Patho test 1 Flashcards
Plasma cells (differentiated B lymphocytes) were found to contain increased amounts of
rough endoplasmic reticulum. What is the explanation for this finding?
Hypertrophy
At autopsy, a small heart in a 90-year-old woman was found full of lipofuscin. What is a reasonable explanation for this finding?
Aging
The left ventricle of the heart was 2.5 cm thick (normal = 1.5 cm). What is the name for
this morphological adaptation to chronic stress?
Hypertrophy
Large amounts of brown pigment were noted in a liver biopsy specimen obtained from a man who had hemolytic anemia. What is the name for this brown pigment? What is the name for this intracellular storage disorder?
Hemosiderin
Hemosiderosis
A 60-year-old man died due to myocardial infarction. At autopsy, the heart tissue
histologically demonstrated loss of nuclei, loss of cell outlines, deeply eosinophilic
staining of the cytoplasm, and loss of cross striation of cardiac myocytes. This heart
shows signs of:
Coagulative Necrosis
A chronic smoker presented to the hospital with relentless coughing and a bronchial
biopsy was performed. The biopsy contained fragments of mature squamous epithelium
with no evidence of nuclear atypia. This pathologic change is called
Metaplasia
Actinic keratosis is a pre-neoplastic condition marked by variation in size and shape of
epithelial cells, irregular nuclei, and disorderly maturation. This condition is an example
of an adaptation to persistent stress termed
Dysplasia
At the autopsy of an 80-year-old man, the brain was found to have thinned gyri and
widened sulci. What is the name for this adaptation to chronic persistent injury?
Atrophy
Renal cell carcinoma may secrete erythropoietin which results in erythrocytosis. The
bone marrow of such patients contains an increased number of red blood cell precursors.
This condition is called erythroid:
Hyperplasia
A slap on the face produced an area of redness on the check. Why did the face become
red? What is the name for this phenomenon?
Vasodilation
Hyperemia
White blood cells (WBCs) were attached to the endothelial cells of small blood vessels in
the area of inflammation. What is the reason for this “pavementing”?
Recruitment of cells to the site of injury.
Margination
The WBC’s recovered from the urethral discharge of a man with gonorrhea were found to
contain bacteria. How did the bacteria enter the WBCs? What is this process called?
Phagocytosis
A kidney was affected by inflammation for 2 months. What types of cells would one expect to find in this tissue?
Lymphocytes, plasma cells, and macrophages
The pericardium was covered with a shaggy, soft, red material that could be removed
easily. What is this surface material largely composed of?
Fibrin
An eye infection was diagnosed in a person who cannot produce tears. Such infections are likely to be recurrent. Name this syndrome.
Sjogren syndrome
A man experienced attacks of sneezing every spring. This is most likely an example of
which hypersensitivity reaction?
Type 1 hypersensitivity
Group A blood given to a group B person caused severe hemolysis. Why did hemolysis
occur?
Complement mediated, antibody-dependent cytotoxicity
Three days after a purified protein derivative (PPD) isolated from Mycobacterium
tuberculosis was injected into the skin of a patient, an area of hardening (induration) 1 cm
in diameter was produced. This area of induration is due to which type of
hypersensitivity reaction taking place in the skin?
Type IV hypersensitivity
A Rh-positive baby, the second child of a Rh-negative mother, was jaundiced. Why was
the child yellow?
Complement medicated, antibody dependent cytotoxicity
A small nodule measuring 2 cm in diameter was removed form the breast of a 25-year-
old woman. If this nodule is a benign neoplasm if ductal epithelial origin it would be
called:
Adenoma
An islet cell tumor measuring 3 cm in diameter was found in the pancreas. There were
also metastases in the lymph nodes. On histologic examination, it could not be
determined whether the primary tumor was benign or malignant. Is this tumor benign or
malignant?
Malignant
A 14-year-old boy died of osteosarcoma that had metastasized in the lungs. Where did
this tumor most likely arise?
Bone
A former shipyard worker who was a smoker developed cancer and received
compensation for a workplace-related injury (asbestosis). What cancer is this? What is
the histological diagnosis?
