General Pathology Multiple choice questions (MCQ)

1. Regarding cell injury and death
a)       Initially there is a reduction in cell size during cell necrosis
b)      Apoptosis is associated with an inflammatory response
c)       Necrosis results from caspases sequestered in mitochondrial membranes
d)      Cellular swelling and fatty change indicate reversible cell injury
2. In which of the following organs is steatosis NOT seen
a)       Heart
b)      Kidney
c)       Lung
d)      Liver

3. Dystrophic calcification can occur in
a)       Coagulative necrosis
b)      Caseous necrosis
c)       Enzyme necrosis of fat
d)      All the above

4. Cholesterol and its esters are
a)       Metabolised in a loosely regulated system within cells
b)      Are seen as xanthomas within monocytes in tendons
c)       Accumulate in macrophages in the gallbladder known as cholesterosis
d)      Are seen in the media propria of the aorta in atherosclerosis

5. Progressive atrophy of the brain in later adult life is thought to be part due to
a)       Decreased workload
b)      Loss of innervation
c)       Diminished blood supply
d)      Loss of endocrine stimulation

6. Inflammation is
a)       Fundamentally a destructive response acutely
b)      Is characterised by exudation of fluid and migration of neutrophils
c)       Results in scarring thru regeneration of native parenchymal cells
d)      Is activated by Toll like receptors on microbes

7. The most common mechanism for the formation of leaky endothelium in inflammation is
a)       Endothelial retraction
b)      Direct endothelial injury
c)       Leukocyte mediated endothelial injury
d)      Endothelial cell contraction

8,Regarding mediators of inflammation
a)       Histamine is a preformed vasoactive mediator causing arteriole vasoconstriction
b)      Histamine is considered to be the principle mediatory of the immediate transient phase of increased vascular permeability
c)       Nitric oxide has dual actions in inflammation, it relaxes vascular smooth muscle and also promotes the cellular response in the inflammatory response
d)      Platelet activating factor is found unique to platelets

9. In leukocyte migration thru blood vessels in inflammation
a)       Extravasation of the leukocyte occurs in the order of: adhesion to the wall, margination and then rolling of the leucocyte across the endothelial wall.
b)      Selectins are the primary molecule who play roles with neutrophil activation
c)       Integrins are  involved in firm adhesion of the leucocyte to the cell wall
d)      Endothelial cells will take 6-12hrs before they express their selctin ( E selectin ) in inflammation

10. Regarding some inflammatory patterns
a)       When mesothelial cells of the peritoneum, pleural and pericardial linings secrete fluid it is usually of a fibrinous nature
b)      A serous exudation consists primarily of neutrophils, liquefactive necrosis and oedematous fluid
c)       When there are large vascular leaks or an associated procoagulant stimulus you commonly see a suppurative exudate
d)      Ulcers can only occur when tissue necrosis and the resultant inflammation is on or near a surface

11.In chronic inflammation, all are true except
a)       It can be caused by prolonged exposure to toxic agents
b)      It involves mononuclear inflammatory cells
c)       It may contribute to the formation of atherosclerosis
d)      It primarily involves tissue destruction

12. The complement system
a)       Most critical step is the proteolysis of the 3rd component C3 to C3a
b)      Is only involved in innate immunity reactions
c)       Causes decreased vascular permeability, chemotaxsis and opsonization of leukocytes
d)      Is a loosely controlled pathway

13, Regarding wound healing,
a)       The inflammatory response in primary healing is more intense than in secondary healing 
b)      At 1 week , the wound strength is 20% of that of unwounded skin
c)       Wound contraction is due in part to fibroblast contraction
d)      In primary union, collagen fibres appear with granulation tissue

14.The most important cause of delay of healing is
a)       Inadequate blood supply
b)      Infection
c)       Foreign body presence
d)      Poor nutritional state of the patient

15. Regarding the extracellular matrix, which is NOT CORRECT?
a)       Fibronectin in its plasma form is involved in blood clot stabilisation
b)      Laminin is the most abundant glycoprotein in the extracellular matrix
c)       Vit D is required for the hydroxylation of procollagen to collagen
d)      The cross linking of collagen is important in providing tensile strength to a wound

