Compiled General Pathology Questions (2009-2010)

Chapter 1

1. Which of the following is not a characteristic of reversible cell injury (Robbins 12)

A. Cell swelling
B. Blebbing of plasma membrane
C. Clumping of nuclear chromatin
D. Detachment of ribosomes from ER
E. Fragmentation of nuclear membrane

2. Which of the following is not a reversible tissue change (Robbins 6)

A. Atrophy
B. Necrosis
C. Metaplasia
D. Hyperplasia
E. Hypertrophy

3. The order of acute cell swelling due to hypoxia is (PBVD 14)

1. Depletion of ATP
2. Deficiency of oxygen
3. Failure of Na+-K+ pump
4. Influx of Na+, CA++, and H2O
5. Decrease in oxidative phosphorylation

A. 1,2,3,4,5
B. 2,1,3,4,5
C. 2,5,1,3,4
D. 2,5,1,4,3
E. 5,4,3,2,1

4. The most likely cellular response to an acute and transient reduction in oxygen supply to tissues is:

a. Atrophy

b. Necrosis

c. Apoptosis

d. Hyperplasia

e. Cellular swelling

5. Which of the following is not expected with cellular necrosis?

a. Karyolysis

b. Cell swelling

c. Adjacent inflammation

d. Nucleosome-size fragments

e. Amorphous mitochondrial densities

6. Place in order the sequence of events leading to cellular hydropic degeneration:

1. Hypoxia

2. Cisternae of ER distend

3. Osmotic water shifts occur

4. Decreased ATP production

5. Sodium enters the cell and Potassium exits

a. 1, 2, 3, 4, 5

b. 1, 3, 2, 4, 5

c. 1, 4, 3, 5, 2

d. 1, 4, 5, 3, 2

e. 5, 4, 3, 2, 1

7. Cardiac glycosides cause myocardial degeneration and necrosis by?

A Inhibition of Na+-K+ pump

B Activation of Na+-K+ pump
C Activation of Ca pump
D Inhibition of Ca pump
E Both A and D

8. Prolonged progesterone induced cystic endometrial hyperplasia is an example of?

 A. Metaplasia
B. Pathologic hyperplasia
C. Pathologic hypertrophy
D. Compensatory hyperplasia
E. Compensatory hypertrophy

9. Which of the following mechanism can lead to cardiac hypertrophy?

1. Stimulation by growth factors

2. Action of mechanical sensor
3. Stimulation by vasoactive agents
4. Switching from adult to neonatal isoforms of proteins
5. Re-expression of embryonic gene like ANF

A. 1,2,3
B. 1,4,5
C. 1,2,4,5
D. 2,3,4,5
E. 1,2,3,4,5

10. Which type of cellular adaptive response is induced by Vitamin A deficiency? (Robbins p. 10)

a. Atrophy

b. Metaplasia

c. Hyperplasia

d. Hypertrophy

e. Both c and d

11. Which cellular adaptations will most likely lead to malignant transformation? (Robbins pgs. 8 & 10)

a. Hypertrophy and Atrophy

b. Hyperplasia and Metaplasia

c. Hypertrophy and Metaplasia

d. Hypertrophy and Hyperplasia

e. All of the above

12. What are two features of reversible cell injury that can be recognized under the light microscope?
(Robbbins p. 12)
 a. Cellular swelling and fatty change

b. Myelin figures and nuclear pyknosis

c. Karyolysis and ribosomal detachment

d. Plasma membrane blebbing and chromatin clumping

e. Adjacent inflammation and amorphous mitochondrial densities

13. On a routine H&E stain, which organelle is responsible for cytoplasmic basophilia? (PBVD p. 8)

a. Rough ER

b. Smooth ER

c. Lysosomes

d. Golgi complex

e. Microtubules

14. Autophagocytosis, lysosomes, and the ubiquitin proteasome pathway likely play a role in which
cellular adaptation? (PBVD p. 38)

