Chapter 1 Q&A

Question 1

1. Bone marrow cells from organ donor cultured in vitro in presence of recomb EPO; colony of cells committed to erythrocyte pathway of differentiation, representing example of which physiologic adaptations to transmembrane signaling?

Answer 1

Hyperplasia

Question 2

2. 50 yo chronic alcoholic presents to ER with 12 hrs of severe abdo pain; pain goes to back and associated with urge to vomit; PE shows abdo tenderness and labs show increased serum amylase; what do we see in peripancreatic tissue of this patient?

Answer 2

Fat necrosis (saponification of fat derived from peripancreatic fat cells exposed to pancreatic enzymes is a feature typical of fat necrosis); saponification is NEFA’s binding with Ca to form soaps)

Question 3

3. 68 yo man with GERD history has massive stroke and expires; esophagus shows different types of cells, why?

Answer 3

Glandular metaplasia (since you’re going from squamous epi to the simple columnar epi of the small intestine)

Question 4

4. CT of 43 yo woman with parathyroid adenoma and hyperparathyroidism shows calcium deposits in lungs and kidney parenchyma; what is the mech of disease?

Answer 4

Metastatic calcification

Question 5

5. 75 yo woman with Alzheimer disease dies of CHF; bran shown and exemplifies what type of response to chronic injury?

Answer 5

Atrophy

Question 6

6. 68 yo woman with heavy smoking and pneumonia hisotyr has fever and productive cough; CXR shows right lower lobe infiltrate; preneoplastic changes in bronchial mucosa

Answer 6

Abnormal pattern of cell maturation (dysplasia of the bronchial epithelium and is a reaction of respiratory epi to carcinogens in tobacco smoke)

Question 7

7. 64 yo man with angina pectoris and arterial hypertension dies of spontaneous intracerebral hemorrhage; heart globoid; LV 2.8 cm on cross section; what changed intracellularly?

Answer 7

mRNA: hypertrophy results from transcriptional regulation!!

Question 8

8. 24 yo woman contracts toxoplasmosis during pregnancy and delivers neonate at 37 wks gestation with severe malformation of CNS; MRI shows porencephaly and hydrocephalus; XR of head shows irregular densities in basal ganglia; what is the mech of disease?

Answer 8

Dystrophic calcification (underlying cell injury; serum levels of calcium normal, and calcium deposits located in previously damaged tissue)

Question 9

9. 30 yo man with AIDS-dementia complex develops acute pneumonia and dies of respiratory insufficiency; many CNS neurons show hydropic degeneration; how did this happen?

Answer 9

Plasma membrane sodium transport (hydropic swelling reflects acute, reversible cell injury; reflects impaired cellular volume regulation, a process that controls ionic concentrations in the cytoplasm)

Question 10

10. 62 yo man brought to ER in disoriented state; PE shows jaundice, splenomegaly, ascites; ALT, AST, alkaline phosphatase, bilirubin all elevated; alcoholic hepatitis seen with Mallory bodies; these cytoplasmic structures have which proteins?

Answer 10

Intermediate filaments (what makes up alcoholic hyaline)

Question 11

11. 65 yo man suffers a heart attack and expires; lungs at autopsy shows pigmented nodules throughout parenchyma? Why?

Answer 11

Anthracosis: storage of carbon particles in lung and regional lymph nodes

Question 12

12. 32 yo woman with poorly controlled diabetes mellitus has healthy boy at 38 weeks gestation; what would we expect to see in pancreatic islets of neonate?

Answer 12

We see hyperplasia (islet cells of pancreas with proliferative capacity and respond to increased demand for insulin)

Question 13

13. 59 yo female alcoholic brought to ER with fever and foul-smelling breath; patient with acute bronchopneumonia and dies of respiratory insufficiency; there is a pulmonary abscess; which path change is seen?

Answer 13

Liquefactive necrosis: rate of dissolution of necrotic cells faster than rate of repair

Question 14

14. 20 yo man from China has persistent cough, night sweats, low-grade fever, general malaise; CXR shows Ghon complex; acid-fast bacilli, what are the path changes?

Answer 14

Caseous necrosis

Question 15

15. 31 yo woman has increased vaginal discharge of 1-mo duration; cervical Pap smear with superficial epi cells compared to deeper intermediate layer, and what do the former exhibit?

