Exam 4 Flashcards
Which of the following statement is/are incorrect?
a) Factor Xa catalyzes the conversion of prothrombin to thrombin.
b) Thrombin catalyzes the conversion of fibrinogen to fibrin.
c) Plasmin catalyzes the cross-linking of fibrin.
d) A & B
c) Plasmin catalyzes the cross-linking of fibrin.
Factor XIIIa catalyzes the cross-linking of fibrin clot
Which of the following statements is/are incorrect?
a) The extrinsic pathway is activated by tissue thromboplastin.
b) Tissue thromboplastin is a sulfated glycosaminoglycan.
c) The intrinsic pathway is activated by contact with collagen
d) A & C
b) Tissue thromboplastin is a sulfated glycosaminoglycan.
The extrinsic pathway is activated by tissue thromboplastin, a lipoprotein released by damaged cells. The intrinsic pathway is activated by contact with collagen.
Which of the following is/are incorrect?
a) Factors II, VII, IX, and X are all vitamin K independent coagulation factors
b) Functional vitamin K dependent coagulation factors all contain gamma-carboxygultamate
c) Vitamin K immediately reveres toxicity produced by warfarin
d) B & C
c) Vitamin K immediately reveres toxicity produced by warfarin
A should be false; Factors II, VII, IX, and X are vitamin K-dependent coagulation factors. Vitamin K allows for conversion of glutamate to gamma-carboxyglutamate in these factors. When treating warfarin toxicity, vitamin K restores capacity for synthesis of functional factors, but this will take time.
Which of the following statements is/are incorrect?
a) A thrombus is formed in the intravascular space after death
b) Vitamin K deficiency predisposes to thrombus formation
c) Antithrombin deficiency predisposes to thrombus formation
d) A & B
d) A & B
A thrombus forms when coagulation factors are viable (i.e. during life). Vitamin K deficiency leads to ineffective vitamin K- dependent factors -> impaired clotting mechanism -> predisposed against thrombus formation. Antithrombin inhibits thrombus formation, thus deficiency = thrombus predisposition.
Which of the following statements is/are incorrect?
a) Heparin is used clinically as a thrombolytic agent
b) Heparin intereferes with the final common pathway of coagulation
c) Cross-linking of fibrin renders thrombi more susceptible to thrombyolysis
d) A & C
d) A & C
Heparin is an anticoagulant, not a thrombolytic. Anticoagulants inhibit thrombus formation; thrombolytics dissolve the thrombus. Heparin binds plasma protein antithrombin, inducing conformational change that enhances inhibitory effect against thrombin and factor Xa. Cross-linking makes the fibrin network harder to break.
Which of the following statements is/are incorrect?
a) The core function of the immune system is destruction of nonself molecules
b) Danger cells include cytoplasmic self proteins in the extracellular space
c) The immune system exhibits tolerance to both self and nonself molecules
d) B & C
a) The core function of the immune system is destruction of nonself molecules
Immune responses are directed against perceived danger. Intracellular self-molecules found in the extracellular space suggest leakage of cell contents resulting from cellular membrane damage. There is normal tolerance is toward self (i.e. self-tolerance) and some non-self (e.g. food, fetus).
Which of the following is/are incorrect?
a) Antibodies are coded by unmodified germline DNA sequences
b) Heavy and light chains contribute to antibody class
c) Heavy and light chains contribute to binding
d) A & C
d) A & C
Adaptive immunity (which involves antibodies) is customized via changes in genome of lymphocytes. B should be incorrect; constant region of heavy chain determines antibody class. C is true; antigen-binding arm involves 1 light chain + part of 1 heavy chain.
Which of the following is/are incorrect?
a) IgA crosses the placental barrier
b) IgG is the most abundant
c) IgM appears first
d) B & C
a) IgA crosses the placental barrier
IgM - 1st to appear during exposure
IgG - majority of circulating antibodies; can cross placental barrier
IgA - majority of secreted Ab in mucosal secretions and in colostrum
IgE - responds against parasitic worms; hypersensitivity and in some forms of allergy
IgD - no biological effector function yet; together with IgM, is the major membrane bound-Ig expressed by mature B-cells
Which of the following statements is/are incorrect?
a) Lysoszymes serve to catalyse hydrolysis of bacterial cell walls
b) Cytokines and chemokines are (sorry can’t read it huhu)
c) Something about endotoxin
d) B & C
b) Cytokines and chemokines are (sorry can’t read it huhu)
Lysozymes catalyze hydrolysis of bacterial cell walls. Cytokines and chemokines are non-antibody proteins that regulate immune function.
