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1 In a 6-month randomized trial of a pharmacologic agent, one group of patients receives a cyclooxygenase-2 (COX-2) inhibitor, and a control group does not. Laboratory measurements during the trial show no significant differences between the groups in WBC count, platelet count, hemoglobin, and creatinine. The group receiving the drug reports subjective findings different from those of the control group, however. Which of the following findings was most likely reported by the group receiving the drug? □ (A) Ankle swelling □ (B) Increased bouts of asthma □ (C) Easy bruisability □ (D) Reduced urticaria □ (E) Increased febrile episodes □ (F) Reduced arthritis pain
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 13). A Saunders Title. Kindle Edition. |
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2 An experiment introduces bacteria into a perfused tissue preparation. Leukocytes leave the vasculature and migrate to the site of bacterial inoculation. The movement of these leukocytes is most likely to be mediated by which of the following substances? □ (A) Bradykinin □ (B) Chemokines □ (C) Histamine □ (D) Prostaglandins □ (E) Complement C3a
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 13). A Saunders Title. Kindle Edition. |
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3 A 53-year-old woman has had a high fever and cough productive of yellowish sputum for the past 2 days. Her vital signs include temperature of 37.8°C, pulse of 83/min, respirations of 17/min, and blood pressure of 100/60 mm Hg. On auscultation of the chest, crackles are audible in both lung bases. A chest radiograph shows bilateral patchy pulmonary infiltrates and fluid in the right pleural cavity. Thoracentesis yields 500 mL of cloudy yellow fluid. Which of the following inflammatory cell types is most likely to be seen in greatly increased numbers in a sputum specimen? □ (A) Macrophages □ (B) Neutrophils □ (C) Mast cells □ (D) Small lymphocytes □ (E) Langhans giant cells
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 13). A Saunders Title. Kindle Edition. |
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4 A 63-year-old man develops worsening congestive heart failure 2 weeks after an acute myocardial infarction. An echocardiogram shows a markedly decreased ejection fraction. He dies 1 day later. At autopsy, a section of the infarct shows that the necrotic myocardium has largely been replaced by capillaries, fibroblasts, and collagen. Various inflammatory cells are present. Which of the following inflammatory cell types in this lesion plays the most important role in the healing process? □ (A) Macrophages □ (B) Plasma cells □ (C) Neutrophils □ (D) Eosinophils □ (E) Epithelioid cells
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 13). A Saunders Title. Kindle Edition. |
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5 A 10-year-old child developed a sore throat and fever over 24 hours. Physical examination shows pharyngeal erythema and swelling. Laboratory findings include leukocytosis. The child is given acetylsalicylic acid (aspirin). Which of the following features of the inflammatory response is most affected by this drug? □ (A) Vasodilation □ (B) Chemotaxis □ (C) Phagocytosis □ (D) Emigration of leukocytes □ (E) Release of leukocytes from bone marrow
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (pp. 13-14). A Saunders Title. Kindle Edition. |
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6 A woman who is allergic to cats visits a neighbor who has several cats. During the visit, she inhales cat dander, and within minutes, she develops nasal congestion with abundant nasal secretions. Which of the following substances is most likely to produce these findings? □ (A) Bradykinin □ (B) Complement C5a □ (C) Histamine □ (D) Interleukin-1 □ (E) Phospholipase C □ (F) Platelet-activating factor □ (G) Tumor necrosis factor
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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7 A 32-year-old woman has had a chronic cough with fever for the past month. On physical examination, she has a temperature of 37.5°C, and on auscultation of the chest, crackles are heard in all lung fields. A chest radiograph shows many small, ill-defined nodular opacities in all lung fields. A transbronchial biopsy specimen shows interstitial infiltrates with lymphocytes, plasma cells, and epithelioid macrophages. Which of the following infectious agents is the most likely cause of this appearance?
