Sorted Samplex Flashcards

1
Q
Normal stress/pathologic stimuli can lead to the following:
A. Viable cells
B. Cell death
C. Adaptation to a new steady state
D. AOTA
A

D

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2
Q

An adaptive mechanism which involves increase in the number of cells:

a. hyperplasia
b. induction
c. hypertrophy
d. metaplasia

A

A

Hyperplasia is an increase in the number of the cells in an organ or tissue, usually resulting in increased mass of the organ or tissue. (Robbins 8th ed, Chapter 1, page 8)

Hypertrophy is increase in cell size. Metaplasia is a change in cell type.

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3
Q
Not an adaptive cell response
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Hypoplasia
A

D

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4
Q

An adaptive mechanism that results in a decrease of cytoplasmic volume and no. of organelles:

a. dysplasia
b. neoplasia
c. atrophy
d. agenesis

A

C

Atrophy is reduced size of an organ or tissue resulting from a decrease in cell size and number. (Robbins 8th ed, Chapter 1, page 9)

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5
Q
In this type of cellular adaptation, there’s a marked increase in number of autophagosomes accompanied by a decrease in number of myofilaments, ER, and 
A. mitochondria
B. hypertrophy
C. hyperplasia
D. atrophy
E. metaplasia
A

C

A decrease in cell size entails a decrease in cytoplasmic volume and no. of organelles. Agenesis is failure of development of cells and tissues. Dysplasia and Neoplasia are not adaptive mechanisms, they are “new growths” that ultimately result in cancer.

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6
Q
A reversible change or alteration in adult cells characterized by variation in size, shape and orientation:
A.	metaplasia
B.	dysplasia
C.	hyperplasia
D.	atrophy
A

B

Dysplasia is the change of adult cells in terms of size, shape and orientation. Metaplasia is change in cell type, but the change is uniform.

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7
Q

An adaptive mechanism which involves an increase in cell size and girth:

a. hyperplasia
b. hypertrophy
c. increase n/c ratio
d. none of the above

A

B

Hypertrophy refers to an increase in the size of cells, resulting in an increase in size of the organ. (Robbins 8th ed, Chapter 1, page 6). Hypertrophy usually entail enlargement and/or synthesis of more functional cellular components like mitochondria and actin/myosin filaments, thus it will not necessarily increase Nucleus/Cytoplasm ratio.

Hyperplasia is an increase in the number of the cells in an organ or tissue, usually resulting in increased mass of the organ or tissue. (Robbins 8th ed, Chapter 1, page 8)

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8
Q

Which is an example of pathologic hypertrophy?
A. Left ventricular enlargement in chronic hypertension
B. Uterus in pregnancy
C. Cosmetic implants in the breasts
D. Bigger biceps in body builders

A

A

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9
Q

An adaptive mechanism which involves transformation of multipotential stem cells into cells not native to the injured cell:

a. dysplasia
b. anaplasia
c. metaplasia
d. hyperplasia

A

C

Metaplasia is the result of a reprogramming of stem cells that are known to exist in normal tissues, or of undifferentiated mesenchymal cells present in connective tissue. In a metaplastic change, these precursor cells differentiate along a new pathway. (Robbins 8th ed, Chapter 1, page 11)

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10
Q

Clinical example of metaplastic phenomenon:

a. cardiomegaly
b. endometrial involution
c. liver regeneration
d. reflux in esophagus

A

D

Metaplasia is an adaptive mechanism wherein one differentiated cell type is replaced by another which is more able to withstand adverse environmental conditions. This phenomenon can occur with persistent gastric acid reflux, which causes the squamous epithelial cells of the lower esophagus to be replaced by intestine-like columnar cells.(a.k.a. Barret’s esophagus)

[A. Cardiomegaly] is an example of hypertrophy;
[B. Endometrial involution] is an example of atrophy;
[C. Liver regeneration] is an example of hyperplasia

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11
Q

Clinical example of a hyperplastic phenomenon:

a. Barret’s esophagus
b. prolapsed ectocervix
c. gastric adenocarcinoma
d. hypertension

A

B

Hyperplasia is the increase in the number of cells in an organ or tissue, leading an increase in its mass. Excess hormonal stimulation (estrogen) in females can cause abnormal proliferation and keratinization of the squamous epithelium of the ectocervix leading to prolapse.

