Pathophysiology- study (copy)

A 50-year-old chronic alcoholic presents to the emergency room with 12 hours of severe abdominal pain. The pain radiates to the back and is associated with an urge to vomit. Physical examination discloses exquisite abdominal tenderness. Laboratory studies show elevated serum amylase. Which of the following morphologic changes would be expected in the peripancreatic tissue of this patient?

Fat necrosis

A CT scan of a 43-year-old woman with a parathyroid adenoma and hyperparathyroidism reveals extensive calcium deposits in the lungs and kidney parenchyma. These radiologic findings are best explained by which of the following mechanisms of disease?

Metastatic calcification

A 75-year-old woman with Alzheimer disease dies of congestive heart failure. The brain at autopsy is shown. This patient's brain exemplifies which of the following responses to chronic injury?

Atrophy

A 64-year-old man with long-standing angina pectoris and arterial hypertension dies of spontaneous intracerebral hemorrhage. At autopsy, the heart appears globoid. The left ventricle measures 2.8 cm on cross section (shown). This adaptation to chronic injury was mediated primarily by changes in the intracellular concentration of which of the following components?

mRNA

A 30-year-old man with AIDS-dementia complex develops acute pneumonia and dies of respiratory insufficiency. At autopsy, many CNS neurons display hydropic degeneration. This manifestation of sublethal neuronal injury was most likely mediated by impairment of which of the following cellular processes?

Plasma membrane sodium transport

A 62-year-old man is brought to the emergency room in a disoriented state. Physical examination reveals jaundice, splenomegaly, and ascites. Serum levels of ALT, AST, alkaline phosphatase, and bilirubin are all elevated. A liver biopsy demonstrates alcoholic hepatitis with Mallory bodies. These cytoplasmic structures are composed of interwoven bundles of which of the following proteins?

Intermediate filaments

A 65-year-old man suffers a heart attack and expires. Histologic examination of the lungs at autopsy reveals numerous pigmented nodules scattered throughout the parenchyma (shown). What is the appropriate diagnosis?

Anthracosis

A 32-year-old woman with poorly controlled diabetes mellitus delivers a healthy boy at 38 weeks of gestation. As a result of maternal hyperglycemia during pregnancy, pancreatic islets in the neonate would be expected to show which of the following morphologic responses to injury?

Hyperplasia

A 59-year-old female alcoholic is brought to the emergency room with a fever (38.7°C/103°F) and foul-smelling breath. The patient subsequently develops acute bronchopneumonia and dies of respiratory insufficiency. A pulmonary abscess is identified at autopsy (shown). Histologic examination of the wall of this lesion would most likely demonstrate which of the following pathologic changes?

Liquefactive necrosis

A 20-year-old man from China is evaluated for persistent cough, night sweats, low-grade fever, and general malaise. A chest x-ray reveals findings "consistent with a Ghon complex." Sputum cultures grow acid-fast bacilli. Examination of hilar lymph nodes in this patient would most likely demonstrate which of the following pathologic changes?

Caseous necrosis

A 31-year-old woman complains of increased vaginal discharge of 1 month duration. A cervical Pap smear is shown. Superficial epithelial cells are identified with arrows. When compared to cells from the deeper intermediate layer (top), the nuclei of these superficial cells exhibit which of the following cytologic features?

Pyknosis

A 52-year-old woman loses her right kidney following an automobile accident. A CT scan of the abdomen 2 years later shows marked enlargement of the left kidney. The renal enlargement is an example of which of the following adaptations?

Hypertrophy

An 82-year-old man has profound bleeding from a peptic ulcer and dies of hypovolemic shock. The liver at autopsy displays centrilobular necrosis. Compared to viable hepatocytes, the necrotic cells contain higher intracellular concentrations of which of the following?

Calcium

A 28-year-old woman is pinned by falling debris during a hurricane. An x-ray film of the leg reveals a compound fracture of the right tibia. The leg is immobilized in a cast for 6 weeks. When the cast is removed, the patient notices that her right leg is weak and visibly smaller in circumference than the left leg. Which of the following terms best describes this change in the patient's leg muscle?

Atrophy

A 70-year-old man is hospitalized after suffering a mild stroke. While in the hospital, he suddenly develops crushing substernal chest pain. Analysis of serum proteins and ECG confirm a diagnosis of acute myocardial infarction. The patient subsequently develops an arrhythmia and expires. A cross section of the left ventricle at autopsy is shown. Histologic examination of the affected heart muscle would demonstrate which of the following morphologic changes?

