Question 1 A 48-year-old 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-a para-aor ortic tic regio region. n. She is treat treated ed with with a chemo chemothe therap rapeut eutic ic agent agent which hich resul esultts in the los loss of indi indivi vid dual ual neo neoplas plasti tic c cell cells s throu hrough gh fragmentation of individual cell nuclei and cytoplasm. Over the next months! the lymphoma decreases in si"e! as documented on a#dominal $% sc scan ans. s. &y whic which h of the the foll follow owin ing g mech mechan anis isms ms has has her her neop neopla lasm sm primarily responded to therapy' A
$oagulative necrosis
&
(itochondrial poisoning
$
)hagocytosis
*
Acute in+ammation in+ammati on
,
Apoptosis
, $O//,$%. %he induction of individual cell death occurs in the process of apoptosis. %he drug e0ect is targeted primarily at the neoplastic cells! not normal cells.
Question A 2-year-old 2-year-old man has experienced severe chest pain for the past 3 hours. On physical examination he is afe#rile! #ut has tachycardia. a#oratory studies show a serum troponin 5 of 16 ng7m. A coronary angiogram is perf perfor orme med d emer emerge gent ntly ly and and revea eveals ls 9 96: 6: occl occlus usio ion n of the the ante anteri rior or inte interv rven entr tric icul ular ar lef leftt ante anteri rior or desc descen endi ding ng arte artery ry.. 5n this this sett settin ing! g! an irreversi#le in;ury to myocardial <#ers will have occurred when which of the following cellular changes occurs' A
=lycogen stores are depleted
&
$ytoplasmic sodium increases
$
>uclei undergo ?aryorrhexis
*
5ntracellular p@ diminishes
,
&le#s form on cell mem#ranes
$ $O//,$%. $hromatin clumping is reversi#le! #ut dissolution of the entire nucleus is not! and when the nucleus is lost! the cell will die. An acute coronary syndrome with myocardial infarction is descri#ed here. Question 2 hile in a home improvement center warehouse #uying paint! a 2-yearold man hears Boo? out #elowCB and is then struc? on the leg #y a falling pallet rac?! which stri?es him on his left leg in the region of his thigh. %he s?in is not #ro?en. ithin days there is a x D cm purple colour to the site of in;ury. hich of the following su#stances has most li?ely accumulated at the site of in;ury to produce a yellow-#rown colour at the site of in;ury 13 days later' A
ipofuscin
&
&iliru#in
$
(elanin
*
@emosiderin
,
=lycogen
* $O//,$%. %he iron in the heme pigment from the red #lood cells in the hemorrhage #eneath the s?in is incorporated into hemosiderin granules that impart the yellow to #rown colour of the healing contusion #ruise from #lunt force trauma. Question 4 A 54-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 sie, and !et "lac# in colour throughout. Which of the following is the most li#ely cause for this appearance to the hilar nodes$ A
Anthracotic pigment
%
&ipochrome deposits
'
(elanin accumulation
)
*emosiderosis
+
(etastatic carcinoma
A '//+'. he "lac# colour comes from car"on pigments in dust particles inhaled oer the years, engulfed "y macrophages, and sent ia l ymphatics to the lymph nodes. 2t loo#s "ad "ut does not compromise lung function. 3mo#ers will hae more anthracosis. Question 5 A 50-year-old woman with a history of unsta"le angina suffers an acute myocardial infarction. hrom"olytic therapy with tissue plasminogen actiator tA is administered to restore coronary "lood flow. 2n spite of this therapy, the degree of myocardial fi"er in!ury may increase "ecause of which of the following cellular a"normalities$ A
'ytos#eletal intermediate filament loss
%
)ecreased intracellular p* from anaero"ic glycolysis
'
2ncreased free radical formation
)
(itochondrial swelling
+
uclear chromatin clumping
6
/educed protein synthesis
' '//+'. 3uch to7ic o7ygen radicals are released from neutrophils when "lood flow is restored following ischemia. his is a reperfusion in!ury. erall, there is li#ely to "e more good than harm to restoration of "lood flow. Question 8 A 19-year-old "oy has had multiple episodes of ear pain accompanied "y feer. n e7amination his right tympanic mem"rane is red and "ulging with yellow e7udate. &a"oratory studies of the e7udate show culture positie for Hemophilus influenzae. A year later he has conductie hearing loss on the right, and a head ' scan shows a mass in the right middle ear. Which of the following materials is most li#ely to "e seen in the tissue curetted from his middle ear$ A
&ipofuscin pigment
%
/ussell "odies
'
eutrophil granules
)
'holesterol crystals
+
Anthracotic pigment
) '//+'. An inflammatory mass persisted, with cellular necrosis, and the lipid from the cell mem"ranes is "ro#en down and cholesterol crystals form. he "oy has the complication of otitis media #nown as a cholesteatoma Question : A 4;-year-old man has complained of mild "urning su"sternal pain following meals for the past ; years.
