Robbins And Cotran Pathologic Basis Of Disease 9th Edition By Kumar – Abbas – Test Bank



Sample  Questions


Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition


Chapter 03: Inflammation and Repair


Test Bank





  1. Transmembrane adhesive heterodimeric proteins, composed of an a and a ß chain, are expressed on activated leukocytes during inflammation. They bind primarily to intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), both of which belong to the family of proteins known as
  2. selectins
  3. integrins
  4. immunoglobulins
  5. lectins
  6. growth factors


ANS: C, Surface proteins expressed on activated leukocytes are integrins, and they bind to intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), which belong to the immunoglobulin family of proteins.


  1. Which of the following mediators of inflammation has chemotactic properties and is increased in persons taking aspirin?
  2. Thromboxane A2
  3. Prostaglandin E2
  4. Platelet-activating factor
  5. Leukotriene B4
  6. Interleukin-1


ANS: D, Leukotriene B4 is chemotactic. It is increased in persons who take aspirin, because aspirin inhibits the cyclooxygenase pathway, thus shunting more arachidonic acid early derivatives into the lipoxygenase pathway. This promotes the synthesis of leukotrienes.


  1. A 2-year-old child known to suffer from recurrent bacterial infections and poor wound healing was found to have leukocyte adhesion molecule deficiency 1 (LAD-1). The leukocytes of this patient do not express CD18, a molecule classified as belonging to the family of
  2. selectins
  3. integrins
  4. lectin type of vascular adhesion molecules
  5. aminotransferases
  6. glycosidases



ANS: B, LAD-1 is characterized by a deficiency of CD18, a cell surface molecule that is a ß2 integrin. The infections occur because the defective leukocytes cannot adhere to endothelial cells, cannot spread and attach, and cannot phagocytose bacteria. PBD7 62


  1. Bradykinin is produced from a high-molecular weight kininogen circulating in the blood. This reaction is mediated by
  2. coagulation factor X
  3. kallikrein
  4. Hageman factor
  5. complement C3
  6. protein C


ANS: B, Kallikrein promotes the formation of bradykinin from the high-molecular weight kininogen. PBD7 67


  1. Nitric oxide synthesis is augmented in endothelial cells by a calmodulin-mediated influx of which element?
  2. Calcium
  3. Sodium
  4. Potassium
  5. Oxygen
  6. Nitrate


ANS: A, Endothelial cell nitric oxide synthase is constitutively expressed at low levels, but it can be increased by a calmodulin-mediated influx of calcium into the endothelial cells. PBD7 72


  1. Which of the following mediators of inflammation causes pain?
  2. Nitric oxide
  3. Complement C3a
  4. Bradykinin
  5. Leukotriene B4
  6. Interleukin-1


ANS: C, Bradykinin causes pain. Other pain-causing substances are substance P and prostaglandin E2. PBD7 65


  1. Aspirin lowers the body temperature by inhibiting the synthesis of which regulator of the central thermostat in the hypothalamus?
  2. Leukotriene B4
  3. Lipoxin
  4. Thromboxane A2
  5. Prostacyclin
  6. Prostaglandin E2


ANS: E, Aspirin inhibits the action of cyclooxygenase, and thus inhibits the synthesis of thromboxane A2, prostacyclin, and prostaglandin E2. However, only prostaglandin E2 is involved in thermoregulation. The synthesis of lipoxin and leukotrienes is not inhibited by aspirin. PBD7 70


  1. C-reactive protein binds to the surface of microbes in tissues acting as a(n)
  2. caspase
  3. peroxidase
  4. opsonin
  5. anaphylatoxin
  6. membrane attack protein


ANS: C, C-reactive protein, an acute phase protein produced by the liver in acute and chronic inflammation, binds to microbes acting as an opsonin. Opsonization of bacteria facilitates phagocytosis.


  1. Fibrillin is important for the scaffolding and deposition of which other component of the extracellular matrix?
  2. Collagen type I
  3. Collagen type III
  4. Elastic fibers
  5. Fibronectin
  6. Laminin


ANS: C,  Fibrillin, a 350 kD glycoprotein, is part of the microfibrils that are important for the scaffolding and deposition of elastic fibers. A congenital defect of fibrillin, as seen in patients with Marfan syndrome, is associated with reduced elasticity of arteries and formation of aneurysms.


