DAVAO MEDICAL SCHOOL FOUNDATION

College of Medicine

GENERAL PATHOLOGY

Chapter 1 CELLULAR ADAPTATIONS, CELL INJURY, AND CELL DEATH

OBJECTIVES:

1. Define and explain atrophy, hypertrophy and hyperplasia and give appropriate examples of each.
2. Define and explain metaplasia and dysplasia and give appropriate examples of each.
3. Explain how the functions of cells are coordinated and integrated and define homeostasis and steady state.
4. Define reversible and irreversible cell injury and describe the flux of water and minerals across the plasma membrane of
injured cells.
5. Explain the cytoplasmic changes in reversible cell injury.
6. Define and describe the nuclear changes in irreversible cell injury.
7. Define apoptosis and give examples of its significance.
8. List the most important causes of cell injury, and explain the role of oxygen radicals in cell injury.
9. Describe outcomes of cell death with special emphasis on calcification.
10. Describe and give clinical examples of extracellular and intracellular accumulations in cell injury.
11. Discuss the current theories of aging with special emphasis on genetic aspects of aging.

QUESTIONS:

________ 1. Acetaminophen may be toxic under certain conditions, for example if taken in large amounts together with
alcohol. It has been shown that the toxicity of acetaminophen is mediated by oxygen radicals, which are produced in large
amounts and due to the depletion of an important scavenger molecule that normally inactivates hydrogen peroxide. Name
that cytosolic scavenger of oxygen radicals.

A. Catalase
B. Iron
C. Oxidase
* D. Glutathione

________ 2. A patient with autoimmune hemolytic anemia was transfused with 24 blood units over a period of 3 years. He
died of pneumonia. At the autopsy the liver was dark brown and contained increased amounts of Prussian blue positive
pigment. Name this pigment.

* A. Hemosiderin
B. Carbon
C. Lipofuscin
D. Melanin

________ 3. A coal-miner suffered from chronic bronchitis and emphysema. At autopsy the lungs appeared black. The
mediastinal lymph nodes were also black. Although you have no histologic slide, you can still make unequivocally the
diagnosis of

A. Alkaptunuria
B. Ochronosis
C. Hemosiderosis
* D. Anthracosis

________ 4. At autopsy of a 60 year old man who died of myocardial infarction, histologically the heart demonstrated:
loss of nuclei, loss of cell outlines, deeply eosinophilic staining of the cytoplasm and a loss of cross striation of cardiac
myocytes. This heart shows signs of

* A. Coagulative necrosis
B. Fat necrosis
C. Caseous necrosis
D. Liquefactive necrosis

________ 5. A mediastinal lymph node of a patient who died of miliary tuberculosis was examined histologically. There
were numerous granulomas, the central areas of which were composed of amorphous granular material. On gross
examination these lymph nodes appear yellow-white, and are a typical example of

A. Coagulative necrosis
B. Fat necrosis
* C. Caseous necrosis
D. Liquefactive necrosis

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________ 6. Following a fracture the leg was placed into a cast. Six weeks later the skeletal muscle cells appear angulated
in histologic sections. These cells have reduced energy requirements. The muscles of the extremity are weak. Name the
form of adaptation that occurred in this muscle.

A. Hypertrophy
B. Hyperplasia
* C. Atrophy
D. Metaplasia

________ 7. A chronic smoker presented to the hospital with relentless coughing. A bronchial biopsy was performed. It
contained fragments of mature squamous epithelium with no evidence of nuclear atypia. This pathologic change is called

A. Hypertrophy
B. Hyperplasia
C. Atrophy
* D. Metaplasia

________ 8. Deposition of calcium salts in lymph nodes affected by tuberculosis is an example of a pathologic process
called

A. Peroxidation
B. Lipolysis
C. Metastatic calcification
* D. Dystrophic calcification

________ 9. Multiple opacities in the cornea of a child given large amounts of vitamin D were found to contain deposits
of calcium phosphate. This pathologic process is an example of

A. Peroxidation
B. Lipolysis
* C. Metastatic calcification
D. Dystrophic calcification

________10. A thrombus of the right coronary artery was lysed by infusion of plasminogen activator into the occluded
coronary artery. A reperfusion injury was induced. Activated oxygen species that induced the injury was in part derived
from the myocardial cells and in part from another source. Name that other source of oxygen radicals in this situation.

