Chapter 1 Q&A Flashcards
- Bone marrow cells from organ donor cultured in vitro in presence of recomb EPO; colony of cells committed to erythrocyte pathway of differentiation, representing example of which physiologic adaptations to transmembrane signaling?
Hyperplasia
- 50 yo chronic alcoholic presents to ER with 12 hrs of severe abdo pain; pain goes to back and associated with urge to vomit; PE shows abdo tenderness and labs show increased serum amylase; what do we see in peripancreatic tissue of this patient?
Fat necrosis (saponification of fat derived from peripancreatic fat cells exposed to pancreatic enzymes is a feature typical of fat necrosis); saponification is NEFA’s binding with Ca to form soaps)
- 68 yo man with GERD history has massive stroke and expires; esophagus shows different types of cells, why?
Glandular metaplasia (since you’re going from squamous epi to the simple columnar epi of the small intestine)
- CT of 43 yo woman with parathyroid adenoma and hyperparathyroidism shows calcium deposits in lungs and kidney parenchyma; what is the mech of disease?
Metastatic calcification
- 75 yo woman with Alzheimer disease dies of CHF; bran shown and exemplifies what type of response to chronic injury?
Atrophy
- 68 yo woman with heavy smoking and pneumonia hisotyr has fever and productive cough; CXR shows right lower lobe infiltrate; preneoplastic changes in bronchial mucosa
Abnormal pattern of cell maturation (dysplasia of the bronchial epithelium and is a reaction of respiratory epi to carcinogens in tobacco smoke)
- 64 yo man with angina pectoris and arterial hypertension dies of spontaneous intracerebral hemorrhage; heart globoid; LV 2.8 cm on cross section; what changed intracellularly?
mRNA: hypertrophy results from transcriptional regulation!!
- 24 yo woman contracts toxoplasmosis during pregnancy and delivers neonate at 37 wks gestation with severe malformation of CNS; MRI shows porencephaly and hydrocephalus; XR of head shows irregular densities in basal ganglia; what is the mech of disease?
Dystrophic calcification (underlying cell injury; serum levels of calcium normal, and calcium deposits located in previously damaged tissue)
- 30 yo man with AIDS-dementia complex develops acute pneumonia and dies of respiratory insufficiency; many CNS neurons show hydropic degeneration; how did this happen?
Plasma membrane sodium transport (hydropic swelling reflects acute, reversible cell injury; reflects impaired cellular volume regulation, a process that controls ionic concentrations in the cytoplasm)
- 62 yo man brought to ER in disoriented state; PE shows jaundice, splenomegaly, ascites; ALT, AST, alkaline phosphatase, bilirubin all elevated; alcoholic hepatitis seen with Mallory bodies; these cytoplasmic structures have which proteins?
Intermediate filaments (what makes up alcoholic hyaline)
- 65 yo man suffers a heart attack and expires; lungs at autopsy shows pigmented nodules throughout parenchyma? Why?
Anthracosis: storage of carbon particles in lung and regional lymph nodes
- 32 yo woman with poorly controlled diabetes mellitus has healthy boy at 38 weeks gestation; what would we expect to see in pancreatic islets of neonate?
We see hyperplasia (islet cells of pancreas with proliferative capacity and respond to increased demand for insulin)
- 59 yo female alcoholic brought to ER with fever and foul-smelling breath; patient with acute bronchopneumonia and dies of respiratory insufficiency; there is a pulmonary abscess; which path change is seen?
Liquefactive necrosis: rate of dissolution of necrotic cells faster than rate of repair
- 20 yo man from China has persistent cough, night sweats, low-grade fever, general malaise; CXR shows Ghon complex; acid-fast bacilli, what are the path changes?
Caseous necrosis
- 31 yo woman has increased vaginal discharge of 1-mo duration; cervical Pap smear with superficial epi cells compared to deeper intermediate layer, and what do the former exhibit?
Pyknosis
- 30 yo woman has tonic-clonic seizure and has delirum and hydrophobia; was bitten on hand by bat 1 mo ago; dies of respiratory failure; viral particles found throughout brainstem and cerebellum; necrosis of virally infected neurons in patient mediated by which mechs?
Humoral and cellular immunity
- 52 yo woman loses right kidney after auto accident; CT scan of abdo 2 yrs later shows marked enlargement of left kidney; what adaptation?
Hypertrophy
- 82 yo man with bleeding from peptic ulcer and dies of hypovolemic shock; liver at autopsy with centrilobular necrosis; what do the necrotic cells have compared to viable hepatocytes?
Higher IC levels Ca
- 28 yo woman pinned by falling debris during hurrican; there is compound fracture of right tibia; right leg is weak and smaller in circumference than left with cast placed and removed; what is the adaptation?
Atrophy
- 70 yo man hospitalized after suffering mild stroke; in hospital, crushing substernal chest pain; arrhythmia develops and patient dies; LV shows what changes?
Coagulative, or ischemic necrosis (lack of O2 impairs mito electron transport, decreasing ATP synthesis
- Which histo features provide definitive evidence of necrosis in myocardium of the 70 yo man?
Nuclear fragmentation (hallmark of COAGULATIVE necrosis)
- 90 yo woman with mild diabetes and Alzheimer disease dies in her sleep. Hepatocytes have golden cytoplasmic granules not staining with Prussian blue. Why does this pigment accumulate?
Advanced age (lipofucsin)
- Which mech of disease describes how this pigment has accumulted in the 90 yo woman?