□ (A) Staphylococcus aureus □ (B) Plasmodium falciparum □ (C) Candida albicans □ (D) Mycobacterium tuberculosis □ (E) Klebsiella pneumoniae □ (F) Cytomegalovirus
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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8 A 36-year-old man has had midepigastric abdominal pain for the past 3 months. An upper gastrointestinal endoscopy shows a 2-cm, sharply demarcated, shallow ulceration of the gastric antrum. A biopsy specimen of the ulcer base shows angiogenesis, fibrosis, and mononuclear cell infiltrates with lymphocytes, macrophages, and plasma cells. Which of the following terms best describes this pathologic process? □ (A) Acute inflammation □ (B) Serous inflammation □ (C) Granulomatous inflammation □ (D) Fibrinous inflammation □ (E) Chronic inflammation
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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9 A 5-year-old child reaches up to the stove and touches a pot of boiling soup. Within several hours, there is marked erythema of the skin of the fingers on the child's right hand, and small blisters appear on the finger pads. Which of the following terms best describes this process? □ (A) Fibrinous inflammation □ (B) Purulent inflammation □ (C) Serous inflammation □ (D) Ulceration □ (E) Granulomatous inflammation
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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10 For the past 2 days, a 41-year-old man has had a severe headache, and he now has a temperature of 39.2°C. A lumbar puncture is performed, and the cerebrospinal fluid obtained has a WBC count of 910/mm3 with 94% neutrophils and 6% lymphocytes. Which of the following substances is the most likely mediator for the fever observed in this patient? □ (A) Bradykinin □ (B) Leukotriene B4 □ (C) Histamine □ (D) Myeloperoxidase □ (E) Nitric oxide □ (F) Phospholipase C □ (G) Tumor necrosis factor
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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11 A 6-year-old child has a history of recurrent infections with pyogenic bacteria, including Staphylococcus aureus and Streptococcus pneumoniae. The infections are accompanied by a neutrophilic leukocytosis. Microscopic examination of a biopsy specimen obtained from an area of soft tissue necrosis shows microbial organisms, but very few neutrophils. An analysis of neutrophil function shows a defect in rolling. This child's increased susceptibility to infection is most likely caused by a defect in which of the following molecules? □ (A) Selectins □ (B) Integrins □ (C) Leukotriene B4 □ (D) Complement C3b □ (E) NADPH oxidase
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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12 One month after an appendectomy, a 25-year-old woman palpates a small nodule beneath the skin at the site of the healed right lower quadrant incision. The nodule is excised, and microscopic examination shows macrophages, collagen, a few small lymphocytes, and multinucleated giant cells. Polarizable, refractile material is seen in the nodule. Which of the following complications of the surgery best accounts for these findings? □ (A) Chronic inflammation □ (B) Abscess formation □ (C) Suture granuloma □ (D) Ulceration □ (E) Edema
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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13 A 3-year-old boy and other male relatives have a history of multiple recurrent infections, including Aspergillus, Staphylococcus, Serratia, Nocardia, and Pseudomonas species. Physical examination shows generalized tender lymphadenopathy. Laboratory findings show normal numbers of morphologically normal circulating WBCs. This child's increased susceptibility to infection is most likely caused by a defect in which of the following steps of the inflammatory response? □ (A) Activation of macrophages by interferon-γ □ (B) Oxygen-dependent killing of bacteria by neutrophils □ (C) Firm adhesion between leukocytes and endothelial cells □ (D) Synthesis of lysozyme in neutrophil granules □ (E) Opsonization of bacteria by immunoglobulins
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 14). A Saunders Title. Kindle Edition. |
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14 In an experiment, neutrophils collected from peripheral blood are analyzed for a “burst” of oxygen consumption. This respiratory burst is an essential step for which of the following events in an acute inflammatory response? □ (A) Increased production in bone marrow □ (B) Attachment to endothelial cells □ (C) Opsonization of bacteria □ (D) Phagocytosis of bacteria □ (E) Generation of microbicidal activity
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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15 A 20-year-old, sexually active woman experiences lower abdominal pain of 24 hours’ duration. She has no previous history of this type of pain. Her temperature is 37.9°C, and on palpation, the left lower abdomen is markedly tender. Laboratory findings include a total WBC count of 29,000/mm3 with 75% segmented neutrophils, 6% bands, 14% lymphocytes, and 5% monocytes. Laparotomy reveals a distended, fluid-filled, reddened left fallopian tube that is about to rupture. A left salpingectomy is performed. Which of the following is most likely to be seen on microscopic examination of the excised fallopian tube? □ (A) Fibroblastic proliferation □ (B) Langhans giant cells □ (C) Liquefactive necrosis □ (D) Mononuclear infiltrates □ (E) Squamous metaplasia
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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16 A 9-year-old boy has had a chronic cough and fever for the past month. A chest radiograph shows enlargement of hilar lymph nodes and bilateral pulmonary nodular interstitial infiltrates. A sputum sample contains acid-fast bacilli. A transbronchial biopsy specimen shows granulomatous inflammation within the lung, marked by the presence of Langhans giant cells. Which of the following mediators is most likely to contribute to giant cell formation? □ (A) Tumor necrosis factor □ (B) Complement C3b □ (C) Leukotriene B4 □ (D) Interferon-γ □ (E) Interleukin-1
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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17 A 5-year-old child has a history of recurrent bacterial infections, including pneumonia and otitis media. Analysis of leukocytes collected from the peripheral blood shows a deficiency in myeloperoxidase. Which of the following is the most likely cause of this child's increased susceptibility to infections? □ (A) Defective neutrophil degranulation □ (B) Defective production of prostaglandins □ (C) Failure to produce hydroxy-halide radicals (HOCl−) □ (D) Decreased oxygen consumption after phagocytosis □ (E) Failure to produce hydrogen peroxide
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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18 A 78-year-old woman experiences a sudden loss of consciousness, with loss of movement on the right side of the body. Cerebral angiography shows an occlusion of the left middle cerebral artery. To prevent further ischemic injury to the cerebral cortex, which of the following mediators would be most beneficial? □ (A) Thromboxane A2 □ (B) Bradykinin □ (C) Nitric oxide □ (D) Platelet-activating factor □ (E) Leukotriene E4
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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19 A 50-year-old man has experienced midabdominal pain for several weeks. He is afebrile. There is mild upper abdominal tenderness on palpation, and bowel sounds are present. Stool is positive for occult blood. An upper gastrointestinal endoscopy is performed, and biopsy specimens are taken. The figure shows microscopic examination of a biopsy specimen of a duodenal lesion. Which of the following terms best describes this lesion?
