Q4 GNMD Flashcards
While in a home improvement center warehouse buying paint, a 35-year-old man hears ‘Look out below!’ and is then struck on the leg by a falling pallet rack, which strikes him on his left leg in the region of his thigh. The skin is not broken. Within 2 days there is a 5 x 7 cm purple colour to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown colour at the site of injury 16 days later?
A Lipofuscin
B Bilirubin
C Melanin
D Hemosiderin
E Glycogen
(D) CORRECT. The iron in the heme pigment from the red blood cells in the hemorrhage beneath the skin is incorporated into hemosiderin granules that impart the yellow to brown colour of the healing contusion (bruise) from blunt force trauma.
A 54-year-old man with a chronic cough has a squamous cell carcinoma diagnosed in his right lung. While performing a pneumonectomy, the thoracic surgeon notes that the hilar lymph nodes are small, 0.5 to 1.0 cm in size, and jet black in colour throughout. Which of the following is the most likely cause for this appearance to the hilar nodes?
A Anthracotic pigment
B Lipochrome deposits
C Melanin accumulation
D Hemosiderosis
E Metastatic carcinoma
(A) CORRECT. The black colour comes from carbon pigments in dust particles inhaled over the years, engulfed by macrophages, and sent via lymphatics to the lymph nodes. It looks bad but does not compromise lung function. Smokers will have more anthracosis.
A 50-year-old woman with a history of unstable angina suffers an acute myocardial infarction. Thrombolytic therapy with tissue plasminogen activator (tPA) is administered to restore coronary blood flow. In spite of this therapy, the extent of myocardial fiber injury may increase because of which of the following cellular abnormalities?
A Cytoskeletal intermediate filament loss
B Decreased intracellular pH from anaerobic glycolysis
C Increased free radical formation
D Mitochondrial swelling
E Nuclear chromatin clumping
F Reduced protein synthesis
(C) CORRECT. Such toxic oxygen radicals are released from neutrophils when blood flow is restored following ischemia. This is a reperfusion injury. Overall, there is likely to be more good than harm to restoration of blood flow.
A 12-year-old boy has had multiple episodes of ear pain accompanied by fever. On examination his right tympanic membrane is red and bulging with yellow exudate. Laboratory studies of the exudate show culture positive for Hemophilus influenzae. A year later he has conductive hearing loss on the right, and a head CT scan shows a mass in the right middle ear. Which of the following materials is most likely to be seen in the tissue curetted from his middle ear?
(D) CORRECT. An inflammatory mass persisted, with cellular necrosis, and the lipid from the cell membranes is broken down and cholesterol crystals form. The boy has the complication of otitis media known as a cholesteatoma
A 43-year-old man has complained of mild burning substernal pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies show the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?
A Dysplasia
B Hyperplasia
C Carcinoma
D Ischemia
E Metaplasia
(E) CORRECT. Metaplasia is the substitution of one tissue normally found at a site for another. The esophageal stratified squamous epithelium undergoes metaplasia in response to the ongoing inflammation from reflux of gastric contents. This is common in the lower esophagus with gastroesophageal reflux disease (GERD).
A 71-year-old woman had loss of consciousness persisting for over an hour. When she becomes arousable, she cannot speak nor move her right arm. A cerebral angiogram reveals an occlusion to her left middle cerebral artery. Three months later, a computed tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding is most likely the consequence of resolution from which of the following pathologic cellular events?
A Liquefactive necrosis
B Atrophy
C Coagulative necrosis
D Caseous necrosis
E Apoptosis
(A) CORRECT. She had a ‘stroke’ with cerebral infarction and loss of brain tissue. The brain undergoes liquefactive necrosis with infarction. As it resolves, macrophaes remove the dead cells and debria, leaving a cystic area that forms in the region of infarction.
A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She continues breast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that began in the breast during pregnancy allowed her to nurse the infant for this period of time?
A Stromal hypertrophy
B Epithelial dysplasia
C Steatocyte atrophy
D Ductal epithelial metaplasia
E Lobular hyperplasia
(E) CORRECT. There is an increase in the breast lobules under hormonal influence, primarily progesterone with pregnancy, to provide for lactation.
