Deck 1: Pathology

Question 1

Which of the following is NOT characteristic of reversible cell injury?

A) Reduced oxidative phosphorylation
B) ATP depletion
C) Cellular shrinking
D) Changes in ion concentrations
E) Water influx

Answer 1

Cellular shrinking

Question 2

Which of the following is NOT a characteristic of irreversible cell injury?

A) Necrosis, which is always pathologic or apoptosis
B) Intracellular accumulations (e.g. lipids) or calcification
C) Structural changes (e.g. mitochondrial densities)
D) Profound disturbances in membrane function
E) Adaptable mitochondrial dysfunction

Answer 2

Adaptable mitochondrial dysfunction

Question 3

Match the cellular response normally seen in cells with the stimuli (description):

-Chronic irritation (chemical or physical)

A) Hyperplasia/Hypertrophy
B) Atrophy
C) Metaplasia
D) Injury/Necrosis/Apoptosis
E) Calcifications/Intracellular accumulations

Answer 3

Metaplasia

Question 4

Match the cellular response normally seen in cells with the stimuli (description):

-Increased demand, increased trophic stimulation

A) Hyperplasia/Hypertrophy
B) Atrophy
C) Metaplasia
D) Injury/Necrosis/Apoptosis
E) Calcifications/Intracellular accumulations

Question 5

Match the cellular response normally seen in cells with the stimuli (description):

-Reduced oxygen supply, chemical injury, infection

A) Hyperplasia/Hypertrophy
B) Atrophy
C) Metaplasia
D) Injury/Necrosis/Apoptosis
E) Calcifications/Intracellular accumulations

Question 6

Match the cellular response normally seen in cells with the stimuli (description):

-Metabolic alterations, genetic or acquired

A) Hyperplasia/Hypertrophy
B) Atrophy
C) Metaplasia
D) Injury/Necrosis/Apoptosis
E) Calcifications/Intracellular accumulations

Question 7

Match the cellular response normally seen in cells with the stimuli (description):

-Decreased nutrients, stimulation

A) Hyperplasia/Hypertrophy
B) Atrophy
C) Metaplasia
D) Injury/Necrosis/Apoptosis
E) Calcifications/Intracellular accumulations

Question 8

Which of the following describes hyperplasia?

A) Increase in the number of cells (mitosis) in an organ or tissue
B) Decrease in the number of cells (mitosis) in an organ or tissue
C) Increase in individual cell size in an organ or tissue
D) Decrease in individual cell size in an organ or tissue
E) Reversible change in which one adult cell is replaced by another adult cell type

Question 9

Most forms of pathologic hyperplasia are caused by excessive hormonal stimulation or growth factors acting on target cells. If a patient had hyperplasia of the endometrium, which of the following is the most likely?

A) Increased risk of miscarriage
B) Decreased risk of miscarriage
C) Increased risk of endometrial cancer
D) Decreased risk of endometrial cancer
E) Increased risk of neurologic disease

Question 10

Infection from which of the following is associated with hyperplasia?

A) Papillomavirus
B) Enterobacteria
C) Staphylococci
D) Streptococci
E) Hook worms

Question 11

Which of the following describes hypertrophy?

A) Increase in the number of cells (mitosis) in an organ or tissue
B) Decrease in the number of cells (mitosis) in an organ or tissue
C) Increase in individual cell size in an organ or tissue
D) Decrease in individual cell size in an organ or tissue
E) Reversible change in which one adult cell is replaced by another adult cell type

Question 12

In the heart, the stimulus for hypertrophy is usually chronic hemodynamic overload, resulting from either hypertension or faulty valves. During cardiac muscle hypertrophy, ____ myosin heavy chains are replaced by ____myosin heavy chains, which leads to ____ ATPase activity and a slower, more efficient contraction.

A) !;"; Increased
B) !;"; Decreased
C) ";!; Increased
D) ";!; Decreased

Question 13

Atrial natriuretic factor (ANF) serves to reduce hemodynamic load. In the embryonic heart, the gene for ANF is expressed in both the atrium and the ventricle. After birth, _____expression of the gene is down regulated. Cardiac hypertrophy is associated with a(n) _________ of ANF gene expression.

A) Atrial; Decrease
B) Atrial; Increase
C) Ventricular; Decrease
D) Ventricular; Increase

Question 14

Which of the following types of atrophy is involved in marasmus?

