QUESTION 36
A 20-year-old male dies during a motor vehicle accident. His body is taken to the medical examiner’s office for autopsy. He has no past medical history and toxicologic analysis of his blood reveals no ethanol or drugs. He is a member of his college’s track and field team. Examination of the skeletal muscle fibers in his thigh would reveal which of the following?
A. Physiologic hyperplasia
B. Physiologic hypertrophy
C. Pathologic hyperplasia
D. Pathologic hypertrophy
Answer for Question 36
Answer: B (physiologic hypertrophy)
Explanation: as a member of the track and field team, hypertrophy of the muscle would be expected. As skeletal muscle essentially cannot divide, hyperplasia would not be present. Because athleticism is considered normal stimulation of the musculature, the changes would be considered physiologic and not pathologic.
QUESTION 37
A 53-year-old male leaves a bar after work intoxicated and while driving home, over-corrects on the road, flips his vehicle and is ejected from the car, striking his head on the ground. He is found dead by first responders. His past medical history includes hypertension, which he has had for 15 years. He is not a chronic alcoholic. Which of the following is the most likely finding at autopsy?
A. Cardiac hyperplasia
B. Cardiac hypertrophy
C. Pulmonary hyperplasia
D. Pulmonary hypertrophy
Answer for Question 37
Answer: B (cardiac hypertrophy)
Explanation: given his past medical history of hypertension for 15 years, he is most likely to have some degree of cardiac hypertrophy. The cardiac myocytes essentially do not divide, so cardiac hyperplasia would not occur. While in some cases, cells within the lung can divide, pulmonary hyperplasia and pulmonary hypertrophy are not often described; also, with only a past medical history of hypertension, involvement of the lungs would not be likely.
QUESTION 38
A 56-year-old male with a past medical history of hypertension is brought to the emergency room by his wife because he is complaining of a sharp shooting pain in his chest. During evaluation, he becomes unresponsive and is unable to be resuscitated. An autopsy reveals an aortic dissection and also a 540 gram heart. Of the following, molecular analysis of the heart would reveal an increased amount of which of the following?
A. α-myosin heavy chain
B. β-myosin heavy chain
C. α-myosin light chain
D. β-myosin light chain
Answer for Question 38
Answer: B (β-myosin heavy chain)
Explanation: β-myosin heavy chain is the fetal form of the myosin heavy chain, and is more effective in its use of energy and slower in its contractions, and hence, in a hypertrophied heart, as would occur in a patient with hypertension, and as a 540 gram heart represents, would be in increased amount. The switch from the adult α-myosin heavy chain to the fetal β-myosin heavy chain represents the body’s adaptation to the increased stress placed on the heart by the systemic hypertension.
QUESTION 39
A 71-year-old male has slowly, over 10 years, developed a significant degree of stenosis in his left femoral artery, which impairs blood flow to his left lower extremity. Of the following, which change would be expected in the skeletal musculature?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
E. Coagulative necrosis
F. Liquefactive necrosis
Answer for Question 39
Answer: C (atrophy)
Explanation: Stenosis of the left femoral artery would cause ischemia of the down-stream musculature. Because the stenosis has developed slowly, the skeletal muscle cells would have a chance to adapt to the change; therefore, necrosis would not be expected. Skeletal muscle cells essentially do not divide, so hyperplasia could not occur–also, ischemia would decrease the amount of oxygen and nutrients available to the cells, so there would be no stimulus for hyperplasia or hypertrophy. Metaplasia does not occur in this context (i.e., there is not a better cell type that the skeletal muscle cells can switch to to better handle the decreased blood flow). The skeletal muscle cells would undergo atrophy.
QUESTION 40
During a breast self-exam, a 44-year-old female detects a mass in her left breast. A biopsy subsequently confirms an invasive ductal carcinoma. A CT scan performed for the purpose of staging identifies a mass in her left ovary, which is subsequently removed, and a diagnosis of a granulosa cell tumor is made. Blood drawn prior to the removal of the tumor confirms an elevated level of estrogen in the blood, which drops back to normal following the oophorectomy. If an endometrial biopsy had been performed at the time of the oophorectomy, of the following, which was most likely to be identified?
A. Physiologic endometrial hypertrophy
B. Physiologic endometrial hyperplasia
C. Pathologic endometrial hypertrophy
D. Pathologic endometrial hyperplasia
Answer for Question 40
Answer: D (pathologic endometrial hyperplasia)
Explanation: the elevated concentration of estrogen would promote division and proliferation of the endometrial glandular epithelium (hyperplasia). Because the stimulus for the proliferation is a tumor, the hyperplasia would be considered pathologic. Physiologic hyperplasia of the endometrium occurs during the proliferative phase of the menstrual cycle.
