5c.docx

Practical’s Copy
Submitted by
Mirza Ali Kumail
Bpd02183227
5th
(C)
Pathology
Submitted to
Mam Rabia Asghar

INDEX
Sr
no.
Date Practical’s Sign
01 16-
10-20
Identification of Healthy Myocardial Cells,
Myocardial Infraction, Acute Myocardial
Infraction, Old Myocardial Infraction
02 23-
10-20
Identification of Normal Prostate, Tuberculosis
and Benign Prostate Hyperplasia
03 06-
11-20
Identification of Normal Appendix, Viral
Pneumonia
Lung Tissue and Appendicitis
04 27-
11-20
Identification of Granulomatous TB in Lymph
Node and Lung Tissue
05 04-
12-20
Identification of Liver with Hepatitis, Liver
Cirrhosis Pyelonephritis and Chronic Peptic
Ulcer
06 11-
12-20
Identification of Human Adenocarcinoma of
Colon, Adenocarcinoma of Breast, Carcinoma of
Liver and Carcinoma of Esophagus
07 18-
12-20
Identification of Carcinoma of Prostate,
Carcinoma of Stomach and Sarcoma of Uterus
08 25-
12-20
Identification of Human Seminoma of Testis and
Human Fibrocystic Disease of the Breast
09 01-
01-20
Identification of Sebaceous Cyst and Pulmonary
Edema

PRACTICALNO.1 16/10/2020
Identification of healthy Myocardial Cells, Myocardial Infarction, Acute
Myocardial Infarction, Old Myocardial Infarction.
Healthy MyocardialCells:

Healthy Myocardial Cells
MyocardialInfarction:

Identification:
In the first 12-24 hours, the myocardial fibers are still well delineated, with intense
eosinophilic (pink) cytoplasm, but lost their transversal striations and nucleus. Notice a few
myocardial fibers showing hypertrophy.
Features:
• Loss of normal cardiac myocyte structure.
• Absence of nucleus.
• Phenomena of hypertrophy are observed in cells.
Acute MyocardialInfarction:

Identification:
Acute myocardial infarction shows coagulative necrosis and wavy fibers widened
spaces between dead fibers. Contains edema fluid and scattered macrophages. Dense
polymorphonuclear leukocytes infiltrate the area of acute myocardial infarction.
Features:
• Presence of leukocytes.
• Widened spaces between cells and fibers.
• Swelling in cells is observed.
Old MyocardialInfarction:

Identification:
Complete loss of structure of myocardial cells and fibers in some regions of the
cardiac muscle with surrounding normal myocardium.
Features:
• Complete loss of structure of myocardial cells and fibers.
• It shows a smooth and soft appearance.
• Absence of all well-defined structures such as the nucleus.
Identification of Normal Prostate, Tuberculosis, and Benign Prostate Hyperplasia.
Normal Prostate
Vascular Tissue Scar
(collagen)
Surrounding Normal
Myocardium

Identification:
We can observe the increased spacing between the alveolar walls, the presence of
granulomas and giant mulitinucleated cells that indicate the condition of tuberculosis.
Features:
• Presence of granuloma.
• Giant multinucleated cells also known as langhans type cells are also present.
• The presence of central caseous necrosis.
• A collar of epitheloid cells is also present.
Benign Prostatic Hyperplasia:

Identification:
Microscopic evaluation shows nodular growths due to the increased number of cells.
Stroma is composed of collagen and smooth muscle. Benign Prostate Hyperplastic (BPH)
cells enlarge and compress the outer zones of prostate resulting in formation of surgical
capsule.
Features:
• Nodular growths are observed due to increased number of cells.
• Fibromuscular stroma is seen.
• Corpora amylacea is also observed.
• Formation of surgical capsule.
Identification of Normal Appendix, Viral Pneumonia Lung Tissue and
Appendicitis.
Normal Appendix
Fibromuscular
Stroma
Corpora
Amylacea
Proliferating
Glands

Viral Pneumonia
Identification:
Alveolar spaces are filled with neutrophils and other such lymphocytes. Fine fibrin
meshwork are observed along with desquamated pneumocytes. Congestion in the alveolar
spaces is also observed.
Features:
• Congestion in alveolar spaces
• Infilteration of neutrophils and other lymphocytes
• Acute inflammation is observed
• Fine fibrin meshwork is observed
Appendicitis
Lymphocyte
infilterate alveolar
spaces

Identification
The left half of the slide shows mucosal destruction with fresh ulcers and dense
polymorphonuclear inflammation.
Features
• Infilteration of lymphocytes.
• Dense inflammation.
• Signs of ulceration.
• Penetration of lymphocytes and lymph nodules that extend from muscularis layer to
the submucosae layer, causing destruction of tissue and cells.
PRACTICALNO. 4 27/11/2020
This dense area shows
inflammation and infilteration
of lymphocytes in the mucosal
layer resulting in its destruction

Identification of Granulomatos TB in Lymph Node and Lung tissue.
TB in Lymph Node
Identification:
The histopathologic examination shows the necrotizing tuberculous lymphadenitis
with a few giant cells. TB lymphadenitis with necrosis is present.
Features:
• Amorphous granular eosinophilic debritic material is present (Caseous Necrosis).
• Modified macrophages with abundant cytoplasm and pale staining slipper shaped
nuclei are present (Epitheloid Cells).
• Presence of multinucleated giant cells.
• Collar of lymphocytes surrounding the epitheloid cells.

TB in Lung Tissue
Centre of
necrosis
Aggregated
Epitheloid cells
Giant Multinucleated
cells
Collarof Lymphocytes
and Plasma cells
Identification:
In this slide of pulmonary tuberculosis we obserce the presence of granuloma and
necrosis, surrounded by a collar of macrophages, plasma cells, lymphocytes, and other
epitheloid cells. This indicates inflammation.
Features:
• Giant multinucleated cells (langhans type granuloma)
• Aggregation of epitheloid cells, plasma cells macrophages and other lymphocytes
form a collar around the granuloma.
• Central necrosis is observed.

Identification of liver with hepatitis, liver cirrhosis, chronic pyelonephritis, and
chronic peptic ulcer.
Liver with Hepatitis
Identification
Histopathology of this slide of liver with hepatitis show the lymphoid aggregates and
fatty changes of the hepatocytes along with some sites of necrosis.
Features
• Lymphoid aggregates are observed.
• Changes in the fatty character of hepatocytes is seen.
• Sites of Piecemeal necrosis are seen.
• Inflammation in the portal tracts.

Liver Cirrhosis
Identification
Abnormal liver architecture in the case of liver cirrhosis depicts nodularity and
fibrosis.
Feature
• Regeneration of nodules.
• Deposition of dense fibrous septa progresses to fibrosis.
• Abnormal liver structure.
Fibrosis
Regenerating
Nodule

Chronic Pyelonephritis
Identification
Signs of sclerosis in the glomerular region and fibrosis in the periglomerular region.
Chronic inflammation in the interstitium is also observed.
Features
• Glomeruli show varying degrees of sclerosis and periglomerular fibrosis.
• Tubules show cases of atrophy.
• Interstitial tissue shows the infilteration of chronic inflammation cells.
Chronic Peptic Ulcer

Identification
Chronic peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and
muscularis propria, produced by acid-pepsin aggression. Ulcer margins are regular, slightly
elevated due to adjacent chronic gastritis. During the active phase, the base of the ulcer shows
4 zones which include inflammatory exudate, fibrinoid necrosis, granulation tissue and
fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with
thrombosis.
Features
• Penetration through the muscularis mucosa and muscularis propria due to the
acidpepsin aggressive action.
• Thickened vessels due to the inflammation are observed.
• Ulcer margins and ulcer base is also observed.
Identification of human adenocarcinoma of colon, adenocarcinoma of breast,
carcinoma of liver, and carcinoma of the esophagus.

Adenocarcinoma of Colon
Identification
Adenocarcinoma of colon is a malignant epithelial tumor, originating from superficial
glandular epithelial cells lining the colon and rectum. It invades the wall, infiltrating the
muscularis mucosae layer, the submucosa, and then the muscularis propria.
Features
• Tumour originating from the epithelial lining of colon.
• Invasion and infilteration of the mucosal layers by the neoplastic cells.

Adenocarcinoma of Breast
Ducts
Neoplastic cells
Identification
Adenocarcinoma of the breast refers to the ductal carcinoma of the ducts and glands
present in the breast. The high power microscope observation shows the ductal carcinoma of
the breast. Neoplastic cells are still within the ductules and have not yet broken through into
the stroma. The two large lobules in the centre also show sites of microcalifications.
Features
• Presence of neoplastic cells in the ducts of the breast.
• Microcalcification sites are also observed.
• Stroma that surrounds the ducts and may provide suitable conditions for the neoplastic
cells when they break through the ducts.
Carcinoma of Liver

Identification
Well vascularized tumors with wide trabeculae, prominent acinar pattern, small cell
changes, cytologic atypia, mitotic activity, vascular invasion, absence of Kupffer cells and the
loss of the reticulin network
Features
• Presence of giant cells.
• Presence of anaplastic cell.
• Absence of Kupffer cells.
• Hyperchromasia is observed.

Carcinoma of Esophagus
Keratinou
pearl
Identification
Esophageal carcinoma is characterized microscopically by keratinocyte-like cells with
intercellular bridges or keratinization present in the squamous cell lining of the esophagus.
Features
• Hyperchromasia is observed.
• Tumour cells (carcinoma) are seen.
• Keratinocyte like cells are present.
• Intercellular bridges are also observed.
Identification of carcinoma of prostate, carcinoma of stomach and sarcoma of
uterus.

Carcinoma of Prostate
Identification
Prostatic carcinoma include extraprostatic spread of glands and, within the prostate,
the findings of perineural invasion, collagenous micronodules, and glomeruloid
intraglandular projections.
Features
• Presence of pleiomorphic cells.
• Hyperchromasia.
• Nodular growths of well formed glands.
• Invasive action of the metastatic cells are observed.
Carcinoma of Stomach

Identification
It is a malignant type of epithelial tumour, orginating from the glandular epithelium of
the gastic mucosa and showing its invasive action into the mucosal layers.
Features
• Tumour originating from the epithelium of gastric mucosa.
• Invasuve action progresses through the mucosal layers.
• High mitotic activity.
• Hyperchromasia.
Sarcoma ofUterus

Hyperchomasia
Dense pink
Stroma
Polygonal
shaped cells
Identification
Sarcoma of the uterus involves the neoplasia of the smooth muscle of the uterus and is
indicated by the presence of uncontrolled proliferation of tomour cells, dense pink shaped
stroma and hyperchromatin character of the nuclei and invasion through the endometrial
layers.
Features
• Presence of Hyperchromasia.
• Dense pink stroma that promotes the development of neoplastic cells.
• Abnormal proliferation of cells.
Identification of Human seminoma of testis and Human fibrocystic disease of the
breast.
Human Seminoma Of Testis

Introduction
Uniform tumor cells with abundant clear cytoplasm, distinct cell border, and large
central nuclei with prominent 1-2 nucleoli. Separated into nests by fibrous septa.
Lymphocytic and plasmacytic infiltrates in fibrous septa.
Features
• Abundant and clear cytoplasm of tumour cells.
• Presence of large central nuclei which indicate abnormal nucleus to cytoplasm ratio.
• Presence of fibrous septae
• Septae are dense with lymphocytes.
Human Fibrocystic DiseaseofBreast

Identification
There are cystically dilated ducts, areas of lobules that are laced with abundant fibrous
connective tissue (Sclerosing adenosis) and stromal fibrosis.
Features
• Presence of dilated ducts.
• Hyperplasia in the epithelium.
• Fibrosis in the stromal region.
• Site of adenosis is also observed.
• Apocrine metaplasia is also observed.
Identification of Sebaceous cyst and Pulmonary edema.

