CELLULAR INJURY AND ADAPTATION MCQs – 43 MCQs

43 Year 3: Gastrointestinal Pathology exam questions on CELLULAR INJURY AND ADAPTATION MCQs for medical students. Includes MCQs, answers, explanations and writt

This MCQ set contains 43 questions on CELLULAR INJURY AND ADAPTATION MCQs in the Year 3: Gastrointestinal Pathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: QUESTION 1 A 17-year-old boy infected with hepatitis A experiences mild nausea for about 1 week and develops very mild scleral icterus. On physical examination, he has minimal right upper quadrant tenderness. Laboratory findings include a serum AST of 68 U/L, ALT of 75 U/L, and total bilirubin of 5.

A. Autophagy by lysosomes
B. Clumping of nuclear chromatin
C. Defects in the cell membrane
D. Dispersion of ribosomes
E. Swelling of the mitochondria ANSWER: C

Correct answer: C – Defects in the cell membrane

Irreversible cell injury is associated with loss of membrane integrity. This allows intracellular enzymes to leak into the serum. All other morphologic changes listed are associated with reversible cell injury, in which the cell membrane remains intact.

Q2: A 16-year-old boy sustained blunt trauma to the abdomen when the vehicle he was driving struck a bridge abutment at high speed. Peritoneal lavage shows a hemoperitoneum, and at laparotomy, a small portion of the left lobe of the liver is removed because of the injury. Several weeks later, a CT scan

A. Apoptosis
B. Dysplasia
C. Fatty change
D. Hydropic change
E. HyperplasiaF. HypertrophyG. Metaplasia ANSWER: E

Correct answer: E – HyperplasiaF. HypertrophyG. Metaplasia ANSWER: E

The liver is one of the few organs in the human body that can partially regenerate. This is a form of compensatory hyperplasia. The stimuli to hepatocyte mitotic activity cease when the liver has attained its normal size.

Q3: QUESTION 3 On a routine visit to the physician, an otherwise healthy 51-year-old man has a blood pressure of 150/95 mm Hg. If his hypertension remains untreated for years, which of the following cellular alterations would most likely be seen in his myocardium?

A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Hemosiderosis
E. Hypertrophy ANSWER: E
F.

Correct answer: E – Hypertrophy ANSWER: E

The pressure load on the left ventricle results in an increase in myofilaments in the existing myofibers. The result of continued stress from hypertension is eventual heart failure with decreased contractility, but the cells do not decrease in size.

Q4: QUESTION 4 A 72-year-old man died suddenly from congestive heart failure. At autopsy, the heart weighed 580 g and showed marked left ventricular hypertrophy and minimal coronary arterial atherosclerosis. A serum chemistry panel ordered before death showed no abnormalities. Which of the following pat

A. Amyloidosis
B. Dystrophic calcification
C. Lipofuscin deposition
D. Hemosiderosis
E. Fatty change ANSWER: B

Correct answer: B – Dystrophic calcification

The valve is stenotic because of nodular deposits of calcium. The process is "dystrophic" because calcium deposition occurs in damaged tissues. The damage in this patient is a result of the wear and tear of aging.

Q5: QUESTION 5 A 69-year-old woman has had transient ischemic attacks for the past 3 months. On physical examination, she has an audible bruit on auscultation of the neck. A right carotid endarterectomy is performed. The curetted atheromatous plaque has a grossly yellow-tan, firm appearance. Microscopic

A. Glycogen
B. Lipofuscin
C. Hemosiderin
D. Immunoglobulin
E. Cholesterol ANSWER: E
F.

Correct answer: E – Cholesterol ANSWER: E

Cholesterol is a form of lipid commonly deposited within atheromas in arterial walls, imparting a yellow color to these plaques. Glycogen is a storage form of carbohydrate seen mainly in liver and muscle.

Q6: QUESTION 6 A 38-year-old woman experienced severe abdominal pain with hypotension and shock that led to her death within 36 hours after the onset of the pain. The mesentery shows focal, chalky white deposits. Which of the following events has most likely occurred?

A. Hepatitis B virus infection
B. Small intestinal infarction
C. Tuberculous lymphadenitis
D. Gangrenous cholecystitis
E. Acute pancreatitis ANSWER: E

Correct answer: E – Acute pancreatitis ANSWER: E

The focal, chalky white deposits are areas of fat necrosis resulting from the release of pancreatic lipases in a patient with acute pancreatitis.

