Infarcts. A. several concurrent infarcts in the "watershed" zones B. often red, often white, often mixed C. usually venous, therefore always red D. wedge-shaped, and almost always red E. wedge-shaped, and almost always pale 36. heart subendocardium, splenic flexure of colon, cerebral cortex [A] 37. lung [D] 38. small intestine, colon, testis [C] 39. spleen, kidney [E] 40. transmural myocardial infarct, embolic cerebral stroke [B] "Collagen-vascular disease is misnomer!" A. CREST syndrome B. dermatomyositis-polymyositis C. mixed connective tissue disease D. scleroderma E. systemic lupus 41. anti-centromeres, calcium in the fingertips, mild disease [A] 42. anti-double stranded DNA; "great imitator", avoid the sunlight [E] 43. anti-Jo, in adults often a marker for occult cancer [B] 44. anti-topoisomerase; kidneys, esophagus, skin, lung, gut fibrosis [D] 45. anti-U1-RNP; bad Raynaud's and bad arthritis [C] Immune injury patterns. A. Type I immediate-type atopy B. Type II antibody-and-complement cytotoxicity C. Type III immune-complex disease D. Type IV-A classic delayed hypersensitivity E. Type IV-B antibody-dependent cell-mediated cytotoxicity 46. classic tuberculin skin reaction, poison ivy [D] 47. Goodpasture's; hemolytic transfusion reaction [B] 47. hay fever, cat allergy, egg allergy, bee-sting allergy, anaphylaxis [A] 49. hepatitis B polyarteritis, serum sickness, Arthus reaction, 'flu aches [C] 50. Hashimoto's autoimmune thyroiditis, Jack Kennedy's autoimmune adrenalitis [E] Altered cell growth. A. atrophy B. dysplasia C. hyperplasia D. hypertrophy E. metaplasia 51. adrenal cortex shrank after the pituitary stopped making ACTH [A] 52. bizarre, precancerous cells on a pap smear of the cervix [B] 53. pumped-up muscles in a bodybuilder [D] 54. red cell marrow precursors after a blood donation [C] 55. stratified squamous epithelium in a smoker's airway [E] Body water. A. angioedema B. ascites C. edema D. effusion E. exudate 56. excess extracellular fluid anywhere [C] 57. excess extracellular fluid which is abnormally rich in protein [E] 58. excess free fluid specifically in the peritoneal cavity [B] 59. free fluid of any kind in the pleural, peritoneal, or pericardial cavity [D] 60. sudden accumulation of fluid, typically in the absence of C1-esterase inhibitor [A] A. anticipation B. chimerism C. lyonization D. mosaicism E. pleiotropism 61. a single abnormal gene affects several organs, in surprisingly different ways [E] 62. a person has a mix of genotypes, as from mutations after fertilization, for example in McCune-Albright, or birthmarks, or artwork made of different-colored stones [D] 63. a person, most likely healthy, who has somatic cells from two different fertilizations, like the monster of Greek mythology [B] 64. inactivation of one of the X-chromosomes, named for the famous lady geneticist [C] 65. "Sherman's paradox", as in myotonic dystrophy; each generation of affected persons has the disease more severely, enabling you to predict or see the results ahead of time [A] 66. Rudolf Virchow, a contemporary of A.T. Still, was the first doctor to... A. describe the four cardinal signs of inflammation B. emphasize "correlating structure and function" C. emphasize hand-washing and good ward hygiene D. publish a scientifically-sound autopsy series * E. use the microscope to study diseased tissue systematically 67. The newest worthwhile technique for prognosticating HIV infection is A. calculating the CD4/CD8 ratio B. counting CD4 cells C. measuring percentages of infected T-cells D. measuring levels of antibodies * E. quantitating the amount of circulating virus 68. Saquinavir, the new wonder-drug for HIV, works by A. enhancing B-cell mediated immunity B. enhancing T-cell mediated immunity C. inhibiting integrase * D. inhibiting protease E. inhibiting reverse transcriptase 69. ONE KODACHROME. Your lecturer, around the time he found out that he had tuberculosis. He used to be a lot stronger. His muscles exhibit A. aplasia B. anaplasia * C. atrophy D. dystrophy E. hypoplasia 