Robbins and Cotran Pathologic Basis of Disease (Robbins Pathology) 9th Edition Test Bank

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Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th EditionChapter02:Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and DeathTest BankMULTIPLE CHOICE1.A 60-year-old man who had generalized atherosclerosis died 24 hours after having a stroke.A cerebral infarct was found at autopsy. Necrosis of the brain is classified asa.coagulative necrosisb.liquefactive necrosisc.fat necrosisd.fibrinoid necrosise.caseous necrosisANS:B,Brain infarcts are characterized by liquefactive necrosis.2.A 30-year-old woman who had leukemia was treated with bone marrowtransplantation. Shedeveloped a skin rash that was interpreted as a sign of a graft-versus-host reaction. A skinbiopsy was performed. In the epidermis, there were scattered dead epidermal cells that hadrounded contours and pyknotic nuclei. This form of cell death is caused bya.activation of caspases through receptor transmitted signals on the cell surfaceb.inhibition of ATPasec.inhibition of oxidative phosphorylationd.activation of lysosomal enzymese.depletion of glycogenANS:A,Graft-versus-host–induced cell death in the epidermis is a form of apoptosis. It ismediated by caspases and other enzymes of the suicide pathway of "programmed cell death."3.Uptake of bacteria into the cytoplasm of neutrophilic leukocytes is calleda.autophagocytosisb.heterophagocytosisc.exocytosisd.pinocytosise.involutionANS:B,Uptake of bacteria and other exogenous particulate material into the phagosomes iscalled phagocytosis.

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.1-24.A 90-year-old man died in a nursing home. During the past 10 years, he was unable to carefor himself and was mentally incoherent. He had no memory and could not hold aconversation. He was unaware of his surroundings. At autopsy, the brain showed signs ofAlzheimer disease, and there were neurons containing numerous neurofibrillary tangles.These cytoplasmic structures are formed from which component of the neurons?a.Nucleusb.Rough endoplasmic reticulumc.Smooth endoplasmic reticulumd.Mitochondriae.CytoskeletonANS:E,Neurofibrillary tangles are composed of microtubule-associated proteins andneurofilaments, which form the cytoskeleton of nerve cells.5.Continuous expression of the gene for atrial natriuretic factor in the myocardial cells of theleft ventricle is typically a consequence ofa.myocardial infarctionb.angina pectorisc.hypertensiond.hypotensione.ventricular fibrillationANS:C,Atrial natriuretic factor (ANF) is produced during fetal life in both the atrial andventricular cells of the heart. After birth, the ANF gene remains active only in the atrium, butcan be activated in ventricular cells undergoing hypertrophy. Arterial hypertension is themost common cause of ventricular hypertrophy.6.Ubiquitin-proteasome degradation of plasma proteins is opposed bya.insulinb.interleukin-1c.tumor necrosis factor αd.glucocorticoidse.thyroid hormonesANS:A,Insulin can oppose ubiquitin-proteasome degradation of plasma proteins, whereasall other hormones and mediators of inflammation listed here accelerate it.7.A 28-year-old man was found to have cirrhosis of the liver and pulmonary emphysema. Theliver cells contained globular inclusions in their cytoplasm, which by electron microscopy areshown to be located inside thea.Golgi apparatusb.smooth endoplasmic reticulumc.rough endoplasmic reticulumd.mitochondriae.peroxisomes

