(1)--病理学期中考试试题及答案

病理学期中考试试题

一、选择题（30分）

1．Which of the following pathologic necroses would most likely be seen in pyogenic bacterial infections?

A.Caseous necrosis

B.Coagulative necrosis

C.Fat necrosis

D.Fibrinoid necrosis

E.Liquefactive necrosis

2．Histologic sections of lung tissue from a 68-year-old woman with congestive heart failure and progressive breathing problems reveal numerous hemosiderin-laden cells within the alveoli. Which of the following cells are these "heart failure cells" derived from?

A.Endothelial cells

B.Eosinophils

C.Lymphocytes

D.Macrophages

E.Pneumocytes

3．Disuse atrophy follows

A.Breakage of the duct of an exocrine gland

B.Immobilization of a joint

C.Interference with the nerve supply to the muscles controlling joint movement

D.Interference with the blood supply

E.The diminished secretion of trophic hormones

4．Hypertrophy is associated with

A.An increase in the number of visible mitoses

B.An increase in the bulk of a given tissue

C.An increase in the number of cells in an organ or tissue

D.An absolute decrease in interstitial tissue

E. Decrease in functional capacity

5．Starvation is associated with a reduction in size of the organs or tissues with the exception of:

A.Fat depots

B.Heart

C.Skeletal muscle

D.Liver

E.Bones

6．Metaplasia, the transformation of one completely differentiated tissue into another, does not occur in:

A.Connective tissue elements

B.The gastrointestinal tract

C.The central nervous system

D.The biliary system

E.The urothelium

7．Which of the following pathologic findings would most likely be seen in a left ventricle, which had undergone a severe myocardial infarction 1 month earlier?

https://www.wendangku.net/doc/bc12918033.html,plete resolution

B.Nodular regeneration

C.Coagulative necrosis

D.Fibrous scar

E.Abscess

8．After a long train trip, a 45-year-old previously healthy female is found to have swelling and tenderness of her legs. An ultrasound examination reveals findings suggestive of femoral vein thrombosis. Which of the following conditions is most likely to have contributed to this problem?

A.Pregnancy

B.Trousseau syndrome

C.Prolonged inactivity

D.Hypertension

E.Chronic renal failure

9．Which of these is the most common cause of pulmonary edema?

A.Pulmonary tuberculosis

B.Pneumonia

C.Left ventricular heart failure

D.Renal failure

E.Pulmonary embolism

10．Which is the main cause for chest pain when in pulmonary infarction?

A.Ventilatory disorder

B.Pleuritis in the infarct area

C.Stimulation of the bronchi by necrotic tissue

D.Stimulation of the bronchi by hemorrhage

E.Pulmonary infection

11．A coronary artery is shown from the autopsy of a 61-year-old patient who had acute chest pain and difficulty breathing. What is most likely to have resulted from the pathologic findings in this artery?

A.Caseous necrosis

B.Coagulative necrosis

C.Apoptosis

D.Fibrinoid necrosis

E.Liquefactive necrosis

12．Which are the main components found in the alveolar spaces during acute pulmonary congestion?

A.Heart failure cells

B.Fibrin

C.Neutrophils

D.Blood-tinged edema fluids

E.Mucus

13．Capillary channels are formed in organized thrombi,which then create conduits and interconnect with the original lumen. This process can partly restore blood flow and is called__

A.Establishment of collateral circulation

https://www.wendangku.net/doc/bc12918033.html,anization

C.Atherothrombosis

D.Recanalization

E.Propagation

14．Which kind of thrombus is completely composed of fibrin?

A.Pale thrombus

B.Mixed thrombus

C.Red thrombus

D.Hyaline thrombus

E.Mural thrombus

15．Most pulmonary thromboemoboli arise from thrombi within:

https://www.wendangku.net/doc/bc12918033.html,rge deep veins of the lower legs

B.Superficial leg veins

C.Portal vein

D.Superior mesenteric vein

E.Renal vein

16．Fat emboli are most likely be found associated with

A.Obstetric procedures

B.Chest wall injury

C.Fractures of long bones

D.Intravenous injection

E.Blood transfusion

17．Which of the following infarcts is liquefactive necrosis:

A.Pulmonary infarct

B.Spleenic infarct

C.Intestinal infarct

D.Cerebral infarct

E.Myocardial infarct

18．Which type of epithelial metaplasia is prone to occur in patients with chronic bronchitis?