Answer 15

Pyknosis

Question 16

16. 30 yo woman has tonic-clonic seizure and has delirum and hydrophobia; was bitten on hand by bat 1 mo ago; dies of respiratory failure; viral particles found throughout brainstem and cerebellum; necrosis of virally infected neurons in patient mediated by which mechs?

Answer 16

Humoral and cellular immunity

Question 17

17. 52 yo woman loses right kidney after auto accident; CT scan of abdo 2 yrs later shows marked enlargement of left kidney; what adaptation?

Answer 17

Hypertrophy

Question 18

18. 82 yo man with bleeding from peptic ulcer and dies of hypovolemic shock; liver at autopsy with centrilobular necrosis; what do the necrotic cells have compared to viable hepatocytes?

Answer 18

Higher IC levels Ca

Question 19

19. 28 yo woman pinned by falling debris during hurrican; there is compound fracture of right tibia; right leg is weak and smaller in circumference than left with cast placed and removed; what is the adaptation?

Answer 19

Atrophy

Question 20

20. 70 yo man hospitalized after suffering mild stroke; in hospital, crushing substernal chest pain; arrhythmia develops and patient dies; LV shows what changes?

Answer 20

Coagulative, or ischemic necrosis (lack of O2 impairs mito electron transport, decreasing ATP synthesis

Question 21

21. Which histo features provide definitive evidence of necrosis in myocardium of the 70 yo man?

Answer 21

Nuclear fragmentation (hallmark of COAGULATIVE necrosis)

Question 22

22. 90 yo woman with mild diabetes and Alzheimer disease dies in her sleep. Hepatocytes have golden cytoplasmic granules not staining with Prussian blue. Why does this pigment accumulate?

Answer 22

Advanced age (lipofucsin)

Question 23

23. Which mech of disease describes how this pigment has accumulted in the 90 yo woman?

Answer 23

Peroxidation of membrane lipids (lipofuscin found in lysosomes and has peroxidation products of unsaturated FA’s

Question 24

24. 45 yo man with increasing abdo girth and yellow discoloration of skin and scelra; hepatomegaly and jaundice; Prussian blue stain of liver biopsy; major intracellular iron storage protein in hepatocytes?

Answer 24

Hemosiderin (denatured form of ferritin that aggregates easily and is recognized microscopically as yellow-brown granules in cytoplasm and turn blue with Prussian blue)

Question 25

25. 60 yo man with chronic cystitis has urinary frequency and pelvic discomfort; biopsy of bladder mucosa has foci of glandular epi and chronic inflammatory cells; what is the response to chronic injury in this case?

Answer 25

Metaplasia

Question 26

26. 60 yo man goes to hospital with acute liver failure; transplanted liver but does not make much bile; poor graft due to reperfusion injury; what caused the reperfusion injury?

Answer 26

ROS

Question 27

27. 68 yo woman with history of hyperlipidemia dies of cardiac arrhythmia after massive heart attack; peroxidation of which causes loss of membrane integrity in cardiac myocytes?

Answer 27

Phospholipids

Question 28

28. 22 yo construction worker sticks himself with a sharp rusty nail; in 24 hrs, wound enlarged to become a 1 cm sore that drains thick, purulent material; skin wound illustrates which of the following necrosis types?

Answer 28

Liquefactive necrosis

Question 29

29. 42 yo man has liver biopsy for hep C virus infection; we see swollen hepatocytes and moderate lobular inflammatory activity; Councilman body seen, but why are these acidophilic bodies seen?

Answer 29

Apoptotic cell death (appear acidophilic)

Question 30

30. Which changes characterize formation of acidophilic bodies in that 42 yo man?

Answer 30

Fragmentation of DNA

Question 31

31. 56 yo woman with history of hyperlipidemia and hypertension develops progressive, right renal artery stenosis; right kidney will eventually demonstrate which adaptations?

Answer 31

Atrophy

Question 32

32. 5 yo boy suffers blunt trauma to leg in automobile accident; six mos later, bone trabeculae form within striated skeletal muscle at site of injury; What adaptations?