Which of the following statement/s is/are incorrect?
a) Phagocytes include neutrophils, macrophages, and monocytes
b) Activation of complement system contributes to opsonization
c) Decreased vascular permeability is a hallmark of inflammation
d) A & B
c) Decreased vascular permeability is a hallmark of inflammation
A and B are true. INCREASED vascular permeability is the hallmark of inflammation.
Which of the following is/are incorrect?
a) Class I MHC molecules are normally expressed on mature human erythrocytes
b) Class I MHC molecules present fragments of endogenous antigens in most cell types
c) Class II MHC molecules typically enable recognition of antigens by T-cytotoxic cells
d) A & C
d) A & C
Class I MHC Molecules are found on most nucleated cells.
They enable recognition of antigens by T cytotoxic cells (e.g. for killing of virus-infected cells.
Class II MHC Molecules are found mainly on professional APCs (dendritic cell, macrophage, B cell).
They enable recognition of antigens by T helper cells.
Which of the following is/are incorrect?
a) T-tytotoxic cells typically destroy their targets by inducing necrosis.
b) T-cytotoxic cells typically bear CD8 coreceptor for antigen recognition
c) T-helper cells typically serve to coordinate adaptive immune responses
d) B & C
a) T-tytotoxic cells typically destroy their targets by inducing necrosis.
T Cytotoxic Cells Typically CD8+ T cells (using CD8 as coreceptor for antigen recognition).
They may recognize and kill cells expressing specific antigens via apoptosis (induced through the action of perforins and granzymes).
T-Helper cells coordinate responses (e.g. helping B cells produce antibody).
Which of the following is/are incorrect?
a) Active immunization entails exposure to the antigen.
b) Passive immunization is exemplified by classical vaccination
c) Passive immunization is exemplified by maternal antibody transfer
d) A & B
b) Passive immunization is exemplified by classical vaccination
A and C are true.
Active immunization is exemplified by classical vaccination.
Which of the following statements is/are incorrect?
a) Blood-group antigens include MHC proteins.
b) Histocompatibility antigens include blood-group antigens.
c) Human leukocyte antigens (HLAs) are blood-group antigens.
d) A & C
d) A & C
Which of the following statements is/are incorrect?
a) Th1 cells typically stimulate cell-mediated killing by T-cytotoxic cells and macrophages
b) Th2 cells typically stimulate antibody production by helping B cells
c) Th17 cells stimulates immune responses mainly against intracellular pathogens
d) B & C
c) Th17 cells stimulates immune responses mainly against intracellular pathogens
Should be: Th17 cells stimulates immune responses mainly against EXTRAcellular pathogens
Th1 cells secrete cytokines that stimulate cell-mediated killing by T cytotoxic cells and macrophages.
Th2 cells secrete cytokines that stimulate antibody production (by helping B cells) which tends to yield IgE (for immunity against helminthes, immediate hypersensitivity).
Th17 Cells secrete IL-17. They are involved in recruiting neutrophils and macrophages vs extracellular pathogens including bacteria and fungi especially at interface (e.g. skin, gut).
Which of the following is/are incorrect?
a) Treg is associated with Foxp3
b) Treg typically increases during infection and decreases post infection
c) Excessive Treg suppresses protective immunity
d) A & B
b) Treg typically increases during infection and decreases post infection
Should be: Treg typically DECREASES during infection and INCREASES post infection
T regulatory cells (Treg) typically express Foxp3 transcriptional regulator. Their regulatory activity tends to decrease with infection and to increase after infection is cleared, avoiding excessive inflammation. They may suppress protective immunity to certain pathogens and cancer.
Which of the following statements is/are incorrect?
a) Cross presentation enables T cytotoxic cell activation against tumors
b) Dendritic cells employ mainly class I MHC for cross-presentation
c) Endogenous antigens are recognized primarily via cross-presentation
d) A & C
c) Endogenous antigens are recognized primarily via cross-presentation
Should be: EXTRACELLULAR antigens are recognized primarily via cross-presentation
Cross-presentation involves presentation of epitope/s from extracellular antigen/s together with Class I MHC instead of Class I MHC. It is observed only in some APCs, especially dendritic cell (DC). It enables cytotoxic T cell activation vs virus when APC is uninfected and vs tumor/cancer.
Which of the following statements is/are incorrect?
a) ABO blood groups are defined by the presence or absence of oligosaccharide molecules
b) Antibodies to A and B antigens are produced by persons of blood type O during normal development
c) Maternal blood type AB is a known risk factor for hemolytic anemia in fetuses of blood type O
d) B & C
c) Maternal blood type AB is a known risk factor for hemolytic anemia in fetuses of blood type O
Should be: Maternal blood type AB is a known risk factor for hemolytic anemia in fetuses of blood type AB
A and B are true.
In ABO hemolytic disease of the newborn, it is when the maternal blood type is O and the fetal blood type is AB that there is the risk.