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.1-3ANS:C,The clinical history (i.e., the concurrence of cirrhosis and pulmonary emphysema)suggests that this young man has1-antitrypsin (AAT) deficiency. The cytoplasmic globulesin the liver cells represent misfolded AAT, which cannot be excreted from the liver cells andremains inside the liver cells in the dilated cisterns of the rough endoplasmic reticulum.8.A 60-year-old obese man was admitted to the hospital for treatment of alcoholism. He hasdiabetes mellitus. A liver biopsy was performed, and the specimen showed that the liver cellscontain increased amounts ofa.hemosiderinb.bilec.triglyceridesd.bilirubine.insulinANS:C,The three most common causes of fatty liver are obesity, alcoholism, and diabetesmellitus. Fat is stored in the liver cells predominantly in the form of triglycerides.9.A 55-year-old man who was on renal dialysis was admitted to the hospital for evaluation ofnausea and vomiting. A gastric biopsy was performed. The gastric mucosa contained foci ofamorphous, bluish (basophilic) material forming aggregates 10-20m in diameter. Theseaggregates were seen mostly in the stroma between the foveolar cells. No other abnormalitieswere seen, and the pathologist concluded that these changes represent evidence ofa.Helicobacter pyloriinfectionb.peptic ulcer formationc.dystrophic calcificationd.metastatic calcificatione.apoptosisANS:D,Bluish material in the stroma of the stomach represents foci of calcification. Inpatients who have chronic renal disease, such calcifications occur in the stomach, the lungs,or the kidneys, and are classified as metastatic. Metastatic calcifications occur in patientswho have hypercalcemia, which in this patient was most likely caused by secondaryhyperparathyroidism.

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Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th EditionChapter 03:Inflammation and RepairTest BankMULTIPLE CHOICE1.Transmembrane adhesive heterodimeric proteins, composed of anand a ß chain, areexpressed on activated leukocytes during inflammation. They bind primarily to intercellularadhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), both ofwhich belong to the family of proteins known asa.selectinsb.integrinsc.immunoglobulinsd.lectinse.growth factorsANS:C,Surface proteins expressed on activated leukocytes are integrins, and they bind tointercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), which belong to the immunoglobulin family of proteins.2.Which of the following mediators of inflammation has chemotactic properties and isincreased in persons taking aspirin?a.Thromboxane A2b.Prostaglandin E2c.Platelet-activating factord.Leukotriene B4e.Interleukin-1ANS:D,Leukotriene B4is chemotactic. It is increased in persons who take aspirin, becauseaspirin inhibits the cyclooxygenase pathway, thus shunting more arachidonic acid earlyderivatives into the lipoxygenase pathway. This promotes the synthesis of leukotrienes.3.A 2-year-old child known to suffer from recurrent bacterial infections and poor woundhealingwasfoundtohaveleukocyteadhesionmoleculedeficiency1(LAD-1).Theleukocytes of this patient do not express CD18, a molecule classified as belonging to thefamily ofa.selectinsb.integrinsc.lectin type of vascular adhesion moleculesd.aminotransferasese.glycosidases

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.2-2ANS:B,LAD-1 is characterized by a deficiency of CD18, a cell surface molecule that isa ß2integrin. The infections occur because the defective leukocytes cannot adhere toendothelial cells, cannot spread and attach, and cannot phagocytose bacteria. PBD7 624.Bradykinin is produced from a high-molecular weightkininogencirculating in the blood.This reaction is mediated bya.coagulation factor Xb.kallikreinc.Hageman factord.complement C3e.protein CANS:B,Kallikrein promotes the formation of bradykinin from the high-molecularweight kininogen. PBD7 675.Nitric oxide synthesis is augmented in endothelial cells by a calmodulin-mediated influxof which element?a.Calciumb.Sodiumc.Potassiumd.Oxygene.NitrateANS:A,Endothelial cell nitric oxide synthase is constitutively expressed at low levels,but it can be increased by a calmodulin-mediated influx of calcium into the endothelialcells. PBD7 726.Which of the following mediators of inflammation causes pain?a.Nitric oxideb.Complement C3ac.Bradykinind.Leukotriene B4e.Interleukin-1ANS:C,Bradykinin causes pain.Other pain-causing substances are substance P andprostaglandin E2. PBD7 657.Aspirin lowers the body temperature by inhibiting the synthesis of which regulator of thecentral thermostat in the hypothalamus?a.Leukotriene B4b.Lipoxinc.Thromboxane A2d.Prostacycline.Prostaglandin E2ANS:E,Aspirin inhibits the action of cyclooxygenase, and thus inhibits the synthesis of

