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28 Cards in this Set
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A 76-year-old man comes to the clinic because of "urine problems". He tells you that he has "trouble with his urinary stream," that over the past month it has been progressively decreasing in force. He also has the urgency to urinate and he finds himself running to the bathroom, but can only pass a small amount of urine. The trips to the bathroom have increased in frequency over the past couple of days and he has started to leak urine. The leakage is only in small amounts, but can occur at any time. Yesterday, he ruined a new pair of pants and is visibly upset and embarrassed. Rectal examination reveals a moderately enlarged, smooth prostate. Urine dipstick in the office is negative for glucose, RBC, WBC, and nitrites. You explain to the patient that the most likely primary cause of his incontinence is benign prostatic enlargement. The changes at cellular level are: A) Metaplasia B) Dysplasia C) Hyperplasia D) Dystrophic calcification E) Hypertrophy only |
C. Hyperplasia Expl: BPH is an example of hyperplasia |
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A 53-year-old man has experienced severe chest pain for the past 6 hours. On physical examination he is afebrile, but has tachycardia. Laboratory studies show a serum troponin I of 10 ng/mL. A coronary angiogram is performed emergently and reveals >90% occlusion of the left anterior descending artery. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs? A Glycogen stores are depleted B Cytoplasmic sodium increases C Nuclei undergo karyorrhexis D Intracellular pH diminishes E Blebs form on cell membranes |
C Nuclei undergo karyorrhexis Expl: Sign of necrosis, especially w/ nuclear deterioration. (C) CORRECT. Chromatin clumping is reversible, but dissolution of the entire nucleus is not. elim: a. x. sign reduced ATP, can be reversible b. x. sign reduced ATP, can be reversible c. correct, d. x. sign reduced ATP, fermentation taking place, can be reversible e. x. sign reduced ATP, blebs begin formation, reversible |
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A 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-aortic region. She is treated with a chemotherapeutic agent which results in the loss of individual neoplastic cells through fragmentation of individual cell nuclei and cytoplasm. Over several weeks, the size of the lymphoma decreases, as documented on abdominal CT scans. By which of the following mechanisms has her neoplasm primarily responded to therapy? A Coagulative necrosis B Mitochondrial poisoning C Phagocytosis D Acute inflammation E Apoptosis |
E Apoptosis (E) CORRECT. The induction of death of individual cells occurs in the process of apoptosis. The drug effect should be aimed primarily at neoplastic cells, not normal cells. |
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Chromatin clumping is a sign of what? a. apoptosis b. irreversible cell injury c. reversible cell injury d. necrosis |
reversible cell injury |
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which strikes him on his left leg in the region of his thigh. The skin is not broken. Within 2 days there is a 5 x 7 cm purple color to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown color 16 days after the injury? A Lipofuscin B Bilirubin C Melanin D Hemosiderin E Glycogen |
(D) CORRECT. The iron in the heme pigment from the red blood cells in the hemorrhage is incorporated into hemosiderin granules. |
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A54-year-old man with a chronic cough has a squamous cell carcinoma diagnosed in his right lung. While performing a pneumonectomy, the thoracic surgeon notes that the hilar lymph nodes are small, 0.5 to 1.0 cm in size, and jet black in color throughout. Which of the following is the most likely cause for this appearance to the hilar nodes? A Anthracotic pigmentation B Lipochrome deposition C Accumulation of melanin D Hemosiderosis E Metastatic carcinoma |
A Anthracotic pigmentation (A) CORRECT. The black color comes from carbon pigments inhaled over the years, engulfed by macrophages, and sent via lymphatics to the nodes. It looks bad but does not compromise lung function. |
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A 50-year-old woman with a history of unstable angina suffers an acute myocardial infarction. Thrombolytic therapy with tissue plasminogen activator (tPA) is administered to restore coronary blood flow early in the course of this myocardial infarction. In spite of this therapy, the degree of myocardial fiber injury may increase because of which of the following cellular abnormalities? A Cytoskeletal intermediate filament loss B A decreased intracellular pH from anaerobic glycolysis C An increase in toxic oxygen radicals D Mitochondrial swelling E Nuclear chromatin clumping and decreased protein synthesis |
(C) CORRECT. Such toxic oxygen radicals are released from neutrophils when blood flow is restored following ischemia. |