A) Decreased workload
B) Loss of innervation
C) Diminished blood supply
D) Inadequate nutrition (protein-calorie)
E) Loss of endrocrine stimulation
F) Aging (senile atrophy)
G) Pressure

Question 15

Which of the following types of atrophy is involved in ischemia?

A) Decreased workload
B) Loss of innervation
C) Diminished blood supply
D) Inadequate nutrition (protein-calorie)
E) Loss of endrocrine stimulation
F) Aging (senile atrophy)
G) Pressure

Question 16

Which of the following is associated with cachexia, seen in patients with chronic
Inflammatory diseases and cancer?

A) Decreased workload
B) Loss of innervation
C) Diminished blood supply
D) Inadequate nutrition (protein-calorie)
E) Loss of endrocrine stimulation
F) Aging (senile atrophy)
G) Pressure

Question 17

Which cellular organelle contains acid hydrolases (e.g. cathepsins) and other enzymes to degrade endocytosed proteins from the extracellular environment and the cell surface as well as some cellular components during atrophy?

A) Smooth ER
B) Rough ER
C) Golgi
D) Mitochondria
E) Lysosomes

Question 18

The -proteasome pathway is responsible for the degradation of many cytosolic
And nuclear proteins.

A) Ubiquitin
B) Ouabain
C) Angiotensin
D) Methionine
E) Decarboxylase

Question 19

Which of the following opposes proteasome-mediated protein degradation?

A) Thyroid hormone
B) Cytokines
C) Glucocorticoids
D) Dexamethasone
E) Insulin

Question 20

Atrophy may be accompanied by residual bodies, such as lipofuscin granules, which
Can turn tissue what color?

A) Yellow
B) Blue
C) Brown
D) White
E) Red

Question 21

Which of the following describes metaplasia?

A) Increase in the number of cells (mitosis) in an organ or tissue
B) Decrease in the number of cells (mitosis) in an organ or tissue
C) Increase in individual cell size in an organ or tissue
D) Decrease in individual cell size in an organ or tissue
E) Reversible change in which one adult cell is replaced by another adult cell type

Question 22

Which of the following is the most common stem cell reprogramming change involved in respiratory tract cancer?

A) Squamous to columnar
B) Squamous to cuboidal
C) Columnar to squamous
D) Columnar to cuboidal
E) Cuboidal to squamous

Question 23

In Barrett esophagus, metaplasia occurs as a result of refluxed gastric acid. Which of the following changes occurs?

A) Squamous to columnar
B) Squamous to cuboidal
C) Columnar to squamous
D) Columnar to cuboidal
E) Cuboidal to squamous

Question 24

Which of the following is associated with cell death and NOT specifically with reversible cell injury?

A) Membrane blebs
B) Clumping of chromatin
C) Swelling of ER
D) Swelling of mitochondria
E) Myelin figures

Question 25

Which of the following is NOT associated with cell death?

A) Nuclear condensation (pyknosis)
B) Nuclear fragmentation (karyorrhexis)
C) Dissolution of the nucleus (karyolysis)
D) Decrease in intracellular Ca++
E) Amorphous mitochondrial densities

Question 26

Which of the following causes of cell injury involves a single amino acid substitution in hemoglobin S in sickle cell anemia?

A) Oxygen deprivation
B) Physical agents
C) Chemical agents and drugs
D) Infectious agents
E) Immunologic reactions
F) Genetic derangements
G) Nutritional imbalances

Question 27

Which of the following is NOT a principle relevant to most forms of cell injury?

A) The cellular response to injurious stimuli depends on the type of injury, its duration, and its severity
B) The result of cell injury involves an increase in ATP production and decrease in intracellular Ca++
C) Cell injury results from functional and biochemical abnormalities in one or more of several essential cellular components
D) The consequences of cell injury depend on the type, state, and adaptability of the injured cell

Question 28

Depletion of ATP to <5% to 10% of normal levels has widespread effects on many critical cellular systems. Which of the following is NOT a condition which may lead to
Depletion of ATP?

A) Activity of the plasma membrane energy-dependent sodium pump is reduced
B) Failure of the Ca++ pump
C) Cellular energy metabolism is altered
D) Increase in protein synthesis followed by necrosis
E) Unfolding or misfolding of existing proteins

Question 29

Ischemia reduces oxidative phosphorylation in mitochondria, resulting in a decrease in ATP production. Which of the following would NOT follow as a morphologic
Consequence?

