A 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-aortic region. She is treated with a chemotherapeutic agent which results in the loss of individual neoplastic cells through fragmentation of individual cell nuclei and cytoplasm. Over several weeks, the size of the lymphoma decreases, as documented on abdominal CT scans. By which of the following mechanisms has her neoplasm primarily responded to therapy?

A Coagulative necrosis

B Mitochondrial poisoning

C Phagocytosis

D Acute inflammation

E Apoptosis

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A 53-year-old man has experienced severe chest pain for the past 6 hours. On physical examination he is afebrile, but has tachycardia. Laboratory studies show a serum troponin I of 10 ng/mL. A coronary angiogram is performed emergently and reveals >90% occlusion of the left anterior descending artery. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs?

A Glycogen stores are depleted

B Cytoplasmic sodium increases

C Nuclei undergo karyorrhexis

D Intracellular pH diminishes

E Blebs form on cell membranes

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While in a home improvement center warehouse buying paint, a 35-year-old man hears "Look out below!" and is then struck on the leg by a falling pallet rack, which strikes him on his left leg in the region of his thigh. The skin is not broken. 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 16 days after the injury?

A Lipofuscin

B Bilirubin

C Melanin

D Hemosiderin

E Glycogen

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A54-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. Which of the following is the most likely cause for this appearance to the hilar nodes?

A Anthracotic pigmentation

B Lipochrome deposition

C Accumulation of melanin

D Hemosiderosis

E Metastatic carcinoma

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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 abnormalities?

A Cytoskeletal intermediate filament loss

B A decreased intracellular pH from anaerobic glycolysis

C An increase in toxic oxygen radicals

D Mitochondrial swelling

E Nuclear chromatin clumping and decreased protein synthesis

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A 12-year-old boy with hemophilia A has had episodes of pain about his knees for the past 6 years. Over time, there has been an increase in size of his knee joints, with deformity. Laboratory studies show decreased levels of coagulation factor VIII activity. Which of the following materials is most likely to be seen within the joint space following episodes of pain?

A Lipofuscin

B Russell bodies

C Neutrophils

D Cholesterol crystals

E Anthracotic pigment

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A 43-year-old man has complained of mild burning substernal or epigastric pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies demonstrate the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?

A Dysplasia

B Hyperplasia

C Carcinoma

D Ischemia

E Metaplasia

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A 59-year-old woman had the loss of consciousness that persisted for over an hour. When she became arousable, she could not speak and she could not move her right arm or leg. A cerebral angiogram revealed an occlusion to her left middle cerebral artery. Months later, a computed tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding most likely demonstrates a lesion that is the consequence of resolution from which of the following events?

A Liquefactive necrosis

B Atrophy

C Coagulative necrosis

D Caseous necrosis

E Apoptosis

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A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She continues breast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that occurred in the breast during pregnancy allowed her to nurse the infant for this period of time?

A Stromal hypertrophy

B Epithelial dysplasia

C Steatocyte atrophy

D Ductal epithelial metaplasia

E Lobular hyperplasia

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An 80-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small (250 gm) and dark brown on sectioning. Microscopically, there is light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance of his heart?

A Hemosiderin resulting from iron overload

B Lipochrome from "wear and tear"

C Glycogen resulting from a storage disease

D Cholesterol as a consequence of atherosclerosis

E Calcium deposition following necrosis

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In an experiment, a series of immunohistochemical stains are employed to identify different cellular components. One particular stain identifies the presence of intermediate filaments within cells. This cytokeratin stain is most likely to be useful for which of the following diagnostic purposes?

