Mechanisms of Disease

Which of the following hormones increases gut motility

A. Gastric Inhibitory Peptide (GIP)

B. Histamine

C. Serotonin

D. Secretin

E. Somatostatin

C. Serotonin

Which of the following is a cause of secondary constipation

A. Pregnancy

B. Opioids

C. Parkinson’s disease

D. Depression

E. All of the above

E. All of the above

Which of the following types of diarrhea is found in irritable bowel syndrome

A. Secretory

B. Osmotic

C. Inflammatory

D. Functional

E. All of the above

D. Functional

Which of the following can lead to vomiting

A. Gastrointestinal mucosa irritation

B. Pain

C. Increased intracranial pressure

D. Uremia

E. All of the above

E. All of the above

Which of the following is the most common cause of ascites

A. Tuberculosis

B. Cirrhosis

C. Cancer

D. Chronic kidney failure

E. Right-sided cardiac failure

B. Cirrhosis

Which of the following can lead to mainly unconjugated hyperbilirubinemia

A. Bile duct stone

B. Hemolysis

C. Pancreatic cancer

D. Post surgical biliary stenosis

E. Periampullary cancer

B. Hemolysis

Which of the following is a pathogenetic cause of ascites

A. High serum albumin levels

B. Increased effective plasma volume

C. Increased renal absorption of sodium and water

D. Decreased lymph production

E. Low intrahepatic resistance

C. Increased renal absorption of sodium and water

Which of the following cells act as ‘pacemaker’ cells of the gut

A. Enterochromaffin (EC) cells

B. Platelet-derived growth factor receptor a (PDGFR-a) cells

C. Interstitial cells of Cajal (ICC)

D. Paneth cells

E. Enteric glia

C. Interstitial cells of Cajal (ICC)

In which type of constipation is a decreased numbers of interstitial cells of Cajal (ICC) found in some studies

A. Dysynergic defecation

B. Slow transit constipation

C. Normal transit constipation

D. Opioid induced constipation

E. Anticholinergic drugs induced constipation

B. Slow transit constipation

Which of the following is NOT a pathogenetic mechanism if conjugated hyperbilirubinemia

A. Hepatocellular dysfunction

B. Intrahepatic Cholestasis

C. Extrahepatic cholestasis

D. Reduced uptake of bilirubin form the liver

E. Defective transport of bilirubin glucuronide across the membrane that separates the hepatocyte from the bile canaliculi

D. Reduced uptake of bilirubin form the liver

Which of the following cell types does NOT belong to the innate immunity arm?

a. Neutrophils

b. Macrophages

c. Plasma cells

d. Dendritic cells

c. Plasma cells

What type of cells do NK cells eliminate?

a. Virus infected cells

b. Malignant cells

c. Senescent cells

d. a+b

d. a+b

Which of the following properties is typically limited or absent in innate immunity?

a. Memory

b. Specificity

c. Self-tolerance

d. a+C

d. a+c

Which cytokine is NOT considered typical of innate immunity?

a. IL-2

b. IL-1β

c. TNFa

d. IL-6

a. IL-2

The effector functions of macrophages include all of the following EXCEPT:

a. Phagocytosis

b. Antibody production

c. Cytokine production

d. Reactive oxygen species release

b. Antibody production

The antibody dependent cell mediated cytotoxicity (ADCC) is mediated by:

a. NK cells

b. Eosinophils

c. CD8 cytotoxic cells

d. Plasma cells

a. NK cells

Which of the following TLRs is expressed on endosomes?

a. TLR4

b. TLR6

c. TLR9

d. TLR5

c. TLR9

Antibodies are involved in which of the following pathways of complement activation?

a. Alternative

b. Classical

c. Lectin

d. Lectin and classical

b. Classical

Complement serum levels are typically reduced in:

a. Rheumatoid arthritis

b. Giant cell arteritis

c. Inflammatory bowel disease (IBD)

d. Systemic lupus erythematosus

d. Systemic lupus erythematosus

Pattern associated molecular patterns (PAMPs) are expressed by:

a. Viruses

b. Bacteria

c. Fungi

d. All the above

d. All the above

B lymphocytes in humans mature in:

a. Bone marrow

b. Thymus

c. Lymph nodes

d. Spleen and bone marrow

a. Bone marrow

T lymphocytes in humans mature in:

a. Bone marrow

b. Thymus

c. Thymus and lymph nodes

d. Thymus, spleen and lymph nodes

b. Thymus

Under normal conditions, antigen presentation takes place in:

a. Bone marrow

b. Spleen

c. Lymph nodes

d. Spleen and lymph nodes

d. Spleen and lymph nodes

ζ protein is part of the:

a. TCR complex

b. BCR complex

c. Both TCR and BCR complexes

d. None of the above

a. TCR complex

Which of the following functions are mediated by B lymphocytes?

