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V - Diseases of the Immune System Flashcards

1
Q

This term refers to protection against infections.

A

Immunity(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.108

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2
Q

It is the collection of cells and molecules that are responsible for defending against pathogenic microbes.

A

Immune system(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.108

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3
Q

Type of immunity mediated by neutrophils, macrophages and natural killer cells and includes epithelial barriers of the skin, GIT and respiratory tract.

A

Innate immunity (natural/native)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.108

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4
Q

Type of immunity mediated by lymphocytes and their products, and is normally silent and responds to the presence of microbes by becoming active, expanding and generating potent mechanisms for neutralizing and eliminating microbes.

A

Adaptive immunity (acquired/specific)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.108

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5
Q

Type of adaptive immunity mediated by soluble antibody proteins that are produced by B lymphocytes.

A

Humoral immunity(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.109

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6
Q

Type of adaptive immunity mediated by T lymphocytes.

A

Cell-mediated or cellular immunity(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.109

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7
Q

Mediated by antibodies and is effective against extracellular microbes.

A

Humoral immunity(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.109

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8
Q

Reaction of T-lymphocytes, designed to combat cell-associated microbes (e.g. Phagocytosed microbes and microbes in the cytoplasm of infected cells).

A

Cell-mediated immunity(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.109

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9
Q

Reaction of immune system against one’s own cells.

A

Autoimmunity(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.119

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10
Q

Results from activation of TH2 CD4+ helper T cells by environmental antigens, leading to the production of IgE antibodies, which become attached to mast cells.

A

Type I Hypersensitivity (immediate)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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11
Q

Caused by antibodies that bind to fixed tissue or cell surface antigens and promote phagocytosis and destruction of the coated cells or trigger pathologic inflammation in tissues.

A

Type II Hypersensitivity (Antibody-mediated)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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12
Q

Caused by antibodies binding to antigens to form complexes that circulate and may deposit in vascular beds and stimulate inflammation, secondary to complement activation.

A

Type III Hypersensitivity (immune complex mediated)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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13
Q

Cell-mediated immune responses in which T lymphocytes cause tissue injury, either by producing cytokines that induce inflammation and activate macrophages, or by directly killing cells.

A

Type IV Hypersensitivity (T-cell mediated/Delayed)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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14
Q

Indicate type of hypersensitivity reaction:SLE

A

Type III(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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15
Q

Indicate type of hypersensitivity reaction:Multiple sclerosis

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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16
Q

Indicate type of hypersensitivity reaction:Transplant rejection

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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17
Q

Indicate type of hypersensitivity reaction:Anaphylaxis

A

Type I(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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18
Q

Indicate type of hypersensitivity reaction:Goodpasture syndrome

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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19
Q

Indicate type of hypersensitivity reaction:Serum sickness

A

Type III(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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20
Q

Indicate type of hypersensitivity reaction:Arthus reaction

A

Type III(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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21
Q

Indicate type of hypersensitivity reaction:Autoimmune hemolytic anemia

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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22
Q

Indicate type of hypersensitivity reaction:Allergies

A

Type I(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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23
Q

Indicate type of hypersensitivity reaction:Type I DM

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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24
Q

Indicate type of hypersensitivity reaction:Tuberculosis

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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25
Q

Indicate type of hypersensitivity reaction:Bronchial asthma

A

Type I(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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26
Q

Indicate type of hypersensitivity reaction:Acute rheumatic fever

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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27
Q

Indicate type of hypersensitivity reaction:Poststreptococcal glumerulonephritis

A

Type III(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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28
Q

Indicate type of hypersensitivity reaction:Polyarteritis nodosa

A

Type III(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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29
Q

Indicate type of hypersensitivity reaction:Rheumatoid arthritis

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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30
Q

Indicate type of hypersensitivity reaction:Inflammatory bowel disease

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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31
Q

Indicate type of hypersensitivity reaction:Tuberculin reaction

A

Type IV(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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32
Q

