1.
In hypoxic cell injury, cell swelling occurs because of increased intracellular:
Correct Answer
D. Water
Explanation
In hypoxic cell injury, cell swelling occurs because of increased intracellular water. During hypoxia, there is a decrease in oxygen supply to the cells, leading to a disruption in cellular metabolism. This disruption affects the sodium-potassium pump, causing an accumulation of intracellular sodium and a decrease in intracellular potassium. This alteration in ion balance leads to an influx of water into the cells, causing them to swell. Therefore, increased intracellular water is responsible for the cell swelling observed in hypoxic cell injury.
2.
A patient is admitted with severe substernal chest pain for 4 hours. Lab tests reveal an increased level of serum creatine kinase. This is most likely due to:
Correct Answer
C. Damage of plasma membranes
Explanation
The increased level of serum creatine kinase in a patient with severe substernal chest pain suggests damage of plasma membranes. Creatine kinase is an enzyme found in various tissues, including the heart muscle. When the plasma membrane of the heart muscle cells are damaged, creatine kinase leaks into the bloodstream, resulting in an increased level of serum creatine kinase. This can occur during a heart attack or myocardial infarction, where the lack of blood flow to the heart muscle causes cell death and membrane damage.
3.
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 the death of hepatocytes and liver cirrhosis?
Correct Answer
A. Fatty change in liver cells
Explanation
Fatty change in liver cells, also known as hepatic steatosis, refers to the abnormal accumulation of fat within liver cells. This condition is commonly associated with alcohol abuse and can lead to the death of hepatocytes and the development of liver cirrhosis. The excessive accumulation of fat within the liver cells disrupts their normal function and can cause inflammation and cell death. Over time, this can progress to liver cirrhosis, a condition characterized by the irreversible scarring of the liver tissue.
4.
A pathologist notes that a biopsy from the lungs of living patients shows morphologic changes indicative of irreversible injury and cell death with no external cause. Which of the following is a type of cell death catalyzed by its own enzymes?
Correct Answer
D. Autolysis
Explanation
Autolysis is the most likely responsible for cell death in a living body in this scenario. Autolysis refers to the process of self-digestion of cells by their own enzymes. In this case, the morphologic changes indicative of irreversible injury and cell death observed in the lung biopsy suggest that the cells in the lung tissue are undergoing autolysis, where their own enzymes are breaking down the cellular components. This process is different from necrosis, putrefaction, and cytolysis, which refer to cell death caused by external factors or processes. Somatic death refers to the death of the entire organism, not just cell death.
5.
Cell death due to autolysis is caused by:
Correct Answer
B. Endogenous enzymes
Explanation
Cell death caused by autolysis is produced by endogenous enzymes. These endogenous enzymes are naturally present within the cells. They break down the cellular components and structures, leading to cell death. This process can occur due to various reasons, such as injury, disease, or natural cell turnover. Antibodies, phagocytic leukocytes, bacterial enzymes, and anoxia (lack of oxygen) are not directly involved in the process of autolysis.
6.
A 10-year-old black male 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:
Correct Answer
B. Coagulative necrosis
Explanation
Coagulative necrosis is the most likely finding on microscopic examination of the spleen in a 10-year-old black male with sickle cell disease presenting with left upper quadrant pain suggestive of a splenic infarct. Coagulative necrosis is a type of necrosis characterized by the preservation of tissue architecture and cellular outlines, but with loss of the nucleus and cytoplasmic staining. This type of necrosis occurs in ischemic tissue, where the blood supply is compromised, as seen in sickle cell disease. The other types of necrosis listed (caseous, fibrinoid, gangrenous, and liquefactive) are not typically associated with splenic infarcts in sickle cell disease.
7.
A pathologist notes cloudy swelling, hydropic change, and fatty change in a patient's liver with a history of alcohol abuse. These morphological changes are all examples of:
Correct Answer
E. Reversible cell injury
Explanation
The pathologist's observations of cloudy swelling, hydropic change, and fatty change in the patient's liver indicate reversible cell injury. Cloudy swelling refers to the accumulation of water in cells, hydropic change refers to the abnormal accumulation of fluid within cells, and fatty change refers to the accumulation of fat within cells. These are all reversible changes that can occur in response to various insults, such as alcohol abuse.
