RUBIN PATHOLOGY CELL INJURY

2 A 50-year-old chronic alcoholic presents to the emergency
room with 12 hours of severe abdominal pain. The pain
radiates to the back and is associated with an urge to vomit.
Physical examination discloses exquisite abdominal tenderness.
Laboratory studies show elevated serum amylase. Which of
the following morphologic changes would be expected in the
peripancreatic tissue of this patient?

A CT scan of a 43-year-old woman with a parathyroid adenoma
and hyperparathyroidism reveals extensive calcium deposits in
the lungs and kidney parenchyma. These radiologic findings
are best explained by which of the following mechanisms of
disease?

A 68-year-old woman with a history of heavy smoking and
repeated bouts of pneumonia presents with a 2-week history of
fever and productive cough. A chest X-ray reveals a right lower
lobe infi ltrate. A transbronchial biopsy confi rms pneumonia
and further demonstrates preneoplastic changes within the
bronchial mucosa. Which of the following best characterizes
the morphology of this bronchial mucosal lesion?

A 24-year-old woman contracts toxoplasmosis during her
pregnancy and delivers a neonate at 37 weeks of gestation
with a severe malformation of the central nervous system. MRI
studies of the neonate reveal porencephaly and hydrocephalus.
An X-ray film of the head shows irregular densities in the basal
ganglia. These X-ray findings are best explained by which of
the following mechanisms of disease?

A 30-year-old man with AIDS-dementia complex develops
acute pneumonia and dies of respiratory insufficiency. At
autopsy, many central nervous system neurons display
hydropic degeneration. This manifestation of sublethal
neuronal injury was most likely mediated by impairment of
which of the following cellular processes?

A 62-year-old man is brought to the emergency room in a
disoriented state. Physical examination reveals jaundice,
splenomegaly, and ascites. Serum levels of ALT, AST, alkaline
phosphatase, and bilirubin are all elevated. A liver biopsy
demonstrates alcoholic hepatitis with Mallory bodies. These
cytoplasmic structures are composed of interwoven bundles
of which of the following proteins?

A 65-year-old man suffers a heart attack and expires. Examination of the lungs at autopsy reveals numerous pigmented
nodules scattered throughout the parenchyma (shown in the
image). What is the appropriate diagnosis?

A 32-year-old woman with poorly controlled diabetes mellitus
delivers a healthy boy at 38 weeks of gestation. As a result of
maternal hyperglycemia during pregnancy, pancreatic islets in
the neonate would be expected to show which of the following morphologic responses to injury?

A 20-year-old man from China is evaluated for persistent
cough, night sweats, low-grade fever, and general malaise.
A chest X-ray reveals fi ndings “consistent with a Ghon complex.” Sputum cultures grow acid-fast bacilli. Examination of
hilar lymph nodes in this patient would most likely demonstrate which of the following pathologic changes?

A 30-year-old woman suffers a tonic-clonic seizure and presents with delirium and hydrophobia. The patient states that
she was bitten on the hand by a bat about 1 month ago. The
patient subsequently dies of respiratory failure. Viral particles are found throughout the brainstem and cerebellum at
autopsy. In addition to direct viral cytotoxicity, the necrosis of
virally infected neurons in this patient was mediated primarily
by which of the following mechanisms?

A 52-year-old woman loses her right kidney following an automobile accident. A CT scan of the abdomen 2 years later shows
marked enlargement of the left kidney. The renal enlargement
is an example of which of the following adaptations?

An 82-year-old man has profound bleeding from a peptic
ulcer and dies of hypovolemic shock. The liver at autopsy displays centrilobular necrosis. Compared to viable hepatocytes,
the necrotic cells contain higher intracellular concentrations
of which of the following?

A 28-year-old woman is pinned by falling debris during a hurricane. An X-ray fi lm of the leg reveals a compound fracture
of the right tibia. The leg is immobilized in a cast for 6 weeks. When the cast is removed, the patient notices that her right leg
is weak and visibly smaller in circumference than the left leg.
Which of the following terms best describes this change in the
patient’s leg muscle?

Which of the following histologic features would provide
definitive evidence of necrosis in the myocardium of the
patient described in Question 20?

Which of the following mechanisms of disease best describes
the pathogenesis of pigment accumulation in hepatocytes in
the patient described in Question 22?

A 45-year-old man presents with increasing abdominal girth
and yellow discoloration of his skin and sclera. Physical examination reveals hepatomegaly and jaundice. A Prussian blue
stain of a liver biopsy is shown in the image. What is the major
intracellular iron storage protein in this patient’s hepatocytes?

A 60-year-old man with chronic cystitis complains of urinary
frequency and pelvic discomfort. Digital rectal examination
is unremarkable. Biopsy of the bladder mucosa reveals foci
of glandular epithelium and chronic infl ammatory cells. No
cytologic signs of atypia or malignancy are observed. Which of
the following terms best describes the morphologic response
to chronic injury in this patient?

A 60-year-old man is rushed to the hospital with acute liver
failure. He undergoes successful orthotopic liver transplantation; however, the transplanted liver does not produce much
bile for the first 3 days. Poor graft function in this patient is
thought to be the result of “reperfusion injury.” Which of the
following substances was the most likely cause of reperfusion
injury in this patient’s transplanted liver?

A 68-year-old woman with a history of hyperlipidemia dies
of cardiac arrhythmia following a massive heart attack. Peroxidation of which of the following molecules was primarily
responsible for causing the loss of membrane integrity in cardiac myocytes in this patient?

A 22-year-old construction worker sticks himself with a
sharp, rusty nail. Within 24 hours, the wound has enlarged to
become a 1-cm sore that drains thick, purulent material. This
skin wound illustrates which of the following morphologic
types of necrosis?
(E) Liquefactive necrosis

Which of the following biochemical changes characterizes the formation of acidophilic bodies in the patient described in Question 29?

A 56-year-old woman with a history of hyperlipidemia and hypertension develops progressive, right renal artery stenosis. Over time, this patient’s right kidney is likely to demonstrate which of the following morphologic adaptations to partial ischemia?

A 5-year-old boy suffers blunt trauma to the leg in an automobile accident. Six months later, bone trabeculae have formed within the striated skeletal muscle at the site of tissue injury. This pathologic condition is an example of which of the following morphologic adaptations to injury?

A 40-year-old man is pulled from the ocean after a boating
accident and resuscitated. Six hours later, the patient develops
acute renal failure. Kidney biopsy reveals evidence of karyorrhexis
and karyolysis in renal tubular epithelial cells. Which
of the following biochemical events preceded these pathologic
changes

A 32-year-old woman develops an Addisonian crisis (acute
adrenal insuffi ciency) 3 months after suffering massive hemorrhage
during the delivery of her baby. A CT scan of the
abdomen shows small adrenal glands. Which of the following
mechanisms of disease best accounts for adrenal atrophy in
this patient?

A 47-year-old man with a history of heavy smoking complains
of chronic cough. A “coin lesion” is discovered in his right
upper lobe on chest X-ray. Bronchoscopy and biopsy fail to
identify a mass, but the bronchial mucosa displays squamous
metaplasia. What is the most likely outcome of this morphologic
adaptation if the patient stops smoking?