Sebaceous Cyst
Sebaceous
Gland
Multilocular dermal
cyst lined by wavy
squamous epithelium
Cavity of cyst only
consists offluid and no
keratin
Identification
The cyst that arises from the sebaceous glands are called sebaceous cysts or
steatocystoma. The histopathological observation shows excess of fluid in the cyst cavity and
the dermal cyst lined by squamous epithelium.
Features
• Presence of dermal cyst.
• Presence of fluid filled cyst cavity.
• Cyst originates from the sebaceous gland.
Pulmonary Edema

Introduction
At high magnification, the alveoli are observed to be filled with a smooth to slightly
floccular pink material characteristic for pulmonary edema. Note also that the capillaries in
the alveolar walls are congested with many red blood cells.
Features
• Presence of transudate (smooth pink material) in the alveoli.
• Thickened alveolar walls.
• Dilation of veins and capillaries is also observed.
Which of the following mediator is responsible for raised bodytemperature during
inflammation?
Pge2
Leukemia and lymphoma are different categories because of their
a) Locationand behavior
b) Aggressiveness
c) Prognosis
Increase productionof can aggravate peptic ulcer
Gastrin
At what point is blood pressure considered high
150/90

An important risk factor for peptic ulcer hemorrhage includes
Non-steroidalanti-inflammatory drug use
Which of the following statement is true about non-Hodgkin’s lymphoma?
None of the option
Which of the following feature distinguish CML from leukemoid reaction?
a) Blastcell
b) Elevatedgranulocytes count
c) Philadelphia chromosome
Following factor play a role in peptic ulcer except
Pepsinogen
Which of the following statement is not rue about adenoma?
Being epithelial neoplasms not arising from gland neither from glandular
pattern
What is the most common symptom of high blood pressure?
Fatigue
Which of the following act as opsonin and fix the complement?

Serum amyloid A
Serum acid phosphataseis raised in
Prostate cancer
The pathophysiology of hypertension involves
a) Increase autonomic activity
b) Vascularremodeling
c) Resetting of baroreceptor complex
Hodgkin’s lymphoma can be distinguished from non-Hodgkin’s lymphomas by
Reed-Sternberg cells
Which of the following correctly defines a peptic ulcer?
A benign lesionof gastric mucosa
Which of the following cell involved in cell mediated immunity?
T cells
Excess release of aldosterone results in
Retentionof salts and water in body
Which of the following factor will be the main determinant of hypertension in 70-
year-old patient?
Increase in peripheral vascularresistance
Which of the following factor will be main determinant of hypertension in 30 years
old patient?
Increase in cardiac output
The injection of tuberculin in to the skin of a sensitized individual elicits
Mantoux reaction
All the following agents aggravate the peptic ulcer except
Prostaglandins

Which of the following condition does not involve feature of granulomatous
inflammation?
a) Rheumatoid arthritis
b) Hodgkin’s disease
c) Spread in contagious lymph nodes
Hypertension cause by excess release of catecholamine’s
Secondaryhypertension
Which of the following karyotypic change is associated with CML?
Philadelphia chromosome
Tumors arising from tissues derived from one or more germ layers are known as
Teratoma
Which of the following is not a classical sign or symptom of all?
Constipation
Which of the following mediator is released from mast cell during type 1
hypersensitivity reaction
a) Leukotrienes
b) Histamines
c) Bradykinin
Septic shock is characterized by
a) Metabolic disturbances
b) Hypotension
c) Intravascularcoagulation
Chronic granuloma represents an attempt by to the body
Control the spread of chronic infection.
Tumors with higher degree of anaplasia is categorized in
Grade 4
Innate immunity is provided by
Phagocytes

The preferred noninvasive test to confirm H. pylori eradication is
a) Urea breath test
b) Acute lymphocytic leukemia
c) Cytoplasm of blast cells have periodic acid Schiff positive material
Which is not true about H. pylori infection
80% of patients with chronic infection will develop ulcer.
Which of the following agents help in adhesion of H. pylori with gastric epithelium
BabA
Granuloma formation is an example of
Cell mediated immunity
Which of the following is not the feature of dysplastic cells
a) Lack of mucin in glandular cells
b) The consequences ofhypertension include
c) Left ventricular hypertrophy
Which of the following statement is correctabout non Hodgkin’s lymphoma
Male are more frequently effectedthen females
Which of the following is not true about papilloma’s ?
Malignant tumor
Which of the following is an example of benign tumor
Meningioma
Finger like projections on mucosal surface of colon is known as
Polyps
Which of the following tumor is an example of benign mesenchymal tumor?
Myoma
Which of the following is not characteristic feature of malignant tumor?
Loss of genetic material
Which of the following statement is true about IgM of humans?

IgM is primarily restricted in circulation
Gastric ulcer is due to
Increase production of acid
stimulates cyclooxygenase that convert arachidonic acid to prostaglandins
TNF
Which of the following autoimmune condition often follow infections
Lupus and sjogrens
Which of the following feature determine the prognosis of lymphomas
a) Type of lymphomas
b) Appearance of lymphomas
c) Age of patient
Blood pressure referred to the force exerted by blood against the walls of
Arteries
All the enzymes are released by tumor cells except
Urease
Lymphocytosis is associated with
None of the given option
Which of the following tumor markers is present in patients with hepatoma
Alpha fetoprotein
Which of the following tissues can be easily envaded by tumor cells
Veins
High blood pressure is the main cause of which of these
a) Strokes
b) Kidney disease
c) Heart attacks
is responsible for raised ESR value associated with chronic inflammation

Fibrinogen
Which of the following endothelial dysfunction predisposeto hypertension?
a) Reducedgenerationof nitric oxide
Metabolic effects of tumor on organs distant from primary lesion are known as
Paraneoplasticsyndromes
Which of these can increase your risk of high blood pressure
a) Obesity
b) Smoking
c) A family history of high blood pressure
elevates COX- 2
IL- 1
Which of the following tumor marker is expressed during multiple myetoma
Immunoglobulins
Which of the following statement is not true about acute H. pylori infection
Hyperchlorhydria
Autoimmune hemolytic anemia is an example of
Type 2 hypersensitivity reaction
Helicobacter pylori bacteria
Are associatedwith peptic ulcer relapse
Cellular features in all types of classic Hodgkin’s lymphoma
Reed-Sternberg cells
The bone marrow involvement indicates which stage of lymphoma
Stage 4
In the stomach lining, the parietal cells release and the chief cells release
HCl and pepsinogen.
Which of the following malignant tumors do not metastasize. Gilomas of brain.

1-Symptoms for acute leukemia is
Bruising and bleeding easily
2-Helicobacter pylori bacteria
3-metabolic effects of tumor on organs distant from primarly lesion are known as
4-increase productionof ----------can aggravate peptic ulcer
Gastrin
5-true about eitheloid cells
Part of cell mediated immunity
6-the bone marrow involvement indicate which stage of lymphoma
Stage IV
7-which of the following factor will be the main determinant of hypertension in 30
years old patient
8-anaphylaxis can be triggered by cross-linking of lgE receptors on
Mastcells
9-AML can involve which of the following cell lineages
White blood cell
10- what is the function of somatostatin
Inhibits H+ secretion
11- which of the following blood picture characterizes aleukmic leukemia
No blast cells are seenin peripheral blood
12- which of the following cell involved in cell-mediated immunity
t-cells

13- which of the following karyotypic change is associated with CML
Philadephia chromosomes
14- high blood pressure is the main cause of which of these
All of the given option
15- TUMOR ARISING FROMTISSUES DERIVED FROM ONE OR MORE
GERM LAYERS ARE KNOWN AS
Teratoma
16- GASTRIC ULCER IS DUE TO
INCREASE PRODUCTION OF ACID
1. Which of the following factorinhibit gastric releaseby antral G Cells?
Answer: smatostatin
2. Why does reducing salt in diet help prevent high blood pressure?
Answer: it reduce fluid buildup in the body.
3. Hepcidin is responsible for---------associatedwithchronic
inflammation.
4.
Answer:None of the given option
5. Which of the following statementis correctabout lymphomas
Answer:All of the given option
6. Which of the following endothelium derived factorcauses
vasoconstriction?
Answer:Endothelin-1
7. Whichnofbthe following tumors are malignant
8. Which of the following statementis true about CCL?

Answer:Hypogmmaoglobinemia
9. Which of the following factor differentiate CML from other types of
Leukemia ?
Answer:specific chromosomaldefectthat occurin virtually all cases
10. Vasodilationfollowing a type hypersensitivity reactionis principally
causedby which molecule
Answer:histamine
11. An autoimmune response is triggeredby........?
Answer:antibodies
1) The most aggressive form of hodgkin’s lymphoma
Mixed cellularity.
2) Rh- mother carries Rh+ foetus. The foetus is at a risk of developing
Haemolytic disease
3) Which of the following condition does not involve features of
granulomatous inflammation
All of given option
4) Gastric ulcer is due to
Increasedproduction of acid
5) Leukemia and lymphoma are different categories because of their
All of given option
6) A 65 year old man who present with elevated white blood cell counts and a
high percentage of blasts in his peripheral blood is most likely to have
B-cellacute lymphoblastic leukemia
7) Is responsible for raised ESR value associated with chronic inflammation
Fibrinogen
8) Stimulate cyclooxygenase that convert arachidonic acid to prostaglandin
TNF

9) Which of the following factor will be the main determinant of the
hypertension in 70 years old patient
10) Metabolic effects of tumor on organ distant from primary lesion are
known as
Paraneoplasticsyndrome
11) Hodgkin’s lymphoma can be distinguish from non hodgkin’s
lymphomas by
Reed-sternberg cells
1. Which of these can increase your risk of high blood pressure?
a. Family history of high blood pressure
b. Smoking
c. Obesity
d. All of these optionby
2. Protective mucus layer of stomach is stimulated by
a. Bicarbonates
b. All of these option
c. Somatostatin
d, Prostaglandin
3.AML can involve which of the following cell lineages
a. White blood cell
b. Platelets
c. All of these option
d. Red autoimmunity
4.Which type of hypersensitivity reaction is Autoimmunity?

a.Type IV
b. Type II
c. Type I
d. None of these option
5.Helicobacter bacteria can live in stomach acidic condition becauseit secret
which neutralizes the acid.
a. Bicarbonate
b. Urease
c. Carbon dioxide
6. Tumor which producemacroscopically visible projection on stomach mucosa
a. Papilloma
b. None of these option
c. Adenoma
d, Polyp
7. Helicobacter pylori bacteria
8. Lymphocytosis are associated with
a. Parasitic infection
b. Bacterial infection
c. None of these option
d. Fungal infection
9.Activation of baroreceptor reflex
a. Increase sympathomimetic activity
b. Cause vasoconstriction
c. All of the given option
d. Augments vagal tone