8.
Which of the following is an example of an agent capable of producing a toxic metabolite and indirect chemical injury?
Correct Answer
A. Alcohol
Explanation
Alcohol is an example of an agent capable of producing a toxic metabolite and indirect chemical injury. When alcohol is metabolized in the liver, it produces acetaldehyde, which is a toxic substance. Accumulation of acetaldehyde can lead to liver damage and other health problems. Additionally, alcohol can indirectly cause chemical injury by impairing judgment and coordination, leading to accidents or risky behaviors that can result in injury or poisoning.
9.
A circumscribed mass of light yellow crumbly to pasty material associated microscopically with a macrophage response is a characteristic of:
Correct Answer
A. Caseous necrosis
Explanation
A circumscribed mass of light yellow crumbly to pasty material associated microscopically with a macrophage response is characteristic of caseous necrosis. This type of necrosis is typically seen in tuberculosis infections and is characterized by the formation of a cheesy, granular material composed of fragmented cells and debris. The macrophage response is a key feature, as these immune cells attempt to clear the necrotic material.
10.
A well-demarcated lesion with increased cytoplasmic eosinophilia, karyolysis, and intact tissue architecture is characteristic of:
Correct Answer
C. Coagulative necrosis
Explanation
A well-demarcated lesion with increased cytoplasmic eosinophilia, karyolysis, and intact tissue architecture is characteristic of coagulative necrosis. Coagulative necrosis is a type of cell death that occurs due to ischemia or infarction. It is characterized by the preservation of tissue architecture and the presence of eosinophilic cytoplasm. Karyolysis refers to the dissolution of the nucleus, which is also seen in coagulative necrosis. This type of necrosis is commonly observed in organs such as the heart, kidney, and liver.
11.
The pattern of cell death that is characterized by the conversion of a single cell to an acidophilic body, usually with loss of the nucleus but with preservation of its shape to permit recognition of cell boundaries, is termed:
Correct Answer
A. Apoptosis
Explanation
Apoptosis is the correct answer because it refers to a pattern of cell death where a single cell undergoes structural changes, such as the loss of the nucleus, while maintaining its shape. This allows for the recognition of cell boundaries. Apoptosis is a tightly regulated process that occurs during normal development and in response to various stimuli, helping to maintain tissue homeostasis. It is different from necrosis, which is a form of cell death characterized by cellular swelling, inflammation, and loss of cell boundaries.
12.
The action of putrefactive bacteria on necrotic tissue results in:
Correct Answer
C. Gangrene
Explanation
Putrefactive bacteria breaking down necrotic tissue leads to the condition known as gangrene. Gangrene occurs when the blood supply to a certain area of the body is cut off, causing tissue death. The bacteria thrive in this necrotic tissue, releasing toxins and causing further tissue damage. This can result in a foul odor, discoloration, and the formation of gas bubbles. If left untreated, gangrene can spread and become life-threatening.
13.
A well-demarcated area of the myocardium appears paler than surrounding tissue and microscopically consists of eosinophilic muscle fibers with only a few karyorrhectic and pyknotic nuclei remaining. Many polys are seen, especially at the margin of this area. The age of the myocardial infarct is most likely:
Correct Answer
C. 2 days
Explanation
The given description of a well-demarcated area of the myocardium appearing paler than surrounding tissue and consisting of eosinophilic muscle fibers with only a few karyorrhectic and pyknotic nuclei remaining suggests that this is a healing myocardial infarct. The presence of many polys, especially at the margin of the area, indicates an inflammatory response. This process takes time to develop, suggesting that the age of the myocardial infarct is most likely 2 days.
14.
You are asked to write a microscopic description of the coagulative necrosis that was noted in the heart of a patient who died of a heart attack because of cocaine abuse. Which of the following best described coagulative necrosis?
