EMQs lor

Medical Students
Volume 1
Second Edition
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Contents
I|s| o| con|t|bu|ots v|
Ite|ece v||
ln|toduc||on |x
Clossety x|
!otmel velues xv
Sel|essessmen| IM Iepets xv|||
Chupter l Ceneru Puthoogy 3
Chupter 2 Heud und Neck 27
Chupter 3 Neuroogy und Psychutry 4l
Chupter 4 Curdovuscuur und Huemutoogy 75
Chupter 5 Resprutory l07
Chupter 6 Ceneru l3l
Chupter 7 Rudoogy l45
Answers l63
lndex 278
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1
CHAPTER
General Patholog
1. PathoIogicaI proccsscs
2. CcIIs of thc immunc systcm
3. Componcnts of antigcns and antibodics
4. Tcchniqucs in moIccuIar mcdicinc
S. Typcs of infIammation
6. Mcdiators of acutc infIammation
7. lnfcctious discascs
8. BactcriaI infcctions
9. Pathogcnic viruscs
10. Typcs of amyIoid protcin
11. Typcs of cpithcIium
12. FnvironmcntaI carcinogcns
13. ViraI and microbiaI carcinogcns
14. Gcnc abnormaIitics in ncopIasia
1S. NcopIasms
16. Fponymous ccIIs
17. Vitamin dcficicncy
18. ActioIogy of aIimcntary tract ncopIasms
19. Primary sitc of mctastatic tumours
20. PathoIogicaI conditions of thc fcmaIc gcnitaI tract
21. PathoIogicaI Icsions in thc brain
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1. THEME: PATHOLOGlCAL PROCESSES
A Apoptoss
B Atrophy
C Dyspusu
D Lmbosm
F lbross
F Hyperpusu
G Hypertrophy
H lnlurcton
l Metupusu
] Metustuss
k Necross
l 1hromboss
Iot eech o| |he pe||en|s l|s|ed belov choose |he mos| epptopt|e|e pe|holog|cel ptocess
|tom |he ebove l|s|. Iech ||em mey be used once, mote |hen once ot no| e| ell.
1. A 45-yeur-od mun presents wth ucd heurtburn'. An endoscopy s perlormed
ut whch the ower oesophugeu mucosu uppeurs red und vevety. A bopsy
tuken lrom ths ureu shows gunduur eptheum.

2. A 75-yeur-od mun presents wth symptoms ol urnury outlow obstructon.

lnvestgutons show un enurged prostute gund.

3. A 2l-yeur-od womun sustuns u lructured elt lemur n u roud trullc uccdent

(R1A). She requres tructon und s bed-bound lor severu weeks. Cn removu ol
the tructon, the elt eg s weuk und the elt quudrceps s vsby wusted.

4. A 32-yeur-od womun who s tukng the oru contruceptve p bourds u lght

lrom London to Sun lruncsco. Cn urrvu, her rght eg lees uncomlortube.
1he loowng duy her rght cul s swoen und tender.

S. A 40-yeur-od womun hus u cervcu bopsy loowng un ubnormu cervcu

smeur. 1he bopsy shows uck ol muturuton throughout the whoe thckness ol
the eptheum.

6. A 65-yeur-od mun wth ong-stundng hypertenson deveops curduc luure. A

chest rudogruph shows enurgement ol the heurt und un echocurdogrum
shows u thckened elt ventrcuur lree wu.

G E N E R A L P AT H L G Y
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2. THEME: CELLS OF THE lMMUNE SYSTEM
A Cytotoxc 1 ymphocyte
B Dendrtc ce
C Heper 1 ymphocyte
D Lungerhuns' ce
F Mucrophuge
F Must ce
G Memory ce
H Nuturu ker ce
l Pusmu ce
] Stem ce
k Vrgn ymphocyte
l Vrgn 1 ymphocyte
Iot eech o| |he desct|p||ons belov, selec| |he cell |ype |tom |he ebove l|s|. Iech cell mey be
used once, mote |hen once ot no| e| ell.
1. An untbody-producng ce wth un eccentrc nuceus, u cock luce' puttern ol
nuceur chromutn und u pernuceur huo.

2. An untgen-presentng ce thut s mportunt n determnng the response to

untgen by vrgn 1 ymphocytes.

3. A ce beurng CD3 und CD4 moecues on ts surluce.

4. A phugocytc ce contunng ysozyme.

S. A ce beurng CD8 thut recognses processed untgen n ussocuton wth cuss

l muor hstocomputbty compex (MHC) moecues.

6. A type ol ymphocyte thut beurs CD56 on ts surluce und cun uttuck tumour
ces und vruy nlected ces wthout the need lor pror senstsuton.

E M Q s F R M E D l C A L S T L D E N T S - V L L M E 1
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3. THEME: COMPONENTS OF ANTlGENS AND
ANTlBODlES
A Lptope
B lub lrugment
C lc lrugment
D Hupten
F Heuvy chun
F HLA
G lgA
H lgL
l lgC
] Lght chun
k Superuntgen
l Vurube regon
Iot eech o| |he desct|p||ons belov, choose |he componen| o| en||gen ot en||body |tom |he
ebove l|s|. Iech ||em mey be used once, mote |hen once ot no| e| ell.
1. 1he purt ol un untgen thut bnds to un untbody.

2. 1he purt ol un mmunogobun moecue thut s responsbe lor untgen

bndng.

3. An mmunogobun nvoved n must-ce degrunuuton.

4. A moecue thut must bnd to u currer proten belore t cun ect un mmune
response.

S. A group ol moecues, coded lor on chromosome 6, whch s responsbe lor

reecton reuctons.

6. An untgen thut cun uctvute 1 ymphocytes wthout beng processed by

untgen-presentng ces.

G E N E R A L P AT H L G Y
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4. THEME: TECHNlQUES lN MOLECULAR MEDlClNE
A DNA lngerprntng
B DNA sequencng
C Hybrdsuton
D Lnkuge unuyss
F Northern bottng
F Poymeruse chun reucton (PCR)
G Southern bottng
H 1runslecton
l 1runslormuton
] \estern bottng
Jhe |ollov|ng ete ell bt|e| desct|p||ons o| common moleculet |echn|ques used |n med|cel
teseetch. Ileese selec| |he |echn|que |he| bes| |||s eech desct|p||on |tom |he ebove l|s|.
Iech |echn|que mey be used once, mote |hen once ot no| e| ell.
1. 1he nserton ol u gene or genes nto mummuun ces.

2. A term used lor the n-vtro lormuton ol buse purs between nucec ucds. lt s
usuuy used to probe lor the presence ol u speclc sequence ol DNA or RNA.

3. A method ol sepurutng und detectng protens usng u denuturng sodum

dodecy suphute (SDS)/poyucryumde ge.

4. An n-vtro technque desgned to soute und umply smu, speclc segments

ol DNA between l0
5
und l0
8
buse purs lrom nsgnlcunt quunttes ol
tempute (ess thun l mg) n u short spuce ol tme.

