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Robbins and Cotran Pathologic Basis of Disease (Robbins Pathology) 9th Edition Test Bank

Robbins and Cotran Pathologic Basis of Disease (Robbins Pathology) 9th Edition Test Bank is your go-to study guide, providing essential notes and practice exercises for exam success.

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    Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition Chapter 0 2 : Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death Test Bank MULTIPLE CH O ICE 1. A 60 - year - old man who had generalized atherosclerosis died 24 hours after having a stroke. A cerebral infarct was found at autopsy. Necrosis of the brain is classified as a. coagulative necrosis b. liquefactive necrosis c. fat necrosis d. fibrinoid necrosis e. caseous necrosis ANS: B, Brain infarcts are characterized by liquefactive necrosis. 2. A 30 - year - old woman who had leukemia was treated with bone marrow transplantation. She developed a skin rash that was interpreted as a sign of a graft - versus - host reaction. A skin biopsy was performed. In the epidermis, there were scattered dead epidermal cells that had rounded contours and pyknotic nuclei. This form of cell death is caused by a. activation of caspases through receptor transmitted signals on the cell surface b. inhibition of ATPase c. inhibition of oxidative phosphorylation d. activation of lysosomal enzymes e. depletion of glycogen ANS: A, Graft - versus - host – induced cell death in the epidermis is a form of apoptosis. It is mediated by caspases and other enzymes of the suicide pathway of "programmed cell death." 3. Uptake of bacteria into the cytoplasm of neutrophilic leukocytes is called a. autophagocytosis b. heterophagocytosis c. exocytosis d. pinocytosis e. involution ANS: B, Uptake of bacteria and other exogenous particulate material into the phagosomes is called phagocytosis.

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 - 2 4. A 90 - year - old man died in a nursing home. During the past 10 years, he was unable to care for himself and was mentally incoherent. He had no memory and could not hold a conversation. He was unaware of his surroundings. At autopsy, the brain showed signs of Alzheimer disease, and there were neurons containing numerous neurofibrillary tangles. These cytoplasmic structures are formed from which component of the neurons? a. Nucleus b. Rough endoplasmic reticulum c. Smooth endoplasmic reticulum d. Mitochondria e. Cytoskeleton ANS: E, Neurofibrillary tangles are composed of microtubule - associated proteins and neurofilaments, which form the cytoskeleton of nerve cells. 5. Continuous expression of the gene for atrial natriuretic factor in the myocardial cells of the left ventricle is typically a consequence of a. myocardial infarction b. angina pectoris c. hypertension d. hypotension e. ventricular fibrillation ANS: C, Atrial natriuretic factor (ANF) is produced during fetal life in both the atrial and ventricular cells of the heart. After birth, the ANF gene remains active only in the atrium, but can be activated in ventricular cells undergoing hypertrophy. Arterial hype r tension is the most common cause of ventricular hypertrophy. 6. Ubiquitin - proteasome degradation of plasma proteins is opposed by a. insulin b. interleukin - 1 c. tumor necrosis factor α d. glucocorticoids e. thyroid hormones ANS: A, Insulin can oppose ubiquitin - proteasome degradation of plasma proteins, whereas all other hormones and mediators of inflammation listed here accelerate it. 7. A 28 - year - old man was found to have cirrhosis of the liver and pulmonary emphysema. The liver cells contained globular inclusions in their cytoplasm, which by electron microscopy are shown to be located inside the a. Golgi apparatus b. smooth endoplasmic reticulum c. rough endoplasmic reticulum d. mitochondria e. peroxisomes