Indicate type of hypersensitivity reaction:Reactive arthritis

A

Type III(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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33
Q

Indicate type of hypersensitivity reaction:Graves disease

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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34
Q

Indicate type of hypersensitivity reaction:Acute rheumatic fever

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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35
Q

Indicate type of hypersensitivity reaction:Myasthenia gravis

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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36
Q

Indicate type of hypersensitivity reaction:Insulin resistant DM

A

Type II (TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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37
Q

Indicate type of hypersensitivity reaction:Pernicious anemia

A

Type II(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

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38
Q

A special form of graft rejection occuring in the setting where preformed antidonor antibodies are present in the circulation of the host before transplant. Occurs within minutes to a few hours after transplantation.

A

Hyperacute rejection(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.133

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39
Q

Rejection which occurs within days to weeks of transplantation in a nonimmunosuppressed host. Caused by both cellular and humoral immune mechanisms.

A

Acute rejection(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.133

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40
Q

Acute rejection most commonly seen within the first months after transplantation, typically accompanied by signs of renal failure. Extensive CD4+ and CD8+ T-cell infiltration with edema and mild interstitial hemorrhage.

A

Acute cellular rejection(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.133

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41
Q

Acute rejection caused by antidonor antibodies. May take the form of necrotizing vasculitis with endothelial cell necrosis, neutrophilic infiltration, deposition of antibody, complement, and fibrin, and thrombosis.

A

Acute humoral rejection(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.133

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42
Q

Rejection which present clinically months to years after transplantation with a progressive rise in serum creatinine levels. Dominated by arteriosclerosis, interstitial fibrosis and loss of renal parenchyma.

A

Chronic rejection(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.133

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43
Q

A multisystem autoimmune disease which principally affects the skin, kidneys, serosal membranes, joints and heart. Associated with autoantibodies including ANAs.

A

Systemic Lupus Erythematosus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.139

44
Q

SOAP BRAIN MD mnemonic for SLE stands for?

A

SerositisOral ulcersArthritisPhotosensitivityBloodRenal disorderANA positiveImmunologic disorderNeurologic disorderMalar rashDiscoid rash(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.140

45
Q

How many symptoms must be present in a patient for her/him to be diagnosed as having SLE?

A

4 out of 11 symptoms(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.140

46
Q

Most serious and most common form of renal lesion in SLE. “Wire-loop” appearance of glomerular capillary walls.

A

Diffuse proliferative glomerulonephritis (Class IV)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.142

47
Q

Cardiac manifestation of SLE, which occurs as nonspecific mononuclear infiltrates and the presence of irregular 1-3mm warty deposits on either surface of the leaflets.

A

Libman-Sacks Endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.144

48
Q

A systemic, chronic inflammatory disease affecting many tissues but principally attacking the joints to produce a nonsuppurative proliferative synovitis that frequently progress to destroy articular cartilage and underlying bone with resulting disabling arthritis.

A

Rheumatoid arthritis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.145

49
Q

Characteristic lesion in RA, formed by proliferating synovial-lining cells admixed with inflammatory cells, granulation tissue and fibrous connective tissue.

A

Pannus(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.146

50
Q

Cytokine which plays a central role in the pathogenesis of RA.

A

TNF(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.146

51
Q

A clinicopathologic entity with a triad of dry eyes, dry mouth and arthritis.

A

Sjogren syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.148

52
Q

Characterized by progressive fibrosis involving the skin, GIT and other tissues. May be a result of activation of fibroblasts by cytokines produced by T cells.

A

Systemic sclerosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.149

53
Q

A vascular disorder characterized by reversible vasospasm of the arteries. Typically the hands turn white due to vasospasm, then blue due to cyanosis, then red due to reactive hyperemia.

A

Raynaud phenomenon(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.151

54
Q

One of the more common forms of primary immune deficiency characterized by absent or markedly decreased numbers of B-cells in the circulation, with depressed serum levels of all classes if immunoglobulin.

