Pathology Exam 2 Combined Sets *FINAL VERSION*

the endocrine pancreas secretes digestive juices into the small intestine.

A. true

B. false

B (the exocrine pancreas does this)

what is the outermost layer of the small intestine?

A. serosa

B. muscularis

C. submucosa

D. mucosa

A

the pulmonary membrane is capable of regenerating after injury?

A. true

B. false

B (once lost, the pulmonary membrane cannot regenerate; the damage is permanent)

Cardiac myocytes contract during diastole to eject blood from the ventricle, and relax during systole to allow the ventricle to fill.

A. true

B. false

B (myocytes contract during systole and relax during diastole)

Vasoconstriction generally increases blood flow and vasodilation generally decreases blood flow.

A. true

B. false

B (the opposite is true)

Granulocytes are the shortest-surviving formed element in blood, surviving four days.

A. True

B. False

A

a 16 y/o white female presents to the ER via ambulance for suspected drug overdose. the pt's mother reports that her daughter locked herself in her room earlier that evening threatening suicide. on PE, the pt is pale and sweating; a basin in her lap holds partially digested white pills. the ER physician explains to the pt's mother that without immediate administration of charcoal and N-acetylcysteine, the pt could go into liver failure. What compound has the pt overdosed on?

a. acetaminophen

b. aspirin

c. alcohol

d. iron

A

A 63 y/o white male presents to the clinic for eval of recurrent chest discomfort that he describes as pressure and pain in his left jaw and shoulder. Previously, the sensation occurred only after walking up a few flights of stairs, but now the sensation occurs at rest. You warn him that he has a 30% chance of having a MI in the next three months. What is his dx?

a. stable angina

b. unstable angina

c. unremitting angina

d. MI

B

What is the lifespan of a neutrophil?

a. 4 days

b. 120 days

c. 1-2 days

d. 7 days

A

Which of the following regarding cholesterol is true?

A. decreasing total cholesterol by 50 mg/dL cuts CV risk by half.

b. for every 5mg/dL LDL is increased, coronary risk declines by 2-3%

c. smoking raises HDL-C

d. exercise and consumption of moderate amounts of alcohol raise LDL-C

A

the liver produces all plasma proteins.

A. true

B. false

B (it does not produce immunoglobulins)

A 25 y/o white female presents to the clinic for eval of a "chest cold." Her sx began one week ago and include moderate fever, muscle aches, HAs, and chest heaviness. Her CBC demonstrates mild lymphocytic leukocytosis. There are minimal findings on CXR consistent with diffuse inflammation of the alveolar septa bilaterally without evidence of consolidation. What disease is responsible for her sx?

a. lobar pneumonia

b. interstitial pneumonia

c. pulmonary edema

d. pleural effusion

B

The myenteric plexus is contained within which of the following:

a. mucosa

b. submucosa

c. serosa

d. muscularis propria

D

a 65 y/o hispanic female presents to the clinic c/o mild abd pain, nausea and vomiting. PE is notable for absence of jaundice and the presence of an abdominal mass. She is sent for CT imaging which reveals a cyst. Subsequent fine needle aspiration of the cyst, guided by US, reveals thin, clear, watery fluid and pieces of pancreatic duct epithelium. What is your dx?

a. pseudocyst

b. serous cystadenoma

c. mucinous cystic neoplasm

d. intraductal papillary mutinous neoplasms

B

The tricuspid and mitral valve leaflets are tethered by chordae tendineae to papillae muscles.

A. true

B. false

A

Leukocytes include monocytes, erythrocytes, and granulocytes.

A. True

B. False

B (Leukocytes are monocytes, lymphocytes, and granulocytes)

2/3rds of blood volume is found in the veins.

A. true

B. false

A

hepatitis B infection:

A. is the most common viral hepatitis in the US

b. causes epidemics of infection

c. is the most likely hepatitis virus infection to cause chronic hepatitis and cirrhosis

d. is transmitted parenterally or by sexual contact

D

What is the smallest division of the lung?

the acinus (plural acini)

which intestinal cells secrete hormones?

