ANATOMY MCQ 2008 GOLD - EmergencyPedia



Pathology MCQ

Recalled Questions (2008-2010)

1) OA vs RA

a. in RA osteoclast stimulation by inflammatory mediators causes bone resorption

2) Ulcers:

a. H.pylori causes damage by the production of cytokines

b. All gastric ulcers heal

c. H-pylori invades tissue

d. 80% of people with H pylori get peptic ulcers

3) Measels

a. Rah is caused by hypersensitivity

4) Intracranial bleed

a. 50%-60% are in the putamen

5) Ectopic pregnancy

a. In in every 500 pregnancies

b. Most commonly happens in the fallopian tubes

c.

6) Immunological tolerance

a. Thymus is involvd in developing peripheral tolerance

b.

7) Severe acute left heart failure causes peripheral oedema because

a. Reduced pressure in the peripheral capillaries

b. Reduced right atrial pressure

c. Increased CO2

d. Increased aortic pressure

8) an aging heart demonstrates

a. an increase in the size of the left ventricular cavity

b. yellow atrophy

c. reduced myocardial mass

9) Chlamydia

a. Can only survice inside host cells

b. Can produce its own ATP

c. Is a small gram postive bacteria

d.

10) Immunoglobulin

a. IgM has a valency of 5

b. IgG is 40% of total protein

c. Immunoglobulins constitute 50% of total protein

d. Antibody and antigen bnd covalently

e. Immunoglobulin response happens within 12 hrs

11) In chronic renal failure here is

a. Hypokalemia

b. Hypocalcemia

c. Pimary hyperparathyroidism

d. Increased PTH

e. Respiratory acidosis

12) In chronic renal failure there is

a. Increased total glomerular filtration rate

b. Hypertrophy of the glomerulus and dilatation of the vasculature

c. Slowed tubular flow

d.

13) Intracerebral abscess will cause

a. Raised CSF WCC and reduced CSF glucose

b. Signs of raised ICP and focal neurological signs

14) mitochondria

a. are able to self replicate

b. are absent from RBCs

c. have only 1 layer

d. predominate in cells with anaerobic swelling

15) tuberculosis pathogenicity is due to

a. type 4 hypersensitivity

b.

16) ATN secondary to ischaemia

a. Happens mainly in the DCT

b. Caused by tubules being blocked by casts

17) The following do NOT cause diffuse interstitial pulmonary fibrosis

a. Asbestos

b. Beryllium

c. Chloramphenicol

d. Scleroderma

e. Sarcoidosis

18) Massive neutropenia by removal or destruction is caused by

a. Massive fungus infection

b. Erythromycin

19) Cyanotic cardiac defects are caused by

a. PDA

b. Tractus arteriosus

c. Pulmonary vein displacement

d. Tricuspid atresia

20) What is the clearance mechanism for particles less than 5 micrometers in diameter

a. Alveolar macrophage phagocytosis

b. Sneezing

c. Mucociliary clearance

21) With regards to complement

a. C5a stimulates arachidonic acid metabolism

b. C5a is connected to C5b

c. C3b causes negative feedback on C3

22) Bradykinin is

a. Converted from a larger precursor by Kallikrein

b. Relaxes smooth muscle

23) Which of the following is not a DNA virus

a. HIV

24) Regarding HIV

a. T-cells must be activated for pro-viral DNA transcription

25) With regard to metastasis

a. Renal carcinoma can invade the IVC

b. Ovarian carcinoma causes peritoneal polymyxoma by secondary seeding

26) Apoptosis

a. Caused by activation of caspases

b. Extrinsic pathway is activated by BCL-2 “death receptor”

