PATHOLOGY TEST BANK - PRACTICE
EXAM 1 QUESTIONS WITH COMPLETE
ANSWERS
An 11-year-old child falls and cuts his hand. The wound becomes infected. Bacteria
extend into the extracellular matrix around capillaries. In the inflammatory response to
this infection, which of the following cells removes the bacteria?
A B lymphocyte
B Fibroblast
C Macrophage
D Mast cell
E T lymphocyte - Answer-Answer: C
Reasoning: Macrophages in tissues derived from circulating blood monocytes are
phagocytic cells that respond to a variety of stimuli, and they represent the janitorial
crew of the body. The other cells listed are not phagocytes.
Extended reasoning: B cells can differentiate into plasma cells secreting antibodies to
neutralize infectious agents. Fibroblasts form collagen as part of a healing response.
Mast cells can release a variety of inflammatory mediators. T cells are a key part of
chronic inflammatory processes in cell-mediated immune responses.
In an experiment, bacteria are introduced into a per- fused tissue preparation.
Leukocytes leave the vasculature and migrate to the site of bacterial inoculation. The
movement of these leukocytes is most likely to be mediated by which of the following
substances?
A Bradykinin
B Chemokines
C Complement C3a
D Histamine
E Prostaglandins - Answer-Answer: B
Reasoning: Chemokines include many molecules that are chemotactic for neutrophils,
eosinophils, lymphocytes, monocytes, and basophils.
Extended reasoning: Bradykinin causes pain and increased vascular permeability.
Complement C3a causes increased vascular permeability by releasing histamine from
mast cells. Histamine causes vascular leakage. Prostaglandins have multiple actions,
but they do not cause chemotaxis.
A 5-year-old child has a history of recurrent bacterial infections, including pneumonia
and otitis media. Analysis of leukocytes collected from the peripheral blood shows a
deficiency in myeloperoxidase. A reduction in which of the following processes is the
most likely cause of this child's in- creased susceptibility to infections?
A Hydrogen peroxide (H2O2) elaboration
B Hydroxy-halide radical (HOCl-) formation
C Failure of migration resulting from complement
,deficiency
D Phagocytic cell oxygen consumption
E Prostaglandin production - Answer-Answer: B
Reasoning: Myeloperoxidase is present in the azurophilic granules of neutrophils. It
converts H2O2 into HOCl-, a powerful oxidant and antimicrobial agent. Degranulation
occurs as phagolysosomes are formed with engulfed bacteria in phagocytic vacuoles
within the neutrophil cytoplasm.
In an experiment, neutrophils collected from peripheral blood are analyzed for a "burst"
of oxygen consumption. This respiratory burst is an essential step for which of the
following events in an acute inflammatory response?
A Attachment to endothelial cells
B Generation of microbicidal activity
C Increased production in bone marrow
D Opsonization of bacteria
E Phagocytosis of bacteria - Answer-.
Answer: B
Reasoning: The respiratory, or oxidative, burst of neutrophils generates reactive oxygen
species (e.g., superoxide anion) that are important in destruction of engulfed bacteria.
Extended reasoning: Neutrophil attachment to endothelium is aided by adhesion
molecules on both the endothelium and the neutrophil surface. These molecules include
selectins and integrins. Myelopoiesis does not depend on generation of superoxide.
Bacteria are opsonized by complement C3b and IgG, allowing the bacteria to be more
readily phagocytosed.
A 4-year-old girl has had numerous infections with Staphylococcus aureus since
infancy. Genetic testing shows a defect leading to a lack of β2 integrin production.
Which of the following abnormalities of neutrophil function is most likely responsible for
these clinical symptoms?
A Decreased generation of hydroxy-halide radicals (HOCl-)
B Diminished phagocytosis of bacteria opsonized with IgG
C Failure of migration to the site of infection
D Inadequate adhesion on cytokine-activated
endothelium
E Reduced respiratory burst after phagocytosis - Answer-Answer: D
Reasoning: During acute inflammation, in the first stage of extravasation, the
neutrophils "roll over" the endothelium. At this stage, the adhesion between the
neutrophils and endothelial cells is weak. Rolling is mediated by binding of selectins to
sialylated oligosaccharides. The next step, firm adhesion, is mediated by binding of
integrins on the leukocytes to their receptors, intercellular adhesion molecule-1 or
vascular cell adhesion molecule-1 (VCAM-1), on endothelial cells.
Extended reasoning: Integrins have two chains, α and β. A genetic lack of β chains
prevents firm adhesion of leukocytes to endothelial cells. This process depends on
adhesion molecules expressed on the neutrophils and endothelial cells. Formation of
HOCl- requires myeloperoxidase released from neutrophil granules. Phagocytosis of
opsonized organisms depends on engulfment, which requires contractile proteins in the
, neutrophil cytoplasm. Neutrophil migration to a site of infection depends on the
presence of chemotactic factors such as complement C5a that bind to the neutrophil
and activate phospholipase C to begin a series of events that culminate in the influx of
calcium, which triggers contractile proteins. The respiratory burst to kill phagocytized
organisms depends on NADPH oxidase, and a deficiency of this enzyme leads to
chronic granulomatous disease.