S. A method used to nvestgute the possbty thut u gene ol nterest s cose to,
und therelore olten nherted wth, u known genetc murker.

E M Q s F R M E D l C A L S T L D E N T S - V L L M E 1
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5. THEME: TYPES OF lNFLAMMATlON
A Acute suppurutve
B usoph-rch
C Cuseutng grunuomutous
D Chronc
F Losnoph-rch
F lbrnous
G Hstocytc
H Non-cuseutng grunuomutous
Iot eech d|seese l|s|ed belov, pleese selec| |he |ype o| |n|lemme||on chetec|et|s||c o| |he
d|seese |tom |he ebove l|s|. Iech |ype mey be used once, mote |hen once ot no| e| ell.
1. 1ubercuoss.

2. Hel|cobec|et pylot|-ussocuted gustrts.

3. Rheumutc percurdts.

4. Surcodoss.

S. ucteru menngts.

6. Hookworm nlecton.

G E N E R A L P AT H L G Y
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6. THEME: MEDlATORS OF ACUTE lNFLAMMATlON
A Aruchdonc ucd
B C3b
C L-seectn
D luctor Xll
F Hstumne
F lnterceuur ce udheson moecue l (lCAM-l)
G lnterleron-
H lntereukn l (lL-l)
l Lysozyme
] Pusmnogen uctvutor
k Prostugundn L
2
l Superoxde unon
Iot eech o| |he desct|p||ons belov, selec| |he cottec| |n|lemme|oty med|e|ot |tom |he
ebove l|s|. Iech med|e|ot mey be used once, mote |hen once ot no| e| ell.
1. A substunce nvoved n the opsonsuton ol bucteru.

2. A substunce reeused lrom must ces thut euds to ncreused vuscuur

permeubty.

3. A moecue mportunt n oxygen-dependent bucteru kng.

4. A member ol the mmunogobun gene superlumy expressed on endotheu

ces.

S. A mutlunctonu peptde thut nduces expresson ol udheson moecues on

vuscuur endotheum und ucts us un endogenous pyrogen.

6. An enzyme thut uttucks the ce wu ol some bucteru speces.

E M Q s F R M E D l C A L S T L D E N T S - V L L M E 1
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7. THEME: lNFECTlOUS DlSEASES
A Actnomycoss
B Amoebuss
C Aspergoss
D Cundduss
F Cryptospordoss
F lucpurum muuru
G Curduss
H Leshmunuss
l Ineumocys||s pneumonu
] Schstosomuss
k Strongyoduss
l 1oxopusmoss
Iot eech o| |he pe||en|s belov, selec| |he mos| l|lely d|seese |tom |he ebove l|s|. Iech
d|seese mey be used once, mote |hen once ot no| e| ell.
1. A 35-yeur-od mun presents wth ubdomnu pun und boody durrhoeu l
month ulter returnng lrom hoduy n lndu. Coonoscopy shows mutpe lusk-
shuped ucers throughout the coon. opsy ol the uceruted ureus shows
perodc ucdSchll (PAS-)postve trophozotes wth ngested red ces n the
ucer sough.

2. A buby presents soon ulter brth wth uundce und un enurged ver. He s uso
lound to huve hydrocephuus und chorodoretnts. A sku rudogruph shows
loc ol cuclcuton.

3. A 35-yeur-od womun who s recevng chemotherupy lor hgh-grude

ymphomu deveops shortness ol breuth, uccompuned by u dry cough. 1he
chest rudogruph shows buteru retcuonoduur shudowng. Sputum cuture s
negutve. 1runsbronchu bopsy shows uveo led wth u loumy eosnophc
muteru und numerous bout-shuped orgunsms thut stun postvey wth u
sver stun.

4. A 48-yeur-od Lgyptun mun presents wth u 6-month hstory ol huemuturu.

Cystoscopy shows u poypod muss n the budder. opsy ol the muss shows
grunuomutous chronc nlummuton uround custers ol puruste ovu.

S. A 30-yeur-od Lngsh ournust who s workng n Alrcu deveops lever und

rgors. Cn exumnuton, she hus heputospenomeguy. Lxumnuton ol u bood
lm shows purustsed red bood ces.

6. A 32-yeur-od mun wth ucqured mmunodelcency syndrome (AlDS) presents

wth u 2-week hstory ol dysphugu. Lndoscopy shows whte puques on the
oesophugeu mucosu. opsy ol the puques shows lungu hyphue und yeust
lorms on the mucosu surluce.

G E N E R A L P AT H L G Y
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8. THEME: BACTERlAL lNFECTlONS
A Cempylobec|et jejun|
B Chlemyd|e |techome||s
C Clos|t|d|um d||||c|le
D Clos|t|d|um pet|t|ngens
F Ischet|ch|e col|
F Heemoph|lus |n|luenzee
G I|s|et|e monocy|ogenes
H !e|sset|e men|ng|||d|s
l Selmonelle |yph|
] S|ephylococcus euteus
k S|tep|ococcus pneumon|ee
l S|tep|ococcus pyogenes
Jhe pe||en|s belov heve ell ptesen|ed v||h |n|ec||ons. Selec| |he bec|et|um vh|ch |s |he
mos| l|lely ceuse |tom |he ebove l|s|. Iech otgen|sm mey be used once, mote |hen once ot
no| e| ell.
1. A 2l-yeur-od medcu student presents wth u l2-hour hstory ol severe
heuduche, photophobu und pyrexu. Cncu exumnuton shows u petechu
rush over the trunk. Anuyss ol the cerebrospnu lud (CSl) shows numerous
neutrophs und Crum-negutve cocc.

2. A 32-yeur-od womun presents wth u 2-duy hstory ol dysuru und lrequency. A

Crum stun ol u mdstreum urne specmen shows neutrophs, erythrocytes und
Crum-negutve buc. Lrne cuture shows >l0
5
orgunsms per m. 1he
coones ure uctose-lermentng.

3. An 84-yeur-od mun beng treuted lor u chest nlecton n u cure-ol-the-edery

wurd deveops ncreusngy severe durrhoeu. Sgmodoscopy shows whte
puques on the mucosu surluce. luecu unuyss soutes u toxn thut s
cytoputhc n ce cuture.

4. A 57-yeur-od vugrunt womun presents wth u l-week hstory ol productve

cough, pyrexu und worsenng shortness ol breuth. A chest rudogruph shows
consoduton ol the elt ower obe. A Crum stun ol the sputum shows muny
neutrophs und Crum-postve dpococc. Sputum cuture shows
-huemoytc, druughtsmun-shuped coones.

S. A 32-yeur-od mun deveops u wound nlecton ulter u rght hemcoectomy lor

Crohn`s dseuse. A Crum stun ol the exuded pus shows custers ol Crum-
postve cocc. Cuture shows couguuse-postve goden-yeow coones.

