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Robbins And Cotran Pathologic Basis Of Disease 9th Edition By Kumar Abbas Test Bank
Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition
Chapter 06: Immunity
ANS: C, Prostaglandin D2 is the most abundant arachidonic acid derivative produced through the cyclooxygenase pathway. It causes bronchospasm and increased mucus production.
ANS: D, This man has Goodpasture syndrome, in which the body produces autoantibodies to the globular part of type IV collagen in the glomerular basement membranes and the lungs.
ANS: A, IgA can activate complement by the alternate pathway.
ANS: B, Antigen-antibody complexes cause inflammation of the vessel wall, accompanied by the insudation of plasma proteins into the site of injury. The necrosis is classified as fibrinoid, because it contains large amounts of fibrin formed from fibrinogen in the plasma insudated into the damaged vessel wall.
ANS: D, Granuloma formation depends on cytokines produced by TH1 cells derived from CD4+ lymphocytes.
ANS: A, TH1 helper lymphocytes accumulate first at the site of exposure to the foreign antigen in the skin; they also are the most important mediators of epidermal cell injury that leads to formation of vesicles and bullae. CD8 cytotoxic cells also take part in later stages of the reaction, but to a lesser degree.
ANS: C, Generic antinuclear antibodies (ANA) reacting with chromatin, histones, and occasionally double-stranded DNA give a diffuse nuclear staining pattern. Rim (or peripheral) staining is due to antibodies to double-stranded DNA. A speckled pattern is typical of antibodies to non-DNA nuclear components, including the Sm-antigen, which is the most specific marker of systemic lupus erythematosus. A nucleolar pattern reflects the presence of antibodies to nucleolar RNA. Cytoplasmic staining is nonspecific and unrelated to antinuclear antibodies.
ANS: D, The most common and clinically the most serious form of lupus nephritis is class IV, diffuse proliferative glomerulonephritis.
ANS: D, Pericarditis is the most common cardiovascular manifestation of systemic lupus erythematosus.
ANS: E, Anti-ribonucleoprotein antibodies (RNP) are found in about 90% patients with Sjgren syndrome and are found in less than 5% of patients with other autoimmune diseases. Hence, these anti-RNP antibodies, called SS-A and SS-B, are very good markers for this disease.
ANS: C, Von Willebrand factor is produced and stored in endothelial cells. An endothelial cell injury leads to elevated levels of this factor in blood.
ANS: B, Almost all patients who have anti-centromere antibodies have a form of scleroderma called CREST. Symptoms of CREST syndrome, a limited form of scleroderma, are calcinosis, Raynaud syndrome, esophageal dysmotility, sclerodactyly, and telangiectasis. In contrast to CREST syndrome, systemic sclerosis is characterized by the appearance of antibodies to DNA topoisomerase (anti-Scl 70).
ANS: A, This girl most likely has dermatomyositis. The antibody most commonly found in inflammatory myopathies is directed against the histidyl-t-RNA.
ANS: E, X-linked agammaglobulinemia (Bruton agammaglobulinemia) is caused by the mutation of Bruton tyrosine kinase (Btk), an enzyme essential for the maturation of pre-B cells into B lymphocytes. Because the defective B lymphocytes cannot produce immunoglobulins, there is agammaglobulinemia and reduced resistance to infections.
ANS: B, Although they lack IgA in their blood and secretion, patients with congenital isolated IgA often have antibodies to IgA. Transfusion of blood to these patients may result in severe anaphylactic reaction due to the reaction of the patients autoantibodies and the IgA in the transfused blood.
ANS: B, CD4, the cell surface marker of T-helper lymphocytes, serves as a high affinity receptor for the human immunodeficiency virus.
ANS: D, The human immunodeficiency virus lives and replicates in CD4+ T-helper lymphocytes and follicular dendritic cells in the germinal centers of lymph nodes.
ANS: A, In general, the most common fungal pathogens in patients with AIDS is Candida albicans. Most often, it infects the mouth and the esophagus, but it can be found in many internal organs such as the vagina.
ANS: D, 2-microglobulin is a component of the major histocompatibility complex on the cell surface and is also normally present in deposits in the tissues of patients on long-term hemodialysis, forming amyloid fibrils.