A

X-linked agammaglobulinemia (Bruton disease)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.152

55
Q

Most common of all the primary immune deficiencies characterized by recurrent sinopulmonary infections and diarrhea.

A

Isolated IgA deficiency(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.154

56
Q

A constellation of genetically distinct syndromes with common feature of defects in both humoral and cell-mediated immune responses, making affected infants susceptible to severe recurrent infections by bacteria, viruses, fungi, protozoans, and opportunistic infections.

A

Severe Combined Immunodeficiency(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.154

57
Q

Autosomal recessive form of SCID is due to deficiency of what enzyme?

A

Adenosine deaminase (ADA)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.154

58
Q

An X-linked recessive disease characterized by thrombocytopenia, eczema, and marked vulnerability to recurrent infection ending in early death.

A

Wiskott-Aldrich Syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.155

59
Q

HIV viral surface proteins essential for viral entry into cells.

A

gp41 and gp120(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.157

60
Q

A form of pneumonia in HIV patients caused by a yeast-like fungus.

A

Pneumocystis carinii pneumonia (PCP)(TOPNOTCH)

61
Q

Main cellular target of HIV.

A

CD4+ helper T cells(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.158

62
Q

P.carinii pneumonia occurs in AIDS patients with CD4+ T cell count of ______.

A

Less than 200 cells/uL(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.163

63
Q

Most common secondary infection of the CNS in patients with AIDS.

A

Toxoplasmosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.163

64
Q

Most common neoplasm in AIDS patients, caused by HHV8. Characterized by cutaneous lesions with or without internal involvement.

A

Kaposi sarcoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.164

65
Q

A disorder of protein misfolding, causing extracellular deposition of pink or red colored deposits stained with Congo red, with apple-green birefringence in polarized light.

A

Amyloidosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.166

66
Q

Cells of immune system

A

T- and B-lymphocytes, dendritic cells, macrophages, natural killer cells, innate lymphoid cells. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 190

67
Q

Tissues of the immune system

A

Bone marrow, thymus, lymph nodes, spleen, mucosal and cutaneous lymphoid tissue. (TOPNOTCH) Robbin Basic Pathology, 9th ed., p. 193

68
Q

The most important antigen-presenting cells for initiating T-cell responses against protein antigens

A

Dendritic cells(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 191

69
Q

A 48 y/o male patient underwent kidney transplant suddenly developed bloody urine few hours after the procedure. Nephrectomy was done and revealed a cyanotic, mottled, and flaccid kidney and necrotic kidney cortex. There is neutrophilic accumulation in the arterioles, glomeruli, and peritubular capillaries. Glomeruli undergo thrombotic occlusion of capillaries and fibrinoid necrosis in arterial walls. The most likely diagnosis is:

A

Hyperacute rejection (TOPNOTCH) Robbin Basic Pathology, 9th ed., p. 233

70
Q

A 45 y/o female presented with signs of kidney failure 2 months after her renal transplant. Immunohistochemical staining reveals both CD4+ and CD8+ lymphocytes. Morphologic findings showed an extensive interstitial inflammation with infiltration of tubules and focal tubular injury. This is a case of:

A

Acute cellular (T-cell mediated) rejection (TOPNOTCH) Robbin Basic Pathology, 9th ed., p. 234

71
Q

Preformed antidonor antibodies present in the circulation of the recipient is implicated in what type of rejection pattern?