  1. Which growth factor is the most potent promotor of angiogenesis in the granulation tissue?
  2. Angiotensin
  3. Platelet-derived growth factor
  4. Tumor growth factor ß
  5. Vascular endothelial growth factor
  6. Epidermal growth factor


ANS: D, Vascular endothelial growth factor (VEGF) is the most important promotor of angiogenesis in the granulation tissue.


  1. A 20-year-old woman suffered extensive burns and developed large irregular scars over her hands. These scars limited the movement of her fingers, and she was unable to fully extend them. What are these lesions called?
  2. Contractures
  3. Desmoids
  4. Aggressive fibromatoses
  5. Keloids
  6. Wound dehiscences


ANS: A, Contractures are extensive scars overlying the joints that limit movements and cause permanent flexure.

Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition


Chapter 11: Blood Vessels


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  1. Arterial hypertension of Cushing syndrome is associated with
  2. elevation of serum renin
  3. elevation of angiotensin in blood
  4. potassium retention in the kidneys
  5. reduced sodium excretion in urine
  6. increased diuresis


ANS: D, Cushing syndrome is associated with steroid-mediated retention of sodium in the kidneys and consequent reduced sodium excretion in the urine. Renin and angiotensin are not involved, and their concentration in serum is not changed.


  1. Antineutrophil cytoplasmic antibodies showing widespread cytoplasmic staining of neutrophils in an indirect immunofluorescence test (c-ANCA) are found in high titers in which disease?
  2. Microscopic polyangiitis
  3. Wegener granulomatosis
  4. Churg-Strauss syndrome
  5. Goodpasture syndrome
  6. Kawasaki syndrome


ANS: B, Wegener granulomatosis is typically associated with high titers of c-ANCA. p-ANCA is found in microscopic polyangiitis or Churg-Strauss syndrome.


  1. Which of the following is the most common form of vasculitis in the elderly?
  2. Temporal (giant cell) arteritis
  3. Takayasu arteritis
  4. Kawasaki disease
  5. Churg-Strauss syndrome
  6. Henoch-Schönlein purpura


ANS: A, Temporal arteritis is a granulomatous arteritis affecting temporal arteries and other arteries of the head in persons over the age of 50 years. Approximately 10% of all persons older than 80 years of age have this disease.



  1. “Pulseless disease” associated with giant cell granulomatous inflammation of the aorta and its major branches arising from the arch of the aorta are features of
  2. temporal (giant cell) arteritis
  3. Takayasu arteritis
  4. Kawasaki disease
  5. Churg-Strauss syndrome
  6. Henoch-Schönlein purpura


ANS: B, Takayasu arteritis, a giant cell inflammation, involves the aorta and its major branches, causing narrowing of the arteries; hence, its nickname “pulseless disease.”


  1. Which type of vasculitis is typically associated with bronchial asthma?
  2. Temporal (giant cell) arteritis
  3. Takayasu arteritis
  4. Kawasaki disease
  5. Churg-Strauss syndrome
  6. Henoch-Schönlein purpura


ANS: D, Churg-Strauss syndrome includes changes similar to polyarteritis nodosa, microscopic polyangiitis, bronchial asthma, and eosinophilia. Most patients have p-ANCA antibodies.


  1. Aneurysms caused by weakening or destruction of the arterial wall by bacteria are called
  2. berry aneurysms
  3. fusiform aneurysms
  4. saccular aneurysms
  5. mycotic aneurysms
  6. cirsoid aneurysms


ANS: D, Mycotic aneurysms are a consequence of bacterial infection that weakens the wall of the artery.


Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th Edition


Chapter 17: The GI Tract


Test Bank





  1. Esophageal diverticulum located above the upper esophageal sphincter is called
  2. congenital diverticulum
  3. postinflammatory diverticulum
  4. traction diverticulum
  5. epiphrenic diverticulum
  6. Zenker diverticulum


ANS: E, Zenker diverticulum is typically located above the upper esophageal sphincter.


  1. Basal zone hyperplasia exceeding 20% of the thickness of the esophageal epithelium, accompanied by elongation of lamina propria papillae and by inflammatory infiltrates that contain eosinophils is a histologic finding most typical of which disease?
  2. Reflux esophagitis
  3. Viral esophagitis
  4. Barrett esophagus
  5. Mallory-Weiss syndrome
  6. Boerhaave syndrome


ANS: A, These histologic findings are typically found in reflux esophagitis.