10.Which of the following karyotype change in associated with CML.
a. Pleomorphism
b. Philadelphia chromosome
c.All of the given option
d. Tumor Specific antigen
11.which of the following is not the classical sign or symptom of all
a. repeated infection
b. constipation
c. Fatigue
d. Bone pain
12.monocytes differentiate into which kind of phagocytic cells?
a. Macrophage
b. B cell
c. T cells
d. Neutrophils
1Which is not true of H. pylori infection?
The most common cause ofpeptic ulcer disease
2.Lymphoma
None of given option
3.Rise in number of more immature neutrophils in blood is referred as;
Shift to left
4.Which of the statement true about NSAIDS?
All of given option

5.The concequenceof hypertension include
All of given option
All of given option
7.In the stomach linig the parietal cells release ---and the chief cell release-----
Hydrochloric acidand pepsinogen
8.which of the following characteristic features distinguish epitheloid cells from
macrophages
All of given option
9.contact dermatitis is an example of a
Type Iv
10. which of the following feature describes the stage of cancer
All of given option
11. which of the following enzyme is constitutively expressed in stomach and
helps in production of prostaglandins
COX1
12. WHICH OF THE following statements is true about the IgM of humans?
IgM is primarily restricted in the circulation
13. Rh- mother carries Rh+ foetus. The foetus is at a risk of developing
Haemoltic disease
14 all of given enzymes are released by tumor cells except:
Plasminogenactivator
15. stimulates cyclooxygenasethat convert arachidonic acid to prostaglandins:
TNF
16. autoimmune condition
Lupus and sjogrens

17. blood pressurerefers to the force exerted by blood against walls of:
Arteries
18. gastric ulcer is due to:
Breakdownofmucosaldefence
19. true about dyplasia:
Reversible if inciting stimulus is removed
20. which of the following endothelial dysfunction predisposeto hypertension
Reducedgenerationof nitric acid
21. Following factors play a role in peptic ulcer disease except:
somatostatin
Q=Which of the following is an example of benign mesenchymal tumors.
A. Benign tumor of cartilage
B. All of the given options
C. Benign tumor of uterine smooth muscles
D. Benign tumor of subcutaneous tissues
Q= which of the following factors are associated with development of leukemia.
A. All of the given options
B. Cytotoxic drugs
C. Immune deficiency
D. Exposure to High levels of benzene
Q= Granulomatous inflammation is associated with those offending agent which
are.
Difficult to eradicate by immune cells

Q= The major effector molecules involved in type IV hypersensitivity reactions
are.
Cytokines
Q= Septic shockis characterized by.
A. Metabolic disturbances
B. Intravascular coagulation
C. Hypertension
D. All of the given options
Q= high blood pressure hypertension is called the silent killer because.
It usually has no obvious symptoms
Q= Helicobacter pyloric can live in the stomach acidic condition becauseit
secrets…. WhWhich neutralize the acid
Urease
Q= Leucocytosis associated with inflammation is known as.
Leukemoid reaction
Q= Cytokine induced systemic reaction is called.
Acute phase response
Q= Which of the following features distinguishes CML from Leukemoid reaction.
A. Elevated granulocyte count
B. Blast cells
C. Philadelphia chromosome
D. All of the given options

E. Which of the following factors will be main determinant of hypertension in a
70 year old male patient?
Increasedperipheral vascularresistance
F. Metabolic effects of tumor on organs distant from primary lesions are known
as:
ParaneoplasticSyndrome
G. Hodgkin's lymphoma can be distinguished from non hodgkin's lymphomas
by:
Reedstemberg cells
H. Which of the following statement is true about NSAIDS?
All of the given options
I. Which of the following tissues can be easily envaded by tumor cells?
J. Which of the following inhibits the release of renin?
a-adrenoceptorstimulation
K. Which of the following factors inhibiting the release of gastrin by antral G-
cells?
Somatostatin
L. What is the function of somatostatin?
Inhibits H+ secretion
M. Which of the following tumor Marker is expressed during multiple
myeloma?
Immunoglobulins
N. Pruritus, rhinorrhea and sneezing caused by animal dander are mostlikely
the example of?
Type 1 hypersensitivity reactions.
O. Increase productionof Can aggravate peptic ulcer? Gastrin

P. Which of the following risk factors are associated with essential
hypertension?
None of the given options
Q. Activation of baroreceptor reflex:
All given options.
Which of the following cells of the immune system do not perform phagocytosis?
Basophill.
Which of the following statement is correctabout Reno medullary system.
Medullipin II exerts a prolonged hypotensive effect.

1-Symptoms for acute leukemia is
Bruising and bleeding easily
2-Helicobacter pylori bacteria
3-metabolic effects of tumor on organs distant from primarly lesion are known as
4-increase productionof ----------can aggravate peptic ulcer
Gastrin
5-true about eitheloid cells
Part of cell mediated immunity
6-the bone marrow involvement indicate which stage of lymphoma
Stage IV
7-which of the following factor will be the main determinant of hypertension in 30
years old patient
8-anaphylaxis can be triggered by cross-linking of lgE receptors on
Mastcells
9-AML can involve which of the following cell lineages
10- what is the function of somatostatin
Inhibits histamine and gastrin releasing cells
11- which of the following blood picture characterizes aleukmic leukemia
No blast cells are seenin peripheral blood
12- which of the following cell involved in cell-mediated immunity
t-cells
13- which of the following karyotypic change is associated with CML

Philadephia chromosomes
14- high blood pressure is the main cause of which of these
All of the given option
15- TUMOR ARISING FROMTISSUES DERIVED FROM ONE OR MORE
GERM LAYERS ARE KNOWN AS
Teratoma
16- GASTRIC ULCER IS DUE TO
INCREASE PRODUCTION OF ACID
17- WHICH IS NOT TRUE OF H-PYLORI INFECTION
THE MOST COMMON CAUSE OF PEPTIC ULCER DISEASE
1. Which of the following factorinhibit gastric releaseby antral GCells?
Answer: smatostatin
2. Why does reducing salt in diet help prevent high blood pressure?
Answer: it reduce fluid buildup in the body.
3. Hepcidin is responsible for---------associatedwithchronic
inflammation.
4.
Answer:None of the given option
5. Which of the following statementis correctabout lymphomas
6. Which of the following endothelium derived factor causes
vasoconstriction?
Answer:Endothelin-1
7. Whichnofbthe following tumors are malignant

8. Which of the following statementis true about CCL?
Answer:Hypogmmaoglobinemia
9. Which of the following factordifferentiate CML from other types of
Leukemia ?
Answer:specific chromosomaldefectthat occurin virtually all cases
10. Vasodilationfollowing a type hypersensitivity reactionis principally
causedby which molecule
Answer:histamine
11. An autoimmune response is triggeredby........?
Answer:antibodies
1) The most aggressive form of hodgkin’s lymphoma
Diffuse large B cell lymphoma
2) Rh- mother carries Rh+ foetus. The foetus is at a risk of developing
Haemolytic disease
3) Which of the following condition does not involve features of
granulomatous inflammation
All of given option
4) Gastric ulcer is due to
Increasedproduction of acid
5) Leukemia and lymphoma are different categories because of their
All of given option
6) A 65 year old man who present with elevated white blood cell counts and a
high percentage of blasts in his peripheral blood is most likely to have
B-cellacute lymphoblastic leukemia
7) Is responsible for raised ESR value associated with chronic inflammation
Fibrinogen
8) Stimulate cyclooxygenase that convert arachidonic acid to prostaglandin

TNF
9) Which of the following factor will be the main determinant of the
hypertension in 70 years old patient
10) Metabolic effects of tumor on organ distant from primary lesion are
known as
Paraneoplasticsyndrome
11) Hodgkin’s lymphoma can be distinguish from non hodgkin’s
lymphomas by
Reed-sternberg cells
1. Which of these can increase your risk of high blood pressure?
a. Family history of high blood pressure
b. Smoking
c. Obesity
d. All of these optionby
2. Protective mucus layer of stomach is stimulated by
a. Bicarbonates
b. All of these option
c. Somatostatin
d, Prostaglandin
a. White blood cell
b. Platelets
c. All of these option
d. Red autoimmunity

4.Which type of hypersensitivity reaction is Autoimmunity?
a.Type IV
b. Type II
c. Type I
d. None of these option
5.Helicobacter bacteria can live in stomach acidic condition becauseit secret
a. Bicarbonate
b. Urease
c. Carbon dioxide
6. Tumor which producemacroscopically visible projection on stomach mucosa
a. Papilloma
b. None of these option
c. Adenoma
d, Polyp
7. Helicobacter pylori bacteria
8. Lymphocytosis are associated with
a. Parasitic infection
b. Bacterial infection
c. None of these option
d. Fungal infection
9.Activation of baroreceptor reflex
a. Increase sympathomimetic activity
b. Cause vasoconstriction
c. All of the given option

d. Augments vagal tone
10.Which of the following karyotype change in associated with CML.
a. Pleomorphism
b. Philadelphia chromosome
c.All of the given option
d. Tumor Specific antigen
11.which of the following is not the classical sign or symptom of all
a. repeated infection
b. constipation
c. Fatigue
d. Bone pain
12.monocytes differentiate into which kind of phagocytic cells?
a. Macrophage
b. B cell
c. T cells
d. Neutrophils
1Which is not true of H. pylori infection?
The most common cause ofpeptic ulcer disease
2.Lymphoma
None of given option
3.Rise in number of more immature neutrophils in blood is referred as;
Shift to left
4.Which of the statement true about NSAIDS?

All of given option
5.The concequenceof hypertension include
All of given option
All of given option
7.In the stomach linig the parietal cells release ---and the chief cell release-----
Hydrochloric acidand pepsinogen
8.which of the following characteristic features distinguish epitheloid cells from
macrophages
All of given option
9.contact dermatitis is an example of a
Type Iv
10. which of the following feature describes the stage of cancer
All of given option
11. which of the following enzyme is constitutively expressed in stomach and
helps in production of prostaglandins
COX2
12. WHICH OF THE following statements is true about the IgM of humans?
IgM is primarily restricted in the circulation
13. Rh- mother carries Rh+ foetus. The foetus is at a risk of developing
Haemoltic disease
14 all of given enzymes are released by tumor cells except:
Plasminogenactivator
15. stimulates cyclooxygenasethat convert arachidonic acid to prostaglandins:
TNF
16. autoimmune condition

Lupus and sjogrens
17. blood pressurerefers to the force exerted by blood against walls of:
Arteries
18. gastric ulcer is due to:
Breakdownofmucosaldefence
19. true about dyplasia:
Reversible if inciting stimulus is removed
20. which of the following endothelial dysfunction predisposeto hypertension
All of given option
21. Following factors play a role in peptic ulcer disease except:
somatostatin
Q=Which of the following is an example of benign mesenchymal tumors.
A. Benign tumor of cartilage
B. All of the given options
C. Benign tumor of uterine smooth muscles
D. Benign tumor of subcutaneous tissues
Q= which of the following factors are associated with development of leukemia.
A. All of the given options
B. Cytotoxic drugs
C. Immune deficiency
D. Exposure to High levels of benzene
Q= Granulomatous inflammation is associated with those offending agent which
are.
Difficult to eradicate by immune cells

E. Which of the following factors will be main determinant of hypertension in a
70 year old male patient?
Increasedperipheral vascularresistance
F. Metabolic effects of tumor on organs distant from primary lesions are known
as:
ParaneoplasticSyndrome
G. Hodgkin's lymphoma can be distinguished from non hodgkin's lymphomas
by:
Reedstemberg cells
H. Which of the following statement is true about NSAIDS?
I. Which of the following tissues can be easily envaded by tumor cells?
J. Which of the following inhibits the release of renin?
a-a drenoceptorstimulation
K. Which of the following factors inhibiting the release of gastrin by antral G-
cells?
Somatostatin
L. What is the function of somatostatin?
Inhibits histamine and gastrin releasing cells
M. Which of the following tumor Marker is expressed during multiple
myeloma?
Immunoglobulins
N. Pruritus, rhinorrhea and sneezing caused by animal dander are mostlikely
the example of?
Type 1 hypersensitivity reactions.
O. Increase productionof Can aggravate peptic ulcer? Gastrin

