Robbins Questions

Question 1

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

Answer 1

C

Question 2

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

Answer 2

E

Question 3

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

Answer 3

E

Question 4

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

Answer 4

B

Question 5

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

Answer 5

E

Question 6

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

Answer 6

E

Question 7

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

Answer 7

B

Question 8

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

Answer 8

B

Question 9

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

Answer 9

D

Question 10

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

Answer 10

C

Question 11

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

Answer 11

B

Question 12

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

Answer 12

C

Question 13

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

Answer 13

A

Question 14

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

Answer 14

B

Question 15

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

Answer 15

B

Question 16

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

Answer 16

E

Question 17

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

Answer 17

B

Question 18

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

Answer 18

D

Question 19

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

Answer 19

A

Question 20

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

Answer 20

D

Question 21

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

Answer 21

B

Question 22

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

Answer 22

B

Question 23

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

Answer 23

C

Question 24

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

Answer 24

C

Question 25

25 A 22-year-old woman with leukemia undergoes bone marrow transplantation and receives partially mismatched donor marrow. One month later, she has a scaling skin rash. Examination of a skin biopsy specimen reveals the cellular change shown in the figure. This change most likely results from which of the following biochemical reactions?
□ (A) Activation of caspases
□ (B) Reduction of ATP synthesis
□ (C) Increase in glycolysis
□ (D) Activation of lipases
□ (E) Lipid peroxidation

Answer 25

A

Question 26

26 At autopsy, the heart of a 63-year-old man weighs only 250 g and has small right and left ventricles. The myocardium is firm, with a dark chocolate-brown color throughout. The coronary arteries show minimal atherosclerotic changes. An excessive amount of which of the following substances would most likely be found in the myocardial fibers of this heart?
□ (A) Melanin
□ (B) Hemosiderin
□ (C) Glycogen
□ (D) Lipofuscin
□ (E) Bilirubin

Answer 26

D

Question 27

27 A 69-year-old woman has had a chronic cough for the past year. A chest radiograph shows a 6-cm mass in the left lung, and a needle biopsy specimen of the mass shows carcinoma. A pneumonectomy is performed, and examination of the hilar lymph nodes reveals a uniform, dark black cut surface. Which of the following factors most likely accounts for the appearance of the lymph nodes?
□ (A) Smoking
□ (B) Bleeding disorder
□ (C) Liver failure
□ (D) Aging
□ (E) Metastases

Answer 27

A

Question 28

28 A 44-year-old man has a history of poorly controlled diabetes mellitus leading to coronary artery disease. He now has decreasing cardiac output. An increase in which of the following substances in his blood is most indicative of reversible cell injury from decreased perfusion of multiple organs and tissues?
□ (A) Carbon dioxide
□ (B) Creatinine
□ (C) Glucose
□ (D) Lactic acid
□ (E) Troponin I

Answer 28

D

Question 29

29 An experiment introduces a “knockout” gene mutation into a cell line. The frequency of shrunken cells with chromatin clumping and cytoplasmic blebbing is increased compared with a cell line without the mutation. Overall survival of the mutant cell line is reduced. Which of the following genes is most likely to be affected by this mutation?
□ (A) BAX
□ (B) BCL-2
□ (C) C-MYC
□ (D) FAS
□ (E) p53

Answer 29

B

Question 30

30 A tissue preparation is experimentally subjected to a hypoxic environment. The cells in this tissue begin to swell, and chromatin begins to clump in the nucleus. ATPases are activated, and ATP production decreases. Which of the following ions released from mitochondria leads to these findings and to eventual cell death?
□ (A) Ca2+
□ (B) Cl−
□ (C) HCO32−
□ (D) K+
□ (E) Na+

Answer 30

A

Question 31

31 A chest radiograph of an asymptomatic 37-year-old man showed a 3-cm nodule in the middle lobe of the right lung. The nodule was excised with a pulmonary wedge resection, and sectioning showed the nodule to be sharply circumscribed with a soft, white center. Culture of tissue from the nodule grew Mycobacterium tuberculosis. Which of the following pathologic processes has most likely occurred in this nodule?
□ (A) Apoptosis
□ (B) Caseous necrosis
□ (C) Coagulative necrosis
□ (D) Fat necrosis
□ (E) Fatty change
□ (F) Gangrenous necrosis
□ (G) Liquefactive necrosis