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A 43-year-old man has complained of mild burning substernal or epigastric pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies demonstrate the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings? A Dysplasia B Hyperplasia C Carcinoma D Ischemia E Metaplasia |
(E) CORRECT. Metaplasia is the substitution of one tissue normally found at a site for another. The epithelium undergoes metaplasia in response to the ongoing inflammation from reflux of gastric contents. It is common in the lower esophagus with gastroesophageal reflux disease (GERD). Squamous > columnar (glandular) metaplasia |
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A 59-year-old woman had the loss of consciousness that persisted for over an hour. When she became arousable, she could not speak and she could not move her right arm or leg. A cerebral angiogram revealed an occlusion to her left middle cerebral artery. Months later, a computed tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding most likely demonstrates a lesion that is the consequence of resolution from which of the following events? A Liquefactive necrosis B Atrophy C Coagulative necrosis D Caseous necrosis E Apoptosis |
A Liquefactive necrosis |
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An 80-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small (250 gm) and dark brown on sectioning. Microscopically, there is light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance of his heart? A Hemosiderin resulting from iron overload B Lipochrome from "wear and tear" C Glycogen resulting from a storage disease D Cholesterol as a consequence of atherosclerosis E Calcium deposition following necrosis |
B Lipochrome from "wear and tear" |
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A 20-year-old woman had Goodpasture syndrome which progressed to chronic renal failure. She was 165 cm tall and weighed 55 kg. She had blood pressure measurements in the range of 150/90 to 180/110 mm Hg, but she did not regularly take medications. Laboratory studies showed her blood urea nitrogen was over 100 mg/dL. She required chronic dialysis. She died from heart failure. At autopsy, her heart weighed 540 gm. The size of her heart is most likely to be the result of which of the following processes involving the myocardial fibers? A Hypertrophy B Fatty infiltration C Hyperplasia D Fatty degeneration E Edema |
A. Hyperptrophy (A) CORRECT. The pressure load of hypertension led to myocardial fiber hypertrophy and a heart twice normal size. |
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A 29-year-old man goes on a snorkeling trip to Looe Key Marine Sanctuary and later spends time on the beach at Bahia Honda State Park. The next day he has a darker complexion. His skin does not show warmth, erythema, or tenderness. His skin tone fades to its original appearance within a month. Which of the following substances contributes the most to the biochemical process leading to these skin changes? A Heme B Lipofuscin C Tyrosine D Homogentisic acid E Glycogen |
(C) CORRECT. The tanning process in skin is stimulated by ultraviolet light exposure. Melanocytes have the enzyme tyrosinase to oxidize tyrosine to dihydroxyphenylalanine in the pathway for melanin production. |
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An autopsy study is performed to identify predisposing risks for tissue changes in which epithelial metaplasia occurred. In which of the following situations is the process of epithelial metaplasia most likely to have occurred? A Tanning of the skin following sunlight exposure B Lactation following pregnancy C Vitamin A deficiency D Acute myocardial infarction E Urinary obstruction from an enlarged prostate |
C Vitamin A deficiency |
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A study is performed involving the microscopic analysis of tissues obtained from surgical procedures. Some of these tissues have the microscopic appearance of an increased cell size of multiple cells within the tissue, due to an increase in the amount of cytoplasm, with nuclei remaining uniform in size. Which of the following conditions is most likely to have resulted in this finding? A The uterine myometrium in pregnancy B The female breast at puberty C The liver following partial resection D The ovary following menopause E The cervix with chronic inflammation |
A The uterine myometrium in pregnancy Expl: Uterine hypertrophy occurs during pregnancy. Elim: B. X. Physiological hyperplasia C. X. Physiological hyperplasia D. X. Physiological atrophy E. X. Metaplasia |
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A 55-year-old man has a 30-year history of poorly controlled diabetes mellitus. He has had extensive black discoloration of skin and soft tissue of his right foot, with areas of yellowish exudate, for the past 2 months. Staphylococcus aureus is cultured from this exudate. A below-the-knee amputation is performed. The amputation specimen received in the surgical pathology laboratory is most likely to demonstrate which of the following pathologic abnormalities? A Neoplasia B Gangrenous necrosis C Coagulopathy D Hemosiderosis E Caseation |
(B) CORRECT. Gangrene is a typical complication of diabetes mellitus with peripheral vascular disease. Gangrene is a form of coagulative necrosis that involves a body part, including several tissues. The infection adds an element of liquefactive necrosis, best described as 'wet gangrene.' |
