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Robbins and Cotran Pathologic Basis of Disease 9th Edition Kumar
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Test Bank For Robbins and Cotran Pathologic Basis of Disease9th Edition Kumar | 9781455726134 | All Chapters with
Answers and Rationals
A 38-year-old man has had headaches and nausea for the past 2 months. Laboratory findings show
hypercalcemia and hypophosphatemia and normal serum albumin. Urine microscopic analysis shows
deposition of calcium salts in the renal tubular epithelium. Which of the following processes has most
likely produced this change in the kidney?
Dystrophic calcification
Renal tubular atrophy
Autophagocytosis
Metastatic calcification
Cellular aging - ANSWER: Rationale: Deposition of calcium in normal healthy tissues as a result of
prolonged hypercalcemia is called metastatic calcification. This process may occur in
hyperparathyroidism. Dystrophic calcification refers to calcium deposition in injured tissues, with
normal serum calcium levels. Atrophy decreases cell size but is not accompanied by calcium
deposition. Autophagocytosis yields more golden-brown lipofuscin pigment in the cytoplasm,
particularly in hepatocytes and myocardial fibers, a process that becomes more apparent with aging.
See pages 38-39.
An experiment introduces a "knockout" gene mutation into a cell line. The frequency of cell
karyorrhexis and cytoplasmic fragmentation is increased, compared with a cell line without the
mutation. Overall survival of the mutant cell line is reduced. Which of the following genes is most
likely to be affected by this mutation?
BAX
BCL-2
C-MYC
FAS
TP53 - ANSWER: Rationale: The BCL-2 gene product inhibits cellular apoptosis by binding to Apaf-1.
The BAX gene product promotes apoptosis. The C-MYC gene is involved with oncogenesis. The FAS
gene encodes for a cellular receptor for FAS ligand, which signals apoptosis. TP53 gene activity
normally stimulates apoptosis, but mutation favors cell survival.
See pages 28-29.
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.
Which of the following chemical mediators is most important in the pathogenesis of this lesion?
Complement C5a
Interferon-γ
Bradykinin
Nitric oxide
Prostaglandin - ANSWER: Rationale: The figure shows a granuloma with many epithelioid cells and
prominent large Langhans giant cells. Macrophage stimulation and transformation to epithelioid cells
and giant cells are characteristic of granuloma formation. Interferon-γ promotes the formation of
epithelioid cells and giant cells. Complement C5a is chemotactic for neutrophils. Although occasional
neutrophils are seen in granulomas, neutrophils do not form a major component of granulomatous
inflammation. Bradykinin, released in acute inflammatory responses, results in pain. Macrophages can
release nitric oxide to destroy other cells, but nitric oxide does not stimulate macrophages to form a
granulomatous response. Prostaglandins are mainly involved in the causation of vasodilation and pain
in acute inflammatory responses.
See pages 73-74.
,A 25-year-old woman with amenorrhea has never had menarche. On physical examination, she is 145
cm (4 ft, 9 in) tall. She has a webbed neck, a broad chest, and widely spaced nipples. Strong pulses are
palpable in the upper extremities, but there are only weak pulses in the lower extremities. On an
abdominal MR imaging, the ovaries are, the ovaries are small, elongated, and tubular. Which of the
following karyotypes is most likely to be present in this patient?
45,X/46,XX
46,X,X(fra)
47,XXY
47,XXX
47,XX,+16 - ANSWER: Rationale: The features described are those of classic Turner syndrome.
Individuals who reach adulthood may have mosaic cell lines, with some 45,X cells and some 46,XX. A
female carrier of the fragile X syndrome, X(fra), is less likely to manifest the disease than a male, but
the number of triple repeat sequences (CGG) increases in her male offspring. The 47,XXY karyotype
occurs in Klinefelter syndrome; affected individuals appear as phenotypic males. The "superfemale"
karyotype (XXX) leads to mild.
See pages 165-167.
A 10-year-old boy who is mentally retarded is able to carry out activities of daily living, including
feeding and dressing himself. On physical examination, he has brachycephaly and oblique palpebral
fissures with prominent epicanthal folds. A transverse crease is seen on the palm of each hand. On
auscultation of the chest, there is a grade III/VI systolic murmur. Which of the following diseases is he
most likely to develop by age 20?
