Block 9 Cell Injury Response Cause Necrosis MCQ's
.JPG "Block 9 Cell Injury Response Cause Necrosis MCQ")
Cellular injury -response, adaptation, causes, morphology, mechanisms, necrosis
Questions and Answers
- 1.
A 65 year old chronic alcoholic woman presents with angina and dyspnea. Her family history is significant for 3 siblings who died of myocardial infarction in their 40's and 50's. Physical examination reveals a diaphoretic woman in acute distress with an elevated blood pressure, pulse and respiratory rate. On general survey, you notice the skin lesions seen below. Biopsies from these skin lesions show foam cells or macrophages with an intracellular accumulation of:
- A.
Protein
- B.
Lipid
- C.
Cholesterol
- D.
Pigment
Correct Answer
C. CholesterolExplanation
The skin lesions seen in the patient are indicative of xanthomas, which are characterized by the accumulation of cholesterol in macrophages. This is consistent with the patient's family history of premature myocardial infarction, as high levels of cholesterol can lead to the development of atherosclerosis and subsequent cardiovascular events. The patient's symptoms of angina and dyspnea, along with the elevated blood pressure, pulse, and respiratory rate, further support the diagnosis of cardiovascular disease.Rate this question:
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- 2.
A 45 year old man comes to the emergency room with slurred speech and right sided weakness. His family history is significant for familial hypercholesterolemia. Physical examination reveals an obese man with difficulty speaking, carotid bruits, and significant weakness in his right upper and lower extremities. Laboratory data reveals elevated serum cholesterol and triglycerides. An MRI of the brain reveaIs an abnormal area in the left temporal lobe. A biopsy of this area would most likely show:
- A.
Coagulative necrosis.
- B.
Liquefactive necrosis
- C.
Liquefactive necrosis and gangrenous necrosis
- D.
Coagulative necrosis and liquefactive necrosis.
Correct Answer
B. Liquefactive necrosisExplanation
Based on the patient's symptoms and physical examination findings, as well as the MRI results showing an abnormal area in the left temporal lobe, the most likely explanation for the biopsy findings would be liquefactive necrosis. Liquefactive necrosis is characterized by the formation of liquid-filled spaces within the affected tissue, typically seen in conditions such as brain infarction. This is consistent with the patient's presentation of slurred speech, right-sided weakness, and the abnormality found in the left temporal lobe. The other options of coagulative necrosis and gangrenous necrosis are less likely based on the clinical presentation and MRI findings.Rate this question:
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- 3.
During your surgery rotation your are part of a medical team performing an exploratory emergency laproscopic surgery of the abdomen. A look through the laprascope reveals the image seen below. What is the most likely diagnosis.
- A.
Traumatic fat necrosis
- B.
Enzymatic fat necrosis
- C.
Caseous necrosis
- D.
Coagulative necrosis and calcifications
Correct Answer
B. Enzymatic fat necrosisExplanation
• Fat Necrosis
– Affects lipid and results from pancreatitis or trauma
– Dependent upon the presence of triglycerides
– Pathogenesis
• Digestive enzymes from pancreatic duct or small intestine are released from cells and activated.
• Phospholipases and proteases attack plasma membranes of adipocytes and triglycerides are released.
• Pancreatic lipase hydrolyzes triglycerides producing fatty acids.
• Free fatty acids bind with calcium forming soaps which appear as amorphous, basophilic deposits at the edges of necrotic adipocytes.
– Grossly material appears chalky.Rate this question:
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- 4.
During your pediatric rotation you are asked to examine a newborn. His physical examination was with normal limits with the exception of his right hand which is shown below. What is the underlying defect that has caused this deformity?
- A.
A defect in physiologic apoptosis and developmental involution
- B.
A defect in pathologic apoptosis and developmental involution
- C.
A defect in physiologic apoptosis and organogenesis
- D.
A defect in pathologic apoptosis and cell death induced by cytotoxic T cells
Correct Answer
A. A defect in physiologic apoptosis and developmental involutionExplanation
The correct answer is a defect in physiologic apoptosis and developmental involution. Physiologic apoptosis is the normal process of programmed cell death that occurs during development and involution is the process of tissue regression. The deformity in the newborn's hand suggests that there is a defect in the normal programmed cell death and tissue regression that should have occurred during development. This defect could be responsible for the abnormality in the hand.Rate this question:
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- 5.
