Robbins Questions Flashcards
1 A 17-year-old boy infected with hepatitis A experiences mild nausea for about 1 week and develops very mild scleral
icterus. On physical examination, he has minimal right upper quadrant tenderness. Laboratory findings include a serum
AST of 68 U/L, ALT of 75 U/L, and total bilirubin of 5.1 mg/dL. The increase in this patient’s serum enzyme levels most
likely results from which of the following changes in the hepatocytes?
□ (A) Autophagy by lysosomes
□ (B) Clumping of nuclear chromatin
□ (C) Defects in the cell membrane
□ (D) Dispersion of ribosomes
□ (E) Swelling of the mitochondria
C
2 A 16-year-old boy sustained blunt trauma to the abdomen when the vehicle he was driving struck a bridge abutment at
high speed. Peritoneal lavage shows a hemoperitoneum, and at laparotomy, a small portion of the left lobe of the liver is
removed because of the injury. Several weeks later, a CT scan of the abdomen shows that the liver has nearly regained
its size before the injury. Which of the following processes best explains this CT scan finding?
□ (A) Apoptosis
□ (B) Dysplasia
□ (C) Fatty change
□ (D) Hydropic change
□ (E) Hyperplasia
□ (F) Hypertrophy
□ (G) Metaplasia
E
3 On a routine visit to the physician, an otherwise healthy 51-year-old man has a blood pressure of 150/95 mm Hg. If his hypertension remains untreated for years, which of the following cellular alterations would most likely be seen in his myocardium?
□ (A) Atrophy
□ (B) Hyperplasia
□ (C) Metaplasia
□ (D) Hemosiderosis
□ (E) Hypertrophy
E
4 A 72-year-old man died suddenly from congestive heart failure. At autopsy, the heart weighed 580 g and showed marked left ventricular hypertrophy and minimal coronary arterial atherosclerosis. A serum chemistry panel ordered before death showed no abnormalities. Which of the following pathologic processes best accounts for the appearance of the aortic valve seen in the figure?
□ (A) Amyloidosis
□ (B) Dystrophic calcification
□ (C) Lipofuscin deposition
□ (D) Hemosiderosis
□ (E) Fatty change
B
5 A 69-year-old woman has had transient ischemic attacks for the past 3 months. On physical examination, she has an audible bruit on auscultation of the neck. A right carotid endarterectomy is performed. The curetted atheromatous plaque has a grossly yellow-tan, firm appearance. Microscopically, which of the following materials can be found in abundance in the form of crystals that produce long, cleft-like spaces?
□ (A) Glycogen
□ (B) Lipofuscin
□ (C) Hemosiderin
□ (D) Immunoglobulin
□ (E) Cholesterol
E
6 A 38-year-old woman experienced severe abdominal pain with hypotension and shock that led to her death within 36 hours after the onset of the pain. From the gross appearance of the mesentery, seen in the figure at the bottom of the previous column, which of the following events has most likely occurred?
□ (A) Hepatitis B virus infection
□ (B) Small intestinal infarction
□ (C) Tuberculous lymphadenitis
□ (D) Gangrenous cholecystitis
□ (E) Acute pancreatitis
E
7 In an experiment, cells are subjected to radiant energy in the form of x-rays. This results in cell injury caused by hydrolysis of water. Which of the following cellular enzymes protects the cells from this type of injury?
□ (A) Phospholipase
B) Glutathione peroxidase
□ (C) Endonuclease
□ (D) Lactate dehydrogenase
□ (E) Protease
B
8 A 47-year-old woman has had worsening dyspnea for the past 5 years. A chest CT scan shows panlobular emphysema. Laboratory studies show the PiZZ genotype of α1-antitrypsin (AAT) deficiency. A liver biopsy specimen examined microscopically shows abundant PAS-positive globules within periportal hepatocytes. Which of the following molecular mechanisms is most likely responsible for this finding in the hepatocytes?