6. A 45-yeur-od womun deveops durrhoeu und ubdomnu pun 2 duys ulter

eutng lred chcken n u restuurunt. A Crum stun ol the lueces shows Crum-
negutve, mote, spru-shuped rods. luecu cuture reveus oxduse-postve
coones.

E M Q s F R M E D l C A L S T L D E N T S - V L L M E 1
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9. THEME: PATHOGENlC VlRUSES
A Coxsuckevrus
B Cytomeguovrus
C Lpstenurr vrus
D Heputts C vrus
F Herpes smpex vrus type 2
F Herpes zoster vrus
G Humun pupomuvrus
H Meuses vrus
l Purunluenzu vrus
] Purvovrus
k Rhnovrus
l Rotuvrus
Iot eech d|seese l|s|ed belov, selec| |he v|tus mos| l|lely |o ceuse |he d|seese. Iech v|tus
mey be used once, mote |hen once ot no| e| ell.
1. Centu wurts.

2. lnlectous mononuceoss.

3. Croup.

4. Aseptc menngts.

S. Durrhoeu n chdren.

6. Subucute scerosng punencephuts.

G E N E R A L P AT H L G Y
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10. THEME: TYPES OF AMYLOlD PROTElN
A AA umyod
B AL umyod
C Atru nutruretc luctor
D Amyod proten
F
2
-Mcrogobun
F Cuctonn
G lset umyod poypeptde
H 1runsthyretn
Iot eech o| |he d|seeses belov selec| |he |ype o| emylo|d pto|e|n depos||ed |n eech d|seese
|tom |he ebove l|s|. Iech |ype mey be used once, mote |hen once ot no| e| ell.
1. Pusmu-ce myeomu.

2. Azhemer's dseuse.

3. Rheumutod urthrts.

4. 1ype 2 dubetes metus.

S. Meduury curcnomu ol the thyrod.

11. THEME: TYPES OF EPlTHELlUM

A Pseudostrutled cuted coumnur
B Smpe coumnur
C Smpe cubodu
D Smpe squumous
F Strutled cubodu
F Strutled squumous, kerutnsng
G Strutled squumous, non-kerutnsng
H 1runstonu-ce
Iot eech o| |he ||ssues ot otgens belov, selec| |he |ype o| ep||hel|um |ound |n eech |tom
|he ebove l|s|. Iech |ype mey be used once, mote |hen once ot no| e| ell.
1. udder.

2. Lctocervx.

3. 1rucheu.

4. Percurdum.

S. Skn.

E M Q s F R M E D l C A L S T L D E N T S - V L L M E 1
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12. THEME: ENVlRONMENTAL CARClNOGENS
A Alutoxn l
B Arsenc
C Asbestos
D -Nuphthyumne
F ete nut
F Cgurette smoke
G Cycophosphumde
H lonsng ruduton
l Ntrosumnes
] Poychornuted bphenys
k Ltruvoet ght
l Vny chorde
Iot eech o| |he |umouts belov, selec| |he mos| l|lely ceuse||ve cetc|nogen |tom |he ebove
l|s| o| op||ons. Iech egen| mey be used once, mote |hen once ot no| e| ell.
1. Mugnunt meunomu ol the skn.

2. Squumous-ce curcnomu ol the ung.

3. 1runstonu-ce curcnomu ol the budder.