ANS: C, Deposits of AL amyloid are typically found in the glomeruli, causing proteinuria. Proteinuria is often severe, leading to a full blown nephrotic syndrome.
Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition
Chapter 07: Neoplasia
ANS: E, Cystadenomas, which may contain serous fluid or mucin and are thus called serous or mucinous cystadenomas, are typically found in the ovary. These benign tumors have malignant counterparts known as cystadenocarcinomas.
ANS: A, Basal cell carcinomas of the skin, the most common malignant tumor in the human body, is a locally invasive malignant tumor, which, if untreated, could ultimately kill the host. However, these tumors are usually diagnosed early and removed adequately, so that they almost never metastasize.
ANS: B, Pseudomyxoma of the ovary usually results from peritoneal seeding of mucin-secreting tumors of the ovary or the gastrointestinal tract, and most often the appendix. Although the ovarian tumor is benign, the implants of the tumor cells seeding the peritoneal cavity can be difficult to eradicate. The cells continue to secrete mucin and fill the abdominal cavity, colloquially known as jelly-belly.
ANS: D, Translocation of the c-myc protooncogene from its normal site on chromosome 8 to chromosome 14 results in the formation of the myc oncogene and plays a major role in the pathogenesis of Burkitt lymphoma.
ANS: B, Homogeneous staining regions and double minutes are signs of gene amplification. Amplification of the N-myc oncogene in neuroblastoma cells is a poor prognostic finding.
ANS: E, BRCA1 and BRCA2 are tumor suppressor genes whose true function has not been fully elucidated. It is thought that they participate in the transcriptional regulation and interact with proteins that regulate double-strand DNA repair.
ANS: D, E-cadherin is a cell-to-cell adhesion molecule that serves to hold many epithelial cells together. This surface adhesion molecule is often lost in adenocarcinomas, accounting for the invasive growth of these neoplasms. Germ line mutation of the E-cadherin gene has been found in families with gastric carcinoma.
ANS: E, Von HippelLindau syndrome was originally described as a syndrome comprising angiomas of the retina and hemangioblastomas of the cerebellum. It is linked to the germ line mutation of the VHL tumor suppressor gene. These patients are at risk of developing renal cell carcinoma and pheochromocytomas. Mutations of the VHL gene also have been found in sporadic renal carcinomas unrelated to Von HippelLindau syndrome.
ANS: A, Mutations of human DNA mismatch repair genes play a pathogenetic role in the development of colonic cancers in families with hereditary nonpolyposis colon cancer (HNPCC). Due to the error in mismatch repair, the microsatellite sequences (normally fixed for life and the same in every tissue) expand. They account for the microsatellite instability, a hallmark of all conditions with defective DNA mismatch repair.
ANS: C, Matrix metalloproteinases, such as type IV collagenase, are important for the invasive growth of tumor cells. These enzymes degrade the basement membranes and the extracellular matrix, allowing the tumor cells to penetrate into the tissues, lymphatics, and blood vessels.
ANS: A, Most of the exogenous procarcinogens are activated into carcinogens in the liver through the action of microsomal cytochrome P-450dependent mono-oxidases found in the smooth endoplasmic reticulum of hepatocytes. Susceptibility to carcinogens is in part determined by the polymorphism of genes that encode these enzymes.
ANS: B, Leukemias represent the most common radiation-induced cancer in humans, closely followed by thyroid cancer, which is the most common malignancy in young persons.
ANS: C, The best and strongest evidence links Helicobacter pylori infection with the onset of mucosa-associated B-cell lymphomas (MALTomas) of the stomach, which are also known as marginal zone lymphomas. It is thought that H. pylori activates T cells, which in turn promote polyclonal proliferation of B cells in the gastric mucosa. In this process, some cells obviously become malignant and give rise to T-cell independent low-grade monoclonal lymphomas.
ANS: C, Clubbing of the fingers and related bone and joint changes of the hand and fingers are signs of hypertrophic osteoarthropathy, which most often occurs in patients with bronchogenic carcinoma. The pathogenesis of these changes is not known.
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