Correct Answer
A. Eosinophilic cytoplasm with cell outlines preserved
Explanation
Coagulative necrosis is a type of cell death characterized by the preservation of cell outlines and the presence of eosinophilic cytoplasm. This means that the cells maintain their shape and structure, but the cytoplasm takes on a pink color when stained with eosin dye. This type of necrosis is commonly seen in ischemic injury, such as in a heart attack, where there is a lack of blood supply to the affected tissue. In this case, the heart tissue of a patient who died of a heart attack due to cocaine abuse would show eosinophilic cytoplasm with preserved cell outlines, indicating coagulative necrosis.
15.
Caseous necrosis is characterized morphologically by:
Correct Answer
E. Amorphous appearance
Explanation
Caseous necrosis is a type of necrosis where the affected tissue appears amorphous, meaning it lacks a definite shape or structure. This is due to the breakdown of cellular components, resulting in a granular, cheese-like appearance. The other options listed in the question are not specific to caseous necrosis. While preservation of tissue outlines and basophilia may be seen in other types of necrosis, the semi-liquid consistency and wedge-shaped periphery are not characteristic of caseous necrosis. Therefore, the correct answer is amorphous appearance.
16.
What would be an example of hypertrophy?
Correct Answer
B. Enlargement of the uterus during pregnancy
Explanation
Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. The number of cells remains the same but the cells become larger. This happens to the uterus during pregnancy when the uterus grows to accommodate the size of the fetus. This enlargement is a normal physiological response to accommodate the developing baby and provide a suitable environment for its growth.
17.
Which tissue is the most susceptible to liquefactive necrosis following ischemic injury?
Correct Answer
D. Brain
Explanation
Brain tissue is the most susceptible to liquefactive necrosis following ischemic injury. Ischemic injury refers to a lack of blood supply to a tissue, leading to oxygen and nutrient deprivation. The brain is highly dependent on a constant supply of blood and oxygen, and any interruption in this supply can quickly lead to tissue damage. Liquefactive necrosis is a type of cell death characterized by the formation of liquid-filled spaces within the affected tissue. Liquefactive necrosis can also occur when lysosomes turn tissues into pus as a result of the lysosomal release of digestive enzymes. Neurons have a higher lysosomal content, leading to a higher tendency toward liquefactive necrosis.
18.
A patient suffers a stroke and has left-sided weakness and paralysis in the upper extremity. The type of necrosis associated with a well-developed infarct of the brain is:
Correct Answer
C. Liquefactive
Explanation
Liquefactive necrosis is the correct answer in this case because it is commonly associated with infarcts in the brain. In liquefactive necrosis, the affected tissue becomes liquefied due to the action of enzymes, leading to the formation of cystic spaces. This type of necrosis is often seen in the brain because the high water content and abundance of enzymes in neural tissue promote the liquefaction process. In the given scenario, the patient's left-sided weakness and paralysis in the upper extremity are consistent with a stroke, which can cause an infarct in the brain leading to liquefactive necrosis.
19.
A 75-year-old woman has a complaint of shortness of breath and chest pain that radiates to the left shoulder. Serum levels of CK-MB (myocardial creatine kinase) and cardiac muscle troponin I (cTnI) are elevated. Which of the following types of myocardial cell death would best account for these findings?
Correct Answer
C. Coagulative necrosis
Explanation
The elevated levels of CK-MB and cTnI indicate damage to the myocardium, which is consistent with myocardial infarction (heart attack). Coagulative necrosis is the most likely type of myocardial cell death in this scenario. Coagulative necrosis occurs in ischemic tissues, such as during a heart attack, where there is a lack of blood supply. It is characterized by the preservation of tissue architecture, but with loss of nuclei and cytoplasmic eosinophilia. This is consistent with the findings of elevated cardiac enzymes and the symptoms described by the patient.
20.
Coagulative necrosis usually results from:
Correct Answer
B. Ischemia
Explanation
Coagulative necrosis is a type of cell death that occurs when there is a lack of blood supply to a specific area, leading to tissue damage. Ischemia, which refers to the insufficient blood flow to an organ or tissue, is a common cause of coagulative necrosis. In this condition, the lack of oxygen and nutrients causes the affected cells to undergo necrosis while still maintaining their overall structure. Other options such as abscess formation, trauma, tuberculosis, and syphilis can lead to different types of necrosis, but they are not specifically associated with coagulative necrosis.