a. Atrophy

b. Metaplasia

c. Hyperplasia

d. Hypertrophy

e. Both c and d

15. All of the following cellular components are frequently damaged by injurious stimuli except:

a. mitochondria,

b. cell membranes

c. DNA in nucleus

d. nuclear membrane

e. the machinery of protein synthesis and packaging

16. All of the following are major causes of ATP depletion except:
a. reduced supply of oxygen and nutrients

b. mitochondrial damage

c. actions of some toxins

d. protein synthesis

e. ischemi

17. Depletion of ATP results in:

a. Cell swelling, dilation of endoplasmic reticulum

b. Decreased rate of anaerobic glycolysis

c. Increased protein synthesis

d. none of the above

e. all of the above

18. Which of the following statements is true regarding mechanisms for increased intracellular Ca2+

causing cell injury:

a. The accumulation of Ca2+ in mitochondria results in opening of the mitochondrial

permeability transition pore and failure of ATP generation.

b. Increased cytosolic Ca2+ activates a number of enzymes (phospholipases,

endonucleases, proteases), with potentially deleterious cellular effects.

c. Increased intracellular Ca2+ levels also result in the induction of apoptosis, by direct

activation of caspases and by increasing mitochondrial permeability.

d. A,B, and C

e. none of the above

19. Following biochemical mechanisms may contribute to membrane damage except:

a. Reactive oxygen species

b. Decreased phospholipid synthesis.

c. Increased phospholipid breakdown.

d. Cytoskeletal abnormalities.

e. Dissemination of lipid breakdown products

20. Irreversible cell injury includes ?

a. Nuclear condensation

b. Loss of ribosomes

c. Lysosome rupture

d. Myelin figures

e. All of the above

21. All of the following are involved in cellular hypertrophy except?

a. IGF-1

b. TGF-β

c. Endothelin-1

d. Angiotensin-II

e. Papillomavirus

22. Which of the following is the earliest manifestation in almost all forms of cellular injury (Robbins:
p13)

A. Cell swelling
B. Cell shrinkage
C. Cell fragmentation
D. Mitochondrial swelling
E. Condensation of chromatin

23. The following changes differentiates necrosis from apoptosis (Robbins: p13)

1. Cell swelling
2. Cell shrinkage
3. Nuclear pyknosis
 4. Nuclear fragmentation
5. Disrupted cell membrane

A. 1,2,4
B. 1,2,5
C. 1,3,5
D. 2,3,5
E. 2,4,5

24. Which of the following will not result in the generation of free radicals? (Robbins p.21 )

a. Inflammation
b. Redox reactions
c. Fenton reactions
d. Catalase activation
e. Absorption of radiant energy

25. Which type of necrosis may lead to the accumulation of gitter cells? (PBVD p.23)

a. Fat
b. Gangrene
c. Caseation
d. Coagulative
e. Liquefactive

26. Which of the following microscopic features differentiates necrosis from post-mortem autolysis?
(PBVD p.20)

a. Cellular swelling
b. Nuclear pyknosis
c. Cytoplasmic eosinophilia
d. Associated inflammation
e. Loss of cell to cell adhesion

27. Administration of which pharmaceutical agent(s) would contribute to ischemia/reperfusion injury?

(Review article)

a. Superoxide dismutase
b. NO synthase inhibitor
c. Xanthine oxidase inhibitor
d. Monoclonal antibody to ICAM-1
e. All of the above
28. Consequences of ischemia include all of the following except?

a. Increased cellular pH

b. Failure of the Ca2+ pump

c. Failure of the Na+/K+ pump

d. Depletion of glycogen stores

e. Detachment of ribosomes from the RE

29. Cyclosporine may reduce cell injury during ischaemia by?

a. Decreased production of cytochrome C

b. Stabilizing membrane-bound Na+/K+ pump

c. Stabilizing membrane-bound Ca2+ channels

d. Reduces production of reactive oxygen species

e. Prevents opening of the mitochondrial permeability transition pore

30. Which of the following is an example of a Fenton reaction?

a. O2- → H2O2

b. H2O2 → H2O + O2

c. OH- → H2O2 → H2O +O2

d. H2O2 + Fe2+ → Fe3+ + OH + OH-

e. H2O2 + Cu3+ → Cu2+ + OH + OH-

31. Ischemia causes all of the following cellular effects except?

a. Increased cytoplasmic calcium

b. Increased anaerobic glycolysis

c. Increased cellular glycogen

d. Detachment of ribosomes

e. Chromatin clumping

32. Increased intracellular calcium activates which of the following?

a. ATPase

b. Proteases

c. Phospholipase

d. Endonucleases

e. All of the above

33. Reactive oxygen species can cause all of the following except?

a. Enhances degradation by the multicatalytic proteasome complex.