A.Transitional cell metaplasia

B.Mucinous metaplasia

C.Squamous metaplasia

D.Goblet metaplasia

E.Columnar cell metaplasia

19．Which of the following is a neoplasm of mesenchymal origin?

A.Leukemia

B.Seminal cell tumor

C.Fibrosarcoma

D.Liposarcoma

E.All of the above

20．Which of the following carcinomas tends to spread via vascular invasion as opposed to lymphatic invasion?

A.Lung carcinoma

B.Renal cell carcinoma

C.Gastric carcinoma

D.Colon carcinoma

E.Nasopharyngeal carcinoma

21．Which gene is most likely to have mutation in the familial breast carcinoma?

A.Bcl2 (antiapoptosis gene)

B.Brcal (DNA repair gene)

C.EGF (epidermal growth factor gene)

D.ErbB2 (growth factor receptor gene)

E.K-ras (GTP-binding protein gene)

22．Which of the following tumors is not malignant?

A.Mesothelioma

B.Seminoma

C.Osteoma

D.Wilm’s tumor

E.Leukemia

23．Which of the following conditions is a not preneoplastic disorder?

A.Chronic atrophic gastritis

B.Chronic ulcerative colitis

C.Leukoplakia of the oral cavity

D.Thyroid adenoma

E.Papilloma of the penis

24．Which of the following features is not true in describing carcinoma in situ?

A.Dysplastic changes involve the entire thickness of the epithelium

B.It is preinvasive neoplasm

C.It is intramucosal carcinoma

D.It is early stage carcinoma

E.It does not metastastasize

25．The characteristic appearance of a neoplasm depends on which of the following?

A.Parenchyma

B.Mesenchyma

C.Metastasis

D.Atypia

E.Mitosis

26．Basal cell carcinoma is most common in which location in the elderly?

A.Hands

B.Face

C.Feet

D.Liver

E.Trunk

27． A 45-year-old man has had a fever and dry cough for 3 days, and now has difficulty breathing and a cough productive of sputum. On physical examination his temperature is 38.5℃.

Diffuse rales are auscultated over the lower lung fields. A chest radiograph shows a right pleural effusion. A right thoracentesis is performed. The fluid obtained has a cloudy appearance with a cell count showing 5500 leukocytes per microliter, 98% of which are neutrophils. Which of the following terms best describes his pleural process?

A.Serous inflammation

B.Purulent inflammation

C.Fibrinous inflammation

D.Chronic inflammation

E.Granulomatous inflammation

28．All of following are true of neutrophils except:

A.Phagocytize bacteria

B.Contain oxidases and proteases

C.First on scene after tissue injury

D.Release histamine

E.Life expectancy in tissue is around 4 days

29．The most characteristic feature of granulomatous inflammation is

A.Aggregations of epithelioid macrophages

B.Necrosis

C.Multinucleated giant cell

https://www.wendangku.net/doc/bc12918033.html,nghans’giant cells

E.Eosinophils

30．All of the following are associated with chronic inflammation except:

A.Preponderance of lymphocytes, macrophages, and plasma cells

B.Arises de novo or from acute inflammation

https://www.wendangku.net/doc/bc12918033.html,sts months to years

D.Macrophages aggregated through macrophage inhibition factor (MIF)

E.Always related to higher levels of tissue damage than seen in acute inflammation

二、名词解释（20分）

1．Hyaline degeneration

2．Lipofuscin

3．Metaplasia

4．Thrombosis

5．Infarct

6．Inflammatory polyp

7．Granuloma

8．Atypia

9．Carcinoma in situ

10．Carcinosarcoma

三、简答题（40分）

1．试述干酪样坏死的大体特点和光学显微镜下病变特点，以及病变结局。

2．何谓纤维素性炎？分别列举一个发生于浆膜、粘膜和实质脏器（如肺）的纤维素性炎，并简述其结局。

3．简述出血性梗死发生的条件。

4．简述癌与肉瘤的区别。

四、病例分析（10分）

患者，女，35岁，发现右侧乳腺包块2个月，右侧腋窝淋巴结增大2天。肿块质地较硬，边界不清。活检组织学检查图像如图1所示。图2是高倍镜下的一个视野。患者有乳腺癌家族史。