A. epithelial cells

B. endothelial cells

A

the common bile duct and main pancreatic duct empty into the small intestine through the:

ampulla of vater

While volunteering at a summer camp for diabetics, you observe one of your students who appears ill. He is able, sweating profusely, and trembling. When you take his wrist, his skin is cool and clammy to the touch and his heartbeat is erratic. What is the likely cause of his sx?

a. presence of an insulinoma

b. complications of new onset diabetes

c. injection of too much insulin

d. hyperglycemia

C

Name the two blood supplies of the liver.

portal vein and hepatic artery

Which of the following statements regarding the bacteria in the GI system are true?

a. they produce vitamin K but not folic acid

b. they serve no purpose in GI immunity

c. they outnumber the body's own cells 5-1

d. when the flora is altered by abx, it can lead to diarrhea

A

A 65 y/o AA male with SOB and tachypnea presents to your ER. On exam he is febrile (103.5) and his mental status is altered. A CXR demonstrates "white out" lung. Which of the following statements is true regarding his disease etiology?

a. chronic course leading to pulmonary failure in nearly 100% of cases

b. characterized by injury to bronchi and bronchioles

c. can be caused by many different underlying conditions

d. caused by mycoplasma pneumonia

C

A 55 y/o AA male presents for episodes of breathlessness, coughing and rapid breathing that have gotten progressively worse over the last month. A chest XR shows a remarkably enlarged heart while his ECHO reveals a normal EF but decreased cardiac output. What is the cause of his sx?

a. left heart failure

b. right heart failure

c. diastolic failure

d. uncompensated heart failure

C

a 7 y/o hispanic male presents to his pediatrician's office with 5 days of unexplained fever. On PE, conjunctivitis, oral ulcers, and desquamation of the palms and soles of his feet are noted. He also has bilateral lymphadenopathy of his cervical lymph nodes. From what vasculitis does he suffer?

A. microscopic polyangitis

b. takayasu arteritis

c. temporal arteritis

d. Kawasaki disease

D

A 42 year old AA male comes to your office for a checkup. His CBC shows a mild microcytic hypo chromic anemia and hemoglobin electrophoresis shows elevated hemoglobin F and decreased hemoglobin A. Target cells are also visible on a peripheral smear. Which of the following diseases does the patient suffer from?

a. sickle cell disease

b. iron deficiency anemia

c. alpha-thalassemia

d. beta-thalassemia minor

D

Put the following in order from superior to inferior: right and left bundle branches, AV node, SA node, Bundle of His.

SA node, AV nodes, bundle of his, right and left bundle branches

What do myeloid progenitor cells give rise to?

A. Granulocytes

B. Monocytes

C. Erythrocytes

D. Megakaryocytes

E. A, B, and C

F. all of the above

F

populations with the lowest average total blood cholesterol have the highest rates of cardiovascular disease.

A. true

B. false

B (countries with the lowest average cholesterol have the lowest rates of CV disease)

A 53 y/o AA female with a PMH significant for RA presents to the clinic. She c/o fatigue, nausea, dark urine, and loss of appetite. Pertinent positives on PE include an enlarged liver and jaundice. Her AST and ALT are elevated, while GGT and Alk Phos are normal. Her hepatitis panel is positive for anti-HCV but her PCR is negative for virus. She is also positive for high titers of anti smooth muscle antibodies. What is the patient's dx?

a. acute viral hepatitis (HCV)

b. autoimmune hepatitis

c. alcoholic hepatitis

d. nonalcoholic fatty liver disease

B

the ability of the pulmonary membrane to allow oxygen and carbon dioxide exchange between air and blood.

Pulmonary diffusion capacity

Name the 3 mesenteries

the greater and lesser omentums and the mesentery proper

what cells make up the pancreatic islets and what do they secrete? ALPHA

A. glucagon

B. insulin

C. somatostatin

D. pancreatic polypeptide

A

Which of the following statements concerning type 2 diabetes is true?

A. pancreatic islets are infiltrated by T lymphocytes

B. it features an absolute lack of insulin

C. It is characterized by periodic episodes of ketoacidosis

D. the islets are gradually replaced by amyloid

D

what cells are responsible for portal blood filtration?

kupffer cells

Concerning aphthous oral ulcers, which is true?

A) They are associated with periodontitis.

B) The cause is unknown.

C) They are caused by herpes virus.

D) They are caused by Candida.

B

Which of the following diseases is characterized by hyper plastic mucus glands, mucus plugs, hypertrophied bronchial smooth muscles, edema and marked eosinophilic inflammation secondary to long-term exposure to severe air pollution?

a. hypersensitivity pneumonitis

b. occupational asthma

c. atopic asthma

d. nonatopic asthma

D

a 44 y/o white woman presents to the ER complaining of breathlessness and heart palpitations. Her PMHx is significant for breast cancer treated with several chemotherapies including Adraimycin. Her ECG strip reveals an elevated (350 bpm) HR, it is regular with more P waves than QRS complexes; and her QRS complexes are normal. What arrhythmia do you suspect?

a. ventricular fibrillation

b. ventricular tachycardia

c. a fib

d. a flutter

D

which one of the following is the site of the initial arterial injury in atherosclerosis?

a. endothelial cell

b. basement membrane

c. muscular wall (media)

d. adventitia

A

Warm antibody hemolytic anemia is characterized by which of the following?

