UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM I 1995-1996 INSTRUCTIONS For the multiple-choice items, including the pictures, fill in your answers on the answer sheet provided. The matching items use each choice ONCE. For the completion items, put your answers on the exam sheet. Use ink if you have it. Your instructor will only review possible grading errors if there is no evidence of erasure. We have tried to write a fair test, but there will surely be problems with certain items. If you have a question, raise you hand and we'll talk about it QUIETLY (don't phonate!) during the exam. IF MEDICAL SCHOOL WERE EASY, YOUR DEGREE WOULD BE WORTHLESS. GOOD LUCK! Matching: Those molecules! A. bcl-2 gene product B. cachectin / "tumor necrosis factor" C. dynein D. fas/Apo1 product E. melatonin 36. Free-radical extinguisher [E] (*) 37. Death trigger [D] (*) 38. With mycobacterial wall products, causes caseation [B] (*) 39. "Mover and shaker" protein of cilia, absent in Kartagener's [C] (*) 40. Prevents apoptosis [A] (*) Matching: Those words! A. pathogen B. pathogenesis C. pathognomonic D. sign E. symptom 41. A microbe that causes disease [A] (*) 42. Finding that tells you "it can only be this particular disease" [C] (*) 43. Story of "how a disease develops" [B] (*) 44. What the patient noticed and then told you [E] (*) 45. What you found on physical examination [D] (*) Matching: Types of immune injury. A. Arthus local reaction, and generalized serum sickness B. Goodpasture's dread hemoptysis and renal-failure C. Hashimoto's thyroid goiter-and-failure D. Sneezy-wheezies after playing in the ragweed field E. Tuberculin skin test turned out positive 46. Type I atopic immediate anaphylactic hypersensitivity [D] (*) 47. Type II antibody-mediated cytotoxicity [B] (*) 48. Type III immune complex injury [A] (*) 49. Type IV classic delayed hypersensitivity [E] (*) 50. Type IV antibody-dependent cell-mediated cytotoxicity [C] (*) Matching: A. "Mixed connective tissue disease" B. Polymyositis-dermatomyositis C. Sj”gren's syndrome D. Systemic lupus E. Systemic sclerosis ("scleroderma") 51. Consistent with etymologic "wolf" associations, patients with this disease are more likely to have dogs with this disease [D] (*) 52. Garden-hose esophagus, and antibodies against topoisomerase [E] (*) 53. "Heliotrope-colored eyelids", and anti-tRNA-synthetase [B] (*) 54. Dry eyes, dry mouth, anti-Ro [C] (*) 55. Anti-U1-ribonucleoprotein, and a good response to steroids [A] (*) Matching: Which white cell comes out for which infection? A. Eosinophils B. Lymphocytes C. Macrophages D. Neutrophils E. Plasma cells 56. Bacterial infections other than typhoid fever[D] (*) 57. Classic typhoid fever [C] (*) 58. Metazoan parasites (worms), classic allergy [A] (*) 59. Syphilis and Lyme disease spirochetes[E] (*) 60. Viruses and rickettsia [B] (*) Matching: A. Angelmann B. Marfan's C. Prader-Willi D. testicular feminization E. Waardenberg's 61. different-colored eyes, deafness [E] (*) 62. string-bean build, "fibrillin" mutation [B] (*) 63. "happy puppet" [A] (*) 64. pudgy, "almond eyes", mentally a bit slow, nice so long as they have their jelly donuts [C] (*) 65. beautiful female model gets told "she" is really a "he"... [D] (*) Matching: A. anticipation B. dot-blotting C. imprinting D. knockout E. lyonization 66. A disease gets worse in each generation [A] (*) 67. A gene functions differently depending on which parent provided it [C] (*) 68. Random inactivation of an X-chromosome which will remain the inactivated one in the cell's progeny [E] (*) 69. The helpful mouse [D] (*) 70. A way of detecting a gene without electrophoresis [B] (*) Matching: A. anasarca B. hamartoma C. hyperemia D. loculation E. vegetation 71. A mass of bacteria growing in fibrin on a heart valve [E] (*) 72. Severe, whole-body edema [A] (*) 73. The arterioles dilated and the area turned red [C] (*) 74. The right tissue types for an organ, but in the wrong quantities and arrangement in a particular area [B] (*) 75. Fibrin or scar dividing an effusion [D] (*) 76. ONE KODACHROME. Joel works out and exhibits muscular A. atrophy B. dystrophy C. hyperplasia D. hypertrophy (*) E. metaplasia 77. ONE KODACHROME. Not something the surgeon likes to see. What do you think it is? A. cancer of the large intestine B. cancer of the small intestine C. infarct (*) D. peritonitis E. pseudomembranous enterocolitis 78. ONE KODACHROME. The renal shutdown was due to A. atheroembolization (*) B. poisoning, possibly mercury C. shock kidney D. thromboembolization E. tuberculosis 79. ONE KODACHROME. Surgical site A. abscess B. anaplastic cancer C. granuloma (*) D. hemorrhage (massive) E. ongoing tissue necrosis without suppuration 80. ONE KODACHROME. Heart. What's wrong? A. abscess with fungi visible ("balloon animals") B. healed infarct C. normal except for abundant lipofuscin D. recent infarct (days) (*) E. recent infarct (weeks, granulation tissue) 81. ONE KODACHROME. Gaucher's disease tissue. What's stored? A. ceramide trihexose B. ganglioside C. glucocerebroside (*) D. mucopolysaccharide E. sphingomyelin 82. ONE KODACHROME. Lung alveoli. The hematoxylin is a bit more red than you're accustomed to; it is far darker than the eosin. What's the process? A. aspiration pneumonia with foreign-body reaction B. congestion due to mitral valve rupture C. dystrophic calcification due to tuberculosis D. metastatic calcification due to parathyroid adenoma (*) E. suppuration due to necrotizing pneumonia 83. ONE KODACHROME. Pancreas. What's the diagnosis? A. fresh abscess B. fresh hemorrhage C. fresh infarct D. old fat necrosis (*) E. old hemorrhage with hemosiderin 84. ONE KODACHROME. Hypertrophied heart. The pigment to which your instructor is pointing is A. alkapton B. fresh blood C. hemosiderin D. lipofuscin (*) E. melanin 85. ONE KODACHROME. Vessel in soft tissue. The most likely diagnosis is A. amyloidosis B. fresh thrombus C. polyarteritis nodosa D. recanalized thrombus E. Wegener's granulomatosis (*) 86. ONE KODACHROME. Liver. You see A. fatty change B. bile plugs C. necrosis and suppuration ("alcoholic hepatitis") D. a & b (*) E. a, b, & c 87. ONE KODACHROME. Pancreas from a diabetic. The hyaline material in the islands is A. alcoholic hyaline (diabetes secondary to EtOH pancreatitis) B. amyloid (*) C. caseous necrosis D. coagulation necrosis E. fibrin 88. ONE KODACHROME. The white blood cell in the center is a(n): A. basophil (*) B. eosinophil C. lymphocyte D. neutrophil E. plasma cell 89. ONE KODACHROME. Methenamine silver stain from an AIDS patient. What's the infectious organism? A. candida fungus (*) B. cryptosporidium protozoan C. herpes virus (simplex or zoster) D. Kaposi's "sarcoma" E. toxoplasmosis protozoan 90. ONE KODACHROME. Coronary artery lesion.... A. amyloidosis B. fresh thrombus C. granulomatous vasculitis, possibly sarcoid D. polyarteritis nodosa E. recanalized thrombus (*) 91. ONE KODACHROME. Lung mass. You are looking at A. bacterial infection with many neutrophils B. cancer (*) C. granuloma D. pale (white) infarct E. red infarct 92. ONE KODACHROME. Radiation therapy is MOST LIKELY to produce which vessel change? A. amyloidosis B. caseation C. fibrinoid necrosis (*) D. granuloma formation E. liquefaction necrosis 93. TWO KODACHROMES. Patient and tissue electron micrograph. The electron micrograph shows: A. amyloid (*) B. dense collagen with characteristic periodicity C. mitochondrial calcifications of cell death D. myelin figures of acute cell injury E. parking-lot crystals of mitochondrial myopathy 94. ONE KODACHROME. This syphilitic lesion of the liver will exhibit a preponderance of A. basophils B. eosinophils C. hyaline inclusion bodies D. neutrophils E. plasma cells (*) 95. ONE KODACHROME. Kidney. The predominant cell in the infiltrate is the A. eosinophil B. lymphocyte C. macrophage D. neutrophil (*) E. plasma cell 96. ONE KODACHROME. What's this lesion involving a small vein? A. amyloid B. ante-mortem thrombus (*) C. congestion D. polyarteritis