P. Which of the following risk factors are associated with essential
hypertension?
None of the given options
Q. Activation of baroreceptor reflex:
Augments vagaltone

 Which of the following feature is associated with septic shock All
of these
 Snake bite patient... Type2
 Which of the example of benign mesenchymal tumor Ans: All of
the given option
 Innate immunity is provided by
 Important risk factor In ulcer:Non steroidal anti inflammatory
drugs Nsaids
 is responsible for anemia associated chronic inflammation Answer
hepicidin
 Opsonin and fix complement Serum amyloid A
 An important risk factor for peptic ulcer hemorrhage includes
Answer : smoking
 At what point is blood pressure considered "high" *Ans* All of
the given options
 Which of the following mediator is responsible for raised body
temperature during inflammation PGE2
 Which of the following cells of the immune system do not perform
phagocytosis Basophil
 Leucocytosis associated with inflammation is known as:
leukemoid reaction
 Risk or high blood pressure *all of these*
 Which of the following tumors are malignant..? Liposarcoma
 Does not involve features of granulomatous inflammation:
Rheumatoid arthritis
 leucocytosis associated with inflammation is known as leukemoid
reaction
 Condition does not involve features of granulomatus
inflammation
 At what point is blood pressure high. All
 granulomatous iflamtion is assoosiated ans is difficult to eradicate
 Characterizes Aleukmic leukemia No blasts cell are seen
 Which of the following tumor marker is expressed during multiple
myeoloma*? *Alpha feto protein*

 Which of the following mediator is released from mast cell s
during type 1 hypersensitivity reaction ans.....all of the given
option
 Masooma Uol: risk factor for peptic ulcer NSAID
 Which hypersensitivity cannot transfer antibody serum Type 4
 Helicobacter pylori bacteria? Are assosiated with peptic ulcer
 Responsible for raised ESR hepcidin
 Septic shock is characterized by All of the given option
 Dr. Iqra Uol: Mast cell type 1 hypertensitivity mediator.
Ans.All.of the given option
 Hamza Most aggressive of hodgkin's Answer : diffuse large B
 Which of the following complication is associated with peptic
ulcer. Ans. All of given option
 What is the most common No symtoms
 Vasodilation following type 1 hypersensitivity is caused by which
molecule? Histamine
 Lymphocytes is associated with Ans: none of the given option
 Which of the following act as opsonin Serum Amyloid A
 autoimmune hemolytic anemia is example of answer:Type2
 Which of the following risk factor is associated with essential
hypertension Renel failure
 Which type of hypersensitivity reaction is auto-immunity? Ans:
Type II
 Which of the following mailgnant tumor do not
metasatzi...leomyoma
 Which of the following tumor markers is present in patients with
hepatoma: Ans Alpha fetoprotein
 Tumor marker is present in patient with hematoma Answer alpha
fetoprotein
 Contact dermatitis is example of a Type4
 Vasodilation following a type 1 hypersensitivity reation is
principally caused by which molecule. Histamine
 Zil Uol: Hodgenkin disease Spread in contiguous lymph nodes
 Exotoxin induces stomach cell apoptosis..ANS VaCA

 Amir Razzaq Z Uol: protective mucus layer by of stomach is Ans
prostaglandins
 Symptom of acute leukemia is None
 Which of the following autoimmune conditions often follow
infections, ANSWER LUPUS ABD SJOGREN,s
 Amir Rai Uol 4b: the major effector molecules involved in type 4
hypersensitivity reactions are
 complement components
 Which of the following enzyme is constitutively expressed in
stomach and help in production of prostaglandine Cox1
 Hodgkins lymphoma can be distinguish from non Hodgkins....
Reed sternberg
 Which of the following autoimmune condition often follow
infection Ans lopus sojogren
 Feature associated with peptic shock~~~ All given option
 Which of the following factors main determinat 30year
hypertension patient? Increase vascular resistance
 increase producation of can aggrevate peptic ulcer answer.
gastrin
 Simulant release of renin B andernocetor
 High blood pressure (hypertension) is called silent killer bcz Ans
is it usually has no obvious symptoms
 Which of the following karyotypic change with CML:
PHILADELPHIA CHROMOSOME
 the major effector molecules involved in type 4 hypersensitivity
reactions are complement components
 Excess release of aldestron results in Retention of salt n water in
body
 Helicobater pylori can live in the stomach.....ans.Urease
 Contact dermatitis is example of type4
 Which of the following is no classic sign or symptom of All is
constipation Constipation
 Metabolic effect of tumor on organ distance from primary lesion
are....*Malignancy*

 Which of the following mediator is released from mast cell during
type 1 hypersensitivity ( histamin)
 Which if the following stumulate th release of renin B
adrenoceptor
 Cellular features in all types of Hodgkin's lymphoma.. Ans reed
 Acute lymphocytic leukaemia ALL.
 Cytoplasm of blast cells have periodic acid schiff positive
material
 Which of the following statement is true about eitheloid cells: a
part of cell mediaated immunity...
 The bone marrow involvement indicate which stage of
Lymphoma? stage IV
 Stimulate cyclooxygenase that convert... TNF
 Which of the following feature describes the stage of cancer: and.
All of the given options.
 Cellular features in all types of Hodgkin's lymphoma..Reed
sternberg cells
 Hodgkin's lymphoma can be distinguish from non Hodgkin's.....
Reed sternberg cells
 which of the following statement is correct about NHL males
are more affected then females have
 Markers for hepatoma are: Alpha fetoproteins
 Acute lymphotic leukemia (ALL) : *Auer rods are present..
 Blood picture charaterizes aleukmic leukemia: No blast cells seen
in peripheral blood
 Which of the following factor will be the main determinant of
hypertension in 30 year old patient: Increase in cardiac output
 Rickettsiael infections are associated with :::: leukopenia
 act as a marker of myocardial infarction............
Answer: C reactive protein
 : CLL Lymphopenia
 Serum acid is raised in prostate cancer
 Which of the following factor will be the main determinant of
hypertension in 30 year old patient: Increase in cardiac output
 Serum acid release is raised in prostate cancer

 Inhibit release of renin Alpha adrenoreceptor
 Septic shock is........all of them

MCQ`s
Tumors covered by stratified squamous epithelium within gall bladder will be
known as
none of the given option
which of the following is an example of malignant tumor:
all of the given options
which of the following feature describes grade of tumor
cell differentiation
which of the following is not characteristic feature of malignant tumors:
loss of genetic material
epithelial tumors arising epithelium of glands, having non glandular pattern:
adenocarcinoma
which of the following is an example of benign tumor:
meningioma
which of the following tumor is an example of benign mesenchymal tumor:
myoma
which of the following tissues are resistant for spread of cancer?
Elastic fibres
finger like projections on mucosal surface of colon are known as:
polyp
which of the following is not true about papilommas:
malignant tumors
an autoimmune responseis triggered by the?:

antibodies
systemic inflammation with itchy rash two days after the administration of serum
immunoglobulins in a snake bite patient is an example of:
Type III hypersensitivity
Lupus is caused by
IgG and IgM
Pruritus, rhinorrhea and sneezing caused by animal dander is most likely an
example of:
Type I hypersensitivity
vasodilation following a Type 1 hypersensitivity reaction is principally caused by
which molecule?
Histamine
contact dermatitis is an example of
type IV/cell mediated hypersensitivity reaction
autoimmune hemolytic anemia is an example of
type II hypersensitivity reaction
which of the following autoimmune conditions often follow infections
Lupus and Sjorgen`s
which of the following mediator is released from mast cells during type I
hypersensitivity reaction?
which type of hypersensitivity reaction is auto immunity
type II

which of the following mediator is responsible for raised bodytemperature during
inflammation
PGE 2
……. simulate cyclooxygenase that convert arachidonic acid to prostaglandins:
TNF
…….. is responsible for anemia associated with chronic inflammation
Hepcidin
all of the given conditions involve features of granulomatous inflammation except
none of the given options
which of the following act as opsonin and fix the complement
serum amyloid A
……….. act as a marker of myocardial infarction
C reactive protein
lymphocytosis is associated with
viral infections
which of the following statement is true about epithelioid cells
Leucocytosis associated with inflammation is known as
leukemoid reaction
following feature are associated with septic shockexcept
hypertension
granulomatous inflammation is associated with those offending agent which are
difficult to eradicate by immune cells

septic shockis characterized by
which of the following condition does not involve features of granulomatous
inflammation
rheumatoid arthritis
granuloma formation is an example of
cell mediated immunity
simulates cyclooxygenase that convert arachidonic acid to prostaglandins
IL-1
rise in number of more immature neutrophils in blood is referred as
shift to the left
hepcidin is responsible for......... associated with chronic inflammation
cytokines induced systemic reaction is called
acute phase response
which of the following characteristic features distinguish epithelioid cells from
macrophages
rickettsiael infections are associated with
leukopenia

1.Monocytesmove fromthe systemiccirculatorysysteminti general connectivetissue,where
theydifferntiate intowhatphagocyticcell type.
.Macrophages
2 .Whichof the followingisnot true about Neutrophil.
.Neutrophil are APCs
3.Naturallyacquiredactive immunitywouldbe most likely acquired throughwhichof the
followingprocesses.
.infectionwithdisease causingorganism followedby recovery
4.Whichof the followingisfalse relatedtoT cells
.Th2 will activate cytotoxic T cells
.Th1 will activate B cellscell
5.Which of the followingisNOTaninnate defense mechanismof the body.
. B lymphocytes
6. The funtionof marcophage is
.all of the above
7.Whichof the followingimmunecells/moleculesare most effectiveat desrtroying
intracellularpathogen ?
.T cytolyticcells
8.Regardingapoptosis,whichof the followingis false?
.associatedwith inflammation
9.Metaplasiais
.isthe process that occurs in Barrett's oesophagitis
10.Whichof the followingistrue about CytotoxicTcells
Both A and B
11.The special enzymesare releasedduringnecrosis from.
.lysosomes
12.Whichof the followingisnotone of the three mainantigen-presentingcelltypes

.Basophil
13.Hypertrophy .
.is triggeredby mechanical and trophic chemical
14.Whichof the followinggene iscalled as Guardianof genome
.p53 gene
15.WHich of the followingisantiapoptoticgene .
.BC12
16.Whichof the followingisnotto protocogenes.
.all are true.
17.Active artificiallyacquiredimmunityisaresult of.
.vaccination.
18. In protooncogenes. ..... mulationwill happentodevelop cancer.
.gain of functionmutation.
19.Coagulative necrosisusuallyresult from.
.ischemia.
20........ isconsideredasglobal trancription factor.
.MYC.
21. RAASprotienisactivatedwhenitisattach with.......
.GTP.
22...............are mulatedformof protooncogenes.
.oncogenes.
23. RP protienphosphorylation.
.promote trancripition of genes.
24.RAS activate MYCby.
.phosphylation.

