BRS Pathology ALL QUESTIONS WITH
CORRECT ANSWERS
The answer is D. The illustration shows marked hypertrophy of the left ventricle.
Hypertrophy of this extent, often seen in hypertensive heart disease, is caused by
increased workload from increased ventricular pressure. This organ enlargement is the
result of an increase in size of the individual muscle cells. - Answer-The illustration
shows a section of the heart from a 45-year-old African-American man with long-
standing hypertension who died of a "stroke." Which of the following adaptive changes
is exemplified in the illustration?
(A) Aplasia
(B) Atrophy
(C) Hyperplasia
(D) Hypertrophy
(E) Hypoplasia
The answer is A. The patient has renal agenesis, absence of the kidney due to failure of
organ development. The congenital lack of one kidney differs from atrophy, in which a
decrease in the size of an organ results from a decrease in the mass of preexisting
cells. Unilateral renal agenesis is usually a harmless malformation, and the opposite
kidney is often enlarged due to compensatory hypertrophy. Bilateral renal agenesis is
incompatible with life and is of special interest since it can lead to the Potter progression
(see Chapter 17). - Answer-A 16-year-old girl undergoes radiologic imaging of her
abdomen and is found to have only one kidney. She had been entirely unaware of this
problem. Which of the following terms is most descriptive of this finding?
(A) Agenesis
(B) Atrophy
(C) Hyperplasia
(D) Hypoplasia
(E) Metaplasia
The answer is E. The sequence of events in hypoxic cell damage is as follows: Hypoxia
results in failure of oxidative phosphorylation, with resultant depletion of ATP and
increase in adenosine monophosphate and adenosine diphosphate. Anaerobic
glycolysis and glycogenolysis are stimulated (notinhibited) through increased
phosphofructokinase and phosphorylase activities, respectively. This results in an
accumulation of cell lactate, with a decrease in intracellular pH and depletion of cellular
glycogen stores. Decreased availability of ATP also results in failure of the Na+K+-
ATPase pump, which then leads to increased cell Na+ and water and decreased cell
K+. - Answer-An impending myocardial infarction was successfully averted by
thrombolytic (clot-dissolving) therapy in a 55-year-old man. Which of the following
biochemical events most likely occurred during the period of hypoxia?
(A) Decreased hydrogen ion concentration
,(B) Increase in oxidative phosphorylation
(C) Loss of intracellular Na+ and water
(D) Stimulation of ATP synthesis
(E) Stimulation of anaerobic glycolysis and glycogenolysis
The answer is C. Pancreatic enzymatic fat necrosis represents autodigestion by
proteolytic and lipolytic enzymes released from damaged parenchymal cells of the
pancreas. Fatty acids liberated by the digestion of fat form calcium soaps, a process
referred to as saponification. The precipitated calcium in the soaps can be visualized by
radiologic imaging. - Answer-A 45-year-old man with a long history of alcoholism
presents with severe epigastric pain, nausea, vomiting, fever, and an increase in serum
amylase. During a previous hospitalization for a similar episode, computed tomography
scanning demonstrated calcifications in the pancreas. A diagnosis of acute pancreatitis
superimposed on chronic pancreatitis was made. In this condition, which of the following
types of necrosis is most characteristic?
(A) Caseous
(B) Coagulative
(C) Enzymatic
(D) Fibrinoid
(E) Liquefactive
The answer is A. Caseous necrosis occurs as part of granulomatous inflammation,
typified by the lesions of tuberculosis. - Answer-A 29-year-old man hospitalized for
acquired immunodeficiency syndrome (AIDS) is found to have pulmonary tuberculosis.
Which type of necrosis is found in the granulomatous lesions (clusters of modified
macrophages) characteristic of this increasingly frequent complication of AIDS?
(A) Caseous
(B) Coagulative
(C) Enzymatic
(D) Fibrinoid
(E) Liquefactive
The answer is B. The decreased size is due to restriction of the blood supply, one of the
causes of atrophy. The increase in size of the opposite kidney is referred to as
compensatory hypertrophy. Unilateral renal artery stenosis is a well-known cause of
secondary hypertension. In this setting, increased renin excretion and stimulation of the
renin-angiotensin system results in a form of hypertension that is potentially curable by
surgical correction of the underlying vascular abnormality. - Answer-A 45-year-old
woman is investigated for hypertension and is found to have enlargement of the left
kidney. The right kidney is smaller than normal. Contrast studies reveal stenosis of the
right renal artery. The size change in the right kidney is an example of which of the
following adaptive changes?
(A) Aplasia
(B) Atrophy
(C) Hyperplasia
(D) Hypertrophy
,(E) Metaplasia
The answer is D. If infarction is averted by immediate thrombolytic therapy, indicators of
necrosis, such as karyorrhexis, pyknosis, and karyolysis, which represent irreversible
changes, would not be expected. Swelling of the endoplasmic reticulum from increased
cell water, one of the earliest ultrastructural changes observed in injured cells, is
reversible and would be expected. - Answer-A 56-year-old man recovered from a
myocardial infarction after his myocardium was entirely "saved" by immediate
thrombolytic therapy. If it had been possible to examine microscopic sections of his
heart during his ischemic episode, which of the following would be the most likely
cellular change to be found?
