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Question 1
Incorrect
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A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed numerous bacilli under the microscope. The organism was non-pathogenic. What is the most likely organism:
Your Answer: Escherichia coli
Correct Answer: Lactobacillus species
Explanation:Lactobacillus is a Gram-positive facultative bacteria. It is commonly present in the vagina and the gastrointestinal tract. Colonization of Lactobacillus is usually benign and it makes up a small portion of the gastrointestinal flora.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 2
Correct
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A 55-year-old male has a mass on the right lung with involvement of the right mediastinal lymph nodes. What is the nodal staging according to the TNM staging?
Your Answer: N2
Explanation:The N stages for lung cancer are from NO to N3 : NO, there is no lung cancer in any lymph nodes: N1, there is lung cancer in the proximal lymph nodes: N2, there is lung cancer in the mediastinal hilar lymph nodes, but on the same side as the affected lung or there is lung cancer in the carinal lymph nodes: N3, there is metastatic lung cancer in lymph nodes on the opposite side of the chest, in the cervical or apical lymph nodes. In this patient the ipsilateral mediastinal node is involved, thus it is classified as N2.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 3
Correct
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A 30-year-old female was alarmed when she started to experience hair loss and balding, however, she also noted increased hair on her face and body and developed an acne breakout. Deepening of her voice also became prominent. She was referred to an oncologist and was diagnosed with a hormone-producing tumour. What is the most likely diagnosis ?
Your Answer: Arrhenoblastoma
Explanation:Arrhenoblastoma, known as ‘Sertoli–Leydig tumour’ is a rare ovarian stromal neoplasm that secretes testosterone. It is mostly seen in women in the reproductive years. The key clinical features of this tumour is due to excessive production of testosterone which leads to progressive masculinisation in a woman who was typical normal beforehand. The lesion tends to grow slowly and rarely metastasises. Treatment is surgical removal of the tumour and the prognosis is generally good.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 4
Correct
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A 45 -year-old female is recently diagnosed with breast cancer. She has a 8-cm-diameter mass in her left breast, with enlarged left axillary node. What is the most likely stage of her disease?
Your Answer: IIIA
Explanation:Stage IIIA breast cancer is T0–2 N2 M0 or T3 N1-2 M0 disease. It describes invasive breast cancer in which either: the tumour is smaller than 5 cm in diameter and has spread to 4 to 9 axillary lymph nodes; or it is found through imaging studies or clinical exam to have spread to internal mammary nodes (near the breastbone found during imaging tests or a physical exam); or the tumour is larger than 5 cm and has spread to 1 to 9 axillary nodes, or to internal mammary nodes. In this stage, the cancer has not metastasized (spread to distant sites).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 5
Incorrect
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Which of the following toxins most likely results in continuous cAMP production, which pumps H2O, sodium, potassium, chloride and bicarbonate into the lumen of the small intestine and results in rapid dehydration?
Your Answer: Bordetella pertussis toxin
Correct Answer: Cholera toxin
Explanation:The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits: a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulphide bond. The five B subunits form a five-membered ring that binds to GM1 gangliosides on the surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins, while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis. Once inside the cell, the disulphide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate the Gs alpha subunit of the heterotrimeric G protein. This results in constitutive cAMP production, which in turn leads to secretion of H2O, Na+, K+, Cl−, and HCO3− into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into V. cholerae by horizontal gene transfer.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 6
Incorrect
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A patient with this type of tumour is advised to follow up regularly for monitoring of tumour size as there is a strong correlation with malignant potential and tumour size. Which of the following is the most likely tumour in this patient?
Your Answer: Prostate adenocarcinoma
Correct Answer: Renal adenocarcinoma
Explanation:The distinction between a benign renal adenoma and renal adenocarcinoma is commonly made on the basis of size. Tumours less than 2 cm in size rarely become malignant as opposed to those greater than 3 cm.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 7
Incorrect
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A 35 year-old female developed food poisoning 24H after eating canned food. She complained of abdominal cramps, with nausea and vomiting. Shortly after she suddenly developed weakness, blurring of vision, difficulty in swallowing and breathing. Which of the following organisms is most likely associated with fatal food poisoning?
Your Answer: Bacillus cereus
Correct Answer: Clostridium botulinum
Explanation:C. botulinum is a Gram-positive, rod-shaped, spore-forming bacterium. It is an obligate anaerobe, meaning that oxygen is poisonous to the cells. Only botulinum toxin types A, B, E, and F cause disease in humans. Types A, B, and E are associated with foodborne illness. Botulism poisoning can occur due to preserved or home-canned, low-acid food that was not processed using correct preservation times and/or pressure. Signs and symptoms of foodborne botulism typically begin between 18 and 36 hours after the toxin gets into the body, but can range from a few hours to several days, depending on the amount of toxin ingested. Botulinum that is produced by Clostridium botulinum can cause respiratory and muscular paralysis.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 8
Incorrect
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Which of the following mediators of inflammation requires arachidonic acid for synthesis?
Your Answer: Tumour necrosis factor
Correct Answer: Prostaglandins
Explanation:Arachidonic acid is normally present in the phospholipids that make up the cell membrane and is cleaved by phospholipase A2 from the phospholipid. Arachidonic acid is a precursor for the production of eicosanoids which include: 1) prostaglandins, prostacyclins and thromboxane, 2) leukotrienes and 3) anandamides. The production of these products along with their action on the body is called the arachidonic acid cascade.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 9
Incorrect
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The accumulation of eosinophils within tissues is mostly regulated by which of the following cytokines?
Your Answer: Interleukin 3
Correct Answer: Interleukin-5
Explanation:IL-5 is produced by TH2 helper cells and by mast cells. They stimulate increased secretion of immunoglobulins and stimulate B cell growth. They are the major regulators in eosinophil activation and control. They are also released from eosinophils and mast cells in asthmatic patients and are associate with a many other allergic conditions.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 10
Incorrect
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A 48-year-old woman has a mass in her right breast and has right axillary node involvement. She underwent radical mastectomy of her right breast. The histopathology report described the tumour to be 4 cm in its maximum diameter with 3 axillary lymph nodes with evidence of tumour. The most likely stage of cancer in this patient is:
Your Answer: IIIB
Correct Answer: IIB
Explanation:Stage IIB describes invasive breast cancer in which: the tumour is larger than 2 centimetres but no larger than 5 centimetres; small groups of breast cancer cells — larger than 0.2 millimetre but not larger than 2 millimetres — are found in the lymph nodes OR the tumour is larger than 2 centimetres but no larger than 5 centimetres; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) OR the tumour is larger than 5 centimetres but has not spread to the axillary lymph nodes.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 11
Incorrect
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Gram positive bacteria differ from gram negative bacteria due to the presence of which of the following structures?
Your Answer: Cytoplasmic membrane
Correct Answer: Outer membrane
Explanation:The reason bacteria are either Gram-positive or Gram-negative is due to the structure of their cell envelope (the cell envelope is defined as the cell membrane and cell wall plus an outer membrane, if one is present.) Gram-positive bacteria, for example, retain the crystal violet due to the amount of peptidoglycan in the cell wall. It can be said therefore that the Gram-stain procedure separates bacteria into two broad categories based on structural differences in the cell envelope.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 12
Incorrect
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Which of the following malignancies is associated with the development of Lambert-Eaton myasthenic syndrome?
