QUESTION 15
A 44-year-old male who is homeless and a chronic alcoholic has had a persistent cough for several weeks. While drinking with other homeless individuals, he starts to cough and coughs up a significant amount of blood. Other than his chronic alcoholism, he has no other significant past medical history. Examination of the lungs would most likely reveals which of the following pathologic findings?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Answer for Question 15
Answer: C (Caseous necrosis)
Explanation: given the fact that he is a homeless chronic alcoholic with a persistent cough, tuberculosis is a distinct possibility. When the disease process erodes into a vessel, patients will often develop hemoptysis. Of the above, caseous necrosis is associated with tuberculosis. Liquefactive necrosis could occur in a person with severe necrotizing pneumonia, which chronic alcoholics also can get; however, given the more chronic nature of his symptoms, this is less likely. Fat necrosis essentially does not occur in the lungs and would not be associated with hemoptysis. An infarct could be associated with hemoptysis and could occur associated with a pulmonary thromboembolus; however, he has no other symptoms, no past medical history, and no other risk factors. Fibrinoid necrosis is associated with some forms of vasculitis and is possible; however, much less common than tuberculosis in this patient population.
QUESTION 16
A 62-year-old male with a history of poorly-controlled diabetes mellitus presents to a primary care clinic with a history of a non-healing sore on his left great toe. Inspection reveals that on the lateral surface of his left great toe is a 1.5 cm ulcer. Physical examination also reveals decreased pulses in the left lower extremity. The ulcer does not appear to be infected. Of the following, which process is occurring on the left great toe?
A. Liquefactive necrosis
B. Gangrenous necrosis
C. Fat necrosis
D. Fibrinoid necrosis
E. Apoptosis
Answer for Question 16
Answer: B (Gangrenous necrosis)
Explanation: Gangrenous necrosis is a term used most commonly for coagulative necrosis of the lower extremities (if there is no bacterial infection, the term dry gangrene can be used and if there is superimposed bacterial infection, the term wet gangrene can be used. Wet gangrene would essentially be coagulative necrosis with superimposed liquefactive necrosis). Gangrenous necrosis can also be used for the pelvic region (i.e., Fournier’s gangrene) and can also be used for some lesions of the gastrointestinal tract (e.g., gas gangrene). Gangrene most often occurs secondary to ischemic injury, such as could occur in diabetics, who often have vascular damage.