A

Hyperacute rejection (TOPNOTCH) Robbin Basic Pathology, 9th ed., p. 233

72
Q

A 30 y/o male developed oliguria and subsequent renal failure 3 weeks after an uneventful kidney transplant. Renal findings showed inflammation of glomeruli and peritubular capillaries, deposition of complement breakdown and focal small vessel thrombosis. This is a case of:

A

Acute antibody-mediated rejection (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 234

73
Q

A 24 y/o female diagnosed with renal failure underwent renal transplant. Four years later, increasing levels of creatinine was noted, and biopsy showed an interstitial fibrosis and tubular atrophy, glomerulopathy with duplication of basement membrane, and multilayering of peritubular capillary basement membranes. Interstitial mononuclear cell infiltrates, NK cells and plasma cells were also noted. This is a case of:

A

Chronic rejection(TOPNOTCH)Robbins Basic Pathology, 9th ed., p.234

74
Q

The result of hypoplasia or lack of thymus in DiGeorge Syndrome

A

Variable loss of T-cell mediated immunity (TOPNOTCH) Robbins Basic Pathology, 9th ed., p.241

75
Q

The hallmark of AIDS

A

Profound immune deficiency, primarily cell-mediated immunity (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 245

76
Q

A 32-year old female, presents to the clinic with symptoms of fatigue, joint pains, and malar rash. CBC revealed anemia and low platelet count. The most likely diagnosis is:

A

Systemic Lupus Erythematosus (TOPNOTCH)

77
Q

The hallmark of SLE

A

Production of autoantibodies (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 218

78
Q

The fundamental defect in SLE

A

Failure of mechanisms that maintain self-tolerance (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 219

79
Q

Most common manifestation of SLE

A

Hematologic manifestation (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 218

80
Q

Most common hematologic finding in SLE

A

Anemia(TOPNOTCH)

81
Q

Most common and most severe form of lupus nephritis

A

Diffuse lupus nephritis/Class IV(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 224

82
Q

The most common causes of death in SLE

A

Renal failure and intercurrent infections (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 225

83
Q

Cytokine most firmly implicated in the pathogenesis of Rheumatoid arthritis

A

TNF (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1210

84
Q

Major cytokine produced by TH1, stimulates macrophage activation and IgG antibody production. Plays a role in autoimmune and other chronic inflammatory diseases.

A

IFN-gamma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 198

85
Q

The dominant immune reactions of these subset of helper cells are the stimulation of IgE production and activation of mast cells and eosinophils.

A

TH2(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 198

86
Q

These are the mediators of adaptive immunity and the only cells that produce specific and diverse receptors for antigens

A

Lymphocytes(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 199

87
Q

Immunity mediated by antibodies and is effective against extracellular microbes in the circulation and mucosal lumens.

A

Humoral immunity(TOPNOTCH)Robbins Basic Pathology, 9th ed p. 200

88
Q

Type of immunity design to combat phagocytosed microbes and microbes in the cytoplasm of infected cells.

A

Cell-mediated immunity(TOPNOTCH)Robbins Basic Pathology, 9th ed p. 200

89
Q

These are cells the help B cells to make antibodies, activate macrophages to destroy ingested microbes, stimulate recruitment of leukocytesand regulate all immune responses to protein antigens.

A

CD4+ helper T cells(TOPNOTCH)Robbins Basic Pathology, 9th Ed p.200

90
Q

These are cells that express antigens in the cytoplasm that are seen as foreign, such as virus-infected and tumor cells.

A

CD8+ cytotoxic T lymphocytes(TOPNOTCH)Robbins Basic Pathology, 9th Ed p.200

91
Q

The most potent vasoactive and spasmodic agents causing increasing vascular permeability and causing bronchial smooth muscle contraction.

A

Leukotrienes C4 and D4(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 203

92
Q

A lipid mediator produced by some mast cell populations, not derived from arachidonic acid, causing platelet aggregation, increased vascular permeability, and vasodilation.

A

Platelet-activating factor(PAF)(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 203

93
Q

True or False. Atopic individuals tend to have higher serum IgE levels and more IL-4 producing Th2 cells.

A

True. (TOPNOTCH)

94
Q

This disease presents with nephritis and lung hemorrhage due to complement and Fc receptor-mediated inflammation due to antibody against noncollagenous protein in basement membranes of kidney glomeruli and lung alveoli.