A. Room temperature antibodies that cause anemia and splenomegaly

B. Autoimmune antibodies that form after exposure to drugs or an infectious etiology

C. Sudden severe back/leg pain, vomiting, diarrhea, and hemoglobinuria

D. Antibodies that are produced after exposure to a cold shower

A

What causes erythropoietin to be released?

A. low oxygen levels detected by the heart

B. low oxygen levels detected by the kidney

C. high oxygen levels detected by the heart

D. high oxygen levels detected by the kidney

B

Total cholesterol < 200mg/dL and LDL-cholesterol

A

failure of the valves to open and may be caused by calcification

A. Stenosis

B. regurgitation

A

which immunoglobulin paints the respiratory epithelium?

A. IgA

B. IgG

C. IgE

A (secreted by MALT)

dietary carbs are broken into what compounds for absorption?

A. disaccharides

B. monosaccharides

B

You observe a 22 y/o white male on the psychiatric ward. His chart lists a dx of schizophrenia. Over several days, you note that he also has several behavioral oddities, tremors and an abnormal gait. On a hunch, you order a slit lamp exam, which reveals the presence of Kayser-Fleischer rings. These findings point to a dx of which of the following diseases?

a. alpha 1 antitrypsin deficiency

b. nonalcoholic fatty liver disease

c. hemochromatosis

d. Wilson disease

D

acute and chronic pancreatitis are often tx with a pancreatectomy.

A. true

B. false

B (tx is supportive care and abstinence from the offending agent)

A 54 y/o AA male presents to the ER with nausea, vomiting, weight loss, and upper abd pain radiating to the back. PE demonstrates a well-developed, non obese male with moderate abdominal tenderness; you note a mild scleral icterus (yellowing of the eyes). A CT demonstrates a large pancreatic mass, and blood studies are remarkable for elevation of non albumin protein, which is determined to be IgG4 on additional testing. What is the most likely etiology of his pancreatitis?

a. autoimmune

b. gallstones

c. malignancy

d. alcohol abuse

A

hepatic failure occurs after 80-90% of the liver's functional capacity is lost.

A. true

B. false

A

which of the following is a condition that involves the stomach?

a. peptic ulcer

b. malabsorption syndrome causing steatorrhea

c. C Dif ulceration

d. Crohn's disease

A

A 50 y/o AA female presents to your clinic for SOB, CP, chills, cough, and fever. She recently moved to the area after being dx with AIDS and is presenting to your clinic to establish care. On further questioning, she confirms exposure to bird droppings. As suspected, her Mantoux skin test is negative. An elevated antibody titer in the blood confirms your suspicion. What organism is responsible for her sx?

a. histoplasmosis

b. coccidiomycosis

c. candida

d.. cryptococcus

A

which of the following is true concerning the drug therapies used to treat HF?

a. beta blockers improved EF by lowering heart rate

b. aldosterone blockers are the mainstay of therapy

c. digoxin effects the renin-aldosterone mechanism

d. angiotensin converting enzyme inhibitors improve myocardial contractility

A

With regards to vascular injury, which of the following is true?

A) Neutrophils are responsible for synthesizing the biological products that effect smooth muscle cells of the media

B) The causative agents of endothelial damage are purely genetic in nature

C) Endothelial chemical mediators stimulate the proliferation and migration of media smooth muscle cells, which accumulate in the sub-endothelial space

D) Injured endothelial cells retain their ability to contract and synthesize scar-like accumulations of collagen and elastin

C

a 54 year old Japanese female presents to the clinic complaining of numbness and tingling in her hands and fingers. Physical exam is positive for plethora, and a CBC demonstrates a hematocrit greater than 60% and thrombocytosis. Which of the following is true about her disease?

A. it is caused by an autoimmune disease resulting in low B 12

B. erythropoietin is increased

C. the treatment of choice is a therapeutic phlebotomy

D. a bone marrow biopsy will demonstrate fibrosis

C

Which of the four major waveforms is not visible on an ECG?

A. atrial depolarization

B. atrial repolarization

C. ventricular depolarization

D. ventricular repolarization

B

How long does a RBC live?