75-year-old woman complains of shortness of breath and chest pain that radiates to the left shoulder. Serum levels of CK-MB (myocardial creatinine kinase) and cardiac muscle troponin I (cTnI) are elevated. Despite thrombolytic therapy the patient dies. What would you most likely see on light microscopic examination of the heart?
- A.
Preservation of cardiac tissue structure without nuclei
- B.
Rupture of cardiac cell membranes
- C.
Cardiomyocyte swelling
- D.
Amorphous appearance of cardiac tissue
Correct Answer
A. Preservation of cardiac tissue structure without nucleiExplanation
The elevated levels of CK-MB and cTnI indicate myocardial damage, which is commonly seen in conditions such as myocardial infarction. Thrombolytic therapy is used to dissolve blood clots and restore blood flow to the heart. However, despite this treatment, the patient dies, suggesting severe damage to the cardiac tissue. Preservation of cardiac tissue structure without nuclei is the most likely finding on light microscopic examination of the heart, as it indicates irreversible cell death and loss of cellular components.Rate this question:
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- 6.
A patient is admitted with severe substernal chest pain of 4 hours duration. Lab tests reveal increased levels of serum troponin. This is most likely due to :
- A.
Mitochondrial swelling associated with reversible injury.
- B.
Nuclear lysis associated with irreversible injury.
- C.
Increase in intracellular calcium associated with irreversible injury.
- D.
Damage of cell membranes associated with irreversible injury.
Correct Answer
D. Damage of cell membranes associated with irreversible injury.Explanation
The increased levels of serum troponin indicate damage to the cell membranes, which is typically associated with irreversible injury. Troponin is a protein found in cardiac muscle cells, and its release into the bloodstream suggests that the cell membranes have been compromised. This damage is unlikely to be reversible, as it indicates significant injury to the cells. Therefore, the most likely explanation for the increased levels of serum troponin in this patient is damage of cell membranes associated with irreversible injury.Rate this question:
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- 7.
You are asked to review a liver biopsy from a patient with a history of alcohol abuse. Which of the following pathologic changes will most likely lead to death of hepatocytes and liver cirrhosis?
- A.
Fatty change
- B.
Hydropic change
- C.
Glycogen deposition
- D.
Karyolysis
Correct Answer
D. KaryolysisExplanation
http://upload.wikimedia.org/wikipedia/en/5/51/Nuclear_changes.jpg
Karyolysis is the complete dissolution of the chromatin matter of a dying cell due to the activity of DNase. The whole cell will eventually stain uniformly with eosin after karyolysis. It is usually preceded by karyorrhexis and occurs mainly as a result of necrosis, while in apoptosis after karyorrhexis the nucleus usually dissolves into apoptotic bodies.Rate this question:
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- 8.
A 1O-year-old African boy with a known history of sickle cell disease presents to the emergency department complaining of left upper quadrant pain suggestive of a splenic infarct. Microscopic examination of the spleen would most likely reveal:
- A.
Caseous necrosis
- B.
Coagulative necrosis
- C.
Fibrinoid necrosis
- D.
Gangrenous necrosis
Correct Answer
B. Coagulative necrosisExplanation
Coagulative necrosis is most commonly caused by conditions that do not involve severe trauma, toxins or an acute or chronic immune response. The lack of oxygen causes cell death in a localised area which is perfused by blood vessels failing to deliver primarily oxygen, but also other important nutrients. It is important to note that while ischemia in most tissues of the body will cause coagulative necrosis, in the central nervous system ischemia causes
--LIQUEFACTIVE NECROSIS-- as there is very little structural framework in neural tissue.Rate this question:
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- 9.
During your obstetrics and gynecology rotation, you are asked to examine a woman with ambiguous genitalia, A biopsy reveals the presence of both ovarian and testicular tissue. This is most likely a result of a defect in:
- A.
Physiologic apoptosis and developmental involution.
- B.
Pathologic apoptosis and developmental involution
- C.
Physiologic apoptosis and hormonal dependent involution
- D.