a. Antibody production

b. Cytokine production

c. Antigen presentation

d. All the above

d. All the above

Which is the key cytokine of CD4+ Th1 cells?

a. IL-4

b. IL-6

c. IFNγ

d. IL-10

c. IFNγ

Which biologic process is mediated by the germinal center reaction?

a. Isotype switch

b. Affinity maturation (high affinity antibodies)

c. None of above

d. a+b

d. a+b

The effector functions of antibodies include all of the following EXCEPT:

a. Opsonization

b. Antibody dependent cell mediated cytotoxicity

c. Neutralization

d. Complement activation through the lectin pathway

d. Complement activation through the lectin pathway

The increased levels of CRP in serum, is mainly the result of which cytokine?

a. IL-1α

b. IL-6

c. TNFα

d. IFNγ

b. IL-6

Which cells do NOT participate in the acute phase of the inflammatory process?

a. Neutrophils

b. Endothelial cells

c. M1 macrophages

d. Fibroblasts

d. Fibroblasts

Which of the following organs has no regenerative potential:

A) Liver

B) Lung

C) Peripheral nervous system

D) Central nervous system

E) Skin

D) Central nervous system

In which of the following diseases is fibrosis not a primary mechanism mediating tissue damage?

A) Microbial sepsis

B) Interstitial lung disease

C) Cystic fibrosis

D) Strabismus

E) Scleroderma

A) Microbial sepsis

Which of the following cells is the primary effector in the fibrotic process?

A) T helper 2 cells

B) Macrophages

C) Innate lymphoid cells type 2

D) Neutrophils

E) Myofibroblasts

E) Myofibroblasts

Which of the following cytokines is the most important mediator of fibrogenesis:

A) IL-6

B) TGFβ

C) TNFa

D) IL-10

E) GM-CSF

B) TGFβ

Among the following medical conditions, which have approved treatments specifically targeting the fibrotic process?

A) Interstitial lung disease

B) Cirrhosis

C) Systemic sclerosis

D) Myocardial infraction

E) Hypertension

A) Interstitial lung disease

In systemic sclerosis, which of the following organs can be affected by the fibrotic process?

A) Skin

B) Lung

C) Kidneys

D) Gastrointestinal

E) All of the above

E) All of the above

Which of the following is considered an appropriate treatment for scleroderma?

A) Proton pump inhibitor

B) Rituximab

C) Warfarin

D) Vancomycin

E) Salospir

B) Rituximab

Fibrosis is always accompanied by tissue loss:

A) Correct

B) False

A) Correct

Among the following cell populations, which one is least likely to give rise to myofibroblasts?

A) Pericytes

B) Resident fibroblasts

C) Epithelial cells

D) Bone marrow derived fibrocytes

E) Neurons

E) Neurons

Among the listed intracellular signaling cascades, which one is not typically associated with the TGFβ signaling pathway?

A) SMAD-dependent signaling

B) MAPK pathways

C) NOTCH signaling

D) PI3K/AKT/mTOR pathway

E) Rho Signaling Pathway

C) NOTCH signaling

Which is not a possibility in the ECG of a pt with hypokalemia?

a) prolong PR interval

b) prominent U waves

c) T wave flattening

d) Prolonged QT interval

e) T wave inversion in precordial leads

d) Prolonged QT interval

Which is not a cause of hypokalemia?

a) insulin administration

b) adrenaline infusion

c) alkalosis

d) furosemide

e) digoxin OD

e) digoxin OD

A rise in the pH by 0.1 causes what decrease in serum K+?

a) 0.1 mEq/L

b) 0.2 mEq/L

c) 0.5mEq/L

d) 0.8 mEq/L

e) 1.0mEq/L

c) 0.5mEq/L

To diagnose SIADH as the cause of hyponatremia which must not be present?

a) hypovolemia

b) hypotonicity

c) no cardiac/renal/ hepatic failure

d) urine osmolality >100ml/kg

e) urinary Na >20 mmol/ml

a) hypovolemia

Which statement is incorrect?