25.Withreqardsof mechanismsof cellularadaptationwhichof the followingstatementsis
TRUE.
.swellingisassociatedwith necrosis.
26.What isthe role of the caspasesin apoptosis.
.caspases are proteasesthat carry out of controlleddestructionof the cellscomponents
during apoptosis.
27.Whichof the followingisresponsibleforthe phosphorylationof RB protien.
cycline dependentkinase.
28. Whichof the followingisassociatedwithextrensicpathwayof apoptosisonly.
T cell associatedapoptosis.
29.The effectof antidiuretichormone(ADH) onthe kidneyis to.
Increase the permeabilityofdistal nephronto H2O
31. The case of example involovedaninmate beingseeninnurse sickcall forcomplaintsof nasal
allergiesandrecentbackstrainhisbloodpressure is148/90mm Hg. at intake amonthago his
bloodpressure was154/92mm Hg.
baseduponthe readingtodaythispatientisat whatstage of hypertension?
Stage 1 hypertension
32.K+ excreationismarkedlyinfluenced by.
Aldosteron
33.Whichof the followingisnota possible role of ubiquitin?
Directs proteinsynthesis
34.Reninisreleasedfromthe kidneyinresponse to......
Low renal perfusion
35.Baroreceptorsof carotidsinusand aorticarh and sensitive to;
Increase in systolicpressure
36. The main physiological stimulusforthe release activationpf reninangiotesinaldosterone
system(RAAS)is.

Blood volume
37.Whichof the followingisfalse aboutthe Gasteric Secretions.
All are true
38.Whichof the followingiscorrectaboutpeptic ulcer
Gastric ulcerpain mostly happenat night
40.The layeroftissue beneathof mucosa is
Submucosa
41.What iswrong about H pylori
It use urease enzyme to neuralise acid by convertingammonia into urea and CO2
43.Which of followingisfalse aboutparietal cells
Sodiumhydrogen pump for acid secretionispresenton lumenal side pfparietal side
43.The physicianordera patientswitha duodenal ulcer....pylori ispresent?
Carbondioxide
44.Foldsinmucosaof stomachare called.....which allows....
Rugae, increase .
45.What isthe wrongaboutCOX1 and COX2 enzymes
COx enzyme isinducible
47.Withregardstomechanismof cellularadaptationwhichis true
Swellingisassociatedwith necrosis
48.Whichof followngisassociatedwithextrinsicpathwayof apoptosis
T cellsassociatedapoptosis
49.Coagulative necrosisusually results
Ischemia
50.The special enzymesare releasedduring necrosis
Lysosomes

51.Whichof the followingusnotan innate defensemechanismof body
Lymphocytes
52.Whichof the followingexpressfirst onWBCsfortransmigration
selectin
53.hicho the followingisfalse relatedtoT cells
All are ture
55.Whichof the followingistrue about exudate
RBCs may present
56.Histamine cause
Both A and B
57.csMacrophagesare derived from
Monocytes
58.Rb protein phospyorylation
Promote transcriptionof gene
59.Whichof the followingisnotbelongto protocogensis
All
60.In sporadicRatinoblastoma initially
Both the allele are normal
61Which of the followingisresponsible forthe phosphylationof Rb protein
Cyclic dependantkinase
62.Loss of functionmutationinGTPase can cause
Over activation
63.What istrue relatedtoP53 gene
All are true
65.Beta cartaninexample of

Protocogenes
66.Whenthere isno furthermutation....genewillneactivated to.....
MDM2 inhibitPS3 protein
1. What is the goal of the renin-angiotensin-aldosterone system (RAAS)?
A. Decrease blood pressure
B. Increase the heart rate
C. Increase the blood pressure
D. Decrease the heart rate
2. When the RAAS is activated due to a change in body hemodynamics, the
stimulates the cells in the kidneys to release .
A. parasympathetic nervous system; mesangial; aldosterone
B. sympathetic nervous system; podocytes; renin
C. parasympathetic nervous system; juxtaglomerular; aldosterone
D. sympathetic nervous system; juxtaglomerular; renin
3. What component of the RAAS (renin-angiotensin-aldosterone system) is created and found in
the liver that is activated by renin?
A. Aldosterone
B. Angiotensin I
C. Angiotensinogen
D. Angiotensin II
4. What is the role of ACE in the renin-angiotensin-aldosteronesystem?
A. It activates angiotensinogen which turns into angiotensin I.
B. It causes the kidney cells to release renin.
C. It causes angiotensin II to trigger the adrenal glands to produce aldosterone.
D. It converts angiotensin I into angiotensin II.
5. Select all the roles of angiotensin II when it is activated in the renin-angiotensin-aldosterone
system:
A. Activates bradykinin
B. Triggers the release of aldosterone
C. Increases the blood volume
D. Causes vasodilation
E. Increases systemic vascular resistance
F. Causes the release of ADH (antidiuretic hormone)
6. During RAAS activation, what gland releases aldosterone?
A. Hypothalamus
B. Thymus
C. Adrenal cortex
D. Pituitary
7. What is the role of aldosterone?
A. It causes constriction of vessels.
B. It causes the kidneys to keep sodium andwater.
C. It causes the kidneys to keep potassium and water.
D. It causes the kidneys to only keep water.

8. During the renin-angiotensin-aldosterone system activation, what gland releases antidiuretic
hormone (ADH)?
A. Pituitary
B. Thyroid
C. Hypothalamus
D. Adrenal cortex
9. What is the role of the antidiuretic hormone during RAAS?
A. Causes the kidneys to keep water
B. Leads to vasoconstriction of vessels
C. Activates the release of angiotensin I
D. Prevents the activation of the parasympathetic nervous system
10. Select belowthe CORRECT sequence in howthe renin-angiotensin-aldosteronesystemworks:
A. Angiotensin I -> Angiotensin II -> ACE -> Renin -> Angiotensinogen
B. Renin-> Angiotensinogen -> Angiotensin I -> ACE-> Angiotensin II
C. Renin -> Angiotensin I -> Angiotensinogen -> ACE -> Angiotensin II
D. Angiotensinogen -> Renin -> ACE -> Angiotensin I -> Angiotensin II
1. In the stomach lining, the parietal cells release and the chief cellsrelease
which both play a role in peptic ulcer disease.
A. pepsin, hydrochloric acid
B. pepsinogen, pepsin
C. pepsinogen, gastric acid
D. hydrochloric acid, and pepsinogen
2. A patient has developed a duodenal ulcer. As the nurse, you knowthat which of the following
plays a role in peptic ulcer formation. Select ALL that apply:
A. Spicy foods
B. Helicobacter pylori
C. NSAIDs
D. Milk
E. Zollinger-Ellison Syndrome
3. You're educating a group of patients at an outpatient clinicabout peptic ulcerformation. Which
statement is correct about how peptic ulcers form?
A. "An increase in gastric acid is the sole cause of peptic ulcer formation."
B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes
histamine tobe releasedwhich signals tothe parietal cells torelease more hydrochloric acid which
erodes the stomach lining further."
C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be
released which signals to the parietal cells to release more pepsinogen which erodes the stomach lining
further."
D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form."
4. Your patient is diagnosedwith peptic ulcerdisease due toh.pylori. This bacterium has a unique
shape which allows it to penetrate the stomach mucosa. You knowthis bacterium is:
A. Rod shaped
B. Spherical shaped
C. Spiral shaped
D. Filamentous shaped

5. Helicobacter pylori can live in the stomach's acidic conditions because it secretes
A. ammonia
B. urease
C. carbon dioxide
D. bicarbonate
6. The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value
will the test measure to determine if h. pylori is present?
A. Ammonia
B. Urea
C. Hydrochloric acid
D. Carbon dioxide
7. A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain
to be relieved by food intake. In addition, the patient reports awaking in the middle of the night
with a gnawing pain in the stomach. Based on the patient's description this appears to be what
type of peptic ulcer?
A. Duodenal
B. Gastric
C. Esophageal
D. Refractory
8. A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting
nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely
experiencing?
A. Gastroparesis
B. Fascia dehiscence
C. Dumping Syndrome
D. Somogyi effect
9. Thinking back to the patient in question 8, select ALL the correct statements on how to educate this
patient about decreasing their symptoms:
A. "It is best to eat 3 large meals a day rather than small frequent meals."
B. "After eating a meal lie down for 30 minutes."
C. "Eat a diet high in protein, fiber, and low in carbs."
D. "Be sure to drink at least 16 oz. of milk with meals."
10. A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to
advance the patient’s diet to solid foods. The patient's lunch tray arrives. Which food should the
patient avoid eating?
A. Orange
B. Milk
C. White rice
D. Banana
11. Which statement is INCORRECT about Histamine-receptor blockers?
A. "H2 blockers block histamine which causes the chief cells to decrease the secretion of
hydrochloric acid."
B. "Ranitidine and Famotidine are two types of histamine-receptor blocker medications."
C. "Antacids and H2 blockers should not be given together."
D. All the statements are CORRECT.

12. You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which
statement by the patient demonstrates they understand howto take this medication?
A. "I will take this medication at the same time I take Ranitidine."
B. "I will always take this medication on an empty stomach."
C. "It is best to take this medication with antacids."
D. "I will take this medication once a week."
13. Select all the medications a physician may order to treat a H. Pylori infection that is causing a
peptic ulcer?
A. Proton-Pump Inhibitors
B. Antacids
C. Anticholinergics
D. 5-Aminosalicylates
E. Antibiotics
F. H2 Blockers
G. Bismuth Subsalicylates
14. A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which
medication is considered a PPI?
A. Pantoprazole
B. Famotidine
C. Magnesium Hydroxide
D. Metronidazole
15. A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment
of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication
may this patient be experiencing?
A. Obstruction of pylorus
B. Upper gastrointestinal bleeding
C. Perforation
D. Peritonitis
1. In hypoxic cell injury, cell swelling occurs because of increased intracellular:
A. lipid
B. protein
C. glycogen
D. lipofuscin
E. water
2. Which of the following is a feature of apoptosis?
A. Karyolysis
B. Cellular swelling
C. Involvement of a large number of cells
D. Chromatin condensation
E. Associated inflammatory changes
3. Which of the following is NOT a feature of reversible cell injury?
A. Cellular swelling
B. Reduction of ATP synthesis
C. Reduced cellular pH
D. Clumping of nuclear chromatin
E. Defects in cell membrane

4. Fatty change:
A. Is irreversible
B. Does not impair cellular function
C. Is most commonly due to diabetes
D. Is caused by alcohol by an increase in intracellular alpha glycero phosphate
E. Only occurs in the liver
5. Metastatic calcification:
A. Is encountered in areas of necrosis.
B. Commonly develops in aging or damaged heart valves.
C. Can occur with normal serum levels of calcium.
D. Can be associated with metastatic malignancy.
E. Is commonly associated with hypoparathyroidism.
6. Regarding apoptosis, which of the following is FALS E?
A. It is the responsible for programmed destruction of cells during embryogenesis.
B. Occurs in pathologic atrophy in parenchymal organs after duct destruction.
C. Cell death by cytotoxic T cells.
D. Associated with inflammation
E. Chromatin condensation and fragmentation are features.
7. With regard to mechanisms of cellular adaptation, which of the following statements is TRU E?
A. Hyperplasia refers to an increase in cell size.
B. TNF always acts as an inhibitor of hyperplasia.
C. The myocardium adapts to increased workload by hypertrophy and hyperplasia
D. Metaplasia is irreversible.
E. Barrett's metaplasia is squamous to columnar epithelium in the distal oesophagus
8. With regard to acute inflammation which of the following is FALS E?
A. Pavementing of leukocytes must occur.
B. The loss of protein from plasma reduces intravascular osmotic pressure.
C. Transmigration of leukocytes occurs as a result of pseudopod formation.
D. P-selectin is found in Weibel-palade bodies.
E. P-selectin is found in Weibel-palade bodies. Leukocyte diapedesis occurs predominantly in the
venules.
9. Which of the following statements about angiogenesis is FALS E?
A. PDGF selectively induces hyperplasia of lymphatic tissue
B. New vessels bud from pre-existing vessels
C. There is proteolytic degradation of the parent vessel basement membrane
D. New vessels are leaky due to incompletely formed inter-endothelial junctions
E. VEGF receptors are largely restricted to endothelial cells
10. In the mononuclear phagocyte system:
A. Aggregations of macrophages in the kidney are known as Kupffer cells
B. The life span of tissue macrophages is about three days.
C. The half-life of blood monocytes is about one month.
D. Chemotactic stimuli for monocytes include C5a and certain growth factors
E. Monocytes transform into smaller macrophages when they reach extravascular tissue.
11. In primary wound healing:
A. Macrophage infiltration occurs at 24hrs
B. Wound strength is 25% of normal at the end of first week

