Pathophysiology 510 Exam Test Questions and Answers 2019 PDF

Dariya Leonidovna Ganka Bekyarova Pathophysiology 510 Exam Test Questions and Answers 2019 Varna  Pathophysiology. 510 Exam Test Questions and Answers...

Dariya Leonidovna Ganka Bekyarova Pathophysiology 510 Exam Test Questions and Answers 2019 Varna  Pathophysiology. 510 Exam Test Questions and Answers CONTENTS PREFACE ------------------------- 7 GENERAL PATHOPHYSIOLOGY ---------------- 9 1. Concepts of Health and Disease _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9 Answers and References: Concepts ofHealth and Disease 12 2. Disorders of Temperature Regulation: Fever, Hyperthermia, Hypothermia _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 13 Answers and References: Disorders of Temperature Regulation: Fever, Hyperthermia, Hypothermia _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 3. Hemodynamic Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 16 3.1. Hyperemia 16 Answers and References: Hyperemia 17 3.2. Thrombosis 18 Answers and References: Thrombosis 19 3.3. Embolism 20 Answers and References: Embolism 21 3.4. Infarction 22 Answers and References: Infarction 23 3.5. Shock 24 Answers and References: Shock 26 4. Disorders of the Immune Response _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 27 4.1. Hypersensitivity Disorders 27 Answers and References: Hypersensitivity Disorders 32 Pathophysiology 4.2. Autoimmune Diseases 33 510 Exam Test Questions and Answers Answers and References: Autoimmune Diseases 35 4.3. Immunodeficiency Disorders 36 Answers and References: Immunodeficiency Disorders 37 © Assist. Prof. Dariya Leonidovna, MD © Prof. Ganka Bekyarova, MD, PhD, DSc 5. Inflammation _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 38 Answers and References: Inflammation 42 First edition 6. Disorders of Fluid and Electrolyte Balance _ _ _ _ _ _ _ _ _ _ _ _ 43 6.1. Edema 43 2019 © All rights reserved. The present edition or any parts from it can not be Answers and References: Edema 44 reproduced ( electronically or mechanically) or distributed in any form without 6.2. Disorders of Sodium Balance 45 the explicit written consent of the author. Answers and References: Disorders of Sodium Balance 46 ISBN 978-619-221-212-4 3  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 7. Disorders of Acid-Base Balance - - - - - - - - - - - - - - - - 47 13. Endocrine System Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 87 Answers and References: Disorders ofAcid-Base Balance 51 13.1. Endocrine pancreas disorders: Diabetes Mellitus 87 Answers and References: Endocrine pancreas disorders: 8. Neoplasia 52 Diabetes Mellitus _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 94 - - - - - - - - - - - - - - - - - - - - - - 53 Answers and References: Neoplasia _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 13.2. Metabolic Syndrome 95 Answers and References: Metabolic Syndrome 96 13.3. Thyroid, Parathyroid and Adrenal Gland Disorders 97 SYSTEMIC PATHOPHYSIOLOGY _ _ _ _ _ _ _ _ _ _ _ _ 54 Answers and References: Thyroid, Parathyroid and Adrenal Gland Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 102 9. Hematopoietic System Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 54 14. Urinary System Disorders 103 9.1. Disorders of Red Blood Cells 54 14.1. Renal System Disorders 103 Answers and References: Disorders ofRed Blood Cells 56 Answers and References: Renal System Disorders l 08 9.2. Disorders of White Blood Cells and Lymphoid Tissues 57 14.2. Lower Urinary Tract Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ 109 Answers and References: Disorders of White Blood Cells Answers and References: Lower Urinary Tract Disorders 109 and Lymphoid Tissues _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 58 15. Alterations in Nutritional Status: Obesity _ _ _ _ _ _ _ _ _ _ __ 110 10. Respiratory Function Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 59 Answers and References: Alterations in Nutritional Status: Obesity _ __ 112 Answers and References: Respiratory Function Disorders 62 16. Gastrointestinal Tract Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 113 11. Cardiovascular System Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 63 16.1. Gastric Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 113 11.1. Atherosclerosis 63 Answers and References: Gastric Disorders _ _ _ _ _ _ _ _ _ _ _ _ 116 Answers and References: Atherosclerosis 67 16.2. Disorders of the Small and Large Intestines _ _ _ _ _ _ _ _ _ 117 11.2. Ischemic Heart Disease 68 Answers and References: Disorders of the Small and Large Intestines _ _ 118 Answers and References: Ischemic Heart Disease 71 16.3. Hepatobiliary Function Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ 119 11.3. Valvular Heart Disease 72 Answers and References: Disorders ofHepatobiliary Function _ _ _ _ _ 121 Answers and References: Valvular Heart Disease 73 16.4. Gallbladder and Exocrine Pancreas Function Disorders _ _ _ _ _ 122 11.4. Myocardial Disorders 74 Answers and References: Disorders of the Gallbladder Answers and References: Myocardial Disorders 74 and Exocrine Pancreas Function _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 123 11.5. Pericardia! Disorders 75 Answers and References: Pericardia! Disorders 75 17. Neural Function Disorders _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 124 11.6. Cardiomyopathies 76 17.1. Pain _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 124 Answers and References: Cardiomyopathies 77 Answers and References: Pain _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 125 11. 