70. ONE KODACHROME. Your lecturer's lung, if his tuberculosis had killed him. What type of necrosis? * A. caseous B. coagulation C. fibrinous D. gummatous E. liquefactive / suppurative 71. ONE KODACHROME. Of these choices, which is the best opsonin? A. leukotriene. * B. immunoglobulin C. interleukin 1 D. prostaglandin E. tumor necrosis factor 72. ONE KODACHROME. Which type of giant cell? * A. Foreign body B. Langhans 73. ONE KODACHROME. The thrombus is * A. ante-mortem B. post-mortem 74. ONE KODACHROME. The carbon pigment is located within A. basal cells B. fibroblasts C. lymphocytes * D. macrophages E. mast cells 75. ONE KODACHROME. Hydrocele fluid is located within the A. cerebral ventricles B. peritoneal cavity C. pleural cavity, causing restrictive disease D. testicular parenchyma * E. tunica vaginalis 76. ONE KODACHROME. The pigment in this section of heart is A. alkapton (homogentisic acid) B. carbon C. hemosiderin * D. lipofuscin E. melanin 77. ONE KODACHROME. From an autopsy. It's probably A. abscess B. cancer * C. foreign-body reaction to a plastic suture D. infarct E. tuberculosis 78. ONE KODACHROME. Liver exhibiting * A. bile plug B. cirrhosis C. fatty change with alcoholic hyaline ("alcoholic hepatitis") D. fatty change without alcoholic hyaline E. iron overload 79. ONE KODACHROME. Artery. The needle-shaped crystals are A. calcium salts * B. cholesterol C. dead cells that have dropped out D. iron deposit E. smooth muscle cells 80. ONE KODACHROME. Lung. The hyaline membranes are composed largely of A. amyloid B. basement membrane * C. fibrin D. monoclonal immunoglobulin E. surfactant 81. ONE KODACHROME. Heart. It shows A. brown atrophy B. fatty change (diphtheria) * C. fatty ingrowth D. hypertrophy (aerobic athlete) E. myocardial infarct / necrosis 82. ONE KODACHROME. Atrium, including epicardial surface, from a patient with kidney failure and uremia. What is the hyaline material? A. actin and myosin B. amyloid C. basement membrane * D. fibrin E. immunoglobulin 83. ONE KODACHROME. Mallory's alcoholic hyaline is composed largely of A. amyloid B. basement membrane C. bile-derived material D. fibrin * E. keratin 84. ONE KODACHROME. It shows A. anaplasia without invasion (i.e., dysplasia) B. coagulation necrosis C. hemorrhage site * D. polys marginating E. suppuration 85. ONE KODACHROME. The round, pink-staining structure is probably a(n): A. blood vessel B. amyloid deposit * C. caseating granuloma D. choristoma E. micro-infarct 86. ONE KODACHROME. Photomicrograph of A. gangrene B. giant mitochondria * C. granulation tissue D. granuloma E. G-spot tissue 87. ONE KODACHROME. Aortic valve, exhibiting * A. dystrophic calcification B. metastatic calcification C. perforation of leaflet, as by endocarditis D. saddle embolus in place E. vegetations on the lines of closure 88. ONE KODACHROME. Aerobic athlete. The heart exhibits A. hyperplasia * B. hypertrophy C. plenty of both, most likely D. neither, getting in shape does not affect the heart muscle itself 89. ONE KODACHROME. Liver. The lesions are probably A. abscesses * B. cysts C. infarcts D. thrombi E. tumors 90. ONE KODACHROME. The patient probably has A. Cheyne-Stokes * B. Ehlers-Danlos C. Marfan's D. tuberous sclerosis E. Von Recklinghausen's 91. ONE KODACHROME. Posterior auricular swelling in a patient with infectious mononucleosis. If someone were foolish enough to biopsy it, the pathologist would report A. dysplasia * B. hyperplasia C. hypertrophy D. metaplasia E. neoplasia 92. ONE KODACHROME. The curious intracellular amyloid of Alzheimer's disease is composed of * A. beta / A4 protein B. HLA molecule light chains C. immunoglobulin light chains D. serum amyloid-associated protein E. transthyretin 93. ONE KODACHROME. Coronary artery. It exhibits A. fibrinoid necrosis as in polyarteritis nodosa B. fresh thrombus C. hyaline accumulation suggesting amyloidosis * D. recanalized thrombus E. rupture and hemorrhage 94. ONE KODACHROME. Excess hemosiderin, as in this pancreas from a hemochromatosis patient: A. becomes a potent