Robbins Test bank – 2

Done by : Hazem Ghabashneh

بسم الله الرحمن الرحيم

CELL INJURY 1-A 77-year-old woman has chronic renal failure. Her serum urea nitrogen is 40 mg/dL. She is given a diuretic medication and loses 2 kg (4.4 lb). She reduces the protein in her diet and her serum urea nitrogen decreases to 30 mg/dL. Which of the following terms best describes cellular responses to disease and treatment in this woman?

A- Adaptation

B- Apoptosis

C- Necroptosis

D-Irreversible injury

E-Metabolic derangement

Answer: A

2-A 53-year-old woman with no prior illnesses has a routine checkup by her physician. On examination she has a blood pressure of 150/95 mm Hg. If her hypertension remains untreated for years, which of the following cellular alteration would most likely be seen in her myocardium?

A-Apoptosis

B-Dysplasia

C-Fatty change

D-Hemosiderosis

E-Hyperplasia

F-Hypertrophy

G-Metaplasia

Answer: F

3-A 16-year-old boy sustained blunt trauma to his abdomen when he struck a bridge abutment at high speed while driving a motor vehicle. Peritoneal lavage shows a hemoperi-toneum, and at laparotomy, a small portion of the left lobe of the injured liver is removed. Two months later, a CT scan of the abdomen shows that the liver has nearly regained its size before the injury. Which of the following processes best explains this CT scan finding?

A- Apoptosis

B-Dysplasia

C-Hyperplasia

D-Hydropic change

E-Steatosis

Answer: C

4-A 71-year-old man has had difficulty with urination, including hesitancy and increased frequency, for the past 5 years. A digital rectal examination reveals that his prostate gland is palpably enlarged to twice normal size. A transurethral resection of the prostate is performed, and the microscopic appearance of the prostate “chips” obtained is that of nodules of glands with intervening stroma. Which of the following pathologic processes has most likely occurred in his prostate?

A- Apoptosis

B- Dysplasia

C- Fatty change

D- Hyperplasia

E- Hypertrophy

F- Metaplasia

Answer: D

5-A 68-year-old woman suddenly lost consciousness and on awakening 1 hour later, she could not speak or move her right arm. Two months later, a head CT scan showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in her brain?

A- Apoptosis

B- Coagulative necrosis

C -Fat necrosis

D- Karyolysis

E-Liquefactive necrosis

Answer: E

6-An experimental drug administered to a tissue preparation is found to inhibit cellular oxidative phosphorylation when given in high doses, and ATP production drops to 5% of normal. Cell membrane function is diminished. Which of the following substances is most likely to be present at increased concentration in culture fluid bathing the tissue?

A-Calcium

B-Glucose

C-Ketones

D-Potassium

E-Sodium

Answer: D

7-A tissue preparation is experimentally subjected to a hypoxic environment. The cells in this tissue begin to swell, and chromatin begins to clump in cell nuclei. ATPases are activated, and ATP production decreases. Which of the following ions accumulating in mitochondria and the cytosol contributes

most to these findings and to eventual cell death?

A-Ca2+

B-Cl−

C-HCO3−

D-K+

E-Na+

F-PO43−

Answer: A

8-On day 28 of her menstrual cycle, a 23-year-old woman experiences onset of menstrual bleeding that lasts for 6 days. She has had regular cycles since menarche. Which of the following processes most likely occurs in her endometrial cells to initiate the onset of menstrual bleeding?

A- Apoptosis

B- Atrophy

C- Caseous necrosis

D- Heterophagocytosis

E- Liquefactive necrosis

Answer: A

9-A 47-year-old man has a lung carcinoma with metastases. He receives chemotherapy. A month later, histologic examination of a metastatic lesion shows many foci in which individual tumor cells appear shrunken and deeply eosinophilic. Their nuclei exhibit condensed aggregates of chromatin under the nuclear membrane. The pathologic process affecting these shrunken tumor cells is most likely triggered by release of which of the following substances into the cytosol?