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 - 3 ANS: C, The clinical history (i.e., the concurrence of cirrhosis and pulmonary emph y sema) suggests that this young man has  1 - antitrypsin (AAT) deficiency. The cytopla s mic globules in the liver cells represent misfolded AAT, which cannot be excreted from the liver cells and remains inside the liver cells in the dilated cisterns of the rough end o plasmic reticulum. 8. A 60 - year - old obese man was admitted to the hospital for treatment of alcoholism. He has diabetes mellitus. A liver biopsy was performed, and the specimen showed that the liver cells contain increased amounts of a. hemosiderin b. bile c. triglycerides d. bilirubin e. insulin ANS: C, The three most common causes of fatty liver are obesity, alcoholism, and di a betes mellitus. Fat is stored in the liver cells predominantly in the form of triglycerides. 9. A 55 - year - old man who was on renal dialysis was admitted to the hospital for evaluation of nausea and vomiting. A gastric biopsy was performed. The gastric mucosa contained foci of amorphous, bluish (basophilic) material forming aggregates 10 - 20  m in diameter. These aggregates were seen mostly in the stroma between the foveolar cells. No other abnormalities were seen, and the pathologist concluded that these changes represent evidence of a. Helicobacter pylori infection b. peptic ulcer formation c. dystrophic calcification d. metastatic calcification e. apoptosis ANS: D, Bluish material in the stroma of the stomach represents foci of calcification. In patients who have chronic renal disease, such calcifications occur in the stomach, the lungs, or the kidneys, and are classified as metastatic. Metastatic calcifications occur in patients who have hypercalcemia, which in this patient was most likely caused by seco n dary hyperparathyroidism.

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    Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition Chapter 0 3 : Inflammation and Repair Test Bank MULTIPLE CHOICE 1. Transmembrane adhesive heterodimeric proteins, composed of an  and a ß chain, are expressed on activated leukocytes during in flammation. They bind primarily to intercellular adhesion molecule 1 (ICAM - 1) and vascular cell adhesion molecule 1 (VCAM - 1), both of which belong to the family of proteins known as a. selectins b. integrins c. immunoglobulins d. lectins e. growth factors ANS: C, Surface proteins expressed on activated leukocytes are integrins, and they bind to intercellular adhesion molecule 1 (ICAM - 1) and vascular cell adhesion molecule 1 (VCAM - 1), which belong to the immunoglobulin family of proteins. 2. Which of the following mediators of inflammation has chemotactic properties and is increased in persons taking aspirin? a. Thromboxane A 2 b. Prostaglandin E 2 c. Platelet - activating factor d. Leukotriene B 4 e. Interleukin - 1 ANS: D, Leukotriene B 4 is chemotactic. It is increased in persons who take aspirin, because aspirin inhibits the cyclooxygenase pathway, thus shunting more arachidonic acid early derivatives into the lipoxygenase pathway. This promotes the synthesis of leukotrienes. 3. A 2 - year - old child known to suffer from recurrent bacterial infections and poor wound healing was found to have leukocyte adhesion molecule deficiency 1 (LAD - 1). The leukocytes of this patient do not express CD18, a molecule classified as belonging to the family of a. selectins b. integrins c. lectin type of vascular adhesion molecules d. aminotransferases e. glycosidases

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 - 2 ANS: B, LAD - 1 is characterized by a deficiency of CD18, a cell surface molecule that is a ß 2 integrin. The infections occur because the defective leukocytes cannot adhere to e n dothelial cells, cannot spread and attach, and cannot phagocytose bacteria. PBD7 62 4. Bradykinin is produced from a high - molecular weight kininogen circulating in the blood. This reaction is mediated by a. coagulation factor X b. kallikrein c. Hageman factor d. complement C3 e. protein C ANS: B, Kallikrein promotes the formation of bradykinin from the high - molecular weight kininogen. PBD7 67 5. Nitric oxide synthesis is augmented in endothelial cells by a calmodulin - mediated influx of which element? a. Calcium b. Sodium c. Potassium d. Oxygen e. Nitrate ANS: A, Endothelial cell nitric oxide synthase is constitutively expressed at low levels, but it can be increased by a calmodulin - mediated influx of calcium into the endothelial cells. PBD7 72 6. Which of the following mediators of inflammation causes pain? a. Nitric oxide b. Complement C3a c. Bradykinin d. Leukotriene B 4 e. Interleukin - 1 ANS: C, Bradykinin causes pain. Other pain - causing substances are substance P and prostaglandin E 2 . PBD7 65 7. Aspirin lowers the body temperature by inhibiting the synthesis of which regulator of the central thermostat in the hypothalamus? a. Leukotriene B 4 b. Lipoxin c. Thromboxane A 2 d. Prostacyclin e. Prostaglandin E 2 ANS: E, Aspirin inhibits the action of cyclooxygenase, and thus inhibits the synthesis of