Acute leukemia
Hepatic cirrhosis
Chronic renal failure
Acute myocardial infarction
Aortic dissection - ANSWER: Rationale: This boy has Down syndrome (trisomy 21), one of the
trisomies that can result in a liveborn infant. Although children with Down syndrome can function
fairly well, they often have many associated congenital anomalies. Among the more common is
congenital heart disease, including ventricular septal defect. There is also a 10- to 20-fold increased
risk of acute leukemia. Virtually all individuals with Down syndrome who live to the age of 40 will have
evidence of Alzheimer disease. Hepatic cirrhosis is a feature of galactosemia. Chronic renal failure
may be seen in genetic disorders that produce polycystic kidneys. Myocardial infarction at a young
age suggests familial hypercholesterolemia. Aortic dissection is seen in persons with Marfan
syndrome.
A 25-year-old woman gives birth to a term infant with a right transverse palmar crease, low-set ears,
oblique palpebral fissures, and a heart murmur. The infant survives to childhood and exhibits only
mild mental retardation. Which of the following chromosomal abnormalities is most likely to be
present in this child?
Haploidy
Monosomy
Mosaicism
Tetraploidy
Triploidy - ANSWER: Rationale: These features are characteristic of trisomy 21, but the child is not
severely affected, which suggests mosaicism. In mosaic individuals, greater numbers of potentially
normal cells having the proper chromosomal complement are present, which may allow infants with
abnormalities of chromosome number to survive to term and beyond. Haploidy is present in gametes.
Loss of an autosomal chromosome is devastating; the only monosomy associated with possible
survival to term is Turner syndrome (monosomy X). Most aneuploid conditions (trisomies and
monosomies) lead to fetal demise; fetuses with trisomy 21 are the most likely to survive to term.
Triploid fetuses rarely survive beyond the second trimester and are virtually never liveborn. Likewise,
tetraploidy accounts for many first-trimester fetal losses and is not survivable.
A 30-year-old woman has had fever and arthralgia for the past 2 weeks. On physical examination, she
has a temperature of 37.6°C and an erythematous malar rash. Initial laboratory studies are positive
,for ANAs at 1:1600 and anti-double-stranded DNA antibodies at 1:3200. Serum creatinine is markedly
elevated, and serum complement levels are decreased. A VDRL test for syphilis is positive, and in vitro
tests of coagulation (prothrombin time and partial thromboplastin time) are prolonged. Which of the
following clinical features of her illness is most likely caused by antibodies that interfere with the
coagulation test?
Arthritis
Recurrent thrombosis
Rash
Renal failure
Fever - ANSWER: Rationale: This patient has clinical and serologic features of systemic lupus
erythematosus (SLE). She also has a false-positive test result for syphilis, indicating the presence of
anticardiolipin antibodies. These antibodies against phospholipid-protein complexes
(antiphospholipid antibodies) are also called lupus anticoagulants, because they interfere with in vitro
clotting tests. However, in vivo, they are thrombogenic. Hence, these patients can have recurrent
thrombosis. Lupus anticoagulants can also occur in the absence of lupus. The other listed options can
occur in SLE, but they are not mediated by antiphospholipid antibodies.
See pages 213-221.
A 37-year-old man who is HIV positive has noticed multiple 0.5- to 1.2-cm, plaque-like, reddish-purple
skin lesions on his face, trunk, and extremities. Some of the larger lesions appear to be nodular. These
lesions have appeared over the past 6 months and have slowly enlarged. Molecular analysis of the
spindle cells found in these skin lesions is likely to reveal the genome of which of the following
viruses?
Cytomegalovirus
Epstein-Barr virus
Adenovirus
Human herpesvirus-8
HIV-1 - ANSWER: Rationale: This patient has AIDS, with Kaposi sarcoma of the skin. Kaposi sarcoma is
associated with a herpesvirus agent that is sexually transmitted: human herpesvirus 8 (HHV-8), also
called the Kaposi sarcoma herpesvirus. Other herpesviruses are not involved in the pathogenesis of
Kaposi sarcoma, although infection with these viruses can occur frequently in persons with AIDS. HIV,
although present in the lymphocytes and monocytes, is not detected in the spindle cells that
proliferate in Kaposi sarcoma. With the exception of the varicella-zoster virus, which is associated
with dermatomally distributed skin vesicles known as shingles, skin lesions are not common
manifestations of herpesviruses, which include cytomegalovirus, Epstein-Barr virus, or adenovirus
infections.
See pages 246-247.
