MCQ Book Questions

Q60022. A 56-year-old woman with a history of hyperlipidemia and hypertension develops progressive, right renal artery stenosis. Over time, this patient’s right kidney is likely to demonstrate which of the following morphologic adaptations to partial ischemia?

Q60023. A 5-year-old boy suffers blunt trauma to the leg in an automo- bile accident. Six months later, bone trabeculae have formed within the striated skeletal muscle at the site of tissue injury. This pathologic condition is an example of which of the fol- lowing morphologic adaptations to injury?

Q60024. A 43-year-old man presents with a scaly, erythematous lesion on the dorsal surface of his left hand. A skin biopsy reveals atypical keratinocytes fi lling the entire thickness of the epider- mis (shown in the image). The arrows point to apoptotic bod- ies. Which of the following proteins plays the most important role in mediating programmed cell death in this patient’s skin cancer?

Q60025. A 16-year-old girl with a history of suicidal depression swal- lows a commercial solvent. A liver biopsy is performed to assess the degree of damage to the hepatic parenchyma. Histologic examination demonstrates severe swelling of the centrilobular hepatocytes (shown in the image). Which of

Q60026. A 68-year-old woman with a history of hyperlipidemia dies of cardiac arrhythmia following a massive heart attack. Per- oxidation of which of the following molecules was primarily responsible for causing the loss of membrane integrity in car- diac myocytes in this patient?

Q60027. A 22-year-old construction worker sticks himself with a sharp, rusty nail. Within 24 hours, the wound has enlarged to become a 1-cm sore that drains thick, purulent material. This skin wound illustrates which of the following morphologic types of necrosis?

Q60028. A 42-year-old man undergoes liver biopsy for evaluation of the grade and stage of his hepatitis C virus infection. The biopsy reveals swollen (ballooned) hepatocytes and moderate lobular infl ammatory activity (shown in the image). The arrow identi- fi es an acidophilic (Councilman) body. Which of the following cellular processes best accounts for the presence of scattered acidophilic bodies in this liver biopsy?

Q60029. A 32-year-old woman develops an Addisonian crisis (acute adrenal insuffi ciency) 3 months after suffering massive hem- orrhage during the delivery of her baby. A CT scan of the abdomen shows small adrenal glands. Which of the following mechanisms of disease best accounts for adrenal atrophy in this patient?

Q60030. A 47-year-old man with a history of heavy smoking complains of chronic cough. A “coin lesion” is discovered in his right upper lobe on chest X-ray. Bronchoscopy and biopsy fail to identify a mass, but the bronchial mucosa displays squamous metaplasia. What is the most likely outcome of this morpho- logic adaptation if the patient stops smoking?

Q60031. A 40-year-old man is pulled from the ocean after a boating accident and resuscitated. Six hours later, the patient develops acute renal failure. Kidney biopsy reveals evidence of karyor- rhexis and karyolysis in renal tubular epithelial cells. Which of the following biochemical events preceded these pathologic changes?

Q60032. A 30-year-old woman presents with a 2-month history of fatigue, mild fever, and an erythematous scaling rash. She also notes joint pain and swelling, primarily involving the small bones of her fi ngers. Physical examination reveals ery- thematous plaques with adherent silvery scales that induce punctate bleeding points when removed. Biopsy of lesional skin reveals markedly increased thickness of the epidermis (shown in the image). Which of the following terms best describes this adaptation to chronic injury in this patient with psoriasis?

Q60033. A 24-year-old woman with chronic depression ingests a bottle of acetaminophen tablets. Two days later, she is jaundiced (elevated serum bilirubin) and displays symptoms of enceph- alopathy, including impairment in spatial perception. In the liver, toxic metabolites of acetaminophen are generated by which of the following organelles?

Q60034. A 45-year-old woman presents with a 2-month history of fatigue and recurrent fever. She also complains of tenderness below the right costal margin and dark urine. Physical exami- nation reveals jaundice and mild hepatomegaly. The serum is positive for hepatitis B virus antigen. Which of the follow- ing best describes the mechanism of indirect virus-mediated hepatocyte cell death in this patient?

Q60035. A 60-year-old farmer presents with multiple patches of discoloration on his face. Biopsy of lesional skin reveals actinic keratosis. Which of the following terms best describes this response of the skin to chronic sunlight exposure?

Q60036. A 59-year-old woman smoker complains of intermittent blood in her urine. Urinalysis confi rms 4+ hematuria. A CBC reveals increased red cell mass (hematocrit). A CT scan demonstrates a 3-cm renal mass, and a CT-guided biopsy displays renal cell car- cinoma. Which of the following cellular adaptations in the bone marrow best explains the increased hematocrit in this patient?

Q60037. A 33-year-old woman has an abnormal cervical Pap smear. A cervical biopsy reveals that the epithelium lacks normal polarity (shown in the image). Individual cells display hyper- chromatic nuclei, a larger nucleus-to-cytoplasm ratio, and disorderly tissue arrangement. Which of the following adap- tations to chronic injury best describes these changes in the patient’s cervical epithelium?

Q60038. A 24-year-old woman accidentally ingests carbon tetrachlo- ride (CCl4) in the laboratory and develops acute liver failure. Which of the following cellular proteins was directly involved in the development of hepatotoxicity in this patient?

Q60039. A 22-year-old woman nursing her newborn develops a tender erythematous area around the nipple of her left breast. A thick, yellow fl uid is observed to drain from an open fi ssure. Examination of this breast fl uid under the light microscope will most likely reveal an abundance of which of the following infl ammatory cells?

Q60040. Which of the following mediators of infl ammation facilitates chemotaxis, cytolysis, and opsonization at the site of infl am- mation in the patient described in Question 1?

Q60041. A 63-year-old man becomes febrile and begins expectorating large amounts of mucopurulent sputum. Sputum cultures are positive for Gram-positive diplococci. Which of the following mediators of infl ammation provides potent chemotactic fac- tors for the directed migration of infl ammatory cells into the alveolar air spaces of this patient?