a) hyperlipidemia can cause an artificially low Na+

b) if the hyponatremia is known to be of less than 48 hours duration it can be corrected quickly

c) in chronic hyponatremia, the Na+ should not be raised by more than 0.5 mmol/l/h

d) if the Na+ level is raised too quickly in a pt with chronic hyponatremia it causes an increase in intracranial pressure

e) central pontine myelinolysis is caused when hypernatremia is corrected to quickly

e) central pontine myelinolysis is caused when hypernatremia is corrected to quickly

What is not a cause of hypercalcemia?

a) hyperparathyroidism

b) tuberculosis

c) lung cancer

d) hypomagnesemia

e) adrenal insufficiency

d) hypomagnesemia

Which equation is incorrect?

a) anion gap = (Na+ + K+) - (Cl- + HCO3-)

b) calculated serum osmolality = 2(Na + urea +glucose)

c) PaO2 ~ PinspO2 – PaCO2/0.8

d) the expected PaCO2 in metabolic acidosis = 1.5 × HCO3- + 8 (±2)

e) expected CO2 rise = +7 mmHg in metabolic alkalosis with HCO3- of 34 mEq/L

b) calculated serum osmolality = 2(Na + urea +glucose)

Which does not cause a high osmolar gap, increased anion gap metabolic acidosis?

a) methanol

b) ethanol

c) ethylene glycol

d) acetone

e) urea

e) urea

Which condition can be acutely compensated for as regards pH?

a) respiratory acidosis

b) respiratory alkalosis and metabolic acidosis

c) metabolic acidosis

d) metabolic alkalosis

e) none of the above

c) metabolic acidosis

Which does not cause a metabolic alkalosis?

a) vomiting

b) diarrhea

c) loop diuretics

d) thiazide diuretics

e) corticosteroids

b) diarrhea

The immunoglobulin class involved in type I hypersensitivity reaction is:

A. IgM

B. IgG

C. IgE

D. IgA

E. IgD

C. IgE

The major cytokine involved in immunoglobulin class switching towards IgE production is:

A. IL-4

B. IL-2

C. IL-5

D. Interferon -γ

E. TNF-α

A. IL-4

Histamine, the main mediator of type I hypesensitivity reactions is released by:

A. Mast cells.

B. T-cells

C. Neutrophils

D. Macrophages

E. Dendritic calls

A. Mast cells.

Late phase allergic reactions are mediated by

A. Histamine

B. TNFα

C. Eicosanoids

D. Leucotrienes

E. Type I interferons

D. Leucotrienes

Classic example of a disease in which the pathogenetic mechanism is depended on pathogenic autoantibody (type II hypersensitivity reaction) is

A. Autoimmune hemolytic anemia

B. Autoimmune thrombocytopenia

C. Good-pasture syndrome

D. Myasthenia Gravis

E. All the above

E. All the above

In Graves disease the pathogenesis against thyroid cells is mediated by:

A. Autoantibodies against T3

B. Autoantibodies against T4

C. Autoantibodies against TSH

D. Autoantibodies against TSH receptor

E. None of the above

D. Autoantibodies against TSH receptor

Antibody depended cellular cytotoxicity (ADCC) is a major mechanism of cellular damage in:

A. Allergic reactions

B. Immune complex mediated diseases

C. Type II hypersensitivity reactions

D. D. Acute delayed hypersensitivity reactions

E. E. Granuloma formation

C. Type II hypersensitivity reactions

The complement proteins play a significant role in

A. Destruction of cells

B. Cellular opsonization

C. Immune complex solubilization.

D. Antibody depended cellular cytotoxicity (ADCC)

E. All the above

E. All the above

Among the following, the cytokine playing a major role in granuloma formation is:

A. IL-6

B. IL-2

C. Interferon α.

D. IL-1

E. Interferon β

B. IL-2

Which of the following is considered as a classic immune complex mediated disease

A. Rheumatoid arthritis

B. Sarcoidosis

C. Cryoglobulinemic vasculitis

D. Hemolytic anemia

E. Autoimmune thrombocytopenia

C. Cryoglobulinemic vasculitis

The following skin reaction is considered as the prototype type IV hypersensitivity reaction.