Q7: QUESTION 7 In an experiment, cells are subjected to radiant energy in the form of x-rays. This results in cell injury caused by hydrolysis of water. Which of the following cellular enzymes protects the cells from this type of injury?

A. Phospholipase
B. Glutathione peroxidase
C. Endonuclease
D. Lactate dehydrogenase
E. Protease ANSWER: B
F.

Correct answer: B – Glutathione peroxidase

Intracellular mechanisms exist that deal with free radical generation, as can occur with radiant injury from irradiation. Glutathione peroxidase reduces such injury by catalyzing the breakdown of hydrogen peroxide.

Q8: QUESTION 8 A 47-year-old woman has had worsening dyspnea for the past 5 years. A chest CT scan shows panlobular emphysema. Laboratory studies show the PiZZ genotype of α1-antitrypsin (AAT) deficiency. A liver biopsy specimen examined microscopically shows abundant PAS-positive globules within peripo

A. Excessive hepatic synthesis of AAT
B. Retention of poorly folded AAT in the endoplasmic reticulum
C. Decreased catabolism of AAT in lysosomes
D. Inability to metabolize AAT
E. Impaired dissociation of AAT from chaperones ANSWER: B
F.

Correct answer: B – Retention of poorly folded AAT in the endoplasmic reticulum

Mutations in the AAT gene give rise to AAT molecules that cannot fold properly. In the PiZZ genotype, both alleles have the mutation. The partially folded molecules accumulate in the endoplasmic reticulum and cannot be secreted.

Q9: A 68-year-old woman suddenly lost consciousness; on awakening 1 hour later, she could not speak or move her right arm and leg. Two months later, a head CT scan showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in the brain?

A. Fat necrosis
B. Coagulative necrosis
C. Apoptosis
D. Liquefactive necrosis
E. Karyolysis ANSWER: D

Correct answer: D – Liquefactive necrosis

The high lipid content of central nervous system tissues results in liquefactive necrosis as a consequence of ischemic injury, as in this case of a "stroke."

Q10: QUESTION 10 A 30-year-old man sustains a left femoral fracture in a skiing accident, and his leg is placed in a plaster cast. After the leg has been immobilized for several weeks, the diameter of the left calf has decreased. This change is most likely to result from which of the following alteration

A. Aplasia
B. Hypoplasia
C. Atrophy
D. Dystrophy
E. Hyalinosis ANSWER: C

Correct answer: C – Atrophy

Reduced workload causes shrinkage of cell size because of loss of cell substance, a process called atrophy. Aplasia refers to lack of embryonic development; hypoplasia describes poor or subnormal development.

Q11: QUESTION 11 An experiment analyzes cells for enzyme activity associated with sustained cellular proliferation. Which of the following cells is most likely to have the highest telomerase activity?

A. Endothelial cells
B. Germ cells
C. Neurons
D. Neutrophils
E. Erythrocytes ANSWER: B
F.

Correct answer: B – Germ cells

Germ cells have the highest telomerase activity, and the telomere length can be stabilized in these cells. This allows testicular germ cells to retain the ability to divide throughout life.

Q12: QUESTION 12 A 32-year-old man experiences "heartburn" and gastric reflux after eating a large meal. After many months of symptoms, he undergoes upper gastrointestinal endoscopy, and a biopsy specimen shows replacement of normal esophageal epithelium with intestinal-type columnar epithelium with gobl

A. Squamous metaplasia
B. Mucosal hypertrophy
C. Columnar epithelial metaplasia
D. Atrophy of lamina propria
E. Goblet cell hyperplasia ANSWER: C
F.

Correct answer: C – Columnar epithelial metaplasia

Inflammation from reflux of gastric acid has resulted in replacement of normal esophageal squamous epithelium by intestinal-type columnar epithelium with goblet cells. Such conversion of one adult cell type to another cell type is called metaplasia.

Q13: QUESTION 13 On day 28 of her menstrual cycle, a 23-year-old woman experiences onset of menstrual bleeding that lasts for 6 days. She has had regular cycles for many years. Which of the following processes is most likely occurring in the endometrium just before the onset of bleeding?