□ (A) Abscess □ (B) Caseating granuloma □ (C) Chronic inflammation □ (D) Purulent exudate □ (E) Serous effusion □ (F) Ulceration
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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20 A 72-year-old man with severe emphysema has had worsening right ventricular failure for the past 5 years. For the past 4 days, he has had fever and increasing dyspnea. A chest radiograph shows an accumulation of fluid in the pleural spaces. Fluid obtained by thoracentesis has a specific gravity of 1.030 and contains degenerating neutrophils. The most likely cause of this fluid accumulation is an increase in which of the following mechanisms? □ (A) Colloid osmotic pressure □ (B) Lymphatic pressure □ (C) Vascular permeability □ (D) Renal retention of sodium and water □ (E) Leukocytic diapedesis
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 15). A Saunders Title. Kindle Edition. |
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21 A 43-year-old man has had a cough and fever for the past 2 months. A chest radiograph shows bilateral nodular densities, some with calcification, located mainly in the upper lobes of the lungs. A transbronchial lung biopsy is performed, yielding a specimen with the microscopic appearance shown in the figure. Which of the following chemical mediators is most important in the pathogenesis of this lesion? □ (A) Complement C5a □ (B) Interferon-γ □ (C) Bradykinin □ (D) Nitric oxide □ (E) Prostaglandin
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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22 A 43-year-old man with a ventricular septal defect has had a cough and fever for the past 2 days. On examination, he has a temperature of 37.6°C and a cardiac murmur. A blood culture grows Streptococcus, viridans group. His erythrocyte sedimentation rate (ESR) is increased. Microbial cells are opsonized and cleared. Which of the following chemical mediators is most important in producing these findings? □ (A) Bradykinin □ (B) C-reactive protein □ (C) Interferon-γ □ (D) Nitric oxide □ (E) Prostaglandin □ (F) Tumor necrosis factor
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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23 In an experiment, peripheral blood T lymphocytes are collected and placed in a medium that preserves their function. The lymphocytes are activated by contact with antigen and incubated for several hours. The supernatant fluid is collected and is found to contain a substance that is a major stimulator of monocytes and macrophages. Which of the following substances is most likely to stimulate these cells? □ (A) Leukotriene B4 □ (B) Histamine □ (C) Interferon-γ □ (D) Interleukin-1 □ (E) Nitric oxide □ (F) Phospholipase C □ (G) Tumor necrosis factor
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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24 A 90-year-old woman is diagnosed with Staphylococcus aureus pneumonia and receives a course of antibiotic therapy. Two weeks later, she no longer has a productive cough, but she still has a temperature of 38.1°C. A chest radiograph shows a 3-cm rounded density in the right lower lobe of the lung whose liquefied contents form a central air-fluid level. There are no surrounding infiltrates. Which of the following terms best describes the outcome of the patient's pneumonia? □ (A) Complete resolution □ (B) Regeneration □ (C) Fibrosis □ (D) Abscess formation □ (E) Progression to chronic inflammation
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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25 A 30-year-old woman with a history of a congenital ventricular septal defect has had a persistent temperature of 38.6°C and headache for the past 3 weeks. A head CT scan shows an enhancing 3-cm, ring-like lesion in the right parietal lobe. Which of the following actions by inflammatory cells most likely produces this CT finding? □ (A) Formation of nitric oxide by macrophages □ (B) Production of interferon-γ by lymphocytes □ (C) Formation of transforming growth factor-β by macrophages □ (D) Generation of prostaglandin by endothelium □ (E) Release of lysosomal enzymes from neutrophils
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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26 A 35-year-old man has had increasing dyspnea for the past 24 hours. A chest radiograph shows large, bilateral pleural effusions. Thoracentesis yields 500 mL of slightly cloudy yellow fluid from the right pleural cavity. Cytologic examination of the fluid shows many neutrophils, but no lymphocytes or RBCs. Which of the following mechanisms contributes most to the accumulation of the fluid in the pleural space? □ (A) Arteriolar vasoconstriction □ (B) Neutrophil release of lysosomes □ (C) Endothelial contraction □ (D) Inhibition of platelet adherence □ (E) Lymphatic obstruction