Your Answer: Oesophageal cancer
Correct Answer: Lung cancer
Explanation:Lambert–Eaton myasthenic syndrome is a rare disorder of the neuromuscular junction. It can occur as a solitary diagnosis but it can also occur as a paraneoplastic syndrome associated with lung cancer, particularly small-cell histology. It can also be associated with other cancers such as lymphoma, non-Hodgkin’s lymphoma, T-cell leukaemia, non-small-cell lung cancer, prostate cancer and thymoma.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 13
Correct
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An 8 year old boy presents with a history of repeated bacterial/pyogenic infections. He had a normal recovery from chickenpox and measles and shows normal antibody response. A decrease in which of the cell types can best explain this history of repeated pyogenic infections?
Your Answer: Neutrophils
Explanation:A decrease in the number of granulocytes, particularly neutrophils is known as agranulocytosis and it increases the susceptibility of an individual towards recurrent infections. Neutropenia can be either due to decreased production or increased elimination of neutrophils.
Ineffective agranulopoiesis is seen in: 1. myeloid stem cell suppression, 2. disease conditions associated with granulopoiesis such as megaloblastic anaemia and myelodysplastic syndromes, 3. rare genetic diseases, 4. splenic sequestration and 5. increased peripheral utilization.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 14
Incorrect
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Which type of thyroid tumour represents 75 - 80% of thyroid cancer cases? This type is predominant in children and in patients who have had a previous history of head or neck radiation.
Your Answer: Follicular carcinoma
Correct Answer: Papillary carcinoma
Explanation:Papillary thyroid carcinoma is the most common thyroid cancer. This cancer has a high cure rate with 10-year survival rates for all patients with papillary thyroid cancer estimated at 80% to 90%.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 15
Incorrect
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A patient is suspected to have a chromosomal abnormality. Which tumour and chromosomal association is correct?
Your Answer: Retinoblastoma – chromosome 11
Correct Answer: Neuroblastoma – chromosome 1
Explanation:Neuroblastoma is associated with a deletion on chromosome 1 and inactivation of a suppressor gene. Neurofibromas and osteogenic sarcoma are associated with an abnormality on chromosome 17. Retinoblastoma (Rb) is associated with an abnormality on chromosome 13. Wilms’ tumours of the kidney are associated with an abnormality on chromosome 11.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 16
Incorrect
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Which of the following is the most abundant WBC seen in a smear from a healthy person.
Your Answer: Eosinophils
Correct Answer: Neutrophils
Explanation:neutrophils are the most abundant cell type of the WBC. These phagocytes are found normally in the blood and increase in number are seen during an acute inflammation. These the percentages of WBC in blood Neutrophils: 40 to 60%
Lymphocytes: 20 to 40%
Monocytes: 2 to 8%
Eosinophils: 1 to 4%
Basophils: 0.5 to 1%
Band (young neutrophil): 0 to 3%. eosinophils, basophils, neutrophils are known as granulocytes and monocytes and lymphocytes as agranulocytes.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 17
Incorrect
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A cell is classified on the basis of its regenerative ability. Which of the following cells represent a permanent cell?
Your Answer: Hepatocyte
Correct Answer: Erythrocyte
Explanation:An erythrocyte is the last cell in the progeny of RBC cell division and is not capable of further division and regeneration. Hepatocytes, osteocytes and epithelium of kidney tubules are all stable cells. Colonic mucosa and pluripotent hematopoietic stem cells are all labile cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 18
Correct
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A 72-year-old male presents with dysuria and chronic haematuria. He was diagnosed with bladder cancer and tumour invasion of the perivesical fat. What is the stage of the patient's bladder cancer?
Your Answer: T3
Explanation:Bladder cancer is the growth of abnormal or cancerous cells on the inner lining of the bladder wall. The staging is as follows; stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only, stage I (T1, N0, M0): tumour has spread onto the bladder wall, stage II (T2, N0, M0): tumour has penetrated the inner wall and is present in muscle of the bladder wall, stage III (T3, N0, M0): tumour has spread through the bladder to fat around the bladder and stage IV: (T4, N0, M0): tumour has grown through the bladder wall and into the pelvic or abdominal wall. The stage of cancer in the case presented is T3 because of the invasion of perivesical fat.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 19
Incorrect
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A 45-year-old woman was brought to the emergency department due to fever and chills. She has a history of recurrent UTI and complains of dysuria and urinary frequency. Urinary white blood cell count is >200 cell/high power field. If urine culture is performed, what is the most likely organism that will grow?
Your Answer: Candida albicans
Correct Answer: Escherichia coli
Explanation:The pathogen that most likely causes recurrent urinary tract infection in young women are E. coli, Enterococcus and Staphylococcus saprophyticus.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 20
Incorrect
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The patient who is diagnosed with bladder cancer asked his physician, what could have been the contributing factor in the development of his bladder cancer?
Your Answer: Radon
Correct Answer: Smoking
Explanation:Tobacco smoking is the main known contributor to urinary bladder cancer. In most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 21
Incorrect
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A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?
Your Answer: Blood culture
Correct Answer: Sputum culture
Explanation:Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 22
Incorrect
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Which antibiotic acts by inhibiting protein synthesis?
Your Answer: Trimethoprim
Correct Answer: Erythromycin
Explanation:Penicillins and cephalosporins (e.g. cefuroxime, cefotaxime, ceftriaxone) inhibit bacterial cell wall synthesis through the inhibition of peptidoglycan cross-linking.
Macrolides (e.g. erythromycin), tetracyclines, aminoglycosides and chloramphenicol act by interfering with bacterial protein synthesis.
Sulphonamides (e.g. trimethoprim, co-trimoxazole) work by inhibiting the synthesis of nucleic acid
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This question is part of the following fields:
- Pharmacology; Microbiology
- Physiology
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Question 23
Incorrect
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A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?
Your Answer: T3
Correct Answer: T2
Explanation:Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 24
Incorrect
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A butcher accidentally cut himself on his right index finger. Which of the following substances when in contact with the basement membrane of the injured vasculature will activate the coagulation cascade as well as the kinin system in a first response to this injury?
Your Answer: Platelet activating factor
Correct Answer: Hageman factor
Explanation:Hageman factor/factor XII in the intrinsic pathway activates prekallikrein and factor XI. Deficiency will not cause excessive bleeding as other coagulation factors will be utilized but the PTT will be greater than 200 seconds.
Thromboxane promotes platelet aggregation and causes vasoconstriction.
Plasmin, which is cleaved from plasminogen acts as an anticoagulant which breaks down thrombi.
Platelet activating factor promotes platelet aggregation and is also chemotactic to neutrophils.
Histamine acts as a vasodilator.
Platelet inhibiting factor acts an anticoagulant.
Renin is a hormone released from the kidney that causes vasoconstriction and water retention.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 25
Incorrect
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Ceftriaxone
Correct Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 26
Incorrect
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The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature. This process is best described as?