Coagulative necrosis

Which of the following histologic features would provide definitive evidence of necrosis in the myocardium of the patient described in above?

Nuclear fragmentation

A 90-year-old woman with mild diabetes and Alzheimer disease dies in her sleep. At autopsy, hepatocytes are noted to contain golden cytoplasmic granules that do not stain with Prussian blue. Which of the following best accounts for pigment accumulation in the liver of this patient?

Advanced age

Which of the following mechanisms of disease best describes the pathogenesis of pigment accumulation in hepatocytes in the patient described in above?

Peroxidation of membrane lipids

A 45-year-old man presents with increasing abdominal girth and yellow discoloration of his skin and sclera. Physical examination reveals hepatomegaly and jaundice. A Prussian blue stain of a liver biopsy is shown. What is the major intracellular iron storage protein in this patient's hepatocytes?

Hemosiderin

A 60-year-old man with chronic cystitis complains of urinary frequency and pelvic discomfort. Digital rectal examination is unremarkable. Biopsy of the bladder mucosa reveals foci of glandular epithelium and chronic inflammatory cells. No cytologic signs of atypia or malignancy are observed. Which of the following terms best describes the morphologic response to chronic injury in this patient?

Metaplasia

A 68-year-old woman with a history of hyperlipidemia dies of cardiac arrhythmia following a massive heart attack. Peroxidation of which of the following molecules was primarily responsible for causing the loss of membrane integrity in cardiac myocytes in this patient?

Phospholipids

A 22-year-old construction worker sticks himself with a sharp, rusty nail. Within 24 hours, the wound has enlarged to become a 1-cm sore that drains thick, purulent material. This skin wound illustrates which of the following morphologic types of necrosis?

Liquefactive

A 56-year-old obese woman (BMI = 32 kg/m2) develops progressive, right renal artery stenosis. Over time, this patient's right kidney is likely to demonstrate which of the following morphologic adaptations to chronic ischemia?

Atrophy

A 5-year-old boy suffers blunt trauma to the leg in an automobile accident. Six months later, bone trabeculae have formed within the striated skeletal muscle at the site of tissue injury. This pathologic condition is an example of which of the following morphologic adaptations to injury?

Metaplasia

A 40-year-old man is pulled from the ocean after a boating accident and resuscitated. Six hours later, the patient develops acute renal failure. Kidney biopsy reveals evidence of karyorrhexis and karyolysis in renal tubular epithelial cells. Which of the following biochemical events preceded these pathologic changes?

Decrease in intracellular pH

A 50-year-old man presents with symptoms of acute renal failure. His blood pressure is 220/130 mm Hg (malignant hypertension). While in the emergency room, the patient suffers a stroke and expires. Microscopic examination of the kidney at autopsy is shown. Which of the following morphologic changes accounts for the red material in the wall of the artery on the right?

Fibrinoid necrosis

A 32-year-old woman develops an Addisonian crisis (acute adrenal insufficiency) 3 months after suffering massive hemorrhage during the delivery of her baby. A CT scan of the abdomen shows small adrenal glands. Which of the following mechanisms of disease best accounts for adrenal atrophy in this patient?

Lack of trophic signals.

A 16-year-old girl undergoes radiologic imaging of her abdomen and is found to have only one kidney. She had been entirely unaware of this problem. Which of the following terms is most descriptive of this finding?

Agenesis

An impending myocardial infarction was successfully averted by thrombolytic (clot-dissolving) therapy in a 55-year-old man. Which of the following biochemical events most likely occurred during the period of hypoxia?

Stimulation of anaerobic glycolysis and glycogenolysis

A 45-year-old woman is investigated for hypertension and is found to have enlargement of the left kidney. The right kidney is smaller than normal. Contrast studies reveal stenosis of the right renal artery. The size change in the right kidney is an example of which of the following adaptive changes?

Atrophy

A 20-year-old man presents with yellowing of the sclerae, skin, and oral mucosa. Which of the following accumulations underlies these findings?

Bilirubin

A 72-year-old man presents with a 3-day history of progressively worsening productive cough, fever, chills, and signs of toxicity. Prominent physical findings include signs of consolidation and rales over the right lung base. Sputum culture is positive for Streptococcus pneumoniae. An intra-alveolar exudate filling the alveoli of the involved portion of the lung is present. Which of the following types of inflammatory cells is most likely a prominent feature of this exudate?

Neutrophils

A routine complete blood count performed on a 22-year-old student reveals an abnormality in the differential leukocyte count. She has been complaining of frequent sneezing and "watery" eyes during the past several weeks and reports that she frequently had such episodes in the spring and summer. Which of the following cell types is most likely to be increased?