A. 60 days

B. 90 days

C. 120 days

D. 150 days

C

the endothelium functions to maintain _______ blood flow and modulate _________ of substances across the wall into tissues.

smooth, diffusion

The pulsating, flapping motion of dorsiflexed wrists (asterixis) characterizes which hepatic syndrome?

a. hepatorenal syndrome

b. hepatopulmonary syndrome

c. hepatic encephalopathy

d. hepatic coma

C

Restrictive lung disease has a markedly decreased FEV1/FVC ratio.

A. true

B. false

B (obstructive lung disease has a markedly decreased FEV1/FVC ratio, while the ratio of restrictive disease is near normal.)

How does fat absorption differ from protein and carbohydrate absorption?

fats are absorbed into lacteals of the lymphatic system, not into blood

the specific test for pancreatitis is _________ while the sensitive test is __________

lipase (specific), amylase (sensitive)

Which of the following structures is a cyst lacking lining epithelium?

A. serous cystadenoma

B. mucinous cystic neoplasm

c. pseudocyst

d. intraductal papillary mucinous neoplasms

C

Cirrhosis is reversible

A. true

B. false

B

which of the following is associated with an increased risk of esophageal carcinoma?

a. candida infection

b. herpesvirus infection

c. achalasia

d. hiatal hernia

C

a 5 y/o hispanic male is brought to the children's ER for eval following smoke exposure. On exam, crackling rales are heard at the lung bases. Which of the following etiologies are you concerned about?

a. hemodynamic edema

b. microvascular injury edema

c. pneumothorax

d. pleural effusion

B

A young athlete presents to your clinic for a physical prior to trying out for his high school basketball team. He denies any complaints or significant past medical history. His family history is positive for the sudden death of his father, at age 35, while playing tennis. On physical exam, you identify a systolic murmur. What are you most concerned about with this patient?

A) Myocarditis

B) Restrictive cardiomyopathy

C) Hypertrophic cardiomyopathy

D) Dilated cardiomyopathy

C

a 70 y/o white woman presents to your office complaining of HA's, vision changes and pain in her jaw muscles during chewing. Her labs reveal an elevated ESR and CRP and a biopsy reveals lymphocytes infiltrating the affected blood vessel wall. What is your dx?

a. polyarteritis nodosa

b. takayasu arteritis

c. temporal arteritis

d. Kawasaki disease

C

Which cell digests foreign antigens for presentation to immune cells?

A) lymphocytes

B) monocytes

C) neutrophils

D) granulocytes

B

What is the equation for calculating mean cell volume (MCV)?

Hct x 10/RBC

what are the 3 layers of large vessels?

intima, media, and adventitia

What are the five principal mechanisms of cardiac dysfunction?

pump failure, obstructed flow, regurgitant flow, shunted flow, abnormal conduction

List the two broad categories of lung disease.

restrictive and obstructive

Where in the intestinal epithelium are digestive enzymes located?

A. serosa

B. muscularis

C. submucosa

D. mucosa

E. brush border

E

water-soluble bilirubin becomes elevated with obstruction of bile flow

A. true

B. false

A

what are the two main causes of both acute and chronic pancreatitis?

A. alcohol abuse and gallstones

B. lipase and amylase

C. Ketoacidosis and hyperosmolar coma

D. mutinous cystic neoplasm and malignancy

A

a 45 y/o white female presents for eval of a right leg pain. PE reveals a jaundiced, gaunt woman with a right leg that is twice the size of the left. Her PE is also positive for abdominal tenderness. On further questioning, the pt confirms recent unintentional weight loss. In the context of these textbook sx, you recognize the blood clot in her leg as Trousseau's sign. Which of the following tumors is responsible for her sx?

A. pancreatic adenocarcinoma

B. Zollinger Ellison Gastrinoma

C. insulinoma

D. Intraductal papillary mucinous neoplasms

A

a 20 y/o hispanic male presents to his college clinic following a recent SB trip to Cancun. He c/o n/v/d. His PE demonstrates marked jaundice. Pertinent labs include increased AST, ALT, (+) IgM, HAV, (+) anti-HbS, (-) anti-HBc, and (-) anti-HCV. Which of the following explains his sx and lab findings?

a. acute HAV infection

b. acute HBV infection

c. acute HCV infection

d. chronic HBV infection

A

which of the following is a cause of luminal phase malabsorption syndrome?

a. chronic pancreatitis

b. gluten-sensitive enteropathy (celiac sprue)

c. Whipple disease

d. tropical sprue

A

Which of the following statements is true regarding the respiratory tract?

a. lacking both glands and cartilage, the smallest airway division is the bronchiole

b. due to lung anatomy, aspirated items are more likely to end in the right lung than the left lung

c. the lung is served by the pulmonary vasculature system alone

d. the first line of defense in the lung is mucosal associated lymphoid tissue (MALT) which is responsible for secreting IgA