Your Answer: Thrombosis
Correct Answer: Organisation of the haematoma
Explanation:Formation of granulation tissue at the periphery of the hematoma is a normal process leading to resolution. This granulation tissue is composed of new capillaries, fibroblasts and collagen. Lysis of a blood clot can occur, but the actual process of this response is known as organization, wherein the scar tissue will become part of the vessels. This is followed by recanalization and embolization which can lead to eventual complications. Proliferation of a clot will occur due to an imbalance in the clotting and lysing systems. Thrombosis has nothing to do with the process described above.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 27
Incorrect
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Which of the given options best describes the metabolic changes which occur following a severe soft tissue injury sustained after a PVA?
Your Answer: Protein anabolism
Correct Answer: Mobilisation of fat stores
Explanation:The following metabolic responses occur following trauma as part of a coping mechanism for the additional stress. These include acid base changes (metabolic acidosis or alkalosis), decrease urine output and osmolality, reduced basal metabolic rate (BMR), gluconeogenesis with amino acid breakdown and shunting, hyponatraemia as a result of impaired functioning of sodium pumps, hypoxic injury, coagulopathies, decreased immunity, increase extracellular fluid and hypovolemic shock, increase permeability leading to oedema, break down and mobilization of fat reserves, pyrexia and reduced circulating levels of albumin.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 28
Correct
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A 15-year-old girl was diagnosed with bacterial meningitis. Gram staining of the spinal fluid shows numerous polymorphonuclear neutrophils and Gram-positive cocci. Which is the empiric drug of choice to be given to the patient until the antibiotic sensitivity report is available?
Your Answer: Ceftriaxone
Explanation:Acute meningitis is a medical emergency. All suspects should receive their first dose of antibiotics immediately and be transferred to hospital as soon as possible. If facilities for blood culture and/or lumbar puncture (LP) are immediately available, they should be performed before administration
of the first dose of antibiotics (see contraindications to LP below). Neither procedure should lead to a significant delay in antibiotic administration.
Administer ceftriaxone 80-100 mg/kg (maximum 2 g, 12 hourly) intravenously. The intramuscular or intraosseous route can be used if there is no vascular access. Penicillin allergy is not a contraindication to ceftriaxone in acute meningitis (C-1). Omit ceftriaxone only if there has been documented ceftriaxone anaphylaxis. Give chloramphenicol 25 mg/kg (maximum 500 mg) intravenously instead, if available. Administer adequate analgesia and transfer the patient immediately to hospital, detailing all administered
medication in the referral letter. -
This question is part of the following fields:
- Microbiology
- Pathology
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Question 29
Correct
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A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?
Your Answer: Ketoconazole
Explanation:Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 30
Incorrect
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Which of the following conditions can present with multiple abscesses that may discharge sulphur granules?
Your Answer: Staphylococcus aureus infection
Correct Answer: Actinomycosis
Explanation:Actinomycosis is primarily caused by any of the several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes. And can cause multiple abscesses that may discharge sulphur granules.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 31
Incorrect
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Epstein-Barr virus (EBV) is known to be a carcinogen for:
Your Answer: Leukaemia
Correct Answer: B-cell lymphoma
Explanation:EBV is known to be carcinogenic for B-cell lymphoma, nasopharyngel carcinoma and Hodgkin’s lymphoma.
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This question is part of the following fields:
- Microbiology; Neoplasia
- Pathology
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Question 32
Incorrect
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A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?
Your Answer: Brown atrophy of the heart
Correct Answer: Viral hepatitis
Explanation:Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.
Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.
Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.
Single cell necrosis is not characteristically seen in chronic alcoholic liver.
Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.
Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.
Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 33
Incorrect
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In a study, breast lumps were analysed to determine the characteristic of malignant neoplasm on biopsy. What microscopic findings are suggestive of malignancy?
Your Answer: Pleomorphism
Correct Answer: Invasion
Explanation:Invasion is suggestive of malignancy and an even better option would have been metastasis. Pleomorphism is found in both benign and malignant neoplasms along with atypia and anaplasia. A height nuclear/cytoplasmic ratio is suggestive of malignancy but not the best indicator. Malignant tumours are aggressive and growth rapidly. Necrosis can be seen in benign tumours if they deplete their blood supply.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 34
Incorrect
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The extent of cancer growth can be described through staging. What is taken into consideration when staging a cancer?
Your Answer: Cell differentiation
Correct Answer: Local invasion
Explanation:Cancer stage is based on four characteristics: the size of cancer, whether the cancer is invasive or non-invasive, whether the cancer has spread to the lymph nodes, and whether the cancer has spread to other parts of the body, in this case beyond the breast. Staging is important as it is often a good predictor of outcomes and treatment is adjusted accordingly.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 35
Incorrect
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What is the 5 year survival rate of a patient who is diagnosed with stage III colon cancer, who underwent successful resection and completed the prescribed session of adjuvant chemotherapy?
Your Answer: 90%
Correct Answer: 30%–60%
Explanation:In this patient who has stage III colon cancer, the survival rate is 30-60%. For stage I or Dukes’ stage A disease, the 5-year survival rate after surgical resection exceeds 90%. For stage II or Dukes’ stage B disease, the 5-year survival rate is 70%–85% after resection, with or without adjuvant therapy. For stage III or Dukes’ stage C disease, the 5-year survival rate is 30%– 60% after resection and adjuvant chemotherapy and for stage IV or Dukes’ stage D disease, the 5-year survival rate is poor (approximately 5%).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 36
Incorrect
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An electronic manufacturing engineer had abdominal distension and underwent a CT scan of the abdomen. Thereafter he was diagnosed with hepatic angiosarcoma. Exposure to what agent is responsible for the development of this neoplasm?
Your Answer: Aflatoxin
Correct Answer: Arsenic
Explanation:Hepatic angiosarcomas are associated with particular carcinogens which includes: arsenic , thorotrast, and polyvinyl chloride. With exposure to this three agents, there is a very long latent period of many years between exposure and the development of tumours.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 37
Correct
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A 30 year old lawyer presented with a history of pleural effusions, pericarditis, arthralgia without joint deformity and episodes of myalgia for the past 12 months. Blood tests reveal a normocytic anaemia. Which of the following tests should be performed to investigate this condition further?
Your Answer: Antinuclear antibody test
Explanation:These non specific findings are suggestive of autoimmune disease. Antinuclear antibody (ANA) is the first test that should be performed when autoimmune diseases are suspected and later on more specific tests should be performed. This tests aids in the diagnosis of SLE, scleroderma, Sjogren’s syndrome, Raynaud’s disease, juvenile chronic arthritis, rheumatoid arthritis and antiphospholipid antibody syndrome etc. To confirm the disease a history, physical examination along with specific tests are required.
CPK is more specific for acute conditions.
ESR is a non specific test for inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 38
Incorrect
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A 27 year old women had developed a darker complexion following a vacation to India. She had no erythema or tenderness. Her skin colour returned to normal over a period of 1 month. Which of the these substances is related to the biochemical change mentioned above?
Your Answer: Hemosiderin
Correct Answer: Tyrosine
Explanation:The tanning process can occur due to UV light exposure as a result of oxidation of tyrosine to dihydrophenylalanine with the help of the tyrosinase enzyme within the melanocytes. Hemosiderin can impart a brown colour due to breakdown of RBC but its usually due to a trauma and is known as haemochromatosis.
Lipofuscin gives a golden brown colour to the cell granules not the skin.
Homogentisic acid is part of a rare disease alkaptonuria, with characteristic black pigment deposition within the connective tissue.