A. Tuberculin test

B. Eczema

C. Skin vasculitis

D. Would repair

E. None of the above

A. Tuberculin test

Chronic myeloid leukemia is characterized by:

A. The presence of the Philadelphia chromosome

B. Leukocytosis with the presence of granulocytes at all stages of maturation in the peripheral blood

C. Inactivated BCR/ABL tyrosine kinase

D. A+B

E. A+B+C

D. A+B

Reactive leukocytosis is observed in:

A. Infections

B. Acute leukemias

C. Inflammation

D. A+B

E. A+C

E. A+C

α-thalassemia is characterized by:

A. Single base-pair point mutation in the α-globin gene resulting in the substitution of one amino acid in the α-globin chain

B. Increased α-globin synthesis that leads to α globin tetramers precipitation with subsequent chronic hemolysis

C. Presence of β chain tetramers (HbH)

D. Presence of sickle cells in the peripheral blood

E. All of the above

C. Presence of β chain tetramers (HbH)

An anemia with low MCV and MCH can be caused by:

A. Iron deficiency

B. Vitamin B12 deficiency

C. Thalassemia

D. Acute myeloid leukemia

E. A+C

E. A+C

Which of the following anemias is caused by increased peripheral red blood cell destruction?

A. Megaloblastic anemia

B. Autoimmune hemolytic anemia

C. Iron deficincy anemia

D. Anemia due to bone marrow infiltration by malignancy

E. Anemia of chronic disease

B. Autoimmune hemolytic anemia

In which of the following disease entities thrombocytopenia is caused by increased peripheral platelet consumption?

A. Myelodysplastic neoplasms

B. Bone marrow infiltration by malignancy

C. Disseminated intravascular coagulation

D. Thrombotic thrombocytopenic purpura

E. C+D

E. C+D

Thrombotic thrombocytopenic purpura (TTP) is caused by

A. Increased cleavage of large molecular weight vWF multimers by ADAMTS13

B. Decreased cleavage of large molecular weight vWF multimers by ADAMTS13

C. Antibodies against platelets

D. Platelet destruction by cytotoxic T cells

E. Antibodies against thrombopoietin

B. Decreased cleavage of large molecular weight vWF multimers by ADAMTS13

Hepcidin levels are decreased in which of the following conditions?

A. Iron deficiency

B. Inflammation

C. Hypoxia

D. All of the above

E. A+C

E. A+C

Immune thrombocytopenia (ITP) can be caused by:

A. Anti-platelet antibodies

B. Platelet destruction by cytotoxic T cells

C. Anti-megakaryocyte antibodies

D. Megakaryocyte destruction by cytotoxic T cells

E. All of the above

E. All of the above

Which of the following hemolytic anemias is immunologically mediated?

A. Sickle cell anemia

B. Hemolytic anemia due to G6PD deficiency

C. Hemolytic anemia after incompatible red blood cell transfusion

D. Paroxysmal nocturnal hemoglobinuria

E. Congenital spherocytosis

C. Hemolytic anemia after incompatible red blood cell transfusion

Types of DNA damage include:

a. DNA oxidation

b. Thymine dimers

c. DNA strand breaks

d. All the above

e. None of the above

d. All the above

Which of the following is/are tumor suppressor genes:

a. MYC

b. RAS

c. EGFR

d. All the above

e. None of the above

e. None of the above

Which of the following is a hallmark of cancer:

a. Genomic instability

b. Absence of invasion

c. Absence of metastasis

d. Apoptosis induction

e. None of the above

a. Genomic instability

Senescent cells:

a. In general proliferate

b. Are resistant to apoptosis

c. Are functionally intact

d. All the above

e. None of the above

b. Are resistant to apoptosis

According to the DNA damage model for cancer development:

a. Oncogene activation leads to apoptosis induction in preneoplastic lesions

b. Oncogene activation leads to induction of cellular senescence in preneoplastic lesions

c. Inactivation of the anti-tumor barriers leads to cancer progression

d. All the above

e. None of the above

d. All the above

DNA lesions cause changes in one or more of the following types of genes:

a. Proto- oncogenes

b. Tumor suppressor genes

c. DNA repair genes

d. Apoptotic genes

e. All the above

e. All the above

In cancer, cellular senescence:

a. Is not the outcome of chemotherapy

b. Is related to better prognosis

c. Acts as an anti-tumor barrier in the earliest stages

d. All the above

e. None of the above

c. Acts as an anti-tumor barrier in the earliest stages

Senolytics are drugs that:

a. Eliminate senescent cells

b. Eliminate proliferating cancer cells

c. Inhibit apoptosis

d. All the above

e. None of the above

a. Eliminate senescent cells

Frequent genetic alterations in cancer cells include:

a. Deletions

b. Amplifications

c. Translocations

d. Point mutations

e. All the above

e. All the above

Cancer cells evade apoptosis by:

a. Increased expression of caspases

b. BCL-2 down-regulation

c. Increased death receptor signalling

d. None of the above

e. All the above

d. None of the above

Type I interferons

a. Are single gene cytokines

b. Have slow kinetics of induction

c. Are induced upon T cell stimulation

d. Affect both the innate and adaptive immune system

e. Activate the NF-κB pathway

d. Affect both the innate and adaptive immune system

Type III interferons are similar to type I IFNs in

a. Their antiviral activity

b. Their ability to modulate inflammation

c. Their genomic organization

d. Their receptor utilization

e. Their expression patterns

a. Their antiviral activity

Which cells are predominant producers of type III interferons?