B

a 29 y/o white female presents to the cardiologist for eval of syncope. Her sx are precipitated by long periods of standing and are characterized by a prodrome of light-headiness, loss of vision, and diaphoresis. Her ECG strip shows a prolonged P-QRS interval, which is characteristic of which of the following?

a. normal ECG

b. 1st degree AV block

c. 2nd degree AV block

d. 3rd degree AV block

B

which of the following is a modifiable risk factor in atherosclerosis?

a. inflammation

b. high blood homocysteine

c. HTN

d. gender

C

an 8 y/o hispanic female is brought to the clinic because she has been increasingly tired over the last month. Her mother reports that in addition to pallor, she also has increased bruising and complaints of bone pain. What do you expect to see on her CBC?

A. elevated WBC count, with greater than 20% blasts

B. anemia

C. thrombocytopenia

D. all of the above

D

How would the MCHC change if hemoglobin production were decreased?

A. decrease

B. remain stable

C. increase

A

HDL and LDL are composed of what four molecular components?

protein, phospholipid, triglyceride and cholesterol

The most common cause of right sided heart failure is left sided heart failure.

A. true

B. false

A

Uncomplicated URIs are typically bacterial.

A. true

B. false

B (usually viral)

How are intestinal bacteria useful?

A.They produce certain vitamins, and the sheer number of them makes it difficult for ingested pathogens to compete successfully for nutrients.

B. lack of objective abnormalities

C. an immune-mediated reaction of bowel epithelium to intestinal bacteria

D. skin flushing, abd pain and diarrhea

E. abd pain, tenderness and spasm of abd muscles to form a rigid abd wall

A

a 55 y/o morbidly obese male with a PMH significant for hyperlipidemia and prediabetic insulin resistance returns to the clinic following a yearly checkup. His PCP is concerned by his elevated AST and ALT. He denies alcohol consumption, previous hx of hepatitis and a hx of autoimmune disease. His hepatitis panel is negative. A liver biopsy demonstrates marked fat deposition. What is his dx?

a. alcoholic cirrhosis

b. chronic viral hepatitis

c. nonalcoholic fatty liver disease

d. autoimmune hepatitis

C

Type 1 diabetes can be cured by weight loss.

A. true

B. false

B (type 2)

All of the complications of diabetes are caused by which one of the following?

A) Circulating ketones

B) Autoimmunity

C) Hyperglycemia

D) Atherosclerosis

C

Name the consequences of portal hypertension.

A. ascites

B. portosystemic shunts with varices

C. splenomegaly

D. all of the above

D

which of the following is a cause of ileus?

a. postoperative state after abd surgery

b. hypokalemia

c. intestinal ischemia

d. all of the above

D

A 24 y/o white male presents to the clinic complaining of hoarseness and pain when he speaks or sings. He is concerned about the upcoming opening night of his troupe's newest production, which has been practicing for "night and day". An upper endoscopy confirms your suspicions and you prescribe vocal rest. What is his dx?

a. vocal cord nodules

b. laryngeal papillomas

c. laryngitis

d. carcinoma of the larynx

A

A mother brings her six-month old infant son to the ped's office. She is concerned because every time her son cries, he turns blue. He was born term, without complications. He has no significant medical history. On PE, he is found to have a loud systolic murmur. An ECHO confirms your dx. You tell his mother that surgery is necessary to correct what heart defect?

a. patent ductus arteriosus

b. transposition of the great arteries

c. tetraology of fallot

d. persistent truncus arteriosus

C

which of the following statements about varicose veins is true?

a. the population most commonly affected by varicose veins is women who have had several pregnancies

b. deep veins are more often affected than superficial ones

c. skin ulcers are a common result of varicose veins

d. varicose veins are found only in the extremities, most commonly in the legs

A

Non-Hodgkin Lymphoma and Hodgkin Lymphoma can be differentiated based on the presence of what?

A. Reed-Sternberg cells

B. Blasts in peripheral blood

C. Malignant cells in lymph nodes

D. Malignant cells in bone marrow

A

A 65 y/o AA male comes to the clinic complaining of bone pain and fatigue. Incidentally, he notes a recent change in urination. A UA reveals Bence-Jones proteins and a skull XR shows punched out lesions. What is your dx?

A. Waldenstrom macroglobulinemia

B. Multiple myeloma

C. monoclonal gammopathy of undetermined significance

D. lymphoplasmacytic lymphoma

B

what is the name of the droplet that carries lipid from the intestines to the bloodstream?

chylomicrons