nodosa E. post-mortem thrombus 97. ONE KODACHROME. Pancreas from a teen with beta-thalassemia major, who has received many blood transfusions. The pigment is: A. bile (reflux up ampulla of Vater) B. ferritin C. hemosiderin (*) D. lipofuscin from hepatitis B infection E. melanin 98. ONE KODACHROME. Lung from a patient with longstanding, mild mitral stenosis. What is the brown pigment in the macrophages? A. aspirated tea B. carbon C. hemosiderin (*) D. lipofuscin E. melanin 99. ONE KODACHROME. Glomerulus from a patient who bled from every orifice after bad snakebite, then died. What's the hyaline mass in the middle of the tuft? A. amyloid B. basement membrane C. fibrin and platelets (*) D. Mallory's hyaline E. snake venom precipitate (venoms are protein) 100. ONE KODACHROME. Bubonic plague features rapidly-enlarging lymph nodes draining the site of inoculation of Y. pestis bacteria. Based on what you already know, what would you expect to see on tissue exam? A. apoptosis without inflammation B. caseation necrosis with macrophages predominant C. hemorrhage, edema, and a paucity of cells D. neutrophils, macrophages, fibrin, and necrosis (*) E. predominantly plasma cells BONUS ITEMS: 101. ONE KODACHROME. What's a psammoma body? [I need something about calcium, at a minimum] (*) 102. ONE KODACHROME. What's the lesion in the skin near the eye, shown here? [xanthoma / xanthelasma] (*) 103. ONE KODACHROME. Lung. What's the lesion? [thromboembolus, will take thrombus or embolus] (*) 104. ONE KODACHROME. Colon. What bacterium causes this lesion? [C. difficile] (*) 105. What is "anaplasia"? [ugly cells indicating genetic damage / malignancy] (*) 106. What do we mean by the "incidence" of a disease? [NEW cases per unit time] (*) 107. Sketch the superoxide radical. [O.-2] (*) 108. What's "pyknosis" of the nucleus? [shank and got dark OR means cells is dead] (*) 109. What's "atresia"? [lumen did not form] (*) 110. What's a hapten? [incomplete antigen / small molecule turns big one antigenic] (*)111. Thalidomide, the infamous teratogen, is coming back into use because it selectively suppresses production of which cytokine? [alpha-TNF / cachectin] (*) 112. Myeloperoxidase is the autoantigen in what disease? [polyarteritis is good enough] (*) 113. "Allergy freaks" are now known to carry an unusual allele for what important protein? [mast-cell IgE receptor; "IgE receptor" gets credit, "IgE" doesn't] (*) 114. What bacterium is known to be a "molecular mimic" for an axonal protein, which probably explains the neuropathy seen in patients with this infection? [Lyme disease] (*) 115. Which protein is Amyloid C ("amyloid AF") beta-pleated from? This is the type that causes the painful familial neuropathy, and for which liver transplantation is now being performed. [transthyretin] (*) 116. Delayed-prolonged leakage! What's the histopathology of a sunburn? Be sure you mention what's really happening to the skin capillaries! [apoptosis] (*) 117. What is granulation tissue? [young scar OR fibrin being invaded] (*) 118. In some families, the men are XX. How can this be? [testis-determining factor translocated to X] (*) 119. P.T. Barnum ("There's a sucker born every minute") exhibited a pair of Siamese (conjoined) twins named Chang and Eng. The two men had a common chest and abdominal wall and probably a common peritoneal cavity, but separate circulatory systems. They had separate wives, separate households, and 22 children between them. One day, one of the twins died (I forget which one). The other twin, who had been healthy when he found his fellow dead, died too. The second twin's death was attributed to "emotional shock". There's a sucker born every minute. What killed the second twin? Be specific. [I need something about cell breakdown products / lactic acid / and-or bacteria from the corpse getting into the living twin's bloodstream] (*) 120. ONE KODACHROME. Why is this man smiling? [he's a toothless albino XYY banjo player, +1 for any correct answer] (*)