□ (A) Excessive hepatic synthesis of AAT
□ (B) Retention of poorly folded AAT in the endoplasmic reticulum
□ (C) Decreased catabolism of AAT in lysosomes
□ (D) Inability to metabolize AAT
□ (E) Impaired dissociation of AAT from chaperones
B
9 A 68-year-old woman suddenly lost consciousness; on awakening 1 hour later, she could not speak or move her right arm and leg. Two months later, a head CT scan showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in the brain?
□ (A) Fat necrosis
□ (B) Coagulative necrosis
□ (C) Apoptosis
□ (D) Liquefactive necrosis
□ (E) Karyolysis
D
10 A 30-year-old man sustains a left femoral fracture in a skiing accident, and his leg is placed in a plaster cast. After the leg has been immobilized for several weeks, the diameter of the left calf has decreased. This change is most likely to result from which of the following alterations in the calf muscles?
□ (A) Aplasia □
(B) Hypoplasia
□ (C) Atrophy □
(D) Dystrophy
□ (E) Hyalinosis
C
11 An experiment analyzes cells for enzyme activity associated with sustained cellular proliferation. Which of the following cells is most likely to have the highest telomerase activity?
□ (A) Endothelial cells
□ (B) Germ cells
□ (C) Neurons
□ (D) Neutrophils
□ (E) Erythrocytes
B
12 A 32-year-old man experiences “heartburn” and gastric reflux after eating a large meal. After many months of symptoms, he undergoes upper gastrointestinal endoscopy, and a biopsy specimen of the esophageal epithelium is obtained. Which of the following pathologic changes, seen in the figure, has most likely occurred?
□ (A) Squamous metaplasia
□ (B) Mucosal hypertrophy
□ (C) Columnar epithelial metaplasia
□ (D) Atrophy of lamina propria
□ (E) Goblet cell hyperplasia
C
13 On day 28 of her menstrual cycle, a 23-year-old woman experiences onset of menstrual bleeding that lasts for 6 days. She has had regular cycles for many years. Which of the following processes is most likely occurring in the endometrium just before the onset of bleeding?
□ (A) Apoptosis
□ (B) Caseous necrosis
□ (C) Heterophagocytosis
□ (D) Atrophy
□ (E) Liquefactive necrosis
A
14 In a clinical trial, a chemotherapeutic agent is given to patients with breast cancer metastases. Samples of the cancer cells are obtained and assessed for the presence of death of tumor cells by apoptosis. Mutational inactivation of which of the following products is most likely to render tumor cells resistant to the effects of such an agent?
□ (A) BCL-2
□ (B) p53
□ (C) NF-κB
□ (D) Cytochrome P-450
□ (E) Granzyme B
B
15 After the birth of her first child, a 19-year-old woman breastfed the infant for about 1 year. Which of the following processes that occurred in the breast during pregnancy allowed her to breastfeed the infant?
□ (A) Stromal hypertrophy
□ (B) Lobular hyperplasia
□ (C) Epithelial dysplasia
□ (D) Intracellular accumulation of fat
□ (E) Ductal epithelial metaplasia
B
16 A 22-year-old woman has a congenital anemia that has required multiple transfusions of RBCs for many years. On physical examination, she now has no significant findings; however, liver function tests show reduced serum albumin. Which of the following findings would most likely appear in a liver biopsy specimen?
□ (A) Steatosis in hepatocytes
□ (B) Bilirubin in canaliculi
□ (C) Glycogen in hepatocytes
□ (D) Amyloid in portal triads
□ (E) Hemosiderin in hepatocytes
E
17 A 50-year-old man experienced an episode of chest pain 6 hours before his death. A histologic section of left ventricular myocardium taken at autopsy showed a deeply eosinophilic-staining area with loss of nuclei and cross-striations in myocardial fibers. There was no hemorrhage or inflammation. Which of the following conditions most likely produced these myocardial changes?