4. Heputoceuur curcnomu.

S. Adenocurcnomu ol the stomuch.

6. Pupury curcnomu ol the thyrod.

G E N E R A L P AT H L G Y
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ANSwERS TO CHAPTER
- GENERAL PATHOLOGY
1. PATHOLOGlCAL PROCESSES
1. l - MctapIasia
Metupusu s u chunge n ce type lrom one luy dllerentuted lorm to unother luy
dllerentuted lorm. lt s usuuy u protectve response to chronc rrtuton or ce
dumuge, the new ce type beng more ube to wthstund the rrtutng ugent thun the
orgnu. A common cuuse ol ucd heurtburn' s gustro-oesophugeu relux, durng
whch gustrc ucd reluxes lrom the stomuch nto the ower oesophugus. 1he
oesophugus s normuy ned by strutled squumous eptheum. 1hs type ol
eptheum cunnot eusy wthstund the dumuge cuused by gustrc ucd und so metu-
pusu occurs to gustrc-type gunduur eptheum, whch s better ube to beur the
dumuge. Lndoscopcuy, the metupustc mucosu hus u red, vevety uppeurunce, n
contrust to the smooth, whte uppeurunce ol normu oesophugeu eptheum. 1hs
condton s known us urrett's oesophugus'. ln common wth muny other metupustc
condtons, urrett's oesophugus s ussocuted wth un ncreused rsk ol mugnuncy.
2. F - HypcrpIasia
Hyperpusu s un ncreuse n the number ol ces n u gven ce popuuton. ln contrust,
hypertrophy s un ncreuse n the sze ol ces wthout un ncreuse n number.
Hyperpusu s usuuy hormonuy drven, whe hypertrophy occurs n response to un
ncreused workoud. Prostutc enurgement n men s common wth ncreusng uge. 1he
growth s hormonuy drven und nvoves un ncreuse n ce number ruther thun ce
sze. 1he process s therelore hyperpusu ruther thun hypertrophy.
3. B - Atrophy
Atrophy s u decreuse n the sze ol ces, tssues or orguns, olten eudng to u oss ol
luncton. Luck ol use ol struted musces, whch olten occurs n putents who ure bed-
bound, euds to shrnkuge n the sze ol myocytes und to oss ol musce buk. 1hs s
known us dsuse utrophy'.
4. l - Thrombosis
1hromboss s the lormuton ol un ntruvuscuur muss lrom the consttuents ol bood n
u lowng crcuuton. luctors thut predspose to the deveopment ol thromboss ncude
proonged mmobty, us occurs durng ong-dstunce lghts, und the oru contru-
ceptve p. Susceptbe putents on trunsutuntc lghts cun deveop thromboss n
deep cul vens, whch munlests us u swoen punlu cul.
S. C - DyspIasia
1he term dyspusu' teruy meuns ubnormu growth, but t s most olten used to
descrbe luure ol normu muturuton ol un eptheum, wth purtu expresson ol u
neopustc phenotype. ln u cervcu bopsy ths s recognsed us urge peomorphc
nuce ubove the busu uyer. 1hs condton s known us cervcu ntrueptheu
neopusu' (ClN) und s gruded l3 uccordng to the severty ol the ubnormuty.
Dyspusu s u premugnunt condton.
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6. G - Hypcrtrophy
As descrbed ubove, hypertrophy s un ncreuse n the sze ol ces wthout un ncreuse
n number und usuuy occurs n response to un ncreused workoud. ln putents wth
hypertenson, the heurt hus to pump ugunst ncreused vuscuur resstunce und ts
workoud s therelore ncreused. 1he consequent ncreuse n sze ol the curduc
myocytes euds to elt ventrcuur hypertrophy und enurgement ol the heurt.
2. CELLS OF THE lMMUNE SYSTEM
1. l - PIasma ccII
Memory ces und pusmu ces ure both luy dllerentuted ymphocytes. Memory
ces muntun memory ol the encounter wth the untgen und become uctvuted l the
untgen s encountered ugun, whe pusmu ces produce und secrete untbody to u
speclc untgen. Pusmu ces huve u snge, eccentrcuy puced nuceus, n whch the
chromutn s perpheruy uggreguted ut the nuceur membrune, gvng u cock luce'
uppeurunce. 1hey uso huve u pernuceur huo, the ste ol the Cog uppurutus, und
busophc cytopusm, ndcutng ubundunt RNA secreton.
2. B - Dcndritic ccII
Dendrtc ces und mucrophuges ure both untgen-presentng ces. Dendrtc ces ure
so-numed becuuse ol ther rreguur shupe und numerous dendrtc processes.
Dendrtc ces puy un mportunt roe n estubshng the lrst-tme response to un
untgen by vrgn' 1 ymphocytes und, ke other untgen-presentng ces, express hgh
surluce eves ol cuss ll muor hstocomputbty compex (MHC) moecues, whch
uugment untgen presentuton.
3. C - HcIpcr T Iymphocytc
1he CD4 moecue s u trunsmembrune gycoproten lound on the surluce ol both
mucrophuges und heper 1 ymphocytes, uthough the concentruton s consderuby
ower n mucrophuges. 1hs moecue nteructs wth cuss ll MHC moecues on
untgen-presentng ces und ncreuses the ullnty ol bndng. 1he CD3 compex, on the
other hund, s expressed ony n 1 ces und s un ubsoute requrement lor 1-ce
luncton. lt ucts us u sgnu trunsducer lor the 1-ce receptor to ntute 1-ce uctvuton.
4. F - Macrophagc
Mucrophuges uct not ony us untgen-presentng ces but uso us phugocytes und ure
therelore mportunt n bucteru kng. Lysozyme s un enzyme thut uttucks the
bucteru ce wu (see unswer 6, Jheme: Med|e|ots o| ecu|e |n|lemme||on, puge l7l)
und s lound wthn ysosomes n mucrophuge cytopusm.
S. A - Cytotoxic T Iymphocytc
1 ymphocytes thut express the CD8 moecue ure cued cytotoxc 1 ces. Lke CD4,
the CD8 moecue s uso u trunsmembrune proten. lts luncton s to bnd wth cuss l
MHC moecues on ces, thereby stubsng 1-ce nteructons wth ces presentng
untgen through the cuss l MHC moecue.
6. H - NaturaI kiIIcr ccII
Nuturu ker (NK) ces ure ces thut resembe ymphocytes morphoogcuy but
whch represent u sepurute neuge lrom ymphocytes und 1 ymphocytes. NK ces
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curry two dstnct surluce moecues, CDl6 und CD56, though the luncton ol these s
unknown. NK ces cun k turget ces such us tumour ces und vruy nlected ces
wthout prevous known senstsuton to the turget, n contrust to cytotoxc 1 ces,
whch cun uso k turget ces but requre pror exposure.
3. COMPONENTS OF ANTlGENS AND ANTlBODlES
1. A - Fpitopc
An untgen s the structure thut generutes u response by the mmune system. An
untbody s u gycoproten thut recognses un ntuct untgen. 1he precse purt ol the
untgen bound by untbody s cued the eptope'. 1hs regon ol the untgen determnes
whch untbody w bnd und so s uso relerred to us un untgenc determnunt'.
2. B - Fab fragmcnt
1reutment ol un mmunogobun moecue wth the proteoytc enzyme pupun ceuves
t nto three lrugments. 1wo ol the lrugments ure dentcu und euch contuns un ntuct
ght chun und purt ol one heuvy chun. 1hese lrugments cun bnd to untgen und so ure
known us the lub' (lrugment untgen bndng) lrugments. 1he thrd lrugment s
composed ol purt ol both heuvy chuns. lt cunnot bnd to untgen but s eusy crys-
tused und so s cued the lc' (lrugment crystusube) lrugment. lt s the ste ol
