NBDE 1998 Micro/Pathology

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NBDE 1998 Micro/Pathology
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NBDE 1998 Micro/Pathology
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  1. The capsule of Streptococcus mutans is an important virulence factor that
    A) has proteolytic activity.
    B) prevents phagocytic digestion.
    C) enhances oral accumulation.
    D) is necessary to cause bacteremia.
    E) causes circulatory collapse.
    C)
    (this multiple choice question has been scrambled)
  2. Which of the following disorders is LEAST likely to be included in the differential diagnosis of a patient with acute appendicitis?

    A) Pelvic inflammatory disease
    B) Crohn's disease
    C) Duodenal peptic ulcer
    D) Gastroenteritis with mesenteric adenitis
    E) Meckel's diverticulitis
    C
  3. Uncomplicated healing of a wound by secondary intention, observed microscopically at three days, is MOST likely to show evidence of which of the following?

    A) Lack of acute inflammation
    B) Ulceration of the epithelial surface
    C) Keloid formation
    D) Granulomatous inflammation
    E) Mature cicatrix
    • B)?
    • Classic model of wound healing:
    • 1. hemostasis
    • 2. inflammatory- bacteria/debris phagocytized and removed
    • 1. PMNs- 1st 2 days + T cells--> cleanse wound
    • 2. Macrophages- after 2 days
    • - essential to wound healing (phagocytize bacteria and damaged tissue)
    • 3. proliferative
    • - angiogenesis by vascular endothelial cells
    • - collagen deposition by fibroblasts
    • - granulation tissue formation (type III)--> replaced later with type I
    • - epithelialization- epithelial cells proliferate and crawl up wound bed to cover
    • - wound contraction by myofibroblasts
    • 4. remodeling - collagen remodeled and realigned along tensions lines; cells no longer needed undergo apoptosis

    • 1. Primary intention- e.g. surgical incision
    • - no/minimal scar formation
    • - wound edges line up
    • 2. Secondary intention- e.g. gingivectomy, gingivoplasty, tooth extraction
    • - granulates--> scar formation- slower healing + wound care
    • 3. Tertiary- e.g. healing of wounds by use of tissue grafts
    • - wound is cleaned and observed; left open
  4. Patients with which of the following malignancies have the poorest prognosis?
    A) Malignant melanoma
    B) Pancreatic carcinoma
    C) Carcinoma of the colon
    D) Lung cancer
    E) Squamous carcinoma of the tongue
    B)

    Pancreatic cancer
    - poor prognosis
    - 3 yr survival rate is 30%
    - "silent killer" bc usually doesn't cause symptoms
    - later symptoms are non-specific: jaundice, pain in upper abdomen, weight loss
    Risk factors:
    - male
    - age
    - smoking
    - obesity
    - diabetes mellitis
    - H. pylori
    - family history
    - gingivitis or perio disease
    (this multiple choice question has been scrambled)
  5. Which of the following is the MOST important function of bacterial pili in causing human infectious disease?A) Allowing bacteria to adhere to human cells
    B) Destroying phagocytic macrophages and neutrophils
    C) Making the bacteria motile
    D) Transfering DNA from one bacterium to another
    A)

    • fimbriae= short pilus used to attach bacteria to host surface
    • - mutant bacteria that lack fimbriae can't attach to surface and can't cause disease
    • - found in gram - and gram + bacteria
  6. A patient with rheumatic heart disease is MOST likely to develop congestive heart failure due which of the following?
    A) Digitalis toxicity
    B) Valvular insufficiency
    C) Aschoff bodies in coronary arteries
    D) Cor pulmonale
    E) Heart murmur
    B)
    (this multiple choice question has been scrambled)
  7. Which of the following are directly associated with destruction of glomerular basement membranes in a patient with glomerulonephritis?
    A) Polymorphonuclear leukocytes
    B) IgE antibodies
    C) Eosinophils
    D) Lymphokines
    A)
    (this multiple choice question has been scrambled)
  8. If Type A blood is accidentally transfused into a Type B recipient, the immediate hemolytic reaction would be the result of which of the following?
    A) T cytotoxic cell activation
    B) IgG against the B antigen
    C) IgM against the A antigen
    D) Sensitization to antigens other than A or B
    E) IgA against the A antigen
    C
  9. A patient who has anemia, poorly localized abdominal pain, and wrist and foot drop probably is manifesting a toxic state induced by which of the following?

    A) Mercury
    B) Carbon tetrachloride
    C) Lead
    D) Bismuth
    E) Carbon monoxide
    • D) Lead
    • - pain, muscle weakness, paresthesia, NVD, diarrhea, constipation, poor appetite
    • - black line on gingiva

    • Bismuth
    • - one of the least toxic of the heavy metals
    • - mostly kidney and liver
    • - skin and respiratory irritation
    • - "bismuth line"= black line on gingiva

    • Mercury
    • - peripheral neuropathy- paresthesia, itching, burning pain
    • - skin discoloration- pink cheeks, fingertips toes
    • - blocks breakdown of catecholamines- -> sweating, tachycardia, salivation, HTN
    • - kidney dysfunction, hypotonia of muscle

    • CCl4
    • - CNS
    • - degenerate liver and kidneys--> can lead to cancer
    • - prolonged--> coma and death
  10. Which of the following is the major VIRAL cause of birth defects in infants in developed countries?A) Varicella-zoster
    B) Rubella
    C) Measles
    D) Herpes simplex
    E) Cytomegalovirus
    E) CMV