Copper can impart a brown golden colour, but is not related to UV light exposure.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 39
Incorrect
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A 70-year-old female who underwent coronary artery bypass graft developed post-operative acute renal failure. Her urinary catheter was left in place to monitor urine output. 6 days later she developed fever and chills. She also complained of suprapubic and left flank pain. She is found to have developed acute ascending pyelonephritis. Which of the following organism was most likely isolated during urine culture?
Your Answer: Staphylococcus aureus
Correct Answer: Escherichia coli with pili
Explanation:The most common cause of urinary tract infection is Escherichia coli. Pilated strains of E. coli ascend the urethra to infect the kidney and the bladder. Catheters have been associated with an increased risk of UTIs.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 40
Incorrect
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The wound healing process is documented in patients undergoing laparoscopic procedures. The port incisions are sutured closed and the wounds observed every few weeks for re-epithelialisation and tensile strength. Which substance is mostly likely to be found at a cellular level involved in wound healing?
Your Answer: Laminin
Correct Answer: Tyrosine kinase
Explanation:Cell surface growth factor receptors require intercellular proteins such as tyrosine kinase which are necessary to initiate a series of events that eventually lead to cell division and growth. Tyrosine kinase is an enzyme that transfers a phosphate group to the tyrosine residue in a protein. This phosphorylation will lead to an up regulation of the enzyme activity.
Fibronectin acts in the extracellular matrix to bind macromolecules (such as proteoglycans) via integrin receptors to aid attachment and migration of cells.
Laminin is an extracellular matrix component that is abundant in basement membranes.
Hyaluronic acid is one of the proteoglycans in the extracellular matrix.
Collagen fibres are part of the extracellular matrix that gives strength and stability to connective tissues.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 41
Incorrect
-
A 60-year-old male who was admitted due to cerebrovascular disease on his 5th hospital stay developed pneumonia. The most likely organism that causes hospital acquired pneumonia is pseudomonas aeruginosa. What is the most likely mechanism for the pathogenesis on pseudomonas infection?
Your Answer: Inhibition of cGMP
Correct Answer: Exotoxin
Explanation:Pseudomonas aeruginosa is a common Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. It is citrate, catalase, and oxidase positive. P. aeruginosa uses the virulence factor exotoxin A to inactivate eukaryotic elongation factor 2 via ADP-ribosylation in the host cell, much the same as the diphtheria toxin does. Without elongation factor 2, eukaryotic cells cannot synthesize proteins and necrotise. The release of intracellular contents induces an immunologic response in immunocompetent patients.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 42
Correct
-
The gynaecologist suspects that her patient has a cervical cancer. What particular test should be done on this patient to screen for cervical cancer?
Your Answer: Pap smear
Explanation:Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly. This makes cervical cancer the second most common cause of death from cancer in women. The mainstay of cervical cancer screening has been the Papanicolaou test (Pap smear).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 43
Incorrect
-
A 55 year-old construction worker is diagnosed with malignant mesothelioma. Exposure to which substance increased his risk in developing mesothelioma?
Your Answer: Silica
Correct Answer: Asbestos
Explanation:Mesothelioma is a rare, aggressive form of cancer that develops in the lining of the lungs, abdomen or heart. It is linked to inhalation of asbestos commonly used in ship building and the insulation industry. It has no known cure and has a very poor prognosis.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 44
Incorrect
-
A 55-year-old man underwent CT scan of the whole abdomen. The result showed renal cell carcinoma with a tumour size of 7cm and extension into the regional lymph. What is the clinical stage of his renal cell cancer?
Your Answer: Stage IV
Correct Answer: Stage III
Explanation:Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule. It is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. Renal cell carcinomas can be staged by using the American Joint Committee on Cancer (AJCC) TNM (tumour-node-metastasis) classification, as follows: Stage I: tumours that are 7 cm or smaller and confined to the kidney, Stage II: tumours that are larger than 7 cm but still confined to the kidney, Stage III: tumours extending into the renal vein or vena cava, involving the ipsilateral adrenal gland and/or perinephric fat, or which have spread to one local lymph node and Stage IV: tumours extending beyond Gerota’s fascia, to more than one local node, or with distant metastases Recent literature has questioned whether the cut-off in size between stage I and stage II tumours should be 5 cm instead of 7 cm. The patient’s cancer in this case is stage III.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 45
Incorrect
-
A patient is suspected to have Blastomyces dermatidis infection. The patient contracted the disease most likely through which port of entry?
Your Answer: Circulatory system
Correct Answer: Respiratory tract
Explanation:Blastomycosis disease is a fungal infection acquired through inhalation of the spores. It caused by the organism Blastomyces dermatitidis and manifests as a primary lung infection in about 70% of cases. The onset is relatively slow and symptoms are suggestive of pneumonia.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 46
Incorrect
-
Which tumour site is more commonly involved in adults than in children?
Your Answer: Soft tissue
Correct Answer: Lung
Explanation:In adults, the most common primary site of tumour is in the lungs, compared to children wherein the most common primary site is the blood.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 47
Incorrect
-
Which of the following is NOT a nutritional factor involved in wound healing:
Your Answer: Vitamin A
Correct Answer: Vitamin B3
Explanation:Vitamin B6 is required for collagen cross-links.
Vitamin A is required for epithelial cell proliferation.
Zinc is required for RNA and DNA synthesis.
Copper is required for cross-linking of collagen.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Physiology
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Question 48
Incorrect
-
Leukotrienes normally function during an asthma attack and work to sustain inflammation. Which of the following enzymes would inhibit their synthesis?
Your Answer: Peroxidase
Correct Answer: 5-lipoxygenase
Explanation:Leukotrienes are produced from arachidonic acid with the help of the enzyme 5-lipoxygenase. This takes place in the eosinophils, mast cells, neutrophils, monocytes and basophils. They are eicosanoid lipid mediators and take part in allergic and asthmatic attacks. They are both autocrine as well as paracrine signalling molecules to regulate the body’s response and include: LTA4, LTB4, LTC4, LTD4, LTE4 and LTF4.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 49
Incorrect
-
T lymphocytes that express the MCH type II antigen are most likely to produce which of the following cytokines?
Your Answer: Tumour necrosis factor
Correct Answer: Gamma interferon
Explanation:Interferon gamma is a soluble cytokine previously known as the macrophage activating factor. It is the only member belonging to the type II class of the interferons. It is secreted by a number of cells taking part in the immune reaction including: T-helper cells (CD-4), cells with immunological memory (CD45PA), killer cells (CD8), dendrite cells (CD23,35), natural killer cells (CD16) and B lymphocytes (CD22,CD23). It has both a defending as well as a pathological effect. It induces differentiation in the myeloid cell in the bone marrow. If macrophages are infected by parasites it activates the macrophages to destroy them. IFN-γ strengthens the anti-tumour activities of the cytotoxic lymphocytes. Together with CD4 or CD8 toxins, produced by lymphocytes, it suppresses the growth of the tumour cells. along with these functions it increases the non specific response of the natural killer cells, causing changes in the cell membrane surface to prevent adhesion and penetration of a virus. It can either increase or decrease B cell response and it activates osteoclasts which increases bone resorption.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 50
Correct
-
Which of the following morphological features is most characteristic of hyaline degeneration?