An 84-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small (250 gm) and dark brown on sectioning. Microscopically, there is light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance of his heart?
A Hemosiderin from iron overload
B Lipochrome from ‘wear and tear’
C Glycogen from a storage disease
D Cholesterol from atherosclerosis
E Calcium deposition following necrosis
(B) CORRECT. Lipochrome (lipofuscin) deposition in myocardial cell cytoplasm is a common finding, though ordinarily there are small amounts of it, and it has little effect upon cardiac function. The ‘brown atrophy’ of the heart in this case is a rare finding.
A 22-year-old man develops marked right lower quadrant abdominal pain over the past day. On physical examination there is rebound tenderness on palpation over the right lower quadrant. Laparoscopic surgery is performed, and the appendix is swollen, erythematous, and partly covered by a yellowish exudate. It is removed, and a microscopic section shows infiltration with numerous neutrophils. The pain experienced by this patient is predominantly the result of which of the following two chemical mediators?
A Complement C3b and IgG
B Interleukin-1 and tumor necrosis factor
C Histamine and serotonin
D Prostaglandin and bradykinin
E Leukotriene and HPETE
(D) CORRECT. The findings are those of acute appendicitis. The acute inflammation is marked by neutrophil exudation. Release of a variety of chemical mediators results in the findings associated with inflammation: calor (warmth), rubor (erythema), tumor (swelling), and dolor (pain). The analgesic aspirin, by inhibiting the cyclooxygenase pathway, can decrease prostaglandin synthesis.
A 40-year-old woman had laparoscopic surgery 3 months ago. Now she has a small 0.5 cm nodule beneath the skin at the incision site that was sutured. Which of the following cell types is most likely to be most characteristic of the inflammatory response in this situation?
A Mast cell
B Eosinophil
C Giant cell
D Neutrophil
E Plasma cell
(C) CORRECT. The suture is a foreign material and produces a foreign body reaction. Persistence of the stimulus recruits macrophages that are activated and transformed to giant cells, in this case foreign body giant cells.
A 39-year-old man incurs a burn injury to his hands and arms while working on a propane furnace. Over the next 3 weeks, the burned skin heals without the need for skin grafting. Which of the following is the most critical factor in determining whether the skin in the region of the burn will regenerate?
A Good cardiac output with tissue perfusion
B Persistence of skin appendages
C Maintenance of underlying connective tissue
D Diminished edema and erythema
E Granulation tissue formation
(B) CORRECT. The skin appendages have epithelium from which the surface epidermis can regenerate. A partial thickness burn retains epithelial elements in the skin. This is why a full thickness burn is much worse and requires grafting.
What cells are commonly seen in chronic inflammation ?
a. neutrophils
b. Macrophages and lymphocytes
c.mast cells
d. basophils
( b ) Macrophages and lymphocytes
What disease is not accompanied by granuloma formation?
a. tuberculosis
b. sarcoidosis
c. bacterial pneumonia
d. syphilis
C. bacterial pneumonia
acute inflammation therefore no granulomas will be present
What is not a cell associated with granulomas?
a. multinucleated giant cells
b. lymphocytes
c. epithelioid
d. basophils
D. basophils
which of the following statements is false regarding mediators of inflammation ?
a. prostaglandins cause vasodilation. edema and pain
b. histamine comes from 3 sources: mast cells, basophils, and platelets
c. during inflammation, platelets are activated first
d. serotonin increases the permeability of blood vessels
C.
mast cells are activated first
which of the following statements is true?
a. serous exudate: prominent cellular component
b. fibrinous exudate: exudate with less inflammatory cells (clear fluir)
c. effusion: excess fluid in the cavities of the body
d. transudate: increased protein content
C
which statement about wound healing is false?
a. 10% tensile strength by the first month
b. wound contraction commonly occurs in healing by the second intention
c. by day 5, granulation tissue fills the area
d. 70-80% tensile strength by the third month
A
what is not a local factor affecting wound wound healing ?
a. size
b. circulatory status
c. motion
d. infection
b
A 22-year-old man develops marked right lower quadrant abdominal pain over the past day. On physical examination there is rebound tenderness on palpation over the right lower quadrant. Laparoscopic surgery is performed, and the appendix is swollen, erythematous, and partly covered by a yellowish exudate. It is removed, and a microscopic section shows infiltration with numerous neutrophils. The pain experienced by this patient is predominantly the result of which of the following two chemical mediators?