Eosinophils

A 2-year-old boy presents with recurrent infections involving multiple organ systems. Extensive investigation results in a diagnosis of chronic granulomatous disease of childhood. Which of the following most closely characterizes the abnormality in this patient's phagocytic cells?

A 2-year-old boy presents with recurrent infections involving multiple organ systems. Extensive investigation results in a diagnosis of chronic granulomatous disease of childhood. Which of the following most closely characterizes the abnormality in this patient's phagocytic cells?

A laboratory experiment is performed to evaluate the chemotactic potential of a group of potential mediators. Which of the following substances most likely has the greatest affinity for neutrophils?

C5a

A 26-year-old African-American woman has bilateral hilar adenopathy, and radiography reveals multiple reticular densities in both lung fields. A bronchoscopic biopsy reveals granulomatous inflammation with multiple giant cells of the Langhans type and no evidence of caseous necrosis. Which of the following is the most likely diagnosis?

Sarcoidosis

In a laboratory exercise for Med Tech students, an unknown compound is studied. The students are informed that the compound has been isolated from endothelial cells and that its synthesis can be inhibited by aspirin. In the laboratory, the students demonstrate that the compound is a potent vasodilator and platelet antiaggregant. Given these findings, the substance is most likely which of the following mediators?

Prostacyclin (PGI2)

A 70-year-old man presents with the sudden onset of left-sided weakness, spasticity, and hyperactive and pathologic reflexes. The most serious consequences of this disorder are the result of damage to which of the following cell types?

Permanent cells

A 22-year-old woman nursing her newborn develops a tender erythematous area around the nipple of her left breast. A thick, yellow fluid is observed to drain from an open fissure. Examination of this breast fluid under the light microscope will most likely reveal an abundance of which of the following inflammatory cells?

Neutrophils

Which of the following mediators of inflammation facilitates chemotaxis, cytolysis, and opsonization at the site of inflammation in the patient described in the above question?

Complement proteins

A 63-year-old man becomes febrile and begins expectorating large amounts of mucopurulent sputum. Sputum cultures are positive for gram-positive diplococci. Which of the following mediators of inflammation provide potent chemotactic factors for the directed migration of inflammatory cells into the alveolar air spaces of this patient?

N-formylated peptides

A 5-year-old boy punctures his thumb with a rusty nail. Four hours later, the thumb appears red and swollen. Initial swelling of the boy's thumb is primarily due to which of the following mechanisms?

Increased capillary permeability

Which of the following serum proteins activates the complement, coagulation, and fibrinolytic systems at the site of injury in the patient described in question above?

Hageman factor

A 24-year-old intravenous drug abuser develops a 2-day history of severe headache and fever. His temperature is 38.7°C (103°F). Blood cultures are positive for gram-positive cocci. The patient is given intravenous antibiotics, but he deteriorates rapidly and dies. A cross section of the brain at autopsy reveals two encapsulated cavities. Which of the following terms best characterizes this pathologic finding?

Suppurative inflammation

A 36-year-old woman with pneumococcal pneumonia develops a right pleural effusion. The pleural fluid displays a high specific gravity and contains large numbers of polymorphonuclear leukocytes. Which of the following best characterizes this pleural effusion?

Purulent exudate

What is purulent inflammation?

Inflammation characterized by exudation of pus (dead and dying neutrophils, plasma proteins, liquefied tissue .

A 33-year-old man presents with a 5-week history of calf pain and swelling and low-grade fever. Serum levels of creatine kinase are elevated. A muscle biopsy reveals numerous eosinophils. What is the most likely etiology of this patient's myalgia?

Parasitic infection

What is the function of eosinophils?

Bactericidal action: cousins of neutrophils but less efficient

Antiparasitic action

Participate in allergic reactions (type 1 hypersensitivity)

A 10-year-old boy with a history of recurrent bacterial infections presents with fever and a productive cough. Biochemical analysis of his neutrophils demonstrates that he has an impaired ability to generate reactive oxygen species. This patient most likely has inherited mutations in the gene that encodes which of the following proteins?

NADPH oxidase

A 41-year-old woman complains of excessive menstrual bleeding and pelvic pain of 4 months in duration. She uses an intrauterine device (IUD) for contraception. Endometrial biopsy shows an excess of plasma cells and macrophages within the uterine stroma and scattered lymphoid follicles. The presence of these cells within the stroma is evidence of which of the following conditions?

Chronic inflammation

What are the mononuclear cells found in chronic inflammatory reactions?

