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A 48-year-old woman has a malignant lymphoma involving lymph nodes in the para-aortic region. She is treated with a chemotherapeutic agent which results in the loss of individual neoplastic cells through fragmentation of individual cell nuclei and cytoplasm. Over the next 2 months, the lymphoma decreases in size, as documented on abdominal CT scans. By which of the following mechanisms has her neoplasm primarily responded to therapy?
A Coagulative necrosis
B Mitochondrial poisoning
C Phagocytosis
D Acute inflammation
E Apoptosis

A 53-year-old man has experienced severe chest pain for the past 6 hours. On physical examination he is afebrile, but has tachycardia. Laboratory studies show a serum troponin I of 10 ng/mL. A coronary angiogram is performed emergently and reveals >90% occlusion of the left anterior descending artery. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs?
A Glycogen stores are depleted
B Cytoplasmic sodium increases
C Nuclei undergo karyorrhexis
D Intracellular pH diminishes
E Blebs form on cell membranes

While in a home improvement center warehouse buying paint, a 35-year-old man hears "Look out below!" and is then struck on the leg by a falling pallet rack, which strikes him on his left leg in the region of his thigh. The skin is not broken. Within 2 days there is a 5 x 7 cm purple color to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown color at the site of injury 16 days later?
A Lipofuscin
B Bilirubin
C Melanin
D Hemosiderin
E Glycogen

A54-year-old man with a chronic cough has a squamous cell carcinoma diagnosed in his right lung. While performing a pneumonectomy, the thoracic surgeon notes that the hilar lymph nodes are small, 0.5 to 1.0 cm in size, and jet black in color throughout. Which of the following is the most likely cause for this appearance to the hilar nodes?
A Anthracotic pigment
B Lipochrome deposits
C Melanin accumulation
D Hemosiderosis
E Metastatic carcinoma

A 50-year-old woman with a history of unstable angina suffers an acute myocardial infarction. Thrombolytic therapy with tissue plasminogen activator (tPA) is administered to restore coronary blood flow. In spite of this therapy, the degree of myocardial fiber injury may increase because of which of the following cellular abnormalities?
A Cytoskeletal intermediate filament loss
B Decreased intracellular pH from anaerobic glycolysis
C Increased free radicals
D Mitochondrial swelling
E Nuclear chromatin clumping and decreased protein synthesis
F Reduced protein synthesis

A 12-year-old boy has had multiple episodes of ear pain accompanied by fever. On examination his right tympanic membrane is red and bulging with yellow exudate. Laboratory studies of the exudate show culture positive for Hemophilus influenzae. A year later he has conductive hearing loss on the right, and a head CT scan shows a mass in the right middle ear. Which of the following materials is most likely to be seen in the tissue curetted from his middle ear?
A Lipofuscin
B Russell bodies
C Neutrophils
D Cholesterol crystals
E Anthracotic pigment

A 43-year-old man has complained of mild burning substernal pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies show the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most likely represented by these findings?
A Dysplasia
B Hyperplasia
C Carcinoma
D Ischemia
E Metaplasia

A 59-year-old woman had the loss of consciousness that persisted for over an hour. When she becomes arousable, she cannot speak nor move her right arm or leg. A cerebral angiogram revealed an occlusion to her left middle cerebral artery. Months later, a computed tomographic (CT) scan shows a large 5 cm cystic area in her left parietal lobe cortex. This CT finding is most likely the consequence of resolution from which of the following cellular events?
A Liquefactive necrosis
B Atrophy
C Coagulative necrosis
D Caseous necrosis
E Apoptosis

A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She continues breast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that began in the breast during pregnancy allowed her to nurse the infant for this period of time?
A Stromal hypertrophy
B Epithelial dysplasia
C Steatocyte atrophy
D Ductal epithelial metaplasia
E Lobular hyperplasia

An 80-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small (250 gm) and dark brown on sectioning. Microscopically, there is light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance of his heart?
A Hemosiderin from iron overload
B Lipochrome from 'wear and tear'
C Glycogen from a storage disease
D Cholesterol from atherosclerosis
E Calcium deposition following necrosis