Mesothelioma
A woman who was diagnosed as having hepatitis B virus (HBV) in her youth developed a carcinoma at the age of 60 years. This carcinoma was found in which organ?
Liver
A mentally retarded child with slanted eyes, epicanthus, and simian crease of the palm was born to a 35-year-old woman. What is the most common procedure for prenatal diagnosis of this genetic disease?
Amniocentesis
An infertile 21-year-old woman was found to have a 45,X karyotype. What is the most
likely explanation of this finding? What is the diagnosis?
What is
the name for the chromosomal error which most likely occurred during meiosis?
Turner Syndrome
Nondisjunction
A man with familial hypercholesterolemia has two sons and two daughters. How many
of his children would be expected to inherit this genetic disease?
2 (50%)
A neonate developed meconium ileus shortly after birth and subsequently developed
pancreatitis and recurrent pulmonary infections. The child’s skin tasted salty. What is
the likely diagnosis? Do the infant’s parents have any signs of the
disease?
Cystic Fibrosis
No
A 16-year-old girl complains that she has not started menstruating like other girls her age. The patient is short (4 feet, 11 inches) and has a thick-webbed neck. Physical examination reveals widely spaced nipples and poor breast
development
a. Turner syndrome, 45 XO karyotype
b. Genetic disorder caused by maternal nondisjunction of somatic cells in early stages of embryogenesis
A 20-year-old gardener presents to his family physician for treatment of
what he describes as “poison ivy.” The patient’s hands and arms appear red and are covered with oozing blisters and crusts
a. Type 4 delayed hypersensitivity reaction
A 20-year-old woman has an ovarian tumor removed. The surgical specimen is 10 cm in diameter and cystic. The cystic cavity is found to contain black hair and sebaceous material. Histologic examination of the cyst wall reveals a variety of benign differentiated tissues, including skin, cartilage, and
glandular epithelium
a. Teratoma
Teratoma contains many different germ cells
A 20-year-old woman with a history of asthma and allergies undergoes skin testing to identify potential allergens in her environment.
a. A positive skin reaction would be mediated by IgE class immunoglobulins (type IV hypersensitivity reaction)
A 31-year-old woman complains of increased vaginal discharge of 1 month duration. A cervical Pap smear is obtained. Superficial epithelial cells in the smear show condensed (pyknotic) nuclei
a. Pyknosis - the irreversible condensation of chromatin in the nucleus of the cell undergoing necrosis or apoptosis. The nucleus becomes smaller and stains deeply basophilic as chromatin clumping continues.
b. Diagnosis - cervical intraepithelial neoplasia
A 35-year-old man asks for advice regarding seasonal eye itching and runny
nose (rhinitis)
a. Hypersensitivity type 1
A 36-year-old woman presents with a suspicious-looking mole on the
posterior surface of her neck. Biopsy confirms the diagnosis of malignant
melanoma.
a. The most dangerous form of skin cancer is malignant melanoma, these cancerous growths develop when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sun or tanning beds) triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors
A 39-year-old man with AIDS is admitted to the hospital with a 3-week history of chest pain and shortness of breath. An x-ray film of the chest shows bilateral nodular masses in the lungs. A CT-guided lung biopsy reveals granulomatous inflammation.
a. Granulomas - collections of epitheloid cells and multinucleated giant cells that are formed by cytoplasmic fusion of macrophages
b. Langhans giant cell - nuclei are arranged around the periphery of the cell in a horseshoe pattern, a foreign pathogenic agent can be seen
c. Diagnosis: AIDS, granulomatous inflammation
A 42-year-old woman gives birth to a neonate with multiple congenital
abnormalities. Physical findings included a flat facial profile, slanted eyes, epicanthal folds, Brushfield spots, short nose, short neck, dysplastic ears, clinodactyly, a large protruding tongue, and a pronounced heart murmur.