Which of the following statements is/are incorrect?
a) Degranulation is induced by crosslinking of receptor-bound IgE on mast cells.
b) Histamine is released during degranulation (exocytosis) of mast cells
c) Epinephrine acts mainly by blocking the binding of histamine to receptors
d) A & B
c) Epinephrine acts mainly by blocking the binding of histamine to receptors
Should be: Epinephrine acts mainly by ANTAGONIZING the binding of histamine to receptors
Epinephrine works by antagonizing the effect of histamine on its effector cells. It does not block it.
Which of the following statements is/are incorrect?
a) Identical primary and secondary immune responses imply immunologic memory.
b) Passive immunization typically fails to induce immunologic memory.
c) Immunologic memory is typically due to proliferation of monocytes.
d) A & C
d) A & C
Immunological memory the ancient observation that someone who had recovered from the plague could safely care for those newly diseased.
Which of the following changes occurs first?
a) Cessation of cell function
b) Ultrastructural changes
c) Light microscopic changes
d) Gross morphologic changes
a) Cessation of cell function
Cyanide poisoning causes hypoxic cell damage through which of the following mechanisms?
a) Inability to pump out CO2 due to respiratory failure
b) Restriction of blood flow due to vasoconstriction
c) Blockage of cell enzyme action
d) Replacement of O2 from hemoglobin
c) Blockage of cell enzyme action
Causes of hypoxia include inadequate oxygenation due to cardiorespiratory failure, loss of blood supply or oxygen-carrying capacity of the blood due to anemia or carbon monoxide poisoning, blockage of cell enzymes as in cyanide toxicosis, and low oxygen.
What happens in both ischemia and hypoxia?
a) Decreased blood supply due to reduced arterial flow
b) Compromised supply of glucose and other nutrients
c) Stasis of blood in compromised tissues
d) Inadequate oxygenation
d) Inadequate oxygenation
A to C (Decreased blood supply due to reduced arterial flow, Compromised supply of glucose and other nutrients, Stasis of blood in compromised tissues) happen only in ischemia.
D (Inadequate oxygenation) happens to BOTH ischemia and hypoxia.
Which of the following mechanisms does not cause oxygen free radical cellular damage?
a) Direct inhibition of ATP production
b) Lipid peroxidation of membranes
c) Damage to cell proteins and enzymes
d) Fragmentation of DNA
a) Direct inhibition of ATP production
Main Sites of Damage in Free Radicals are lipid peroxidation of membranes, damage to proteins (peptide fragmentation), and damage to DNA (DNA fragmentation).
Which of the following changes does not occur in cells deprived of oxygen supply?
a) Shift from aerobic to anaerobic ATP production
b) Increase in production of lactic acid and inorganic phosphates
c) Decreased cell pH
d) NOTA
d) NOTA
All occur on cells deprived of oxygen supply. Also see the figure below.
Which of the following is not a functional and morphologic consequence of decreased intracellular ATP during cell injury?
a) Cellular swelling
b) Loss of microvilli
c) Clumping of nuclear chromatin
d) NOTA
d) NOTA
ER swelling, cellular swelling, loss of microvilli, blebs, clumping of nuclear chromatin, lipid deposition
Which of the following functional and morphologic changes result from inhibition of the NaK-ATPase pump which occurs during cellular hypoxia?
a) Influx and accumulation of sodium and calcium ions inside the cell
b) Increased permeability to and efflux of potassium ions
c) Cellular swelling
d) Hyperpolarization of the cell membrane
d) Hyperpolarization of the cell membrane
From the responses to clarifications: “The question should be NOT a result from inhibition of NaK-ATPase pump”
Which of the following does not result from ischemia?
a) Increased glycogen inside the cell
b) Decreased oxidative phosphorylation
c) Increased anaerobic glycolysis
d) Decreased ATP
a) Increased glycogen inside the cell
decrease O2, decrease ATP, increase cytosolic Ca++ (Cell response to stress ppt slide 34)
Which of the following are possible targets of cell damage?
a) Cell membrane integrity
b) Mitochondrial function
c) Genetic integrity
d) Functional and structural protein
e) AOTA
e) AOTA
Which of the following statements is not true with regards to cell injury?
a) Because of the interdependent nature of cellular systems, damage to one part may result to secondary injury to other systems
b) Cell injury results from functional and biochemical abnormalities in one or more essential cellular functions
c) Biochemical and morphological manifestations of injury are usually seen first before loss of cellular function occurs
d) NOTA
c) Biochemical and morphological manifestations of injury are usually seen first before loss of cellular function occurs
Which term refers to the cell’s ability, under physiological stresses or pathological stimuli to achieve a new steady state that would be compatible with their viability in the new environment?