A- BCL2

B- Catalase

C-Cytochrome c

D-Lipofuscin

E-Phospholipase

Answer: C

10-A 69-year-old woman has had a chronic cough for the past year. A chest radiograph shows a 6-cm mass in the left lung. A needle biopsy specimen of the mass shows carcinoma. A pneumonectomy is performed, and examination of the hilar lymph nodes reveals a uniform, dark black cut surface. Which of the following factors most likely accounts for the appearance of these lymph nodes?

A- Aging effects

B- Bleeding disorder

C- Cigarette smoking

D- Liver failure

E- Multiple metastases

Answer: C

11-A 22-year-old woman from Albania has a congenital anemia requiring multiple transfusions of RBCs for many years. On physical examination, her skin has a bronze color. Liver function tests show reduced serum albumin. Which of the following findings would most likely appear in a liver biopsy specimen?

A- Amyloid in portal triads

B- Bilirubin in canaliculi

C-Glycogen in hepatocytes

D-Hemosiderin in hepatocytes

E-Steatosis in hepatocytes

Answer: D

12-An experiment analyzes cells for enzyme activity associated with sustained cellular proliferation. Which of the following cells is most likely to have the highest telomerase activity?

A- Endothelial cells

B- Erythrocytes

C- Germ cells

D- Neurons

E- Neutrophils

Answer: C

INFLAMMATION 1-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: C

2-A 72-year-old man with severe emphysema has had worsening right ventricular failure for the past 5 years. For the past 4 days, he has had fever and increasing dyspnea. A chest radiograph shows an accumulation of fluid in the pleural spaces. Fluid obtained by thoracentesis has a specific gravity of 1.030 and contains degenerating neutrophils. The most likely cause of this fluid accumulation is due to changes in which of the following?

A-Colloid osmotic pressure

B-Leukocytic diapedesis

C-Lymphatic pressure

D-Renal sodium retention

E-Vascular permeability

Answer: E

3-A 35-year-old man has had increasing dyspnea for the past 24 hours. A chest radiograph shows large, bilateral pleural effusions. Thoracentesis yields 500 mL of slightly cloudy yellow fluid from the right pleural cavity. Cytologic examination of the fluid shows many neutrophils, but no lymphocytes or RBCs. Which of the following mechanisms contributes most to the pleural fluid accumulation?

A-Arteriolar vasoconstriction

B-Endothelial contraction

C-Inhibition of platelet adherence

D-Lymphatic obstruction

E-Neutrophil release of lysosomes

Answer: B

4-A 6-year-old child has a history of recurrent infections with pyogenic bacteria, including Staphylococcus aureus and Streptococcus pneumoniae. The infections are accompanied by a neutrophilic leukocytosis. Microscopic examination of a biopsy specimen obtained from an area of soft tissue necrosis shows microbial organisms, but very few neutrophils. An analysis of neutrophil function shows a defect in rolling. This child’s increased susceptibility to infection is most likely caused by a defect involving which of the following molecules?

A-Complement C3b

B-Integrins

C-Leukotriene B4

D-NADPH oxidase

E-Selectins

Answer: E

5-In an experiment, bacteria are introduced into a perfused 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: B

6-A 12-month-old boy with a 6-month history of repeated infections has had a fever and cough for the past 3 days. A Gram stain of sputum shows many gram-positive cocci in chains. CBC shows neutrophilia. Laboratory studies show that the patient’s neutrophils phagocytose and kill organisms promptly in the presence of normal human serum, but not in his own serum. The neutrophils migrate normally in a chemotaxis assay. Which of the following is the most likely cause of this boy’s increased susceptibility to infection?

A-Abnormality of selectin expression

B-Diminished opsonization

C-Defective neutrophil generation of hydrogen peroxide

D-Deficiency of integrins

E-Phagocytic cell microtubular protein defect

Answer: B

7-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: B

8-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: D

9-In an experiment, T lymphocytes from peripheral blood are placed in a medium that preserves their function. The lymphocytes are activated by contact with antigen and incubated for 4 hours. The supernatant fluid is collected and is found to contain a substance that is a major stimulator of monocytes and macrophages. Which of the following substances released into this fluid medium is most likely to stimulate macrophages?