A) Increased anaerobic glycolysis
B) Increase in pH and glycogen
C) Decrease in protein synthesis
D) Influx of Ca++, H2O, and Na++
E) Efflux of K+

Question 30

Which of the following would NOT cause mitochondrial damage?

A) Increase in cytosolic Ca++
B) Oxidative stress
C) Retention of cytochrome c
D) Breakdown of phospholipids through the phospholipase A2 and sphingomyelin pathways
E) Lipid breakdown products (e.g. free fatty acids and ceramide)

Question 31

Which of the following most likely occurs if cytochrome c is released into the cytosol

A) Apoptosis
B) Hypertonicity
C) Hypotonicity
D) Increased extracellular Ca++
E) Decreased intracellular K+

Question 32

Cell injury often results in increased intracellular calcium and this in turn mediates a variety of deleterious effects. Which of the following is NOT activated by calcium?

A) ATPases
B) Phospholipases
C) Proteases
D) Endonucleases
E) ATP synthase

Question 33

Some energy producing processes produce reactive oxygen species (free radicals) that can cause damage to cells. Which of the following is NOT a mechanism of free
Radical generation?

A) Absorption of radiant energy
B) Enzymatic metabolism of exogenous chemicals or drugs
C) During creation of ATP via glycolysis
D) Free electron donation from transition metals (e.g. copper, iron)
E) Reduction-oxidation reactions during normal metabolic processes

Question 34

Which of the following is NOT a mechanism by which free radicals cause cell injury?

A) Lipid peroxidation of membranes
B) Oxidative modification of proteins
C) Lesions in DNA
D) Reactions with!-carotene
E) Reactions with thymine

Question 35

Which of the following is NOT involved in free radical neutralization?

A) Superoxide dismutase (SOD)
B) Nitric oxide (NO)
C) Vitamins A, C, and E
D) Glutathione peroxidase and reductase
E) Fenton (ferritin)

Question 36

The two patterns of reversible cell injury are cellular swelling and fatty change. Which of the following would NOT be an ultrastructural change seen in such a cell?

A) Decreased lysosomal activity
B) Plasma membrane alterations
C) Mitochondrial changes
D) Dilation of the ER Nuclear alteration

Question 37

Which of the following would NOT be an ultrastructural change seen in a reversibly injured cell?

A) Blebbing
B) Microvillli distortion
C) Myelin figured
D) Amorphous densities
E) Cell shrinking
F) Loosening of intracellular attachments

Question 38

In the image to the right, A is normal myocardium and B is myocardium with coagulation necrosis. Which of the following can be discerned in B, suggesting necrosis?

A) Eosinophilia
B) Myeline figures
C) Blebbing
D) Cell swelling
E) Apoptosis

Question 39

Match the following description with the term:

-Nuclear shrinkage and increased basophilia

A) Karyolysis
B) Pyknosis
C) Karyorrhexis

Question 40

Match the following description with the term:

-Nucleus undergoes fragmentation

A) Karyolysis
B) Pyknosis
C) Karyorrhexis

Question 41

Match the following description with the term:

-Basophilia of the chromatin may fade

A) Karyolysis
B) Pyknosis
C) Karyorrhexis

Question 42

Which of the following occurs as a result of release of activated pancreatic enzymes and can leave white, chalky deposits representing calcium soap?

A) Coagulative necrosis
B) Liquefactive necrosis
C) Causeous necrosis
D) Fat necrosis
E) Gangrenous necrosis

Question 43

Which of the following implies preservation of the basic outline of the involved cell for a span of at least some days?

A) Coagulative necrosis
B) Liquefactive necrosis
C) Causeous necrosis
D) Fat necrosis
E) Gangrenous necrosis

Question 44

Which of the following has a cheesy, yellow-white appearance at the area of necrosis and is encountered most often in foci of tuberculous infection?

A) Coagulative necrosis
B) Liquefactive necrosis
C) Causeous necrosis
D) Fat necrosis
E) Gangrenous necrosis

Question 45

Which of the following is characteristic of focal bacterial or, occasionally, fungal infections, because microbes stimulate the accumulation of inflammatory cells?

A) Coagulative necrosis
B) Liquefactive necrosis
C) Causeous necrosis
D) Fat necrosis
E) Gangrenous necrosis

Question 46

Which of the following types of cell injury involves anaerobic energy generation stoping after glycolytic substrates are exhausted, or glycolytic function becoming inhibited by the accumulation of metabolites?