* A. Leukocytes
B. Thrombus
C. Plasminogen
D. Mitochondria

________11. Hydropic swelling of the cell is characterized by each of the following EXCEPT

A. increased number of cytoplasmic organelles

B. dilatation of cisternae of endoplasmic reticulum
C. impairment of cellular volume regulation
* D. influx of sodium into the cell

________12. Hypertrophic heart muscle cells contain increased amounts of

A. water in the sarcoplasmic reticulum

B. smooth endoplasmic reticulum
C. rough endoplasmic reticulum
* D. messenger RNA

________13. Erythroid hyperplasia of the bone marrow is often found in people who live

A. at sea level
* B. at extremely high altitude (10,000 feet)
C. in the equatorial jungles of Brasil
D. above the polar circle in Canada

Chapter 2 ACUTE AND CHRONIC INFLAMMATION

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Know the clinical signs of inflammation, the cause(s) of each, and appreciate their importance
to you in a diagnostic sense.
2. Differentiate exudate from transudate.
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 3. Know the vascular and cellular changes happening in acute inflammation.
4. Know the various chemical mediators involve in acute inflammation.
5. Understand that the inflammatory process can lead to several outcomes, and that it will tend to persist
until the inciting agent is eliminated.
6. Know the different morphologic patterns of acute inflammation.
7. Know the causes, morphologic features, and inflammatory cells involved in chronic inflammation.
8. Define granulomatous inflammation and list down its morphologic characteristics.
9. Know the clinical and pathologic changes that make up the acute phase response.

QUESTIONS:

________ 1. Formylated peptides derived from bacteria, leukotrienes derived from plasma membranes and complement
fragments have in common that they all mediate a process important for formation of an exudate. This process is called

* A. Chemotaxis
B. Phagocytosis
C. Extravasation
D. Margination

________ 2. Which biogenic amine released from mast cells accounts for the increased vascular permeability at the site of
inflammation?

A. Bradykinin
B. Interferon
C. Tumor necrosis factor -alpha
* D. Histamine

________ 3. The arachidonic acid derivations produced through the lipoxygenase pathway in neutrophils, mast cells and
macrophages in bronchial asthma, and known as slow reacting substances of anaphylaxis belong to the group of chemical
substances known collectively as

A. Prostaglandin
* B. Leukotrienes
C. Lipoxin
D. Histamine

________ 4. Hageman factor activates kallikrein, which in turn produces a polypeptide that is an important plasma derived
mediator of increased vascular permeability. Name this substance.

* A. Bradykinin
B. Interferon
C. Tumor necrosis factor -alpha
D. Histamine

________ 5. Name the group of plasma proteins that upon activation form intermediate complexes and fragments which
act as vasoactive mediators of inflammation, prime phagocytic cells for a more active response to bacteria, and act as
chemotactic factors.

A. Hageman factor
B. Kinins
* C. Complement
D. Kallikreins

________ 6. Which plasma protein if activated by a variety of stimuli can initiate the clotting cascade, the fibrinolytic
pathway and kinin production?

* A. Hageman factor
B. Kinins
C. Complement
D. Kallikreins

________ 7. The process in which fragments of complement or IgG bind to bacteria facilitating phagocytosis is called

* A. Opsonization
B. Margination
C. Extravasation
D. Adhesion

________ 8. The adhesion of leukocytes to the endothelial cells in the early stages of inflammation is preceded by changes
in the blood flow, most notably apportioning of leukocytes to the peripheral parts of the blood stream. This process is called
A. Opsonization
* B. Margination
C. Extravasation
D. Adhesion
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________ 9. Which process representing an essential aspect of inflammation is mediated by cell surface glycoproteins
known as LFA, ICAM-1, GMP-140? _______________

A. Opsonization
B. Margination
C. Extravasation
* D. Adhesion

________10. Name the mobile cell in tissue that actively presents the antigen to lymphocytes and by secreting interleukins,
regulates lymphocyte function.

A. Neutrophil
B. Natural killer cell
C. Langerhans cell
* D. Macrophage

Chapter 3 TISSUE RENEWAL AND REPAIR: REGENERATION, HEALING, AND

FIBROSIS

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Discuss the phases of the cell cycle and their relation to the proliferative potential of the cells of the body.
to you in a diagnostic sense.
2. Have a basic knowledge about stem cells and its potentials in the process of tissue regeneration.
3. Know the several growth factors important to tissue regeneration and repair.
4. Know the general modes of signaling.
5. Know the major types of receptors and how they deliver signals to the cell interior.
6. List the 5 major components of the extracellular matrix. Describe the function(s) of the matrix .
7. Have a basic knowledge of the healing processes like angiogenesis, synthesis of ECM proteins and tissue
remodeling
8. Describe the process of wound healing in skin
9. Discuss 3 complications of wound healing and their probable etiologies .
10. Know the clinical and pathologic changes that make up the acute phase response.

QUESTIONS:

________ 1. Name the glycoprotein that is deposited early in wound healing and is known for its binding sites for fibrin,
fibrinogen, collagen, and other components of the extracellular matrix.

* A. Fibronectin
B. Laminin
C. Fibrillin
D. Collagen

________ 2. ) Name the tissue filling the bottom of a non-healing wound that consists histologically of capillaries,
fibroblasts, collagen, and a variable number of inflammatory cells.

