenal gland is found in 60-70% of cases
d) it is found more frequently in men aged 20-30 years
e) primary adrenal neoplasm is responsible for 60% of cases
18. Rheumatoid arthritis:
a) is thought to be initiated by a microbial agent
b) is associated with IgE in 80% of patients
c) is an inflammatory synovitis triggered by an endogenous agent
d) may lead to destructive proliferative synovitis initiated by eosinophils and/or neutrophils
e) is not shown to have genetic susceptibility
19. Membranous glomerulonephritis
a) is always due to an underlying renal condition
b) is idiopathic in 10% of cases
c) leads to chronic renal failure in 60% of patients
d) has a typically aggressive disease progression
e) is the most common cause of nephrotic syndrome in adults
20. Regarding pyelonephritis:
a) uncontrolled hypertension is a major predisposing factor
b) the microscopic changes in chronic pyelonephritis are pathognomonic
c) staphylococci and streptococci faecalis are common pathogens
d) in the first year of life, it is more common in females
e) it is generally a benign and self limited condition
21. Regarding macroscopic changes in myocardial infarcts:
a) changes may be accentuated as early as 1-2 hours by histochemical stains
b) by 18-24 hours, infarcted tissue becomes dark and swollen
c) in the first week, the lesion becomes sharply defined, yellow and soft
d) at four days, a rim of hyperaemic granulation tissue appears
e) a fibrous scar is well established at two weeks
22. Venous thromboses:
a) are rarely occlusive
b) never embolise to the cerebral circulation
c) affect the lower extremities in 75% of cases
d) tend to contain more erythrocytes and are therefore known as red thrombi
e) can be easily distinguished from post mortem clots on autopsy
23. Which of the following types of vasculitis is immune complex mediated:
a) Wegener’s granulomatosis
b) Kawasaki’s disease
c) allograft organ rejection
d) Goodpasture’s syndrome
e) Henoch-Schonlein purpura
24. In acute inflammation, which is the correct sequence of events with regard to vascular flow and caliber:
a) vasodilation, margination, stasis, vasoconstriction
b) vasoconstriction, stasis, margination, vasodilation
c) vasodilation, stasis, vasoconstriction, margination
d) vasoconstriction, vasodilation, stasis, margination
e) vasodilation, vasoconstriction, stasis, margination
25. All of the following are associated with thrombus formation EXCEPT:
a) endothelial injury
b) antiphospholipid antibody syndrome
c) Reynold’s number < 2,000
d) mutations in factor V
e) homocysteinuria
26. Fracture healing:
a) involves formation of an osseous callus in the second stage
b) occurs at the same speed for all types of fractures
c) is not affected by alignment
d) is better in comminuted fractures
e) involves organisation of haematoma in the first stage
27. The epithelioid cells of follicular granulomas are:
a) reticular
b) fibroblasts
c) modified macrophages
d) plasma cells
e) lymphocytes
28. Regarding HIV infection and AIDS
a) lymphocytosis altered T-cell function and polyclonal (-cell activation are major abnormalities of immune function in AIDS
b) AIDS defining opportunistic infections include mycobacterial, staphylococcal and cryptosporidial infections
c) the period of clinical latency correlates with vigorous viral replication
d) there is a 5% risk of seroconversion after an accidental needlestick with infected blood
e) the 5 year mortality with full-blown AIDS is 50%
29. Vascular permeability in inflammation is increased by:
a) C3b and C3bI
b) C3b
c) C3a and C5a
d) C5b – 9
e) C3bI
30. Pernicious anaemia is associated with:
a) hepatocellular carcinoma
b) stomach carcinoma
c) colonic carcinoma
d) leukoplakia
e) squamous cell carcinoma of the genital system
31. With regards to air pollution:
a) sulphur dioxide is a major component of smog and has minimal effect on the airways
b) ultra fine particles cause injury due to free radical formation in the atmosphere
c) ozone is a minor component of smog and decreases airway reactivity
d) radon is prevalent in homes and is associated with lung cancer
e) formaldehyde in low concentration causes nasal tumours in humans
32. Type I hypersensitivity:
a) involves local formation or deposition of immune complexes
b) is mediated by IgG formed in response to a particular antigen
c) involves CD8+ cytotoxic lymphocytes, neutrophils and mast cells
d) can have a delayed phase that is characterised by infiltration of inflammatory cells and tissue damage
e) is the principal pattern of response to fungi, protozoa and parasites
33. Neoplasia:
a) shows nuclear pleomorphism
b) shows decreased nuclear-cytoplasmic ratio
c) results when protogenes are activated
d) involves proto-oncogenes in their natural forms
e) is initiated by a single genetic alteration
34. Atherosclerosis:
a) is initiated by endothelial injury
b) is a disease of the media of blood vessels
c) predominantly involves arterioles
d) is most common in the internal carotid arteries
e) begins in middle age
35. Regarding clostridia:
a) clostridia degrade extracellular matrix proteins, but their virulence is mainly due to the many toxins they produce
b) C. botulinum proliferates in puncture wounds releasing a potent neurotoxin which causes convulsive contractions of skeletal muscle
c) C. tetani causes an anaerobic cellulitis or myonecrosis and may cause severe sepsis
d) C. perfringens overgrows other intestinal flora in antibiotic-treated patients causing pseudomembranous collitis
e) clostridia are gram-negative bacilli that grow under anaerobic conditions
36. Regarding tuberculosis:
a) pathogenicity is related to its ability to escape killing by macrophages and induce delayed type hypersensitivity
b) commonly affects the thyroid and pancreas
c) primary infection in the lungs most often occurs in the apices
d) is associated with liquefactive necrosis
e) infections and deaths are declining in Europe and Africa
37. Concerning pyogenic bacteria:
a) suppurative inflammation of the lungs caused by strep pneumoniae destroys alveolar walls
b) streptococci are obligatory anaerobic gram positive cocci
c) staphylococci are able to auto induce expression of virulence factors
d) alpha toxin is a haemolytic toxin produced by streptococci
e) skin exfoliation is a common complication of group A streptococci
Pathology Answers (2004)
Robbins 6th Edition, unless otherwise stated
1 B 700
2 B 438 – 443 Pocket
3 B 904 – 907
4 C 712 – 716
5 E 709 – 712
6 A 509 Guyton and Hall, 10th Edition
7 D 718 – 720
8 E 848 – 851
9 B 989 – 990
10 A 885
11 E 436 – 437 Pocket
12 A 1131 – 1133
13 A 130 – 131
14 C 68 – 69 Pocket
15 D 595 – 596 Pocket
16 B 345 – 350
17 B 1153 – 1154
18 A 1248 – 1251
19 E 953 – 954
20 E 526 – 529
21 C 282 Pocket
22 D 126 – 128
23 E 203 Pocket, 5th Edition
24. D 33 Pocket
25. C 78 – 82 Pocket
26. E 599 Pocket
27. C 42 Pathology Illustrated, 5th Edition
28. C 131 – 137 Pocket
29. C 44 Pocket
30. B 149 Pocket
31. D 416 – 418
32. D 111 – 114 Pocket
33. A 110 – 119 Pocket, 5th Edition
34. A 258 – 260 Pocket
35. A 334, 807 - 808
36. A 349 – 351
37. C 365 – 367
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