[A. Barret’s esophagus] is an example of metaplasia.
[C. Gastric adenocarcinoma] is an example of neoplasia (all carcinomas are neoplasias)
[D. Hypertension] is more related to hypertrophy; Hemodynamic overload can stimulate an increase in the size of myocardial cells.

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12
Q
Hyperplasia is the typical adaptive response of which of the following tissues?
A. Neurons
B. Squamous epithelium
C. Myocardium
D. Skeletal muscle
A

B

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13
Q

Clinical example of hypertrophic phenomenon:

a. Barret’s esophagus
b. myocardial infarct
c. tuberculoma
d. hypertensive cardiomegaly

A

D

Hypertrophy is an increase in the size of individual cells, and hence, the size of the organ itself. Hypertension can increase the mechanical load on the heart and stimulate the myocardial cells to become larger and synthesize more proteins.

[A. Barret’s esophagus] is an example of metaplasia. Kulit!
[B. Myocardial Infarct] will display coagulative necrosis. Although it can be remotely related to hypertrophy (Cardiomegaly  Heart failure  M.I.), the association is vague.
[C. Tuberculoma] is a non-neoplastic but tumor-like mass resulting from the enlargement of a caseated tubercle. Although the web definition may suggest that it can be associated with hypertrophy, this is still not the safest answer.

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14
Q

Clinical example of an atrophic phenomenon:

a. Alzheimer’s disease
b. endometrial hyperesteremia
c. tuberculoma
d. splenic infarct

A

A

Atrophy is the reduce in the size of an organ or tissue resulting from a decrease in cell size or number, and can be caused by decreased workload, denervation, diminished blood supply, inadequate nutrition, loss of endocrine stimulation or pressure. Progressive atrophy of the frontal and parietal regions of the brain can be seen in Alzheimer’s disease.

[B. Endometrial hyperesteremia] – hyperplasia
[C. Tuberculoma] (discussed above)
[D. Splenic infarct] – This will display coagulative necrosis and may involve complications such as organ rupture, hemorrhage or abscess formation.

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15
Q

Metaplastic transformation of squamous to glandular epithelium is seen in:
A. Respiratory tract in chronic smokers
B. Endocervical junction in adult women
C. Esophagogastric junction in chronic gastric reflux
D. AOTA

A

C

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16
Q

Common sequelae of metaplastic phenomenon:

a. pulmonary failure
b. adrenocortical carcinoma
c. endometrial carcinoma
d. gastric carcinoma

A

D

Metaplasia is brought upon by chronic cellular irritation. Gastric adenomas, 30% of which progress to carcinomas, often occur in a background of chronic gastritis and intestinal metaplasia [Robbins].

Pulmonary failure is more likely due to atrophy or hypertrophy.

Hyperplasia usually happens in glandular epithelium in response to hormonal stimulation. Adrenocortical carcinoma and endometrial carcinoma are preceded by hyperplasia.

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17
Q

Common sequelae of hypertrophy:

a. pulmonary failure
b. cardiac failure
c. hematopoietic failure
d. esophageal adenocarcinoma

A

B

In the heart, the stimulus for hypertrophy is usually chronic hemodynamic overload, resulting from either hypertension or faulty valves… Whatever the exact mechanism of cardiac hypertrophy, it eventually reaches a limit beyond which enlargement of muscle mass is no longer able to compensate for the increased burden, and cardiac failure ensues. (Robbins, 8th ed, page 6-7)

Pulmonary failure is more likely due to atrophy or hypertrophy. Hematopoeitic failure is usually due to either decrease in cell reproduction or hyperplasia of dysfunctional blood cells. Esophageal adenocarcinoma is due to chronic irritation and is preceded by metaplasia.