C. Type I collagen is replaced by type III collagen
D. Neovascularisation is maximal at day five
E. All of the above

1. Regarding apoptosis , which of the following is false? Associated with
inflammation.
2. What is the role of caspases in apoptosis caspases areproteasesthat
carry out the controlled destruction of the cell’s components during
apoptosis.
3. Which of the following is the anti apoptotic gene? BCL2
4. The special enzymes are release durung the necrosis from lysosomes
5. Which of the following is associated with extrinsic pathway of
apoptosis only t cell associated apoptosis
6. Metaplasia is it is typically and irreversible process and is the process
that occurs in barretts oesophagitis both c and d
7. hypertrophy is triggered by mechanical and trophic chemicals.
8. With regard to mechanism of the cellular adaptation , which of the
following statements is TRUE? SWELLING IS ASSOCIATED WITH
NECROSIS
9. Coagulative Necrosis Usually results from: ischemia
10.Which of the following is true about cytotoxic T cells. THEYARE
ALSO CALLED AS CD8+ CELLS
11.WHICH OF THE FOLLOWING IS FALSE RELATED TO T CELLS TH2 WILL
ACTIVATE CYTOTOXIC T CELLS AND TH1 WILL ACTIVATE BCELLS
12.WHICH OF THE FOLLOWING IS NOT TRUE ABOUT NEUTROPHIL
NEUTROPHIL ARE APCs
13.NATURALLY ACQUIRED ACTIVE IMMUNITY WOULD BE MOST LIKELY
ACQUIRED THROUGH WHICH OF THE FOLLOWING PROCESS ?
INFECTION WITH DISEASE CAUSING ORGANISM FOLLOWED BY
RECOVERY
14.ACTIVE ARTIFICIALLY ACQUIRED IMMUNITY IS A RESULT OF
VACCINATION

15.WHICH OF THE FOLLOWING IMMUNE CELLS MOLECULES ARE
MOST EFFECTIVE AT DESTROYING INTRACELLULAR PATHOGENS? T
CYTOTOXIC CELLS
16.MONOCYTES MOVE FROM THE SYSTEMIC CIRCULATORY SYSTEM
INTO GENERAL CONNECTIVE TISSUES , WHERE THEY DIFFERENTIATE
INTO WHAT PHAGOCYTIC CELL TYPE ? MACROPHAGES
17.WHICH OF THE FOLLOWING IS NOT ONE THE THREE MAIN ANTI
GEN PRESENTING CELL TYPES ? BASOPHILS
18. THE FUNCTION OF MACROPHAGE IS ALL OF THE ABOVE
19.WHICH OF THE FOLLOWING IS NOT AN INNATE DEFENCE
MECHANISM OF THE BODY? B LYMPHOCYTES
20.WHICH OF THE FOLLOWING EXPRESSES FIRST ON THE WBCs FOR
THE TRANMIGRATION ? PCAM
21.WHICH OF THE FOLLOWING CELL MEDIATORS ARE INVOLVED IN
GIANT CEL GRANULOMATOUS INFLAMMATION?
22.WHICH OF THE FOLLOEING IS TRUE ABOUT EXUDATE? RBCs MAY
PRESENT
23. HISTAMINE CAUSE ALL ARE TRUE
24. CsMACROPHAGES ARE DERIVED FROM MONOCYTE
25.WHICH OF THE FOLLOWING EFFECT OF INFLAMMATION IS
ASSOCIATED WITH CHEMOTACIS AND STIMULATE ADHESION
MOLECULES ? IL1 AND TNF
26.RB PROTEIN PHOSPHORYLATION PROMOTE TRANSCRIPTION OF
GENES.
27. RAS PROTEIN IS ACTIVATED WHEN IT IS ATTACH WITH GTPASE
28. ARE MUTATED FORM OF PROTO ONCO GENES ONCOGENES
29. IS CONSIDERED AS GLOBAL TRANCRIPTION FACTOR MYC

BEACAUSE OFHYPERALDOSTERONISM
30.WHICH OF THE FOLLOWING IS NOT BELONG TO
PROTOONCOGENES?
31.WHICH OF THE FOLLOWING IS RESPONSIBE FOR THE
PHOSPHORYLATION OF RB PROTEIN? CYCLINE DEPENDENT KINASE
32. RAS ACTIVATE MYC BY PHOPHORYLATION
33.IN PROTOONCOGENES MUTATION WILL HAPPEN TO DEVELOP
CANCER ?
34.WHICH OF THE FOLLOWING GENE IS CALLED AS GUARDIAN OF
GENOME? P53 GENE
35. IN SPORADIC RATINOBLASTOMA INITIALLY BOTH ALLELES ARE
NORMAL
36. BETA CANTANINE IS EXAMPLE OF PROTOONCOGENES.
37.LOSS OF FUNCTION MUTATION IN GTPASE CAN CAUSE OVER
ACTIVATION OF RAS
38.WHAT IS TRUE RELATED TO P53 GENE ? IT WILL BE ACTIVATED BY
ATM GENE I RESPOSE TO MUTATION
39. WHEN THERE IS NO FURTHER MUTATION
………………………………………………. GENE WILL BE ACTIVATED TO …………………..?
MDM2 TO INHIBIT P53
40. P53 GENE CAN BE ACTIVATED BY ??? ATM PROTEIN
41.WHICH OF THE FOLLOWING IS NOT THE FUNCTION OF
ANGIOTENSIN 2? DECREASE SECRITION OF VASOPRESIN FROM
42.WHICH OF THE FOLLOWING IS ASSOCIATED WITH LOW RENIN
HYPERTENSION?
43.HYPERTHYRODISM CAUSE THE HYPERTENSION BY WHICH OF THE
FOLLOWING MECHANISM?? T3 MEDIATED INCREASED BRECEPTORS
DENSITY
HYPOTHALAMUS

44.WHAT WOULD NOT RESULT FROM AN INCREASED END DIASTOLIC
VOLUME ? WEAKER CONTRACTION OF THE VENTRICLES
45.IF A BARORECEPTOR IN THE AORTA DETECTS LOW BLOOD
PRESSURE WHICH OF THE FOLLOWING WILL RESULT ?
VASOCONSTRICTION
46.WHICH OF THE FOLLOWING IS THE MAJOR FACTOR THAT
INFLUENCE MEAN ARTERIAL PRESSURE??? TOTAL PERPHERAL
RESISTANCE BLOOD VOLUME CARDIAC OUTPUT
47.WHEN THE RAAS IS ACTIVATED DUE TO A CHANGE IN BODY
HEMODYNAMICS .THE …………. STIMULATES THE..............CELLS IN
THE KIDNEY TO RELEASE................................ ? SYMPTHETIC NERVOUS SYSTEM ,
JUXTAGLOMERULAR , RENIN
48.DURIN THE RENIN AHGIOTENSIN ALDOSTERONE SYSTEM
ACTIVATION WHAT GLAND RELEASES ANTIDIURETIC HORMONE
ADH? PITUITARY
49. 49.

1. Monocytes move fromthe systemic circulatory system inti general connective
tissue,where theydifferntiateinto what phagocyticcelltype.
.Macrophages
2.Whichofthefollowingisnottrueabout Neutrophil.
.Neutrophil are APCs
3.Naturally acquired active immunity would bemost likelyacquired through which ofthe
following processes.
.infection with disease causing organism followed byrecovery
4.Which of the followingisfalserelatedtoTcells
.Th2 will activate cytotoxic T cells
.Th1 will activate B cells cell
5. Which of the followingisNOT aninnate defensemechanismofthebody.
.B lymphocytes
6. The funtionofmarcophageis
.all of the above
7. Which ofthe following immune cells/ molecules are most effective at desrtroying
intracellular pathogen?
.T cytolyticcells
8. Regarding apoptosis,whichof the followingisfalse?
.associated with inflammation
9.Metaplasia is
.isthe processthatoccursinBarrett'soesophagitis
10.Which ofthe following is true about Cytotoxic T cells
.They are also called as CD8+ cells

11. The specialenzymesarereleasedduringnecrosisfrom.
.lysosomes
12. Whichofthefollowingisnotoneof thethreemainantigen-presenting celltypes

.Basophil
13.Hypertrophy .
.is triggered by mechanical and trophic chemical
14. Whichofthefollowinggeneiscalled asGuardian of genome
.p53 gene
15. WHichofthefollowingisantiapoptoticgene.
.BC12
16. Whichofthefollowingisnot to protocogenes.
.all are true.
17. Activeartificiallyacquiredimmunity isaresult of.
.vaccination.
18. Inprotooncogenes...mulation willhappento developcancer.
.gain of function mutation.
19. Coagulative necrosisusually result from.
.ischemia.
20.... isconsideredasglobaltrancriptionfactor.
.MYC.
21. RAAS protien is activated when it is attach with.......
.GTP.
22........ are mulatedformof protooncogenes.
.oncogenes.

23. RP protien phosphorylation.
.promote trancripition of genes.
24.RAS activate MYC by.
.phosphylation.

25. With reqardsof mechanisms ofcellular adaptation which ofthe following statements is
TRUE.
.swelling is associated with necosis.
26. What istheroleof the caspasesinapoptosis.
.caspases areproteases that carry out ofcontrolleddestruction ofthe cells components during
apoptosis.
27. Which ofthe following is responsible for the phosphorylation ofRB
protien. cycline dependentkinase.
28. Whichofthefollowingisassociatedwithextrensicpathwayof apoptosisonly.
T cell associated apoptosis.
29. The effect ofantidiuretic hormone (ADH) on the kidney is
to. Increasethe permeabilityof distalnephronto H2O
30. He formofcellularadapationinwhichcellsizedecreaseduetodecreaseinworkloadis.
31. The case ofexample involoved an inmate beingseen in nurse sick call for complaints of
nasal allergies and recent back strain hisblood pressure is148/ 90mm Hg. at intake amonth
ago his bloodpressure was154/92mmHg.
based upon the reading today this patientis at what stage ofhypertension?
Stage 1hypertension
32. K+ excreation ismarkedly influenced
by. All
33. Which ofthe following is not apossible role of
ubiquitin? Directsproteinsynthesis
34. Reninisreleasedfromthekidneyinresponseto......
Low renal perfusion
35. Baroreceptors ofcarotidsinus and aorticarh and sensitive to;

Increase in systolic pressure
36. The main physiological stimulus forthe release activation pfrenin angiotesin aldosterone
system(RAAS)is.