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A 38-year-old man incurs a traumatic blow to his upper left arm. He continues to have pain and tenderness even after 3 months have passed. A plain film radiograph reveals a 4 cm circumscribed mass in the soft tissue adjacent to the humerus. The mass contains areas of brightness on the x-ray. Over the next year this process gradually resolves. Which of the following terms best describes this process? A Dysplasia B Hyperplasia C Hypertrophy D Metaplasia E Neoplasia |
(D) CORRECT. The brightness on x-ray suggests calcification from osseous metaplasia that developed in the healing process. This condition is known as myositis ossificans, because there is bone formation in the injured muscle. |
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A 31-year-old primigravida has a difficult delivery of a term infant. There is loss of 1500 cc of blood. She has hypotension for 6 hours. Over the next month, her ACTH level decreases. Within the next 3 months, her adrenal glands become only about 2 grams each (normal 4 to 6 grams). This alteration of the adrenals is primarily due to which of the following cellular processes? A Metaplasia of the cortex B Lipid depletion of the cortex C Atrophy of the medulla D Atrophy of the cortex E Adrenal infarction |
(D) CORRECT. The loss of ACTH leads to cortical atrophy with decreased glucocorticoid and mineralocorticoid production. |
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A 73-year-old man suffers a "stroke." On physical examination he cannot move his right arm. A cerebral angiogram demonstrates occlusion of the left middle cerebral artery. An echocardiogram reveals a thrombus within a dilated left atrium. Which of the following is the most likely pathologic alteration from this event that occurs in his brain? A Cerebral softening from liquefactive necrosis B Pale infarction with coagulative necrosis C Predominantly the loss of glial cells D Recovery of damaged neurons if the vascular supply is reestablished E Wet gangrene with secondary bacterial infection |
A Cerebral softening from liquefactive necrosis Expl: Liquefactive necrosis typifies brain infarction. |
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A 90-year-old woman dies from pneumonia complicating Parkinson disease. At autopsy her heart is normal in size. On microscopic examination, there is increased lipochrome (lipofuscin) seen adjacent to the nuclei within the myocardial fibers. This microscopic finding is most likely to result from which of the following cellular mechanisms? A Nuclear pyknosis B Myocardial fiber hypertrophy C Coagulative necrosis D Autophagocytosis E Anaerobic glycolysis |
D Autophagocytosis Expl: The lipochrome represents the residual debris of organelles and appears with increased frequency with aging, particularly in heart and liver |
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Adenovirus induces what? a. hypertrophy b. hyperplasia c. necrosis d. apoptosis |
apoptosis |
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HPV induces what? a. hypertrophy b. hyperplasia c. necrosis d. apoptosis |
pathological hyperplasia |
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HIV induces what? a. hypertrophy b. hyperplasia c. necrosis d. apoptosis |
apoptosis |
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Causes apoptosis** |
> Viral infection (NOT HPV) = adenovirus = HIV > Pathological atrophy due to duct obstruction > Growth factor deprivation > DNA damage > menopause uterus (atrophy) |
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Pancreatic duct obstruction results in: a. hypertrophy b. hyperplasia c. necrosis d. apoptosis |
apoptosis |
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Chromatin condensation in what? a. hypertrophy b. hyperplasia c. necrosis d. apoptosis e. reversible cell injury f. irreversible cell injury |
apoptosis |
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Initiator caspases. Executioner caspses. |
Initiator caspase: 8, 9 Executor capsases: 3, 6 |
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Apoptosis - Result - Mechanism - Manifestations |
Mechanism: Extrinsic and intrinsic pathways Extrinsic: > caspase 8, 10 activated via death receptor Intrinsic: > increased mitochondrial permeability caspase 9 activatated via cyc. c from mitochondria Both result in: > caspase 3, 6 activation Result: > cell shrinkage (vs. swelling in cell injury normal) > chromatin condensation (most characteristic feature of apoptosis) > cytoplasmic blebbing and apoptositic bodies = extensive surface blebbing, fragmentation into membrane bound bodies > no inflammation (no leakage of cellular contents) |
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What is the most characteristic feature of apoptosis? a. extensive surface blebbing b. chromatin condensation c. nuclear membrane fragmentation d. inflammation e. phagocytosis of apoptotic cells via macrophages f. cell shrinkage |
chromatin condensation Expl: Chromatin condensation is the most characteristic feature of apoptosis |