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.2-3thromboxane A2, prostacyclin, and prostaglandin E2. However, only prostaglandin E2isinvolved in thermoregulation. The synthesis of lipoxin and leukotrienes is not inhibitedby aspirin. PBD7 708.C-reactive protein binds to the surface of microbes in tissues acting asa(n)a.caspaseb.peroxidasec.opsonind.anaphylatoxine.membrane attack proteinANS:C,C-reactive protein, an acute phase protein produced by the liver in acute andchronic inflammation, binds to microbes acting as an opsonin. Opsonization of bacteriafacilitates phagocytosis.9.Fibrillin is important for the scaffolding and deposition of which other component of theextracellular matrix?a.Collagen type Ib.Collagen type IIIc.Elastic fibersd.Fibronectine.LamininANS:C,Fibrillin, a 350 kD glycoprotein, is part of the microfibrils that are importantfor the scaffolding and deposition of elastic fibers. A congenital defect of fibrillin, asseen in patients with Marfan syndrome, is associated with reduced elasticity of arteriesand formation of aneurysms.10.Which growth factor is the most potent promotor of angiogenesis in the granulationtissue?a.Angiotensinb.Platelet-derived growth factorc.Tumor growth factor ßd.Vascular endothelial growth factore.Epidermal growth factorANS:D,Vascular endothelial growth factor (VEGF) is the most important promotor ofangiogenesis in the granulation tissue.11.A 20-year-old woman suffered extensive burns and developed large irregular scars overher hands. These scars limited the movement of her fingers, and she was unable to fullyextend them. What are these lesions called?a.Contracturesb.Desmoidsc.Aggressive fibromatosesd.Keloids

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.2-4e.Wound dehiscencesANS:A,Contractures are extensive scars overlying the joints that limit movements andcause permanent flexure.

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Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th EditionChapter04:Hemodynamic DisordersTest BankMULTIPLE CHOICE1.A 60-year-old man had congestive heart failure and sodium retention. Pitting edema of thelower extremities in this patient is most likely associated with an increased blood level ofa.albuminb.globulinc.aldosteroned.troponine.plasminogenANS:C,Renal hypoperfusion due to heart failure leads to secondary hyperaldosteronism andconsequent retention of sodium and water.2.A 60-year-old woman had a mastectomy for advanced cancer in her left breast, followed bychemotherapy and radiation therapy. She developed edema of the left arm. This edema iscaused bya.obstruction of the lymph flowb.arterial thrombosisc.venous thrombosisd.spread of cancer into the soft tissue of the arme.hypoalbuminemia secondary to liver injury caused by hepatic metastasesANS:A,Arm edema following a mastectomy is a complication of breast cancer treatmentcaused by an obstruction of the lymphatics in the axilla. This obstruction of lymphatics is aconsequence 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 bycoronary thrombosis. At autopsy, the lungs were heavy. Upon sectioning of the lungs, frothyfluid was seen oozing from the cut surface of the parenchyma. Which of the following is themost likely diagnosis?a.Pulmonary embolismb.Pulmonary infarctionc.Pulmonary edemad.Atelectasise.Lobar pneumoniaANS:C,Lungs that are heavy and on cross section show oozing of frothy fluid are filled withedema fluid. In this case, edema developed due to left-sided heart failure.

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.4-24.A 60-year-old man who had longstanding congestive heart failure complained of pain underthe right costal margin. He died of worsening heartfailure.At autopsy, the liver appearedenlarged and congested, showing a "nutmeg pattern" on cross section. Histologically thisliver will showa.atrophy of bile ductsb.dilatation of bile ductsc.intralobular cholestasisd.centrolobular necrosis and loss of hepatocytese.fibrosis of the Glisson capsuleANS:D,Chronic passive congestion of the liver caused by heart failure leads toaccumulation of blood in the terminal hepatic venule and the centrolobular sinusoids.Aggravation of the heart failure expands the blood-containing spaces, causing centrolobularliver cell necrosis.5.Which form of hemorrhage is most typical of defective platelet function seen in uremia (endstage kidney failure)?a.Multiple petechiaeb.Multiple ecchymosesc.Solitary ecchymosesd.Hematomae.HemarthrosisANS:A,Defective platelet function in uremia is typically associated with multiple petechiaein the skin and on mucosal surfaces.6.Which of the following substances is an anticoagulant secreted by endothelial cells?a.Von Willebrand factorb.Prothrombinc.Inhibitor of plasminogen activatord.Thrombomoduline.Tissue factorANS:D,Thrombomodulin isan anticoagulantthat actsby binding tothrombin andconverting 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 bloodvessels, because GpIb is the receptor for which essential coagulation protein?a.Hageman factor (factor XII)b.Von Willebrand factorc.Fibrinogend.Factor VIIIe.ThrombinANS:B,GpIb, a platelet cell membrane glycoprotein, is the receptor for the von Willebrand