A Cytoskeletal alterations are seen with impending cell death

B A neoplasm can be determined to be a carcinoma

C Contractile properties of the cells can be determined

D A history of chronic alcoholism can be confirmed

E The degree of metaplasia or dysplasia can be assessed

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A 20-year-old woman had Goodpasture syndrome which progressed to chronic renal failure. She was 165 cm tall and weighed 55 kg. She had blood pressure measurements in the range of 150/90 to 180/110 mm Hg, but she did not regularly take medications. Laboratory studies showed her blood urea nitrogen was over 100 mg/dL. She required chronic dialysis. She died from heart failure. At autopsy, her heart weighed 540 gm. The size of her heart is most likely to be the result of which of the following processes involving the myocardial fibers?

A Hypertrophy

B Fatty infiltration

C Hyperplasia

D Fatty degeneration

E Edema

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A 29-year-old man goes on a snorkeling trip to Looe Key Marine Sanctuary and later spends time on the beach at Bahia Honda State Park. The next day he has a darker complexion. His skin does not show warmth, erythema, or tenderness. His skin tone fades to its original appearance within a month. Which of the following substances contributes the most to the biochemical process leading to these skin changes?

A Heme

B Lipofuscin

C Tyrosine

D Homogentisic acid

E Glycogen

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An autopsy study is performed to identify predisposing risks for tissue changes in which epithelial metaplasia occurred. In which of the following situations is the process of epithelial metaplasia most likely to have occurred?

A Tanning of the skin following sunlight exposure

B Lactation following pregnancy

C Vitamin A deficiency

D Acute myocardial infarction

E Urinary obstruction from an enlarged prostate

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In an experiment, a disease process is found which leads to scattered loss of individual cells, with the microscopic appearance of karyorrhexis and cell fragmentation. The overall tissue structure remains intact. This process is most typical for which of the following diseases?

A Viral hepatitis

B Brown atrophy of the heart

C Renal transplant rejection

D Chronic alcoholic liver disease

E Barbiturate overdose

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A 60-year-old woman has noted a dark red-black appearance to her great toe and second and third toes of her left foot for the past month. On physical examination, the toes are cold to touch and have no sensation. The dorsalis pedis and posterior tibial pulses are not palpable on the left. A transmetatarsal amputation is performed. These findings are most typical for a patient with which of the following conditions?

A Diabetes mellitus

B Monckeberg's arteriosclerosis

C Blunt force trauma

D AIDS

E Type III hypersensitivity reaction

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A study is performed involving the microscopic analysis of tissues obtained from surgical procedures. Some of these tissues have the microscopic appearance of an increased cell size of multiple cells within the tissue, due to an increase in the amount of cytoplasm, with nuclei remaining uniform in size. Which of the following conditions is most likely to have resulted in this finding?

A The uterine myometrium in pregnancy

B The female breast at puberty

C The liver following partial resection

D The ovary following menopause

E The cervix with chronic inflammation

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A 17-year-old adolescent receives whole body radiation as part of a preparatory regimen for bone marrow transplantation to treat acute lymphocytic leukemia. Which of the following cells and tissues in the body is most likely to remain unaltered by the effects of this therapeutic radiation?

A Ovarian follicles

B Small intestinal epithelium

C Erythropoietic cells of bone marrow

D Spermatogonia of testicular tubules

E Neurons of cerebral cortex

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A 79-year-old man has a large myocardial infarction involving much of the left ventricular free wall. He developes congestive heart failure (CHF) with decreased cardiac output. Now, a year later, his CHF is worsening. By echocardiography there is a large, bulging akinetic area typical for a left ventricular aneurysm. Which of the following laboratory tests on serum would best indicate poor peripheral tissue perfusion in this patient?

A Elevated troponin I

B Increased sodium

C Elevated lactate

D Increased hematocrit

E Increased sedimentation rate

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A 22-year-old woman has a congenital anemia. She has required multiple transfusions of red blood cells for many years. She now has no significant findings on physical examination. Laboratory studies now show a serum AST of 74 U/L and ALT 75 U/L with albumin 3.6 g/dL. Which of the following microscopic findings would most likely appear in a liver biopsy?