7. Heart Failure 78 17.2. Motor Function Disorders and Neurodegenerative Diseases _ _ _ 126 Answers and References: Heart Failure 79 Answers and References: Motor Function Disorders and Neurodegenerative Diseases _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 128 12. Disorders of Blood Pressure Regulation _ _ _ _ _ _ _ _ _ _ _ _ 80 17.3. Brain Function Disorders: Brain Infarction _ _ _ _ _ _ _ _ _ _ 129 12.1. Systemic Hypertension: Hypertensive Heart Disease, Answers and References: Brain Function Disorders: Brain Infarction _ _ 130 Hypertensive Vascular Disease _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 80 Answers and References: Systemic Hypertension: Hypertensive Heart Disease, Hypert _____________________ 83 REFERENCES _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 131 12.2. Systemic Hypotension 84 Answers and References: Systemic Hypotension 85 12.3. Pulmonary Hypertension: Pulmonary (Right-Sided) Hypertensive Heart Disease ( Cor Pulmonale) _ _ _ _ _ _ _ _ _ _ _ 86 Answers and References: Pulmonary Hypertension: Pulmonary (Right-Sided) Hypertensive Heart Disease (Cor Pulmonale) _ _ _ _ _ _ 86 4 5  Pathophysiology. 510 Exam Test Questions and Answers PREFACE Goal and Audience This book serves as a study guide and source of practice questions for the Pathophysiology final exam. It is suitable for students from the Medicine, Dental Medicine and Pharmacy faculties. We hope the amount of material in the book will not demotivate you. "Repetition is the mother of learning", says the Latin proverb. We have tried our best to focus on pathophysiologic principles that allow for less learning by heart and more understanding. It is our genuine hope that the student will apply this very approach to acquire an in-depth understanding of Pathophysiology. Organization and Content The book is organized in two parts. Part One, General Pathophysiology, presents the cellular and tissue responses common to altered health states. Pathophysiology of the disease, organized by human body systems, is presented in Part Two, Systemic Pathophysiology. Features to Promote Learning In order to facilitate learning we have provided this book with a number of features that guide and support understanding. These include: figures (diagrams, photos, flow charts, etc.), answers, and answer references. Figures that accompany many of the questions are intended to provide information useful in answering the questions. Each answer has a reference to that answer, as a starting point for reading more about the subject. Even though knowing the answer to any individual question gives some measure of joy, it should not represent a stopping point. It should motivate you to read further so that you can effortlessly answer questions from any perspective on that subject. We strongly advise you to: Read the question and then record your answer before you read the correct answer. Read the source reference citation. We hope you will find this book helpful! 7  Pathophysiology. 510 Exam Test Questions and Answers GENERAL PATHOPHYSIOLOGY 1. CONCEPTS OF HEAL TH AND DISEASE 1. The World Health Organization (WHO) defines health as a: A. "state of complete physical well-being" B. "state of complete physical, mental, and social well-being" C. "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity" D. None of the above 2. Congenital conditions are defects that are present at birth, although they may not be evident until later in life: True False 3. Acquired defects are those that are caused by events that occur before birth: True False 4. Pathogenesis describes: A. What sets the disease process in motion B. How the disease process evolves C. Both D. Neither 5. Signs and symptoms are terms used to describe: A. Structural changes that accompany a disease B. Functional changes that accompany a disease C. Both D. Neither 6. A symptom is: A. A subjective complaint that is noted by the person with a disorder B. A manifestation that is noted by an observer C. Both D. Neither 9  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 7. A sign is: 13. Morbidity reflects: A. A subjective complaint that is noted by the person with a disorder A. Effects an illness has on a patient's life B. A manifestation that is noted by an observer B. Causes of death in a given population C. Both C. Both D. Neither D. Neither 8. A syndrome is: 14. Mortality reflects: A. Possible adverse extensions of a disease or outcomes from treatment A. Causes of death in a given population B. Lesions or impairments that follow or are caused by a disease B. Effects an illness has on a patient's life C. A compilation of signs and symptoms that are characteristic of a specific C. Both disease state D. Neither D. None of the above 15. Conditions suspected of contributing to the development of a disease are 9. An acute disorder is one that is: called etiologic factors: A. Relatively severe and non-self-limiting True B. Relatively severe but self-limiting False C. Both D. Neither 16. Conditions suspected of contributing to the development of a disease are called: l 0. Epidemiology is the study of: A. Etiologic factors A. Disease occurrence in human populations B. Risk factors B. Events that take place from the time of initial contact with an etiologic C. Both agent until the ultimate expression of a disease D. Neither C. Pathologic discontinuity of a body organ or tissue D. None of the above l 7. Carrier status refers to an individual who harbors an organism but is not infected: 11. Incidence reflects: True A. Existing disease in a population at a given point in time False B. Number of new cases arising in a population at risk during a specified time C. Both 18. The causes of disease are known as: D. Neither A. Risk factors B. Etiologic factors 12. Prevalence reflects: C. Predisposing factors A. Existing disease in a population at a given point in time D. All of the above B. Number of new cases arising in a population at risk during a specified time C. Both D. Neither 10 11  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 19. Chronic disease