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PATHOLOGY1 epithelial cells have an increased number and wider distribution of which of the following receptors?A. IL-B. LamininC. HistamineD. ComplementE. Immunoglobulincorrect answer is choice B. When normal cells become malignant, a number of changes can occur in their receptors. The number and d...

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PATHOLOGY 1.Malignant epithelial cells have an increased number and wider distribution of which of the following receptors? A. IL-1 B. Laminin C. Histamine D. Complement E. Immunoglobulin

correct answer is choice B. When normal cells become malignant, a number of changes can occur in their receptors. The number and distribution of normal receptors may change, and the tumor cell may express new receptors not previously shown. These are known as tumor-specific antigens. This concept is the basis for potential immunological treatment of tumors. In this case, malignant epithelial cells increase the number of receptors known as laminin receptors, on the cell surface. In general, for tumors caused by chemical carcinogens, when cells of identical genetic background are transformed with the same chemical carcinogen, each tumor formed has its own unique tumor-specific antigens. When cells are transformed by an oncogenic virus, all new tumors express the same tumor-specific antigen. Cells transformed by different viruses exhibit different tumor-specific antigens. So the correct answer to question is choice B. 2. A 65-year-old man who experiences urinary retention or difficulty in voiding his bladder most likely has 1. carcinoma of the prostate. 2. benign prostatic hyperplasia. 3. malignant neoplasm involving the urethra. 4. bladder metastasis of bronchogenic carcinoma. The correct choice is choice 2, benign prostatic hyperplasia. Benign prostatic hyperplasia or BPH is so common that it is considered by some to be a normal consequence of aging. Half of men over the age of 50 have BPH and almost all men over the age of 70 have BPH. BPH is characterized by the formation of nodules in the prostatic tissue surrounding the prostatic urethra. When these nodules enlarge, urinary obstruction often follows. Most obstruction is partial obstruction. It causes voiding difficulty. The individual cannot fully empty his bladder and he must make frequent trips to the restroom. Complete obstruction may also occur. The individual rapidly develops hydronephrosis and acute renal failure. This is a life-threatening condition as the renal failure become less and less reversible as time elapses. Carcinoma of the prostate, choice 1, rarely causes urinary retention. The carcinoma arises in the lateral lobes of the prostate. It must reach very large proportions to compromise the prostatic urethra which is located centrally. Malignant neoplasms of the urethra, choice 3, may cause urinary retention. These lesions are extremely rare, however. Bronchogenic carcinoma. choice 4, may metastasize to the bladder. However, metastatic lesions and primary tumors of the bladder usually cause hematuria rather than urinary retention. Once again, the correct choice to question is choice 2. 3. A benign neoplasm of the myometrium of the uterus is a

1. myeloma. 2. fibroma. 3. leiomyoma. 4. myoblastoma. 5. rhabdomyoma. The correct answer is choice 3. Leiomyoma, or fibroid tumors, are benign smooth muscle neoplasms of the uterus and are the most common tumor in women. They rarely transform into malignant tumors. Myelomas, choice 1, are plasma cell dyscrasias with multiple plasma cell tumors scattered throughout the body. Choice 2, fibromas, are tumors of connective tissue often found in ovaries, but not myometrium of the uterus. Choice 4, myoblastomas, are benign circumscribed lesions of soft tissue often found in the tongue but not of muscular origin. They possibly arise from Schwann cells. Choice 5, rhabdomyomas, are benign cardiac muscle tumors usually seen in children. So the correct answer to question is choice 3. 4.

A common oral manifestation of Addison's disease is 1. melanosis. 2. xerostomia. 3. glossodynia. 4. "cotton-wool" bone. 5. loss of lamina dura.

The correct choice is answer #1, melanosis. Addison's disease is the term used for adrenal insufficiency of any etiology. Adrenal insufficiency may be primary due to autoimmune phenomena, tuberculosis infiltration, metastatic tumor or amyloidosis, or it may be secondary due to abnormalities of the hypothalamus or pituitary, or exogenous administration of steroids. In primary adrenal insufficiency, feedback inhibition of adrenal hormones on the hypothalamus and pituitary is lost. Consequently, the production of adrenocorticotropic hormone (ACTH) is increased. Linked to ACTH production is the production of melanotropin and this hormone causes pigmentation of the skin and mucous membranes in a phenomenon known as melanosis. Xerostomia, choice 2, means dry mouth. It can be seen in a variety of diseases, but is most common in Sjogren's disease and other rheumatologic illnesses. Glossodynia, choice 3. means painful tongue. This can result from a local burn or trauma or from metastatic tumor infiltration of the lingual nerve. The term "cotton wool bone", choice 4, describes the radiographic appearance of bone in Paget's disease. Paget's disease is a metabolic disorder of bone characterized by an increased rate of bone resorption coupled with new bone synthesis. The lamina dura, choice 5, is a thick layer of tissue lining the dental alveolar bone. This tissue is lost in periodontal disease, but is uninvolved in Addison's disease. Once again, the correct choice to question is choice 4 b. Addison's Disease, a disorder of adrenal insufficiency, can lead to the development of oral lesions in any area of the mouth; however, these oral lesions are most commonly found on the A. Buccal mucosa B. Dorsum of the tongue