问题1、乳腺最常见的良性肿瘤和恶性肿瘤是什么？

问题2、请给出与家族性乳腺癌有关的两种基因突变。

问题3、根据图1的组织学结构，请解释为什么肿瘤比较硬？

问题4、图2箭头所指的是什么病理学结构？

问题5、患者右侧腋窝淋巴结肿大，最可能的原因是什么？

图1：右侧乳腺包块活检组织学

图2：高倍镜下的一个视野

病理学期中考试试题答案

二、名词解释

1．Hyaline degeneration：玻璃样变性，又称透明变性，是一种十分常见的变性，系指在细胞内或间质中出现均质、半透明状蛋白质蓄积。

2．Lipofuscin：脂褐素，细胞内自噬溶酶体中的细胞器碎片发生某些理化反应后，不能被溶酶体酶消化，形成一种不溶性的黄褐色残存小体。

3．Metaplasia：化生，一种分化成熟的细胞为另一种分化成熟的细胞所替代的过程。4．Thrombosis：血栓形成，在活体的心脏和血管中，血液发生凝固或血液中某些有形成分凝集形成固体质块的过程。

5．Infarct：梗死，器官或局部组织由于血管阻塞、血流停止导致缺氧而发生坏死。6．Inflammatory polyp：炎性息肉，在致炎因子长期作用下，局部粘膜上皮和腺体及肉芽组织增生而形成的突出于粘膜表面的赘生物，常带蒂。常见的炎性息肉如宫颈息肉，鼻息肉等。

7．Granuloma：肉芽肿，是指由巨噬细胞局部增生构成的境界清楚的结节状病灶。8．Atypia：异型性，肿瘤组织无论在细胞形态和组织结构上，都与其发源的正常组织有不同程度的差异，这种差异称为异型性。

9．Carcinoma in situ：原位癌，一般指粘膜上皮层内或皮肤表皮层内的非典型增生累及上皮的全层，但尚未侵破基底膜向下浸润生长。

10．Carcinosarcoma：癌肉瘤，一个肿瘤内既有癌的成分，又有肉瘤的成分。

三、简答题

1.试述干酪样坏死的大体特点和光学显微镜下病变特点，以及病变结局。

大体特点：土黄色，干燥易碎，状似干酪。

镜下特点：坏死彻底，原有组织结构消失，呈红染的颗粒状。周围可见上皮样细胞、郎罕巨细胞和其外的淋巴细胞浸润带。

病变结局：小病灶可吸收；大病灶常常被纤维结缔组织包裹，可发生钙化。

2．何谓纤维素性炎？分别列举一个发生于浆膜、粘膜和实质脏器（如肺）的纤维素性炎，并简述其结局。

纤维素性炎：以渗出物中含有大量纤维素为特征的渗出性炎症。

浆膜：纤维素性心包炎，见于风湿、结核、尿毒症等，可形成“绒毛心”，少量纤维素可溶解吸收，较多纤维素时不能完全吸收，可发生机化甚至浆膜腔粘连，形成缩窄性心包炎；纤维素性胸膜炎，常见于大叶性肺炎、结核、尿毒症等，结局同纤维素性心包炎。

粘膜：又称假膜性炎。渗出的纤维素、白细胞和坏死的粘膜组织及病原菌等在粘膜表面形成一层灰白色膜状物，称为“假膜”。如白喉，咽白喉与深部组织结合牢固，不易脱落，强行剥离可发生出血和溃疡，气管白喉与深部组织粘连不密切，易脱落阻塞气道引起窒息危险；细菌性痢疾引起大肠的假膜性炎，假膜脱落可形成溃疡。

肺：大叶性肺炎，肺泡内弥漫的纤维素性渗出。随病程进展肺泡腔内渗出的纤维素可完全被吸收，炎症痊愈，若不能完全吸收，可发生肺肉质变。

3．简述出血性梗死发生的条件。

出血性梗死的条件：1）严重淤血，当器官原有严重淤血时，血管阻塞引起的梗死为出血性梗死，如肺淤血。严重淤血是肺梗死的先决条件；2）组织疏松，肠和肺的组织较疏松，梗死初期疏松的组织间隙可容纳多量漏出的血液，当组织坏死吸收水分而膨胀时，也不能把漏出的血液挤出梗死灶外，因而梗死灶为出血性。

4.简述癌与肉瘤的区别。

四、病例分析

问题1, 答案：乳腺最常见良性肿瘤是纤维腺瘤，最常见恶性肿瘤是乳腺癌。

问题2, 答案：Brca1、Brca2、p53、PTEN

问题3, 答案：因为肿瘤间质含有丰富的胶原纤维，所以肿瘤比较硬。

问题4, 答案：病理性核分裂像。

问题5, 答案：肿瘤发生同侧腋窝淋巴结转移。