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 - 3 thromboxane A 2 , prostacyclin, and prostaglandin E 2 . However, only prostaglandin E 2 is involved in thermoregulation. The synthesis of lipoxin and leukotrienes is not inhibited by aspirin. PBD7 70 8. C - reactive protein binds to the surface of microbes in tissues acting as a(n) a. caspase b. peroxidase c. opsonin d. anaphylatoxin e. membrane attack protein ANS: C, C - reacti ve protein, an acute phase protein produced by the liver in acute and chronic inflammation, binds to microbes acting as an opsonin. Opsonization of bacteria facilitates phagocytosis. 9. Fibrillin is important for the scaffolding and deposition of which other component of the extracellular matrix? a. Collagen type I b. Collagen type III c. Elastic fibers d. Fibronectin e. Laminin ANS: C, Fibrillin, a 350 kD glycoprotein, is part of the microfibrils that are important for the scaffolding and deposition of elastic fibers. A congenital defect of fibrillin, as seen in patients with Marfan syndrome, is associated with reduced elasticity of arteries and formation of aneurysms. 10. Which growth factor is the most potent promotor of angiogenesis in the granulation tissue? a. Angiotensin b. Platelet - derived growth factor c. Tumor growth factor ß d. Vascular endothelial growth factor e. Epidermal growth factor ANS: D, Vascular endothelial growth factor (VEGF) is the most important promotor of angiogenesis in the granulation tissue. 11. A 20 - year - old woman suffered extensive burns and developed large irregular scars over her hands. These scars limited the movement of her fingers, and she was unable to fully extend them. What are these lesions called? a. Contractures b. Desmoids c. Aggressive fibromatoses d. Keloids

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 - 4 e. Wound dehiscences ANS: A, Contractures are extensive scars overlying the joints that limit movements and cause permanent flexure.

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    Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition Chapter 0 4: Hemodynamic Disorders Test Bank MULTIPLE CHOICE 1. A 60 - year - old man had congestive heart failure and sodium retention. Pitting edema of the lower extremities in this patient is most likely associated with an increased blood level of a. albumin b. globulin c. aldosterone d. troponin e. plasminogen ANS: C, Renal hypoperfusion due to heart failure leads to secondary hyperaldoster o nism and consequent retention of sodium and water. 2. A 60 - year - old woman had a mastectomy for advanced cancer in her left breast, followed by chemotherapy and radiation therapy. She developed edema of the left arm. This edema is caused by a. obstruction of the lymph flow b. arterial thrombosis c. venous thrombosis d. spread of cancer into the soft tissue of the arm e. hypoalbuminemia secondary to liver injury caused by hepatic metastases ANS: A, Arm edema following a mastectomy is a complication of breast cancer treatment caused by an obstruction of the lymphatics in the axilla. This obstruction of lymphatics is a consequence of radiation injury or scarring associated with surgery. 3. A 63 - year - old woman died 2 days after the onset of severe myocardial ischemia caused by coronary thrombosis. At autopsy, the lungs were heavy. Upon sectioning of the lungs, frothy fluid was seen oozing from the cut surface of the parenchyma. Which of the following is the most likely diagnosis? a. Pulmonary embolism b. Pulmonary infarction c. Pulmonary edema d. Atelectasis e. Lobar pneumonia ANS: C, Lungs that are heavy and on cross section show oozing of frothy fluid are filled with edema fluid. In this case, edema developed due to left - sided heart failure.

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 - 2 4. A 60 - year - old man who had longstanding congesti ve heart failure complained of pain under the right costal margin. He died of worsening heart failure. At autopsy, the liver appeared enlarged and congested, showing a "nutmeg pattern" on cross section. Histologically this liver will show a. atrophy of bile ducts b. dilatation of bile ducts c. intralobular cholestasis d. centrolobular necrosis and loss of hepatocytes e. fibrosis of the Glisson capsule ANS: D, Chronic passive congestion of the liver caused by heart failure leads to accumulation of blood in the terminal hepatic venule and the centrolobular sinusoids. Aggr a vation of the heart failure expands the blood - containing spaces, causing centrolobular liver cell necrosis. 5. Which form of hemorrhage is most typical of defective platelet function seen in uremia (end stage kidney failure)? a. Multiple petechiae b. Multiple ecchymoses c. Solitary ecchymoses d. Hematoma e. Hemarthrosis ANS: A, Defective platelet function in uremia is typically associated with multiple pet e chiae in the skin and on mucosal surfaces. 6. Which of the following substances is an anticoagulant secreted by endothelial cells? a. Von Willebrand factor b. Prothrombin c. Inhibitor of plasminogen activator d. Thrombomodulin e. Tissue factor ANS: D, Thrombomodu lin is an anticoagulant that acts by binding to thrombin and converting it from a procoagulant to an anticoagulant capable of activating protein C. 7. Bernard - Soulier syndrome is a bleeding disorder caused by a defect of glycoprotein Ib (GpIb) on platelets. Platelets lacking GpIb cannot adhere to the wall of the damaged blood vessels, because GpIb is the receptor for which essential coagulation protein? a. Hageman factor (factor XII) b. Von Willebrand factor c. Fibrinogen d. Factor VIII e. Thrombin ANS: B, GpIb, a platelet cell membrane glycoprotein, is the receptor for the von Willebrand