  1. Carcinoma of the esophagus most often presents on gross examination as a
  2. polypoid exophytic lesion
  3. flat induration of the mucosa
  4. volcano-like excavated lesion
  5. diffuse narrowing of the esophageal lumen
  6. linitis plastica


ANS: A, Esophageal cancer presents most often (in 60% of cases) as a protruding, exophytic polypoid tumor. Flat lesions are found in 15% of cases and excavated lesions in 25% of all cases.


  1. Autoimmune atrophic gastritis and pernicious anemia are most often associated with
  2. Helicobacter pylori infection
  3. peptic ulceration of the duodenum
  4. Ménétrier disease
  5. Hashimoto thyroiditis
  6. trichobezoars


ANS: D, Autoimmune atrophic gastritis is an autoimmune disease, and it may be associated with other autoimmune diseases, such as Hashimoto thyroiditis.


  1. Protein-losing gastroenteropathy will most likely develop in patients who have
  2. acute erosive gastritis
  3. chronic Helicobacter pylori-related gastritis
  4. autoimmune atrophic gastritis
  5. hypertrophic gastropathy
  6. gastric peptic ulcer


ANS: D, Hypertrophic gastropathy may be associated with extensive protein loss that may cause hypoalbuminemia and even generalized edema.


  1. Most gastric polyps are microscopically classified as
  2. tubular adenomas
  3. villous adenomas
  4. hyperplastic polyps
  5. fundic gland polyps
  6. carcinoids


ANS: C, In 90% of cases, gastric polyps are non-neoplastic and are microscopically classified as hyperplastic polyps.


  1. Nonbacterial gastroenteritis in adults presenting with nausea, vomiting, watery diarrhea, and abdominal pain in most instances is caused by
  2. astrovirus
  3. Norwalk virus
  4. rotavirus
  5. enteric adenovirus
  6. poliovirus


ANS: B, Norwalk virus is responsible for most viral gastrointestinal infections in adults.


  1. The finding of anti-endomysial antibodies in a person with intestinal malabsorption strongly favors the diagnosis of
  2. Whipple disease
  3. celiac sprue
  4. tropical sprue
  5. lactase deficiency
  6. abetalipoproteinemia


ANS: B, Anti-endomysial and anti-gliadin antibodies strongly suggest a malabsorption syndrome that is caused by celiac sprue.


  1. Which intestinal malabsorption syndrome is accompanied by a complete absence of chylomicrons, very-low-density lipoproteins, and low-density lipoproteins in plasma?
  2. Crohn disease
  3. Celiac sprue
  4. Tropical sprue
  5. Lactase deficiency
  6. Abetalipoproteinemia


ANS: E, Abetalipoproteinemia is an inborn error of metabolism characterized by an inability to produce apolipoprotein B. Accordingly, all lipoproteins that contain apoprotein B are absent from the plasma.


  1. Crohn disease is most often diagnosed in which age group?
  2. 5-10 years
  3. 15-25 years
  4. 40-50 years
  5. 60-70 years
  6. Older than 80 years


ANS: B, Crohn disease can occur at any age, but most often it is diagnosed in the second and third decade (i.e., between 15 and 25 years of age).


  1. Angiodysplasia causing lower intestinal bleeding is most often located in the
  2. jejunum
  3. ileum
  4. cecum
  5. transverse colon
  6. rectum


ANS: C, Angiodysplasia is most often located in the cecum, probably because the cecum has the widest diameter. The mechanism of formation of angiodysplastic lesions is not known. It is thought that the cecum, as the most dilated part of the colon, generates the highest pressure on intramural blood vessels, thus causing their tortuosity and dilatation that predisposes to rupture.


  1. In adults, which part of the intestine is most often involved in volvulus?
  2. Jejunum
  3. Ileum
  4. Cecum
  5. Transverse colon
  6. Sigmoid colon


ANS: E, Volvulus (i.e., torsion of the intestinal loops around the mesentery) occurs most often in the sigmoid colon.



  1. Polyps of Peutz-Jeghers syndrome are best classified as
  2. serrated adenomas
  3. hyperplastic polyps
  4. tubular adenoma
  5. villous adenomas
  6. hamartomas


ANS: E, Polyps of Peutz-Jeghers syndrome are hamartomas, composed of branching fibromuscular network enclosing glands lined by normal intestinal epithelium with numerous goblet cells.


  1. Which cells in the intestines are the precursors of carcinoids?
  2. Goblet cells
  3. Enterocytes
  4. Paneth cells
  5. Neuroendocrine cells
  6. Stromal cells


ANS: D, Carcinoids originate from resident neuroendocrine intestinal cells.


