1 A 77-year-old woman has chronic renal failure.

Her serum urea

nitrogen is 40 mg/dL. She is given a diuretic medication and loses 2 kg
(4.4 lb). She reduces the protein in her diet and her serum urea nitrogen
decreases to 30 mg/dL. Which of the following terms best describes
cellular responses to disease and treatment in this woman?
A *Adaptation
B Apoptosis
C Necroptosis
D Irreversible injury
E Metabolic derangement
2 A 53-year-old woman with no prior illnesses has a routine checkup by
her physician. On examination she has a blood pressure of 150/95 mm
Hg. If her hypertension remains untreated for years, which of the
following cellular alterations would most likely be seen in her
myocardium?
A Apoptosis
B Dysplasia
C Fatty change
D Hemosiderosis
E Hyperplasia
F *Hypertrophy
G Metaplasia
3 A 22-year-old woman becomes pregnant. A fetal ultrasound
examination at 13 weeks gestation shows her uterus measures 7 4 3
cm. At delivery of a term infant, her uterus measures 34 18 12 cm.
Which of the following cellular processes has contributed most to the
increase in her uterine size?
A Endometrial glandular hyperplasia
B Myometrial fibroblast proliferation
C Endometrial stromal hypertrophy
D *Myometrial smooth muscle hypertrophy
E Vascular endothelial hyperplasia
4 A 20-year-old woman breastfeeds her infant. On examination, her
breasts are slightly increased in size. Milk can be expressed from both
nipples. Which of the following processes that occurred in her breasts
during pregnancy enables her to breastfeed the infant?
A Ductal metaplasia
B Epithelial dysplasia
C Intracellular lipid deposition
D *Lobular hyperplasia
E Stromal hypertrophy
5 A 16-year-old boy sustained blunt trauma to his abdomen when he
struck a bridge abutment at high speed while driving a motor vehicle.
Peritoneal lavage shows a hemoperitoneum, and at laparotomy, a small
portion of the left lobe of the injured liver is removed. Two months later,
a CT scan of the abdomen shows that the liver has nearly regained its size
before the injury. Which of the following processes best explains this CT
scan finding?
A Apoptosis
B Dysplasia
C *Hyperplasia
D Hydropic change
E Steatosis
6 A 71-year-old man has had difficulty with urination, including
hesitancy and increased frequency, for the past 5 years. A digital rectal
examination reveals that his prostate gland is palpably enlarged to twice
normal size. A transurethral resection of the prostate is performed, and
the microscopic appearance of the prostate chips obtained is that of
nodules of glands with intervening stroma. Which of the following
pathologic processes has most likely occurred in his prostate?
A Apoptosis
B Dysplasia
C Fatty change
D *Hyperplasia
7 A 29-year-old man sustains a left femoral fracture in a mo-
torcycle accident. His leg is placed in a plaster cast. After his left
leg has been immobilized for 6 weeks, the diameter of the left calf
has decreased in size. This change in size is most likely to result
from which of the following alterations in his calf muscles?
A Aplasia
B *Atrophy
C Dystrophy
D Hyalinosis
E Hypoplasia
8 A 34-year-old obese woman has experienced heartburn from
gastric reflux for the past 5 years after eating large meals. She
undergoes upper gastrointestinal endoscopy, and a biopsy
specimen of the distal esophagus is obtained. Which of the
following microscopic changes, seen in the figure, has most likely
occurred?
A *Columnar metaplasia
B Goblet cell hyperplasia
C Lamina propria atrophy
D Squamous dysplasia
E Mucosal hypertrophy
9 An 11-year-old girl becomes infected with hepatitis A and
experiences mild nausea for 1 week. On physical examination, she
has minimal right upper quadrant tenderness and scleral icterus.
Laboratory findings include a serum AST of 68 U/L, ALT of 75
U/L, and total bilirubin of 5.1 mg/dL. Her laboratory findings
most likely result from which of the following changes in her
hepatocytes?
A Cell membrane defects
B Lysosomal autophagy
C Mitochondrial swelling
D *Nuclear chromatin clumping
E Ribosomal dispersion
10 A 33-year-old woman has had increasing lethargy and
decreased urine output for the past week. Laboratory studies
show her serum creatinine is 4.3 mg/dL and urea nitrogen 40
mg/dL. A renal biopsy is performed, and the specimen is
examined using electron microscopy. Which of the following
morphologic cellular changes most likely suggests a diagnosis of
acute tubular necrosis?
A Chromatin clumping
B Mitochondrial swelling
C Nuclear fragmentation
D *Plasma membrane blebs
E Ribosomal disaggregation
11 A 50-year-old man has experienced an episode of chest pain
for 6 hours. A representative histologic section of his left
ventricular myocardium is shown in the figure. There is no
hemorrhage or inflammation. Which of the following conditions
most likely produced these myocardial changes?
A *Arterial thrombosis
B Autoimmunity
C Blunt chest trauma
D Protein-deficient diet
E Viral infection
12 A 38-year-old woman has experienced severe abdominal pain
over the past day. On examination she is hypotensive and in
shock. Laboratory studies show elevated serum lipase. From the
representative gross appearance of the mesentery shown in the
figure, which of the following events has most likely occurred?
A *Acute pancreatitis
B Gangrenous cholecystitis
C Hepatitis B virus infection
D Small intestinal infarction
E Tuberculous lymphadenitis
13 A 68-year-old woman suddenly lost consciousness and on
awakening 1 hour later, she could not speak or move her right
arm. 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 her brain?
A Apoptosis
B Coagulative necrosis
C Fat necrosis
D Karyolysis
E *Liquefactive necrosis
14 A screening chest radiograph of an asymptomatic 37-year-old
man shows a 3-cm nodule in the middle lobe of his right lung.
The nodule is excised with a pulmonary wedge resection, and
sectioning shows a sharply circumscribed mass with a soft, white
center. The microscopic appearance is shown in the figure. The
serum interferon gamma release assay is positive. Which of the
following pathologic processes has most likely occurred in this
nodule?
A Apoptosis
B *Caseous necrosis
C Coagulative necrosis
D Fat necrosis
E Fatty change
F Gangrenous necrosis
G Liquefactive necrosis
15 An experimental drug administered to a tissue preparation is
found to inhibit cellular oxidative phosphorylation when given in
high doses, and ATP production drops to 5% of normal. Cell
membrane function is diminished. Which of the following
substances is most likely to be present at increased concentration
in culture fluid bathing the tissue?
A Calcium
B Glucose
C Ketones
D Potassium
E *Sodium