A. Collagen
B. Granuloma
* C. Granulation Tissue
D. Fibrin

________ 3. Name the cell that accounts for the primary contraction of the wound. This cell has features of both a
fibroblast and a smooth muscle cell.

A. Collagen
* B. Myofibroblast
C. Fibroblast
D. Myoblast

________ 4. An exuberant (hypertrophic) scar developed after plastic surgery in a 20 year old Afro-American woman.
This complication of wound healing is called

A. Hypertrophy
* B. Scar
C. Granulation tissue
D. Keloid

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________ 5. Name the family of transmembrane proteins that interact with the cytoskeleton and the extracellular matrix.

A. Fibrillin
B. Collagen
C. Fibrin
* D. Integrin

________ 6. Renal proximal tubule cells are capable of repair after tubular necrosis unless there is destruction of the

A. Extracellular matrix
B. Basement membrane
C. Upper layer of the epithelium
* D. A & B are correct

________ 7. What is the name of the process characterized by a growth of newly formed blood vessels, stimulated by
growth factors? _______________(Angiogenesis (Granulation Tissue).)

A. Fibrosis
B. Extravasation
* C. Angiogenesis
D. Granulation

________ 8. Bursting of a wound is called _______________(Dehiscence.)

A. Contracture
* B. Dehiscence
C. Keloid
D. 2nd intenetion

________ 9. Name a growth factor derived from platelets that are capable of inducing new growth of mesoderm-derived
components (fibroblasts, etc.) in wounds. _______________(Platelet-Derived Growth Factor.)

* A. Platelet derived growth factor

B. Platelet factor
C. Interferon
D. Platelet growth factor

________10. Each of the following are examples of atrophy EXCEPT

A skeletal muscle following transection of its nerve

B skeletal muscles following long term immobilization
C ovary following hypophysectomy
D endometrium following administration of estrogen
E brain of an 100 year old man

Chapter 5 GENETICS

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Able to define and discuss the 3 categories of mutation with special emphasis on the gene mutation.
2. Able to know and briefly discuss the transmission patterns of single gene disorders.
3. Able to briefly explain the biochemical and molecular basis of single-gene (Mendelian Disorders).
4. Able to know morphologically, clinically and pathogenesis of some selected disorders associated with defects in structural
proteins, receptor proteins, enzymes, regulatory proteins.
5. Able to know the terminology system in karyotyping.
6. Able to briefly discuss the most common forms of alterations in chromosome structure and the notations used to
signify them.
7. Able to know morphologically, clinically and pathogenesis of some selected cytogenetic disorders involving autosomes and
sex chromosomes.
8. Able to know morphologically, clinically and pathogenesis of some selected single gene disorders with non-classic
inheritance.

QUESTIONS:

________ 1. Worried parents come to your office concerned about an increased risk of transmitting genetic disease to their
offspring. You reassure them that there is no increased risk of having a second, afflicted child even if their first child is born
with:
A. Cleft lip
B. Hydrops fetalis
C. Albinism
* D. Torch embryopathy

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________ 2. Neonatal lymphedema, short stature, infertility, normal intelligence, and coarctation of the aorta are
characteristics typical of which genetic abnormality?
A. Trisomy 21
* B. Turner syndrome
C. Any autosomal aneuploidy
D. Cri du Chat syndrome
E. Fragile X syndrome

________ 3. Epicanthal fold, Brushfield spots, dysplastic ears, megacolon, congenital heart disease, and a simian crease
are all clinical features of a numerical abnormality of chromosome number:
A. 11
B. 17
C. 18
* D. 21

________ 4. Cardiovascular disorders, particularly dissecting aortic aneurysm, are the most common cause of death in
which autosomal dominant disorder?
A. Neurofibromatosis
B. Familial hypercholesterolemia
C. Erhler-Danlos syndrome
* D. Marfan syndrome

________ 5. Inherited as an autosomal dominant trait:

* A. Neurofibromatosis type I
B. Cystic fibrosis
C. Alcaptonuria
D. Neimann-Pick disease
E. Gaucher disease

________ 6. The inheritance pattern of cleft lip and cleft palate is:
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
* D. Multifactorial

________ 7. An exchange of fragments of chromatids between non-homologous chromosomes may occur during the first
meiotic division. This chromosomal structural abnormality is called:
A. Deletion
B. Inversion
C. Nondisjunction
D. Segregation
* E. Translocation

Chapter 6 DISEASES OF IMMUNITY

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Define and distinguish between natural immunity and acquired immunity

2. List the main organs and cells that participate in the immune response.
3. Understand the major histocompatibility complex and its relationship to transplantation and disease.
4. Discuss the mechanisms of the four hypersensitivity reactions.
5. Describe the main forms of transplants: homograft, isograft, autograft, and xenograft.
6. Able to discuss the mechanisms and morphology of transplant rejection.
7. Able to know the methods on increasing graft survival.
8. Able to know the concept of auto tolerance and how they can be bypassed.
9. Able to know the etiology, pathogenesis , morphology and clinical presentation of selected autoimmune disorders
and immunologic deficiency syndromes.
10. Able to know the etiology, pathogenesis, morphology and clinicla presentation of amyloidosis.

