, Damjanov: Pathophysiology
Test Bank
Set 1 (questions 1-25)
MULTIPLE CHOICE
1. Cytoplasmic inclusion bodies are found in the liver cells of chronic alcoholics. These inclusions,
known as Mallory’s hyaline, are composed of damaged intermediate filaments covalently bound
to
A. cytochrome P450
B. alanine transaminase
C. ubiquitin
D. actin
E. myosin
ANS: C
Damaged intermediate filaments, like many other damaged cytoplasmic proteins, are covalently
bound to ubiquitin. This process marks the proteins for degradation by cytosolic proteases.
2. Estrogen produced by certain ovarian tumors causes thickening of the endometrium, which most
often represents endometrial
A. hyperplasia
B. hypertrophy
C. atrophy
D. dysplasia
E. metaplasia
ANS: A
Estrogen stimulates the proliferation of endometrial cells, causing thickening of the
endometrium. Such thickening, which is attributable to an increased number of cells, is called
hyperplasia. Hypertrophy implies an increased cell mass due to enlargement of individual cells,
whereas atrophy means reduced size of the cells or tissues. Dysplasia and metaplasia imply
changes in cell differentiation that may occur only if estrogenic stimulation is very long or
combined with the action of additional adverse stimuli, such as carcinogens.
3. Cell death caused by the action of perforin, which is produced by cytotoxic T lymphocytes in
certain cell-mediated immune reactions, is associated with
A. activation of initiating and effector caspases
B. inhibition of adenosine triphosphate (ATP)-dependent sodium/potassium pump
C. increased water content of the cytoplasm
D. influx of sodium into the cytoplasm
E. activation of growth factor XORs on the cell surface
ANS: A
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-2
Through the action of perforin, T lymphocytes induce apoptosis, a form of cell death,
characterized by activation of "suicide pathway enzymes," the most notable of which are
caspases. Inhibition of the ATP-dependent sodium/potassium pump, resulting in an influx of
water and sodium into the cell cytoplasm, is typical of ischemic or toxic cell injury leading to
vacuolar (hydropic) change or necrosis. Cell surface growth factor receptors are not activated by
perforin.
4. Which of the following enzymes plays a crucial role in the scavenging of free reactive oxygen
radicals?
A. alkaline phosphatase
B. cytochrome C oxidase
C. catalase
D. caspase-3
E. adenosine triphosphatase
ANS: C
Catalase is a peroxisomal enzyme that inactivates superoxide, one of the three main free oxygen
radicals. The other two oxygen radicals are hydrogen peroxide and hydroxyl radical. Other
enzymes listed here do not act as scavengers of free oxygen radicals.
5. Which of the following pathogenetic mechanisms plays a role in the pathogenesis of fatty liver
caused by chronic alcohol abuse?
A. increased influx of free fatty acids into the liver
B. decreased esterification of free fatty acids to triglycerides in the liver
C. increased oxidation of free fatty acids
D. increased production of lipoproteins
E. increased degradation of hepatic triglycerides
ANS: A
Alcohol leads to increased hepatic influx of free fatty acids (FFAs) from peripheral stores.
Alcohol also causes increased intrahepatic esterification of FFAs to triglycerides, decreased
oxidation of FFAs, and because of protein malnutrition it reduces the export of lipids in the form
of lipoproteins.
6. Fibrinoid necrosis is typically seen in the
A. myocardium
B. lung parenchyma
C. arteries and arterioles
D. brain parenchyma
E. adrenal cortex
ANS: C
Fibrinoid necrosis typically occurs in arteries affected by immune-mediated vasculitis or in
arteries and arterioles damaged by hypertension of sudden onset.
7. A 60-year-old man died two days after a thrombotic occlusion of the right coronary artery.
Histologically, the myocardial cells appeared necrotic and had small condensed dark blue nuclei.