In an experiment, a series of immunohistochemical stains are employed to identify different cellular components. One particular stain identifies the presence of intermediate filaments within cells. This cytokeratin stain is most likely to be useful for which of the following diagnostic purposes?
A Cytoskeletal alterations indicate impending cell death
B A neoplasm is determined to be a carcinoma
C Contractile properties of the cells can be assessed
D A history of chronic alcoholism can be confirmed
E The degree of metaplasia or dysplasia can be assessed

A 20-year-old woman had Goodpasture syndrome which progressed to chronic renal failure. She was 165 cm tall and weighed 55 kg. She had blood pressure measurements in the range of 150/90 to 180/110 mm Hg, but she did not regularly take medications. Laboratory studies showed her blood urea nitrogen was over 100 mg/dL. She required chronic dialysis. She died from heart failure. At autopsy, her heart weighed 540 gm. The size of her heart is most likely to be the result of which of the following processes involving the myocardial fibers?
A Hypertrophy
B Fatty infiltration
C Hyperplasia
D Fatty degeneration
E Edema

A 29-year-old man goes on a snorkeling trip to Looe Key Marine Sanctuary and later spends time on the beach at Bahia Honda State Park. The next day he has a darker complexion. His skin does not show warmth, erythema, or tenderness. His skin tone fades to its original appearance within a month. Which of the following substances contributes the most to the biochemical process leading to these skin changes?
A Iron oxide
B Lipofuscin
C Tyrosine
D Homogentisic acid
E Glycogen

A study is performed to identify predisposing risks for tissue changes. In some persons epithelial metaplasia occurs. In which of the following situations is the process of epithelial metaplasia most likely to take place?
A Tanning of the skin following sunlight exposure
B Lactation following pregnancy
C Vitamin A deficiency
D Acute myocardial infarction
E Urinary obstruction from an enlarged prostate

In an experiment, a disease process is found which leads to scattered loss of individual cells, with the microscopic appearance of karyorrhexis and cell fragmentation. The overall tissue structure remains intact. This process is most typical for which of the following diseases?
A Viral hepatitis
B Brown atrophy of the heart
C Renal transplant rejection
D Chronic alcoholic liver disease
E Barbiturate overdose

A 60-year-old woman has noted a dark red-black appearance to her great toe and second and third toes of her left foot for the past month. On physical examination, the toes are cold to touch and have no sensation to touch. The dorsalis pedis and posterior tibial pulses are not palpable on the left. A transmetatarsal amputation is performed. These findings are most typical for a patient with which of the following conditions?
A Diabetes mellitus
B Monckeberg arteriosclerosis
C Blunt force trauma
E Autoimmunity

A study is performed involving the microscopic analysis of tissues obtained from surgical procedures. Some of these tissues have the microscopic appearance of an increased cell size of multiple cells within the tissue, due to an increase in the amount of cytoplasm, with nuclei remaining uniform in size. Which of the following conditions is most likely to have resulted in this finding?
A Uterine myometrium in pregnancy
B Female breast at puberty
C Liver following partial resection
D Ovary following menopause
E Cervix with chronic inflammation

A 17-year-old adolescent receives whole body radiation as part of a preparatory regimen for bone marrow transplantation to treat acute lymphocytic leukemia. Which of the following cells and tissues in the body is most likely to remain unaltered by the effects of this therapeutic radiation?
A Ovarian follicles
B Small intestinal epithelium
C Erythropoietic cells of bone marrow
D Spermatogonia of testicular tubules
E Neurons of cerebral cortex

A 79-year-old man has a large myocardial infarction involving much of the left ventricular free wall. He develops congestive heart failure (CHF) with decreased cardiac output. Now, a year later, his CHF is worsening. By echocardiography there is a large, bulging akinetic area typical for a left ventricular aneurysm. Which of the following laboratory tests on serum would best indicate poor peripheral tissue perfusion in this patient?
A Elevated troponin I
B Increased sodium
C Elevated lactate
D Increased hematocrit
E Increased sedimentation rate

A 22-year-old woman has a congenital anemia. She has required multiple transfusions of red blood cells for many years. She now has no significant findings on physical examination. Laboratory studies now show a serum AST of 74 U/L and ALT 75 U/L with albumin 3.6 g/dL. Which of the following microscopic findings would most likely appear in a liver biopsy?
A Steatosis in hepatocytes
B Bilirubin in canaliculi
C Hemosiderin in hepatocytes
D Glycogen in hepatocytes
E Amyloid in portal triads

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