QUESTIONS:

________ 1. A 30 year old woman with leukemia was irradiated and transfused with bone marrow cells of a related donor.
She developed skin rash, diarrhea and jaundice. What is the name of this disease?

A. Hypersensitivity reaction
* B. Graft vs. host reaction
C. Immune deficiency reaction
D. AIDS

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________ 2. A complex of genes on chromosome 6, the products of which are important in antigen presentation, and for
mounting an immune reaction to transplanted foreign tissues.

* A. Major histocompatibility complex

B. T-cell receptor
C. CD3 proteins
D. Human leukocyte antibody

________ 3. A skin biopsy in a 30 year old woman with a skin rash showed deposits of IgG and complement along the
basement membrane in a granular pattern. The patient had positive ANA antinuclear anti ds-DNA antibody, arthritis and
glomerular inflammation. Name this disease. _______________

A. Amyloidosis
B. AIDS
* C. Sytemic lupus erythematosus
D. Scleroderma

________ 4. A 40 year old female presents with “tight”, atrophic skin, dyspnea (shortness of breath), esophageal
dysphagia, Raynaud’s phenomenon and kidney disease. Skin biopsy shows markedly condensed connective tissue. What
autoimmune disease could account for this constellation of symptoms?

A. Amyloidosis
B. AIDS
C. Sytemic lupus erythematosus
* D. Scleroderma

________ 5. A 40 year old man presents with hemoptysis, renal failure. He has antibodies to collagen type IV that react
with glomerular basement membranes in a linear manner. Name this disease. _______________

A. Systemic lupus erythematosus

B. Graft vs. host reaction
C. Serum sickness
* D. Goodpasture syndrome

________ 6. Name the mobile cell in tissue that actively presents the antigen to lymphocytes and by secreting interleukins,
regulates lymphocyte function.

A. Lymphocyte
B. Plasma cell
* C. Macrophage
D. Neutrophils

________ 7. Each of the following represents a type II hypersensitivity (cytotoxic) reaction EXCEPT
A. Coomb's positive hemolytic anemia
B. myasthenia gravis
C. pemphigus vulgaris
* D. bronchial asthma

________ 8. A 28 year old female presents herself to your clinic complaining of a rash that worsens upon exposure to
sunlight. She reports fatigue x 1 month and swollen, painful joints. Serology for anti-nuclear antibody and anti-double-
stranded DNA are positive, in high titers. What is the best diagnosis?
A. dermatomyositis
B. graft vs. host reaction
C. rheumatoid arthritis
* D. type III hypersensitivity

________ 9. Severe myalgia (muscle pain), elevated CPK with MM isotype, and a rash involving the eyelids is
characteristic of this disease.
* A. dermatomyositis
B. Goodpasture syndrome
C. graft vs. host reaction
D. mixed connective tissue disease

________10. A 40 year old female patient experiences a difficulty swallowing (due to esophageal fibrosis upon biopsy),
myositis, and later in her course even develops arthritis. Anti-double-stranded DNA serology is negative, and serologic
markers for dermatomyositis are not pathognomonic. A short course of corticosteroids seems to improve her condition
somewhat. What is the best diagnosis?
A. dermatomyositis
B. Goodpasture syndrome
* C. mixed connective tissue disease
D. graft vs. host reaction

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Chapter 7 NEOPLASIA

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Define neoplasia and its related terms: tumor, cancer, and oncology.
2. Differentiate the two basic components of tumor.
3. Understand the nomenclature of tumors.
4. Differentiate benign from malignant tumors based on differentiation, rate of growth, local invasion and
metastasis.
5. Discuss the basic principles of the molecular basis of cancer.
6. List down and briefly describe the seven fundamental changes in cell physiology that determine malignant
phenotype.
7. Discuss the normal cell cycle and how it progress from one phase to another.
8. Define oncogene, list their main groups and give examples of each, and discuss the mechanism of how
they promote cancer.
9. Discuss the importance of ras oncogenes.
10. Give a brief discussion on cancer suppressor genes.
11. Discuss the concepts of multistep carcinogenesis, tumor progression and heterogeneity.
12. Give a brief description on the steps involved in chemical carcinogenesis.
13. Give a brief description on the steps involved in radiation carcinogenesis.
14. Give a brief description on the steps involved in microbial carcinogenesis as exemplied by several viruses.
16. Able to discuss the possible ways and means a body can defend itself against tumors.
17. Able to know the effects of tumor to the body.
18. Able to know the difference between grading and staging of cancer.
19. Able to list down the laboratory aids in diagnosing cancer.