Your Answer: Homogeneous, ground-glass, pink-staining appearance of cells
Explanation:The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.
Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 51
Incorrect
-
A 10-year-old boy was sent for an x-ray of the leg because he was complaining of pain and swelling. The x-ray showed the classic sign of Codman's triangle. What is the most likely diagnosis of this patient?
Your Answer: Aneurysmal bone cyst
Correct Answer: Osteosarcoma
Explanation:Codman’s triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. The main causes for this sign are osteosarcoma, Ewing’s sarcoma, eumycetoma, and a subperiosteal abscess.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 52
Incorrect
-
A 35 year-old man presents with high grade fever for 7 days after returning from a trip to India. He tested positive for widal test. What is the most likely organism that caused his fever?
Your Answer: Escherichia coli
Correct Answer: Salmonella typhi
Explanation:Typhoid fever is caused by virulent bacteria called Salmonella typhi. Salmonella typhi spread through contaminated food or water and occasionally through direct contact with someone who is infected.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 53
Incorrect
-
Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?
Your Answer: Lymphocytic infiltration
Correct Answer: Vasodilation
Explanation:Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated from the centre to the periphery of the vessel, 2. rolling: selectins are upregulated on the vessel walls, 3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 54
Incorrect
-
In which of the following situations will fat necrosis occur?
Your Answer: Muscle injury
Correct Answer: Trauma to the breast
Explanation:Fat necrosis is necrosis of adipose tissue with subsequent deposition of calcium, giving it a white chalky appearance. It is seen characteristically in trauma to the breast and the pancreas with subsequent involvement of the peripancreatic fat. In the breast it may present as a palpable mass with is usually painless or as an incidental finding on mammogram. Fatty acids are released from the traumatic tissue which combine with calcium in a process known as saponification, this is an example of dystrophic calcification in which calcium binds to dead tissue. The central focus is surrounded by macrophages and neutrophils initially, followed by proliferation of fibroblasts, neovascularization and lymphocytic migration to the site of the insult.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 55
Correct
-
An organ transplant patient may be at risk of developing which type of cancer?
Your Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 56
Incorrect
-
A histological examination of a lump showed an abnormal amount and arrangement of normal tissue in an otherwise normal area. This condition is known as?
Your Answer: Embryonal tumour
Correct Answer: Hamartoma
Explanation:A hamartoma is a condition best described as tissue normally present in an area arranged haphazardly in an disorganized, abnormal fashion. They are never malignant and do not metastasis.
All the neoplastic, cancerous lesions comprise of a mixture of different cells that are not normal to that area.
Metaplasia is a change in the type of the epithelium.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 57
Correct
-
Which is the most common benign germ-cell tumour that could occur in a premenopausal woman?
Your Answer: Dermoid cyst
Explanation:A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature and solid tissues. Dermoid cysts grow slowly and this type of cystic teratoma is nearly always benign.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 58
Incorrect
-
A 36-year-old female was advised to undergo genetic testing of BRCA1 and BRCA2. BRCA1 and BRCA2 are tumour markers specifically for which organ?
Your Answer: Rectum
Correct Answer: Breast
Explanation:Women with harmful mutations in either BRCA1 or BRCA2 have a risk of breast cancer that is about five times the normal risk.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 59
Incorrect
-
When a patient that is less than 21 years of age develops a bone tumour. What is the most common benign bone tumour that would be considered in individuals below 21 years?
Your Answer: Giant-cell tumour
Correct Answer: Osteochondroma
Explanation:Osteochondroma is a benign new bone growth that protrudes from the outer contour of bones and is capped by growing cartilage. Nearly 80% of these lesions are noted before the age of 21 years.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 60
Incorrect
-
A 37-year-old woman with a history of rheumatic heart disease presents with 10 days recurrent low fever. Patient underwent laboratory work up and was diagnosed with infective endocarditis. What is the most likely organism that caused the infective endocarditis in this patient?
Your Answer: Escherichia coli
Correct Answer: Streptococcus viridans
Explanation:Subacute bacterial endocarditis is often due to streptococci of low virulence, mainly streptococcus viridans. It is a mild to moderate illness which progresses slowly over weeks and months (>2weeks) and has low propensity to hematogenously seed to extracardiac sites.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 61
Incorrect
-
A patient with Paget's disease of the bone is predisposed to developing which type of cancer?
Your Answer: Metastatic duct carcinoma of the breast
Correct Answer: Osteosarcoma
Explanation:Paget’s disease of bone (PDB) is a focal disorder of bone. It is presumed benign in nature and mediated by abnormal osteoclast function. However osteosarcomas may occur in <1% of patients with Paget's disease of the bone. Osteosarcomas are osteogenic in origin, and consistently arise in sites of pagetic bone. This is not to be confused with Paget's disease of the breast.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 62
Incorrect
-
A young girl who presented with a clinical picture of type I hypersensitivity reaction with eosinophilia is most likely to have?
Your Answer: Amyloidosis
Correct Answer: Liver flukes
Explanation:Usually a parasitic infection will be associated with a type I hypersensitivity reaction.
Amyloid deposition will not cause an immune reaction.
Organic dust will lead to a type III hypersensitivity reaction.
Cell mediated as well as humoral immune mechanism play a part in syphilis, but they are do not specifically cause a type I reaction.
Malaria is cause by plasmodium and is not cause of a hypersensitivity reaction.
Atopic dermatitis will not be accompanied by eosinophilia.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 63
Incorrect
-
Which of these is secreted by both macrophages and muscle cells?
Your Answer: Interleukin 1
Correct Answer: Interleukin-6
Explanation:IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 64
Incorrect
-
A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung underwent complete atelectasis and he has a 7cm tumour involving the chest wall. What is the stage of the lung cancer of this patient?
Your Answer:
Correct Answer: T3
Explanation:Non-small-cell lung cancer is staged through TNM classification. The stage of this patient is T3 because based on the TNM classification the tumour is staged T3 if > 7 cm or one that directly invades any of the following: Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or the tumour is in the main bronchus < 2 cm distal to the carina but without involvement of the carina, Or it is associated with atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 65
Incorrect
-
What is the 5-year survival rate of carcinoma of the pancreas?
Your Answer:
Correct Answer: 30 per cent
Explanation:Pancreatic cancer typically has a poor prognosis, partly because the cancer usually initially remains symptomless, leading to locally advanced or metastatic disease at the time of diagnosis. Median survival from diagnosis is around 3–6 months. Even in those suitable for resectional surgery, 5-year survival rates are still only 30 per cent.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 66
Incorrect
-
The physician suggested lifestyle modification for his patient because his present condition could increase his risk for the development of adenocarcinoma of the oesophagus. What is the most common predisposing factor for the development of adenocarcinoma of the oesophagus?
Your Answer:
Correct Answer: Gastro-oesophageal reflux disease
Explanation:Barret’s oesophagus is attributed primarily to gastro-oesophageal reflux disease. The chronic acidic environment damages the squamous epithelial lining of the oesophagus, and subsequently undifferentiated pluripotent stem cells develop into columnar epithelium, this is then known as Barret’s oesophagitis.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 67
Incorrect
-
A middle aged man presented in OPD with a low grade fever and a persistent cough. His blood smear showed an increase in cells with large bi-lobed nuclei. Which of these cells represent the one seen on the smear?