Macrophages

Lymphocytes

Plasma cells

Sputum cultures obtained from the patient described in the previous question are positive for Streptococcus pneumoniae. Removal of bacteria from the alveolar air spaces in this patient involves opsonization by complement, an important step in mediating which of the following leukocyte functions?

Phagocytosis

A 14-year-old boy receives a laceration on his forehead during an ice hockey game. When he is first attended to by the medic, there is blanching of the skin around the wound. Which of the following mechanisms accounts for this transient reaction to neurogenic and chemical stimuli at the site of injury?

Constriction of precapillary arterioles

An 8-year-old girl with asthma presents with respiratory distress. She has a history of allergies and upper respiratory tract infections. She also has history of wheezes associated with exercise. Which of the following mediators of inflammation is the most powerful stimulator of bronchoconstriction and vasoconstriction in this patient?

Leukotrienes

Which of the following preformed substances is released from mast cells and platelets, resulting in increased vascular permeability in the lungs of the patient described in the question above?

Leukotrienes (SRS-A)

A 75-year-old woman complains of recent onset of chest pain, fever, and productive cough with rust-colored sputum. A chest x-ray reveals an infiltrate in the right middle lobe. Sputum cultures are positive for Streptococcus pneumoniae. Phagocytic cells in this patient's affected lung tissue generate bacteriocidal hypochlorous acid using which of the following enzymes?

Myeloperoxidase

A 28-year-old woman cuts her hand while dicing vegetables in the kitchen. The wound is cleaned and sutured. Five days later, the site of injury contains an abundance of chronic inflammatory cells that actively secrete interleukin-1, tumor necrosis factor-α, interferon-α, numerous arachidonic acid derivatives, and various enzymes. Name these cells.

Macrophages

A 25-year-old machinist is injured by a metal sliver in his left hand. Over the next few days, the area around the sliver becomes reddened, tender, swollen, and feels warm to the touch. Redness at the site of injury in this patient is caused primarily by which of the following mechanisms?

Vasodilation

The patient described in the question above goes to the emergency room to have the sliver removed. Which of the following mediators of inflammation plays the most important role in stimulating platelet aggregation at the site of injury following this minor surgical procedure?

Thromboxane A2

Arachidonic Acid Derivatives

Leukotrienes—chemotaxis, vascular permeability, bronchospasm

Lipoxins—vasodilatation, inhibition of neutrophil chemotaxis, monocyte adhesion

Thromboxane—platelet aggregation, thrombosis

Prostacyclin—opposes the effects of thromboxane

Prostaglandins—smooth muscle contraction

Twenty-four hours later, endothelial cells at the site of injury in the patient described in the above question release a chemical mediator that inhibits further platelet aggregation. Name this mediator of inflammation.

Prostaglandin (PGI2)

. A 37-year-old man with AIDS is admitted to the hospital with a 3-week history of chest pain and shortness of breath. An x-ray film of the chest shows bilateral nodularities of the lungs. A CT-guided lung biopsy is shown. The multinucleated cell in the center of this field is most likely derived from which of the following inflammatory cells?

Macrophages

How are granuloma formed?

Formed in response to bacteria or fungi that cannot be readily eliminated.

M. tuberculosis or Histoplasma capsulatum

MQ becomes activate and transform into epitheloid cells

Some epitheloid cells fuse to become multinucleated cells.

A 45-year-old woman with autoimmune hemolytic anemia presents with increasing fatigue. Which of the following mediators of inflammation is primarily responsible for antibody-mediated hemolysis in this patient?

Complement proteins

A 25-year-old woman presents with a 2-week history of febrile illness and chest pain. She has an erythematous, macular facial rash and tender joints, particularly in her left wrist and elbow. A CBC shows mild anemia and thrombocytopenia. Corticosteroids are prescribed for the patient. This medication induces the synthesis of an inhibitor of which of the following enzymes in inflammatory cells?

Phospholipase A2

A 25-year-old woman develops a sore, red, hot, swollen left knee. She has no history of trauma and no familial history of joint disease. Fluid aspirated from the joint space shows an abundance of segmented neutrophils. Transendothelial migration of acute inflammatory cells into this patient's joint space was mediated primarily by which of the following families of proteins?

Integrins

Aspirin is effective in relieving symptoms of acute inflammation in the patient described in the above question because it inhibits which of the following enzymes?

Cyclooxygenase

labile cells

Epidermis

stable cells

A. Pancreatic Islets

B. Liver

C. Adrenal Cortex

D.Vascular Endothelium

Which one of the following are cardinal features of granulation tissue?