)ysplasia
%
*yperplasia
'
'arcinoma
)
2schemia
+
(etaplasia
+ '//+'. (etaplasia is the su"stitution of one tissue normally found at a site for another. he esophageal stratified squamous epithelium undergoes metaplasia in response to the ongoing inflammation from reflu7 of gastric contents. his is common in the lower esophagus with gastroesophageal reflu7 disease =+/). Question > A :1-year-old woman had the loss of consciousness that persisted for oer an hour. When she "ecomes arousa"le, she cannot spea# nor moe her right arm. A cere"ral angiogram reealed an occlusion to her left middle cere"ral artery. (onths later, a computed tomographic ' scan shows a large 5 cm cystic area in her left parietal
lo"e corte7. his ' finding is most li#ely the consequence of resolution from which of the following cellular eents$ A
&iquefactie necrosis
%
Atrophy
'
'oagulatie necrosis
)
'aseous necrosis
+
Apoptosis
A '//+'. 3he had a ?stro#e? with cere"ral infarction and loss of "rain tissue. he "rain undergoes liquefactie necrosis with infarction. As it resoles, macrophaes remoe the dead cells and de"ria, leaing a cystic area that forms in the region of infarction. Question @ A 1@-year-old woman gies "irth to her first child. 3he "egins "reast feeding the infant. 3he continues "reast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that "egan in the "reast during pregnancy allowed her to nurse the infant for this period of time$ A
3tromal hypertrophy
%
+pithelial dysplasia
'
3teatocyte atrophy
)
)uctal epithelial metaplasia
+
&o"ular hyperplasia
+ '//+'. here is an increase in the "reast lo"ules under hormonal influence, primarily progesterone with pregnancy, to proide for lactation. Question 10 An >4-year-old man dies from complications of Alheimer disease. At autopsy, his heart is small 950 gm and dar# "rown on sectioning. (icroscopically, there is light "rown perinuclear pigment with *+ staining of the cardiac muscle fi"ers. Which of the following su"stances is most li#ely increased in the myocardial fi"ers to produce this appearance of his heart$ A
*emosiderin from iron oerload
%
&ipochrome from ?wear and tear?
'
=lycogen from a storage disease
)
'holesterol from atherosclerosis
+
'alcium deposition following necrosis
% '//+'. &ipochrome lipofuscin deposition in myocardial cell cytoplasm is a common finding, though ordinarily there are small amounts of it, and it has little effect upon cardiac function. he ?"rown atrophy? of the heart in this case is a rare finding. Question 11 2n an e7periment, a series of immunohistochemical stains are employed to identify different cellular components. ne particular stain identifies the presence of intermediate filaments within cells. his cyto#eratin stain is most li#ely to "e useful for which of the following diagnostic purposes$ A
'ytos#eletal alterations indicate impending cell death
%
A neoplasm is determined to "e a carcinoma
'
'ontractile properties of the cells can "e assessed
)
A history of chronic alcoholism can "e confirmed
+
he degree of metaplasia or dysplasia can "e assessed
A 2ncorrect. 'ytos#eletal alterations occur with ischemia, "ut are not a useful mar#er for such an eent. % '//+'. 'arcinomas are deried from epithelium and contain cyto#eratins, while sarcomas deried from mesenchymal cells contain imentin ' 2ncorrect. (any cell types contain intermediate filaments ) 2ncorrect. (allory?s alcoholic hyaline can "e o"sered "y *+ staining. *oweer, it is not entirely specific for alcoholism
+ 2ncorrect. (etaplasia and dysplasia are assessed "y light microscopic appearances with *+ staining. Question 19 A 90-year-old woman had =oodpasture syndrome which progressed to chronic renal failure. 3he is 185 cm tall and weighs 55 #g. 3he now has "lood pressure measurements in the range of 150B@0 to 1>0B110 mm *g, "ut does not regularly ta#e medications. &a"oratory studies show her "lood urea nitrogen is oer 100 mgBd& and she requires chronic dialysis. A chest 7-ray shows an enlarged heart. he sie of her heart is most li#ely to "e the result of which of the following processes inoling the myocardial fi"ers$ A
*ypertrophy
%
6atty infiltration
'
*yperplasia
)
6atty degeneration
+
+dema
A '//+'. he ongoing pressure load of the systemic hypertension led to myocardial fi"er hypertrophy and a heart that increased in sie. /enal failure often leads to hypertension, and ice ersa. % 2ncorrect. 6at in the heart does not increase in response to the increase in wor# load from hypertension. ' 2ncorrect. (yocardial fi"ers do not undergo a significant degree of hyperplasia. ) 2ncorrect. 6atty degeneration of myocardium is typically the result of a to7ic or hypo7ic in!ury. + 2ncorrect. (yocardial edema is not a characteristic feature of myocardial in!ury or increased wor# load. *oweer, heart failure could lead to peripheral edema. Question 1; A 9@-year-old man goes on a snor#eling trip to &ooe Cey (arine 3anctuary and later spends time on the "each at %ahia *onda 3tate ar#. he ne7t day he has a dar#er comple7ion. *is s#in does not show warmth, erythema, or tenderness. *is s#in tone fades to its original appearance within a month. Which of the following su"stances contri"utes the most to the "iochemical process leading to these s#in changes$ A
2ron o7ide
%
&ipofuscin
'
yrosine
)
*omogentisic acid
+
=lycogen
A 2ncorrect. *eme containing iron as part of hemosiderin from "rea#down of red "lood cells can impart a "rownish colour, "ut this is typically local from trauma or more glo"al as part of an iron storage disease such as hemochromatosis. 2ron o7ide is also used in tattoo pigments. % 2ncorrect. &ipochrome lipofuscin is a ?wear and tear? pigment imparting a golden "rown appearance to granules in cells such as myocytes or hepatocytes, "ut this is not a feature of s#in. ' '//+'. he tanning process in s#in is stimulated "y ultraiolet light e7posure. (elanocytes hae the enyme tyrosinase to o7idie tyrosine to dihydro7yphenylalanine in the pathway for melanin production. atural s#in tone is related to the leel of tyrosinase enyme actiity ) 2ncorrect. *omogentisic acid can "e part of the process of the rare disease al#aptonuria, in which a "lac# pigment is deposited in connectie tissues. + 2ncorrect. =lycogen in quantity is starch-li#e and imparts a paler colour to organs in which it is stored in e7cess. 2t does not inole the s#in.