mportunt lunctons such us compement uctvuton und udherence to speclc
receptors on the surluce ol neutrophs und mucrophuges.
3. H - lgF
lmmunogobun L (lgL) s present ut extremey ow eves n the serum ol normu nd-
vduus but s ncreused n ndvduus who ure utopc or n putents wth uerges und
type l (mmedute) hypersenstvty. lgL s uso rused n response to purustc nlectons.
1he mun ellector luncton ol lgL s to bnd to must ces through lc receptors on the
surluce ol the must ce und to uctvute them. Actvuton cuuses must-ce degrunuuton,
whch resuts n potent ocused, und occusonuy generused, vuscuur ellects.
4. D - Haptcn
Some moecues ure too smu to uct us untgens themseves. Such moecues, known us
huptens', cun ony ect un mmune response when bound to currer protens. ln the
resutng huptencurrer compex, the hupten ucts us un eptope. 1he untbodes lormed
ugunst ths compex cun reuct speclcuy n souton wth the lree hupten (eg n sens-
tvty reuctons to certun drugs).
S. F - HlA
1he MHC s u coecton ol genes thut code lor protens nvoved n mmune lunctons
such us recognton ol untgen by1 ymphocytes. 1he humun MHC systems uso cued
the humun eucocyte untgen' or HLA' system und s coded lor on chromosome 6,
where there ure sx oc, three lor cuss l untgens (A, und C) und three lor cuss ll
untgens (DP, DQ und DR). Cuss l moecues ure expressed on vrtuuy u nuceuted
ces, whereus cuss ll moecues ure lound ony on untgen-presentng ces und
ymphocytes. HLA moecues ure the domnunt group ol untgens governng trunspunt
reecton reuctons.
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6. k - Supcrantigcn
A lew untgens cun bnd to MHC cuss ll protens wthout lrst beng processed by
untgen-presentng ces. 1hese ure known us superuntgens'. 1hey ure mpcuted n
severu dsorders, ncudng rubes, ucqured mmunodelcency syndrome (AlDS), und
ucute 1-ymphocyte responses to certun bucteru exotoxns such us those ol
S|ephylococcus euteus, whch ure responsbe lor toxc shock syndrome.
4. TECHNlQUES lN MOLECULAR MEDlClNE
1. H - Transfcction
1runslecton s u method ol puttng genes nto mummuun ces. 1he term urose
becuuse the trunsler ol genes s smur to vru nlecton. ln contrust, bucteru ces ure
sud to be trunslormed' becuuse n u cussc experment non-puthogenc bucteru were
mude puthogenc by uddng u trunslormng prncpe'. oth ce types spontuneousy
pck up DNA, but ellcency s very ow. Seecton und screenng technques uow
stube' trunslectunts to be detected.
2. C - Hybridisation
Hybrdsuton s the lormuton ol buse purs between nucec ucds. 1he term wus org-
nuy restrcted to the lormuton ol hybrd doube-strunded moecues, us n u northern
bot, where DNA/RNA hybrds ure lormed. 1ypcuy, u mxture ol nucec ucds s
resoved on u ge, botted onto ntroceuose, und the bot s hybrdsed wth u ubeed
(eusy detectube) pece ol DNA or RNA the probe'. 1he probe stcks to ts compe-
mentury strund, the bot s then wushed to remove unbound und non-speclcuy
bound probe, und the remunng probe s then detected (usuuy by usng rudouctve
ubeng und uutorudogruphy). A modlcuton ol the technque cun be used n stu to
detect the presence ol mRNA n tssues.
3. ] - Wcstcrn bIotting
ottng' s u descrptve term lor the trunsler ol moecues out ol u ge und onto u lter
membrune by u wckng ucton, uthough the term s now used lor eectro- or vucuum
trunslers. ln the orgnu descrpton ol bottng, Dr Ldwn Southern deveoped the tech-
nque to muke the ge-resoved nucec ucd DNA more uccessbe to subsequent
munpuuton, such us dentlcuton by hybrdsuton Southern bottng'. Northern
und western bottng loowed the orgnu nomencuture (perhups not very hepluy).
ln western bottng, protens ure sepuruted on u ge, botted, und then probed wth unt-
bodes to detect the speclc proten ol nterest. Northern bottng s the smur sepu-
ruton und bottng ol RNA.
4. F - PoIymcrasc chain rcaction
1he poymeruse chun reucton (PCR) s st u reutvey new technque thut hus revou-
tonsed muny uspects ol moecuur boogy. lt umples DNA to produce udequute
umounts lor subsequent use. ln prncpe, two synthetc ogonuceotde prmers ure
desgned, whch ure typcuy 2025 nuceotdes ong, und lunk the DNA segment to
be umpled. 1hese prmers, orentuted 5' to 3', ure hybrdsed to opposte strunds ol
the turget sequence und extended usng DNA poymeruse unt the regon between the
two prmers s competey repcuted. lntu hybrdsuton ol the two ogonuceotdes
requres heut denuturuton ol the doube-strunded DNA tempute. 1he temperuture s
then owered to un optmum ut whch prmers unneu to ther compementury
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sequences. lnuy, poymeruse eonguton, ugun requrng un optmu temperuture,
competes the synthess, whch ellectvey resuts n doubng the concentruton ol the
turget DNA segment. 1hs cyce s repeuted 2535 tmes usng commercuy uvuube
thermu cycers.
S. D - linkagc anaIysis
ll the ony nlormuton uvuube ubout u gene s the phenotype thut t produces (eg u
dseuse or churucterstc), the gene cun be demonstruted to e neur to u chromosomu
regon contunng un estubshed murker (usuuy u restrcton-ength poymorphsm or
unother gene whose genomc poston s known), thut therelore tends to be nherted
wth t. 1he regon ol nterest cun then be exumned lor the presence ol u cunddute
gene cuusng the dsorder or churucterstc n queston und the exuct mututon cun then
dentled by other technques such us drect DNA sequencng.
5. TYPES OF lNFLAMMATlON
1. C - Cascating granuIomatous
1ubercuoss s the urchetypu grunuomutous dseuse. 1he grunuomus ure composed
ol hstocytes, u Lunghuns-type mutnuceute gunt ce und u perpheru rm ol
ymphocytes. 1ypcuy there s centru cuseutng necross. 1he terms cuseutng' or
cuseous' ure used when the necross uppeurs solt und cheesy' mucroscopcuy und
structureess hstoogcuy.
2. D - Chronic
Hel|cobec|et pylot| cuuses u chronc gustrts wth numerous ymphocytes und pusmu
ces n the umnu propru. Clten there ure uso numerous ymphod loces.
Neutrophs ure commony seen wthn surluce und gund eptheum, n whch cuse
the term uctve chronc gustrts' s used, but they ure never the predomnunt 1 ce us
they woud be n ucute gustrts.
3. F - Fibrinous
lbrnous percurdts s the most common puthoogcu type ol percurdts. Common
cuuses ncude ucute myocurdu nlurcton, uruemu, rheumutc lever und systemc
upus erythemutosus (SLL). ln lbrnous percurdts the surluce s dry wth u lne
grunuur roughenng. At uutopsy, the strunds ol lbrn on the surluces ol the puretu und
vsceru percurdum pu upurt ke two peces ol buttered breud, gvng rse to the term
breud und butter' percurdts. A percurdu lrcton rub s the most strkng cncu