C. Gingival margin D. Soft palate E. This disease is not associated with the development of oral lesions. The correct answer is A. Addison's disease is a condition caused primarily by inadequate glucocorticoid production. This disorder is primarily caused by a destruction of the zona fasciculata by an autoimmune response of the body. This disorder primarily produces oral lesions on the buccal mucosa, although these lesions can appear anywhere in the mouth. The lesions are typically blotches or spots of bluish-black to dark brown pigmentation. Furthermore, there is a diffuse pigmentation of the skin around the lesions. In addition to these oral lesions, individuals will normally experience a dramatic decrease in blood glucose levels several hours after a meal. In other words, individuals with this disorder may experience hypoglycemia. In this disorder, there usually are elevated ACTH levels. Furthermore, one would typically expect to see hyponatremia and excessive water loss. One of the classic characteristics of Addison's disease is that patients often present with chronic weakness secondary to a continual weight loss. 4c An individual with Addison's disease is most likely to experience which of the following? A. Decreased ACTH levels B. Hypernatremia C. Hypoglycemia D. Water retention E. Weight gain The correct answer is C. The symptoms of this disorder are primarily due to the destruction of the zona fasciculata by an autoimmune response of the body. In Addison's disease, individuals will normally experience a dramatic decrease in blood glucose levels several hours after a meal. In other words, individuals with this disorder may experience hypoglycemia. In this disorder, there are normally elevated ACTH levels (choice A). Furthermore, one would typically expect to see hyponatremia (choice B) and excessive water loss (choice D). One of the classic characteristics of Addison's disease is that patients often present with chronic weakness secondary to a continual weight loss (choice E). 5. A complication of peptic ulcer disease that accounts for the majority of deaths is 1. bleeding. 2. perforation. 3. surgical complication. 4. malignant transformation. 5. obstruction from edema or scarring. The correct answer is choice 2. Peptic ulcers are chronic isolated ulcers in areas of the esophagus, stomach or duodenum bathed by pepsin and HCL, and are the result of lowered mucosal resistance. The major complications of peptic

ulcers include hemorrhage, perforation, obstruction and pain. Malignant transformation, choice 4, is rare in stomach ulcers and unknown in duodenal ulcers, and so is incorrect. Bleeding, choice 1, is a common problem with ulcers, but does not account for the majority of deaths, which is what the question is looking for. Perforation, in which the ulcer grows until it is completely open through the outer wall of the stomach and into the peritoneal cavity, is a serious medical problem and may cause death, and it is our correct answer. Choice 3 is incorrect. Most ulcers are not surgically treated and those that are do not commonly result in death through surgical complications, so it is not the most common cause of death. Likewise, in choice 5, obstruction may occur but does not lead to death as often as does perforation. So the correct answer to question is choice 2. 6. A lesion on which of the following nerves would not affect the gustatory pathway? A. V B. VII C. VIII D. IX E. X Cranial nerve VIII (choice C) or the vestibulocochlear nerve is the only cranial nerve listed that is not associated with the gustatory pathway. Damage to this nerve during a surgical procedure would not affect any aspect of the gustatory pathway. The vestibulocochlear nerve is primarily associated with balance, equilibrium and hearing. Cranial nerve V or the trigeminal nerve (choice A) provides information concerning the general texture of food as well as the taste-related sensations of peppery or hot. The taste buds are monitored by cranial nerves VII (Facial) (choice B), IX (Glossopharyngeal) (choice D), and X (Vagus) (choice E). The sensory afferents of these nerves synapse within the nucleus solitarius of the medulla oblongata and the axons of the postsynaptic neurons enter the medial lemniscus, which join axons carrying somatic sensory information. This type of sensory information is related to touch, pressure and propioception. 7. A mother states that when she feeds or bathes her newborn, the infant becomes cyanotic; however, the baby appears normal the rest of the time. What is the most likely cause of the infants signs and symptoms? A. Anemia B. Asthma C. Patent ductus arteriosus D. Septicemia E. Upper respiratory infection The correct answer is C. Congenital circulatory problems are normally associated with an abnormal formation of the heart or problems with the interconnection between the heart and the major blood vessels. For example, the incomplete closure of the ductus arteriosus results in the bypassing of the lungs and the recirculation of blood into the systemic circuit. Since normal oxygenation of the blood does not continually occur, the infant can become cyanotic during of