a) Homeostasis
b) Adaptation
c) Cellular Integrity
d) Apoptosis
b) Adaptation
Which of the following is not a major mechanism for electrical injury?
a) Disruption of cell membranes and alteration of conformation of biomolecules
b) Alteration of cell membrane resting potential and eliciting of muscle tetany
c) Conversion of electrical energy into thermal energy
d) Mechanical injury with direct trauma due to falls or violent muscle contraction
e) NOTA
e) NOTA
Major mechanisms of electricity-induced injury include direct tissue damage, disruption of cell membranes and alteration of conformation of biomolecules, alteration of cell membrane resting potential and eliciting of muscle tetany, conversion of electrical energy into thermal energy leading to massive tissue destruction and coagulation necrosis, and mechanical injury with direct trauma due to falls or violent muscle contraction.
Injury from ionizing radiation is cause by which of the following?
a) Damage to genetic material/chromosome
b) Mechanical injury with direct trauma due to falls or violent muscle contraction
c) Formation of crystals that puncture walls
d) Direct injury to cellular structure
a) Damage to genetic material/chromosome
a) Damage to genetic material/chromosome-> is caused by ionizing radiation.
b) Mechanical injury with direct trauma due to falls or violent muscle contraction-> is electricity-induced.
c) Formation of crystals that puncture walls-> is cold-induced.
d) Direct injury to cellular structure-> is mechanical-induced.
Extreme cold can cause cell damage by which of the following?
a) Free radical formation and breaking of chemical bonds
b) Mechanical injury with direct trauma due to falls or violent muscle contraction
c) Formation of crystals that puncture cells
d) Direct injury to cellular structure
c) Formation of crystals that puncture cells
A-> is caused by ionizing radiation.
B-> is electricity-induced.
C-> is cold-induced.
D-> is mechanical-induced.
Mechanical trauma causes what kind of injury?
a) Free radical formation and breaking of chemical bonds
b) Mechanical injury with direct trauma due to falls or violent muscle contraction
c) Formation of crystals that puncture cells
d) Direct injury to cellular structure
d) Direct injury to cellular structure
A-> is caused by ionizing radiation.
B-> is electricity-induced.
C-> is cold-induced.
D-> is mechanical-induced.
How does rheumatic fever cause cellular damage?
a) Production of toxin that is harmful to cardiac cells
b) Triggering an inflammatory or immune response that inadvertently injures cardiac cells
c) Replication of the pneumococcal bacteria inside the myocardial cells disrupting the integrity of the cell
d) Abnormal suppression of immune response to bacteria increasing vulnerability to infection
b) Triggering an inflammatory or immune response that inadvertently injures cardiac cells
Disease from pathogenic organisms are caused by replicating inside host cell and disrupting structural integrity of cell (direct cytopathic activity, e.g. herpes virus), production of toxin harmful to host cell (e.g. clostridia and diphtheria), and triggering an inflammatory or immune response that inadvertently injures host cells (e.g. rheumatic fever, tuberculosis).
Which of the following is an example of physiological atrophy?
a) Atrophy of the thymus in adulthood
b) Disuse atrophy
c) Duchenne’s muscle atrophy
d) Denervation atrophy
a) Atrophy of the thymus in adulthood
Physiological atrophy is a genetically programmed “normal” decrease in size. Examples include involution of thymus gland in childhood, cessation of ova production in menopause, and aging = reduced activity.
Which statement regarding hypertrophy is incorrect?
a) It usually occurs in tissue with cells that cannot divide like muscle
b) Allows the cell to achieve equilibrium between demand and function.
c) Increase in cell size resulting into increase function tissue mass
d) Changes are usually permanent at some point in time
d) Changes are usually permanent at some point in time
Hypertrophy occurs in cells that cannot divide (e.g. cardiac and skeletal muscle). The number of cells remains the same, but the mass increases due to an increase in size. The 2 Causes of Hypertrophy are increased functional demand (allows the cell to achieve equilibrium between demand and function) and hormonal stimulation (e.g. estrogenic stimulation of uterine smooth muscle during pregnancy). Hypertrophy is reversible.
Which of the following is not an example of physiologic hypertrophy?
a) Muscular hypertrophy in weight lifters
b) Uterine hypertrophy in pregnancy
c) Left ventricular hypertrophy in hypertension
d) Hypertrophy of breast tissue in lactating women
c) Left ventricular hypertrophy in hypertension
C is pathologic.
A person who broke his ankle had his leg in a cast for 2 months. Upon removal of the cast, his leg was noticeably smaller than his normal leg. What type of atrophy is seen in this example?
a) Denervation atrophy
b) Ischemic atrophy
c) Disuse atrophy
d) Duschenne muscle atrophy
c) Disuse atrophy
Placement in a cast decreases workload -> disuse atrophy.