implies a: 2. DISORDERS OF TEMPERATURE REGULATION: FEVER, A. Disorder that is relatively severe, but self-limiting HYPERTHERMIA, HYPOTHERMIA B. Continuous, long-term process, which can present with exacerbations and rem1ss10ns C. Both 1. Which of the following is a fever-producing cytokine? D. Neither A. Interleukin- I (IL-I) B. Interleukin-6 (IL-6) 20. Epidemiologic methods are used to determine: C. Tumor necrosis factor-a (TNF-a) A. How a disease is spread D. All of the above B. How to prevent a disease C. How to eliminate a disease 2. Neurogenic fever is characterized by a high temperature that is resistant to D. All of the above antipyretic therapy and is not associated with sweating: True False 3. Which of the following is considered to be the final fever mediator in the hypothalamus? A. Tumor necrosis factor-a (TNF-a) B. Interleukin-6 (IL-6) C. Interleukin-I (IL-1) D. Prostaglandin E2 (PGE2) Answers and References: Concepts of Health and Disease 4. Which of the following represents a pathologic increase in core body 1. The answer is C, CM Porth, 8th ed., pp.2-3. temperature without a change in the hypothalamic set point? 2. The answer is True, CM Porth, 8th ed., p.3 A. Fever 3. The answer is False, CM Porth, 8th ed., p.3 4. The answer is B, CM Porth, 8th ed., p.3 B. Hypothermia 5. The answer is C, CM Porth, 8th ed., p.3 C. Hyperthermia 6. The answer is A, CM Porth, 8th ed., p.3 D. None of the above 7. The answer is B, CM Porth, 8th ed., p.3 8. The answer is C, CM Porth, 8th ed., p.4 9. The answer is B, CM porth, 8th ed., p.5 5. Elderly patients often have a higher baseline temperature: 10. The answer is A, CM Porth, 8th ed., p.5 True 11. The answer is B, CM Porth, 8th ed., p.6 False 12. The answer is A, CM Porth, 8th ed., p.6 13. The answer is A, CM Porth, 8th ed, p.6 14. The answer is A, CM Porth, 8th ed., p.6 15. The answer is False, CM Porth, 8th ed., p.6 16. The answer is B, CM Porth, 8th ed., p.6 17. The answer is True, CM Porth, 8th ed., p.5 18. The answer is B, CM Porth, 8th ed., p.3 19. The answer is B, CM Porth, 8th ed., p.5 20. The answer is D, CM Porth, 8th ed., p.6 12 13  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 6. Illustrated below is a schematic representation of fever patterns. Please 10. Increased frequency of fever in infants and young children could be specify the intermittent fever pattern: explained by: A. Decreased immunologic function and more common infections with virulent organisms B. Not yet fully developed mechanisms for controlling temperature p.rn. a.m. p.rn.1a.rn. p.rn. a.rn. p.m. a.m. p.m. C. Both 1 Days C D. Neither 4o,s 39,4 38,3 37, 36 7 B a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.rn.1a.rn. p.rn. 1 2 4 Days A, because in intermittent fever temperature returns to normal at least once every 24 hours. B, because in intermittent fever temperature does not return to normal and varies a few degrees in either direction. C, because in intermittent fever temperature remains above normal with minimal variations (usually less than 0.55°C or 1°F). D, because in intermittent fever there is one or more episodes of fever, each as long as several days, with one or more days of nonnal temperature between episodes. 7. Which of the following represents a disorder of thermoregulation in which there is an upward displacement of the set-point for temperature control? A. Hyperthermia B. Hypothermia C. Fever D. None of the above Answers and References: Disorders of Temperature Regulation: Fever, Hyperthermia, Hypothermia 8. Hypothermia is linked to: 1. The answer is D, CM Porth, 8th ed., p.219 2. The answer is True, CM Porth, 8th ed., p.219 A. Hypothyroidism 3. The answer is D, CM Porth, 8th ed. p.219 B. Alcohol 4.- The answer is C, CM Porth, 8th ed., p.223 C. Sedative pharmaceutical agents 5. The answer is False, CM Porth, 8th ed., p.223 6. The answer is A, CM Porth, 8th ed., p.220 D. All of the above 7. The answer is C, CM Porth, 8th ed., p. 219 8. The answer is D, CM Porth, 8th ed., p.227 9. Alcohol predisposes to hypothermia through shivering inhibition: 9. The answer is True, CM Porth, 8th ed., p.227 True 10. The answer is C, CM Porth, 8th ed., p.222 False 14 15  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 3. HEMODYNAMIC DISORDERS 7. The ability of tissues to increase blood flow in situations of increased activity, such as exercise, is called: 3.1. Hyperemia A. Reactive hyperemia B. Functional hyperemia 1. Hyperemia is a passive process resulting from reduced outflow of blood from C. Passive hyperemia a tissue: D. None of the above True False 8. The transient redness seen on an arm after leaning on a wall is an example of: A. Reactive hyperemia 2. Hyperemia is an active process in which arteriolar dilation leads to increased B. Functional hyperemia blood flow: C. Passive hyperemia True D. None of the above False 9. Erythema is linked to: 3. Congested tissues take on a dusky reddish-blue color (cyanosis) due to: A. Hyperemia (an active process) A. Red blood cell stasis B. Congestion (a passive process) B. Presence of deoxygenated hemoglobin C. Both C. Both D. Neither D. Neither 10. From the listed below mechanisms, choose the one that explains edema in 4. An increased delivery of oxygenated blood to the tissue is associated with: congested tissues: A. Congestion ( a passive process) A. Increased osmotic pressure B. Hyperemia (an active process) B. Increased hydrostatic pressure C. Both C. Both D. Neither D. Neither 5. Congestion commonly leads to edema: True False Answers and References: Hyperemia 1. The answer is False, Robbins, 9th ed., p.115 6. Reactive hyperemia refers to: 2. The answer is True, Robbins, 9th ed., p.115 A. Increased blood flow to the tissue in situations of increased activity, such 3. The answer is C, Robbins, 9th ed., p.116 as exercise 4. The answer is B, Robbins, 9th