A Steatosis in hepatocytes

B Bilirubin in canaliculi

C Hemosiderin in hepatocytes

D Glycogen in hepatocytes

E Amyloid in portal triads

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A 20-year-old man is involved in a motor vehicle accident which results in multiple blunt trauma and lacerations to his lower extremities. The left femoral artery is lacerated, and he incurs extensive blood loss and remains hypotensive for hours during transport to the emergency department. On admission, his hematocrit is 12%. Which of the following tissues is most likely to withstand the impact of these events with the least damage?

A Skeletal muscle

B Small intestinal epithelium

C Retina

D Myocardium

E Hippocampus

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A 40-year-old woman has the sudden onset of severe abdominal pain. On physical examination she has diffuse tenderness in all abdominal quadrants, with marked guarding and muscular rigidity. She has laboratory findings that include serum AST of 43 U/L, ALT of 30 U/L, LDH 630 U/L, and lipase 415 U/L. An abdominal CT scan reveals peritoneal fluid collections and decreased attenuation along with enlargement of the pancreas. Which of the following cellular changes is most likely to accompany these findings?

A Ccagulative necrosis

B Dry gangrene

C Fat necrosis

D Apoptosis

E Liquefactive necrosis

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A 26-year-old man died from complications of destruction of the aortic valve by large, irregular vegetations from which Staphylococcus aureus was cultured. At autopsy, the spleen on sectioning grossly reveals the presence of a tan to white, wedge-shaped 1.5 x 3 cm lesion with base on the capsule. The splenic findings are most likely to result from which of the following cellular abnormalities?

A Coagulative necrosis

B Abscess formation

C Metaplasia

D Caseous necrosis

E Liquefactive necrosis

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A 35-year-old woman developed increasing icterus over the last week of life. Labortory studies had revealed hyperammonemia. She is found at autopsy to have a 3500 gm liver with a uniform, yellow, greasy cut surface. No necrosis of hepatoccytes is noted microscopically. This pathologic appearance of the liver most likely resulted from which of the following conditions?

A Galactosemia

B Hemochromatosis

C Tuberculosis

D Alcoholism

E Hypoxemia

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A clinical study is performed in which the conditions leading to the apperance of calcification on chest and abdominal CT scans are analyzed in patients from 60 to 90 years of age. One set of patients is found in which the finding of calcification was incidental, with no serious health problems. In which of the following tissue locations was this incidental calcification most likely to be noted?

A Coronary artery

B Renal cortex

C Aortic valve

D Pulmonary parenchyma

E Aortic arch

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A 55-year-old man has a 30-year history of poorly controlled diabetes mellitus. He has had extensive black discoloration of skin and soft tissue of his right foot, with areas of yellowish exudate, for the past 2 months. Staphylococcus aureus is cultured from this exudate. A below-the-knee amputation is performed. The amputation specimen received in the surgical pathology laboratory is most likely to demonstrate which of the following pathologic abnormalities?

A Neoplasia

B Gangrenous necrosis

C Coagulopathy

D Hemosiderosis

E Caseation

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The lifestyle patterns of healthy persons from 20 to 30 years of age are studied. A subset of these persons have a lifestyle characterized by consumption of a lot of pizza and very little physical exercise. Which of the following tissue changes is most likely to develop in this subset of persons as a consequence of this lifestyle?

A Fatty metamorphosis of liver

B Pancreatic fat necrosis

C Fatty degeneration of myocardium

D Hypertrophy of steatocytes

E Metaplasia of muscle to adipose tissue

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In an experiment, a tissue preparation is subjected to oxidant stress. There are increased numbers of free radicals generated within the cells and increase in number. Generation of which of the following substances within these cells is most likely to reduce the number of free radicals?