leuture. 1he deveopment ol u percurdu elluson cun obterute the lrcton rub by
sepurutng the two uyers ol percurdum.
4. H - Non-cascating granuIomatous
Lke tubercuoss, surcodoss s u grunuomutous mutsystem dseuse but, n contrust
to tubercuoss, the grunuomus ure not cuseutng. 1hs leuture cun be heplu n
dstngushng pumonury tubercuoss lrom pumonury surcod n ung bopses, but
cunnot be competey reed upon becuuse tubercuoss occusonuy cuuses non-
cuseutng grunuomus.
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S. A - Acutc suppurativc
ln bucteru menngts, the suburuchnod spuce contuns u creumy, puruent ucute
nlummutory exudute thut s rch n neutrophs. 1he cerebrospnu lud (CSl), whch
crcuutes n the suburuchnod spuce, s therelore turbd und shows numerous
neutrophs on mcroscopc exumnuton. 1hs contrusts wth vru menngts, n whch
the CSl contuns scuttered ymphocytes but no neutrophs.
6. F - FosinophiI-rich
Losnophs puy un mportunt roe n delence ugunst purustc nlestuton. 1ssue und
bood eosnophu s olten seen n such nlectons. Hookworm urvue penetrute
humun skn und puss n the boodstreum to the ungs, where they cun cuuse un
eosnophc pneumonu. lrom the ungs the urvue uscend through the bronch nto
the phurynx und ure then swuowed, endng up n the smu ntestne, where they
muture nto udut worms. 1he uduts suck' bood lrom the smu-ntestnu mucosu,
cuusng un ron-delcency unuemu.
6. MEDlATORS OF ACUTE lNFLAMMATlON
1. B - C3b
Cpsonsuton s one ol the steps nvoved n the phugocytoss ol bucteru by
mucrophuges und neutrophs. ucteru couted wth certun substunces ure ngested
more reudy. 1he luctors thut cout bucteru ure cued opsonns' (lrom the Creek
opson, reudy lor eutng') und the process s known us opsonsuton'. 1here ure two
mun opsonns: mmunogobun (lgC) und the C3b component ol compement. 1here
ure receptors lor both these opsonns on the ce surluce ol phugocytc ces.
Cpsonsed lrugments uttuch to the phugocytc ce und ure nternused to become
phugosomes. Lysosomes luse wth the phugosome und reeuse proteoytc enzymes
thut k the bucteru.
2. F - Histaminc
Hstumne s u vusouctve umne thut s stored n und reeused lrom must ces,
busophs und puteets. lt cuuses vusoduton und ncreuses the permeubty ol
venues. 1he ucton ol hstumne on vesses s meduted vu H
l
receptors, whe some ol
ts other uctons, such us bronchoconstrcton, ure ellected by H
2
receptors. luctors thut
stmuute hstumne reeuse ncude physcu nury lrom heut, mechuncu truumu or
ruduton, und chemcu ugents, such us mmunogobuns, bee-stng venom, C3u und
C5u, und ntereukn l (lL-l). Ant-H
l
unthstumnes ony nhbt the mmedute phuse
ol the vuscuur response to nury, meunng thut hstumne s ony mportunt durng ths
eury phuse.
3. l - Supcroxidc anion
Alter un nvudng bucterum hus been phugocytosed, ts kng nvoves oxygen-
dependent und oxygen-ndependent mechunsms. 1he oxygen-dependent mechunsm
s ussocuted wth u burst ol oxdutve uctvty known us the resprutory burst'. 1hs
essentuy resuts n the stepwse reducton ol moecuur oxygen nto un oxygen-lree
rudcu, the superoxde unon, und then to hydrogen peroxde. Phugocytes cunnot k
ngested orgunsms n the ubsence ol the resprutory burst und wthout producton ol
the superoxde unon. lndeed, uck ol one ol the enzymes nvoved n ths process,
ncotnumde udenne dnuceotde phosphute (NADPH) oxduse, euds to chronc
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grunuomutous dseuse ol chdhood, un nherted dseuse n whch neutrophs ure ube
to ngest bucteru but cunnot k them.
4. F - lntcrccIIuIar ccII adhcsion moIccuIc 1 (lCAM-1)
1he mmunogobun gene superlumy s u group ol nterceuur udheson moecues
so numed becuuse euch contuns severu domuns resembng the structure ol
mmunogobuns. 1hree such moecues huve been dentled: nterceuur ce
udheson moecues l und 2 (lCAM-l und lCAM-2) und vuscuur ce udheson
moecue (VCAM-l). lCAM-l s expressed ut ow eves normuy but ts expresson s
ncreused n ucute nlummuton by stmuunts such us lL-l. Leucocytes bnd to lCAM-
l through gunds on ther surluce known us ntegrns'.
S. H - lntcrIcukin 1 (ll-1)
lL-l s u potent reguutor ol both ocu nlummutory events und u number ol systemc
ones. Muny ol ts uctvtes ure smur to those ol tumour necross luctor uphu (1Nl).
1he synthess ol lL-l s stmuuted by other cytoknes und by vurous mcrobu
products, such us bucteru endotoxn. Locuy, t upreguutes expresson ol lCAM-l,
ncreusng eucocyte udheson, t stmuutes reeuse ol hstumne und stmuutes
mucrophuges to produce chemoknes. Systemcuy, lL-l ucts us un endogenous
pyrogen (e t produces lever), nduces gucocortcod synthess und stmuutes the
reeuse ol prostugundns und ucute-phuse protens.
6. l - lysozymc
Lysozyme s u ow-moecuur-weght cutonc enzyme thut uttucks the mucopeptde
ce wus ol some bucteru speces, purtcuury Crum-postve cocc. lt s lound n
ysosomes und s one ol the oxygen-ndependent mechunsms ol bucteru kng.
7. lNFECTlOUS DlSEASES
1. B - Amocbiasis
lnlecton wth In|emoebe h|s|oly||ce cuuses umoebuss. oth ths und schstosomuss
cun eud to coonc uceruton, but n schstosomuss the ucers ure not typcuy lusk-
shuped. 1he lndng ol perodc ucdSchll (PAS-)postve trophozotes wth ngested
red ces s dugnostc ol umoebuss.
2. l - ToxopIasmosis
Congentu toxopusmoss s cuused by muternu nlecton wth Joxoplesme gond|| n
the lrst trmester. ln normu uduts, ths puruste cuuses subcncu nlecton or md
ymphudenoputhy, but n nlunts, who huve not deveoped ce-meduted mmunty,
nlecton euds to severe ubnormutes. 1here s wdespreud necross ol the brun,
ver, heurt, ungs und retnu. Cuclcuton cun occur n loc ol ong-stundng necross
n the brun.
3. l - Pneumocysls pncumonia
Ineumocys||s cet|n|| s un ubqutous orgunsm thut does not cuuse dseuse n normu
ndvduus but cuuses u severe pneumonu n mmunosuppressed putents, ncudng
those on chemotherupy. 1he orgunsm cunnot be grown n cuture, so dugnoss requres
cytoogcu or hstoogcu dentlcuton. Lselu cytoogcu prepurutons ncude
bronchu wushngs or uvuge. 1runsbronchu bopsy shows loumy eosnophc muteru
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n the uveour spuces. Cn both cytoogy und hstoogy the orgunsm s seen us u bout-
shuped or cup-shuped structure on sver stunng.
4. ] - Schistosomiasis
lnlecton wth Sch|s|osome heeme|ob|um s endemc n purts ol the Mdde Lust und
Alrcu. opsy ol the nlected budder shows puruste ovu surrounded by grunuo-
mutous nlummuton und numerous eosnophs. Heung by lbross euds to ureterc
obstructon, wth consequent hydronephross und chronc pyeonephrts. 1here s
uso un ussocuton between urnury schstosomuss und squumous-ce curcnomu ol
the budder.
S. F - FaIciparum maIaria