QUESTIONS:

________ 1. Each of the following statements concerning multi-stage carcinogenesis is CORRECT, EXCEPT
A. DNA damage is involved during initiation
B. requires a long time for tumors to evolve
C. occurs in animal models, but not in humans
D. involves multiple genetic events
* E. implicated in tumors of epithelial origin

________ 2. The following are common characteristics of metastatic cells EXCEPT

* A. often resemble primary tumor
B. spread by lymphatic vessels
C. vascular spread
D. invade basement membranes
E. incapable of degrading extracellular matrix

________ 3. Select the gene most likely associated with the condition. A 50 year old woman presents to her physician with
fatigue, fever and splenomegaly. Blood work-up indicates granulocytic leukocytosis in peripheral blood (20,000/ul). Her
physician diagnoses the patient as being in the early stages of chronic myelogenous leukemia.

A. Ki-ras oncogene
* B. c-src oncogene
C. BCR/abl oncogene
D. c-myc oncogene

________ 4. Select the gene most likely associated with the condition. A 2 cm mass is removed from a 45 year old
woman's breast. Frozen sections are prepared and the diagnosis from the surgical pathologist is ductal adenocarcinoma,
grade three. As the attending physician, you request that the pathologist perform immunohistochemistry staining for this
oncogene product to assist you in predicting this woman's prognosis.
A. Ki-ras oncogene
B. c-src oncogene
* C. BCR/abl oncogene
D. c-myc oncogene

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________ 5. Select the MOST LIKELY tumor suppressor gene to be implicated. A 42 year old woman patient visits her
physician for a yearly examination and a 1 cm lump is detected in her left breast. An excisional biopsy is performed and the
diagnosis is grade 2 adenocarcinoma. Further examination of the above patient's family history reveals that she has a
mother and sister who both have had breast cancer diagnosed before menopause. It is likely that these women have
inherited a germline mutation in this tumor suppressor gene.
* A. p53
B. Rb
C. Wilms tumor gene
D. APC gene

________ 6. The following are common characteristics of metastatic cells EXCEPT

* A. often resemble primary tumor
B. spread by lymphatic vessels
C. vascular spread
D. invade basement membranes
E. incapable of degrading extracellular matrix

________ 7. Which of the following statements regarding oncogenic DNA viruses is CORRECT?

A. transforming genes are homologous to c-oncs

B. play no role in human cancers
C. only one connected with human cancer is HTLV-1
* D. produce proteins capable of inactivating Rb and p53
E. cause cancer by insertional mutagenesis.

________ 8. Each of the following factors can contribute to weight loss in a cancer patient EXCEPT

A. anorexia
B. decreased food intake
* C. lowered metabolic rate
D. reduction of stored fat due to TNF
E. depression

________ 9. Select the most likely gene product. A nuclear protein which can induce apoptosis or alternatively can cause
cell cycle arrest by turning on expression of cyclin inhibitors.

A. Ras p21
B. HER2/neu
* C. BCR/abl
D. PDGF

________10. Select the most likely gene product. A nuclear protein which controls cell cycle by regulating the entry into S
phase by binding up essential transcription factors.

A. Ras p21
* B. HER2/neu
C. BCR/abl
D. PDGF

Chapter 9 ENVIRONMENTAL AND NUTRITIONAL PATHOLOGY

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Know the basic components of a typical dose-response curve for acute toxicity.
2. Know the basic principles of xenobiotic metabolism.
3. Know the pathogenic mechanism of tobacco and alcohol abuse and its effects on various organs.
4. Know the pathogenic mechanism of selected dangerous and therapeutic drugs.
5. Know the pathogenic mechanism and its sources of selected outdoor and indoor pollutants.
6. Know the sources and effects on various organs of selected industrial and agricultural pollutants.
7. Define ionizing radiation, give its units of measurement, and describe its adverse effects--short and long term--on
tissues.
8. Discuss the radiosensitivity of the various types of tissues to radiation.
9. Discuss total body radiation, amounts involved, and acute and chronic effects.
10. List the adverse long-term and short-term effects of sunlight on the skin.
11. Know the various terms that is being use in the various types of injuries caused by mechanical, thermal, electrical and
athmosperic pressure.
12. Know the complications in the early and late stages of burns.
13. Know the differences between kwashiorkor and marasmus.
14. Know the active compound, consequences of the deficiency, and pathogenesis of the fat and water soluble vitamins
deficiency.
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15. Know the 5 important trace elements and their function and deficiency syndromes.
16. Know the simplified scheme of the development of obesity.
17. Know the various methods in determining fat accumulation.

QUESTIONS:

________ 1. A patient with anorexia, dyspnea, a smooth sore tongue, numbness and tingling of feet, and mild paralysis of
legs, was found to have megaloblastic anemia which was not reversed by folate therapy. What was the vitamin deficiency?