27) Non-atopic asthma caused by

a. Virus

28) Acute pancreatitis

a. Associated with associated with alcohol or gallstones in 40%

b. Caused by biliary reflux

c. Caused by intraductal activation of enzymes

d. Alpha cells secrete trypsin and pepsinongen

29) Chronic pancreatitis

a. 40% is idiopathic

b. 40% have pseudocysts

c. Not connected to pancreatic carcinoma

30) Hepatitis A

a. Does not caue chronic hepatitis

b. Is a DNA virus

c. Causes a chronic carrier state

31) Subacute endocarditis is caused by

a. Strep pyogenes

b. Staph aureus

c. Staph epidermitis

d. Strep viridians

32) In acute MI

a. There is sudden loss of contractility within 60 sec

b. Necrosis occurs after 60 minutes

33) White infarcts

a. Occur in solid organs and end arteries

b. Occur in the intestine

c. Most common in the liver

34) Vesicoureteric reflux

a. Most common cause of UTI

b. Caused by atony secondary to spinal cord injury

c. Is because of the lengthening of the intravesical part of the ureter

35) DIC is

a. Associated with activated fiBrinolysis

b. Caused by extrinsic pathway activation

c. Associated with thrombocytosis

d. Malignancy presents with bleeding diathesis

36) Volume of intravenous air reqired to causes symptoms is

a. 100ml

37) Stress fractures

a. Caused by abnormal repetitive axial loads

b. Cause a periosteal reaction

c. Associated with pagets disease

38) Fat embolism

a. Causes a petechial rash

b. Symptoms obvious within 12 hrs

c. Associated only with trauma

d. Associated with long bone fratures only.

39) Absorption of iron

a. Increased by vitamin C

b. In the body is stored mainly in cytochrome and myoglobin

40) Rickettsia affects

a. Endothelial cells

b. Hepatocytes

41) First event in inflammation

a. Arteriolar vasoconstriction

42) silicosis

a. most common in coal workers

b. causes mesothelioma

c. causes anthracosis

d. can rapidly progress to respiratory failure

43) lead poisoning causes

a. macrocytosis

b. learning difficulties in children

44) irreversible cell death

a. cell swelling

b. mitochondrial dysfunction

c. microvilli and bleb appearance

d. ribosomal detachment from the RER

45) Smooth ER

a. involed in Protein synthesis

b. ribosomes are present

c. lipid synthesis

d. electron transport chain

46) metastatic cancer

a. well-differentiated tumors don’t metastasize

b. malignant tumours can invade surrounding tissues while appearing cohesive

47) urticaria

a. local degranulation of mast cells

b. characterized by pruritic papules

48) Aortic dissection

a. Most commonly associated with hypertension

49) Rh compatibility

a. Erythroblastosis foetalis

b. C, E, D –ve

50) Emphysema in smoking is

a. Centroacinar

51) Post mortem changes in a clot

a. Chicken fat supernatant

52) Macrophages release

a. Oxygen free radicals

53) Pituitary adenoma

a. Acromegaly

b.

54) Nephritic syndrome

a. Caused by post-stretococcal GN

55) cirrhosis

a. causes a distortion of vascular architecture by fibrosis

b. involves inflammation

PATHOLOGY

(2008)

 

Regarding peptic ulcer disease

              Most duodenal ulcers occur in the posterior wall

              Most stomach ulcers occur in the posterior wall

              Heaping up of the margins of the peptic ulcer is diagnostic of malignancy (true)

              The size and location differentiate a benign from a malignany ulcer (does not)

              30% of pts have co-existing duodenal and gastric ulcers (10-20%)

 

Differences btw OA and RA in morphology

              inflammatory mediators activate osteoclasts

              Erosion of subchondrial surface causes pseudo-articular surface

             

Decompression sickness does not cause

              Intracerebral haemorrhage

              confusion

              subchondral avascular necrosis femur

              vertigo

              arthalgia

 

Mitochondria and ATP

              60% ATP is formed in mitochondria

              The last step in ATP formation is transport of O2 along the ETC?

              Hydrogen ions release passively diffuse out of mitochondria

              glycolysis occurs in cytoplasm

 

Ab-mediated acute transplant rejection – what is characteristic?

              vasculitis

              cell mediated immunity

 

Apart from T cells, what is the major component of cell mediated immunity?

              NPs

              macrophages

              B cells

              complement

             

Which cells can directly kill without prior sensitization to Ag?