(A) Karyolysis
(B) Karyorrhexis
(C) Pyknosis
(D) Swelling of the endoplasmic reticulum
The answer is E. Liquefactive necrosis is characteristic of ischemic injury in the CNS
and suppurative infections that cause abscess formation (see Chapter 2). The changes
in the cerebrospinal spinal fluid characteristic of bacterial meningitis are detailed in
Chapter 3. - Answer-A 64-year-old woman presents with fever, chills, headache, neck
stiffness, vomiting, and confusion. The Kernig sign (passive knee extension eliciting
neck pain) and Brudzinski sign (passive neck flexion eliciting bilateral hip flexion) are
both positive. Examination of the cerebrospinal fluid reveals changes consistent with
bacterial meningitis, and brain imaging demonstrates a localized abscess. Which of the
following types of necrosis is most characteristic of abscess formation?
(A) Caseous
(B) Coagulative
(C) Enzymatic
(D) Fibrinoid
(E) Liquefactive
The answer is A. Yellowing of the sclerae, skin, and oral mucosa are all characteristic of
jaundice, the accumulation of bilirubin, the catabolic product of the heme moiety of
hemoglobin. Jaundice can occur by diverse mechanisms: hemolytic (see Chapter 11),
hepatocellular (see Chapter 16), or obstructive (see Chapter 16). - Answer-A 20-year-
old man presents with yellowing of the sclerae, skin, and oral mucosa. Which of the
following accumulations underlies these findings?
(A) Bilirubin
(B) Hemosiderin
(C) Lead
(D) Melanin
(E) Silver
The answer is B. The figure illustrates general preservation of myocardial architecture
with some fragmentation, more intense cytoplasmic staining corresponding to increased
cellular eosinophilia, and loss of nuclei, all of which are characteristics of coagulative
, necrosis. - Answer-This figure illustrates the microscopic appearance of the heart of a
56-year-old man who died after a 24-hour hospitalization for severe "crushing" chest
pain complicated by hypotension and pulmonary edema. The type of necrosis shown is
best described as
(A) caseous.
(B) coagulative.
(C) fibrinoid.
(D) gangrenous.
(E) liquefactive.
The answer is A. The figure illustrates fatty change of the liver, which is characterized
by the accumulation of intracellular parenchymal triglycerides. It is seen most frequently
in the liver, heart, and kidney and is commonly secondary to alcoholism. Fatty change
results from an imbalance between the uptake, utilization, and mobilization of fat from
liver cells. Alcoholic fatty liver may be reversible with complete abstinence from alcohol.
- Answer-The illustration is from a liver biopsy of a 34-year-old woman with a long
history of alcoholism. Which of the following is the best explanation for the changes
shown here?
(A) Accumulation of triglycerides within hepatocytes
(B) Apoptosis with replacement of damaged cells by lipid-laden macrophages
(C) Bilirubin accumulation with mobilization of fat by bile salts
(D) Enzymatic fat necrosis with digestion of liver parenchyma by released enzymes
(E) Irreversible damage to mitochondria
The answer is B. In advanced form, primary (hereditary) hemochromatosis is
characterized by the triad of cirrhosis, diabetes, and hyperpigmentation, or so-called
bronze diabetes. The disease is most often caused by a mutation in the Hfegene on
chromosome 6 and is characteristically familial rather than sporadic. The manifestations
of the disorder are the result of iron overload and deposition of hemosiderin in tissues
such as the liver, pancreas, skin, joints, and pituitary. Laboratory abnormalities of note
include increased serum iron and decreased TIBC. The skin hyperpigmentation is due
largely to increases in melanin and to lesser accumulations of hemosiderin. - Answer-A
45-year-old man is referred because of a recent diagnosis of hereditary
hemochromatosis. Which of the following is a correct statement about this disorder?
(A) Damage to organs results from abnormal deposition of lead
(B) It can progress to liver cirrhosis, diabetes mellitus, and skin pigmentation
(C) Most cases are due to spontaneous mutations
(D) Skin hyperpigmentation is due to bilirubin accumulation
(E) The TIBC is characteristically increased
The answer is D. Metastatic calcification, or deposition of calcium in previously normal
tissue, is caused by hypercalcemia. In this patient, tumor metastases to the bone with
increased osteolytic activity caused mobilization of calcium and phosphate, resulting in
hypercalcemia. Metastatic calcification should be contrasted with dystrophic
calcification, in which the serum calcium concentration is normal and previously
damaged tissues are the sites of deposition. - Answer-A 60-year-old woman with breast