18
Q

A newborn baby died. Upon autopsy, it was found that the left lung was small and underdeveloped while the right lung was larger and heavier than normal. The baby has:
A. Left lung hypoplasia, right lung hypertrophy
B. Left lung atrophy, right lung hypertrophy
C. Left lung hypoplasia, right lung hyperplasia
D. Small left lung, big right lung

A

A

Since the left lung was underdeveloped (hypoplasia; atrophy means that the lung affected was once normal, but that is not the case); right lung had to compensate so it hypertrophied. Hyperplasia is only for the skin and epithelial organs like glands.

19
Q
Which among the following is the most common cause of cellular injury?
A. Genetic changes
B. Infection from biological agents
C. Hypoxia
D. Chemical agents
A

C

20
Q
Features of an injured cell except:
A. Decreased ATP
B. Low intracellular calcium
C. Increased membrane permeability
D. Oxygen-derived free radicals
A

B

21
Q
Fibrinoid necrosis can be expected in:
A. Diabetes
B. Plasmacytoma
C. SLE
D. Fibrinous peritonitis
A

C

Systemic lupus erythematosus, often abbreviated to SLE or lupus, is a chronic autoimmune connective tissue disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage. SLE most often harms the heart, joints, skin, lungs, blood vessels… (Wikipedia, 6/27/10)

Fibrinoid necrosis is a special form of necrosis usually seen in immune reactions involving blood vessels. This pattern of necrosis typically occurs when complexes of antigens and antibodies are deposited in the walls of arteries. (Robbins, 8th ed, p 16-17)

Fibrinoid necrosis is seen in autoimmune diseases, eg. SLE. (Cell Injury, Death, and Adaptation 2014 Trans)

22
Q
Liquefactive necrosis is expected in:
A. Cerebral infarct
B. Splenic infarction
C. Myocardial infarction
D. Hydrocephalous vacuole
A

A

For unknown reasons, hypoxic death of cells within the central nervous system often manifests as liquefactive necrosis. (Robbins, 8th ed, p.15)

Also, the heart and the spleen are end organs with high protein content. Thus, it would show coagulative necrosis instead. “Seen in myocardial infarction and splenic infarction” (Cell Injury, Death, and Adaptation 2014 Trans)

Hydrocephalus vacuole is an accumulation of CSF in the brain, not connected with necrosis. (Wikipedia - Hydrocephalus)  not sure

23
Q
Gangrenous necrosis can be expected in:
A. diabetic foot
B. diabetic granuloma
C. diabetic neuropathy
D. mucocele of appendix
A

A

Gangrenous necrosis is not a specific pattern of cell death, but the term is commonly used in clinical practice. It is usually applied to a limb, generally the lower leg that has lost its blood supply and has undergone necrosis. (Robbins, 8th ed, p. 15)

Dry Gangrene is bacterial infection superimposed on coagulative necrosis, seen in diabetic foot and can smell horrible. (Cell Injury, Death, and Adaptation 2014 Trans)

Granuloma is hyperplasia of fibroblasts that have necrosed. Neuropathy is caused by injury to nerve cells, not necessarily necrosis.

24
Q
Caseation necrosis can be expected in:
A. filariasis
B. sarcoidosis
C. histoplasma
D. scrofula
A

C

Simplified version: Caseation necrosis is commonly caused by Myobacterium (TB) some fungi (histoplasmosis) or some foreign bodies.