ed., p.115 B. Increased blood flow to the tissue that occurs following a brief period of 5. The answer is True, Robbins, 9th ed., p.115 6. The answer is B, CM Porth, 8th ed., p. 468 ischemia ( e.g., arterial occlusion) 7. The answer is B, CM Porth, 8th ed., p.468 C. Increased blood flow to the tissue in the course of inflammatory process 8. The answer is A, CM Porth, 8th ed., p.468 D. None of the above 9. The answer is A, Robbins, 9th ed., p.115 10. The answer is B, Robbins, 9th ed., p.115 16 17  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 3.2. Thrombosis 5. Stasis is a major contributor in the development of arterial thrombi: True 1. Illustrated below is a Virchow triad in thrombosis. Specify the missing False element: 6. Normal blood flow is laminar. Stasis and turbulence therefore: A. Promote endothelial activation B. Bring platelets into contact with the endothelium C. Prevent washout and dilution of activated clotting factors by fresh flowing blood and the inflow of clotting factor inhibitors D. All of the above 7. Thrombi can develop anywhere in the cardiovascular system: True Abnonnal blood flow · Hypercoagulability False A. Stasis 8. Arterial or cardiac thrombi usually begin at sites of: B. Turbulent blood flow A. Turbulence C. Endothelial injury B. Endothelial injury D. Hypocoagulablity C. Both D. Neither 2. Inflammation and other noxious stimuli promote thrombosis by shifting the pattern of gene expression in endothelium to one that is "prothrombotic": 9. Most venous thrombi occur in the superficial or deep veins of the leg: True True False False 3. Endothelial activation or dysfunction refers to: 10. Although any tissue can be affected by the arterial thrombi, the brain, A. The pattern of gene expression in endothelium to one that is kidneys, and spleen are affected the most: "prothrombotic True B. The pattern of gene expression in endothelium to one that is False "antithrombotic" Answers and References: Thrombosis C. Both 1. The answer is C, Robbins, 9th ed., p.122 D. Neither 2. The answer is True, Robbins, 9th ed., p.123 3. The answer is A, Robbins, 9th ed., p.123 4. Turbulence contributes to arterial and cardiac thrombosis by: 4. The answerjs C, Robbins, 9th ed., pl 23 5. The answer is False, Robbins, 9th ed., p.123 A. Causing endothelial injury or dysfunction 6. The answer is D, Robbins, 9th ed., p.123 B. Fonning countercurrents that contribute to local pockets of stasis 7. The answer is True, Robbins, 9th ed., p.125 C. Both 8. The answer is C, Robbins, 9th ed., p.125 D. Neither 9. The answer is True, Robbins, 9th ed., p.126 10. The answer is True, Robbins, 9th ed., p125 18 19  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 3.3. Embolism 7. Systemic emboli may derive from: A. Cardiac mural or valvular thrombi B. Aortic aneurysms 1. The vast majority of emboli are dislodged thrombi: C. Atherosclerotic plaques True D. All of the above False 8. Fat emboli most commonly derive from: 2. The vast majority of pulmonary emboli are clinically silent because they are A. Bone marrow at the site of bone fracture small: B. Adipose tissue at the site of bone fracture True C. Both False D. Neither 3. Almost all pulmonary emboli are thrombi that arise from deep vein 9. Paradoxical embolism results from: thrombosis in the lower extremities: A. A venous embolus passed through an interatrial defect True B. A venous embolus passed through an interventricular defect False C. Both D. Neither 4. Decompression sickness results from: A. Sudden decreases in atmospheric pressure (e.g., scuba and deep sea 10. Emboli may be composed of: divers) A. Foreign bodies B. Persistent gas emboli in the skeletal system with multiple foci of ischemic B. Thrombi fragments necrosis C. Nitrogen bubbles C. Both D. All of the above D. Neither 5. Caisson disease is pathogenically linked to: A. Sudden decreases in atmospheric pressure ( e.g., scuba and deep sea divers) B. Persistent gas emboli in the skeletal system with multiple foci of ischemic necrosis C. Both Answers and References: Embolism D. Neither 1. The answer is True, Robbins, 9th ed., p.127 2. The answer is True, Robbins, 9th ed., p.127 6. Amniotic fluid embolism is among the most common cause of maternal 3. The answer is True, CM Porth, 8th ed., p. 728 mortality worldwide: 4. The answer is A, Robbins, 9th ed., p.128 5. The answer is B, Robbins, 9th ed., p.128 True 6. The answer is True, Robbins, 9th ed., p.129 False 7. The answer is D, Robbins, 9th ed., p.129 8. The answer is C, CM Porth, 8th ed., p.128 9. The answer is C, Robbins, 9th ed., p.127 10. The answer is D, Robbins, 9th ed., p.127 20 21  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 3.4. Infarction 7. Hemorrhagic (red) infarcts occur with arterial occlusions in solid organs with end-arterial circulation (e.g., heart, spleen, and kidney): 1. An infarct is an area of ischemic necrosis caused by: True A. Occlusion of the arterial supply False B. Occlusion of the venous drainage C. Both 8. Slowly developing occlusions are less likely to cause infarction: D. Neither True False 2. Arterial thrombosis or arterial embolism underlies the vast majority of infarctions: 9. Which of the following cell types remain viable even after many hours of True ischemia? False A. Neurons B. Fibroblasts 3. Infarction may result from: C. Cardiomyocytes A. Traumatic vascular rupture D. None of the above B. Torsion of a vessel C. Extrinsic vessel compression 10. Septic infarction occurs when: D. All of the above A. Infected cardiac valve vegetations embolize necrotic tissue B. Microbes seed necrotic tissue 4. Neurons undergo irreversible damage when deprived of their blood supply C. Both for only 3 to 4 minutes: D. Neither True False 5. Myocardial cells are quite sensitive to ischemia and die after only 20 to 30 minutes of ischemia: True False 6. Infarcts caused