a. Fibroblasts

b. Epithelial cells

c. Macrophages

d. B cells

e. T cells

b. Epithelial cells

Interferon γ (IFN-γ) is induced by

a. Toll-like receptor stimulation

b. Viral components

c. Bacterial components

d. RIG-I/MDA-5 stimulation

e. Cytokines such as IL-12 and IL-2/IL-15

e. Cytokines such as IL-12 and IL-2/IL-15

Effective immunity to viral infections depends on

a. Exuberant type I IFN responses

b. Deficient type I IFN responses

c. Fine-tuned type I and type III IFN responses

d. Exuberant type III IFN responses

e. Deficient type III IFN responses

c. Fine-tuned type I and type III IFN responses

Autoantibodies to type I IFNs are responsible for

a. Rapid viral clearance

b. Induction of innate immunity

c. Induction of adaptive immunity

d. Development of autoimmune disease

e. Development of severe COVID-19

e. Development of severe COVID-19

Type I IFN signatures

a. Are common in autoimmune diseases

b. Are common in allergic diseases

c. Are common in cardiovascular diseases

d. Drive adaptive immune responses

e. Are induced through the activation of NF-kB

a. Are common in autoimmune diseases

Type I interferon therapeutics are approved for

a. Rheumatoid arthritis

b. Viral diseases and forms of cancer

c. Cardiovascular diseases

d. Diabetes

e. Allergic diseases

b. Viral diseases and forms of cancer

Loss-of function mutations in genes of the type I IFN machinery are responsible for

a. Autoimmunity

b. Excessive inflammation

c. Susceptibility to viral infections

d. Susceptibility to cancer

e. Induction of type III interferons

c. Susceptibility to viral infections

Type III (Lambda) interferons

a. Drive autoimmunity

b. Trigger inflammation

c. Promote susceptibility to cancer

d. Inhibit JAK/STAT activation

e. Exhibit broad spectrum antiviral activity

e. Exhibit broad spectrum antiviral activity

Which is the main substance leading to body temperature rise

a. Interleukin-10 (IL-10)

b. Prostagladin E2

c. Transforming growth factor beta (TGF-b)

d. Interleukin-6 (IL-6)

e. Vascular endothelial growth factor (VEGF)

b. Prostagladin E2

Which of the following metabolic effects are associated with fever

a. Increased oxygen demand

b. Decreased heart rate

c. Decreased respiratory rate

d. Decreased use of body proteins as an energy source

e. All of the above are false

a. Increased oxygen demand

Which of the following is an exogenous pyretogen

a. Interleuikin-6 (IL-6)

b. Tumor necrosis factor (TNF)

c. Lipopolysaccharide (LPS)

d. Vascular endothelial growth factor (VEGF)

e. Hepsidin

c. Lipopolysaccharide (LPS)

In which of the following does hyperthermia has deleterious effects

a. Gastrointestinal tract

b. Heart

c. Liver

d. All of the above

e. None of the above

d. All of the above

Which of the following type of fibers are most commonly used in nociception

a. Αδ fibers

b. C fibers

c. Αβ fibers

d. a and b are correct

e. a and c are correct

d. a and b are correct

Which of the following is involved in inhibition of nociception

a. Interleukin-1 (IL-1)

b. Prostagladin E2

c. Glutamate

d. Glycine

e. Interleuin-6 (IL-6)

d. Glycine

Which of the following are found in chronic pain ‘inflammation’ soup

a. Interleukin-6 (IL-6)

b. Interleuin 1b (IL-1b)

c. Bradykinin

d. Tumor necrosis factor alpha (TNF-a)

e. All of the above

e. All of the above

Which of the following type of fibers are most commonly used in pruritus

a. Αδ fibers

b. C fibers

c. Αβ fibers

d. a and b are correct

e. a and c are correct

d. a and b are correct

Which of the following may lead to pruritus inhibition

a. Interleukin-6 (IL-6)

b. Histamine

c. Interleukin-4 (IL-4)

d. Enkephalin

e. Natriuretic peptide

d. Enkephalin