16. The causes of liver steatosis do not include:
a)       Alcohol abuse
b)      Protein malnutrition
c)       XI-antitrypsin deficiency
d)      CCl4

17.Regarding metastatic calcification, which of the following is not a cause?
a)       Renal failure
b)      Paget’s disease
c)       Sarcoidosis
d)      Hypoparathyroidism

18. Depletion of AtP cause all EXCEPT

a)                 efflux of Ca2+
b)      efflux of K
c)       influx of Na+
d)      decrease pH cells

19.The most common causes of fatty liver in the developed world  are
a)       Hypercholesterolaemia and lipid storage diseases
b)      Alcohol abuse and hypercholesterolaemia
c)       NAFLD and alcohol abuse
d)      NAFLD and hypercholesterolaemia

20   .Examples of intracellular accumulations of lipid do NOT include
a)       Niemann-Pick disease type C
b)      Atherosclerosis
c)       Xanthomas
d)      Amyloidosis

21. .Regardig white cell extravasation in acute inflammation which of the following pairs are incorrect
a)       P selectin: neutrophil rolling
b)      ICAM: neutrophil rolling
c)       E selectin neutrophil rolling
d)      CD34: neutrophil rolling
22.Which of the following disorders are examples of chronic leukocyte induced injury
a)       Arthritis
b)      Asthma
c)       Atherosclerosis
d)      Septic  shock

23.Leukotrienes does not mediate the following actions
a)       Vasoconstriction
b)      Chemotaxis
c)       Increased vascular permiability
d)      Vasodilatation

24.Which is NOT true regarding blood clot formation?
a)       The clot contains red cells, fibrin, fibronectin and complement
b)      Within 24 hours of injury, macrophages migrate in along the fibrin scaffold
c)       Neutrophils release proteolytic enzymes that clean out debris and bacteria
d)      Platelet adhesion and aggregation, and formation of the clot leads to inflammation

25.          Which of the following is true about formation of granulation tissue:
a)       Granulation tissue forms around day 6 from proliferation of fibroblasts and vascular endothelial cells
b)      Characteristic histological feature is presence of new small blood vessels (angiogenesis) and proliferation of fibroblasts
c)       The new vessels in angiogenesis are tight and restrict passage of plasma proteins.
d)      There is a similar amount of granulation tissue in wounds healing by both primary and secondary intention

26.          The following complications of healing are true, except:
a)       Hypertrophic scars result from accumulation of granulation tissue
b)      Keloid scars grow beyond the boundaries of the original wound and don't regress
c)       Dehiscence, common after abdominal surgery, is due to increased abdominal pressure
d)      Wounds can ulcerate because of inadequate vascularisation
27.          Which is NOT true regarding wound healing?
a)       A scar is composed of fibroblasts, collagen, elastic tissue and other ECM components.    
b)      Wound contraction is important in healing by secondary intention.
c)       The initial matrix of fibrin, fibronectin and type I collagen is ultimately replaced by type III collagen.
d)      The tensile strength after one week in an incisional surgical wound is about 10% of unwounded skin.

28. Which of the following is not an example of peripheral immunologic tolerance?
a)       Anergy
b)      Thymic deletion
c)       Suppression by regulatory T-cells
d)      Antigen sequestration

29. Regarding mitochondrial alterations, which is true?

a)       In cell hypertrophy, there is corresponding increase in mitochondrial size.
b)      Mitochondrial myopathies are associated with increased numbers of morphologically abnormal mitochondria
c)       Oncocytomas are malignant tumours consisting of cells with abundant enlarged mitochondria
d)      Hepatocytes in alcoholic liver disease assume megamitochondria -> extremely large, normally shaped mitochondria (abnormal shapes)

30.Regarding lysosomes which is incorrect?

a)       Primary lysosomes are membrane bound
b)      Contain hydrolytic enzymes
c)       Are synthesised in the smooth endoplasmic reticulum
d)      May persist in the cell as residual bodies

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