Peroxidation of membrane lipids (lipofuscin found in lysosomes and has peroxidation products of unsaturated FA’s
- 45 yo man with increasing abdo girth and yellow discoloration of skin and scelra; hepatomegaly and jaundice; Prussian blue stain of liver biopsy; major intracellular iron storage protein in hepatocytes?
Hemosiderin (denatured form of ferritin that aggregates easily and is recognized microscopically as yellow-brown granules in cytoplasm and turn blue with Prussian blue)
- 60 yo man with chronic cystitis has urinary frequency and pelvic discomfort; biopsy of bladder mucosa has foci of glandular epi and chronic inflammatory cells; what is the response to chronic injury in this case?
Metaplasia
- 60 yo man goes to hospital with acute liver failure; transplanted liver but does not make much bile; poor graft due to reperfusion injury; what caused the reperfusion injury?
ROS
- 68 yo woman with history of hyperlipidemia dies of cardiac arrhythmia after massive heart attack; peroxidation of which causes loss of membrane integrity in cardiac myocytes?
Phospholipids
- 22 yo construction worker sticks himself with a sharp rusty nail; in 24 hrs, wound enlarged to become a 1 cm sore that drains thick, purulent material; skin wound illustrates which of the following necrosis types?
Liquefactive necrosis
- 42 yo man has liver biopsy for hep C virus infection; we see swollen hepatocytes and moderate lobular inflammatory activity; Councilman body seen, but why are these acidophilic bodies seen?
Apoptotic cell death (appear acidophilic)
- Which changes characterize formation of acidophilic bodies in that 42 yo man?
Fragmentation of DNA
- 56 yo woman with history of hyperlipidemia and hypertension develops progressive, right renal artery stenosis; right kidney will eventually demonstrate which adaptations?
Atrophy
- 5 yo boy suffers blunt trauma to leg in automobile accident; six mos later, bone trabeculae form within striated skeletal muscle at site of injury; What adaptations?
Metaplasia (myositis ossificans); formation of bony trabeculae within striated muscle
- 42 yo man presents with a scaly erythematous lesion on dorsal surface of left hand; skin biopsy shows atypical kertainocytes in thickness of epidermis; Which proteins play important role in mediating programmed cell death?
Cytochrome c (mito)
- 16 yo girl with history of suicidal depression swallows commercial solvent; we see severe swelling of the centrilobular hepatocytes; what accounts for the reversible changes seen in liver biopsy?
Decreased IC stores of ATP
- 40 yo man pulled from ocean after boating accident; patient gets acute renal failure; kidney biopsy shows karyorrhexis and karyolysis in renal tubular epi cells; which events preceded these changes?
Decrease in intracellular pH
- 58 yo man has acute renal failure; BP 220/130; patient has stroke and dies; what accounts for red material in wall of artery?
Fibrinoid necrosis: alteration of injured blood vessels; insudation and accumulation of plasma proteins cause wall to stain intensely with eosin
- 20 yo girl with advanced features of progeria; child has mutations in gene encoding which types of IC proteins?
Lamin
- 32 yo woman has Addisonian crisis 3 mos after suffering massive hemorrhage during delivery of baby; CT scan of abdo shows small adrenal glands; what mechs account for adrenal atrophy?
Lack of trophic signals
- 47 yo man with history of heaving smoking complains of chronic cough; coin lesion in right upper lobe on CXR; bronchoscopy and biopsy can’t identify mass, but bronchial mucosa shows squamous metaplasia; what happens if patient stops smoking?
Reversion to normal
- 60 yo farmer has multiple patches of discoloration on face; biopsy shows actinic keratosis; what describes response of skin to chronic sunlight exposure?
Dysplasia
- 59 yo woman smoker has intermitten blood in urine; CBC has increased red cell mass; CT has 3-cm renal mass and we see renal cell carcinoma; what explains the increased crit?
Hyperplasia
- 33 yo woman has abnormal cervical Pap smear; cervical biopsy shows that epi lacks normal polarity; individual cells show hyperchromatic nuclei, larger nucleus-to-cytoplasm ratio, disorderly tissue arrangement; what is the adaptation?
Dysplasia
- 24 yo woman ingests CCl4 and has acute liver failure; which proteins involved in development of hepatotoxicity in patient?
Mixed function oxygenase (CCl4 metabolized to chlorid ion and highly reactive trichloromethyl free radical)
- 30 yo woman presents with 2-mo history of fatigue, mild fever, erythematous scaling rash; joint pain, swelling, erythematous plaques with adherent silvery scales; increased thickness of the epidermis; what is the adaptation?
Hyperplasia
- 24 yo woman with chronic depression ingests bottle of acetaminophen tablets; she is jaundiced and has encephalopathy symptoms, like impairment in spatial perception; in liver, toxic metabolites of acetaminophen made by which organelle?
Smooth ER
- 45 yo woman has 2-mo history of fatigue and recurrent fever; tenderness below right costal margin and dark urine; jaundice and mild hepatomegaly; serum pos for hep B virus antigen; what is mech for the cell death?
Immune recognition of viral antigens on cell surface
- IC accumulation of abnormally folded protein plays role in path of which disease?
Alpha1-antitryptin deficiency
- 38 yo woman shows evidence of early cataracts, hair loss, skin atrophy, osteoporosis, and accelerated atherosclerosis; which inherited mutations does she have?
Helicase
- 28 yo man with history of radiation/bone marrow transplant for leukemia presents with severe diarrhea; develops septic shock and expires; colon epi shows numerous acidophilic bodiesand small cells with pyknotic nuclei; which proteins led to the radiation-induced cell death in patient’s mucosa?
p53