Muuru s cuused by lour speces ol Ilesmod|um purustes und s trunsmtted by the
lemue nopheles mosquto. lucpurum muuru s cuused by Ilesmod|um |elc|petum
und s the most common type. 1he sgns, symptoms und puthoogcu leutures ol
muuru ure reuted to the sequeue ol vurous uspects ol the puruste's le cyce n mun.
lt s dugnosed by lndng rng trophozotes nsde red ces on u bood smeur.
6. D - Candidiasis
1he lndng ol lungu hyphue n ths putent's bopsy s dugnostc ol lungu
oesophugts. 1he dllerentu dugnoss es between uspergoss, cuused by
spetg|llus speces, und cundduss cuused by Cend|de speces, usuuy Cend|de
elb|cens. 1he luct thut yeust lorms were uso present rues out spetg|llus us ths s not u
yeust-lormng lungus. ln uddton, the endoscopc uppeurunce ol whte puques on the
mucosu surluce s typcu ol cundduss. 1hs dseuse s common n mmunosup-
pressed putents such us those wth AlDS.
8. BACTERlAL lNFECTlONS
1. H - Nessera mennglds
1hs putent hus bucteru menngts. 1he two most key cuuses lrom the st ure
!e|sset|e men|ng|||d|s (menngococcus) und S|tep|ococcus pneumon|ee (pneumo-
coccus). 1he petechu rush s churucterstc ol menngococcu septcuemu. 1hs s
conlrmed by lndng Crum-negutve cocc on CSl exumnuton.
2. F - Fschercha col
1he putent's symptoms und lndngs on urnuyss ure typcu ol urnury truct nlecton.
Ischet|ch|e col| s the cuuse ol 6090% ol urnury truct nlectons. 1hs orgunsm s u
normu commensu ol the urge ntestne und n women enters the urnury truct by
drect spreud up the urethru lrom the perneum. I. col| s u Crum-negutve, uctose-
lermentng bucus
3. C - Closlrdum dllcle
1hs putent hus u compcuton ol untbotc therupy, numey pseudomembrunous
cots. 1he lndng ol whte puques on the urge-bowe mucosu s churucterstc ol ths
dseuse. 1he cuusutve orgunsm s u toxgenc strun ol Clos|t|d|um d||||c|le, un
unuerobc Crum-postve bucus. C. d||||c|le produces two toxns: toxn A s un entero-
toxn thut s responsbe lor the gustrontestnu symptoms, toxn s u cytotoxn thut
hus u cytoputhc ellect n ce cutures.
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4. k - Slrelococcus neumonae
1hs putent s sullerng lrom obur pneumonu. Vugrunts und ucohocs who huve poor
socu und medcu cure ure purtcuury prone to ths type ol pneumonu. 1he cuusutve
orgunsm n upproxmutey 90% ol cuses s S|tep|ococcus pneumon|ee. 1hese occur us
Crum-postve dpococc, whch show uphu-huemoyss on bood ugur. 1he coones
ure typcuy descrbed us druughtsmun-shuped on uccount ol ther sunken centre.
S. ] - Slahylococcus aureus
\ound nlecton s un mportunt cuuse ol postoperutve sepss. 1he most common
cuuse s S|ephylococcus euteus, but other possbe orgunsms ncude S|tep|ococcus
pyogenes, purtcuury when there s ussocuted ceuts, und Ischet|ch|e col| when the
wound loows ubdomnu surgery. ln ths putent, Crum stun ol the pus lrom the
wound shows Crum-postve cocc, rung out I. col|. S. euteus und S. pneumon|ee ure
both Crum-postve cocc, but the lndng ol couguuse-postve orgunsms s dugnostc
ol S. euteus.
6. A - Camylobacler jejun
Cempylobec|et speces, purtcuury Cempylobec|et jejun|, ure now recognsed us u
muor cuuse ol durrhoeu dseuse n the LK. Common sources ol nlecton ure poutry,
meut und mk. C. jejun| s u Crum-negutve curved or spru-shuped rod. lt s u lugeute
orgunsm und therelore hghy mote. 1hs leuture dstngushes t lrom enteroputho-
genc struns ol I. col|, whch ure uso Crum-negutve rods but ure non-lugeute.
9. PATHOGENlC VlRUSES
1. G - Human papiIIomavirus
\urts ure bengn tumours ol squumous eptheum und ure known us squumous-ce
pupomus'. 1hey urse not ony n kerutnsed squumous eptheum, such us the skn,
but uso n non-kerutnsed squumous eptheum such us thut nng the ectocervx. A
wurts ure cuused by humun pupomuvrus (HPV), u DNA vrus beongng to the pupo-
vuvrus lumy. 1here ure muny serotypes ol HPV. Centu wurts ure sexuuy trunsmtted
und ure cuused by HPV types 6 und ll. Cther serotypes, notuby l6, l8 und 3l huve
been mpcuted n the deveopment ol hgh-grude cervcu ntrueptheu neopusu
und nvusve cervcu curcnomu.
2. C - Fpstcin-Barr virus
lnlectous mononuceoss s u mutsystem dsorder cuused by Lpstenurr vrus (LV).
1hs s u DNA vrus beongng to the herpesvrus lumy. Dugnoss ol nlectous
mononuceoss s mude by lndng heteroph untbodes to sheep erythrocytes n the
putent's serum. As we us cuusng nlectous mononuceoss, LV hus u strong ussoc-
uton wth certun humun mugnunces, purtcuury urktt's ymphomu und nusophu-
ryngeu curcnomu.
3. l - ParainfIucnza virus
Croup or ucute uryngotrucheobronchts, s most commony ussocuted wth purun-
luenzu vrus type l. 1hs s un RNA vrus beongng to the Ietemyxov|tus lumy. Croup s
seen muny n nlunts und young chdren, und the symptoms ncude hourseness, cough
und nsprutory strdor. As we us croup, purunluenzu vruses ure ussocuted wth bron-
chots und pneumonu n young chdren und wth the common cod' n uduts.
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4. A - Coxsackicvirus
ln useptc' menngts, the CSl contuns ymphocytes ruther thun neutrophs und CSl
cuture s negutve. Aseptc menngts s usuuy due to vruses ol the In|etov|tus group,
ol whch coxsuckevrus s u member. Lnterovruses ure RNA vruses thut beong to the
pcornuvrus lumy. Cther enterovruses thut cuuse useptc menngts ncude
echovrus und poovrus.
S. l - Rotavirus
Vruses ure un mportunt cuuse ol ucute durrhoeu, purtcuury n chdren. ln the deve-
opng word, vru gustroenterts s u muor cuuse ol nlunt mortuty but the condton s
ess severe n the LK. A common cuuse ol vru gustroenterts s rotuvrus, un RNA vrus
thut beongs to the Reov|tus lumy. Cther cuuses ncude udenovrus und ustrovrus.
6. H - McasIcs virus
Subucute scerosng punencephuts s u rure, severe, progressve neuroogcu dseuse
thut occurs n chdren und young uduts. lt presents wth personuty chunge und nte-
ectuu mpurment, loowed by convusons und myoconc movements, und even-
tuuy euds to comu und deuth. lt s cuused by persstent nlecton wth delectve
meuses vrus loowng u prmury meuses nlecton severu yeurs prevousy. Meuses s
un RNA vrus thut beongs to the Ietemyxov|tus lumy.
10. TYPES OF AMYLOlD PROTElN
1. B - Al amyIoid
Amyod deposted n ths dseuse s olten systemc n dstrbuton und s ol the AL type.
1he mugnunt pusmu ces produce ubnormu umounts ol monoconu
mmunogobun, ether the whoe moecue or ust the ght chuns, usuuy ol one
type. 1hese ght chuns ure relerred to us ence lones proten und ure lound n the
serum und urne ol putents wth pusmu-ce myeomu und other monoconu -ce
prolerutons. Around 5l5% ol putents wth pusmu-ce myeomu who huve lree
ght chuns deveop cncu umyodoss.
2. D - AmyIoid protcin