A

Goodpasture syndrome(TOPNOTCH)Robbbins Basic Pathology, 9th ed., p. 206

95
Q

This disease causes demyelination in CNS is perivascular inflammation due to inflammation mediated by TH1 and TH17 cytokines, myelin destruction by activated macrophages.

A

Multiple sclerosis(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 209

96
Q

Type of immunity primarily affected by AIDS

A

Cell-mediated immunity(TOPNOTCH)

97
Q

Mucocutatnous ulcerations involving the mouth, esophagus, external genitalia, and perianal region in AIDS patient may be caused by

A

Herpes simplex virus infection(TOPNOTCH)

98
Q

An 18 year old female presents with a day-old circular erythematous plaque with vesicles on her neck. She relates a history of wearing a new metallic pendant three days ago, and has had a similar history with other metallic jewelry. If the plaque is biopsied, which inflammatory cell is expected to predominate? (A) neutrophil (B) eosinophil (C) mast cell (D) lymphocyte

A

Lymphocyte (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp128-130

99
Q

An 8 year old male with a strep throat four weeks ago develops tea-colored urine. A kidney biopsy showed hypercellular glomeruli with neutrophils. Electron microscopy showed subepithelial “humps.” These findings are caused by (A) antibodies against glomerular basement membrane (B) antibodies against endothelium (C) immune complex deposition (D) T-cell mediated recruitment of neutrophils

A

immune complex deposition (TOPNOTCH) Robbins Basic Pathology, 8th ed. P126

100
Q

A 5 year old female with a strep throat two weeks ago develops joint pains and fever. Auscultation revealed a friction rub. What type of hypersensitivity is responsible?

A

Type II (TOPNOTCH)Robbins Basic Pathology, 8th Ed p.120

101
Q

A 33 year old female presents with morning stiffness of the PIP and MCP joints of the hands. On workup, she is positive for rheumatoid factor. Which of the following is expected in the involved joints? (A) synovial hypertrophy with dense lymphoid aggregates (B) synovial atrophy with epithelioid macrophages (C) synovial hypertrophy devoid of leukocytes (D) synovial atrophy with dense lymphoid aggregates

A

synovial atrophy with dense lymphoid aggregates (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp145-146

102
Q

A 50 year old female with chronic red eye is diagnosed with keratoconjunctivitis sicca and is referred to by her ophthalmologist for bilateral infraauricular masses. Her oral mucosa has multiple fissures. Biopsy of the infraauricular masses will likely show (A) epithelial and myoepithelial cells admixed with chondroid stroma (B) lymphoplasmacytic infiltration with ductal hyperplasia (C) basaloid cells in cribriform structures (D) highly pleomorphic epithelial cells and numerous atypical mitoses

A

lymphoplasmacytic infiltration with ductal hyperplasia (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp148-149

103
Q

Patients with diffuse scleroderma have sclerotic atrophy of the skin. Which other organ is most commonly involved? (A) kidneys (B) heart (C) lungs (D) gastrointestinal tract

A

gastrointestinal tract (90% of patients) (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp 149-150

104
Q

A 22 year old male has unprotected sex and develops generalized lymphadenopathy five days later. The following month, he tests positive on HIV screening. Excision biopsy of one of his lymph nodes would likely show (A) marked follicular hyperplasia (B) epithelioid macrophages and giant cells (C) diffuse infiltration by atypical mononuclear cells (D) subcapsular necrosis

A

marked follicular hyperplasia (TOPNOTCH) Robbins Basic Pathology, 8th ed. P 165

105
Q

A 68 year old female with multiple myeloma dies of acute renal failure. At autopsy, her kidneys and liver were pale gray, with waxy cut sections, while her spleen showed tapioca-like granules. On histology, these organs show deposits that (A) have empty vacuoles that uptake Sudan black (B) are infiltrated by neutrophils and histiocytes (C) will fluoresce an apple green color when stained with Congo red (D) are bluish, with concentric lamellations

A

will fluoresce an apple green color when stained with Congo red (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp 169-170

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