Blood volume
37. Which ofthe following is false about the Gasteric
Secretions. All are true
38. Which ofthe following is correct about
pepticulcer Gastriculcerpainmostlyhappenat M8
40. The layer oftissue beneath ofmucosa
is Submucosa
41. What iswrong about H pylori
Ituse urease enzyme to neuralise acid byconverting ammonia into ureaand CO2
43.Which of followingisfalse about parietalcells
Sodiumhydrogen pump for acid secretion is present onlumenal side pfparietal side
43.The physician order apatientswitha duodenal ulcer......pyloriispresent?
Carbondioxide
44. Foldsin mucosaofstomacharecalled.....whichallows....
Rugae, increase .
45. What is the wrong about COX1 and COX2 enzymes
COxenzymeisinducible
47. With regardsto mechanism ofcellular adaptation which istrue
Swelling is associatedwithnecrosis
48. Which offollowng is associated with extrinsic pathway of
apoptosis T cellsassociatedapoptosis
49. Coagulative necrosis usually results
Ischemia

50. The special enzymes are released during
necrosis Lysosomes
51. Whichofthefollowingusnot aninnate defensemechanismofbody

Lymphocytes
52. Which ofthe following expressfirst onWBCsfor transmigration
CD28
53. hich o the followingisfalse relatedtoT cells
.Th2willactivatecytotoxicTcellsandTh2willactivatebetacells
54.Which ofthe following chemical mediators are involved ingiant cell
55.Which of the followingistrue about exudate
RBCs maypresent
56.Histamine cause
All are true
57. csMacrophagesare derived
from Monocytes
58. Rb protein
phospyorylation Promote
transcription ofgene
59. Which ofthe following is not belong to
protocogensis All
60. In sporadic Ratinoblastoma
initiallyBoththeallelearenormal
61Which ofthe following is responsible for the phosphylation ofRb protein
Cyclic dependantkinase
62. Loss of function mutation in GTPase can

cause Overactivation
63. What istrue related to P53 gene
All aretrue
64. Which ofthe following effect ofinflammation is associated with chemotaxsis and
stimulate adhesionmolecules
65. Betacartaninexampleof

Protocogenes
66. Whenthereisnofurthermutation....genewillneactivatedto.....
MDM2 inhibit PS3 protein

PEPTIC ULCER
RABIA ASGHAR
Assistant Professor

Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first
part of the small intestine, or sometimes the lower esophagus. They’re usually
formed as a result of inflammation caused by the bacteria H. pylori, as well as from
erosion from stomach acids. Peptic ulcers are a fairly common health problem.
There are three types of peptic ulcers:
• gastric ulcers: ulcers that develop inside the stomach
• esophageal ulcers: ulcers that develop inside the esophagus
• duodenal ulcers: ulcers that develop in the upper section of the smallintestines,
called the duodenum
RABIA ASGHAR (Assistant Professor) 2

Risk factors
Different factors can cause the lining of the stomach, the esophagus, and thesmall
intestine to break down. These include:
• Helicobacter pylori (H. pylori), a type of bacteria that can cause astomach
infection and inflammation
• Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• smoking
• drinking too much alcohol
• radiation therapy
• stomach cancer
• A family history of ulcers.
• Behcet disease
• Zollinger-Ellison syndrome
• Crohn disease
• liver cirrhosis

Symptoms of peptic ulcers
The most common symptom of a peptic ulcer is burning abdominal pain that
extends from the navel to the chest, which can range from mild to severe. In some
cases. Small peptic ulcers may not produce any symptoms in the early phases.
• Other common signs of a peptic ulcer include:
• changes in appetite
• nausea
• bloody or dark stools
• indigestion
• vomiting
• chest pain
• Bloated feeling
• Burping
• Lack of appetite or weight loss

Complications
• Gastrointestinal bleeding
• Perforation : Erosion of the gastrointestinal wall by the ulcer leads to
spillage of the stomach or intestinal contents into the abdominal cavity,
leading to an acute chemical peritonitis. The first sign is often sudden
intense abdominal pain. Posterior gastric wall perforation may lead to
bleeding due to the involvement of gastroduodenal artery that lies
posterior to the first part of the duodenum. Penetration is a form of
perforation in which the hole leads to and the ulcer continues into adjacent
organs such as the liver and pancreas.
• Gastricoutlet obstruction ( narrowing of the pyloric canal by scarring and
swelling of the gastric antrum and duodenum due to peptic ulcers. The
person often presents with severe vomiting).
• Cancer is included in the differential diagnosis (elucidated
by biopsy), Helicobacterpylori as the etiological factor making it 3 to 6
times more likely to develop stomach cancer from the ulcer.

• H. pylori
PATHOPHYSIOLOGY
• Helicobacter pylori is one of the major causative factors of peptic ulcer disease.
When food enters the stomach, the protein component stimulates G cells situated
in the distal antral region of the stomach to release the hormone gastrin which
circulates and again stimulates the parietal cells in the body region to secrete
acid. As the acidity of the stomach and duodenum increases, protective feedback
pathways are activated to inhibit further acid secretion. One important
acid-mediated inhibitory control involves the release of somatostatin by D cells
within the antral mucosa. This hormone exerts paracrine inhibitory control on
gastrin release by the antral G cells. H. pylori infection can interfere with these
physiological control processes, resulting in disturbances in gastric acid secretion.
• H. pylori is a Gram-negative, spiral rod-shaped bacterium. Its adaptations to
acidic environment of stomach include an ability to tolerate a microaerophilic
environment, the expression of a urease enzyme that modulates the bacterial
microenvironment by raising pH, and flagellae that provide motility, allowing H.
pylori to access the deep mucous layer of the stomach wall, thereby utilizing the
host mucosal defences to develop a survivable niche.

• It expresses blood group antigen adhesin (BabA) and outer inflammatory protein
adhesin (OipA), which enables it to attach to the gastric epithelium. The
bacterium also expresses virulence factors such as CagA, VacA and PicB, which
cause stomach mucosal inflammation. CagA disrupts cell integrity and breaks
down the tight junctions between stomach cells. It also stimulates production of
certain cytokines (e.g, IL-8) within the cells. IL-8 attracts the neutrophils and illicit
inflammatory response. VacA induces stomach cell apoptosis. Combination of
CagA and VagA thus causes breakage of stomach layers thus inducing
inflammation. Acute infections results in hypochlorhydria, whearas chronic
infections results in either hypo or hyperchlorhydria, depending upon anatomic
site of infection. The acute infection causes marked inflammation of the antrum
and body of the stomach and the hypochlorhydria is assumed to be due to the
bacterium and/or accompanying inflammation inhibiting parietal cell function.
Following the initial acute episode, the infection enters a chronic phase. The
effect of chronic H. pylori gastritis on gastric acid secretion depends upon the
relative extent to which the gastritis involves the antral or body mucosa. It also
depends upon whether the infection is only producing inflammation of the
mucosa or has resulted in the development of atrophy with loss of glands.

• NSAIDs
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs)and aspirin can
increase the risk of peptic ulcer disease by four times comparedto
non-users. Risk of bleeding increases if NSAIDs are combined with selective
serotonin reuptake inhibitor (SSRI), corticosteroids, antimineralocorticoids,
and anticoagulants. The gastric mucosa protects itself fromgastric
acid with a layer of mucus, the secretion of which is stimulated by
certain prostaglandins. NSAIDs block the function of cyclooxygenase 1
(COX-1), which is essential for the production of these prostaglandins.
Besides this, NSAIDs also inhibit stomach mucosa cells proliferation and
mucosal blood flow, reducing bicarbonate and mucus secretion, which
reduces the integrity of the mucosa. Another type of NSAIDs, called COX-2
selective anti-inflammatorydrugs (such as celecoxib), preferentially
inhibit COX-2, which is less essential in the gastric mucosa. This reduces the
probability of getting peptic ulcers; however, it can still delay ulcer healing
for those who already have a peptic ulcer.

Other factors:
• Other causes of peptic ulcer disease include stress,diet, gastric ischaemia, drugs, metabolic
disturbances, cytomegalovirus (CMV), upper abdominal
radiotherapy, Crohn's disease, and vasculitis. Gastrinomas
(Zollinger–Ellison syndrome), or rare gastrin-secreting tumors, also
cause multiple and difficult-to-heal ulcers.
• It is still unclear if smoking increases the risk of getting peptic ulcers.

PEPTIC ULCERS
Ulcer
An ulcerisa local defect,orexcavationof the surface of an organ or tissue,whichisproducedbythe
sloughing(shedding) of inflammatorynecrotictissue.
Pepticulcer
A pepticulcerisa chronicmucosal defectthatOccurs in any level of the GITexposed tothe
aggressive actionof acid-pepsinsecretion.
Common sites
About98%-99% of pepticulcersoccur ineitherfirstpartof duodenumorstomach.
1. Firstportionof the duodenum (75%)
2. Antrumof the stomachadjacentto the acid-secretingfundicmucosa(25%)
Predisposingfactors
1. Helicobacterpylori
It isthe mostimportantetiological factorinpepticulcerdisease,accountingfor100% of duodenal
ulcerand 70% of gastric ulcers.
2. Heredity
Pepticulcertendstorun infamilies.Twospecificfactorsidentified are:
 Larger parietal cell mass:Withincreased gastricacidoutputinpatientswithduodenal ulcer
perhapsrepresentsaninborncharacteristicof the individual.
 Bloodgroupand bloodgroupantigen:Those withbloodgroupandthose unable tosecrete
theirbloodgroupantigenintothe salivaandgastricjuice are more predisposedtopeptic
ulceration.
3. NSAIDs
Aspirinandother inflammatoryagentsdamage the gastric non-steroidal anti-mucosal barrierand
are an importantetiologicfactorin30% casesof gastric ulcer.These drugsare alsoresponsible tor
very small proportion of duodenal ulcers.
4. Smoking
Smokingisan importantriskfactor.It alsodecreasesthe rate of healingandincreasesthe riskof
recurrence.Tobaccoexertsitseffectsbystimulatingacid secretionandimpairingmucosal defenses
by meansof decreasedbloodflow andreducedprostaglandinsynthesis.
5. Associationwith other diseasesor known factors
 Higherincidence inpatientswithCOPDpulmonale,cirrhosis,chronicrenal failure
 Steroidsinhighdoses
 Severe burns(Curling's ulcer)
 Intracranial lesions(Cushing's ulcer)
 Alcohol anddietaryfactorsdonot appearto cause peptic ulcer