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 - 3 factor (vWF), which mediates the adhesion of platelets to the damaged vascular wall. Congenital deficiency of GpIb, as seen in Bernard - Soulier syndrome, is similar to the deficiency of vWF in von Willebrand disease and results in a bleeding disorder. 8. The most common form of congenital coagulopathy, factor V mutation ( Leyden mutation), causes the altered coagulation factor V to be resistant to the action of which enzyme? a. Protein C b. Protein S c. Antithrombin III d. Plasmin e. Thrombin ANS: A, Leyden mutation of factor V makes this factor resistant to the action protein C. Under normal circumstances, protein C inactivates factor V, and the mutation eliminates this very important anticoagulant control mechanism. As a result of these changes, there is uncontrollable activation of factor V, which promotes thrombosis. 9. In the antiphospholipid syndrome of systemic lupus erythematosus, arterial thrombi occur most often in the arteries of the a. brain b. heart c. kidneys d. intestines e. bronchi ANS: A, Antiphospholipid syndrome is characterized by widespread venous and arterial thrombi. Venous thrombi are found most often in the veins of the lower extremities, whereas the arterial thrombi are most often found in the cerebral arteries. 10. Which of the following is the most common site for arteriolar thromboembolization? a. Brain b. Heart c. Kidneys d. Lower extremities e. Eyes ANS: D, The lower extremities are the major site of arteriolar thromboemboli. This site is involved in 75% of all cases. 11. A 30 - year - old woman fractured her leg, and a few days later developed a diffuse petechial rash in the nondependent areas of the body. She was short of breath and had minor neurologic symptoms. Laboratory studies showed thrombocytopenia. These findings are most consistent with a. air embolism b. bone marrow embolism c. fat embolism

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 - 4 d. talc embolism e. cholesterol crystal embolism ANS: C, Rash in nondependent areas of the body following fracture of major bones, e s pecially if associated with thrombocytopenia, is suggestive of fat embolism. Shortness of breath is indicative of pulmonary embolization, and neurologic symptoms suggest that the emboli have passed through the lungs and entered the cerebral vessels. 12. Most cases of septic shock are caused by endotoxin - producing bacteria, which are classified as a. pyogenic b. gram - positive c. gram - negative d. encapsulated e. acid fast ANS: C, Most cases of septic shock (70%) are caused by endotoxin - producing gram - negative bacteria. Endotoxins produced by gram - negative bacteria are lipopolysaccharides that bind to leukocytes, stimulating the release of cytokine, which in turn acts on vessels and other cells, propagating the development of shock.

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    Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition Chapter 05: Genetic Disorders Test Bank MULTIPLE CHOICE 1. Which of the following diseases is caused by a trinucleotide repeat mutation? a. Marfan syndrome b. Achondroplastic dwarfism c. Fanconi syndrome d. Fragile X syndrome e. Hemophilia B ANS: D, Fragile X syndrome is caused by a trinucleotide repeat mutation of the long arm of the X chromosome. Patients with the disease present with mental retardation and enlarged testes. 2. In which of the following Mendelian disorders is the age of onset delayed and the symptoms of the disease do not appear before adulthood? a. Tay - Sachs disease b. Niemann - Pick disease c. Huntington disease d. Marfan syndrome e. Turner syndrome ANS: C, Symptoms of Huntington disease, which include chorea and mental deterioration, are typically delayed and do not appear before adulthood. 3. Mutation of the gene for lysyl hydroxylase in the kyphoscoliosis type Ehlers - Danlos syndrome (ED type VI) causes weakness of bones and cutis laxa because of abnormal collagen a. synthesis b. secretion c. cross - linking d. degradation e. resorption ANS: C, Lysyl hydroxylase is an enzyme that is essential for cross - linking of collagen. Without it, the collagen never achieves full structural integrity and strength; accordingly, the bones are weak and prone to deformation, whereas the skin becomes hyperextensible ("cutis laxa").