25
Q
Caseation necrosis is commonly seen in
A. viral infection		
B. mycobacterium infection	   
C. vascular disorders	        
D. autoimmune disorders
A

B

Long version: Histoplasmosis is a rare disease (imagine that) that resembles tuberculosis when chronic and is normally associated with caseation necrosis. It is caused by the fungi Histoplasma capsulatum that primarily affects the lungs with granulomas present in biopsies. Filariasis involves a worm. Sarcoidosis is typically marked with NON-caseating granulomas. Scrofula is caused by Myobacterium tuberculosis but is however, a skin disease. (Wikipedia: Caseous necrosis)

26
Q
Coagulation necrosis can be expected in:
A. pulmonary infarct
B. intestinal infarct
C. cerebral infarct
D. splenic infarct
A

D

Coagulation necrosis occurs in end arterial organs (kidney, spleen, heart). Only D fits the description. (cell injury and death)

27
Q
The pattern of necrosis in myocardial infarction is:
A. coagulation necrosis
B. Fat necrosis
C. liquetactive necrosis
D. caseation necrosis
A

?

28
Q

Which of the following is true:
A. gangrene refers to tissue necrosis with or without infection
B. acute inflammation does not occur around necrotic tissues
C. apoptosis usually does not cause inflammation
D. The blood vessels surrounding acutely inflamed tissues usually show progressive dilation from the time of injury

A

C

Apoptosis involves the lack of inflammatory response. (cell injury and death)

29
Q
Necrosis is a characteristic of chronic inflammation:
A. leptospirosis
B. gummatous inflammation
C. plasmacytosis
D. tuberculosis
A

D

Probably D because TB can induce chronic inflammation and is associated with caseation necrosis.
Maybe B: Gummatous inflammation is mostly associated with spirochaetal infections which in turn results to syphilis. It later leads to necrosis. (Wikipedia: Gummatous necrosis)
A is out because leptospirosis leads to hemorrhaging and not inflammation.
C is out. There is no evidence that shows plasmacytosis causing necrosis.

30
Q
Caseous or caseation necrosis is descriptive of TB lesions seen:
A) on light micrsocopy 
B) grossly
C) using electron miscroscope
D) AOTA
A

D

31
Q
A 40y.o. patient having a lymphoma involving the lymph nodes in the paraaortic areas. Treated with chemotherapy results to loss of individual neoplastic cells through fragmentation of individual nucleus and cytoplasm. Over the weeks, lymphoma decreased in size as documented by abdominal CT scan. By which of the following mechanisms did the neoplasm primarily respond to the therapy?
A. coagulative necrosis
B. phagocytosis
C. autolysis
D. apoptosis
A

D

Fragmentation of the nucleus and cytoplasm and decrease in cell size are morphologies of apoptosis.

Necrosis causes increased cell size then later explosion of the cell and its contents, causing inflammatory response to neighboring cells. Autolysis (autophagy) may undergo apoposis or necrosis. Phagocytosis engulf the defective cell as a whole or in parts, so the cell will not necessarily break into fragments

32
Q
A 43y.o. man has complained of mild burning substernal or epigastric pain following meals for the past 3 years. Upper GI endoscopy was performed and biopsies were taken of an erythematous area of the lower esophageal mucosa 3cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies demonstrated the presence of columnar epithelium with goblet cells. Which of the ff. mucosal alteration is most likely represented by these findings?
A. agenesis
B. hypertrophy
C. adenocarcinoma
D. metaplasia
A

D

Glandular metaplasia of the esophagus
Due to chronic acid reflux
Esophagus now has a glandular epithelium, which is more tolerant to acid than stratified squamous epithelium

33
Q
A 59y.o. woman lost consciousness for an hour. Upon arousal she was unable to speak or move her right arm and leg. Angiography showed an occlusion in her left cerebral artery. Months later, a CT scan revealed a 5cm cystic mass on her left parietal lobe. This is a result of the resolution of a previous:
A. liquefactive necrosis
B. Coagulation necrosis
C. Fat necrosis
D. None of the above
A

A

Liquefactive Necrosis
Primary biochemical process is autolysis
Occurs in tissues with high fluid content
Seen in brain infarcts and abscesses

Coagulation necrosis happens in end arterial organs like heart and spleen. Fat necrosis happens exclusively in intestinal mesentery, being caused by the action of pancreatic juices to damage the mesentery