Your Answer:
Correct Answer: Monocytes
Explanation:Monocytes are white cells that protect the body against harmful pathogens. They are mobile and are produced in the bone marrow, mature there and circulate in the blood for about 1-3 days, where they enter the tissues and transform into macrophages. They are characteristically identified by their large bi-lobed nuclei.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 68
Incorrect
-
Which of the following cells would be increased in a patient suffering from a hydatid cyst in the liver?
Your Answer:
Correct Answer: Eosinophils
Explanation:Eosinophils are granulocytes that respond to parasitic infections. They are also involved in allergy response and asthma. They contain granules which stain red with Romanowsky’s method and contain peroxidase, Rnase, Dnase, histamine, lipase and major basic proteins that are toxic to the parasite as well as the hosts tissue. They are about 1-5% of the total WBC population and persist in the blood for 6-12 hours.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 69
Incorrect
-
Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer:
Correct Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 70
Incorrect
-
A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?
Your Answer:
Correct Answer: Caseation necrosis
Explanation:The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 71
Incorrect
-
A week after a renal transplant the patient received antilymphocyte globulins. Shortly after she developed fever and hypotension. Which of the following mechanisms is involved in this response?
Your Answer:
Correct Answer: Type III hypersensitivity
Explanation:Type III hypersensitivity is characterized by soluble immune complexes which are aggregations of IgG and IgM antibodies with antigens that deposit in different tissues e.g. the skin, joints, kidneys. They can then trigger an immune response by activating the complement cascade. This reaction can take hours to develop and examples include: immuno-complex glomerulonephritis, rheumatoid arthritis, SLE, subacute bacterial endocarditis, arthus reaction and serum sickness.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 72
Incorrect
-
A histology report of a cervical biopsy taken from a patient with tuberculosis revealed the presence of epithelioid cells. What are these cells formed from?
Your Answer:
Correct Answer: Macrophages
Explanation:Granulomas formed in tuberculosis are called tubercles and are made up polynuclear phagocytes, Langhans cells and epithelioid cells. Macrophages when enlarged, consist of abundant cytoplasm and have a tendency of arranging themselves very closely to each other representing epithelial cells. These enlarged macrophages are therefore termed as epithelioid cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 73
Incorrect
-
A 27 year old women works in a dry-cleaning shop. She was exposed to massive amounts of carbon tetrachloride on her skin as well as inhaled. Which of the following organs is most susceptible to damage?
Your Answer:
Correct Answer: Liver
Explanation:Carbon tetrachloride (CCl4) is a common agent used in the dry cleaning industry and is thought to cause the formation of free radicals. It causes rapid breakdown of the endoplasmic reticulum due to decomposition of lipids and severe liver cell injury. Within less than 30 mins, hepatic protein synthesis declines, lipid export is reduced due to lack of apoprotein and there is an influx of calcium and cell death.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 74
Incorrect
-
Anthrax is an infection caused by the bacterium Bacillus anthracis. Anthrax spores have been used as a biological warfare weapon. What is the drug of choice in treating anthrax infection?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Early antibiotic treatment of anthrax is essential. A delay may significantly lessen the chances for survival of the patient. Treatment for anthrax infection include large doses of intravenous and oral antibiotics, such as fluoroquinolones (ciprofloxacin), doxycycline, erythromycin, vancomycin, or penicillin.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 75
Incorrect
-
A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?
Your Answer:
Correct Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 76
Incorrect
-
Staphylococcus aureus can be identified in the laboratory based on the clotting of plasma. Which microbial product is responsible for this activity?
Your Answer:
Correct Answer: Coagulase
Explanation:Staphylococcus aureus is the most pathogenic species and is implicated in a variety of infections. S. aureus can be identified due to its production of coagulase. The staphylococcal enzyme coagulase will cause inoculated citrated rabbit plasma to gel or coagulate. The coagulase converts soluble fibrinogen in the plasma into insoluble fibrin.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 77
Incorrect
-
Which of the following key features will be seen in an organ undergoing atrophy?
Your Answer:
Correct Answer: A greater number of autophagic vacuoles
Explanation:Atrophy is characterised by the breakdown of intracellular components along with organelles and packing them into vacuoles known as autophagic vacuoles. This is an adaptive response that separates the damaged cellular structures from the rest of the cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 78
Incorrect
-
A patient is diagnosed with Brucellosis. What is the mode of transmission of this disease?
Your Answer:
Correct Answer: Unpasteurised milk
Explanation:Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretions.
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This question is part of the following fields:
- Microbiology
- Pathology
-
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Question 79
Incorrect
-
Which of the following factors will not affect the wound healing process in a young women who suffered serious burns to her chest and hands?
Your Answer:
Correct Answer: Vitamin A deficiency
Explanation:Healing can be sped-up or slowed down due to various reasons: 1. blood supply, 2. infection, 3. denervation, 4. collection of blood/hematoma, 5. mechanical stress, 6. foreign body, 7. techniques used during surgery and 8. dressing of the wound. Other systemic factors include 1. nutrition e.g. deficiency of zinc, vitamin C, protein deficiency, 2. metabolic status, 3. circulatory status and 4. hormonal influence
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
-
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Question 80
Incorrect
-
Where do the cells belonging to the mononuclear phagocyte system originate?
Your Answer:
Correct Answer: Bone marrow
Explanation:The macrophage originates from a committed bone marrow stem cell. It is called the pluripotent hematopoietic stem cell. This differentiates into a monoblast and then into a promonocyte and finally matures into a monocyte. When called upon they leave the bone marrow and enter into the circulation. Upon entering the tissue they transform into macrophages. Tissue macrophages include: Kupffer cells (liver), alveolar macrophages (lung), osteoclasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen and lymph nodes.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 81
Incorrect
-
A 5-year-old child is rushed to the emergency department because of fever, erythema and neck stiffness. The child is also hypotensive upon physical examination. Which is the most likely toxin responsible for this child's condition?
Your Answer:
Correct Answer: Endotoxin
Explanation:An endotoxin is part of the bacterial outer membrane, and it is not released until the bacterium is killed by the immune system. The body’s response to an endotoxin can involve severe inflammation. In general, the inflammation process is usually considered beneficial to the infected host, but if the reaction is severe enough, it can lead to sepsis.
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This question is part of the following fields:
- Microbiology
- Pathology
-
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Question 82
Incorrect
-
Perforin are present in the granules of which cell?
Your Answer:
Correct Answer: Natural killer cell
Explanation:Perforins are characteristically found In the granules of CD8+ T cells and natural killer cells. They are cytolytic proteins that insert into the target plasma membrane forming a hole and resulting in lysis. They along with granzyme B induce apoptosis in the target cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 83
Incorrect
-
Tumours derived from all three germ-cell layers in new-borns usually occur in which of the following sites?
Your Answer:
Correct Answer: Sacrococcygeal area
Explanation:A teratoma is a tumour with tissue or organ components resembling normal derivatives of more than one germ layer. It is derived from all three cell layers. The most common location of teratoma in new-born infants is in the sacrococcygeal area.