A-Histamine

B-Interferon-γ

C-Leukotriene B4

D-Nitric oxide

E-Phospholipase C

F-Tumor necrosis factor (TNF)

Answer: B

10-A 19-year-old woman develops a sore throat and fever during the past day. Physical examination shows pharyngeal erythema and swelling. Laboratory findings include leukocytosis. She is given naproxen. Which of the following features of the acute inflammatory response is most affected by this drug?

A-Chemotaxis

B-Emigration

C-Leukocytosis

D-Phagocytosis

E-Vasodilation

Answer: E

11-A 77-year-old woman experiences a sudden loss of consciousness, with loss of movement on the right side of the body. Cerebral angiography shows an occlusion of the left middle cerebral artery. Elaboration of which of the following mediators will be most beneficial in preventing further ischemic injury to her cerebral cortex?

A-Bradykinin

B-Leukotriene E4

C-Nitric oxide

D-Platelet-activating factor

E-Thromboxane A2

Answer: C

12-In an experiment, bacteria are inoculated into aliquots of normal human blood that have been treated with an anticoagulant. It is observed that the bacteria are either phagocytized by neutrophils or undergo lysis. Which of the following blood plasma components is most likely to facilitate these effects?

A-Complement

B-Fibrin

C-Kallikrein

D-Plasmin

E-Thrombin

Answer: A

13-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: D

14-A 68-year-old man has had worsening shortness of breath for the past week. On physical examination, his temperature is 38.3° C. On percussion, there is dullness over the left lung fields. Thoracentesis performed on the left pleural cavity yields 800 mL of cloudy yellow fluid that has a WBC count of 2500/mm3 with 98% neutrophils and 2% lymphocytes. A Gram stain of the fluid shows gram-positive cocci in clusters. Which of the following terms best describes the process occurring in his left pleural cavity?

A-Abscess

B-Chronic inflammation

C-Edema

D-Fibrinous inflammation

E-Purulent exudate

F-Serous effusion

Answer: E

15-A 29-year-old woman with a congenital ventricular septal defect has had a persistent temperature of 38.6° C and headache for the past 3 weeks. A head CT scan shows an enhancing 3-cm, ring like lesion in the right parietal lobe of her brain. Which of the following actions by inflammatory cells has most likely produced this CT finding?

A-Elaboration of nitric oxide by macrophages

B-Formation of immunoglobulin by B lymphocytes

C-Generation of prostaglandin by endothelium

D-Production of interferon-γ by T lymphocytes

E-Release of lysosomal enzymes from neutrophils

Answer: E

16-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: B

17-A 65-year-old man develops worsening congestive heart failure 2 weeks after an acute myocardial infarction. An echocardiogram shows a markedly decreased ejection fraction. Now, capillaries, fibroblasts, collagen, and inflammatory cells have largely replaced the infarcted myocardium. Which of the following inflammatory cell types in this lesion plays the most important role in the healing process?

A-Eosinophils

B-Epithelioid cells

C-Macrophages

D-Neutrophils

E-Plasma cells

Answer: C

18-A 9-year-old boy has had a chronic cough and fever for the past month. A chest radiograph shows enlargement of hilar lymph nodes and bilateral pulmonary nodular interstitial infiltrates. A sputum sample contains acid-fast bacilli. A transbronchial biopsy specimen shows granulomatous inflammation with epithelioid macrophages and Langhans-giant cells. Which of the following mediators is most likely

to contribute to giant cell formation?

A-Complement C3b

B-Interferon-γ

C-Interleukin-1 (IL-1)

D-Leukotriene B4

E-Tumor necrosis factor (TNF)

Answer: B

19-One month after an appendectomy, a 25-year-old woman palpates a small nodule beneath the skin at the site of the healed right lower quadrant sutured incision. The nodule is excised, and microscopic examination shows macrophages, collagen deposition, small lymphocytes, and multinucleated giant cells. Polarizable, refractile material is seen in the nodule. Which of the following complications of the surgery best accounts for these findings?