A Complement C3b and IgG
B Interleukin-1 and tumor necrosis factor
C Histamine and serotonin
D Prostaglandin and bradykinin
E Leukotriene and HPETE
(D) CORRECT. The findings are those of acute appendicitis. The acute inflammation is marked by neutrophil exudation. Release of a variety of chemical mediators results in the findings associated with inflammation: calor (warmth), rubor (erythema), tumor (swelling), and dolor (pain). The analgesic aspirin, by inhibiting the cyclooxygenase pathway, can decrease prostaglandin synthesis.
A 40-year-old woman had laparoscopic surgery 3 months ago. Now she has a small 0.5 cm nodule beneath the skin at the incision site that was sutured. Which of the following cell types is most likely to be most characteristic of the inflammatory response in this situation?
A Mast cell
B Eosinophil
C Giant cell
D Neutrophil
E Plasma cell
(C) CORRECT. The suture is a foreign material and produces a foreign body reaction. Persistence of the stimulus recruits macrophages that are activated and transformed to giant cells, in this case foreign body giant cells.
A 39-year-old man incurs a burn injury to his hands and arms while working on a propane furnace. Over the next 3 weeks, the burned skin heals without the need for skin grafting. Which of the following is the most critical factor in determining whether the skin in the region of the burn will regenerate?
A Good cardiac output with tissue perfusion
B Persistence of skin appendages
C Maintenance of underlying connective tissue
D Diminished edema and erythema
E Granulation tissue formation
(B) CORRECT. The skin appendages have epithelium from which the surface epidermis can regenerate. A partial thickness burn retains epithelial elements in the skin. This is why a full thickness burn is much worse and requires grafting.
A 58-year-old woman has had a cough with fever for 3 days. A chest radiograph reveals infiltrates in the right lower lobe. A sputum culture grows Streptococcus pneumoniae. The clearance of these organisms from the lung parenchyma would be most effectively accomplished through generation of which of the following substances by the major inflammatory cell type responding to this infection?
A Platelet activating factor
B Prostaglandin E2
C Kallikrein
D Leukotriene B4
E Hydrogen peroxide
(E) CORRECT. Hydrogen peroxide is reduced by myeloperoxidase to a powerful oxidant that kills bacteria. She has an acute inflammatory response to a bacterial organism, and the majority of inflammatory cells responding will be neutrophils.
A clinical study is performed of patients with pharyngeal infections. The most typical clinical course averages 3 days from the time of onset until the patient sees the physician. Most of these patients experience fever and chills. On physical examination, the most common findings include swelling, erythema, and pharyngeal purulent exudate. Which of the following types of inflammation did these patients most likely have?
A Granulomatous
B Acute
C Gangrenous
D Resolving
E Chronic
(B) CORRECT. The short course of days and the purulent exudate are typical features of acute inflammation with a neutrophilic response, most often caused by a bacterial organisms such as group A Streptococcus. Lacking evidence for an acute bacterial infection, avoid use of antibiotics.
A 56-year-old man has had increasing dyspnea for 6 years. He has no cough or fever. He had chronic exposure to inhalation of silica dust for many years in his job. A chest x-ray now shows increased interstitial markings and parenchymal 1 to 3 cm solid nodules. His pulmonary problems are most likely to be mediated through which of the following inflammatory processes?
A Neutrophilic infiltrates producing leukotrienes
B Foreign body giant cell formation
C Plasma cell synthesis of immunoglobulins
D Mast cell histamine release
E Macrophage elaboration of cytokines
E) CORRECT. Cytokines including growth factors are released from macrophages that have ingested silica crystals, and these factors stimulate collagen production by fibroblasts, producing interstitial fibrosis and nodule formation that reduces and restricts the amount of normal lung parenchyma and makes breathing more difficult.