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.4-3factor (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 thedeficiency 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 Cb.Protein Sc.Antithrombin IIId.Plasmine.ThrombinANS: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 thisvery important anticoagulant control mechanism. As a result of these changes, there isuncontrollable activation of factor V, which promotes thrombosis.9.In the antiphospholipid syndrome of systemic lupus erythematosus, arterial thrombi occurmost often in the arteries of thea.brainb.heartc.kidneysd.intestinese.bronchiANS:A,Antiphospholipid syndrome is characterized by widespread venous and arterialthrombi. Venous thrombi are found most often in the veins of the lower extremities, whereasthe arterial thrombi are most often found in the cerebral arteries.10.Which of the following is the most common site for arteriolar thromboembolization?a.Brainb.Heartc.Kidneysd.Lower extremitiese.EyesANS:D,The lower extremities are the major site of arteriolar thromboemboli. This site isinvolved in 75% of all cases.11.A 30-year-old woman fractured her leg, and a few days later developed a diffuse petechialrash in the nondependent areas of the body. She was short of breath and had minorneurologic symptoms. Laboratory studies showed thrombocytopenia. These findings aremost consistent witha.air embolismb.bone marrow embolismc.fat embolism

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.4-4d.talc embolisme.cholesterol crystal embolismANS:C,Rash in nondependent areas of the body following fracture of major bones,especially if associated with thrombocytopenia, is suggestive of fat embolism. Shortness ofbreath is indicative of pulmonary embolization, and neurologic symptoms suggest that theemboli have passed through the lungs and entered the cerebral vessels.12.Most cases of septic shock are caused by endotoxin-producing bacteria, which are classifiedasa.pyogenicb.gram-positivec.gram-negatived.encapsulatede.acid fastANS:C,Most cases of septic shock (70%) are caused by endotoxin-producing gram-negativebacteria. Endotoxins produced by gram-negative bacteria are lipopolysaccharides that bind toleukocytes, stimulating the release of cytokine, which in turn acts on vessels and other cells,propagating the development of shock.

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Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th EditionChapter 05: Genetic DisordersTest BankMULTIPLE CHOICE1.Which of the following diseases is caused by a trinucleotide repeat mutation?a.Marfan syndromeb.Achondroplastic dwarfismc.Fanconi syndromed.Fragile X syndromee.Hemophilia BANS:D,Fragile X syndrome is caused by a trinucleotide repeat mutation of the long arm ofthe X chromosome. Patients with the disease present with mental retardation and enlargedtestes.2.In which of the following Mendelian disorders is the age of onset delayed and the symptomsof the disease do not appear before adulthood?a.Tay-Sachs diseaseb.Niemann-Pick diseasec.Huntington diseased.Marfan syndromee.Turner syndromeANS:C,Symptoms of Huntington disease, which include chorea and mental deterioration,are typically delayed and do not appear before adulthood.3.Mutation of the genefor lysyl hydroxylase in the kyphoscoliosis type Ehlers-Danlossyndrome (ED type VI) causes weakness of bones and cutis laxa because of abnormalcollagena.synthesisb.secretionc.cross-linkingd.degradatione.resorptionANS:C,Lysyl hydroxylase is anenzyme that is essential for cross-linking of collagen.Without it, the collagen never achieves full structural integrity and strength; accordingly, thebones are weak and prone to deformation, whereas the skin becomes hyperextensible ("cutislaxa").