* A. Vitamin B12
B. Vitamin B1
C. Vitamin B6
D. Vitamin A

________ 2. An infant developed petechial hemorrhages 5 days following birth. Deficiency in what vitamin might have
been contributory?

A. Vitamin A
B. Vitamin D
C. Vitamin E
* D. Vitamin K

________ 3. ) A chronic alcoholic developed signs and symptoms of beriberi (Wernicke encephalopathy, cardiac failure,
sight loss, peripheral neuropathy, muscle wasting, edema). What was the vitamin deficiency?

A. Vitamin B12
* B. Vitamin B1
C. Vitamin B6
D. Vitamin A

________ 4. A patient presented with night blindness, keratomalacia, corneal ulceration and bronchopneumonia. What
vitamin deficiency might be suspected?

* A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K

________ 5. A woman was diagnosed as having diabetes, myocardial infarction and gallstones. She was suffering from
the most common nutritional disorder in industrial counties. Name this disorder

A. Kwashiorkor
B. Marasmus
* C. Obesity
D. Beri-beri

________ 6. A patient presented with dermatitis, diarrhea and dementia. What is the most likely vitamin deficiency?

* A. Niacin
B. Pyridoxin
C. Ascorbic acid
D. Riboflavin

________ 7. A boy presented with irritability and ataxia, and was found to have hemolytic anemia, basophilic stippling of
erythrocytes, and dark gray gingival pigmentation. Chronic poisoning with _______________ was diagnosed.

A. Chromium
B. Cobalt
C. Cadmium
* D. Lead

_______ 8. A man was found semiconscious in his backyard beside a metal ladder, suffering from a burn on his hand and
cardiac arrhythmias. What was probably the cause of his problem?

A. Heat stroke
* B. Electrical injury
C. Too much alcohol
D. High altitude illness

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________ 9. A healthy adult running a marathon in the summer developed hot dry skin, cessation of sweating, lactic
acidosis, hypocalcemia, and rhabdomyolysis. What is your diagnosis?_______________(Heat stroke.)

A. Heat cramps
B. Heat exhaustion
* C. Heat stroke
D. Hypothermia

________10. A boxer won his fight but received a black eye in the process. This lesion is best classified as

A. Laceration
* B. Contussion
C. Abrasion
D. Incision

________11. A severely depressed individual committed suicide by running his car engine in his closed garage. The
cherry-red color of his tissues at autopsy is due to the presence of

* A. Carboxyhemoglobin
B. Nitrogen
C. Carbon monoxide
D. Hemoglobin

________12. A patient involved in a house fire was hospitalized with subepidermal bullae which eventually healed without
skin grafts. These skin lesions represent

A. 1st degree burn

* B. 2nd degree burn
C. 3rd degree burn
D. 4th degree burn

________13. A boy, roller blading without knee and hand protection, fell and scraped his skin. Name this skin lesion.

A. Laceration
B. Contussion
*C. Abrasion
D. Incision

________14. A chronic alcoholic ran out of liquor and imbibed some anti-freeze containing ethylene glycol. He died and
many of his renal tubules contained oxalate crystals. This is an example of

* A. Biotransformation
B. Bioaccumulation
C. Biologic dose
D. Toxic dose

________15. An HIV positive drug abuser was found dead and autopsy demonstrated severe pulmonary edema and foreign
body granulomas. What drug most likely cause his death?

A. Cocaine
B. Marijuana
C. Shabu
* D. Heroin

Chapter 10 DISEASES OF INFANCY AND CHILDHOOD

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Know the four time spans of a child.

2. Know at least 3 causes of death related with age.
3. Define the following: malformations, disruptions, deformations and syndrome.
4. Know the 3 major causes of anomalies and discuss some examples of each.
5. Discuss some important principles in developmental pathology.
6. Know how infants are classified based on gestational age and the basis of the classification.
7. Differentiate prematurity from fetal growth restriction and discuss the major risk factors of each.
8. Know the major organs affected in a preterm infant and briefly describe the changes seen in each.
9. Know and understand the Apgar score system.
10. Know the common and most important birth injuries.
11. Know the etiology, pathogenesis, morphology and clinical course of the following disorders
a. idiopathic respiratory distress syndrome of the newborn
b. necrotizing enterocolitis
c. fetal hydrops
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12. Know the clinical presentation, pathogenesis, morphology (if any) and treatment of the following inborn errors of
metabolism:
a. phenylketonuria
b. galactosemia
c. cystic fibrosis
13. Know the definition, incidence and epidemiology, morphology and pathogenesis of SIDS.
14. Able to know the clinical presentation of the following benign tumors:
a. hemangiomas
b. lymphangiomas
c. teratomas
15. Able to know the morphology and clinical course of the following malignant tumors:
a. neuroblastoma
b. retinoblastoma
c. Wilm’s tumor