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This question is part of the following fields:
- Neoplasia
- Pathology
-
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Question 84
Incorrect
-
A 40 year old woman, who is under anaesthesia for an elective procedure, received an antibiotic injection. She immediately developed a rash and her airway constricted raising the airway pressure. Which mechanism is responsible for this reaction?
Your Answer:
Correct Answer: Type I hypersensitivity
Explanation:Type I hypersensitivity reaction is an immediate reaction that occurs due to binding of the antigen with antibodies attached to mast cells in a previously sensitized person. It has an immediate phase, which is characterised by vasodilation, leakage of plasma, smooth muscle spasm, or glandular secretions. This manifests in about 5-30 min and usually resolves within 60 mins. The delayed phase follows after 24 hours and can persist up to several days. It is due to infiltration of eosinophils, neutrophils, basophils and CD4+ cells and leads to tissue destruction. The nature of the reaction varies according to the site. It can take the form of skin allergy, hives, allergic rhinitis, conjunctivitis, bronchial asthma or food allergy.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 85
Incorrect
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Which of the following changes in the histology of the cell is most likely to be accompanied by disruption of the cell membrane following an injury?
Your Answer:
Correct Answer: Coagulative necrosis
Explanation:The process of necrosis ends with the rupture of the cell membrane and the consequent release of the cellular components into the surrounding tissue. Apoptosis, pyknosis and karyorrhexis are not reversible events but the cell membrane remains intact. Cloudy swelling and hydropic changes are also reversible but again the cell membrane remains intact and they are therefore different and distinct from necrosis.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 86
Incorrect
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A patient is diagnosed with lung cancer. His physician told him that his lung cancer type is aggressive. It can grow rapidly and may undergo early metastasis, however it is very sensitive to chemotherapy and radiotherapy. Which lung cancer type is most likely present
Your Answer:
Correct Answer: Small-cell carcinoma
Explanation:Small-cell lung carcinoma (SCLC) is a type of highly malignant cancer that most commonly arises within the lung. SCLC usually metastasizes widely very early on in the natural history of the tumour, and in nearly all cases responds dramatically to chemotherapy and/or radiotherapy. Surgery has no role in the treatment of this disease.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 87
Incorrect
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An excised lesion is found to be a premalignant during examination by the pathologist. What is the most likely histopathology report of this lesion?
Your Answer:
Correct Answer: Solar keratosis
Explanation:Premalignant condition is a state of disordered morphology of cells that is associated with an increased risk of cancer. If this condition is left untreated, it may lead to the development of cancer. The following are examples of pre-malignant lesions: actinic keratosis, Barret’s oesophagitis, atrophic gastritis, ductal carcinoma in situ, dyskeratosis congenita, sideropenic dysphagia, lichen planus, oral submucous fibrosis, solar elastosis, cervical dysplasia, leucoplakia and erythroplakia.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 88
Incorrect
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Langhans giant cells are characteristically seen in which type of inflammation?
Your Answer:
Correct Answer: Granulomatous inflammation
Explanation:Langhans giant cells are characteristically seen in granulomatous inflammation. They form when epithelioid cells fuse together. They usually contain a nuclei with a horseshoe-shaped pattern in the periphery of the cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 89
Incorrect
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An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?
Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 90
Incorrect
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An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is HIV-positive. Examination of stool sample showed numerous acid-fast cysts. Which of the following organism is the most likely cause of diarrhoea?
Your Answer:
Correct Answer: Cryptosporidium parvum
Explanation:Cryptosporidium parvum is one of several species that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. Primary symptoms of C. parvum infection are acute, watery, and non-bloody diarrhoea. C. parvum infection is of particular concern in immunocompromised patients, where diarrhoea can reach 10–15 l per day.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 91
Incorrect
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A 40-year-old woman is suspected to have an ovarian cancer. Which tumour marker should be requested to confirm the diagnosis?
Your Answer:
Correct Answer: CA-125
Explanation:CA-125 is a protein that is used as a tumour marker. This substance is found in high concentration in patients with ovarian cancer. It is the only tumour marker recommended for clinical use in the diagnosis and management of ovarian cancer.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 92
Incorrect
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A 5 year-old-child with fever complains of sore throat . She was brought to her paediatrician for consult because she has also developed a rash and has swollen lymph nodes. Upon physical examination she cried when her liver was palpated and the tip of her spleen is slightly palpable. Full blood count shows haemoglobin 13 g/dL, Haematocrit 40%, white blood cell count 13x109/L with a WBC differential count of 45 neutrophils, 4 bands, 26 lymphocytes, 15 atypical lymphocytesm, 10 monocytes and 1 eosinophil. Whick is the most likely infectious agent that is responsible for the patient's condition?
Your Answer:
Correct Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus (EBV), also known as human herpes virus 4,is a member of the herpes virus family. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis. Symptoms of EBV can include fatigue, fever, inflamed throat, swollen lymph nodes in the neck, enlarged spleen, swollen liver and rash.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 93
Incorrect
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Which of the following terms best describes the movement of leukocytes towards a specific target?
Your Answer:
Correct Answer: Chemotaxis
Explanation:The movement of leukocytes towards a chemical mediator is termed chemotaxis and the mediators likewise called chemoattractants.
Diapedesis is the squeezing of the leukocytes from the capillary wall into the intercellular space.
Endocytosis is engulfing of a small substance by the cells e.g. glucose, protein, fats.
Margination is lining of the WBC along the periphery of the blood vessel.
Adhesion is attachment with the vessel wall.
Phagocytosis is described as engulfing the bacteria or the offending substance.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 94
Incorrect
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Which of the following accumulates within a cell due to the aging process?
Your Answer:
Correct Answer: Lipofuscin
Explanation:Lipofuscin , also known as lipochrome, is a wear and tear pigment or an aging pigment. It represents free radical injury or lipid peroxidation. On microscopic examination is appears as a yellowish brown pigment around the nucleus (perinuclear pigment). It is often seen in cells which are undergoing regressive changes, commonly in the liver and heart of old patients or patients with cancer, cachexia or severe malnutrition.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 95
Incorrect
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Medulloblastoma usually occurs in children between 5 to 9 years old. Where does medulloblastoma commonly originate from?
Your Answer:
Correct Answer: Cerebellar vermis
Explanation:Medulloblastoma is the most common malignant brain tumour in children, accounting for 10-20% of primary CNS neoplasms. Most of the tumours originate in the cerebellar vermis.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 96
Incorrect
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A 35 year old man presented to the surgical OPD with a lump on his right forearm which appeared 3 weeks ago and was tender on examination. He gave a history was being in a car accident with pieces of glass from the windshield piercing his forearm removed manually and on further elective surgery. Which of these cells are characteristically found during inflammation in this situation?
Your Answer:
Correct Answer: Giant cell
Explanation:A foreign body reaction Is characteristic of giant cells. Glass being the foreign object initiates an inflammatory response in this condition.
Mast cells are involved in allergic reactions.
Eosinophils are characteristic of a parasitic infection and allergic inflammatory process but are not due to foreign bodies.
Plasma cells are typical of chronic inflammation.
Lymphocytes are involved in viral infections.
Macrophages combine together to form giant cells.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 97
Incorrect
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Which of the following is NOT a Gram-negative rod?
Your Answer:
Correct Answer: Clostridium tetani
Explanation:Gram-positive rods include Clostridia, Listeria and diphtheroids.