A) Ischemic
B) Hypoxic
C) Ischemic reperfusion
D) Chemical induced

Question 47

When blood flow is restored to cells that have been previously made ischemic but have not died, injury is often exacerbated and proceeds at an accelerated pace.

Question 48

Increased generation of oxygen free radicals from parenchymal and endothelial cells and from infiltrating leukocytes would cause damage in which of the following cell injury mechanisms?

A) Ischemic
B) Hypoxic
C) Ischemic reperfusion
D) Chemical induced

Question 49

Chemically induced cell injury from carbon tetrachloride (CCl4) and acetaminophen (Tylenol) affect which organ?

A) Brain
B) Kidneys
C) Pancreas
D) Spleen
E) Liver

Question 50

CCl4 is converted by P-450 to which highly reactive toxic free radical?

A) CCl2
B) CCl3
C) CCl5
D) CCl6
E) Cl+

Question 51

Like tissue necrosis, cell apoptosis causes inflammation.

Question 52

Which of the following is considered physiologic apoptosis, NOT pathologic apoptosis?

A) Cell death from cytotoxic anticancer drug damage to DNA
B) Cell death due to damage from viral hepatitis
C) Cell death in tumors
D) Cell death induced by cytotoxic T cells
E) Pathologic atrophy in parenchymal organs after duct obstruction

Question 53

Which of the following is NOT a morphologic feature of cells undergoing apoptosis?

A) Hypoxia
B) Cell shrinkage
C) Chromatin condensation
D) Formation of cytoplasmic blebs and apoptotic bodies
E) Phagocytosis of apoptotic cells or cell bodies, usually by macrophages

Question 54

Certain cellular alterations permit the early recognition of dead cells by macrophages. What is the result of this process?

A) Protein hydrolysis involving the activation of caspases
B) Swelling of cellular mitochondria
C) Phagocytosis without the release of cytokines
D) Ubiquitin destruction of cellular components
E) Destruction of surrounding tissue

Question 55

Which of the following is inhibitory to the Fas (extrinsic) apoptosis pathway?

A) FasL
B) FADD
C) FLIP
D) Pro Caspase-8
E) Active Caspase-8

Question 56

Which of the following is inhibitory to the mitochondrial (intrinsic) apoptosis pathway?

A) Cytochrome c
B) Bcl-2
C) Apaf-1
D) IAPs
E) Pro Caspase-9
F) Active Caspase-9
G) AIF

Question 57

Expression of the CD-31 marker (PECAM-1) does which of the following?

A) Prevents neutrophils from binding to macrophages
B) Allows neutrophils to bind to macrophages
C) Prevents neutrophils from being phagocytized
D) Allows neutrophils to be phagocytized
E) Is only expressed on the surface of cancer cells

Question 58

Which of the following caspases is an executioner and not an initiator of apoptosis?

A) CASP2
B) CASP8
C) CASP9
D) CASP10
E) CASP3, CASP6, CASP7

Question 59

Match the type of apoptosis with the involved item:

-Apoptosis After Growth Factor Deprivation

A) p53
B) Granzyme B
C) FasL
D) Bcl

Question 60

Match the type of apoptosis with the involved item:

-DNA Damage-Mediated Apoptosis

A) p54
B) Granzyme B
C) FasL
D) Bcl

Question 61

Match the type of apoptosis with the involved item:

-Apoptosis Induced by Tumor Necrosis Factor Family of Receptors

A) p55
B) Granzyme B
C) FasL
D) Bcl

Question 62

Match the type of apoptosis with the involved item:

-Cytotoxic T-Lymphocyte-Mediated Apoptosis

A) p56
B) Granzyme B
C) FasL
D) Bcl

Question 63

The ER is involved in metabolism of various chemicals via cytochrome P-450 and cells exposed to these chemicals show of ER. Mitochondrial and cytoskeletal abnormalities are also apparent in injured cells.

