MCQ Book Questions

Q60002. A 68-year-old man with a history of gastroesophageal refl ux disease suffers a massive stroke and expires. The esophagus at autopsy is shown in the image. Histologic examination of the abnormal tissue shows intestine-like epithelium composed of goblet cells and surface cells similar to those of incompletely intestinalized gastric mucosa. There is no evidence of nuclear atypia. Which of the following terms best describes this morphologic response to persistent injury in the esophagus of this patient?

Q60003. A 24-year-old woman contracts toxoplasmosis during her pregnancy and delivers a neonate at 37 weeks of gestation with a severe malformation of the central nervous system. MRI studies of the neonate reveal porencephaly and hydrocephalus. An X-ray fi lm of the head shows irregular densities in the basal ganglia. These X-ray fi ndings are best explained by which of the following mechanisms of disease?

Q60004. A 30-year-old man with AIDS-dementia complex develops acute pneumonia and dies of respiratory insuffi ciency. At autopsy, many central nervous system neurons display hydropic degeneration. This manifestation of sublethal neuronal injury was most likely mediated by impairment of which of the following cellular processes?

Q60005. A 62-year-old man is brought to the emergency room in a disoriented state. Physical examination reveals jaundice, splenomegaly, and ascites. Serum levels of ALT, AST, alkaline phosphatase, and bilirubin are all elevated. A liver biopsy demonstrates alcoholic hepatitis with Mallory bodies. These cytoplasmic structures are composed of interwoven bundles of which of the following proteins?

Q60006. A 65-year-old man suffers a heart attack and expires. Exami- nation of the lungs at autopsy reveals numerous pigmented nodules scattered throughout the parenchyma (shown in the image). What is the appropriate diagnosis?

Q60007. A 75-year-old woman with Alzheimer disease dies of congestive heart failure. The brain at autopsy is shown in the image. This patient’s brain exemplifi es which of the following responses to chronic injury?

Q60008. A 68-year-old woman with a history of heavy smoking and repeated bouts of pneumonia presents with a 2-week history of fever and productive cough. A chest X-ray reveals a right lower lobe infi ltrate. A transbronchial biopsy confi rms pneumonia and further demonstrates preneoplastic changes within the bronchial mucosa. Which of the following best characterizes the morphology of this bronchial mucosal lesion?

Q60009. A 30-year-old woman suffers a tonic-clonic seizure and pres- ents with delirium and hydrophobia. The patient states that she was bitten on the hand by a bat about 1 month ago. The patient subsequently dies of respiratory failure. Viral par- ticles are found throughout the brainstem and cerebellum at autopsy. In addition to direct viral cytotoxicity, the necrosis of virally infected neurons in this patient was mediated primarily by which of the following mechanisms?

Q60010. A 52-year-old woman loses her right kidney following an auto- mobile accident. A CT scan of the abdomen 2 years later shows marked enlargement of the left kidney. The renal enlargement is an example of which of the following adaptations?

Q60011. An 82-year-old man has profound bleeding from a peptic ulcer and dies of hypovolemic shock. The liver at autopsy dis- plays centrilobular necrosis. Compared to viable hepatocytes, the necrotic cells contain higher intracellular concentrations of which of the following?

Q60012. A 28-year-old woman is pinned by falling debris during a hur- ricane. An X-ray fi lm of the leg reveals a compound fracture of the right tibia. The leg is immobilized in a cast for 6 weeks.

Q60013. A 32-year-old woman with poorly controlled diabetes mellitus delivers a healthy boy at 38 weeks of gestation. As a result of maternal hyperglycemia during pregnancy, pancreatic islets in the neonate would be expected to show which of the follow- ing morphologic responses to injury?

Q60014. A 59-year-old female alcoholic is brought to the emer- gency room with a fever (38.7°C/103°F) and foul-smelling breath. The patient subsequently develops acute broncho- pneumonia and dies of respiratory insuffi ciency. A pulmo- nary abscess is identifi ed at autopsy (shown in the image). Histologic examination of the wall of this lesion would most likely demonstrate which of the following pathologic changes?

Q60015. A 20-year-old man from China is evaluated for persistent cough, night sweats, low-grade fever, and general malaise. A chest X-ray reveals fi ndings “consistent with a Ghon com- plex.” Sputum cultures grow acid-fast bacilli. Examination of hilar lymph nodes in this patient would most likely demon- strate which of the following pathologic changes?

Q60016. Which of the following mechanisms of disease best describes the pathogenesis of pigment accumulation in hepatocytes in the patient described in Question 22?

Q60017. A 45-year-old man presents with increasing abdominal girth and yellow discoloration of his skin and sclera. Physical exam- ination reveals hepatomegaly and jaundice. A Prussian blue stain of a liver biopsy is shown in the image. What is the major intracellular iron storage protein in this patient’s hepatocytes?

Q60018. A 60-year-old man with chronic cystitis complains of urinary frequency and pelvic discomfort. Digital rectal examination is unremarkable. Biopsy of the bladder mucosa reveals foci of glandular epithelium and chronic infl ammatory cells. No cytologic signs of atypia or malignancy are observed. Which of the following terms best describes the morphologic response to chronic injury in this patient?

Q60019. A 60-year-old man is rushed to the hospital with acute liver failure. He undergoes successful orthotopic liver transplanta- tion; however, the transplanted liver does not produce much bile for the fi rst 3 days. Poor graft function in this patient is thought to be the result of “reperfusion injury.” Which of the following substances was the most likely cause of reperfusion injury in this patient’s transplanted liver? When the cast is removed, the patient notices that her right leg is weak and visibly smaller in circumference than the left leg. Which of the following terms best describes this change in the patient’s leg muscle?

Q60020. A 70-year-old man is hospitalized after suffering a mild stroke. While in the hospital, he suddenly develops crushing subster- nal chest pain. Analysis of serum proteins and ECG confi rm a diagnosis of acute myocardial infarction. The patient subse- quently develops an arrhythmia and expires. A cross section of the left ventricle at autopsy is shown in the image. Histologic examination of the affected heart muscle would demonstrate which of the following morphologic changes?

Q60021. Which of the following histologic features would provide defi nitive evidence of necrosis in the myocardium of the patient described in Question 20?