    TORCHeS
  11. Phage conversion is responsible for which o'f the following?
    A) Transformation of bacteria
    B) Production of beta-galactose
    C) Production of pyrogenic toxin
    D) Ability of Rhizobium species to fix nitrogen
    C)

    Bacteriophage= vector for transduction from one cell to another
    (this multiple choice question has been scrambled)
  12. MOST rickettsial diseases can produce severe illness in humans because rickettsiae

    A) produce potent exotoxins.
    B) cause extensive CNS damage.
    C) are destructive for endothelial cells.
    D) are destructive for epithelial cells.
    C)
    (this multiple choice question has been scrambled)
  13. Hereditary angioedema is the result of which the following?
    A) Bare Iymphocytes (no Class I/II antigens)
    B) Deficiency in C1 esterase inhibitor
    C) Defective VH gene recombination to DJH
    D) Lack of a thymus
    E) Developmental arrest of Iymphocytes
    B)

    - presents in 20's-40s
    - local swelling in subcutaneous tissues
    - doesn't respond to antihistamines, corticosteroids, or Epi

    Cause:
    - deficiency of C1 esterase inhibitor
    - C1 inhibitor inhibits C1, Factor XII, and kallikrein--> therefore give rise to vasoactive substances when unregulated

    Tx
    - want to treat the edema, esp if larynx
    - AUTOSOMAL DOMINANT
    (this multiple choice question has been scrambled)
  14. Which of the following viral diseases has the LONGESTincubation period?
    A) Herpetic gingivostomatitis
    B) Influenza
    C) Measles
    D) Rabies
    E) Common cold
    D)

    Rabies
    - viral disease
    - causes acute encephalitis
    - travels to brain following peripheral nerves
    - zoonotic- bite from infected animal
    - incubation period is few months in humans--> once reach CNS, symptoms show and fatal within 7 days

    - mania, lethargy, depression, uncontroled excitement
    (this multiple choice question has been scrambled)
  15. Adult respiratory distress syndrome might be caused by each of the following EXCEPT one. Which one is this EXCEPTION?
    A) Viral pneumonia
    B) Breathing 100 percent O2
    C) Shock
    D) Cigarette smoking
    E) Heroin overdose
    D)

    ARDS "Acute" is more appropriate

    - serious rxn to various injuries of lung
    - severe lung disease
    - inflamm of lung parenchmya= impaired gas exchange--> inflamm, hypoxemia, multiple organ failure
    - often fatal and need to be put in ICU on mechanical ventilation
    - most commonly associated w/ diffuse alveolar damage
    (this multiple choice question has been scrambled)
  16. Normal clotting time and normal platelet count accompanied by prolonged bleeding time suggest which of the following?
    A) Polycythemia vera
    B) Thrombocytopenic purpura
    C) Steatorrhea
    D) Hemophilia
    E) Excessive aspirin ingestion
    E)

    Aspirin inhibits the COX pathway--> prostaglandins (PCI2 and TXA2)
    - Thromboxane A2 in charge of platelet aggregation
    (this multiple choice question has been scrambled)
  17. Which of the following bacterial vaccines is given routinely to children in the U.S.A.?
    A) Measles, mumps, rubella
    B) BCG
    C) Cholera
    D) Diptheria, pertussis, tetanus
    E) Polyvalent pneumococcus
    D

    DPT vaccine

    • - diphtheria and tetanus toxoids
    • - killed whole cells of bordetella pertussis
    • - 5 doses btwn 2 months and 5 yrs
  18. Normal human cells contain gene sequences homologous to virus genome sequences known to induce cancer in animals. What term applies to these gene sequences when found in human cells?
    A) Protooncogenes
    B) Viral oncogenes
    C) Homologous chromosomes
    D) Retroviral genes
    E) Analogous chromosomes
    A)
    (this multiple choice question has been scrambled)
  19. If a foreign antigen enters the body through the skin, which of the following portions of the lymphoid system is the antigen MOSTlikely to reach FIRST?
    A) Lymph nodes
    B) Spleen
    C) Liver
    D) Mucosal-associated lymphoid tissue
    E) Thymus
    A)
    (this multiple choice question has been scrambled)
  20. Which of the following statements is CORRECT regarding glioblastoma multiforme?
    A) Its prognosis is generally more favorable than Grade I astrocytoma.
    B) It is classified as a type of meningioma.
    C) It is the most common type of astrocytoma.
    D) The tumor is most common before puberty.
    E) It is derived from the epithelial lining of the ventricles.
    C)

    - it is a type IV astrocytoma
    - most common primary brain tumor/astrocytoma
    - butterfly glioma bc crosses corpus callosum
    - v. poor prognosis <1 yr survival
    - found in cerebral hemispheres
    (this multiple choice question has been scrambled)
  21. The appearance of new strains of human immunodeficiency virus are primarily the result of
    A) errors in translation.
    B) natural selection.
    C) errors in transcription.
    D) genomic recombination
    C
  22. Each of the following is commonly associated with congestive heart failure EXCEPT one. Which one is this EXCEPTION?
    A) Ankle edema
    B) Dyspnea
    C) Anasarca
    D) Cyanosis
    E) Passive congestion of the liver
    C)

    "anasarca"= extreme generalized edema
    - widespread swelling of skin due to effusion of fluid into EC space
    - usually caused by renal, liver, heart failure
    Plasmodium falciparum nephrosis edema PHIL 3894 lores.jpg
    (this multiple choice question has been scrambled)

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