A) Rough; Atrophy
B) Rough; Hypertrophy
C) Smooth; Atrophy
D) Smooth; Hypertrophy

Question 64

Match the abnormality which results in intracellular accumulations in nonneoplatics
cells with the resultant disease:

-Abnormal metabolism

A) Lysosomal storage diseases
B) Hemosiderosis
C) Alpha1-antitrypsin deficiency
D) Fatty change in liver

Question 65

Match the abnormality which results in intracellular accumulations in nonneoplatics
cells with the resultant disease:

-Mutations causing alterations in protein folding and transport

A) Lysosomal storage diseases
B) Hemosiderosis
C) Alpha1-antitrypsin deficiency
D) Fatty change in liver

Question 66

Match the abnormality which results in intracellular accumulations in nonneoplatics
cells with the resultant disease:

-Deficiencies in critical enzymes

A) Lysosomal storage diseases
B) Hemosiderosis
C) Alpha1-antitrypsin deficiency
D) Fatty change in liver

Question 67

Match the abnormality which results in intracellular accumulations in nonneoplatics
cells with the resultant disease:

-Inability to degrade phagocytosed particles

A) Lysosomal storage diseases
B) Hemosiderosis
C) Alpha1-antitrypsin deficiency
D) Fatty change in liver

Question 68

How do intracellular hyaline deposits, such as reabsorption droplets, Russell bodies, and Mallory alcoholic hyaline, appear when stained histologically with hematoxylin and eosin?

A) Homogeneous and pink
B) Homogenous and purple
C) Disperse and pink
D) Disperse and purple

Question 69

Which of the following diseases would most likely show glycogen abnormalities if tissues, such as the descending loop of Henle and liver cells, are stained with periodic acid shiff (PAS) ?

A) Chronic hypertension
B) Congestive heart failure
C) Abdominal aortic aneurysm
D) Rheumatoid arthritis
E) Diabetes mellitus

Question 70

Hemosiderin is a hemoglobin-derived, golden yellow-to-brown, granular or crystalline pigment that can indicate a local excess of which of the following?

A) Oxygen
B) CO2
C) Iron
D) Macrophages
E) Ca++

Question 71

Bilirubin is hemoglobin-derived and the normal major pigment found in bile. If found in excess, what color does it change the skin?

A) Black
B) White
C) Red
D) Yellow
E) Blue

Question 72

The deposition of calcium salts in otherwise normal tissues is known as calcification, and it almost always results from secondary to some disturbance in
Calcium metabolism.

A) Dystrophic; Hypercalcemia
B) Dystrophic; Hypocalcemia
C) Metastatic; Hypercalcemia
D) Metastatic; Hypocalcemia

Question 73

Which of the following would NOT be associated with metastatic calcification?

A) Increased secretion of parathyroid hormone (PTH)
B) Destruction of bone tissue
C) Vitamin D-related disorders
D) Renal failure
E) Aortic stenosis

Question 74

Acute and Chronic Inflammation

-Which of the following is associated with acute inflammation?

A) Neutophils
B) Macrophages
C) Lymphocytes
D) Tissue fibrosis
E) Tissue necrosis

Question 75

Acute and Chronic Inflammation

-Acute inflammation may be triggered by infections, trauma, physical or chemical agents, tissue necrosis, foreign bodies, and immune reactions. Which of the following is NOT seen in acute inflammation?

A) Alterations in vascular caliber
B) Decrease in blood flow
C) Structural changes in the microvasculature (edema)
D) Plasma proteins and leukocytes leaving the circulation
E) Leukocyte focusing to eliminate the offending agent

Question 76

Acute and Chronic Inflammation

-Vascular changes associated with acute inflammation include_____ (from histamine and NO) and vascular permeability.

A) Vasoconstriction; Decreased
B) Vasoconstriction; Increased
C) Vasodilation; Decreased
D) Vasodilation; Increased

Question 77

Match the endothelial molecule (leukocyte adhesion molecule) with its major role:

-Rolling, adhesion to activated endothelium (neutrophils, T cells)

A) ICAM-1
B) P-selectin
C) E-selectin
D) VCAM-1
E) GlyCam-1
F) CD31 (PECAM)

Question 78

Match the endothelial molecule (leukocyte adhesion molecule) with its major role:

-Adhesion (eosinophils, monocytes, lymphocytes)

A) ICAM-1
B) P-selectin
C) E-selectin
D) VCAM-1
E) GlyCam-1
F) CD31 (PECAM)

Question 79

Match the endothelial molecule (leukocyte adhesion molecule) with its major role:

-Leukocyte migration through endothelium

A) ICAM-1
B) P-selectin
C) E-selectin
D) VCAM-1
E) GlyCam-1
F) CD31 (PECAM)

Question 80

Match the endothelial molecule (leukocyte adhesion molecule) with its major role:

-Rolling (neutrophils, monocytes, lymphocytes)

A) ICAM-1
B) P-selectin
C) E-selectin
D) VCAM-1
E) GlyCam-1
F) CD31 (PECAM)