A Glutathione peroxidase

B Catalase

C Hydrogen peroxide

D NADPH oxidase

E Myeloperoxidase

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A 38-year-old man incurs a traumatic blow to his upper left arm. He continues to have pain and tenderness even after 3 months have passed. A plain film radiograph reveals a 4 cm circumscribed mass in the soft tissue adjacent to the humerus. The mass contains areas of brightness on the x-ray. Over the next year this process gradually resolves. Which of the following terms best describes this process?

A Dysplasia

B Hyperplasia

C Hypertrophy

D Metaplasia

E Neoplasia

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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?

A Metaplasia of the cortex

B Lipid depletion of the cortex

C Atrophy of the medulla

D Atrophy of the cortex

E Adrenal infarction

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A 48-year-old man has a history of chronic alcohol abuse. He is still able to perform his work at his job. He has had no major illnesses. On physical examination, there are no significant findings. Laboratory studies show a serum albumin of 4.1 g/dL, ALT 40 U/L, AST 40 U/L, and total bilirubin 1.1 mg/dL. Which of the following microscopic findings in his liver is most likely to be present?

A Cholestasis

B Fatty change

C Hemochromatosis

D Hypertrophy of smooth endoplasmic reticulum

E Coagulative necrosis

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A 44-year-old woman has had episodes of right upper quadrant pain during the past 2 weeks. Her stools have become pale in color over the past 3 days. Laboratory studies show a serum total bilirubin of 9.7 mg/dL. A cholangiogram shows that a gallstone has passed into the common bile duct, resulting in obstruction of the biliary tract. Which of the following cellular alterations is most likely to be visualized on her skin surfaces?

A Hemosiderosis

B Calcification

C Lipofuscin deposition

D Icterus

E Steatosis

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A 45-year-old man has a traumatic injury to his forearm and incurs extensive blood loss. On physical examination in the emergency department his blood pressure is 70/30 mm Hg. Which of the following cellular changes is most likely to represent irreversible cellular injury as a result of this injury?

A Epithelial dysplasia

B Cytoplasmic fatty metamorphosis

C Nuclear pyknosis

D Atrophy

E Anaerobic glycolysis

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A 73-year-old man suffers a "stroke." On physical examination he cannot move his right arm. A cerebral angiogram demonstrates occlusion of the left middle cerebral artery. An echocardiogram reveals a thrombus within a dilated left atrium. Which of the following is the most likely pathologic alteration from this event that occurs in his brain?

A Cerebral softening from liquefactive necrosis

B Pale infarction with coagulative necrosis

C Predominantly the loss of glial cells

D Recovery of damaged neurons if the vascular supply is reestablished

E Wet gangrene with secondary bacterial infection

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A 30-year-old woman is claiming in a civil lawsuit that her husband has abused her for the past year. A workup by her physician reveals a 2 cm left breast mass. There is no lymphadenopathy. No skin lesions are seen, other than a bruise to her upper arm. An excisional biopsy of the breast mass is performed. On microscopic examination, the biopsy shows fat necrosis. This biopsy result is most consistent with which of the following etiologies?

A Physiologic atrophy

B Breast trauma

C Lactation

D Radiation injury

E Hypoxic injury

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A 45-year-old man has smoked 2 packs of cigarettes per day for the past 30 years. He has had a chronic cough for the past 3 years, worsening over the past 2 weeks. A suspicious left pulmonary parenchymal lesion is seen on a chest x-ray. He has a bronchcoscopy performed. A biopsy of a segmental bronchus shows squamous metaplasia. Which of the following statements represents the most appropriate interpretation of this finding?

A This change indicates irreversible tissue damage

B It may be due to an irritant that can be avoided

C The patient will probably develop cancer

D The etiology is probably a viral infection that can be treated

E The patient will probably develop a dysplasia

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A 45-year-old woman has had congestive heart failure for the past 4 years. She develops a fever that persists for over a week. On physical examination, a heart murmur is present. Her temperature is 38.4 C. The spleen tip is palpable. On echocardiography she has an abnormally thickened mitral valve. Laboratory studies show a blood culture positive for Streptococcus, viridans group. Another echocardiogram reveals a 1 cm vegetation on the superior aspect of her mitral valve. Which of the following findings would you most expect to appear in the kidney as a consequence of these events?