a. Down’s syndrome - trisomy 21, 3 copies of 21ist chromosome
b. Maternal nondisjunction during the first meiotic division of gametogenesis
A 43-year-old pregnant woman inquires about the possibility of Down syndrome in her unborn child
- Maternal non-disjunction, risk increases with age
- Amniocentesis and chorionic villus biopsy are safe and reliable prenatal testing
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
demonstrates iron overload
a. Hemosiderin - a partially denatured form of ferritin that aggregates easily and is yellow-brown in the cytoplasm but turns blue with the Prussian blue reaction
b. Hereditary hemochromatosis - a genetic abnormality of iron absorption in the small intestine. Excess iron is stored mostly in the form of hemosiderin, primarily in the liver
A 45-year-old woman complains of severe headaches and difficulty
swallowing. Over the past 6 months, she has noticed small, red lesions
around her mouth as well as thickening of her skin. The patient has “stone facies” on physical examination
Scleroderma - autoimmune disease of connective tissue (collagen vascular disease) - type 4 hypersensitivity
A biopsy would show an accumulation of collagen
5-year-old boy punctures his thumb with a rusty nail. Four hours later, the thumb appears red and swollen
a. initial swelling is from increased capillary permeability - localized inflammatory edema
b. Diagnosis - inflammatory edema
A 50-year-old man is found to have blood in his urine during a routine
checkup (hematuria). An abdominal CT scan reveals a 2-cm right renal mass. You inform the patient that staging of this tumor is key to selecting treatment and evaluating prognosis
a. TNM staging system assesses tumor size and spread locally and systemically (vs. grading system which assesses the degree of differentiation and proliferative capacity)
Tumor
Nodes
Metastasis
b. Diagnosis - renal cell carcinoma
A 50-year-old man presents with a lesion on the sun-exposed, dorsal surface of his right hand. Biopsy reveals malignant keratinocytes
Squamous cell carcinoma
A 50-year-old man with polycystic kidney disease dies in renal failure
(uremia). A shaggy exudate on the surface of his heart is observed at autopsy
Fribrinous exudate - fibrinous pericarditis (bread and butter), friction rub will be heard on auscultation
Diagnosis - ESRD
A 50-year-old woman dies of metastatic ovarian cancer. During the autopsy, a segment of mesentery attached to a loop of small intestine is studded with
small white tumor nodules.
Seeding of body cavity
Ovarian cancer, carcinomatosis
52-year-old man presents with a pigmented skin lesion that he first noticed 6 months ago
Melanoma
A 58-year-old woman with colon cancer presents with 3 months of
increasing shortness of breath. A chest x-ray reveals numerous “coin lesions” in both lungs. Histologic examination of an open lung biopsy demonstrates metastatic colon cancer
After invading interstitial tissue, malignant cells penetrate lymphatic or vascular channels
Adenocarcinoma of the colon
A 60-year-old man suffered a massive myocardial infarction and expired. At autopsy, the heart tissue histologically demonstrated loss of nuclei, deeply eosinophilic staining of the cytoplasm, and loss of cross striation of cardiac myocytes.
Coagulative necrosis
A 64-year-old man suffers repeated heart attacks and subsequently dies of cardiac tamponade. Histological examination of the heart at autopsy shows abundant scar tissue, which is stained blue with trichrome stain
Collagen scar tissue
A 65-year-old man from China suffers a massive stroke and expires. The lungs are examined at autopsy. Revealed numerous pigmented nodules scattered throughout parenchyma
Anthrosis/”Coal miner lung”, often develops pulmonary fibrosis
A 65-year-old man with a history of heavy smoking dies of an acute
myocardial infarction. The heart is examined at autopsy
Mural thrombus
A 68-year-old man with chronic renal disease complains of headaches and
dizziness. Blood pressure is 220/130 mm Hg (malignant hypertension).
While in the emergency room, the patient suffers a massive stroke and
expires. Microscopic examination of the kidney at autopsy shows areas of
fibrinoid necrosis.
Fibrinoid necrosis is seen in patients with necrotizing vasculitis (alteration of injured blood vessels, in which the insulation and accumulation of plasma proteins cause the wall to stain intensely with eosin - red material in the wall of the artery)
A 68-year-old woman dies of congestive heart failure. A cross-section of the heart at autopsy is shown
a. Pulmonary hypertension. Cor pulmonale is RV hypertrophy and dilation secondary to pHTN. The most common cause of cor pulmonale is COPD, usually from smoking
b. Diagnosis: cor pulmonale, pulmonary hypertension
A 72-year-old man dies of complications of pneumococcal pneumonia. Histological examination of the lungs at autopsy shows acute inflammatory cells filling the pulmonary alveoli
Purulent exudate in the alveoli, alveoli are filled with neutrophils and PMN leukocytes.