Proliferating capillaries and fibroblasts

The most important factor that determines whether a wound will heal by primary intention or bysecondary intention is

Apposition of the edges

Which of the following organs is the most likely to regenerate following injury?

liver

Wound contraction results from

Myofibroblast action

A collection of modified macrophages (epithelioid cells), with a rim of small lymphocytesconstitutes a/an

granuloma

A single 1 cm infarct of the kidney will heal by

Disorderly regeneration

Delay in the formation of scar tissue results from each of the following EXCEPT

Corticosteroid therapy

Granulation tissue is a histologic feature of each of the following EXCEPT

Healing of soft tissue abscess

The main feature of a healing wound is:

Granulation tissue

Polymorphonuclear leukocytes (neutrophils) are by definition part of

A granuloma

Esophageal stricture following ingestion of a caustic chemical is primarily caused by

Contracture

A keloid is composed predominantly of:

Dense collagen

A function of histiocytes is:  A

Phagocytosis

Early granulation tissue is BEST characterized by the presence of:

Fibronectin, fibrin, type I collagen

Which one of the following statements is FALSE?

Neurons in the brain can regenerate, provided that granulation tissue has time to form, before scarring.

Which one of the following statements about the cell cycle is TRUE?

Slowly dividing cells spend more time in M phase than rapidly dividing cells.

A 74-year-old woman presents with acute chest pain and shortness of breath. Cardiac catheterization demonstrates occlusion of the left anterior descending coronary artery. Laboratory studies and ECG are consistent with acute myocardial infarction. Which of the following is the most likely pathologic finding in the affected heart muscle 4 weeks later?

Collagen-rich scar tissue

A 4-year-old boy falls on a rusty nail and punctures his skin. The wound is cleaned and covered with sterile gauze. Which of the following is the initial event in the healing process?

Formation of a fibrin clot.

An 82-year-old man dies 4 years after developing congestive heart failure. He had a history of multiple myocardial infarcts over the past 10 years. What is the predominant type of collagen found in this mature scar tissue?

type I

A 25-year-old woman sustains a deep laceration over her right forearm in a motorcycle accident. The wound is cleaned and sutured. Which of the following cell types mediates contraction of the wound?

Myofibroblasts

During the next 3 months, the wound heals with formation of a linear scar. Which of the following nutritional factors is required for proper collagen assembly in the scar tissue of the patient described in Question 4?

Vitamin C.

A 58-year-woman undergoes lumpectomy for breast cancer. One month following surgery, she notices a firm 0.3-cm nodule along one edge of the surgical incision. Biopsy of this nodule reveals chronic inflammatory cells, multinucleated giant cells, and fibrosis. The multinucleated cells in this nodule most likely formed in response to which of the following pathogenic stimuli?

Foreign material

A 10-year-old boy trips at school and scrapes the palms of his hands. The wounds are cleaned and covered with sterile gauze. These superficial abrasions will heal primarily through which of the following pathways?

Regeneration

Which of the following cellular processes is involved in the restoration of normal epithelial structure and function in the patient described in Question above?

Deposition of collagen-rich extracellular matrix

A 34-year-old woman has a benign nevus removed from her back under local anesthesia. Which of the following families of adhesion molecules is the principal component of the "provisional matrix" that forms during early wound healing?

Fibronectins

. Which of the following families of glycoproteins plays the most important role in regulating the migration and differentiation of leukocytes and connective tissue cells during wound healing in the patient described in the Question above?

Integrins

. A 29-year-old carpenter receives a traumatic laceration to her left arm. Which of the following is the most important factor that determines whether this wound will heal by primary or secondary intention?

Apposition of edges

A 9-year-old boy receives a deep laceration over his right eyebrow playing ice hockey. The wound is cleaned and sutured. Which of the following describes the principal function of macrophages that are present in the wound 24-48 hours after injury?

Phagocytosis

. A 69-year-old woman with a history of hypertension is hospitalized after suffering a mild stroke. Which of the following cells is the principal mediator of tissue repair in the brain of this patient?

Glial cells

A 30-year-old fire fighter suffers extensive third-degree burns over his arms and hands. This patient is at high risk for developing which of the following complications of wound healing?

Contracture

A 15-year-old boy with asthma is brought to the physician's office in acute respiratory distress. Physical examination shows expiratory wheezes and use of accessory muscles for inspiration. Which of the following biologic responses is mediated by leukotrienes C4, D4, and E4 formed in the lungs of this patient with bronchial asthma?

Smooth muscle contraction