              NK cells

              cytotoxic CD8 cells

              other wrong ones

 

Coal causes all but

              bronchiogenic carcinoma

              Caplan syndrome

              pneumoconiosis

              pulmonary fibrosis

              anthracosis

 

Black pigment in smokers lungs deposits in (repeat)

              Type I pneumocytes

              Type II pneumocytes

              Alveolar Macrophages

 

Squamous cell carcinoma (repeat)

              occurs commonly in the periphery

              occurs more commonly in women

              closely a/w smoking

              5 year mortality survival is 40%

 

The pulmonary disorder predisposing you to cor pulmonale

              asthma

              pulmonary eosinophilia

              cystic fibrosis (I thought this one)

              streptococcal pneumonia

              Severe acute respiratory syndrome

 

Atherosclerosis – what is in the core? (repeat)

              Smooth muscle

              T cells

              foam cells

              macrophages

              lymphocytes

 

Increased destruction/removal of neutrophils causing neutropenia is due to

              psoriatic arthritis

              Lyme disease

              severe fungal infection

              erythromycin

             

Aging effects on the heart include

              sigmoid ventricular septum

              dilated L atrium

              dilated L ventricle

              fibrosis of leaflets

              calcification of aortic valve

 

Hep E (repeat)

              20% mortality in pregnant women

              parenteral transmission

              DNA virus

              incubation period of days (4-5?)

 

Rickettsial infection (repeat) – which is not transmitted by arthropods?

              Scrub typhus

              endemic typhus

              Rocky mountain spotted

              Q fever

              pediculosis

 

Passive hyperaemia (WTF? – it’s either congestion if its passive or active if its hyperaemic) is due to

              exercising muscle

              arterial dilatation

              blushing

              release of vasoactive substances

              portal hypertension

 

Metastatic calcification typically occurs in

              interstitial tissue in gastric mucosa

              old TB lesion

              healed ?

              mitral valve

              damaged/healed ?? hip joint??

 

What causes Vit B12 deficiency

              Anti-convulsants

              autoimmune gastritis

              fat malabsorption

 

Regarding shock

              reversible stage is characterized by hypoperfusion of vital organs

              arterial pressure may be normal

              marked peripheral vasoconstriction is characteristic

              Pulse pressure changes

              lactic acidosis enhances the vasomotor response

 

Loss of 1000mL of blood in a 70 kg man  - what is correct

              Hct decreases immediately

              Iron absorption in the gut doesn’t change

              35% plasma volume is lost

              something about blood pressure that didn’t seem right (? BP drops)

                           

Renal artery stenosis

              causes abnormally high renal vein renin?

usu bilateral

more common in women

causes ipsilateral kidney enlargement

commonly caused by fibromuscular dysplasia

 

Adult PCKD

              is rare, causing 1% of CRF

              autosomal recessive

              causes solitary and multiple cysts in a normal-sized kidney

              40% die from ruptured berry aneurysm

              causes mitral valve complications

             

Apoptosis

              is activated by caspases

              chromatin condensation is not a feature

              death receptor pathway is activated by BCl-2 receptors

              2 other wrong stems

 

Regarding neoplasms

              pleocytosis causes lack of differentiation

              anaplasia is the hallmark of malignancy

              mitoses is only seen in malignancy

              Well differentiated only occurs in benign tumours             

 

Function of centrioles (repeat): involved with spindles for mitosis

Regarding electrical injuries

              Death is usually a/w massive skin burns

              Dry skin is a good conductor

              All body tissues can conduct electricity

              Lightening is … thermal burns? (sth wrong)

              Amperage is not important

 

Insulin

              increases mRNAs in lipogenesis (this is the right answer)

              inactivates glycolytic enzymes

              activates phosphorylases and glucokinase

              decreases transport of glucose into cells

 

What is an example of hypertrophy?

