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Question 1

Question 1
A 43-year-old man has complained of mild burning epigastric pain following meals for the past 3 years. Upper GI endoscopy is performed, and biopsies are taken of an erythematous area of the lower oesophageal mucous 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no haemorrhage note. The biopsies demonstrate the presence of columnar epithelium with goblet cells. Which alteration is most likely represented by these findings?

Answer 1

Metaplasia

Question 2

A 59-year-old woman experienced loss of consciousness that persisted for over an hour. Subsequently, she could not speak, and she could not move her right arm or leg. A cerebral angiogram revealed an occlusion to her left middle cerebral artery. Months later, a computed tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding most likely demonstrates a lesion that is the consequence of resolution form which of the following events?

Answer 2

Liquefactive necrosis

Question 3

A 26-year-old female presented with ‘feeling something hard’ in her left cheek for several years. History was unremarkable except for having trauma to her face when about 5 years old. Physical examination revealed nothing unusual except for several small (<1cm) moveable nodules that could be palpated in her cheek. A CT scan of this area revealed radiopaque masses in the muscle tissue. Laboratory findings showed her serum calcium was 9.4mg/dl and serum phosphorus was 3.9mg/dL. Which pattern of cellular or tissue alteration is likely to be responsible for this?

Answer 3

Dystrophic calcification

Question 4

A 26-year-old female of African- American ethnicity complains of a swelling on her right ear lobe. The patient had ear piercings at age 3 and again at age 23. The swelling arose after the second piercing and has continued to grow. The swelling was firm, non-tender, dumbbell-shaped, measuring 3cm in diameter. Histopathology (Movat stain) findings showed thick, eosinophilic, hyalinised collagen bundles. IHC was positive for aSMA and negative for desmin. Which pattern of cellular or tissue alteration is likely to be responsible for this?

Answer 4

Keloids

Question 5

A 52-year-old female visiting Sudan, is admitted with abdominal pain. Physical examination revealed massive hepatosplenomegaly and portal hypertension. FBC indicated a pancytopenia and there was elevation of liver ALT and AS. An ultrasound fibroscan result of 10kPa was found. Viral screening was negative. Kato-Katz examination of a stool sample was positive. Which pattern of cellular or tissue alteration is likely to be responsible for this?

Answer 5

Fibrosis

Question 6

A 53-year-old African man who emigrated from Mali 25 years ago complained of skin nodules in the periumbilical area which were present ‘intermittently’ for the past 5 years. Physical examination was positive for two 0.5cm diameter subcutaneous nodule. FBC indicated an eosinophilia and serology for anti-strongyloidiasis IgG was positive. The patient responded to treatment with ivermectin. Which pattern of cellular or tissue alteration is likely to be responsible for this?

Answer 6

Chronic inflammation