by venous occlusion typically are: Answers and References: Infarction A. Anemic (white) 1. The answer is C, Robbins, 9th ed., p.129 2. The answer is True, Robbins, 9th ed., p.129 B. Hemorrhagic (red) 3. The answer is D, Robbins, 9th ed., p.129 C. Both 4. The answer is True, Robbins, 9th ed., p.130 D. Neither 5. The answer is True, Robbins, 9th ed., pl 30 6. The answer is B, Robbins, 9th ed., p.131 7. The answer is False, Robbins, 9th ed., p.130 8. The answer is True, Robbins, 9th ed., p.130 9. The answer is B, Robbins, 9th ed., p.130 10. The answer is C, Robbins, 9th ed., p.130 22 23  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 3.5. Shock 5. Which shock state is characterized by loss of blood vessel tone, enlargement of the vascular compartment, and displacement of the vascular volume away 1. The main types of shock are summarized in the figure below. Which of the from the heart and central circulation? above depicts cardiogenic shock? A. Septic shock B. Anaphylactic shock C. Neurogenic shock D. All of the above 6. A progressive stage of shock is characterized by: A. Activated reflex compensatory mechanisms and maintained perfusion of vital organs B. Tissue hypoperfusion and onset of worsening circulatory and metabolic imbalances, including lactic acidosis C. Cellular and tissue injury so severe that even if the hemodynamic defects are corrected, survival is not possible A B C D D. None of the above A, because cardiogenic shock is caused by an alteration in cardiac function. 7. Patients with hypovolemic and cardiogenic shock present with hypotension, a B, because cardiogenic shock is caused by decreased blood volume. weak, rapid pulse, tachypnea, and cool, clammy, cyanotic skin: C, because cardiogenic shock is caused by obstruction of blood flow through True the circulatory system. False D, because cardiogenic shock is caused by vasodilation and maldistribution of blood flow. 8. Which of the following compensatory mechanisms help to maintain cardiac output and blood pressure in early nonprogressive phase of shock? 2. Which of the following types of shock is tightly linked to anaphylaxis? A. Baroreceptor reflexes A. Distributive B. Activation of the renin-angiotensin-aldosterone system B. Obstructive C. Generalized sympathetic stimulation C. Cardiogenic D. All of the above D. Hypovolemic 9. Cardiogenic shock results from low cardiac output due to low blood volume: 3. Any type of shock can result in hypoxic tissue injury if not corrected: True True False False 4. Which of the following shock states does not share the basis of circulatory pattern of distributive shock? A. Hypovolemic shock B. Anaphylactic shock C. Septic shock D. Neurogenic shock 24 25  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 10. From the listed below, choose the most adequate definition for circulatory 4. DISORDERS OF THE IMMUNE RESPONSE shock: A. Shock is a state in which diminished cardiac output impairs tissue 4.1. Hypersensitivity Disorders perfusion and leads to cellular hypoxia. B. Shock is a state in which reduced effective circulating blood volume 1. Which of the following hypersensitivity reactions is IgE mediated? impairs tissue perfusion and leads to cellular hypoxia. A. Type I C. Shock is a state in which diminished cardiac output or reduced effective B. Type II circulating blood volume impairs tissue perfusion and leads to cellular C. Type III hypoxia. D. Type IV D. None of the above 2. Latex allergy may result from: A. IgE-mediated hypersensitivity response B. T cell-mediated hypersensitivity response C. Both D. Neither 3. Which of the following cell types are central to a Type I hypersensitivity reaction? A. Type 2 helper T (TH2) cells B. Mast cells C. Basophils D. All of the above 4. Type III, hypersensitivity reactions result from binding of antibodies to normal or altered surface antigens: True False 5. Anaphylaxis is characterized by: Answers and References: Shock A. Widespread edema l. The answer is A, CM Porth, 8th ed., p.623 2. The answer is A, CM Porth., 8th ed., p.628 B. Vascular shock secondary to vasodilation 3. The answer is True, Robbins, 9th ed., p.134 C. Difficulty in breathing 4. The answer is A, CM Porth, 8th ed., pp.627-630 D. All of the above 5. The answer is D, CM Porth., 8th ed., pp.627-630 6. The answer is B, Robbins, 9th ed., p.133 7. The answer is True, Robbins, 9th ed., p.134 6. Listed below are the most common atopic disorders except: 8. The answer is D, Robbins, 9th ed., p.133 A. Urticaria (hives) 9. The answer is False, Robbins, 9th ed., p.131 B. Allergic rhinitis (hay fever) 10. The answer is C, Robbins, 9th ed. p.131 C. Anaphylaxis D. Atopic dermatitis 26 27  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 7. Type II hypersensitivity reactions are mediated by: 13. Leukotrienes C4 and D4 are considered the most potent vasoactive and A. IgG spasmogenic agents: B.IgM True C. Both False D. Neither 14. The classical T cell-mediated inflammatory reaction is immediate type 8. Hypersensitivity reactions, which involve the formation and deposition of hypersensitivity: insoluble antigen-antibody complexes fall into the category of: True A. Type I False B. Type II C. Type III 15. The cell-mediated type of hypersensitivity is caused by inflammation D. Type IV resulting from: A. Cytokines produced by CD4+ T cells 9. Which of the following represents a Type I hypersensitivity reaction? B. Cell killing by CDS+ T cells A. Anaphylactic shock C. Both B. Allergic rhinitis (hay fever) D. Neither C. Bronchial asthma D. All of the above 16. Illustrated below are mechanisms of hypersensitivity reactions. Please specify the hypersensitivity reaction type depicted: 10. Arthus reaction is an example of:. A. Type I hypersensitivity reaction Cytok.ine-mediated inflammation B. Type II hypersensitivity reaction C. Type III hypersensitivity