 The role of psychological stressuncertain
Pathogenesis
All pepticulcersarise because of animbalance betweenthe aggressive factorsandthe normal
defensesof the gastroduodenalmucosa.
Defense factorsof mucosa
 Secretionof mucusbysurface epithelial cells
 Secretion of bicarbonate intothe surfacemucus, tocreate abuffered surface environment.
 Rapidgastric epithelialregeneration
 Vigorousmucosal bloodflow tosweepawayhydrogenionsthathave back-diffusedintothe
mucosafrom the lumen,andto sustainthe highcellularmetabolicandregenerative activity
 Mucosal secretionof prostaglandins, whichmayhelpmaintainmucosal bloodflow.
Aggravating factors
 Helicobacterpylori infection:Itisa gram negative bacillusthatsecretesureaseanprotease
that breakdownglycoproteiningastricmucus.The organismalsosecretesphospholipases,
whichcan damage epithelial cells.Italsoattractsneutrophilswhichrelease myeloperoxidase
that can the epithelial cells.The chronicallyismore susceptibletodestroythe inflamed
mucosal acid injury.
 Non-Steroidal Anti-InflammatoryDrugs(NSAIDS)inhibitprostaglandinsynthesis.
 Smokingstimulatesacidsecretionandinhibitsulcer healing.
 Ischemialeadstodecreasedmucosal bloodflow.
 Duodenogastricrefluxmayaggravate the condition.
 Pyloricsphincterincompetence resultinginrefluxof the bile acidsand lysolectithinwhich
diffuse backintothe stomach,damage the mucosal barrier,andthusleadsto chronic
gastritisandsimultaneouslytoincreasedacidproduction,whichhaspotential toproduce an
ulcer.
Defense factors Aggravating factors
Surface mucus secretion Helicobacterpyloricinfection
Bicarbonate secretion NSAIDs
Rapid epithelial regenerative capacity Smoking
Vigorousmucosal blood flow Ischemia
Mucosal secretionofprostaglandin Duodenogastricreflux
Morphology
 The pepticulcersare usually solitary, oftenlarge (>1cm) and roundto oval inshape witha
punched-outappearance.
In pepticulceration,initial damage todefensive mucosal barrierresultsfromHelicobacterpylori
infection,NSAIDs,smokingandotherfactors.Thisdamage of mucosal barrierfacilitatesthe
damagingeffectof acidand pepsinthatleadstoulceration.
Summary of pathogenesis

 The marginsof the ulcerare perpendicularandthere issome mildoedemaof the
immediatelyadjacentmucosa,butunlike cancerousulcersthere isnosignificantelevation
or bleedingof the edges.
 The floorof the ulcerissmoothand itsbase isthickand firmbecause of fibrosis.
 Favouredsitesof ulcerare anteriorandposteriorwallsof the firstportionof duodenumand
the lessercurvature of the stomach.
Clinical features
1. Epigastricpain
2. Vomiting
Complicationsof pepticulcers
 Bleeding
 Perorationorpenetrationintoanadjacent Viscus
 Obstructionfromscarringof the pylorusor duodenum
Investigation
Endoscopy
Treatment
H2, receptorantagonistssuchasClimitidine,Ranitidine
Protonpumpinhibitors
Acute gastric ulceration(stressulcers)
Stressulcersare acutelydevelopinggastricmucosal defectsthatappearaftersevere stress;theyare
multiple lesionslocatedmainly inthe stomachandoccasionallyinthe duodenum.
Predisposingfactors
1. Severe trauma,majorsurgical proceduresor sepsis
2. Extensive burns(calledCurling's ulcers)
3. Traumatic or surgical injurytoCNS(calledCushing’sulcers)
4.Chronicexposure togastricirritantdrugse.g.NSAIDsandcorticoste

NEOPLASIA
PREMALIGNANT(PRECANCEROUS)LESIONS
Premalignant lesions are a group of conditions which predispose to the subsequent development of cancer. Certain
clinical conditions are well recognized predisposition to the development of malignant neoplasia. It is important
to recognize premalignant condition because it is possible at this stage to completely eradicate the lesion.
Carcinomain situ (intraepithelial neoplasia)
When the cytological features of malignancy are present but the malignant cells are confined to epithelium without
invasion across the basement membrane (i.e. basement membrane is intact). It is called as carcinoma in situ or
intraepithelial neoplasia (CIN). It may regress and return to normal or may develop into invasive cancer.
Carcinoma in situ is a true neoplasm with all features of malignancy except invasiveness. The common sites are
the following: uterine cervix, oral leukoplakia and intralobular and intraductal carcinoma of breast. Examples:
Bowen's disease of skin, actinic or solar keratoses, erythroplasia of Queyrat, leukoplakia with dysplasia, cervical
dysplasia, Paget's disease of skin.
Dysplasia
Dysplasia is an abnormality of both differentiation and maturation of cells. It is an alteration in adult cells
characterized by variation in their size, shape and organization. It is a loss of uniformity of cells and loss in their
structural orientation. Dysplasia is encountered principally in epithelium. The dysplastic cells show:
1. Pleomorphism: Variation in size and shape
2. Increased nuclear: cytoplasmic ratio—increased size of nucleus which causes
increased nuclear cytoplasmic ratio chromatin.
3. Hyperchromasia—increased content resulting in deeply stained nuclei
4. Increased mitotic figure, but pattern is normal of
5. Cytoplasmic abnormalities—lack keratinization in squamous cells and lack of
mucin in glandular epithelium
6. Disorderly arrangement of cells from basal layer to the surface layer associated with
chronic

Dysplasia is inflammation or irritation. This is non-neoplastic proliferation which differs from neoplasia in that
the growth of dysplastic cell is controlled and stops when inciting stimulus ceases, while the growth of neoplastic
cell is uncontrolled that persists even after the cessation of the stimulus. Hyperplasia and metaplasia are not
directly premalignant conditions, but if they are severe and sustained they may progress to dysplasia which Carrie
the risk of conversion to malignancy. Dysplasia carries high risk of conversion to malignant neoplasm.
Common sites
1. Cervix
2. Lung
3. Oral cavity
4. Gallbladder
Clinical significance
1. Dysplasia is reversible when inciting stimulus is removed.
2. There are higher chances of neoplastic transformation.
Neoplasia means new growth and is characterized by unceasing abnormal and excessive proliferation of
cells.

Premalignant(precancerous)lesions
Premalignant Cancer
Hyperplasia
 Endometrial hyperplasia
 Breast tubular and ductal
hyperplasia
 Liver, cirrhosis of liver
 Endometrial carcinoma
 Breast carcinoma
 Hepatocellular carcinoma
Dysplasia
 Cervix
 Skin
 Bladder
 Bronchial epithelium
 Squamous carcinoma
 Squamous carcinoma of cervix
 Transitional cell carcinoma
 Lung carcinoma
Metaplasia
 Grandular metaplasia of
esophagus  Adenocarcinoma of esophagus
Inflammatory
lesions
Ulcerative
colitis
Atrophic
gastritis
Hashimoto’s thyroiditis
 Carcinoma of colon
 Carcinoma of stomach
 Thyroid carcinoma
Benign tumors
 Colonic adenoma
 Neurofibroma
 Carcinoma of colon
 Malignant
Neoplasia
Neoplasia means new growth and is characterized by unceasing and abnormal excessive proliferation of
cells
Neoplasm
The neoplasm (commonly called tumor) is defined as the abnormal mass of tissue, the growth of which exceeds
and is uncoordinated with that of the normal tissue, and persists in the same excessive manners after the cessation
of the stimuli which evoked the change.
Oncology
The study of neoplasm (tumor) is called oncology.

Differentiation
The extent to which the neoplastic parenchymal cells resemble their normal parent cells, both morphologically and
functionally, is called differentiation.
Anaplasia
Irreversible loss of differentiation is called anaplasia.
Components of neoplasm
• Parenchyma: It constitutes the proliferating part of the neoplasm.
• Stroma: It is made up of connective tissue, blood vessels and lymphatics. It
provides support for the growth of parenchymal
cells.

Desmoplasia—the excess of stromal component in a tumor is called desmoplasia and such a tumor is called
scirrhous tumor.
Types of neoplasms
(tumors)
1. Benign tumors
2. Malignant tumors
Benign tumor
It is the tumor with relatively innocent characteristics such as:
• It will remain localized.
 It cannot spread to other sites.
 It is amenable to local surgical removal.
 The patient survives.
Malignant tumor
It is also called cancer. The malignant tumor is destructive and dangerous, having characteristics such as:
 It can invade and destroy adjacent structures.
 It spreads to distant sites (metastasis).
 The patient dies.
Nomenclature of
tumors
The tumor is named on the basis of:
1. Cell or tissue of origin
2. Whether it is benign or malignant
Benign tumors
In general, these are designated by attaching the suffix "oma" to the cell of origin.
Examples

1. Benign tumor arising from fibroblastic cells is called Fibroma.
2. Benign tumor arising from meninges is called meningioma.
Important note
Benign tumors of mesenchymal cells generally follow the above rule of just attaching "oma" to the cell of origin.
Nomenclature of benign tumors of epithelial cells is more complex. They are named on multiple basis e.g.
 Cell of origin
 Microscopic architecture
 Macroscopic patterns
Examples of benign epithelial cell tumors
Adenoma
The benign epithelial neoplasm that forms glandular pattern as well as those derived from gland,
although not necessarily reproducing glandular pattern, is called adenoma e.g. benign epithelial
neoplasm that arises from renal

tubular cells growing in the form of glands would be termed as adenoma, while epithelial tumors arising
from adrenal gland even not growing in gland pattern would also be called adenoma.
Papilloma
The benign epithelial neoplasms producing microscopically or macroscopically visible fingerlike
projections from epithelial surfaces are called papilloma’s.
Cystadenoma
When retention of secretion is marked, a cyst forms in adenoma and such a tumor is called cystadenoma.
Polyp
The tumor that produces macroscopically visible projection above a mucosal surface (e.g. into gastric
or colonic lumen) is called polyp.
Examples of benign mesenchypnal cell tumors
Fibroma
This benign tumor arises in subcutaneous tissues, fascia, periosteum, kidney and ovary.
Myxoma
This benign tumor is a variant of fibroma and represents a degenerative change characterized by
accumulation of ground substances in mature tissues.
Lipoma
This benign tumor arises from fat of cells in subcutaneous tissue arising from cartilage.
Chondroma
This benign tumor arises from cartilage.
Osteoma
This benign tumor arises from bones.

Myoma
It arises from muscles and is divided into:
1. Leiomyoma: It is the benign tumor of smooth muscles. It can occur wherever
there is smooth muscle present but is especially common in uterus (mostly)
and media of blood vessels. It also occurs in GI T, ovary, and kidney.
2. Rhabdomyoma: This is a rare benign tumor of skeletal and heart muscles.
Malignant tumors
The nomenclature of malignant tumors follows the same rules as for benign tumors with certain additions.
There are two types of malignant tumors:
Carcinoma
The malignant tumors of epithelial cell origin are called carcinoma. The word carcinoma is attached to
the type of tissue
e.g. malignant epithelial tumor of renal cells is called renal cell carcinoma.

Sarcomas
The malignant tumors arising in mesenchymal tissues ae called sarcomas . The word sarcomas is attached to the
type of tissues e.g. malignant tumors of fibroblastic cells is called fibrosarcoma.
Carcinoma Sarcoma
Epithelial origin Mesenchymal origin
More common Less common
Metastasis preferably via
lymphatic’s in
early stages
Metastasis preferably via
blood vessels
specially in veins
Necrosis common Necrosis less common
Hemorrhages less frequent Hemorrhages more frequent
Examples of carcinoma
Adenocarcinoma:
The carcinoma in which neoplastic epithelial cells grow in gland-pattern is called adenocarcinoma. Tissue of
origin is also specified e.g. adenocarcinoma of renal cell, stomach, colon, breast, gall bladder, prostate and
uterus.
Squamous cell carcinoma:
The carcinoma in which neoplastic cells resemble stratified squamous epithelium called squamous cell
carcinoma. The carcinoma arising from the area either covered by stratified
squamous epithelium (e.g. skin, oral esophagus) or from the epithelium which has undergone metaplasia from
columnar squamous type as seen in gall bladder, bronchi and cervix.
Some variations
Lymphoma, mesothelioma, melanoma and seminoma are malignant tumors although they have
suffix "omaa characteristic of benign tumors.

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