Diagnosis: bacterial pneumonia
A 92-year-old woman is brought unconscious to the emergency room from a nursing home. Her blood pressure is 70/30 mm Hg. She is febrile (100.5oF) and breathing rapidly (tachypneic). Laboratory studies demonstrate an elevated white blood cell count with 92% neutrophils. Urinalysis reveals
numerous gram-negative organisms
Septic shock
A chronic smoker presented to the hospital with relentless coughing. A
bronchial biopsy was performed. The biopsy contained fragments of mature squamous epithelium, with no evidence of nuclear atypia (not a neoplasm).
Metaplasia
A small benign neoplasm measuring 2 cm in diameter was removed from the right breast of a 25-year-old woman
Adenoma - benign neoplasm of ductal epithelial origin
A tall, infertile 18-year-old man was found to have atrophic testes, increased follicle stimulating hormone (FSH) in the serum, and an abnormal karyotype
Kleinfelter syndrome, 47XXY
A young man sneezed each time he was close to cats.
Type 1 immediate hypersensitivity reaction
Mediated by mast cells + IgE receptors that degranulate and release histamine
At the autopsy, the brain was found to have thinned gyri and widened sulci
Atrophy
Autopsy of an 80-year-old woman with a history of congestive heart failure reveals marked enlargement of the left ventricle
hypertrophy
Biopsy of the uterine endocervix in a 38-year-old woman shows an abnormal focus of squamous epithelium. There is no evidence of cytologic atypia
Common with HPV
During a medical conference you are asked to discuss differences between tumor staging and grading
a. staging and grading are used to predict the behavior of neoplasms and determine therapy
b. grading: assessment of the degree of differentiation and proliferative activity
Low grade = well differentiated.
High grade = poorly differentiated, more aggressive, more anapestic pleomorphism
b. Staging: assessment of tumor size and extent of spread locally and distally (nodes and metastases), TNM staging system
Glass slides are examined using a double-headed microscope in the Pathology Department. White blood cells are found attached to the endothelial cells of small blood vessels in an area of tissue injury.
Acute inflammatory process. Phase 1 activated with the injury occurs, changes to small blood vessels in the area of injury, loss of fluid and movement of WBCs to the area (vascular permeability).
Margination and pavementing of WBCs is chemotaxis
Group A blood is given by mistake to a group B individual. The patient
developed severe hemolysis and mild jaundice (hyperbilirubinemia)
Complement-mediated antibody-dependent cytotoxicity was elicited when immune complexes formed (not an immediate response, rather when antibodies formed large complexes in the blood that circulated).
Large amounts of brown pigment were noted in a liver biopsy specimen obtained from a man who had hemolytic anemia
Hemosiderin: Brown pigment is iron storage complex
Hemosiderosis: Prussion blue is the stain
The parents of a child with cleft lip and cleft palate visit a genetic counselor to discuss the chances that a similar birth defect will occur in their future offspring
a. Cleft lip/palate is a multifactorial inheritance pattern that occurs from disturbances in gene expression (hereditary and environmental) leading to interference with proper fusion (around 35th day of gestation)
b. It is also often encountered in children with chromosomal abnormalities
c. Risk in first degree relatives is 5-10%. Familial inheritance that does not obey simple mendelian rules
This cervical biopsy shows neoplastic cells occupying the full thickness of the epithelium, confined by the underlying basement membrane
Carcinoma in situ
You attend a clinical conference on molecular diagnostics. During the
conference you are asked to discuss the difference between reactive
hyperplasia and neoplasia.
Hyperplasia - result of increased functional demand of the cells, hormonal stimulation, or persistent cell injury. It is reversible in the absence of stressors.
Neoplasm - clonal proliferation of cells with autonomous growth; results from alterations (mutation) in DNA. Can be benign or malignant. Result of dysplasia. No longer reversible but can be removed/excised