  1. T-cell lymphoma was diagnosed in a 55-year-old man who had a lengthy history of intestinal disease. Which of the following diseases most likely preceded this malignancy?
  2. Celiac disease
  3. Whipple disease
  4. Crohn disease
  5. Abetalipoproteinemia
  6. AIDS


ANS: A, Most likely this man had celiac sprue, a disease associated with a disproportionately high incidence of T-cell lymphomas.


  1. A 60-year-old man who complained of persistent right lower quadrant pain underwent an appendectomy. The appendix appeared globular and dilated due to an obstruction by a fecalith. It was filled with mucus. Histologically, the cavity was lined with normal appendiceal mucosa; there was no evidence of neoplasia. This lesion most likely represents a
  2. mucocele
  3. mucinous cystadenoma
  4. mucinous cystadenocarcinoma
  5. pseudomyxoma peritonei
  6. pseudocyst


ANS: A, A mucocele is a dilatation of the appendix in which the lumen of the appendix is filled with mucus. It results from an obstruction of the appendix by a fecalith or chronic inflammation, and less often by tumors.



  1. Primary tumors of the peritoneum are called
  2. adenocarcinomatosis peritonei
  3. pseudomyxoma peritonei
  4. peritoneal sarcoma
  5. mesothelioma
  6. myxomatosis


ANS: D, Malignant tumors of the peritoneum are called mesotheliomas. Histologically, they are indistinguishable from mesotheliomas of the pleural cavity.


  1. This esophageal carcinoma developed in a 65-year-old man who had reflux esophagitis for 15 years. Most likely this tumor was histologically classified as



  1. adenocarcinoma
  2. squamous cell carcinoma
  3. transitional cell carcinoma
  4. basal cell carcinoma
  5. oat cell carcinoma


ANS: A, The squamo-columnar line in this esophagus is a few centimeters above the normal gastroesophageal junction, suggesting that the terminal esophagus has undergone metaplasia into a Barrett esophagus. Tumors originating in Barrett esophagus are typically adenocarcinomas.


  1. This slide shows the muscle layer of a stomach that was removed from a 60-year-old man who complained of dyspepsia and bleeding. The tissue section was taken from the muscle underneath a large prepyloric ulcer. Which of the following is the most likely diagnosis?



  1. Peptic ulcer disease
  2. Helicobacter pylori-related gastritis
  3. Autoimmune gastritis
  4. Hyperplastic gastropathy
  5. Adenocarcinoma


ANS: E, The muscle layer of this stomach is infiltrated with adenocarcinoma cells forming irregular tubular and gland-like structures.


  1. This figure shows a portion of the mesentery and omentum removed during a work-up of a 60-year-old woman with ascites and large multicystic ovarian masses. The lesions seen here are most consistent with the diagnosis of



  1. primary peritoneal benign tumor
  2. primary peritoneal malignant tumor
  3. metastatic carcinoma
  4. metastatic sarcoma
  5. lymphoma


ANS: C, The white nodules in the omentum most likely represent metastases of an ovarian carcinoma. The ovarian masses, described above, most likely represent ovarian carcinoma, which is often bilateral and typically metastasizes by seeding through the peritoneal cavity.


  1. This small intestinal lesion was removed from a 56-year-old woman and is most likely a



  1. tubular adenoma
  2. hamartoma
  3. carcinoma
  4. sarcoma
  5. pseudopolyp


ANS: C, This large partially exophytic and partially ulcerated necrotic lesion most likely represents an adenocarcinoma. Although adenocarcinomas are uncommon in the small intestine, they are nevertheless more common than sarcomas. The tumor is too large and too irregular and necrotic to be benign.


  1. This slide illustrates the lesions seen in the partial colectomy specimen obtained from a 78-year-old man who has chronic constipation, left lower quadrant pain, and fever. On cross section, this sigmoid colon shows changes most consistent with the diagnosis of



  1. Crohn disease
  2. toxic megacolon
  3. carcinoma of the colon
  4. carcinoid
  5. diverticulitis


ANS: E, The cross section through this sigmoid colon shows the outpouchings typical of diverticulosis. Because the diverticula are surrounded by collars of fibrous tissue, it can be assumed that there is pericolonic inflammation, which originates in the diverticula. The disease thus is best classified as diverticulitis.