A 45-year-old woman has experienced difficulty in swallowing that has increased in severity over the
past year. She has also experienced malabsorption, demonstrated by a 5-kg weight loss in the past 6
months. She reports increasing dyspnea during this time. On physical examination, her temperature is
36.9°C, pulse 66/min, respirations 18/min, and blood pressure 145/90 mm Hg. Echocardiography
shows a large pericardial effusion. The ANA test result is positive at 1:512 with a nucleolar pattern.
Which of the following serious complications of the patient's underlying autoimmune disease is most
likely to occur?
Meningitis
Glomerulonephritis
Perforated duodenal ulcer
Adrenal failure
Malignant hypertension - ANSWER: Rationale: This patient has diffuse systemic sclerosis
(scleroderma). The small arteries of the kidney are damaged by a hyperplastic arteriolosclerosis that
can be complicated by very high blood pressure and renal failure. Meningitis and adrenal failure are
not typical features of autoimmune diseases. Glomerulonephritis is a more typical complication of
systemic lupus erythematosus. With scleroderma, the gastrointestinal tract undergoes fibrosis,
without any tendency to perforation or ulceration.
See pages 223-225.
, An epidemiologic study is conducted to determine risk factors for HIV infection. The study documents
that persons with coexisting sexually transmitted diseases such as chancroid are more likely to
become HIV positive. It is postulated that an inflamed mucosal surface is an ideal location for the
transmission of HIV during sexual intercourse. Which of the following cells in these mucosal surfaces
is most instrumental in transmitting HIV to CD4+ T lymphocytes?
CD8+ cells
Natural killer cells
Dendritic cells
Neutrophils
Plasma cells - ANSWER: Rationale: Three types of cells can carry HIV: dendritic cells, monocytes, and
CD4+ T cells. Mucosal dendritic cells (i.e., Langerhans cells) can bind to the virus and transport it to
CD4+ cells in the lymph nodes. Whether the virus is internalized by mucosal dendritic cells is not clear.
Monocytes and CD4+ T cells express CD4 and the coreceptors (CCR5 and CXCR4); therefore, HIV can
enter these cells. Follicular dendritic cells are distinct from mucosal or epithelial dendritic cells; they
trap antibody-coated HIV virions by means of their Fc receptors. The other listed cells cannot be
infected by HIV.
See pages 238-243.
A 26-year-old woman has had bouts of joint pain for the past 2 years. She also has a rash on the
cheeks and bridge of the nose. On physical examination, there is no joint swelling or deformity,
although generalized lymphadenopathy is present. Laboratory studies indicate anemia, leukopenia, a
polyclonal gammopathy, and proteinuria. The serum ANA test result is positive at a titer of 1:1024
with a rim pattern identified by immunofluorescence. The light microscopic and immunofluorescent
(with antibody to IgG) appearances of a skin biopsy are shown. Which of the following is the best
information to give this patient about her disease?
Blindness is likely to occur within 5 years
Avoid exposure to cold environments
Joint deformities will eventually occur
Chronic renal failure is likely to occur
Cardiac valve replacement will eventually be required - ANSWER: Rationale: This patient has systemic
lupus erythematosus (SLE). Many persons with SLE have glomerulonephritis and eventually develop
renal failure. Blindness is uncommon in SLE. Raynaud phenomenon is associated with many
autoimmune diseases, but it is most troublesome in scleroderma. Although synovial inflammation is
common in SLE, joint deformity is rare. The Libman-Sacks endocarditis associated with SLE tends to be
nondeforming and limited, and there is minimal valve damage. It is now uncommon, because of the
use of corticosteroid therapy in the treatment of SLE.
See pages 213-221.
A 9-month-old child has a history of recurrent infections with multiple agents, including
cytomegalovirus, Candida albicans, Staphylococcus aureus, and Staphylococcus epidermidis. A careful
family history and pedigree analysis show this to be a genetic disorder that is inherited in an
autosomal recessive pattern. Which of the following laboratory studies is likely to be most useful in
establishing the underlying mechanism of immunodeficiency in this infant?
Quantitative serum immunoglobulin levels
Enumeration of B cells in blood
Enumeration of CD3+ cells in blood
Tests of neutrophil function
Adenosine deaminase levels in leukocytes - ANSWER: Rationale: This patient is susceptible to
bacterial, fungal, and viral infections and most likely has severe combined immunodeficiency (SCID).
The autosomal recessive pattern of inheritance implicates adenosine deaminase (ADA) deficiency
rather than mutations in the γ chain of cytokine receptors. Low ADA levels in the leukocytes are
diagnostic. The other listed options are relevant to the workup of primary immunodeficiencies, but
they are not specific to SCID.
See pages 234-235.
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