reaction... + Cytokines Inflammation - Tissue damage D. Type IV hypersensitivity reaction ' Antigen- presenting CD4+T Cell 11. Hemolytic anemia is an example of: cell A. Type I hypersensitivity reaction B. Type II hypersensitivity reaction T ~ell-mediated eytolysb C. Type III hypersensitivity reaction D. Type IV hypersensitivity reaction 12. The vast majority of immediate hypersensitivity disorders are caused by - Antiten- CD8+T CeUldUlng excessive Type 2 helper T (TH2) responses: p:resenting Cell cell True B False A. Type I B. Type II C. Type III D. Type IV 28 29  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 17. IgE-mediated response to the latex protein is less common but can cause far 19. Illustrated below are immune complex reactions involving complement- more serious anaphylactic reactions: activating IgG or IgM immunoglobulins with formation of blood-borne immune True complexes that are deposited in tissues. Specify the hypersensitivity reaction False depicted below: 18. Illustrated below is the mechanism of hypersensitivity reaction. Please specify the hypersensitivity reaction type: Antigeo "'. T helper 2 cell l ~n.-4-. B cell l lgCantibody produl.#ion Mast ~l --.mzal:ion Depos7munc --. I 2 complexes Degranulation and Membrane Release of Eosinophil recruitment release of mediators phospholipids eytokines Inflammatory cells activation l L S~ry Recruitment and early response late response. activation of Mucosa! edema inflammatory cells Vasodilation Mucus secretion Vascular damage Leukocyte inliltralion Smooth muscle Bronchospasm spasm Epithelial damage - - - - - A. Type I Tissue damaging mediators Fibrinoid necrosis B. Type II C. Type III D. Type IV A. Type I B. Type II C. Type III D. Type IV 20. Type IV hypersensitivity reactions are linked to: A. Direct cell-mediated cytotoxicity (CDS+ cytotoxic T lymphocytes) B. Delayed-type hypersensitivity (CD4+ helper T cells) C. Both D. Neither 30 31  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers Answers and References: Hypersensitivity Disorders 4.2. Autoimmune Diseases 1. The answer is A, CM Porth, 8th ed., p.410 2. The answer is C, CM Porth, 8th ed., p.418 3. The answer is D, CM Porth, 8th ed., p.411 1. Autoimmune reactions may be triggered by infections: 4. The answer is False, CM Porth, 8th ed., p.415 True 5. The answer is D, CM Porth, 8th ed., p.413 False 6. The answer is C, CM Porth, 8th ed., p.413 7. The answer is C, CM Porth, 8th ed., p.414 8. The answer is C, CM Porth, 8th ed., pp 415-416 2. Which of the following is an example of organ-specific autoimmune disease? 9. The answer is D, CM Porth, 8th ed., pp.410-414 A. Type IA Diabetes mellitus, in which the autoreactive T cells and 10. The answer is C, CM Porth, 8th ed., p.416 antibodies are specific for p cells of the pancreatic islets 11. The answer is B, CM Porth, 8th ed., pp.414-415 B. Multiple sclerosis, in which autoreactive T cells react against central 12. The answer is True, Robbins, 9th ed., p.202 13. The answer is True, Robbins, 9th ed., p.203 nervous system myelin 14. The answer is False, Robbins, 9th ed., p.208 C. Both 15. The answer is C, Robbins., 9th ed., p. 208 D. Neither 16. The answer is D, Robbins, 9th ed., p.209 17. The answer is True, CM Porth, 8th ed., p.418 18. The answer is A, Robbins, 9th ed., p.203 3. Autoimmunity arises from: 19. The answer is C, CM Porth, 8th ed., p. 416 A. A combination of the inheritance of susceptibility genes 20. The answer is C, CM Porth, 8th ed., p. 416 B. Environmental triggers, such as infections and tissue damage C. Both D. Neither 4. Among the genes known to be associated with autoimmunity, the greatest contribution is that ofHLA genes: True False 32 33  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 5. Illustrated below are principal mechanisms of central at1d peripheral self- 8. Autoimmune diseases tend to be chronic, and the tissue damage is often tolerance in T and B cells. Specify the mechanism of central type of self- progressive: tolerance: True False Antigen- presenting T cells B cells cell 9. Some viruses cause polyclonal B-cell activation, which may result in. , \o Bcell Deletion production of autoantibodies: Deletion True '-. :~ False Development of regulatory T cell Bone A Thymus marrow l 0. Infections may protect against some autoimmune diseases: True ~.o-:- Aner[IY Anergy False 1 Antigen- Deletion presenting B cell A, because in this process, immature self-reactive T and B lymphocyte clones that recognize self-antigens during their maturation in the central (or generative) lymphoid are killed or rendered harmless. B, because in this process mature lymphocytes that recognize self-antigens in peripheral tissues become functionally inactive (anergic ), or are suppressed by regulatory T lymphocytes, or die by apoptosis 6. Which of the following mechanisms may explain the link between infections and autoimmunity? A. Infections may upregulate the expression of costimulators on APCs, and Answers and References: Autoimmune Diseases if these cells are presenting self-antigens, the result may be a breakdown 1. The answer is True, Robbins, 9th ed., p.216 of anergy. 2. The answer is C, Robbins, 9th ed., p.212 B. Some pathogens may express antigens that have the same amino acid 3. The answer is C, Robbins, 9th ed., p.214 sequences as self-antigens, which may result in the molecular mimicry 4. The answer is True, Robbins, 9th ed., p.215 5. The answer is A, Robbins, 9th ed., pp.212-213 phenomenon. 