stress. When the baby is eating or bathing, blood is shunted to the stomach or skin respectively. When these stressful events are NOT occurring, there is sufficient blood flow to the lungs to prevent cyanosis. Although there are several kinds of anemia (choice A), the classic signs and symptoms of this condition are chronic fatigue and tachypnea on exertion. Asthma (choice B) is characterized by chronic (or episodic) wheezing, dyspnea and cough. Septicemia (choice D) is defined as a severe systemic infection. If the child had septicemia, she would not appear normal most of the time; the infant would appear very lethargic, hyperthermic and "septic." If the infant had an upper respiratory infection (choice E), the child would most likely appear weak, lethargic and would be coughing. 8. A neoplasm composed of all three germ layers is referred to as a(n): A. adenoma B. osteoma C. teratoma D. sarcoma E. carcinoma The correct answer is choice C. Simple neoplasms arise from one cell type or germ layer. Mixed neoplasms arise from two, and teratomas ("monster growths") arise from all three and often have a bizarre appearance. Cancers arising from epithelium or endoderm are usually called carcinomas (choice E), whereas those originating from mesoderm are called sarcomas (choice D). An adenoma (choice A) is a benign epithelial tumor, and an osteoma (choice B) is a benign bone tumor. 9. A patient with dentinogenesis imperfecta has a history of multiple fractures. Examination reveals blue sclera. The most probable diagnosis is 1. achondroplasia. 2. Marfan's syndrome. 3. osteogenesis imperfecta. 4. Albers-Schonberg disease.

The correct answer is choice 3. Osteogenesis imperfecta is a hereditary disease of collagen metabolism. It is characterized by thin deformed bones, blue sclera, fractured ear ossicles, malformed discolored teeth, and mitral valve prolapse. Choice 1 is incorrect. Achondroplasia refers to a hereditary disease of impaired cartilage formation, poor long bone formation and dwarfism. Choice 2 is also incorrect. Marfan's syndrome is a hereditary connective tissue disease, possibly due to defective elastin in ground substance. Clinically, it may involve aortic aneurysm, mitral valve prolapse, or subluxed lens. Choice 4. Albers-Schonberg disease is another term for osteopetrosis, a rare hereditary disease characterized by abnormally dense bone due to defective resorption of immature bone. So the correct answer to question is choice 3. 10. A patient with facial erythema, fever, Raynaud's phenomenon, joint pain and photophobia probably has 1. scleroderma. 2. Paget's disease.

3. Sjögren's syndrome. 4. erythema multiforme. 5. systemic lupus erythematosus. The correct choice is choice 5, systemic lupus erythematosus. Systemic lupus erythematosus or SLE is an autoimmune disease primarily affecting women. Antibodies to a host of nuclear and cytoplasmic antigens develop as in other autoimmune diseases. The most specific marker of SLE, however, is antibody directed against double-stranded DNA. The anti-nuclear and anti-cytoplasmic antibodies are responsible for many manifestations of the disease. They deposit as antibody antigen complexes in the kidneys, joints, and blood vessels, and activate complement. Tissue destruction then ensues. In addition to the symptoms mentioned in the question, an individual with SLE may suffer from hematuria, proteinuria, nephrosis, pericarditis, pleuritis, lymphadenopathy, leukopenia, thrombocytopenia, and decreased cognition. The disease tends to be chronic with intermittent exacerbations and remissions. Exacerbations require steroid therapy to minimize tissue destruction. Scleroderma, choice 1, is also an autoimmune disease. Many anti-nuclear and anti-cytoplasmic antibodies can be isolated in affected individuals, the most specific of which are antibodies against centromeres and nonhistone nuclear proteins. This disorder is characterized by extensive fibrosis involving the skin and viscera. It begins with thickening of the hands and arthritis. As it progresses, the esophagus thickens, causing dysphagia. The disease may also involve the lungs, leading to pulmonary fibrosis; tke lower GI tract, and the kidneys. Paget's disease, choice 2, is a very common, usually asymptomatic, disease of bone characterized by bone destruction, with excessive bone reformation. When symptoms do occur, they usually include musculoskeletal pain, pathologic fracture, and skeletal deformity. The etiology of Paget's disease is not known. Sjogren's disease, choice 3, is another autoimmune phenomenon. The most specific marker of this disease is antibody called SSB E which is directed against an extractable nuclear antigen. Clinically, Sjogren's disease is characterized by the sicca syndrome which includes dry mouth and dry eyes caused by lymphocytic infiltration of the salivary and-lacrimal glands. Sjogren's disease is commonly associated with rheumatoid arthritis or SLE, but by itself is not a disseminating disease. Erythema multiforme, choice 4, may be associated with SLE, but more commonly it represents a hypersensitivity reaction to drugs or infectious agents. It is characterized by a maculopapular rash which develops into a bullous process. Erythema multiforme is uncommon and selflimited. Once again, the correct choice to question is choice 5. 11. A patient, with which of the following disease states, is at the highest risk for development of an oral infection following a tooth extraction? A. Congestive heart failure B. Depression C. Diabetes mellitus D. Hypertension E. Hyperthyroidism The correct answer is C. Diabetes mellitus is a disease characterized by polyuria, polydipsia, ketonemia, and/or ketonuria. Complications of this disease are caused by prolonged periods of blood glucose levels greater than 126 mg/dL. Patients with diabetes mellitus are at an increased risk for post-operative