QUESTIONS

________ 1. The patient was a 2 year old female with a large right sided abdominal mass that was discovered by her
parents while changing a diaper. Histologic examination of the kidney after nephrectomy revealed a triphasic combination
of blastemal, stromal, and epithelial cell types. What is the diagnosis?
A. Leukemia
B. Neuroblastoma
* C. Wilms tumor
D. Renal cell carcinoma

________ 2. A baby was born without kidneys and a typical Potter complex. The abnormal amount of amniotic fluid
found in this complex is called oligohydramnios. Oligohydramnios is a form of

* A. Sequence
B. Malformation
C. Disruption
D. Deformation

________ 3. A child born to an Rh negative mother was found to have severe edema, which was apparently caused by a
hemolytic anemia and congestive heart failure. The subsequent work-up of the mother and the newborn disclosed severe
Rh incompatibility between them and the existence of anti-Rh antibodies in the maternal circulation. What is the clinical
name for this severe form of Rh incompatibility?

* A. Hydrops fetalis
B. Phenylketonuria
C. Oligohydramnios
D. Acute Lymphocytic Leukemia (ALL)

________ 4. A child born with an abnormality involving the cystic fibrosis membrane conductance regulator was found to
have signs of intestinal obstruction. Name this neonatal complication of this autosomal recessive disease.

A. Galactosemia
* B. Meconium Ileus
C. Phenylketonuria
D. Necrotizing enterocolitis

________ 5. A baby boy was born prematurely at 30 weeks of gestation. He weighed 2,000 grams. After birth the baby
became short of breath and had difficulties with breathing. The alveolar ducts of the lungs of such babies are lined with
eosinophilic structures called

A. Bronchiole
B. Alveolus
C. Meconium
* D. Hyaline membrane

________ 6. A newborn child was found to have an inborn error of amino acid metabolism. The progressive mental
deterioration that develops typically in this disease can be prevented by placing the child on a special diet that does not
contain an essential amino acid. Name this autosomal recessive disorder

A. Galactosemia
B. Meconium ileus
* C. Phenylketonuria
D. Cystic fibrosis

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Chapters 11 & 12 CARDIOVASCULAR DISORDERS

OBJECTIVES:

At the completion of this unit, the student should be able to ...

1. Describe the anatomic structure and normal physiology of the heart and circulatory system.
2. Appreciate the inter-relationship among the cardiovascular, pulmonary and renal systems.
3. Define and describe the autonomic nervous system's role in cardiovascular regulation.
4. Describe the pathogenesis, pathophysiology, and symptoms of atherosclerotic coronary and peripheral vascular
disease.
5. Define and be able to use essential cardiovascular terminology, such as angina pectoris, ischemia, infarction,
hypertrophy, dilatation, stenosis, regurgitation, pre-load, after-load, stroke volume, and cardiac index.
6. Identify the major risk factors for coronary artery disease.
7. Describe the use of laboratory tests in the diagnosis and treatment of cardiovascular disease (i.e., cholesterol
fractionation, CPK isoenzymes).
8. Define and describe the pathogenesis, pathophysiology and symptoms of heart failure: right-sided vs. left-sided;
systolic vs. diastolic dysfunction.
9. Explain the compensatory mechanisms in heart failure.
10. Recognize and discuss exacerbating factors in heart failure, such as anemia, hypoxemia, fever, uncontrolled
hypertension, hyperthyroidism, tachyarrhythmias, drug toxicity and ischemia.
11. Identify common types of valvular heart disease, such as aortic stenosis, mitral regurgitation and (rheumatic)
mitral stenosis.
12. Discuss the pathogenesis of acute myocardial infarction, as well as its electrical and mechanical complications.
13. Identify the cardiovascular complications of hypertension, such as left ventricular hypertrophy and aortic
dissection.
14. Recognize the gross and microscopic findings associated with atherosclerotic coronary artery disease,
myocardial infarction, chamber hypertrophy and dilatation.
15. Define the role and pharmacology of commonly prescribed cardiac medications in the treatment of cardiac
diseases (digoxin, diuretics, beta-blockers, ACE inhibitors, anti-arrhythmic, nitrates, anti-coagulants and lipid
lowering agents).
16. State the differential diagnosis of chest pain and briefly describe how commonly used non-invasive studies
(EKG, Echo, stress test) may be helpful diagnostically.

