Question 1
Question
A 50-year-old man has experienced severe chest pain for the past 4 hours. On physical examination he is afebrile, but has tachycardia. Laboratory studies and EKG confirms a diagnosis of myocardial infarction. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs?
Question 2
Question
A 35-year-old man sustain a blunt trauma to the right leg. The skin is intact. Within 2 days there is a 5 x 7 cm purple color to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown color at the site of injury 2weeks later?
Answer
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Lipofuscin
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Hemosiderin
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Melanin
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Glycogen
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Bilurubin
Question 3
Question
Which of the following disorders is an example of coagulation necrosis?
Answer
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Lobar pneumonia in an alcoholic
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Hepatic abscess in a patient with amoebiasis
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Arteriolitis in Polyarteritis Nodosa (PAN)
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Diminished brain mass in a patient with Alzheimer’s disease
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Splenic infarction in sickle cell disease
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Lung consolidation in Tuberculosis
Question 4
Question
A 31-year-old primigravida has a difficult delivery of a term infant. There is loss of 1500 cc of blood. She has hypotension for 6 hours. Over the next month, her ACTH level decreases. Within the next 3 months, her adrenal glands become only about 2 grams each (normal 4 to 6 grams). This alteration of the adrenals is primarily due to which of the following cellular processes?
Answer
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Metaplasia of the cortex
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Lipid depletion of the cortex
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Atrophy of the adrenal medulla
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Atrophy of the adrenal cortex
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Adrenal infarction
Question 5
Question
A 58-year-old man with a 50-pack-year history of smoking presents with a chronic cough productive of thick, white sputum. The photograph shows a histologic section of the left main stem bronchus obtained by bronchoscopy. The arrow represents which of the following cellular adaptations?
Answer
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Atrophy
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Hyperplasia
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Metaplasia
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Hypertrophy
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Hypoplasia
Question 6
Question
A 62-year-old man was admitted to the hospital with severe retrosternal chest pain that radiated down the left arm. Three days later, he developed a ventricular arrhythmia and died. In the hours shortly after the patient first experienced chest pain, which of the following biochemical changes would have marked the beginning of irreversible damage to the cardiac muscle?
Answer
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Decreased intracellular Ph
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Decreased sodium potassium ATPase pump activity
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Increased activity of phosphofructokinase
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Increased concentration of cytosolic calcium
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Increased conversion of pyruvate to lactate
Question 7
Question
A 28-year-old man with a history of bronchiectasis secondary to cystic fibrosis develops bacteremia secondary to the lung condition and dies. At autopsy, a single lesion was discovered within the cerebral cortex (see image). Which of the following mechanisms is responsible for the pattern of necrosis seen in this lesion?
Answer
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Release of hydrolytic enzymes by neutrophils causing the tissue to liquefy
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Denaturation of structural enzymes and proteins
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Lipid release from cell walls of tuberculous mycobacteria producing acellular material
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Vascular acellular necrosis in immune mediated disease producing fibrinoid deposits
Question 8
Question
A 48-year-old man with a history of chronic alcohol abuse has epigastric pain that radiates into the back. Over three days, he develops shock and respiratory problems consistent with acute respiratory distress syndrome. The photograph shows the pancreas removed at autopsy. Which of the following best describes the type of necrosis that is present in the peripancreatic fat (black arrow)?
Answer
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Caseous necrosis
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Coagulative necrosis
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Enzymatic fat necrosis
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Fibrinoid necrosis
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Liquefactive necrosis
Question 9
Question
A 50-year-old woman with a history of unstable angina suffers an acute myocardial infarction. Thrombolytic therapy with tissue plasminogen activator (tPA) is administered to restore coronary blood flow early in the course of this myocardial infarction. In spite of this therapy, the degree of myocardial fiber injury may increase because of which of the following cellular mechanisms?
Answer
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Development of a second thrombus in his coronary artery
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Cell damage by reactive oxygen metabolites
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tPA induced apoptosis
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Antibody dependent cytotoxicity
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Hemorrhage into the infarct
Question 10
Question
In an experiment, a tissue preparation is subjected to oxidant stress. There are increased numbers of free radicals generated within the cells. Generation of which of the following enzymes within these cells is most likely to reduce the number of free radicals?
Answer
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Glutathione peroxidase
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Hydrogen peroxide
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NADPH oxidase
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Myeloperoxidase
Question 11
Question
An 83-year-old, previously healthy woman from a nursing home develops headache, fever, cough, malaise and difficulty breathing during a community outbreak affecting numerous other residents at the home. A diagnosis of bronchopneumonia is made. During her stay in the hospital, her condition worsens, and she passes away. Histologic examination of a section of her heart reveals findings seen in the image below. Which of the following best represents the pigment seen in the image?
Answer
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Bilirubin
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Cytochrome c
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Hemosiderin
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Lipofuscin
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Transferrin
Question 12
Question
A 69-year-old female was killed in an automobile accident. She had no previous history of ill health. At autopsy the lesions shown in the attached image were noted coincidently on her aortic valve. The nodules were of firm consistency. Which of the following is responsible for the calcification seen in the image attached?
Answer
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Aluminum intoxication
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Areas of necrosis
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Hyperparathyroidism
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Milk-alkali syndrome
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Renal failure
Question 13
Question
. 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 size, and jet black in color throughout. A biopsy image is attached. Which of the following is the most likely cause for this appearance to the hilar nodes?
Answer
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Lipofuscin
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Melanin
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Lead
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Anthracosis
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Homogentisic acid