Answer 32

Metaplasia (myositis ossificans); formation of bony trabeculae within striated muscle

Question 33

33. 42 yo man presents with a scaly erythematous lesion on dorsal surface of left hand; skin biopsy shows atypical kertainocytes in thickness of epidermis; Which proteins play important role in mediating programmed cell death?

Answer 33

Cytochrome c (mito)

Question 34

34. 16 yo girl with history of suicidal depression swallows commercial solvent; we see severe swelling of the centrilobular hepatocytes; what accounts for the reversible changes seen in liver biopsy?

Answer 34

Decreased IC stores of ATP

Question 35

35. 40 yo man pulled from ocean after boating accident; patient gets acute renal failure; kidney biopsy shows karyorrhexis and karyolysis in renal tubular epi cells; which events preceded these changes?

Answer 35

Decrease in intracellular pH

Question 36

36. 58 yo man has acute renal failure; BP 220/130; patient has stroke and dies; what accounts for red material in wall of artery?

Answer 36

Fibrinoid necrosis: alteration of injured blood vessels; insudation and accumulation of plasma proteins cause wall to stain intensely with eosin

Question 37

37. 20 yo girl with advanced features of progeria; child has mutations in gene encoding which types of IC proteins?

Answer 37

Lamin

Question 38

38. 32 yo woman has Addisonian crisis 3 mos after suffering massive hemorrhage during delivery of baby; CT scan of abdo shows small adrenal glands; what mechs account for adrenal atrophy?

Answer 38

Lack of trophic signals

Question 39

39. 47 yo man with history of heaving smoking complains of chronic cough; coin lesion in right upper lobe on CXR; bronchoscopy and biopsy can't identify mass, but bronchial mucosa shows squamous metaplasia; what happens if patient stops smoking?

Answer 39

Reversion to normal

Question 40

40. 60 yo farmer has multiple patches of discoloration on face; biopsy shows actinic keratosis; what describes response of skin to chronic sunlight exposure?

Answer 40

Dysplasia

Question 41

41. 59 yo woman smoker has intermitten blood in urine; CBC has increased red cell mass; CT has 3-cm renal mass and we see renal cell carcinoma; what explains the increased crit?

Answer 41

Hyperplasia

Question 42

42. 33 yo woman has abnormal cervical Pap smear; cervical biopsy shows that epi lacks normal polarity; individual cells show hyperchromatic nuclei, larger nucleus-to-cytoplasm ratio, disorderly tissue arrangement; what is the adaptation?

Answer 42

Dysplasia

Question 43

43. 24 yo woman ingests CCl4 and has acute liver failure; which proteins involved in development of hepatotoxicity in patient?

Answer 43

Mixed function oxygenase (CCl4 metabolized to chlorid ion and highly reactive trichloromethyl free radical)

Question 44

44. 30 yo woman presents with 2-mo history of fatigue, mild fever, erythematous scaling rash; joint pain, swelling, erythematous plaques with adherent silvery scales; increased thickness of the epidermis; what is the adaptation?

Answer 44

Hyperplasia

Question 45

45. 24 yo woman with chronic depression ingests bottle of acetaminophen tablets; she is jaundiced and has encephalopathy symptoms, like impairment in spatial perception; in liver, toxic metabolites of acetaminophen made by which organelle?

Answer 45

Smooth ER

Question 46

46. 45 yo woman has 2-mo history of fatigue and recurrent fever; tenderness below right costal margin and dark urine; jaundice and mild hepatomegaly; serum pos for hep B virus antigen; what is mech for the cell death?

Answer 46

Immune recognition of viral antigens on cell surface

Question 47

47. IC accumulation of abnormally folded protein plays role in path of which disease?

Answer 47

Alpha1-antitryptin deficiency

Question 48

48. 38 yo woman shows evidence of early cataracts, hair loss, skin atrophy, osteoporosis, and accelerated atherosclerosis; which inherited mutations does she have?

Answer 48

Helicase

Question 49

49. 28 yo man with history of radiation/bone marrow transplant for leukemia presents with severe diarrhea; develops septic shock and expires; colon epi shows numerous acidophilic bodiesand small cells with pyknotic nuclei; which proteins led to the radiation-induced cell death in patient's mucosa?

Answer 49

p53