NBME PATHOLOGY EXAM NEWEST 2024 WITH COMPLETE
QUESTIONS AND CORRECT VERIFIED ANSWERS (DETAILED
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Apoptosis: - ANSWER-Programmed cell death. REQUIRES ATP. Can occur via the
intrinsic or extrinsic pathways, both of which involve activation of cytosolic
caspases which mediate cellular breakdown. ***Unlike necrosis, apoptosis
does not involve significant inflammation. Involves eosinophilic cytoplasm, cell
shrinkage, pyknosis and basophilia, membrane blebbing and karyorrhexis, and
formation of apoptotic bodies which are phagocytosed. **DNA laddering is a
sensitive indicator of apoptosis** Occurs because during karyorrhexis
endonucleases yield 180bp fragments.
Radiation therapy does what? - ANSWER-Causes apoptosis of cancer cells
because it causes formation of free radicals which lead to dsDNA breakage.
rapidly dividing cells like skin and GI mucosa are highly susceptible to radiation-
induced apoptosis.
Intrinsic pathway of apoptosis: what is its general purpose / when does it
occur? - ANSWER-It's involved in tissue remodeling in embryogenesis. Often
occurs when a regulating factor is withdrawn from a proliferating cell
population. For example, low IL-2 after completion of an immunological
reaction causes apoptosis of proliferating effector cells. Also occurs in response
to injury from radiation, toxins, hypoxia,etc. Changes in proportions of pro- and
anti-apoptotic factors leads to an increase in mitochondrial permeability and
cyt c release.
,BAK, BAX, Bcl-2: Which of these are pro- and which are anti-apoptotic? -
ANSWER-BAX and BAK are pro. Bcl-2 is anti-apoptotic.
How does Bcl-2 function? - ANSWER-It prevents cyt c release by binding to an
inhibiting Apaf-1, which normally INDUCES caspases.
What happens if Bcl-2 is overexpressed? - ANSWER-This occurs in follicular
lymphoma. Apaf-1 is over-inhibited which leads to tumorigenesis because of
lowered caspase activation.
Extrinsic pathway of apoptosis: 2 basic pathways? - ANSWER-1. Ligand receptor
interactions. FasL binding to Fas (CD95). 2. Immune cell-->cytotoxic T-cell
release of perforin and granzyme B.
Where is Fas-FasL interaction required? - ANSWER-In thymic medullary
negative selection. Mutations in Fas increases the numbers of circulating self-
reactive lymphocytes due to failure of clonal deletion. **Defective fas-fasL
interactions is the basis of autoimmune disorders**
How does Fas initiate cell death? - ANSWER-After it crosslinks with FasL,
multiple Fas molecules coalesce. This makes a binding site for a death domain.
Necrosis: - ANSWER-Exogenous injury causes enzymatic degradation and
protein denaturation of a cell. IC components extravasate. **There's an
inflammatory process unlike apoptosis**
Coagulative necrosis occurs in the: - ANSWER-Caused by ischemia or infarction
typically. heart, liver, kidney. Occurs in tissues supplied by end arteries. High
cytoplasmic binding of acidophilic dye. Proteins denature first followed by
enzymatic degradation.
, Liquefactive necrosis occurs in the: - ANSWER-brain, bacterial abscess and
pleural effusion. Occurs in CNS because of high fat content there. Unlike coag
necrosis, enzymatic degradation due to release of lysosomal enzymes occurs
first.
Caseous necrosis: - ANSWER-TB, systemic fungi, Nocardia. Tissue maintains a
cheese-like appearance. Tissue is a proteinaceous dead cell mass.
Fatty necrosis: - ANSWER-Enzymatic--Pancreas. Saponification. Released fatty
acids interact with calcium to form soaps. Calc deposits appear dark on
staining. Nonenzymatic--breast trauma.
Gangrenous necrosis: - ANSWER-Dry (ischemic coagulative) and wet (infection).
Common in limbs and GI tract.
Reversible cell injury with O2: - ANSWER-low ATP synthesis, cellular swelling
because with no ATP there's impaired Na/K pump. Nuclear chromatin
clumping. Low glycogen. Fatty change. Ribosomal detachment (low protein
synthesis).
Areas of the brain susceptible to ischemia: - ANSWER-ACA / MCA / PCA
boundary areas. The watershed areas, or border zones, receive dual blood
supply from most distal branches of two arteries. However, systemic
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