b. Generation of CCl3 from CCl4

c. Protein-protein cross linkages

d. DNA strand breaks

e. Lipid peroxidation

34. Intracellular calcium is mostly found in which of the following compartments?

a. ER

b. Cytosol

c. Mitochondria

d. Lysosomes

e. A and C

35. Increase cytosolic calcium levels affect mitochondria in which of the following ways?

a. opening of the mitochondrial transition pore

b. Detachment of ribosomes from RER

c. Misfolding of proteins

d. clumping of chromatin

e. production of ROS

36. Reperfusion of ischemic tissue causes cell damage by which of the following mechanisms?

a. Massive influx of intracellular calcium

b. Generation of reactive oxygen species

c. Direct damage from neutrophils

d. Activation of complement

e. all of the above

37. Which of the following are effects of hypoxia inducible factor-1?

1. Suppresses the formation of free radicals

2. Stimulation of cell survival pathways

3. Enhancement of anaerobic glycolysis

4. Inhibits oxidative phosphorylation

5. New blood vessel formation

a. 1,2,3

b. 1,4,5

c. 2,3,4

d. 2,3,5

e. 3,4,5

38. Rigor mortis may not occur in which of the following cases (PBVD 26)

A. High temperatures
B. ATP depleted animals
C. Within 10 minutes of death
D. A & B
E. All of the above

39. Which of the following is not a major cause of ATP depletion (Robbin 18)

A. Reduced oxygen supply

B. Reduced nutrient supply
C. Mitochondrial damage
D. Some toxic action
E. None of the above

40. The suggested hypothesis of ischemia/reprofusion injury is an imbalance of which of the following
(J Pathol 2000;190:255-266)

1. ICAM-1
2. Endothelin
3. Superoxide
4. Nitric oxide
5. Prostacyclin

A. 1,2
B. 2,3
C. 2,4
D. 3,4
E. 3,5

41. Direct consequences of increased intracellular calcium include (Robbins P. 19)

1. Activation of cellular phospholipases, proteases and endonucleases

2. Depletion of ATP production due to mitochondrial damage
3. Activates caspases and induces apoptosis
4. Increases free radical production
5. Increases anaerobic glycolysis

A. 1,2,3
B. 1,2,3,4
C. 1,3,4,5
D. 4,5
E. 1,2,3,4,5

42. Which if the following is true regards ischemic reperfusion injury to the endothelium of the blood
vessels (Review article)

A. Impaired nitric oxide function in the arterioles

B. Increased inflammatory response in the venules

C. Increased filtration into interstitium and reduced capillary reperfusion

D. Decreased nitric oxide production leads to increased superoxide production

E. All the above

43. Which of the following is the most reactive O2 derived free radical?

A. Hydroxyl ion
B. Superoxide anion
C. Hydrogen peroxide
D. Peroxynitrate anion
E. Hydrogen free radicle

44. Formation of superoxide anion by oxidative enzymes can take place in all of the following cellular
organelles except?

A. ER
B. Nucleus
C. Peroxisome
D. Mitochondria
E. Plasma membrane

45. Inactivation of free radical H2O2 to H2O and O2 can be done by which of the following enzyme
system?

A. Glutathione peroxidase
B. Superoxide dismutase
C. Catalase
D. All of the above
E. A and C only

46. Hypothermia can reduce the deleterious effect of ischemia by all of the following mechanism except?

A. Reducing metabolic demands of stressed cells

B. Decreasing free radical formation
C. Enhancing anaerobic glycolysis
D. Decreasing cell swelling
E. Reducing inflammation