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.5-24.Splenomegaly and skeletal changes due to a nonlethal lysosomal storage disease caused bythe mutation of the gene encoding glucocerebrosidase are features of which disease?a.Tay-Sachs diseaseb.Niemann-Pick diseasec.Hurler diseased.Gaucher diseasee.Hunter syndromeANS:D,Gaucher disease is caused by a mutation of the gene encoding glucocerebrosidase.In the most common of the three forms of Gaucher disease, which accounts for 99% of allcases, there is splenomegaly, lymphadenopathy, involvement of the bone marrow, andskeletal changes.5.A 7-year-old child complained of frequent muscle cramps during play. A muscle biopsyrevealed accumulation of glycogen in the skeletal muscle cells and a lack of musclephosphorylase. Whichform of glycogenosis is this?a.Type I (von Gierke disease)b.Type II (Pompe disease)c.Type III (Cori-Forbes’ disease)d.Type IV (Andersen disease)e.Type V (McArdle disease)ANS:E,Type V glycogenosis, also known as McArdle disease, is caused by musclephosphorylase deficiency. Patients present with muscle cramps. In these patients, the bloodlevel of lactic acid does not rise after exercise, because the enzyme deficiency preventsanaerobic glycolysis in the muscle cells.6.Which malignancy occurs at a high rate in persons affected with Down syndrome?a.Acute lymphoblastic leukemiab.Chronic lymphocytic leukemiac.Chronic myelogenous leukemiad.Plasmacytomae.Brain tumorsANS:A,Children with Down syndrome are at a 10 to 20-fold higher risk of developing acutelymphoblastic leukemia or acute myelogenous leukemia than are their age-matched controls.7.Chromosome 22q11 deletion is typically associated witha.rocker-bottom feetb.horseshoe kidneysc.thymic hypoplasiad.microphthalmiae.simian crease on hands

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Test BankCopyright ©2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.5-3ANS:C,Chromosome 22q11 deletion is found in children who have DiGeorge syndromeand velocardiofacial syndrome. These two syndromes are known to be closely related andare known as the CATCH 22 syndrome (cardiac abnormalities, anomalous facial features,thymic hypoplasia with T-cell deficiencies, cleftpalate, and hypocalcemia due tohypoparathyroidism resulting from chromosome 22q11 deletion).8.An infertile woman was examined cytogenetically and was found to have deletions ofportionsofthelongarmandshortarmofthechromosomeX,resultinginaringchromosome, 46,X,r(X). Which of the following is the most likely diagnosis?a.Gonadal dysgenesisb.Hermaphroditismc.Male pseudohermaphroditismd.Female pseudohermaphroditisme.Turner syndromeANS:E,A ring chromosome, 46,X,r(X), is found in patients with Turner syndrome. Suchpatients are in a minority, since most patients with Turner syndrome (57%) actually have a45,X karyotype and lack one of the two X chromosomes.

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Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th EditionChapter 06:ImmunityTest BankMULTIPLE CHOICE1.Which of the following is the most abundant bronchospasm-inducing arachidonic acidderivative generated by cyclooxygenase in the mast cells?a.Leukotriene B4b.Prostacyclinc.Prostaglandin D2d.Thromboxanee.LipoxinANS:C,Prostaglandin D2is the most abundant arachidonic acid derivative produced throughthe cyclooxygenase pathway. It causes bronchospasm and increased mucus production.2.A 40-year-old man presents with hemoptysis and renal failure.A kidney biopsy specimenrevealed linear deposits of IgG in glomerular basement membranes and crescents betweenthe glomerular capillary loops and the Bowman capsule.The antibodies causing thesepathologic changes react witha.lamininb.fibronectinc.collagen type Id.collagen type IVe.podocytes of glomerular epithelial cellsANS:D,This man has Goodpasture syndrome, in which the body produces autoantibodies tothe globular part of type IV collagen in the glomerular basement membranes and the lungs.3.Which antibody can most effectively activate complement by the alternate pathway, evenwithout prior forming an antigen-antibody complex?a.IgAb.IgDc.IgEd.IgGe.IgMANS:A,IgA can activate complement by the alternate pathway.

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