16 A 47-year-old woman has poorly controlled diabetes mellitus

and develops coronary artery disease. She now has decreasing
cardiac output with blood pressure of 80/40 mm Hg and ejection
fraction of 18%. An increase in which of the following substances
in her blood is most indicative of reversible cell injury from
decreased systemic arterial perfusion of multiple organs and
tissues?
A Carbon dioxide
B Creatinine
C Glucose
D *Lactic acid
E Troponin I
17 A tissue preparation is experimentally subjected to a hypoxic
environment. The cells in this tissue begin to swell, and chromatin
begins to clump in cell nuclei. ATPases are activated, and ATP
production decreases. Which of the following ions accumulating
in mitochondria and the cytosol contributes most to these
findings and to eventual cell death?
A *Ca2+
B Cl
C HCO3
D K+
E Na+
F PO43

18. A 63-year-old man has a 2-year history of worsening

congestive heart failure. An echocardiogram shows mitral valve
stenosis with left atrial dilation. A mural thrombus is present in
the left atrium. One month later, he experiences left flank pain
and notes hematuria. Laboratory testing shows an elevated serum
AST. The representative microscopic appearance of the lesion is
shown in the figure. Which of the following patterns of tissue
necrosis is most likely to be present in this man?
A Caseous
B *Coagulative
C Fat
D Gangrenous
E Liquefactive
19 A 54-year-old man experienced severe substernal chest pain
for 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 tissue events most likely
occurred in the myocardium after t-PA therapy?
A Cellular regeneration
B Drug toxicity
C *Increased synthesis of CK
D Myofiber atrophy
E Reperfusion injury

20 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 since menarche. Which of the following
processes most likely occurs in her endometrial cells to initiate the
onset of menstrual bleeding?
A *Apoptosis
B Atrophy
C Caseous necrosis
D Heterophagocytosis
E Liquefactive necrosis

END OF QUIZ
22 An experiment introduces a knockout gene mutation into a cell line. The frequency of shrunken cells with
chromatin clumping, karyorrhexis, and cytoplasmic blebbing is increased compared with a cell line without the
mutation. Overall survival of the mutant cell line is reduced. Which of the following genes is most likely to be
affected by this mutation?
A BAX
B BCL2
C C-MYC
D FAS
E p53

23. A 22-year-old woman with leukemia undergoes bone marrow transplantation and receives a partially
mismatched donor marrow. One month later, she has a scaling skin rash. A skin biopsy is obtained, and on
microscopic examination, it has the cellular change shown in the figure. This change most likely results from which
of the following biochemical reactions?
A Activation of caspases
B Elaboration of lipases
C Increase in glycolysis
D Peroxidation of lipids
E Reduction of ATP synthesis

24. A 47-year-old man has a lung carcinoma with metastases. He receives chemotherapy. A month later, histologic
examination of a metastatic lesion shows many foci in which individual tumor cells appear shrunken and deeply
eosinophilic. Their nuclei exhibit condensed aggregates of chromatin under the nuclear membrane. The pathologic
process affecting these shrunken tumor cells is most likely triggered by release of which of the following substances
into the cytosol?
A BCL2
B Catalase
C Cytochrome c
D Lipofuscin
E Phospholipase

25 An experimental study of steatohepatitis in metabolic syndrome reveals that hepatocyte cell membrane injury
with necrosis occurs in response to increased amounts of tumor necrosis factor (TNF). When a pharmacologic agent
inhibiting caspases is administered, cell necrosis still occurs. Which of the following substances forms a
supramolecular complex that increases the generation of reactive oxygen species?
A Catalase
B Cytochrome c
C Interleukin 1-beta converting enzyme
D Receptor-interacting protein
E Ubiquitin ligase