QUESTIONS

________ 1. Microscopic examination of the myocardial infarction in a patient who expired 24-48 hours following
the occlusion of the coronary artery shows:
A. Well-developed granulation tissue
* B. Necrosis of myocardium and infiltrates of polymorphonuclear leukocytes
C. Plasma cell infiltrates
D. Fibroblastic proliferation

________ 2. A 60 year old man is admitted to the hospital with a chief complaint of substernal chest pain and
perspiration. Examination reveals an obese man with a long history of angina and intermittent claudication.
a blood test after 4 hours would usually reveal elevated levels of:
A. Aspartate transaminase
B. Acid phosphatase
* C. Creatine kinase
D. Lactate dehydrogenase

________ 3. Hematuria and flank pain are observed in a patient with a seven-day history of trans-mural myocardial
infarction. What is the most likely underlying cause?
A. Emboli from ventricular mural thrombi
B. Emboli from atrial mural thrombi
* C. Emboli from aortic valve vegetations
D. Acute pyelonephritis

________ 4. A patient with a massive myocardial infarction dies suddenly on the sixth hospital day. Autopsy reveals: E
A. Lymphocytic infiltrate of myocardium
B. Plasma cell infiltrate of coronary arteries
C. Bilateral occlusions of coronary sinuses
* D. Rupture of left ventricle and hemopericardium

________ 5. A newborn infant is noted to have a holosystolic murmur. The infant is not cyanotic. Which of the following
congenital abnormalities is most likely to be present. B
A. Ebstein's anomaly
* B. Complete transposition of the great vessels
C. Ventricular septal defect
D. Atrial septal defect

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________ 6. A benign, painful tumor originating from the neuromyoarterial receptors in the tips of the fingers or toes.
Select the most likely diagnosis.
A. aldosterone-secreting adrenal tumor
* B. glomus tumor
C. bacillary angiomatosis
D. berry aneurysm

________7. A 65 year old male patient with a history of poorly controlled hypertension develops sudden 'tearing'
pain in the chest followed by signs of cardiac tamponade. Select the most likely diagnosis. F
* A. dissecting aneurysm
B. angiosarcoma
C. bacillary angiomatosis
D. berry aneurysm

________ 8. A 60 year old male presents with a history of sinusitis and cough. Chest x-ray shows large cavitary pulmonary
infiltrates. Routine urinalysis reveals hematuria. A renal biopsy shows evidence of vasculitis in addition to
glomerulonephritis. Select the most likely diagnosis.
* A. Wegener granulomatosis
B. angiosarcoma
C. bacillary angiomatosis
D. berry aneurysm

________ 9. A patient develops a petechial reaction to a thiazide diuretic. A skin biopsy reveals fibrinoid necrosis
of small blood vessels with acute inflammation and nuclear debris. Select the most likely diagnosis.
A. aldosterone-secreting adrenal tumor
* B. leukocytoclastic vasculitis
C. bacillary angiomatosis
D. berry aneurysm

________10. A 30 year old woman complains of severe pain and pallor of her hands and toes, precipitated by
exposure to cold. Select the most likely diagnosis.
* A. Raynaud phenomenon
B. angiosarcoma
C. bacillary angiomatosis
D. berry aneurysm

________11. A 50 year-old female who has had a radical mastectomy and axillary node dissection for breast cancer a year
ago, now notices that her arm becomes swollen by the end of the day. Select the most likely diagnosis.
A. aldosterone-secreting adrenal tumor
B. angiosarcoma
C. bacillary angiomatosis
* D. lymphedema

12. A 75 year-old male presents with headache and visual disturbances. A thickened, tortuous temporal artery is
palpable. Select the most likely diagnosis.
A. aldosterone-secreting adrenal tumor
B. angiosarcoma
* C. giant cell arteritis
D. berry aneurysm

13. A renal biopsy of a 40 year-old African-American male revealed fibrinoid necrosis and "onion-skin" lesions of renal
arterioles. Select the most likely diagnosis.
A. aldosterone-secreting adrenal tumor
* B. malignant hypertension
C. bacillary angiomatosis
D. berry aneurysm

________14. Which of the following congenital heart diseases presents with cyanosis at birth or during the first few weeks
of postnatal life?
A. atrial septal defect, ostium primum type
* B. Tetralogy of Fallot
C. ventricular septal defect, membranous
D. ventricular septal defect, muscular

________15. Myocardial infarct involving the posterior portion of the interventricular septum is caused by an occlusion of
which coronary artery?
* A. right
B. left anterior descending
C. left circumflex
D. left diagonal

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________16. Which of the following is the most characteristic cardiac lesion of acute rheumatic fever?
A. streptococcal abscess
* B. Aschoff body
C. calcification of aortic valves
D. mitral stenosis

________17. Which of the following diseases is most often associated with non-bacterial thrombotic endocarditis?
A. rubella
B. syphilis
* C. carcinoma of the stomach
D. intestinal carcinoid metastatic to liver

________18. Classically, left ventricular rupture occurs at 1-2 weeks post-MI when the heart is maximally infiltrated by
A. lymphocytes
* B. macrophages
C. fibroblasts
D. mature collagen

________19. Jones major criteria for diagnosing rheumatic fever include each the following EXCEPT
A. carditis
* B. aortitis
C. polyarteritis
D. chorea

________20. The most common cause of death during the first two hours following an acute myocardial infarction is
* A. arrhythmia
B. loss of myosin from injured cells
C. loss of troponin T from necrotic cells
D. loss of calcium from sarcoplasmic reticulum

15