Pathologic apoptosis and hormonal dependent involution
Correct Answer
A. Physiologic apoptosis and developmental involution.Explanation
This woman with ambiguous genitalia and the presence of both ovarian and testicular tissue most likely has a disorder of sex development (DSD) known as ovotesticular disorder. This condition occurs due to a defect in physiologic apoptosis and developmental involution, which refers to the normal process of programmed cell death and tissue regression that occurs during fetal development. In this case, the failure of apoptosis and involution leads to the persistence of both ovarian and testicular tissue. Pathologic apoptosis and hormonal dependent involution are not the likely causes in this scenario.Rate this question:
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- 10.
You are asked to participate in a research project on stroke in a rat model. Which of the following occurs in ischemic cell injury?
- A.
Influx of Na+ and Ca++ resulting in liquefactive necrosis
- B.
Influx of K+ and Ca++ resulting in coagulative necrosis
- C.
Efflux of K+ and Ca++ resulting in liquefactive necrosis
- D.
Efflux of Na+ and Ca++ resulting in coagulative necrosis
Correct Answer
A. Influx of Na+ and Ca++ resulting in liquefactive necrosisExplanation
In ischemic cell injury, there is a lack of oxygen and nutrients reaching the cells, leading to cell damage and death. This lack of oxygen and nutrients causes an influx of sodium (Na+) and calcium (Ca++) ions into the cells. The accumulation of these ions disrupts the cell membrane integrity and leads to the activation of enzymes that break down cellular components. As a result, the affected cells undergo liquefactive necrosis, where the tissue becomes liquefied due to the breakdown of cellular structures.Rate this question:
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- 11.
69 year old African American man complains of chest pain which radiates to the left arm. He is rushed to the emergency room (ER) for evaluation. His past medical history is significant for poorly controlled hypertension. Physical exam reveals an obese diaphoretic man in acute distress. His vital signs reveal an increase in the respiratory and pulse rate as well as an elevated blood pressure. A complete blood count with differential and chemistry panel was done upon arrival to the ER and was within normal limits. His EKG was abnormal with S-T segment elevations. Despite thrombolytic therapy the patient dies two hours later. A consent for autopsy was obtained from his wife. What would you expect to find upon gross examination of the heart?
- A.
Coagulative necrosis of myocardium
- B.
Increased serum creatinine kinase myocardiaI band (CK-MB) fraction
- C.
Left ventricle hypertrophy
- D.
Neutrophils infiltrating the myocardium
Correct Answer
C. Left ventricle hypertrophyExplanation
The key here is GROSS EXAMINATION.
while the rest would occur in this pt, they would not be observed "grossly"
look for these descriptive words on the mini.Rate this question:
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- 12.
A 60 year old Mexican woman has been complaining of retrosternal burning and discomfort shortly after meals far the last 15 year. She reports taking antacids for relief. An extensive work-u p is done to rule out myocardial infarction. A biopsy of her esophagus reveals mucus secreting columnar epitheIium. What are the most likely diagnosis and explanation?
- A.
Barrett's esophagitis, which is an irreversible metaplastic adaptive response
- B.
Barrett's esophagitis which is an irreversible dysplastic adaptive response
- C.
Barrett's esophagitis which is a reversi ble hyperplastic adaptive response
- D.
Barrett's esophagitis which is a reversible metaplastic adaptive response
Correct Answer
D. Barrett's esophagitis which is a reversible metaplastic adaptive responseExplanation
http://en.wikipedia.org/wiki/File:Pancreatic_acinar_metaplasia_-_high_mag.jpg
METAPLASIA is the reversible replacement of one differentiated cell type with another mature differentiated cell type. The change from one type of cell to another may generally be a part of normal maturation process or caused by some sort of abnormal stimulus. In simplistic terms, it is as if the original cells are not robust enough to withstand the new environment, and so they change into another type more suited to the new environment. If the stimulus that caused metaplasia is removed or ceases, tissues return to their normal pattern of differentiation. HYPERPLASIA is a common preneoplastic response to stimulus. Microscopically cells resemble normal cells but are increased in numbers. Sometimes cells may also be increased in size. Hyperplasia is different from hypertrophy in that the adaptive cell change in hypertrophy is an increase in cell size, whereas hyperplasia involves an increase in the number of cells. DYSPLASIA is a term used in pathology to refer to an abnormality of development. This generally consists of an expansion of immature cells, with a corresponding decrease in the number and location of mature cells. Dysplasia is often indicative of an early neoplastic process. The term dysplasia is typically used when the cellular abnormality is restricted to the originating tissue, as in the case of an early, in-situ neoplasm. Anaplasia – dedifferentiation Hyperplasia – physiological proliferation Increase in number of cells Neoplasia – abnormal proliferation Dysplasia – maturation abnormality Metaplasia – cell type conversion Prosoplasia – cell type develops new function Desmoplasia – connective tissue growthRate this question:
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- 13.
