Question 1
A 42-year-old man comes to the physician because of multiple lesions over his body.
Physical examination shows flaccid bullous erosions involving the upper and lower
extremities. A biopsy specimen of one of the lesions shows extensive epidermal
acantholysis resulting in the formation of an intraepidermal blister. An intact basal layer of
keratinocytes adherent to the basement membrane is identified. Which of the following is
most likely related to the pathogenesis of this disorder?
Select one:
A. Immediate (type I) hypersensitivity reaction to a topically applied agent
B. Infection with a herpesvirus
C. Development of autoantibodies against desmosomal proteins
D. Deposition of lga-containing immune complexes within dermal papilla
E. Mutation of an anchoring filament protein
CORRECT ANSWER
C. Development of autoantibodies against desmosomal proteins
Question 2
A 75 year old man presents to the orthopedic clinic with the complaint of bone pain. His
laboratory report shows elevated level of serum alkaline phosphatase. A histologic
examination shows haphazardly oriented, prominent cement lines, that create a mosaic
pattern of lamellar bone. Which of the following cell types is most likely involved in the
initial lesion of his condition?
Select one:
A. Osteoclasts
1
,B. Osteoblasts
C. Fibroblast
D. Endothelial cells
E. Chondrocytes
CORRECT ANSWER
A. Osteoclasts
Question 3
A 50-year-old woman is brought to the emergency department because of a 2-hour history
of shortness of breath and chest pain that radiates to her back between the shoulder
blades. Her respirations are 28/min. Physical examination shows diaphoresis. An ECG
shows no abnormalities. Coronary angiography shows occlusion of the marginal branch of
the left anterior descending coronary artery. A percutaneous coronary revascularization is
done. Due to revascularization free radicals mediate cardiac muscles injury expected
because her serum concentrations of myocardial creatine kinase (CK-MB) and troponin I
are increased. Which of the following mechanisms best explains these laboratory findings?
Select one:
A. Membrane lipid peroxidation
B. Liquefactive necrosis of the myocardium
C. Cell shrinkage
D. Protease inactivation by cytoplasmic free calcium ions
E. Formation of apoptotic bodies
CORRECT ANSWER
A. Membrane lipid peroxidation
Question 4
Which of the following cells in the inner ear are involved in detecting movements of the
head?
2
,Select one:
A. Outer pillar cells
B. Cells of Hensen
C. Inner pillar cells
D. Hair cells in the organ of Corti
E. Hair cells in the maculae
CORRECT ANSWER
E. Hair cells in the maculae
Question 5
An 11-year-old boy has repeated episodes of staphylococcal pneumonia. When incubated
in vitro with Staphylococcus aureus, his peripheral blood neutrophils fail to demonstrate a
respiratory burst and do not kill the microorganisms, even though electron microscopy of
the neutrophils shows bacterial cells within phagosomes. This failure to kill phagocytosed
organisms is due to a deficiency of which of the following?
Select one:
A. Lactoferrin
B. NADPH oxidase
C. Superoxide dismutase
D. Lysozyme
E. Lysosomal proteases
CORRECT ANSWER
B. NADPH oxidase
Question 6
3
, A 76-year-old man with congestive heart failure comes to the physician because of a 1-
month history of shortness of breath after walking up a flight of stairs. He has had
frequent nausea, and he has had to use two pillows to sleep during this period. Diffuse,
moist crackles are heard over both lungs. There is pitting edema above the ankles. Which
of the following best describes the function of the product secreted by the atrial myocytes
in this patient?
Select one:
A. Decreased glomerular filtration rate
B. Increased sodium reabsorption
C. Induction of vasoconstriction
D. Inhibition of renin release
E. Stimulation of aldosterone release
CORRECT ANSWER
D. Inhibition of renin release
Question 7
Various regions of the respiratory system are reviewed at autopsy for evidence of
histopathology. Which of the following features is first to disappear as the epithelium
changes along the respiratory tube?
Select one:
A. Elastic fibers
B. Smooth muscle
C. Epithelium
D. Cartilage
E. Cilia
CORRECT ANSWER
D. Cartilage
4
A 42-year-old man comes to the physician because of multiple lesions over his body.