6. The answer is C, Robbins, 9th ed., p.216 C. Both 7. The answer is False, Robbins, 9th ed., p.217 D. Neither 8. The answer is True, Robbins, 9th ed., p.217 9. The answer is True, Robbins, 9th ed., p.216 10. The answer is True, Robbins,9th ed., p.216 7. Autoimmune diseases are usually acute, and the damage is reversible: True False 34 35  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 4.3. Immunodeficiency Disorders 6. Susceptibility to infections in individuals with Chediak-Higashi syndrome results from: 1. Bruton agammaglobulinemia is seen almost entirely in males: A. T-cell deficiency resulting from failure of development of the third and True fourth pharyngeal pouches False B. Reduced transfer oflysosomal enzymes to phagocytic vacuoles in phagocytes 2. Deficiency of early components of the classical pathway (C2 or C4), is C. Low levels of both serum and secretory IgA associated with: D. Failure of B-cell precursors (pro-B cells and pre-B cells) to develop into A. Bacterial infections mature B cells B. Viral infections 7. The immune system and the central nervous system are considered two major C. Both targets of HIV infection: D. Neither True False 3. Bruton agammaglobulinemia is characterized by: A. Failure of B-cell precursors (pro-B cells and pre-B cells) to develop into 8. Profound immune deficiency in patients with AIDS results from: mature B cells A. Infection and subsequent loss of CD4+ T cells B. T-cell deficiency resulting from failure of development of the third and B. Infection and subsequent loss of CDS+ T cells fourth pharyngeal pouches C. Both C. Thrombocytopenia, eczema, and a marked vulnerability to recurrent D. Neither infection D. Low levels of both serum and secretory IgA 9. Which of the following statements explains immune deficiency in patients with AIDS? 4. Secondary deficiencies of T-cell function are more common than primary A. Loss of CD4+ T cells deficiencies: B. Defective macrophage functions True C. Destruction of architecture of lymphoid tissues False D. All of the above I 0. Patients with AIDS have a high incidence of malignant tumors: 5. Disorders that affect both Band T lymphocytes will result in: True A. Impaired cell-mediated immunity False B. Impaired humoral immunity C. Both Answers and References: Immunodeficiency Disorders D. Neither 1. The answer is True, Robbins, 9th ed., p.240 2. The answer is C, Robbins, 9th ed., p.238 3. The answer is A, Robbins, 9th ed., p.240 4. The answer is True, CM Porth, 8th ed., p.406 5. The answer is C, CM Porth, 8th ed., p.406 6. The answer is B, CM Porth, 8th ed., p.409 7. The answer is True, Robbins, 9th ed, p245 8. The answer is A, Robbins, 9th ed., p.245 9. The answer is D, Robbins, 9th ed., pp.243-256 10. The answer is True, Robbins, 9th ed., p.253 36 37  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 5. INFLAMMATION 6. Illustrated below are cell-derived mediators of acute inflammation. Please specify the missing element: 1. Which of the mentioned below is NOT a cardinal sign of inflammation? I Cell-derived mediators A. Rubor B. Tumor Preformed mediators 1_ _ _.....__ _ _ Newly synthesized C. Functio laesa D. Fever Mast cells j Leukocytes Lymphocytes 2. Vascular changes that occur with inflammation involve: Macrophages Macrophages A. Arterioles Endothelial cells l B. Capillaries Histamine Lysosomal Serotonin Prostaglandins Cytokines C. Venules Nitric oxide enzymes Leukotrienes Reactive D. All of the above Platelet- Oxygen Species activating factor 3. The cellular component of acute inflammation is characterized by: A. Changes in the endothelial cells A. N eutrophils B. Movement of phagocytic leukocytes into the area of injury or infection B. Macrophages C. Both C. Both D. Neither D. Neither 4. Which of the following is not a cell-derived inflammatory mediator/s? 7. Mediators of inflammation are the substances that: A. Histamine A. Initiate inflammatory reactions B. Bradykinin B. Regulate inflammatory reactions C. Lysosomal enzymes C. Both D. Prostaglandins D. Neither 5. Mentioned below are cell-derived inflammatory mediators except: 8. As one of the major vasoactive amines, histamine causes: A. Leukotrienes A. Dilation of arterioles B. Serotonin B. Increases the permeability of venules C. Histamine C. Both D. Factor XII (Hageman factor) D. Neither 9. Leukotrienes are produced by: A. Leukocytes B. Mast cells C. Both D. Neither 38 39  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 10. Acute inflammation is manifested by: 14. Eosinophils are abundant in immune reactions mediated by IgE and in A. Vascular changes parasitic infections: B. Edema True C. Predominantly neutrophilic False D. All of the above 15. Nitric oxide (NO) plays multiple roles in inflammation including: 11. Chronic inflammation is characterized by: A. Smooth muscle relaxation A. Infiltration with mononuclear cells B. Inhibits platelet adhesion, aggregation, and degranulation B. Tissue destruction C. Serves as an endogenous regulator of leukocyte recruitment C. Attempts at healing D. All of the above D. All of the above 16. Viral infections produce a decrease in neutrophils (neutropenia) and an 12. The illustration below shows the central role of an inflammatory cytokine/s increase in lymphocytes (lymphocytosis): in the acute inflammatory response. Please specify the missing cytokine/s: True False T cells bacteria 17. Bacterial infections produce a relatively selective increase in eosinophils: True / ff False ' Macrophage / 18. Parasitic and allergic responses induce: A. Increase in neutrophils (neutrophilia) B. Increase in lymphocytes (lymphocytosis) C. Increase in eosinophils (eosinophilia) D. Decrease in neutrophils (neutropenia) Endod1e1ia1 cells 19. Acute inflammation involves the presence of mononuclear cells (lymphocytes and macrophages) rather than granulocytes: True False 20. Which of the following is the systemic manifestation of inflammation? A. TNF-a A. Fever B. IL-I B. Increased levels of CRP and other acute phase proteins C. Both C. Leukocytosis D. Neither D. All of the above 13. The dominant cells in most chronic inflammatory reactions are neutrophils: True False 40 41  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers Answers