ABPath - American Board of Pathology General Pathology Principles Questions and Answers 1 — Questions and Answers
Question 1: A 68-year-old male with a long history of hypertension and coronary artery disease dies of a massive myocardial infarction. At autopsy, the heart is enlarged, and the left ventricular wall is notably thickened. Microscopically, the cardiac myocytes are increased in size, but not in number. This cellular alteration is best described as which of the following?
- Hyperplasia
- Atrophy
- Hypertrophy (Correct answer)
- Metaplasia
Correct answer: Hypertrophy
Hypertrophy is an increase in the size of cells, resulting in an increase in the size of the organ. [20] It occurs in cells with limited capacity to divide, such as cardiac myocytes, in response to increased workload. [28, 30] In this case, chronic hypertension increased the workload on the heart, leading to an adaptive increase in myocyte size. Hyperplasia is an increase in the number of cells. Atrophy is a decrease in cell size. [20] Metaplasia is the replacement of one mature cell type with another. [28]
Question 2: Which of the following is a key feature that distinguishes apoptosis from necrosis?
- Significant inflammatory response
- Cell swelling and membrane rupture
- Caspase activation and formation of apoptotic bodies (Correct answer)
- Uncontrolled release of cellular contents
Correct answer: Caspase activation and formation of apoptotic bodies
Apoptosis, or programmed cell death, is a tightly regulated process characterized by the activation of a cascade of enzymes called caspases. This leads to the orderly dismantling of the cell and formation of membrane-bound apoptotic bodies, which are phagocytosed without eliciting an inflammatory response. [22] In contrast, necrosis is characterized by cell swelling, loss of membrane integrity, uncontrolled release of cellular contents, and a significant inflammatory response. [15, 24]
Question 3: A 45-year-old woman presents with bilateral lower extremity swelling that has worsened over several months. She has a history of severe congestive heart failure. Physical examination reveals pitting edema to the mid-shin. The primary mechanism responsible for this patient's edema is an increase in which of the following?
- Plasma oncotic pressure
- Capillary hydrostatic pressure (Correct answer)
- Lymphatic drainage
- Interstitial oncotic pressure
Correct answer: Capillary hydrostatic pressure
Edema in congestive heart failure is primarily caused by an increase in capillary hydrostatic pressure. [19] The failing heart cannot pump blood effectively, leading to venous congestion and increased pressure in the capillaries, which forces fluid into the interstitial space. Decreased plasma oncotic pressure, as seen in nephrotic syndrome or liver failure, can also cause edema, but increased hydrostatic pressure is the dominant mechanism in heart failure. [3, 11, 19]
Question 4: Which of the following cellular infiltrates is most characteristic of chronic inflammation?
- Neutrophils and eosinophils
- Basophils and mast cells
- Erythrocytes and platelets
- Lymphocytes and macrophages (Correct answer)
Correct answer: Lymphocytes and macrophages
Chronic inflammation is characterized by the infiltration of mononuclear cells, primarily lymphocytes, macrophages, and plasma cells. [4, 21, 29] This is in contrast to acute inflammation, which is dominated by neutrophils. [4, 29] Macrophages play a central role in chronic inflammation through phagocytosis, antigen presentation, and secretion of cytokines and growth factors that perpetuate the inflammatory response and promote tissue remodeling. [21]
Question 5: A biopsy of a lung mass in a 60-year-old smoker reveals a malignant neoplasm composed of glandular structures. Based on this histologic finding, what is the most appropriate classification for this tumor?
- Adenocarcinoma (Correct answer)
- Squamous cell carcinoma
- Sarcoma
- Lymphoma
Correct answer: Adenocarcinoma
A malignant neoplasm of epithelial origin that forms glandular patterns is classified as an adenocarcinoma. [5, 17] Carcinomas are malignant tumors arising from epithelial cells. [5] Squamous cell carcinoma also arises from epithelial cells but is characterized by keratinization and intercellular bridges. Sarcomas are malignant neoplasms arising from mesenchymal tissue (e.g., connective tissue, muscle), and lymphomas are malignancies of lymphocytes. [17]
Question 6: A 50-year-old woman undergoes a routine Papanicolaou (Pap) test. The report describes a reversible change in which the normal columnar epithelium of the endocervix has been replaced by stratified squamous epithelium. This cellular adaptation is known as:
- Dysplasia
- Anaplasia
- Metaplasia (Correct answer)
- Hyperplasia
Correct answer: Metaplasia
Metaplasia is a reversible change in which one differentiated cell type is replaced by another cell type, often in response to chronic irritation. [20, 28] In the cervix, the columnar epithelium of the endocervix can undergo squamous metaplasia in response to the acidic vaginal environment. While this is an adaptive response, it can be a precursor to dysplasia if the injurious stimulus persists. [28] Dysplasia refers to disordered growth, anaplasia to lack of differentiation in malignant tumors, and hyperplasia to an increase in cell number. [13, 30]
ABPath - American Board of Pathology General Pathology Principles Questions and Answers 1
A 68-year-old male with a long history of hypertension and coronary artery disease dies of a massive myocardial infarction.
At autopsy, the heart is enlarged, and the left ventricular wall is notably thickened.
Microscopically, the cardiac myocytes are increased in size, but not in number.
This cellular alteration is best described as which of the following?