A-Abscess formation

B-Chronic inflammation

C-Exuberant granulation tissue

D-Granuloma formation

E-Healing by second intention

Answer: D

20-A 41-year-old man has had a severe headache for the past 2 days. On examination, his temperature is 39.2° C. A lumbar puncture is performed, and the cerebrospinal fluid obtained has a WBC count of 910/mm3 with 94% neutrophils and 6% lymphocytes. Which of the following substances is the most likely mediator for the fever observed in this man?

A-Bradykinin

B-Histamine

C-Leukotriene B4

D-Nitric oxide

E-Tumor necrosis factor (TNF)

Answer: E

21-A 43-year-old man with a ventricular septal defect has had a cough and fever for the past 2 days. On examination, he has a temperature of 37.6° C and a cardiac murmur. A blood culture grows Streptococcus, viridans group. His erythrocyte sedimentation rate (ESR) is increased. Microbial cells are opsonized and cleared. Which of the following chemical mediators is most important in producing these findings?

A-Bradykinin

B-C-reactive protein

C-Interferon-γ

D-Nitric oxide

E-Prostaglandin

F-Tumor necrosis factor (TNF)

Answer: B

22-A 54-year-old man undergoes laparoscopic hernia repair. In spite of the small size of the incisions, he has poor wound healing. Further history reveals that his usual diet has poor nutritional value and is deficient in vitamin C. Synthesis of which of the following extracellular matrix components is most affected by this deficiency?

A-Collagen

B-Elastin

C-Fibronectin

D-Integrin

E-laminin

Answer: A

23-A 20-year-old woman undergoes cesarean section to deliver a term infant, and the lower abdominal incision is sutured. The sutures are removed 1 week later. Which of the following statements best describes the wound site at the time of suture removal?

A-Collagen degradation exceeds synthesis

B-Granulation tissue is still present

C-No more wound strength will be gained

D-Type IV collagen predominates

E-Wound strength is 80% of normal tissue

Answer: A

24-A 24-year-old man with acute appendicitis undergoes surgical removal of the inflamed appendix. The incision site is sutured. A trichrome-stained section representative of the site with blue appearing collagen is shown in the figure. How long after the surgery would this appearance most likely be seen?

A-1 day

B-2 to 3 days

C-4 to 5 days

D-2 weeks

E-1 month

Answer: E

25-A 40-year-old man underwent laparotomy for a perforated sigmoid colon diverticulum. A wound infection complicated the postoperative course, and surgical wound dehiscence occurred. Primary closure was no longer possible, and the wound “granulated in.” Six weeks later, the wound is only 10% of its original size. Which of the following processes best accounts for the observed decrease in wound size over the past 6 weeks?

A-Elaboration of adhesive glycoproteins

B-Increase in synthesis of collagen

C-Inhibition of metalloproteinases

D-Myofibroblast contraction

E-Resolution of subcutaneous edema

Answer: D

26-In an experiment involving observations on wound healing, researchers noted that intracytoplasmic cytoskeletal elements, including actin, interact with the extracellular matrix to promote cell attachment and migration in wound healing. Which of the following substances is most likely responsible for such interaction between the cytoskeleton and the extracellular matrix?

A-Epidermal growth factor

B-Fibronectin

C-Integrin

D-Platelet-derived growth factor

E-Type IV collagen

F-Vascular endothelial growth factor

Answer: C

27-A 23-year-old woman receiving corticosteroid therapy for an autoimmune disease has an abscess on her upper outer right arm. She undergoes minor surgery to incise and drain the abscess, but the wound heals poorly over the next month. Which of the following aspects of wound healing is most likely to be deficient in this patient?

A-Collagen deposition

B-Elaboration of VEGF

C-Neutrophil infiltration

D-Re-epithelialization

E-Serine proteinase production

Answer: A

28-A 58-year-old man had chest pain persisting for 4 hours. A radiographic imaging procedure showed an infarction involving a 4-cm area of the posterior left ventricular free wall. Laboratory findings showed serum creatine kinase of 600 U/L. Which of the following pathologic findings would most likely be seen in the left ventricular lesion 1 month later?

A-Chronic inflammation

B-Coagulative necrosis

C-Complete resolution

D-Fibrous scar

E-Nodular regeneration

Answer: D

GOOD LUCK