Medicine Exam Answer Key

1- A pathologist notes the following findings after light microscopic examination of a section of liver from a chronic alcoholic. Which of the following is an example of a reversible injury? a- Pyknosis b- Cytoplasmic vacuoles c- Rupture of cell membrane d- Karyolysis e- Karyorrhexis 2- You are asked to review an electron micrograph of a section of liver from a chronic alcoholic Which of the following is an example of an irreversible injury? a- Cellular edema b- Chromatin clumping c- Cytoplasmic inclusions d- Mitochondrial swelling e- Rupture of cell membrane 3- A patient is admitted with severe substernal chest pain of 4 hours duration. Lab tests reveal increased level of the serum creatine kinase. This is most likely due to: a- Mitochondrial swelling b- Nuclear lysis c- Plasma membrane damage d- Increased ER e- Increased Golgi activity 4- You are asked to review a liver biopsy from a patient with history of alcohol abuse. Which of the following pathologic changes will most likely lead to death of hepatocytes and liver cirrhosis? a- Fatty change in liver cells b- Hydropic change of hepatocyte c- Karryolysis in myocardial cells d- Glycogen deposit in hepatocyte cells 5- A pathologist notes that a biopsy from the lung of living patients shows the morphologic changes indicative of irreversible injury and cell death. Which of the following is most likely responsible for cell death in a living body? a-cytolysis b- necrosis c-autolysis e- Somatic death 6- You are asked to participate in a research project on myocardial infarctions in a rat model. Which of the following occurs in ischemic cell injury? a- Influx of Na+ and Ca ++ b- Influx of K+ and Na+ c- Influx of K+ and Ca++ 7- Cell death causes by autolysis is produced by a- Antibodies b- Endogenous enzymes c- Phagocytic leukocytes d- Bacterial enzymes e- Anoxia 8- A 10-year-old black man with a known history of sickle cell disease presents to the emergency department complaining of left upper quadrant pain suggestive of a splenic infarct. Microscopic examination of the spleen would most likely reveal a- Causes necrosis b- Coagulative necrosis c- Fibrinoid necrosis d- Gangrenous necrosis e- Liquefactive necrosis 9- A pathologist notes cloudy swelling, hydropic change and fatty change in the liver of a patient with a history of alcohol abuse. These morphological changes are all examples of a- Early cancer b- Hyaline change c- Patterns of cell death d- Reversible cell injury 10Which of the following is an example of an agent capable of producing a toxic metabolite and indirect chemical injury? a- Alcohol b- Aspirin c- CO d- Mercury poisoning e- Cyanide 11A circumscribed mass of light yellow crumbly to pasty material associated microscopically with a macrophage response is characteristic of a- Caseous necrosis b- Coagulative necrosis c- Fibrinoid necrosis d- Gangrenous necrosis 12A well-demarcated lesion with increased cytoplasmic eosinophilia, karyolysis, and intact tissue architecture is characteristic of a- Caseous necrosis b- Enzymatic fat necrosis c- Coagulative necrosis d- Cloudy swelling e- Liquefactive necrosis 13The pattern of cell death that is characterized by conversion of a single cell to an acidophilic body, usually with loss of the nucleus but with preservation of its shape to permit recognition of cell boundaries is termed a- Apoptosis b- Caseous necrosis c- Fibrinoid necrosis d- Liquefactive necrosis 14A 65 year old man presents with angina and dyspnea. He has a family history of hypercholesterolemia. Unfortunately, despite thrombolytic therapy he dies. What would you expect to see on light microscopic examination of cardiac tissue? a- Caseous necrosis b- Enzymatic fat necrosis c- Liquefactive necrosis d- Coagulative necrosis 15Laparoscopic examination of the abdomen was performed on a 50 year old chronic alcoholic man. The surgeon noted digestion of tissue with soap formation and calcification. Which of the following is this most likely characteristic of? a- Caseous necrosis b- Enzymatic fat necrosis c- Liquefactive necrosis d- Coagulative necrosis 16The action of putrefactive bacteria on necrotic tissue results in a- Coagulation b- Infarction c- Gangrene d- Embolism e- Caseation 17A well-demarcated area of myocardium appears paler than surrounding tissue and microscopically consists of eosinophilic muscle fibers with only a few karyorrhectic and pyknotic nuclei remaining. Many polys are seen, especially at the margin of this area. The age of the myocardial infarct is most likely a- 2 min b- 2h c- 2d d- 2 weeks e- 2 months 18You are asked to write a microscopic description of the coagulative necrosis that was noted in the heart of a patient who died of a heart attack because of cocaine abuse. Which of the following best described coagulative necrosis? a- Eosinophilic cytoplasm with cell outlines preserved b- Granular, friable mass of material devoid of cell outlines c- Localized, solid, basophilic lesion with calcification d- Necrosis in with tissue is converted into a fluid 19Caseous necrosis is characterized morphologically by a- Preservation of tissue outlines b- Basophilia c- Semi liquid d- Wedge-shaped periphery e- Amorphous appearance 20Which tissue is the most susceptible to liquefactive necrosis following ischemic injury? a- Pancreas b- Liver c- Spleen d- Brain e- GI 21A patient suffers a stroke and has left sided weakness and paralysis in the upper extremity. The type of necrosis associated with a well-developed infarct of the brain is a- Coagulative b- Enzymatic fat c- Liquefactive d- Gangrenous 2275-year-old woman has a complaint of shortness of breath and chest pain that radiates to the left shoulder. Serum levels of CK-MB (myocardial creatine kinase) and cardiac muscle troponin I (cTnI) are elevated. Which of the following types of myocardial cell death would best account for these findings? a- Apoptosis b- Coagulative c- Fat necrosis d- Liquefactive e- Caseous necrosis 23Coagulative necrosis usually results from a- Ischemia b- Trauma c- TB d- Syphilis 1 b 2 e 11 a c 12 c 21 c 3 c 13 a 22 b 4 c 14 d 23 a 5 6 a 15 b 7 b 16 c 8 b 17 c 9 d 18 a 10 a 19 e 20 d