Gram-negative rods include Escherichia coli, Klebsiella, Yersinia, Haemohilus, Pseudomonas, Shigella, Legionella, proteus and Salmonella
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 98
Incorrect
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Which of the following morphological characteristic is a salient feature of a pure apoptotic cell?
Your Answer:
Correct Answer: Chromatin condensation
Explanation:Apoptosis is the programmed death of cells which occurs as a normal and controlled part of an organism’s growth or development. The changes which occur in this process include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, chromosomal DNA fragmentation, and global mRNA decay. The cell membrane however remains intact and the dead cells are phagocytosed prior to any content leakage and thus inflammatory response.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 99
Incorrect
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A cyclist fell and sustained a laceration to his elbow which was shortly sutured in the emergency department. Which of the following factors will aid in the wound healing process?
Your Answer:
Correct Answer: Presence of sutures
Explanation:Foreign bodies including sutures will delay wound healing, however due to the net affect being helpful they are used. Secondary wound infection will delay healing and is a potential post op complication. Corticosteroids depresses the wound healing ability of the body. Poor nutrition will also delay healing leading to decreased albumin, vit D and vit C. Diabetic patients with atherosclerosis with poor perfusion of tissues have notoriously delayed/poor healing.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 100
Incorrect
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A 27 year-old male patient was admitted to the hospital due to recurrent fever for the past 2 weeks. The patient claimed that he is an intravenous drug user. Following work up, the patient was diagnosed with infective endocarditis. Which is the most likely organism responsible for this diagnosis?
Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Acute bacterial endocarditis is a fulminant illness lasting over days to weeks (<2weeks). It is most likely due to Staphylococcus aureus especially in intravenous drug abusers.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 101
Incorrect
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An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?
Your Answer:
Correct Answer: Complement C3b
Explanation:C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
IgM does not act as an opsonin but igG does.
Selectins aid leukocytes to bind to the endothelial surfaces.
C5a is a chemo-attractant and histamine a vasodilator.
NADPH oxidises offending substance after phagocytosis within the macrophage.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 102
Incorrect
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A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is diagnosed with bladder cancer. Which is the most likely type?
Your Answer:
Correct Answer: Transitional cell carcinoma
Explanation:90% of bladder cancers are transitional cell carcinomas derived from the bladder urothelium. Risk factors include industrial chemicals, smoking and infection. Schistosomiasis and bladder stones predispose to the squamous cell variety.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 103
Incorrect
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A 60-year-old male is suspected to have pancreatic cancer. What particular tumour marker should be requested to aid in the confirmation of the diagnosis of pancreatic cancer?
Your Answer:
Correct Answer: Carcinoembryonic antigen (CEA)
Explanation:Carcinoembryonic antigen (CEA) is used as a tumour marker. CEA test measures the amount of this protein that may appear in the blood of some people who have certain types of cancers especially cancer of the colon and rectal cancer. It may also be present in the pancreas, breast, ovary or lung.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 104
Incorrect
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What is the role of ICAM-1 and VCAM-1 in the inflammatory process?
Your Answer:
Correct Answer: Leukocyte adhesion
Explanation:Steps involved in leukocyte arrival and function include:
1. margination: cells migrate from the centre to the periphery of the vessel.
2. rolling: selectins are upregulated on the vessel walls.
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes. Interaction of these results in adhesion.
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product.
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 105
Incorrect
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A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?
Your Answer:
Correct Answer: Nephroblastoma
Explanation:Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 106
Incorrect
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A 5-year-old child presents with fever and otalgia. Greenish pustular discharge was seen in his left ear during physical examination. The patient is diagnosed with otitis externa. Which of the following organisms most likely caused the infection?
Your Answer:
Correct Answer: Pseudomonas aeruginosa
Explanation:P. aeruginosa is a multidrug resistant pathogen recognised for its ubiquity, its advanced antibiotic resistance mechanisms and its association with serious illnesses – especially hospital-acquired infections such as ventilator-associated pneumonia and various septic syndromes. The species name aeruginosa is a Latin word meaning verdigris (copper rust), referring to the blue-green colour of laboratory cultures of the species. This blue-green pigment is a combination of two metabolites of P. aeruginosa, pyocyanin (blue) and pyoverdine (green), which impart the blue-green characteristic colour of cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 107
Incorrect
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A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer:
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 108
Incorrect
-
Which of the following is not seen as a complication of wound healing?
Your Answer:
Correct Answer: Malignancy
Explanation:Complications in wound healing can originate due to abnormalities in the repair process. These abnormalities are :
1) Deficient scar formation: insufficient granulation tissue can lead to wound dehiscence and ulceration. Dehiscence or wound rupture is seen most commonly in abdominal surgery due to increased intraabdominal pressure. Ulcerations are common in extremity wounds due to inadequate vascularization.
2) Excessive formation of repair components: collagen being laid down may begin normally however later lead to a raised scar also called a hypertrophic scar, which can extend beyond its boundaries to form a keloid and
3) Formation of contractures.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 109
Incorrect
-
A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?
Your Answer:
Correct Answer: Liposarcoma
Explanation:Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 110
Incorrect
-
The specimen sent to the pathologist for examination was found to be benign. Which one of the following is most likely a benign tumour?
Your Answer:
Correct Answer: Warthin’s tumour
Explanation:Warthin’s tumour is also known as papillary cystadenoma lymphomatosum. It is a benign cystic tumour of the salivary glands containing abundant lymphocytes and germinal centres. It has a slightly higher incidence in males and most likely occur in older adults aged between 60 to 70 years. This tumour is also associated with smoking. Smokers have an eight-fold greater risk in developing the tumour compared to non-smokers.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 111
Incorrect
-
The ability of the bacteria to cause disease or its virulence is related to :
Your Answer:
Correct Answer: Toxin and enzyme production
Explanation:The pathogenicity of an organism or its ability to cause disease is determined by its virulence factors. Many bacteria produce virulence factors that inhibit the host’s immune system. The virulence factors of bacteria are typically proteins or other molecules that are synthesized by enzymes. These proteins are coded for by genes in chromosomal DNA, bacteriophage DNA or plasmids. The proteins made by the bacteria can poison the host cells and cause tissue damage.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 112
Incorrect
-
A 68-year-old man underwent sigmoid resection with diverting colostomy for a ruptured sigmoid diverticulum 10 days ago. He received gentamicin and ampicillin post-op. 2 days after he was discharged from the hospital, he was readmitted because of high grade fever and chills. His blood culture grew Gram-negative bacilli. Which organism is most likely responsible for the patient's infection?
Your Answer:
Correct Answer: Bacteroides fragilis
Explanation:Bacteroides fragilis is an anaerobic, Gram-negative, rod-shaped bacterium. It is part of the normal flora of the human colon and is generally a commensal, but can cause infection if displaced into the bloodstream or surrounding tissue following surgery, disease, or trauma.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 113
Incorrect
-
The passage of leukocytes through the wall of the blood vessels is best described by which of the following terms?
Your Answer:
Correct Answer: Diapedesis
Explanation:The steps involved in leukocyte arrival and function are:
1. margination: cells migrate from the centre to the periphery of the vessel
2. rolling: selectins are upregulated on the vessel walls
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes, interaction of these results in adhesion
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