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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27 A 12-month-old boy with a 6-month history of repeated infections has had a fever and cough for the past 3 days. A Gram stain of sputum shows many gram-positive cocci in chains. CBC shows neutrophilia. Laboratory studies show that the patient's neutrophils phagocytose and kill organisms normally in the presence of normal human serum, but not in his own serum. The neutrophils migrate normally in a chemotaxis assay. Which of the following is the most likely cause of the child's increased susceptibility to infection? □ (A) Deficiency of integrins □ (B) Neutrophil microtubular protein defect □ (C) Immunoglobulin deficiency □ (D) Defective neutrophil generation of hydrogen peroxide □ (E) Deficiency of selectins
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 16). A Saunders Title. Kindle Edition. |
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28 A 35-year-old woman takes acetylsalicylic acid (aspirin) for arthritis. Although her joint pain is reduced with this therapy, the inflammatory process continues. The aspirin therapy alleviates her pain mainly through reduction in the synthesis of which of the following mediators? □ (A) Complement C1q □ (B) Prostaglandins □ (C) Leukotriene E4 □ (D) Histamine □ (E) Nitric oxide
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 17). A Saunders Title. Kindle Edition. |
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29 A 70-year-old woman has had worsening shortness of breath for the past week. On physical examination, her temperature is 38.3°C. On percussion, there is dullness over the left lung fields. Thoracentesis yields 800 mL of cloudy yellow fluid from the left pleural cavity. Analysis of the fluid reveals a WBC count of 2500/mm3 with 98% neutrophils and 2% lymphocytes. A Gram stain of the fluid shows gram-positive cocci in clusters. Which of the following terms best describes the process occurring in the left pleural cavity? □ (A) Abscess □ (B) Chronic inflammation □ (C) Edema □ (D) Fibrinous inflammation □ (E) Purulent exudate □ (F) Serous effusion
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 17). A Saunders Title. Kindle Edition. |
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30 A 5-year-old boy has a history of recurrent infections with gram-positive bacteria, including Staphylococcus aureus. Genetic testing shows a defect leading to a lack of β2-integrin production. Which of the following abnormalities of neutrophil function is most likely responsible for these clinical symptoms? □ (A) Normal neutrophil rolling but inadequate sticking on cytokine-activated endothelial cells □ (B) Failure of neutrophils to migrate to the site of infection after leaving the vasculature □ (C) Reduced respiratory burst in neutrophils after phagocytosis of bacteria □ (D) Diminished phagocytosis of bacteria opsonized with IgG □ (E) Failure to generate hydroxy-halide radicals (HOCl−)
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 17). A Saunders Title. Kindle Edition. |
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31 An experiment isolates peripheral blood cells into a culture medium that preserves their metabolic activity. After interferon-γ is added to this culture, the cells are incubated. Next, a cell-free supernatant from this culture is added to a second culture medium containing Escherichia coli organisms. Which of the following cell types is the most likely source for observed bactericidal activity against E. coli □ (A) Basophil □ (B) B lymphocyte □ (C) CD4 lymphocyte □ (D) CD8 lymphocyte □ (E) Macrophage □ (F) Neutrophil □ (G) Natural killer cell
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 17). A Saunders Title. Kindle Edition.
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 17). A Saunders Title. Kindle Edition. |
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32 Patients with extensive endothelial injury from Escherichia coli sepsis have consumption of coagulation factors as well as an extensive inflammatory response. Administration of activated protein C decreases this inflammatory response by reducing the amount of a substance that normally binds to protease-activated receptors to trigger expression of adhesion molecules, cytokines, and chemokines. What is this substance most likely to be? □ (A) Complement □ (B) Fibrin □ (C) Kallikrein □ (D) Plasmin □ (E) Thrombin
Klatt, Edward C.; Vinay Kumar (2009-07-14). Robbins and Cotran Review of Pathology E-Book (p. 17). A Saunders Title. Kindle Edition. |
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