34
Q
A 19-year old recently gave birth to her first child. She started breastfeeding and continued for 2 years. Which of the following cellular processes that occurred during pregnancy which allowed her to do this?
A. Stromal hypertrophy
B. Epithelial dysplasia
C. Ductal epithelial metaplasia
D. Lobular hyperplasia
A

D

Hyperplasia usually is the response of glandular tissue (breast) to increased hormonal stimulation (prolactin). The stroma is not responsible for breastmilk production. Epithelial dysplasia may predispose the patient to breast cancer. Ductual epithelial metaplasia may be caused by chronic irritation, which is not the case in breastfeeding.

35
Q
Increased hormonal stimulation may cause cells to undergo
A. Metaplasia
B. Hyperplasia
C. Dysplasia
D. atrophy
A

B

36
Q

A 80 y/o man dies from complications of Alzheimer’s disease. At autopsy his heart is small (250g) and dark brown on sectioning. Microscopically there is a light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance in the heart?

a. hemosiderin from reabsorbed hemorrhages
b. lipochrome from “wear and tear”
c. dystrophic calcifications
d. carbon pigments from anthracosis

A

B

No complications relating to the heart was mentioned in the case. You can assume that the case looks for findings in the normal aging cardiac muscle.

Lipofuscin or “wear and tear ” lipochrome pigment is an insoluble brownish-yellow granular intracellular material that accumulates in tissues like heart, liver and brain as a function of aging and atrophy.

Hemosiderin may happen in muscle tissue in case of trauma (bruises) that is resorbed in short time. Dystrophic calcifications and carbon pigments will not appear brown in H &E. Carbon is usually limited to the respiratory tract with inhalation of carbon.

37
Q

A 20- year old woman had Goodpasture syndrome which progressed to chronic renal failure. She was 165 cm tall, weighed 55kg and had a blood pressure of 150/90 – 180/110 but she did not take regular medications. Lab studies showed her BUN over 100 mg /dl. She required chronic dialysis. She died from heart failure. At autopsy her height weighed 540g. the size of the heart is the result of:

a. hypertrophy
b. amyloid infiltration
c. post-infarct myocyte hyperplasia
d. fatty change

A

A

Renal failure would have led to an increase in hemodynamic load. In order to compensate, the heart would have hypertrophied (since its cells are nondividing) to the point of failure.

Amyloidosis is a consequence of renal failure but does not explain the size of the heart. Myocytes do not divide therefore it could not have been hyperplasia. Fatty change, while observable in the heart, the history suggests that the chronicity of the condition and ultimate heart failure makes hypertrophy more likely.

38
Q

A 43-year-old man has complained of mild burning substernal pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies show the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?

a. dysplasia
b. hyperplasia
c. metaplasia
d. carcinoma

A

C

This is characteristic of Barrett’s esophagus where chronic gastric reflux turns the squamous lining of the esophagus into the more tolerant intestinal-like columnar epithelium: a metaplastic process.

39
Q

A 26- year old man had destruction of the aortic valve by Staphylococcus aureus. Autopsy of the spleen reveals presence of tan to white wedge-shaped 1.5 x 3 cm lesion with base on capsule. What is the possible pathogenesis?

a. coagulation necrosis
b. gangrenous necrosis
c. lymphoreticular hyperplasia
d. sinusoidal hypertrophy

A

A

Organs with end-artery vasculature such as the spleen, kidney and heart display a coagulative pattern of necrosis. Coagulative necrosis is marked by an area of pallor, often wedge-shaped. Gangrenous necrosis often refer to the extremities. Hyperplasia or hypertrophy would present grossly as an increase in organ size, not described here.

40
Q
Apoptosis
A. Is enzymatic
B. Is never pathologic
C. Is associated with inflammation
D. All of the above
A

A

Apoptosis is tightly regulated by enzymes. It may be pathologic (viral infection where the cell infected undergoes apoptosis). Apoptosis is cell death in the ABSENCE of inflammation.