Amyod betu proten (A) s u 4000-duton peptde thut consttutes the core ol cerebru
puques lound n Azhemer's dseuse us we us the umyod deposted n the wus ol
cerebru bood vesses n putents wth ths dseuse. 1he A proten s derved lrom u
much urger trunsmembrune gycoproten cued umyod precursor proten' (APP), the
luncton ol whch s unknown.
3. A - AA amyIoid
1he umyod deposts n ths condton ure systemc n dstrbuton und ure composed ol
AA proten. 1hs s derved lrom serum umyod A (SAA), un ucute-phuse proten synthe-
ssed by the ver n u number ol chronc nlummutory condtons such us rheumutod
urthrts, tubercuoss, chronc osteomyets, bronchectuss und nlummutory bowe
dseuse. Nowuduys, rheumutod urthrts s the most commony ussocuted condton.
Amyodoss occurs n ubout 3% ol putents wth rheumutod urthrts und s cncuy
sgnlcunt n ubout hul ol those ullected.
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4. G - lsIct amyIoid poIypcptidc
lset umyod poypeptde (lAPP), uso known us umyn', s u 37-umno-ucd peptde
thut s normuy produced by the -ces ol the sets ol Lungerhuns und s co-secreted
wth nsun. ln putents wth type 2 dubetes metus, ths proten uccumuutes n the
snusodu spuce outsde the -ces, n cose contuct wth ther ce membrunes. lt s
not known whether deposton ol lAPP uctuuy contrbutes to the puthogeness ol the
dseuse or l t s u consequence ol dsordered -ce luncton.
S. F - CaIcitonin
Meduury curcnomu ol the thyrod s one ol the endocrne tumours n whch ocused
deposts ol umyod cun be lound n the stromu, other exumpes beng phueochromo-
cytomu und set-ce tumours ol the puncreus. 1he umyod n meduury curcnomu s
derved lrom the peptde hormone cuctonn, whch s secreted by the tumour ces.
11. TYPES OF EPlTHELlUM
1. H - TransitionaI-ccII
1runstonu-ce eptheum s u specu lorm ol strutled eptheum thut s ony lound
n the urnury truct und so s uso cued urotheum'. lt s specused to wthstund the
toxcty ol urne und to uccommodute u hgh degree ol stretchng. lt hus un uppeurunce
ntermedute between thut ol strutled cubodu eptheum und strutled squumous
eptheum, hence trunstonu'.
2. G - Stratificd squamous, non-kcratinising
Strutled squumous eptheums usuuy severu uyers thck und mutures progressvey
lrom the busu uyer, whch hus cubodu-shuped ces, through to the surluce uyer,
where the ces ure luttened. \hen the muturng ces reuch the surluce, they degen-
erute und eventuuy sough oll. Lctocervcu eptheum cun wthstund moderute
ubruson becuuse ol ts thckness but s not kerutnsed us t does not normuy need to
wthstund desccuton.
3. A - Pscudostratificd ciIiatcd coIumnar
1he trucheu s ned by pseudostrutled cuted coumnur eptheum, uso known us
resprutory eptheum'. 1hs s uctuuy u true smpe eptheum becuuse u the ces
rest on the busement membrune, but the nuce ol the ces ure ut dllerent eves, gvng
u luse mpresson ol strutlcuton. 1he umnu surluce ol the ces beurs cu, the
luncton ol whch s to prope surluce lms ol mucus or lud n u consstent drecton
over the eptheu surluce.
4. D - SimpIc squamous
Smpe squumous eptheum conssts ol u snge uyer ol luttened ces und s lound
nng surluces nvoved n the trunsport ol guses, numey the uveo, und luds (e
ymphutcs und bood vesses). lt uso nes the serous body cuvtes, such us the per-
curdum, peuru und pertoneum, where t s known us mesotheum'. Mesotheum
permts the pussuge ol u smu umount ol lud nto und out ol the cuvtes us requred.
S. F - Stratificd squamous, kcratinising
Lke the cervx, the skn s ned by strutled squumous eptheum. Lnke the cervx,
however, the skn s kerutnsed us t must be ube to wthstund desccuton.
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12. ENVlRONMENTAL CARClNOGENS
1. k - UItravioIct Iight
1he utruvoet (LV) porton ol the sour spectrum cun be dvded nto three wuve-
ength runges: LVA (320400 nm), LV (280320 nm) und LVC (200280 nm). Cl
these, LV s beeved to be responsbe lor the nducton ol cutuneous neopusms,
ncudng mugnunt meunomu, squumous-ce curcnomu und busu-ce curcnomu.
1he curcnogencty ol LV s uttrbuted to ts lormuton ol pyrmdne dmers n DNA.
1hs type ol dumuge s repured by the nuceotde excson repur puthwuy. \th
excessve sun exposure, ths puthwuy s overwhemed, und so some dumuged DNA
remuns unrepured. 1hs euds to trunscrptonu errors und subsequent deveopment
ol mugnuncy.
2. F - Cigarcttc smokc
Cgurette smoke contuns u number ol curcnogens, ncudng poycycc uromutc
hydrocurbons, whch ure umong the most potent curcnogens known. 1hey ure uct-
vuted by mxed-luncton oxduses to lorm epoxdes, whch ure more wuter soube und
more reuctve thun the purent compound. Lpoxdes bnd to DNA, cuusng mututons,
und uso to mucromoecues n the cytopusm ol turget ces.
3. D - -NaphthyIaminc
etu-nuphthyumne hus been responsbe n the pust lor un ncreused ncdence ol
budder cuncer n workers n the unne dye und rubber ndustres. y tsel, -nuph-
thyumne s not curcnogenc, but ulter ubsorpton t s hydroxyuted n the ver to un
uctve lorm belore beng detoxled by conuguton wth gucuronc ucd. 1hs non-toxc
compound s excreted by the kdney und concentruted n the budder. 1he humun budder
mucosu contuns the enzyme -gucuronduse, whch ceuves the non-toxc substunce
und n so dong reeuses the curcnogenc moecue.
4. A - AfIatoxin B1
Alutoxn l s u nuturuy occurrng curcnogen thut s produced by some struns ol
spetg|llus |levus thut thrve on mpropery stored gruns und peunuts. A strong corre-
uton hus been lound between the detury eve ol ths toxn und the ncdence ol hepu-
toceuur curcnomu n certun purts ol Alrcu und the lur Lust. lt uppeurs thut synergy
exsts between ulutoxn und chronc heputts vrus nlecton. Alutoxns produce u
pont mututon ut codon 249 ol the JISJ gene, eudng to producton ol un ubnormu
gene product.
S. l - Nitrosamincs
Lke -nuphthyumne, ntrosumnes requre metuboc uctvuton to lorm u curcno-
genc ugent. ln the course ol ths uctvuton, ukyutng ugents ure produced thut bnd to
guunne n DNA, thereby enhuncng mugnunt trunslormuton. Ntrosumnes ure
lormed n the gustrontestnu truct lrom the reucton ol ntrostube umnes und ntrtes.
Ntrtes ure present n urge umounts n pcked, suted und smoked loods, und the nc-
dence ol gustrc curcnomu s hgh n countres such us lupun, where there s u hgh
detury ntuke ol these loods. ln uddton, ntrtes cun be lormed n the stomuch lrom
ntrutes (lound n lood preservutves) by the ucton ol bucteru.
6. H - lonising radiation
1here s un ncreused rsk ol curcnomu ol the thyrod n peope who huve hud
onsng ruduton to the neck, purtcuury n chdhood. 1hs onsng ruduton cun
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