A. Apoptosis
B. Caseous necrosis
C. Heterophagocytosis
D. Atrophy
E. Liquefactive necrosis ANSWER: A

Correct answer: A – Apoptosis

The onset of menstruation is an example of orderly, programmed cell death (apoptosis) through hormonal stimuli. The endometrium breaks down, sloughs off, and then regenerates.

Q14: QUESTION 14 In a clinical trial, a chemotherapeutic agent is given to patients with breast cancer metastases. Samples of the cancer cells are obtained and assessed for the presence of death of tumor cells by apoptosis. Mutational inactivation of which of the following products is most likely to rend

A. BCL-2
B. p53
C. NF-κB
D. Cytochrome P-450
E. Granzyme B ANSWER: B
F.

Correct answer: B – p53

When DNA damage is induced by chemotherapeutic drugs (or other agents), normal p53 genes trigger the cells to undergo apoptosis. When p53 is inactivated, this pathway of cell death can be blocked, rendering the chemotherapy less effective.

Q15: After the birth of her first child, a 19-year-old woman breastfed the infant for about 1 year. Which of the following processes that occurred in the breast during pregnancy allowed her to breastfeed the infant?

A. Stromal hypertrophy
B. Lobular hyperplasia
C. Epithelial dysplasia
D. Intracellular accumulation of fat
E. Ductal epithelial metaplasia ANSWER: B

Correct answer: B – Lobular hyperplasia

Lobules increase under hormonal influence (mainly progesterone) to provide for normal lactation. The breast stroma plays no role in lactation and may increase with pathologic processes.

Q16: QUESTION 16 A 22-year-old woman has a congenital anemia that has required multiple transfusions of RBCs for many years. On physical examination, she now has no significant findings; however, liver function tests show reduced serum albumin. Which of the following findings would most likely appear in

A. Steatosis in hepatocytes
B. Bilirubin in canaliculi
C. Glycogen in hepatocytes
D. Amyloid in portal triads
E. Hemosiderin in hepatocytes ANSWER: E

Correct answer: E – Hemosiderin in hepatocytes ANSWER: E

Each unit of blood contains about 250 mg of iron. The body has no mechanism for getting rid of excess iron. Over time, hemosiderosis involves more and more tissues of the body, particularly the liver.

Q17: QUESTION 17 A 50-year-old man experienced an episode of chest pain 6 hours before his death. A histologic section of left ventricular myocardium taken at autopsy showed a deeply eosinophilic-staining area with loss of nuclei and cross-striations in myocardial fibers. There was no hemorrhage or infla

A. Viral infection
B. Coronary artery thrombosis
C. Blunt chest trauma
D. Antibodies directed against myocardium
E. Protein-deficient diet ANSWER: B

Correct answer: B – Coronary artery thrombosis

The deep eosinophilic staining, loss of nuclei, and loss of cell structure suggest an early ischemic injury, resulting in coagulative necrosis. This finding is typically caused by loss of blood flow.

Q18: A 69-year-old man has had difficulty with urination, including hesitancy and frequency, for the past 5 years. A digital rectal examination reveals that the prostate gland is palpably enlarged to about twice normal size. A transurethral resection of the prostate is performed, and the microscopic appe

A. Apoptosis
B. Dysplasia
C. Fatty change
D. Hyperplasia
E. HypertrophyF. Metaplasia ANSWER: D

Correct answer: D – Hyperplasia

Nodular prostatic hyperplasia (also known as benign prostatic hyperplasia [BPH]) is a common condition in older men that results from proliferation of prostatic glands and stroma. This is an example of pathologic hyperplasia.

Q19: A 54-year-old man experienced onset of severe substernal chest pain over 3 hours. An ECG showed changes consistent with an acute myocardial infarction. After thrombolytic therapy with tissue plasminogen activator (t-PA), his serum creatine kinase (CK) level increased. Which of the following events m

A. Reperfusion injury
B. Cellular regeneration
C. Chemical injury
D. Increased synthesis of CK
E. Myofiber atrophy ANSWER: A

Correct answer: A – Reperfusion injury

If the existing cell damage is not great after myocardial infarction, the restoration of blood flow can help prevent further damage. The reperfusion of damaged cells results in generation of oxygen-derived free radicals, however, causing a reperfusion injury.

