Chapter 3: Repair, Regeneration & Fibrosis

Question 1

A 74-year-old woman presents with acute chest pain and
shortness of breath. Cardiac catheterization demonstrates
occlusion of the left anterior descending coronary artery. Laboratory
studies and ECG are consistent with acute myocardial
infarction. Which of the following is the most likely pathologic
fi nding in the affected heart muscle 4 weeks later?

Answer 1

1. Collagen-rich scar tissue.

Question 2

A 4-year-old boy falls on a rusty nail and punctures his skin.
The wound is cleaned and covered with sterile gauze. Which
of the following is the initial event in the healing process?

Answer 2

2. Formation of a fibrin clot.

Question 3

An 82-year-old man dies 4 years after developing congestive
heart failure. He had a history of multiple myocardial infarcts
over the past 10 years. A trichrome stain of heart muscle at
autopsy is shown in the image. What is the predominant type
of collagen found in this mature scar tissue?

Answer 3

3. Type I collagen.

Question 4

A 25-year-old woman sustains a deep, open laceration over
her right forearm in a motorcycle accident. The wound is
cleaned and sutured. Which of the following cell types mediates
contraction of the wound to facilitate healing?

Answer 4

4. Myofi broblasts.

Question 5

During the next 3 months, the wound heals with formation
of a linear scar. Which of the following nutritional factors is
required for proper collagen assembly in the scar tissue of the
patient described in Question 4?

Answer 5

5. Vitamin C.

Question 6

A 70-year-old woman with diabetes develops an ulcer on her
right leg (shown in the image). The ulcer bed is covered with
granulation tissue. Which of the following are the principle
cellular components found in the bed of this wound?

Answer 6

6. Fibroblasts and endothelial cells.

Question 7

Which of the following proteins helps stimulate healing and
angiogenesis in the wound of the patient described in Question
6?

Answer 7

7. Metalloproteinase

Question 8

A 68-year-old man presents for repair of an abdominal aortic
aneurysm. Severe complicated atherosclerosis is noted at surgery,
prompting concern for embolism of atheromatous material
to the kidneys and other organs. If the patient were to
develop a renal cortical infarct as a result of surgery, which of
the following would be the most likely outcome?

Answer 8

8. Scar formation.

Question 9

A 40-year-old woman presents with a painless lesion on her
right ear lobe (shown in the image). She reports that her ears
were pierced 4 months ago. Which of the following best
explains the pathogenesis of this lesion?

Answer 9

9. Maturation arrest of collagen assembly. Keloid

Question 10

A 58-year-old woman undergoes lumpectomy for breast
cancer. One month following surgery, she notices a fi rm
0.3-cm nodule along one edge of the surgical incision. Biopsy
of this nodule reveals chronic infl ammatory cells, multinucleated
giant cells, and extensive fi brosis. The multinucleated
cells in this nodule most likely formed in response to which of
the following pathogenic stimuli?

Answer 10

10. Foreign material.

Question 11

A 57-year-old man with a history of alcoholism presents
with yellow discoloration of his skin and sclerae. Laboratory
studies show elevated serum levels of liver enzymes (AST
and ALT). A trichrome stain of a liver biopsy is shown in the
image. A similar pattern of regeneration and fi brosis would be
expected in the liver of a patient with which of the following
conditions?

Answer 11

11. Chronic viral hepatitis.

Question 12

A 10-year-old boy trips at school and scrapes the palms of
his hands. The wounds are cleaned and covered with sterile
gauze. Which of the following terms best characterizes the
healing of these superfi cial abrasions?

Answer 12

12. Regeneration

Question 13

Which of the following cellular processes helps restore normal
epithelial structure and function in the patient described in
Question 12?

Answer 13

13. Contact inhibition of epithelial growth and

motility.

Question 14

A 34-year-old woman has a benign nevus removed from her
back under local anesthesia. Which of the following families
of cell adhesion molecules is the principal component of the
“provisional matrix” that forms during early wound healing?

Answer 14

14. Fibronectin

Question 15

Which of the following families of glycoproteins plays the
most important role in regulating the migration and differentiation
of leukocytes and connective tissue cells during wound
healing in the patient described in Question 14?

Answer 15

15. Integrins.

Question 16

A 29-year-old carpenter receives a traumatic laceration to her
left arm. Which of the following is the most important factor
that determines whether this wound will heal by primary
or secondary intention?

Answer 16

16. Apposition of edges.

Question 17

Activated fi broblasts, myofi broblasts, and capillary sprouts are
most abundant in the wound of the patient described in Question
16 at which of the following times after injury?

Answer 17

17. 3 to 5 days.

Question 18

A 9-year-old boy receives a deep laceration over his right eyebrow
playing ice hockey. The wound is cleaned and sutured.
Which of the following describes the principal function of
macrophages that are present in the wound 24 to 48 hours
after injury?

Answer 18

18. Phagocytosis.

Question 19

Which of the following collagens is deposited fi rst during

wound healing in the patient described in Question 18?

Answer 19

19. Type III.

Question 20

A 16-year-old boy suffers a concussion during an ice hockey
game and is rushed to the emergency room. A CT scan of
the brain reveals a cerebral contusion of the left frontal lobe.
The boy lies comatose for 3 days but eventually regains
consciousness. Which of the following cells is the principal
mediator of scar formation in the central nervous system of
this patient?

Answer 20

20. Glial cells.

Question 21

A 30-year-old fi refi ghter suffers extensive third-degree burns
over his arms and hands. This patient is at high risk for
developing which of the following complications of wound
healing?

Answer 21

21. Contracture

Question 22

A 23-year-old man suffers a crush injury of his foot, which
becomes secondarily infected. He undergoes a below-the-knee
amputation. Six months later, the patient complains of chronic
pain at the site of amputation. A fi rm nodule is identifi ed at
the scar site. A biopsy of the nodule demonstrates haphazard
growth of nerves (shown in the image). Which of the following
is the most likely diagnosis?

Answer 22

22. Neuroma.

Question 23

A 34-year-old man presents with a 5-day history of a painful
sore on his hand. Physical examination reveals a 0.5-cm
abscess on the extensor surface of the left hand that drains
a thick, purulent material. Diapedesis of leukocytes into and
around this patient’s infected wound occurs primarily at which
of the following anatomic locations?

Answer 23

23. Postcapillary venules.

Question 24

A 35-year-old pregnant woman with a history of chronic
gastritis presents to the emergency room complaining of
acute abdominal pain. Physical examination reveals hepatomegaly,
ascites, and mild jaundice. The patient subsequently
develops acute hepatic failure and expires. Autopsy reveals
thrombosis of the hepatic veins (Budd-Chiari syndrome).
During the autopsy, a lesion is identifi ed in the distal stomach
and examined by light microscopy (shown in the image).
Which of the following best describes this incidental fi nding
at autopsy?

Answer 24

24. Ulcer.