Physical examination shows flaccid bullous erosions involving the upper and lower
extremities. A biopsy specimen of one of the lesions shows extensive epidermal
acantholysis resulting in the formation of an intraepidermal blister. An intact basal layer of
keratinocytes adherent to the basement membrane is identified. Which of the following is
most likely related to the pathogenesis of this disorder?
Select one:
A. Immediate (type I) hypersensitivity reaction to a topically applied agent
B. Infection with a herpesvirus
C. Development of autoantibodies against desmosomal proteins
D. Deposition of lga-containing immune complexes within dermal papilla
E. Mutation of an anchoring filament protein
CORRECT ANSWER
C. Development of autoantibodies against desmosomal proteins
Question 2
A 75 year old man presents to the orthopedic clinic with the complaint of bone pain. His
laboratory report shows elevated level of serum alkaline phosphatase. A histologic
examination shows haphazardly oriented, prominent cement lines, that create a mosaic
pattern of lamellar bone. Which of the following cell types is most likely involved in the
initial lesion of his condition?
Select one:
A. Osteoclasts
1
,B. Osteoblasts
C. Fibroblast
D. Endothelial cells
E. Chondrocytes
CORRECT ANSWER
A. Osteoclasts
Question 3
A 50-year-old woman is brought to the emergency department because of a 2-hour history
of shortness of breath and chest pain that radiates to her back between the shoulder
blades. Her respirations are 28/min. Physical examination shows diaphoresis. An ECG
shows no abnormalities. Coronary angiography shows occlusion of the marginal branch of
the left anterior descending coronary artery. A percutaneous coronary revascularization is
done. Due to revascularization free radicals mediate cardiac muscles injury expected
because her serum concentrations of myocardial creatine kinase (CK-MB) and troponin I
are increased. Which of the following mechanisms best explains these laboratory findings?
Select one:
A. Membrane lipid peroxidation
B. Liquefactive necrosis of the myocardium
C. Cell shrinkage
D. Protease inactivation by cytoplasmic free calcium ions
E. Formation of apoptotic bodies
CORRECT ANSWER
A. Membrane lipid peroxidation
Question 4
Which of the following cells in the inner ear are involved in detecting movements of the
head?
2
,Select one:
A. Outer pillar cells
B. Cells of Hensen
C. Inner pillar cells
D. Hair cells in the organ of Corti
E. Hair cells in the maculae
CORRECT ANSWER
E. Hair cells in the maculae
Question 5
An 11-year-old boy has repeated episodes of staphylococcal pneumonia. When incubated
in vitro with Staphylococcus aureus, his peripheral blood neutrophils fail to demonstrate a
respiratory burst and do not kill the microorganisms, even though electron microscopy of
the neutrophils shows bacterial cells within phagosomes. This failure to kill phagocytosed
organisms is due to a deficiency of which of the following?
Select one:
A. Lactoferrin
B. NADPH oxidase
C. Superoxide dismutase
D. Lysozyme
E. Lysosomal proteases
CORRECT ANSWER
B. NADPH oxidase
Question 6
3
, A 76-year-old man with congestive heart failure comes to the physician because of a 1-
month history of shortness of breath after walking up a flight of stairs. He has had
frequent nausea, and he has had to use two pillows to sleep during this period. Diffuse,
moist crackles are heard over both lungs. There is pitting edema above the ankles. Which
of the following best describes the function of the product secreted by the atrial myocytes
in this patient?
Select one:
A. Decreased glomerular filtration rate
B. Increased sodium reabsorption
C. Induction of vasoconstriction
D. Inhibition of renin release
E. Stimulation of aldosterone release
CORRECT ANSWER
D. Inhibition of renin release
Question 7
Various regions of the respiratory system are reviewed at autopsy for evidence of
histopathology. Which of the following features is first to disappear as the epithelium
changes along the respiratory tube?
Select one:
A. Elastic fibers
B. Smooth muscle
C. Epithelium
D. Cartilage
E. Cilia
CORRECT ANSWER
D. Cartilage
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