A Marked passive congestion

B Ischemic infarct

C Extensive edema

D Granulomatous inflammation

E Gangrenous necrosis

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A 19-year old G2 P1 woman has an amniocentesis performed at 18 weeks gestation. Fibroblasts recovered from amniocentesis are grown in culture to assess the karyotype of fetal cells. These cells are subcultured for additional experimental work, but the culture is lost after 50 doublings of the cells has occurred, and the fibroblasts no longer grow. Which of the following factors affecting these cells is most likely demonstrated by this phenomenon?

A Nutrition

B Mutation

C Apoptosis

D Aging

E Oxidation

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A 55-year-old man has sudden onset of severe, sharp chest pain with diaphoresis and dsypnea. On physical examination he has tachycardia with an irregular heart rhythm. Electrocardiographic changes suggest the possibility of focal myocardial damage involving the left lateral ventricular wall. Which of the following laboratory tests on the patient's serum is most useful in this situation?

A Total and HDL cholesterol

B Creatine kinase

C Triglyceride

D Amylase

E Sedimentation rate

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A 42-year-old previously healthy woman notes that over the past week her eyes have developed a jaundiced appearance. She has had mild nausea and vomiting over the past week. On physical examination she has scleral icterus. She has no other major physical examination findings except for mild right upper quadrant tenderness. Which of the following underlying conditions is most likely to contribute to development of her icterus?

A Hypercholesterolemia

B Thrombocytopenia

C Metastatic carcinoma

D Hepatitis

E Diabetes mellitus

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A 56-year-old woman has smoked 2 packs of cigarettes per day for the past 35 years. She has had a chronic cough for the past 8 years, but recently has noted increased sputum production. On physical examination she has a few crackles ausculated best over the lung bases. Bronchoscopy with biopsy is performed. The biopsy reveals bronchial epithelium with squamous metaplasia. Which of the following statements represents the best interpretation of these findings?

A This is a physiologic process of aging

B This process is irreversible, even if she stops smoking

C She has metastases to lung from a primary somwhere else

D She has an increased risk for pulmonary infection

E A pulmonary thromboembolus caused pulmonary infarction

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A 90-year-old woman dies from pneumonia complicating Parkinson disease. At autopsy her heart is normal in size. On microscopic examination, there is increased lipochrome (lipofuscin) seen adjacent to the nuclei within the myocardial fibers. This microscopic finding is most likely to result from which of the following cellular mechanisms?

A Nuclear pyknosis

B Myocardial fiber hypertrophy

C Coagulative necrosis

D Autophagocytosis

E Anaerobic glycolysis

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An experiment is conduccted to determine if cell membrane injury is lessened by the effects of vitamin E ingestion. Which of the following cellular components is primarily involved in generation of lipid peroxides, the formation of which is inhibited by the vitamin E?

A Glutathione

B Ionized calcium

C Lactate

D Ferric iron

E Lipase

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A 35-year-old woman has had headaches and abdominal pain worsening for 3 months. There are no remarkable physical examination findings. On radionucleide scanning of the neck, she is found to have a mass involving one of her parathyroid glands. An abdominal CT scan suggests extensive nephrocalcinosis along with urinary tract calculi. Which of the following laboratory test findings is most likely to accompany her disease?

A CO2 of 30 mmol/L

B Phosphorus of 2.2 mg/dL

C Uric acid of 15.1 mg/dL

D Sodium of 121 mmol/L

E Calcium of 4.5 mg/dL

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A 21-year-old woman has a routine Pap smear performed for a health screening examination. The pathology report indicates that some cells are found cytologically to have larger, more irregular nuclei. A follow-up cervical biopsy microscopically demonstrates disordered maturation of the squamaous epithelium, with hyperchromatic and pleomorphic nuclei extending nearly the full thickness of the epithelial surface. No inflammatory ccells are present. Which of the following descriptive terms is best applied to these Pap smear and biopsy findings?