Answer 31

B

Question 32

32 The nonpregnant uterus of a 20-year-old woman measures 7 × 4 × 3 cm. The woman becomes pregnant and just before delivery of a term infant, the uterus measures 34 × 18 × 12 cm. Which of the following cellular processes has contributed most to the increase in uterine size?
□ (A) Endometrial glandular hyperplasia
□ (B) Myometrial fibroblast proliferation
□ (C) Endometrial stromal hypertrophy
□ (D) Myometrial smooth muscle hypertrophy □ (E) Vascular endothelial hyperplasia

Answer 32

D

Question 33

33 A 40-year-old woman has had chronic congestive heart failure for the past 3 years. In the past 2 months, she developed a cough productive of rust-colored sputum. A sputum cytology specimen shows numerous hemosiderin-laden macrophages. Which of the following subcellular structures in macrophages is most important for the accumulation of this pigment?
□ (A) Lysosome
□ (B) Endoplasmic reticulum
□ (C) Ribosome
□ (D) Golgi apparatus
□ (E) Chromosome

Answer 33

A

Question 34

34 In an experiment, a large amount of a drug is administered to subjects and is converted by cytochrome P-450 to a toxic metabolite. The accumulation of this metabolite leads to increased lipid peroxidation within cells, causing damage to cell membranes and cell swelling. Depletion of which of the following substances by this mechanism within the cytosol exacerbates the cellular injury?
□ (A) ADP
□ (B) Calcium
□ (C) Glutathione
□ (D) NADPH oxidase
□ (E) Nitric oxide synthase
□ (F) mRNA
□ (G) Sodium

Answer 34

C

Question 35

35 An experiment is conducted in which cells in tissue culture are subjected to high levels of ultraviolet radiant energy. Electron microscopy shows cellular damage in the form of increased cytosolic aggregates of denatured proteins. In situ hybridization reveals that protein components in these aggregates also are found in proteasomes. Which of the following substances is most likely to bind to the denatured proteins, targeting them for catabolism by cytosolic proteasomes?
□ (A) Adenosine monophosphate
□ (B) Calcium
□ (C) Caspase
□ (D) Granzyme B
□ (E) Hydrogen peroxide
□ (F) Ubiquitin

Answer 35

F

Question 36

36 A 71-year-old man diagnosed with pancreatic cancer is noted to have decreasing body mass index. His normal cells comprising skeletal muscle undergo atrophy by sequestering organelles and cytosol in a vacuole followed by fusion with a lysosome. However, the cancer continues to increase in size. Which of the following processes is most likely occurring in the normal cells but inhibited in the cancer cells of this man?
□ (A) Aging
□ (B) Apoptosis
□ (C) Autophagy
□ (D) Hyaline change
□ (E) Karyorrhexis

Answer 36

C

Question 37

37 A 5-year-old child ingests 50 iron tablets, each with 27 mg of iron. Within 6 hours the child develops abdominal pain and lethargy. On physical examination he is hypotensive. Laboratory studies show metabolic acidosis. Through formation of which of the following compounds is the cell injury in this child most likely mediated?
□ (A) Ascorbic acid
□ (B) Hemosiderin
□ (C) Hydroxyl radical
□ (D) Nitric oxide
□ (E) Superoxide dismutase

Answer 37

C

Question 38

38 A proponent of Malbec, Syrah, and Merlot wines (all reds) touts their contribution to longevity, but this wine aficionado also controls the caloric content of his diet such that his body mass index is <22. This lifestyle promotes increased insulin sensitivity and glucose utilization. He fully expects to live long because he has read that caloric restriction prolongs life. In this man, which of the following proteins will most likely mediate the effect of calorie restriction upon increased longevity?
□ (A) Caspase
□ (B) Glutathione
□ (C) Sirtuin
□ (D) Telomerase

Answer 38

C