Q20: QUESTION 20 A 33-year-old woman has had increasing lethargy and decreased urine output for the past week. Laboratory studies show serum creatinine level of 4.3 mg/dL and urea nitrogen level of 40 mg/dL. A renal biopsy is performed, and the specimen is examined using electron microscopy. Which of the

A. Mitochondrial swelling
B. Plasma membrane blebs
C. Chromatin clumping
D. Nuclear fragmentation
E. Ribosomal disaggregation ANSWER: D

Correct answer: D – Nuclear fragmentation

Loss of the nucleus results in cell death. All other cellular morphologic changes listed represent reversible cellular injury. The plasma membrane and intracellular organelles remain functional unless severe damage causes loss of membrane integrity.

Q21: QUESTION 21 A 40-year-old man had undifferentiated carcinoma of the lung. Despite chemotherapy, the man died of widespread metastases. At autopsy, tumors were found in many organs. Histologic examination showed many foci in which individual tumor cells appeared shrunken and deeply eosinophilic. Thei

A. Lipofuscin
B. Cytochrome c
C. Catalase
D. Phospholipase
E. BCL-2 ANSWER: B

Correct answer: B – Cytochrome c

This histologic picture is typical of apoptosis produced by chemotherapeutic agents. The release of cytochrome c from the mitochondria is a key step in many forms of apoptosis, and it leads to the activation of caspases.

Q22: A 70-year-old man died suddenly. At autopsy, multiple tissue sites were sampled for microscopic analysis. Examination of the tissues showed noncrystalline amorphous deposits of calcium salts in gastric mucosa, renal interstitium, and alveolar walls of lungs. Which of the following conditions would m

A. Chronic hepatitis
B. Chronic glomerulonephritis
C. Disseminated tuberculosis
D. Generalized atherosclerosis
E. Normal aging processF. Pulmonary emphysema ANSWER: B

Correct answer: B – Chronic glomerulonephritis

The microscopic findings suggest metastatic calcification, with deposition of calcium salts in tissues that have physiologic mechanisms for losing acid. Chronic renal disease reduces phosphate excretion by the kidney, resulting in an increase in serum phosphate, triggering increased parathyroid hormone output to increase the calcium level, which promotes calcium deposition.

Q23: QUESTION 23 A 63-year-old man has a 2-year history of worsening congestive heart failure. An echocardiogram shows mitral stenosis with left atrial dilation. A thrombus is present in the left atrium. One month later, he experiences left flank pain and notes hematuria. Laboratory testing shows elevate

A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
E. Gangrenous necrosis ANSWER: C

Correct answer: C – Coagulative necrosis

Embolization of the thrombus led to blockage of a renal arterial branch, causing an acute renal infarction in this patient. An ischemic injury to most internal organs produces a pattern of cell death called coagulative necrosis.

Q24: QUESTION 24 At autopsy, a 40-year-old man has an enlarged (2200 g) liver with a yellow cut surface. The microscopic appearance shows lipid vacuoles in many hepatocytes. Before death, the man's total serum cholesterol and triglyceride levels were normal, but he had a decreased serum albumin concentra

A. Injecting heroin
B. Playing basketball
C. Drinking beer
D. Smoking cigarettes
E. Ingesting aspirin ANSWER: C
F.

Correct answer: C – Drinking beer

The appearance of lipid vacuoles in many of the hepatocytes is characteristic of fatty change (steatosis) of the liver. Alcohol is a hepatotoxin that produces hepatic steatosis. Decreased serum albumin levels and increased prothrombin time suggest alcohol-induced hepatocyte damage.

Q25: A 22-year-old woman with leukemia undergoes bone marrow transplantation and receives partially mismatched donor marrow. One month later, she has a scaling skin rash. Examination of a skin biopsy specimen reveals shrunken cells with dense eosinophilic cytoplasm and pyknotic nuclei. This change most l

A. Activation of caspases
B. Reduction of ATP synthesis
C. Increase in glycolysis
D. Activation of lipases
E. Lipid peroxidation ANSWER: A

Correct answer: A – Activation of caspases

This cell is shrunken and has been converted into a dense eosinophilic mass. This pattern is typical of apoptosis. Caspase activation is a universal feature of apoptosis, regardless of the initiating cause. Apoptosis induced in recipient cells from donor lymphocytes occurs with graft-versus-host disease.