□ (A) Viral infection
□ (B) Coronary artery thrombosis
□ (C) Blunt chest trauma
□ (D) Antibodies directed against myocardium □ (E) Protein-deficient diet
B
18 A 69-year-old man has had difficulty with urination, including hesitancy and frequency, for the past 5 years. A digital rectal examination reveals that the prostate gland is palpably enlarged to about twice normal size. A transurethral resection of the prostate is performed, and the microscopic appearance of the prostate “chips” obtained is that of nodules of glands with intervening stroma. Which of the following pathologic processes has most likely occurred in the prostate?
□ (A) Apoptosis
□ (B) Dysplasia
□ (C) Fatty change
□ (D) Hyperplasia □
(E) Hypertrophy
□ (F) Metaplasia
D
19 A 54-year-old man experienced onset of severe substernal chest pain over 3 hours. An ECG showed changes consistent with an acute myocardial infarction. After thrombolytic therapy with tissue plasminogen activator (t-PA), his serum creatine kinase (CK) level increased. Which of the following events most likely occurred after t-PA therapy?
□ (A) Reperfusion injury
□ (B) Cellular regeneration
□ (C) Chemical injury
□ (D) Increased synthesis of CK
□ (E) Myofiber atrophy
A
20 A 33-year-old woman has had increasing lethargy and decreased urine output for the past week. Laboratory studies show serum creatinine level of 4.3 mg/dL and urea nitrogen level of 40 mg/dL. A renal biopsy is performed, and the specimen is examined using electron microscopy. Which of the following morphologic changes most likely suggests a diagnosis of acute tubular necrosis?
□ (A) Mitochondrial swelling
□ (B) Plasma membrane blebs
□ (C) Chromatin clumping
□ (D) Nuclear fragmentation
□ (E) Ribosomal disaggregation
D
21 A 40-year-old man had undifferentiated carcinoma of the lung. Despite chemotherapy, the man died of widespread metastases. At autopsy, tumors were found in many organs. Histologic examination showed many foci in which individual tumor cells appeared shrunken and deeply eosinophilic. Their nuclei exhibited condensed aggregates of chromatin under the nuclear membrane. The process affecting these shrunken tumor cells was most likely triggered by the release of which of the following substances into the cytosol?
□ (A) Lipofuscin
□ (B) Cytochrome c
□ (C) Catalase
□ (D) Phospholipase
□ (E) BCL-2
B
22 A 70-year-old man died suddenly. At autopsy, multiple tissue sites were sampled for microscopic analysis. Examination of the tissues showed noncrystalline amorphous deposits of calcium salts in gastric mucosa, renal interstitium, and alveolar walls of lungs. Which of the following conditions would most likely explain these findings?
□ (A) Chronic hepatitis
□ (B) Chronic glomerulonephritis
□ (C) Disseminated tuberculosis
□ (D) Generalized atherosclerosis
□ (E) Normal aging process
□ (F) Pulmonary emphysema
B
23 A 63-year-old man has a 2-year history of worsening congestive heart failure. An echocardiogram shows mitral stenosis with left atrial dilation. A thrombus is present in the left atrium. One month later, he experiences left flank pain and notes hematuria. Laboratory testing shows elevated serum AST. Which of the following patterns of tissue injury is most likely to be present?
□ (A) Liquefactive necrosis
□ (B) Caseous necrosis
□ (C) Coagulative necrosis
□ (D) Fat necrosis
□ (E) Gangrenous necrosis
C
24 At autopsy, a 40-year-old man has an enlarged (2200 g) liver with a yellow cut surface. The microscopic appearance of this liver is shown in the figure. Before death, the man’s total serum cholesterol and triglyceride levels were normal, but he had a decreased serum albumin concentration and increased prothrombin time. Which of the following activities most likely led to these findings?
□ (A) Injecting heroin
□ (B) Playing basketball
□ (C) Drinking beer
□ (D) Smoking cigarettes
□ (E) Ingesting aspirin
C