infections and impaired wound healing secondary to the sustained periods of hyperglycemia as well as the circulation problems commonly seen in diabetic patients. Therefore, of the diseases listed, patients with diabetes mellitus are at the highest risk for infectious complication and impaired wound healing following a surgical procedure. Congestive heart failure (choice A) is a condition characterized by an abnormality of cardiac function. In this condition, there is a failure of the heart to pump blood throughout the body at a rate sufficient to meet the requirements of the metabolizing tissues and/or the heart is only able to meet these requirements when the end-diastolic volume is abnormally elevated. This disease is not associated with an increased development of oral infections. Depression (choice B) is a psychiatric disorder where patients have prolonged feelings of hopelessness, sadness, worthlessness, and changes in appetite and sleep behavior. Often, these patients relate feelings of anxiety or guilt and have difficulty thinking or concentrating; suicidal ideation may also be present. Although patients with psychiatric disorders are more prone to inflict self-injury, their ability to heal following a surgical procedure is not impaired. Hypertension (choice D) is a disease associated with high blood pressure. Over 50 million Americans have this disease and the majority of them experience no impairment of wound healing following a surgical procedure. Hyperthyroidism (choice E) is an endocrine disorder characterized by sweating, weight change, nervousness, irritability and fatigue; this hypermetabolic disorder is generally NOT associated with impaired wound healing. However, a patient with hypothyroidism will commonly experience some degree of impairment of wound healing following a surgical procedure. 12. A person with anti-A and anti-B isoagglutinins in the serum belongs to blood group 1. A 2. B 3. AB 4. O The correct choice is choice 4, 0. Isoagglutinins are antibodies which cause clumping of cells. These antibodies are not normally present in all individuals. They are only present in those individuals who lack the specific antigens with which the antibodies react. Blood is typed on the basis of the antigens present on the red cell membrane. Type A blood cells, for example, have A antigen on their surface. An individual with type A blood has antibody to B antigens. Individuals with type AB blood have both A and B antigens. They have no anti-A or anti-B antibodies in their serum. If they did, they would agglutinate their own red cells. Type 0 blood cells have no antigens of the A or B class on their surface. Individuals with type 0 blood have anti-A and anti-B antibody in their serum. Consequently, type 0 individuals may only receive type 0 blood during a transfusion. The lack of A and B antigens on the surface of type 0 red blood cells enables type 0 individuals to donate blood to individuals of any blood type. Type 0 individuals are consequently called universal donors, while type AB individuals are termed universal recipients. Once again, the correct choice to question is choice 4. 13 Adenocarcinomas of the large intestine are most common in which segment? 1. Ascending colon 2. Transverse colon

3. Descending colon 4. Rectosigmoid colon The correct answer is choice 4. Adenocarcinomas of the colon or large intestine constitute approximately 98% of all colonic cancers. They are environmentally linked and are associated with dietary factors including possibly low fiber diets or excess meat and fat intake. They are also associated with villous adenomas such as ulcerative colitis, Crohn's disease, Gardiner's syndrome and familial polyposis. They can spread by extension or met...