autoantigen B. binds to DNA and prevents cell division * C. generates free radicals D. plugs blood vessels E. plugs lymphatic vessels 95. ONE KODACHROME. Tuberous sclerosis is * A. autosomal dominant, presumptive anti-oncogene deletion syndrome B. autosomal recessive, presumptive enzyme deficiency disease C. polygenic disorder with incomplete penetrance D. polygenic disorder with complete penetrance E. X-linked disease, gene not yet cloned 96. ONE KODACHROME. The histology is most consistent with A. granulation tissue B. granuloma formation C. iron overload D. purpura * E. wet gangrene, with lots of neutrophils 97. ONE KODACHROME. This should make you think of A. alcoholism B. amyloidosis C. hemophilia * D. polyarteritis E. syphilis 98. TWO KODACHROMES. The intranuclear inclusions in this case of herpes are composed of A. amyloid B. fibrin C. immunoglobulin D. necrotic debris * E. virus components 99. TWO KODACHROMES. These photographs of muscle exhibit A. atrophy B. hypertrophy * C. mitochondrial myopathy D. necrosis E. storage disease 100. ONE KODACHROME. Colon. It demonstrates.. A. chronic inflammation * B. dysplasia / anaplasia C. gangrene / red infarction D. pseudomembrane formation E. squamous metaplasia BONUS ITEMS: 101. What's the usual activator of clotting factor IX in real life, in your body? [credit for anything with VII in it] 102. What's a paradoxical embolus? [from systemic veins to systemic arteries] 103. What is argyria? [silver salts in the skin] 104. How does diphtheria toxin block the burning of fat? [poisons carnitine] 105. Bantu beer, in sub-Saharan Africa, is notorious for being overloaded with what harmful substance? [iron] 106. What accumulates in myxoid change? [ground substance] 107. Name any prion disease. [Cruetzfeldt-Jakob, scrapie, kuru, Gerstmann-Strassler, familial] [insomnia, mad cow / bovine spongiform, mink encephalopathy] 108. What does transthyretin do for you in health? [carries thyroid hormone and vitamin A] 109. What is a retrovirus? [RNA copied to DNA] 110. What's the main problem for people who are deficient in protein S? [hypercoagulable blood / thrombi] 111. In "chronic granulomatous disease" of children plagued by staphylococci, what cells are defective? [neutrophils] 112. Where are your dynein arms? [in your cilia] 113. What's the fas/Apo1 product? [death-trigger / suicide receptor / receptor tells cell to die] 114. What cells are killed by glutamate excitotoxicity? [neurons] * 115. How can a person who is a pure XX turn out to be a fertile male? [translocated testis determining factor] 116. What do we mean by "imprinting", as in the pathogenesis of Prader-Willi? [mom's and dad's chromosomes are different] 117. Autoantibodies against endothelium have finally been discovered, and are considered to cause some of the damage, in what ANCA-negative disease? [scleroderma] 118. What clinical syndrome results from a defective leptin receptor? [obesity] 119. What's the disease caused, in familial cases, by a mutant superoxide dismutase which produces a poison? [amyotrophic lateral sclerosis] 120. ONE KODACHROME. Why is this man smiling? [just realized he could get a flattop haircut, ] [+1 for any reasonable answer] NAME: ___________________ 100 points University of Health Sciences Pathology Exam I -- 1996-7 INSTRUCTIONS: For the multiple choice items, choose the one best answer. There are a few type-K questions from Quizbank. For the matching items, use each choice exactly once. For the fill-in-the-blank items, we're prefer that you use ink. Think before you write. If there is evidence of erasure, we cannot reconsider the scoring of a contested item. If you have a question, raise you hand and I'll get with you. Please do not phonate. The first person finished posts the key. Write your challenges on it. You are also allowed to follow the standard procedure (see Bryan or me for a challenge form) -- but why wait? This exam is not intended to be especially difficult. Be prepared for somewhat more challenging exams in the future. GOOD LUCK!