This nuclear change is called
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-3
A. karyolysis
B. karyorrhexis
C. pyknosis
D. heterochromatin
E. euchromatin
ANS: C
Condensation of nuclei in necrotic cells is called pyknosis (from the Greek word pyknos,
meaning dense). Karyolysis and karyorrhexis are two other nuclear changes found in necrotic
cells. Karyolysis is characterized by dissolution of the nucleus, whereas karyorrhexis is
associated with fragmentation of the nucleus into smaller pieces. Heterochromatin and
euchromatin are parts of the normal nucleus: heterochromatin represents the condensed
transcriptionally active chromatin and euchromatin represents the finely dispersed inactive
chromatin.
8. A 66-year-old woman had a myocardial infarction. Laboratory testing performed 12 hours after
the onset of symptoms disclosed elevated blood concentrations of
A. cytochrome oxidase
B. catalase
C. superoxide dismutase
D. xanthine oxidase
E. creatine kinase
ANS: E
Creatine kinase, an enzyme found in muscle cells, is released from injured muscle cells. It occurs
in two isoforms: isoenzyme creatine kinase MB is found in the myocardial cells and is useful for
diagnosing myocardial infarcts. The isoenzyme MM is found in the skeletal muscle cells and is
elevated in blood after muscle injury or in patients who have myositis.
9. Which of the following biologically active substances produced by endothelial cells leads to
relaxation of smooth muscle cells and inhibits platelet aggregation?
A. thromboxane
B. P-selectin
C. angiotensin II
D. nitric oxide
E. endothelin
ANS: D
Nitric oxide, a very small molecule produced by endothelial cells, was originally known as the
endothelial cell-derived relaxation factor. It induces relaxation of vascular smooth muscle cells
and also inhibits the aggregation of platelets. Endothelin, thromboxane A2, and angiotensin II
cause vascular constriction. P-selectin mediates the rolling of leukocytes and is essential for
subsequent adhesion of leukocytes to endothelial cells during inflammation.
10. A 40-year-old man was hospitalized for high fever and severe headache. A localized cavitary
lesion was found in the brain by computerized tomography. A needle biopsy during exploratory
craniotomy revealed that the lesion contained numerous neutrophils, many of which were dead
or dying. This lesion most likely represents a(n)
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
Test Bank
Set 1 (questions 1-25)
MULTIPLE CHOICE
1. Cytoplasmic inclusion bodies are found in the liver cells of chronic alcoholics. These inclusions,
known as Mallory’s hyaline, are composed of damaged intermediate filaments covalently bound
to
A. cytochrome P450
B. alanine transaminase
C. ubiquitin
D. actin
E. myosin
ANS: C
Damaged intermediate filaments, like many other damaged cytoplasmic proteins, are covalently
bound to ubiquitin. This process marks the proteins for degradation by cytosolic proteases.
2. Estrogen produced by certain ovarian tumors causes thickening of the endometrium, which most
often represents endometrial
A. hyperplasia
B. hypertrophy
C. atrophy
D. dysplasia
E. metaplasia
ANS: A
Estrogen stimulates the proliferation of endometrial cells, causing thickening of the
endometrium. Such thickening, which is attributable to an increased number of cells, is called
hyperplasia. Hypertrophy implies an increased cell mass due to enlargement of individual cells,
whereas atrophy means reduced size of the cells or tissues. Dysplasia and metaplasia imply
changes in cell differentiation that may occur only if estrogenic stimulation is very long or
combined with the action of additional adverse stimuli, such as carcinogens.
3. Cell death caused by the action of perforin, which is produced by cytotoxic T lymphocytes in
certain cell-mediated immune reactions, is associated with
A. activation of initiating and effector caspases
B. inhibition of adenosine triphosphate (ATP)-dependent sodium/potassium pump
C. increased water content of the cytoplasm
D. influx of sodium into the cytoplasm
E. activation of growth factor XORs on the cell surface
ANS: A
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-2
Through the action of perforin, T lymphocytes induce apoptosis, a form of cell death,
characterized by activation of "suicide pathway enzymes," the most notable of which are
caspases. Inhibition of the ATP-dependent sodium/potassium pump, resulting in an influx of
water and sodium into the cell cytoplasm, is typical of ischemic or toxic cell injury leading to
vacuolar (hydropic) change or necrosis. Cell surface growth factor receptors are not activated by
perforin.