and References: Inflammation 6. DISORDERS OF FLUID AND ELECTROLYTE BALANCE 1. The answer is D, CM Porth, 8th ed., p.378 2. The answer is D, CM Porth, 8th ed., p.380 3. The answer is C, CM Porth, 8th ed., p.381 6.1. Edema 4. The answer is B, CM Porth, 8th ed., p. 384 5. The answer is D, CM Porth, 8th ed., p.384 1. All of the following contribute to edema formation except: 6. The answer is C, CM Porth, 8th ed., p.384 A. Increased capillary pressure 7. The answer is C, Robbins, 9th ed., p.82 8. The answer is C, Robbins, 9th ed., p.83 B. Increased colloidal osmotic pressure 9. The answer is C, Robbins, 9th ed., p.85 C. Increased capillary permeability 10. The answer is D, Robbins, 9th ed., p.93 D. Obstruction oflymphatic flow 11. The answer is D, Robbins, 9th ed., pp.93-94 12. The answer is C, CM Porth, 8th ed., p.387 2. Which of the following contributes to the formation of edema in case of 13. The answer is False, Robbins, 9th ed., p.94 14. The answer is True, Robbins, 9th ed. p.96 decreased colloidal osmotic pressure? 15. The answer is D, CM Porth, 8th ed., p. 387 A. Starvation 16. The answer is True, CM Porth, 8th ed., p.390 B. Protein-losing kidney diseases 17. The answer is False, CM Porth, 8th ed., p.390 C. Extensive bums 18. The answer is C, CM Porth, 8th ed., p.390 19. The answer is False, CM Porth, 8th ed., p.390 D. All of the above 20. The answer is D, CM Porth, 8th ed., p.389 3. The swelling of hands and feet that occurs in healthy persons during hot weather is an example' of edema that is caused by: A. Vasodilation of superficial blood vessels B. Sodium and water retention C. Both D. Neither 4. Edema due to decreased capillary colloidal osmotic pressure results from: A. Inadequate production of proteins B. Abnormal loss of plasma proteins C. Both D. Neither 5. Pitting edema occurs when: A. Plasma proteins have accumulated in the tissue spaces and coagulated B. Accumulated interstitial fluid exceeds the absorptive capacity of the tissue gel C. Both D. Neither 6. Edema resulting from decrease in capillary colloidal osmotic pressure affects tissues in nondependent as well as dependent parts of the body: True False 42 43  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 6.2. Disorders of Sodium Balance 7. Accumulation of interstitial fluid that exceeds the absorptive capacity of the tissue gel may result in: 1. Isotonic fluid volume deficit may result from: A. N onpitting edema A. Polyuria B. Brawny edema B. Diarrhea C. Pitting edema C. Sweating D. All of the above D. All of the above 8. Noninflammatory collections of serous fluid within the pleural cavities are 2. Isotonic fluid volume deficit may result from: called: A. Loss of body fluids A.Empyema B. Decrease in fluid intake B. Hydrothorax C. Both C. Pneumothorax D. Neither D. None of the above 3. Fluid volume excess represents an isotonic expansion of the extracellular 9. Which of the following contributes to the formation of edema via increased fluid compartment with increases in: capillary permeability? A. Vascular volume A. Burn injury B. Interstitial volume B. Inflammation C. Both C. Allergic reactions D. Neither D. All of the above 4. Isotonic fluid volume excess results from: 10. Type of edema in which the skin thickens and hardens is called: A. Excessive sodium intake A. Pitting edema B. Decrease in sodium and water elimination B. Brawny edema C. Both C. Dependent edema D. Neither D. None of the above 5. Hyponatremia is one of the most common electrolyte disorders seen in general hospital patients: Answers and References: Edema True 1. The answer is B, CM Porth, 8th ed., p. 768 False 2. The answer is D, CM Porth, 8th ed., p. 768 3. The answer is C, CM Porth, 8th ed., p. 768 4. The answer is C, CM Porth, 8th ed., p. 768 6. Hypertonic (translocational) hyponatremia results from: 5. The answer is B, CM Porth, 8th ed., p. 769 A. Osmotic shift of water from the intracellular fluid compartment to the 6. The answer is True, CM Porth., 8th ed., p. 768 extracellular fluid compartment 7. The answer is C, CM Porth, 8th ed., p. 769 8. The answer is B, Robbins, 9th ed., p. 722 B. Osmotic shift of water from the extracellular fluid compartment to the 9. The answer is D, CM Porth, 8th ed., p.768 intracellular fluid compartment 10. The answer is B, CM Porth., 8th ed., p. 769 C. Both D. Neither 44 45  Dariya Leonidovna, Ganka Bekyarova Pathophysiology. 510 Exam Test Questions and Answers 7. Diuretic therapy can cause: 7. DISORDERS OF ACID-BASE BALANCE A. Hypovolemic hyponatriemia B. Euvolemic hyponatremia 1. Proteins are the largest buffer system in the body: C. Both True D. Neither False 8. Which of the following is an early sign ofhyponatremia? 2. The renal control of pH is fast: A. Muscle cramps True B. Weakness False C. Fatigue D. All of the above 3. The respiratory control of pH is rapid, occurring within minutes, and is maximal within 12 to 24 hours: 9. Hypovolemic hypotonic hyponatremia occurs when water is lost along with True sodium, but to a lesser extent: False True False 4. The diminished capacity to excrete acid and generate base in chronic renal failure results in: 10. Edema-associated disorders such (e.g. decompensated heart failure) are A. Metabolic acidosis associated with: B. Metabolic alkalosis A. Hypervolemic hypotonic hyponatremia C. Respiratory acidosis B. Euvolemic hypotonic hyponatremia D. Respiratory alkalosis C. Both D. Neither 5. Most of the H+ secretion and reabsorption of HC03 takes place in the proximal tubule: True False 6. Metabolic acidosis can be defined as: A. Decrease in plasma HCQ3- B. Decrease in plasma pH Answers and References: Disorders of Sodium Balance C. Both 1. The answer is D, CM Porth., 8th ed., p. 776 D. Neither 2. The answer is C, CM Porth, 8th ed., p. 776 3. The answer is C, CM Porth, 8th ed., p. 778 4. The answer is C, CM Porth., 8th ed., p