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 - 2 4. Splenomegaly and skeletal changes due to a nonlethal lysosomal storage disease caused by the mutation of the gene encoding glucocerebrosidase are features of which disease? a. Tay - Sachs disease b. Niemann - Pick disease c. Hurler disease d. Gaucher disease e. Hunter syndrome ANS: D, Gaucher disease is caused by a mutation of the gene encoding glucocerebros i dase. In the most common of the three forms of Gaucher disease, which accounts for 99% of all cases, there is splenomegaly, lymphadenopathy, involvement of the bone marrow, and skeletal changes. 5. A 7 - year - old child complained of frequent muscle cramps during play. A muscle biopsy revealed accumulation of glycogen in the skeletal muscle cells and a lack of muscle phosphorylase. Which form of glycogenosis is this? a. Type I (von Gierke disease) b. Type II (Pompe disease) c. Type III (Cori - Forbes’ disease) d. Type IV (Andersen disease) e. Type V (McArdle disease) ANS: E, Type V glycogenosis, also known as McArdle disease, is caused by muscle phosphorylase deficiency. Patients present with muscle cramps. In these patients, the blood level of lactic acid does not rise after exercise, because the enzyme deficiency prevents anaerobic glycolysis in the muscle cells. 6. Which malignancy occurs at a high rate in persons affected with Down syndrome? a. Acute lymphoblastic leukemia b. Chronic lymphocytic leukemia c. Chronic myelogenous leukemia d. Plasmacytoma e. Brain tumors ANS: A, Children with Down syndrome are at a 10 to 20 - fold higher risk of developing acute lymphoblastic leukemia or acute myelogenous leukemia than are their age - matched controls. 7. Chromosome 22q11 deletion is typically associated with a. rocker - bottom feet b. horseshoe kidneys c. thymic hypoplasia d. microphthalmia e. simian crease on hands

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    Test Bank Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 - 3 ANS: C, Chromosome 22q11 deletion is found in children who have DiGeorge sy n drome and velocardiofacial syndrome. These two syndromes are known to be closely r e lated and are known as the CATCH 22 syndrome (cardiac abnormalities, anomalous f a cial features, thymic hypoplasia with T - cell deficiencies, clef t palate, and hypocalcemia due to hypoparathyroidism resulting from chromosome 22q11 deletion). 8. An infertile woman was examined cytogenetically and was found to have deletions of portions of the long arm and short arm of the chromosome X, resulting in a ring chromosome, 46,X,r(X). Which of the following is the most likely diagnosis? a. Gonadal dysgenesis b. Hermaphroditism c. Male pseudohermaphroditism d. Female pseudohermaphroditism e. Turner syndrome ANS: E, A ring chromosome, 46,X,r(X), is found in patients with Turner syndrome. Such patients are in a minority, since most patients with Turner syndrome (57%) actually have a 45,X karyotype and lack one of the two X chromosomes.

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    Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition Chapter 06: Immunity Test Bank MULTIPLE CHOICE 1. Which of the following is the most abundant bronchospasm - inducing arachidonic acid derivative generated by cyclooxygenase in the mast cells? a. Leukotriene B 4 b. Prostacyclin c. Prostaglandin D 2 d. Thromboxane e. Lipoxin ANS: C, Prostaglandin D 2 is the most abundant arachidonic acid derivative produced through the cyclooxygenase pathway. It causes bronchospasm and increased mucus pr o duction. 2. A 40 - year - old man presents with hemoptysis and renal failure. A kidney biopsy specimen revealed linear deposits of IgG in glomerular basement membranes and crescents between the glomerular capillary loops and the Bowman capsule. The antibodies causing these pathologic changes react with a. laminin b. fibronectin c. collagen type I d. collagen type IV e. podocytes of glomerular epithelial cells ANS: D, This man has Goodpasture syndrome, in which the body produces autoantibo d ies to the globular part of type IV collagen in the glomerular basement membranes and the lungs. 3. Which antibody can most effectively activate complement by the alternate pathway, even without prior forming an antigen - antibody complex? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: A, IgA can activate complement by the alternate pathway.

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