4. Which of the following enzymes plays a crucial role in the scavenging of free reactive oxygen
radicals?
A. alkaline phosphatase
B. cytochrome C oxidase
C. catalase
D. caspase-3
E. adenosine triphosphatase
ANS: C
Catalase is a peroxisomal enzyme that inactivates superoxide, one of the three main free oxygen
radicals. The other two oxygen radicals are hydrogen peroxide and hydroxyl radical. Other
enzymes listed here do not act as scavengers of free oxygen radicals.
5. Which of the following pathogenetic mechanisms plays a role in the pathogenesis of fatty liver
caused by chronic alcohol abuse?
A. increased influx of free fatty acids into the liver
B. decreased esterification of free fatty acids to triglycerides in the liver
C. increased oxidation of free fatty acids
D. increased production of lipoproteins
E. increased degradation of hepatic triglycerides
ANS: A
Alcohol leads to increased hepatic influx of free fatty acids (FFAs) from peripheral stores.
Alcohol also causes increased intrahepatic esterification of FFAs to triglycerides, decreased
oxidation of FFAs, and because of protein malnutrition it reduces the export of lipids in the form
of lipoproteins.
6. Fibrinoid necrosis is typically seen in the
A. myocardium
B. lung parenchyma
C. arteries and arterioles
D. brain parenchyma
E. adrenal cortex
ANS: C
Fibrinoid necrosis typically occurs in arteries affected by immune-mediated vasculitis or in
arteries and arterioles damaged by hypertension of sudden onset.
7. A 60-year-old man died two days after a thrombotic occlusion of the right coronary artery.
Histologically, the myocardial cells appeared necrotic and had small condensed dark blue nuclei.
This nuclear change is called
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-3
A. karyolysis
B. karyorrhexis
C. pyknosis
D. heterochromatin
E. euchromatin
ANS: C
Condensation of nuclei in necrotic cells is called pyknosis (from the Greek word pyknos,
meaning dense). Karyolysis and karyorrhexis are two other nuclear changes found in necrotic
cells. Karyolysis is characterized by dissolution of the nucleus, whereas karyorrhexis is
associated with fragmentation of the nucleus into smaller pieces. Heterochromatin and
euchromatin are parts of the normal nucleus: heterochromatin represents the condensed
transcriptionally active chromatin and euchromatin represents the finely dispersed inactive
chromatin.
8. A 66-year-old woman had a myocardial infarction. Laboratory testing performed 12 hours after
the onset of symptoms disclosed elevated blood concentrations of
A. cytochrome oxidase
B. catalase
C. superoxide dismutase
D. xanthine oxidase
E. creatine kinase
ANS: E
Creatine kinase, an enzyme found in muscle cells, is released from injured muscle cells. It occurs
in two isoforms: isoenzyme creatine kinase MB is found in the myocardial cells and is useful for
diagnosing myocardial infarcts. The isoenzyme MM is found in the skeletal muscle cells and is
elevated in blood after muscle injury or in patients who have myositis.
9. Which of the following biologically active substances produced by endothelial cells leads to
relaxation of smooth muscle cells and inhibits platelet aggregation?
A. thromboxane
B. P-selectin
C. angiotensin II
D. nitric oxide
E. endothelin
ANS: D
Nitric oxide, a very small molecule produced by endothelial cells, was originally known as the
endothelial cell-derived relaxation factor. It induces relaxation of vascular smooth muscle cells
and also inhibits the aggregation of platelets. Endothelin, thromboxane A2, and angiotensin II
cause vascular constriction. P-selectin mediates the rolling of leukocytes and is essential for
subsequent adhesion of leukocytes to endothelial cells during inflammation.
10. A 40-year-old man was hospitalized for high fever and severe headache. A localized cavitary
lesion was found in the brain by computerized tomography. A needle biopsy during exploratory
craniotomy revealed that the lesion contained numerous neutrophils, many of which were dead
or dying. This lesion most likely represents a(n)
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