A 95-year-old woman touches a pot of boiling water. Within 2 hours, she has marked
erythema of the skin of the fingers of her hand, and small blisters appear on the finger
pads. This has led to which one of the following inflammatory responses?
A Fibrinous inflammation
B Granulomatous inflammation
C Purulent inflammation
D Serous inflammation
E Ulceration - Answer-Answer: D
Reasoning: Serous inflammation is the mildest form of acute inflammation. A blister is a
good example of serous inflammation. It is associated primarily with exudation of fluid
into the subcorneal or subepidermal space. Because the injury is mild, the fluid is
relatively protein-poor.
Extended reasoning: protein-rich exudate results in fibrin accumulation. Granulomatous
inflammation is characterized by collections of transformed macrophages called
epithelioid cells. Acute inflammatory cells, mainly neutrophils, exuded into a body cavity
or space form a purulent (suppurative) exudate, typically associated with liquefactive
necrosis. Loss of the epithelium leads to ulceration.
A 37-year-old man has had midepigastric pain for the past 3 months. An upper
gastrointestinal endoscopy shows a 2-cm, sharply demarcated, shallow ulceration of the
gastric antrum. Microscopic examination of a biopsy from the ulcer base shows
angiogenesis, fibrosis, and mononuclear cell infiltrates with lymphocytes, macrophages,
and plasma cells. Which of the following terms best describes this pathologic process?
A Acute inflammation
B Chronic inflammation
C Fibrinous inflammation
D Granulomatous inflammation
E Serous inflammation - Answer-Answer: B
Reasoning: One outcome of acute inflammation with ulceration is chronic inflammation.
This is particularly true when the inflammatory process continues for weeks to months.
Chronic inflammation is characterized by tissue destruction, mononuclear cell
infiltration, and repair. In acute inflammation, the healing process of fibrosis and
angiogenesis has not begun.
Extended reasoning: In fibrinous inflammation, typically involving a mesothelial surface,
there is an outpouring of protein-rich fluid that results in precipitation of fibrin.
Granulomatous inflammation is a form of chronic inflammation in which epithelioid
macrophages form aggregates. Serous inflammation is an inflammatory process
involving a mesothelial surface (e.g., lining of the pericardial cavity), with an outpouring
of fluid having little protein or cellular content.
EXAM 1 QUESTIONS WITH COMPLETE
ANSWERS
An 11-year-old child falls and cuts his hand. The wound becomes infected. Bacteria
extend into the extracellular matrix around capillaries. In the inflammatory response to
this infection, which of the following cells removes the bacteria?
A B lymphocyte
B Fibroblast
C Macrophage
D Mast cell
E T lymphocyte - Answer-Answer: C
Reasoning: Macrophages in tissues derived from circulating blood monocytes are
phagocytic cells that respond to a variety of stimuli, and they represent the janitorial
crew of the body. The other cells listed are not phagocytes.
Extended reasoning: B cells can differentiate into plasma cells secreting antibodies to
neutralize infectious agents. Fibroblasts form collagen as part of a healing response.
Mast cells can release a variety of inflammatory mediators. T cells are a key part of
chronic inflammatory processes in cell-mediated immune responses.
In an experiment, bacteria are introduced into a per- fused tissue preparation.
Leukocytes leave the vasculature and migrate to the site of bacterial inoculation. The
movement of these leukocytes is most likely to be mediated by which of the following
substances?
A Bradykinin
B Chemokines
C Complement C3a
D Histamine
E Prostaglandins - Answer-Answer: B
Reasoning: Chemokines include many molecules that are chemotactic for neutrophils,
eosinophils, lymphocytes, monocytes, and basophils.
Extended reasoning: Bradykinin causes pain and increased vascular permeability.
Complement C3a causes increased vascular permeability by releasing histamine from
mast cells. Histamine causes vascular leakage. Prostaglandins have multiple actions,
but they do not cause chemotaxis.
A 5-year-old child has a history of recurrent bacterial infections, including pneumonia
and otitis media. Analysis of leukocytes collected from the peripheral blood shows a
deficiency in myeloperoxidase. A reduction in which of the following processes is the
most likely cause of this child's in- creased susceptibility to infections?
A Hydrogen peroxide (H2O2) elaboration
B Hydroxy-halide radical (HOCl-) formation
C Failure of migration resulting from complement
,deficiency
D Phagocytic cell oxygen consumption
E Prostaglandin production - Answer-Answer: B
Reasoning: Myeloperoxidase is present in the azurophilic granules of neutrophils. It
converts H2O2 into HOCl-, a powerful oxidant and antimicrobial agent. Degranulation
occurs as phagolysosomes are formed with engulfed bacteria in phagocytic vacuoles
within the neutrophil cytoplasm.