              Increase in breast at puberty

              Increase in liver size after partial hepatectomy

Uterus growth in pregnancy

              increased resp epithelium in Vit A deficiency

 

After formation of the blood clot in wound healing, what occurs next?

              loss of granulation tissue

              granulation tissue

              formation of blood clot

              infiltration of neutrophils and epithelial migration from the wound margin

              collagen deposition

 

What occurs first in fracture healing?

              collagen

              woven bone /lamellar bone combo

              procallus formation (we put this one – there was nothing about NP infiltration)

              neovascularisation?

 

Regarding phagocytosis

              opsonisation occurs with C5b

              2 stages: engulfment and killing

              largely dependent on O2 for killing (this one)

 

Regarding platelets

              concentration normally is 150 x 10^6 – 450 x 10^6 / litre of blood

needs vWF for degranulation

              are the main source of thrombin

 

Regarding tissue macrophages

The half life is 5-8 days

a minority are formed from monocytes

              can be activated endotoxin (I put this one)

 

Regarding the heart

              ATP reduction by 50% occurs within 10 mins

              first affected is epicardium

              60% of occlusive thrombus is due to ulceration/fissure of plaque

 

Regarding chronic pancreatitis

              Up to 40% is idiopathic

              equally affects women and men

              most commonly caused by cholelithiasis

              has no association with pancreatic cancer

              causes pseudocysts in 25%

 

Regarding acute pancreatitis

              trypsin activates the kinin system

              less than 5% are idiopathic

              35% with gallstones develop pancreatic

              gallstones are present in 80% of cases

 

What is a feature of chronic renal failure?

              hyperkalaemia

              hypocalcaemia

              primary hyperparathyroidism

              respiratory acidosis

 

Nephrotic syndrome

              causes salt and water retention

              usually does not cause raised plasma lipids

              usually a/w raised ASOT

              causes haematuria

 

What presents with nephritic syndrome?

              Acute post-strep GN

              membranous GN

              FSGS

              proliferative …glomerulopathy ..

 

Regarding testicular torsion

              peak incidence in toddlers

              bell clapper deformity is characteristic in neonates

              usually unilateral anatomical abnormality

              is due to twisting of spermatic cord causing impaired venous drainage             

 

Regarding the pathogenesis of T1 DM

              decreased sensitivity of insulin to receptors

              it is due to insulinitis from autoimmune process (this one)

 

Non-thrombocytopaenic purpura occurs in

              AIDS

              meningococcal

             

What is not a major risk factor in atherosclerosis?

              Hypertension

              Diabetes

              OCP

              hypertriglyceridaemia

              smoking

             

What is not a major criterion of the Jones criteria for rheumatic fever?

              Fever

              carditis

              sydenham’s chorea

              erythema marginatum

              large migratory polyarthopathy

 

Regarding chronic hypertension and intracranial haemorrhages

              causes haemorrhage in the putamen in 50-60 of cases

              saccular aneurysms

              30% die from ruptured intracranial haemorrhage ?

              the majority of intracranial haemorrages is due to chronic hypertension

 

What is characteristic of chronic bronchitis?

              decreased goblet cell numbers

              smooth muscle hypertrophy of bronchial wall

              increased size of mucous glands (I put this one)

              thickened basement membrane

 

What causes leaking of vascular membranes in acute inflammation?

              gap in endothelium of venules (this one)

              gap in basement membrane

              few others that seemed wrong

 

What is the best definition of gangrenous necrosis?

              Digestion of dead tissue by bacteria

              Digestion of living tissue by bacteria

              coagulative necrosis by bacterial toxins

              gas production in the tissue

 

Regarding hyperbilirubinaemia

              Unconjugated bilirubin is water soluble

              uncongugated bilirubin is tightly bound to albumin (this one)

              Causes kernicterus in adult brains

              Unconjugated bilirubin is excreted in urine

 

Lipofuscin pigment

              does not damage cell function or cell

              is water soluble

 

The most common cause of acute haemodynamic (cardiac) pulmonary edema is

              decreased colloid oncotic pressure

              increased hydrostatic pressure (this one)

              altered surfactant

              ..other weird ones

 

Acute graft rejection is characterized morphologically by

              vasculitis

              interstitial mononuclear infiltration

              fibrosis

 

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