A 62-year-old medical missionary has recently returned to the US from a tour in an emerging nation. She presents to her family physician with a complaint of a productive cough and some dyspnea. She says that this has been going on for some time, but she wanted to wait for medical care in the states. She has no history of smoking and rarely drinks alcohol. Physical exam reveals some lung consolidation on auscultation and a low grade fever. A chest x-ray reveals multifocal 1-3 cm nodules, a few being cavitated. Acid fast stains of the sputum reveal acid-fast organisms; however the results of cultures are yet to be determined. Which of the following is the Most Likely cause of the lung lesions?
- A.
Acute purulent pneumonitis
- B.
Bronchogenic carcinoma
- C.
Granulomatous pneumonitis
- D.
Parasitic migration tracts
- E.
Pulmonary abscesses
Correct Answer
C. Granulomatous pneumonitisExplanation
The most likely cause of the lung lesions in this case is granulomatous pneumonitis. The patient's history of being a medical missionary in an emerging nation suggests possible exposure to infectious agents. The presence of lung consolidation, low grade fever, and acid-fast organisms seen on acid fast stains of the sputum are consistent with granulomatous pneumonitis caused by Mycobacterium tuberculosis, which is an acid-fast organism. The cavitated nodules seen on chest x-ray also support this diagnosis.Rate this question:
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- 14.
A pathologist receives a surgical specimen taken from a 12-year-old boy. The submitted history is not helpful. The specimen is processed for histopathology and the pathologist submits the following report. The specimen was one cm in diameter and nodular. The cut surface revealed a central region of white creamy material surrounded by a rim of firm tissue. Microscopically, the central region consisted of neutrophils, some of which were apoptotic. The neutrophils were surrounded by a capsule of proliferating granulation tissue. What is your diagnosis?
- A.
Abscess
- B.
Benign neoplasm
- C.
Cellulitis
- D.
Granuloma
- E.
Infarct
Correct Answer
A. AbscessExplanation
The given report describes a specimen that is one cm in diameter and nodular, with a central region of white creamy material surrounded by a rim of firm tissue. Microscopically, the central region consists of neutrophils, some of which are apoptotic, surrounded by a capsule of proliferating granulation tissue. This description is consistent with an abscess, which is a localized collection of pus surrounded by inflamed tissue.Rate this question:
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- 15.
A 50 y/o white man complains of sudden onset of chest pain. His laboratory test show elevated cardiac enzymes and troponin in his serum. This increase in enzyme levels is most likely a resuIt of which of the following changes in myocardiocytes?
- A.
Swelling of the mitochondria
- B.
Disruption of protein synthesis
- C.
Heterophagy by Iysosomes
- D.
Damage to the cell membrane
- E.
Karryorhexis of the nucleus
Correct Answer
D. Damage to the cell membraneExplanation
The elevated cardiac enzymes and troponin in the man's serum indicate damage to the cell membrane of his myocardiocytes. This damage could be a result of various factors such as ischemia, injury, or inflammation. When the cell membrane is damaged, it can lead to the release of intracellular enzymes into the bloodstream, causing an increase in their levels. This is a common finding in myocardial infarction, where the damaged heart muscle releases enzymes like creatine kinase (CK) and lactate dehydrogenase (LDH) into the bloodstream.Rate this question:
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.JPG "During your surgery rotation your are part of a medical team performing an exploratory emergency laproscopic surgery of the abdomen. A look through the laprascope reveals the image seen below. What is the most likely diagnosis.")
.JPG "During your pediatric rotation you are asked to examine a newborn. His physical examination was with normal limits with the exception of his right hand which is shown below. What is the underlying defect that has caused this deformity?")
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