A Dysplasia

B Metaplasia

C Anaplasia

D Hyperplasia

E Aplasia

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Question 46

A 38-year-old man has a health screening examination. He has a routine chest x-ray that shows a 2 cm nodule in the right lower lobe. The nodule has focal calcifications. A wedge resection of the nodule is done. On microscopic examination the nodule shows caseous necrosis and calcification. Which of the following processes explains the appearance of the calcium deposition:

A Dystrophic calcification

B Apoptosis

C Hypercalcemia

D Metastatic calcification

E Excessive ingestion of calcium

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A 3-year-old child has been diagnosed with ornithine transcarbamylase deficiency and has developed hepatic failure. The left lobe of an adult donor liver is used as an orthotopic transplant. A year later, the size of each liver in donor and recipient is greater than at the time of transplantation. Which of the following cellular alterations is most likely to explain this phenomenon?

A Metaplasia

B Dysplasia

C Hyperplasia

D Anaplasia

E Neoplasia

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A morbidly obese 51-year-old woman dies from complications of heart disease. At autopsy, her heart weighs 600 gm (normal up to 300 gm) with all the chambers enlarged. Microscopically, there is increased fibrous connective tissue seen in the interstitium between myocardial fibers. The fibers are increased in size. Beneath the epicardium can be seen adipocytes interdigitating with the myocardial fibers. Which of the following terms best describes the presence of the adipocytes in her myocardium?

A Steatosis

B Lipid degeneration

C Fatty infiltration

D Cholesterolosis

E Xanthomatosis

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A 48-year-old man has an episode of severe substernal chest pain radiating to his left arm. Four months later he has increasing dyspnea and orthopnea. On physical examination there are rales heard over all lung fields. An echocardiogram shows a left ventricular aneurysm. He has decreased cardiac output with an ejection fraction of 29%. Which of the following findings is most likely to be indicative of the original acute event at the time he presented with chest pain?

A Elevated serum troponin I

B Collagenous scar tissue in the myocardium

C Chronic passive congestion of the liver

D Organizing mural thrombus in left ventricle

E Recanalization of a coronary artery thrombosis

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A 53-year-old man suffers a cardiac arrest and his wife calls emergency services. The paramedics arrive a few minutes later and begin life support measures. A regular heart rate is established after about 40 minutes of resuscitative efforts as he is being transported to the hospital. A thrombolytic agent (tPA) is administered. Which of the following cellular processes is most likely to occur in his myocardium following administration of the tPA?

A Apoptosis

B Free radical injury

C Heterophagocytosis

D Squamous metaplasia

E Accumulation of cytokeratins

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A 38-year-old woman has severe abdominal pain with hypotension and shock that has developed over the past 36 hours. On physical examination, her abdominal muscles are rigid and her abdomen is extremely tender. An abdominal CT scan reveals fluid density in the region of the pancreas, which appears to be enlarged. Which of the following laboratory test findings in the patient's serum is most likely to be present?

A Alanine aminotransferase of 1123 U/L

B Total cholesterol of 324 mg/dL

C Creatine kinase of 869 U/L

D Urea nitrogen of 110 mg/dL

E Lipase of 1134 U/L

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A 45-year-old man has noted scleral icterus for the past 4 days. He has been feeling tired and "run down" for about a month. On physical examination, other than mild tachycardia, his vital signs are normal. No other physical examination findings are of noted other than scleral icterus. Laboratory studies show a hematocrit of 25%. Which of the following conditions is most likely to account for these findings?

A Systemic hypertension

B Excessive iron absorbtion

C Diabetes mellitus, type I

D Intravascular hemolysis

E Pulmonary squamous cell carcinoma

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