In an experiment, neutrophils collected from peripheral blood are analyzed for a "burst"
of oxygen consumption. This respiratory burst is an essential step for which of the
following events in an acute inflammatory response?
A Attachment to endothelial cells
B Generation of microbicidal activity
C Increased production in bone marrow
D Opsonization of bacteria
E Phagocytosis of bacteria - Answer-.
Answer: B
Reasoning: The respiratory, or oxidative, burst of neutrophils generates reactive oxygen
species (e.g., superoxide anion) that are important in destruction of engulfed bacteria.
Extended reasoning: Neutrophil attachment to endothelium is aided by adhesion
molecules on both the endothelium and the neutrophil surface. These molecules include
selectins and integrins. Myelopoiesis does not depend on generation of superoxide.
Bacteria are opsonized by complement C3b and IgG, allowing the bacteria to be more
readily phagocytosed.
A 4-year-old girl has had numerous infections with Staphylococcus aureus since
infancy. Genetic testing shows a defect leading to a lack of β2 integrin production.
Which of the following abnormalities of neutrophil function is most likely responsible for
these clinical symptoms?
A Decreased generation of hydroxy-halide radicals (HOCl-)
B Diminished phagocytosis of bacteria opsonized with IgG
C Failure of migration to the site of infection
D Inadequate adhesion on cytokine-activated
endothelium
E Reduced respiratory burst after phagocytosis - Answer-Answer: D
Reasoning: During acute inflammation, in the first stage of extravasation, the
neutrophils "roll over" the endothelium. At this stage, the adhesion between the
neutrophils and endothelial cells is weak. Rolling is mediated by binding of selectins to
sialylated oligosaccharides. The next step, firm adhesion, is mediated by binding of
integrins on the leukocytes to their receptors, intercellular adhesion molecule-1 or
vascular cell adhesion molecule-1 (VCAM-1), on endothelial cells.
Extended reasoning: Integrins have two chains, α and β. A genetic lack of β chains
prevents firm adhesion of leukocytes to endothelial cells. This process depends on
adhesion molecules expressed on the neutrophils and endothelial cells. Formation of
HOCl- requires myeloperoxidase released from neutrophil granules. Phagocytosis of
opsonized organisms depends on engulfment, which requires contractile proteins in the
, neutrophil cytoplasm. Neutrophil migration to a site of infection depends on the
presence of chemotactic factors such as complement C5a that bind to the neutrophil
and activate phospholipase C to begin a series of events that culminate in the influx of
calcium, which triggers contractile proteins. The respiratory burst to kill phagocytized
organisms depends on NADPH oxidase, and a deficiency of this enzyme leads to
chronic granulomatous disease.
A 95-year-old woman touches a pot of boiling water. Within 2 hours, she has marked
erythema of the skin of the fingers of her hand, and small blisters appear on the finger
pads. This has led to which one of the following inflammatory responses?
A Fibrinous inflammation
B Granulomatous inflammation
C Purulent inflammation
D Serous inflammation
E Ulceration - Answer-Answer: D
Reasoning: Serous inflammation is the mildest form of acute inflammation. A blister is a
good example of serous inflammation. It is associated primarily with exudation of fluid
into the subcorneal or subepidermal space. Because the injury is mild, the fluid is
relatively protein-poor.
Extended reasoning: protein-rich exudate results in fibrin accumulation. Granulomatous
inflammation is characterized by collections of transformed macrophages called
epithelioid cells. Acute inflammatory cells, mainly neutrophils, exuded into a body cavity
or space form a purulent (suppurative) exudate, typically associated with liquefactive
necrosis. Loss of the epithelium leads to ulceration.
A 37-year-old man has had midepigastric pain for the past 3 months. An upper
gastrointestinal endoscopy shows a 2-cm, sharply demarcated, shallow ulceration of the
gastric antrum. Microscopic examination of a biopsy from the ulcer base shows
angiogenesis, fibrosis, and mononuclear cell infiltrates with lymphocytes, macrophages,
and plasma cells. Which of the following terms best describes this pathologic process?
A Acute inflammation
B Chronic inflammation
C Fibrinous inflammation
D Granulomatous inflammation
E Serous inflammation - Answer-Answer: B
Reasoning: One outcome of acute inflammation with ulceration is chronic inflammation.
This is particularly true when the inflammatory process continues for weeks to months.
Chronic inflammation is characterized by tissue destruction, mononuclear cell
infiltration, and repair. In acute inflammation, the healing process of fibrosis and
angiogenesis has not begun.
Extended reasoning: In fibrinous inflammation, typically involving a mesothelial surface,
there is an outpouring of protein-rich fluid that results in precipitation of fibrin.
Granulomatous inflammation is a form of chronic inflammation in which epithelioid
macrophages form aggregates. Serous inflammation is an inflammatory process
involving a mesothelial surface (e.g., lining of the pericardial cavity), with an outpouring
of fluid having little protein or cellular content.