QUESTION 41
A pathologist is examining a section of tissue from the lower extremity. There is variation in cell size on cross section, with some skeletal muscle cells smaller than others. In these cells, the peripheral nuclei are more closely packed than normal. Of the following, what is the most likely etiology for this histologic abnormality?
A. Congenital defect
B. Infection
C. Trauma
D. Neoplasia
E. Vascular stenosis
Answer for Question 41
Answer: E (vascular stenosis)
Explanation: some of the skeletal myocytes are smaller than normal, hence the decreased size on cross section with the resultant more closely packed nuclei. This is atrophy. While in some way, each of the choices could potentially be associated with skeletal muscle atrophy (e.g., due to wasting, or nerve involvement), the only condition listed that could be consistently associated with atrophy of the skeletal muscle would be vascular stenosis, which would result in ischemia of the downstream tissue.
QUESTION 42
A 63-year-old male with a long history of cigarette use collapses while golfing with friends. An autopsy is performed to determine the cause of death. Other than a 10 year history of hypertension, effectively treated with medication, he has no significant past medical history. During microscopic examination of the lungs, which of the following is most likely to be identified
A. Metastatic calcification of the alveolar septa
B. Squamous metaplasia of the bronchi
C. Gastric metaplasia of the bronchi in response to aspiration
D. Atrophy of the bronchial submucosal glands
E. Extensive dystrophic calcification
Answer for Question 42
Answer: B (squamous metaplasia of the bronchi)
Explanation: due to prolonged exposure to the toxins in cigarette smoke, the lining of the trachea and bronchi can switch from respiratory type epithelium to squamous metaplasia, as the squamous metaplasia is better designed to handle such exposures. With no history of a condition producing elevated serum concentrations of calcium (e.g., parathyroid gland adenoma) metastatic calcification would not occur. While dystrophic calcification could be present as aged tissue is damaged to some extent and can calcify, it should not be extensive in distribution. Patients who smoke can develop chronic bronchitis, which would be associated with hyperplasia of submucosal glands. With no history of a neuromuscular condition predisposing to aspiration, chronic aspiration is very unlikely, also, if gastric metaplasia did occur in patients, it would be very rare to find.
QUESTION 43
A hospital surgical pathologist is examining the right lung of a 64-year-old male, who underwent a pneumonectomy for the treatment of a non-small cell carcinoma of the lung. Given that the patient had a long history of heavy cigarette use, of the following, which is the pathologist most likely to identify on microscopic examination of the non-neoplastic lung tissue adjacent to the tumor?
A. Abundant anthracotic pigment and focal squamous metaplasia
B. Abundant anthracotic pigment and focal respiratory metaplasia
C. Abundant anthracotic pigment and focal osseous metaplasia
D. Scant anthracotic pigment and numerous Russell bodies
E. Scant anthracotic pigment and prominent steatosis
Answer for Question 43
Answer: A (abundant anthracotic pigment and focal squamous metaplasia)
Explanation: a patient with a long history of heavy cigarette use would be expected to have prominent amount of anthracotic pigment (i.e., carbonaceous pigment). In addition, with long term exposure to cigarette smoke, the respiratory epithelium can undergo squamous metaplasia. This process can lead to the development of a squamous cell carcinoma in the lung (i.e., one form of non-small cell carcinoma). Respiratory metaplasia does not occur, as the respiratory epithelium is the expected normal type of epithelium. Honey comb change can have respiratory epithelium, but this would be expected in a person with a history of interstitial lung disease. Steatosis is most commonly encountered in the liver, but also the heart and skeletal muscle, but essentially not in the lung. Russell bodies would be found in plasma cells, and plasma cells could be found in the lung in this case; however, the number of Russell bodies would not be prominent and scant anthracotic pigment would not be what was expected.
QUESTION 44
In a research laboratory, using a restriction endonuclease to cleave nuclear DNA derived from a certain normal organ typically yields four bands. A student is examining a gel from the same organ, however, the nuclear DNA is present in multiple discrete bands. Of the following, what was the most likely source of the DNA?
A. Infarcted myocardium
B. Cerebellar hemorrhage
C. Menstrual phase endometrium
D. Abscess fluid
E. Cerebellar infarct
Answer for Question 44
Answer: C (menstrual phase endometrium)
Explanation: apoptosis is an orderly destruction of a cell. During the menstrual cycle, the endometrium thickens in preparation for implantation; however, if implantation does not occur, the proliferated tissue must be removed. Apoptosis would allow for an orderly removal of tissue without promoting a significant inflammatory infiltrate. As a part of apoptosis, the nucleus is fragmented, and the DNA when run on a gel will then appear as numerous discrete bands whereas in necrosis, which is uncoordinated destruction of the nucleus, the DNA run on a gel would appear more as a smear.
QUESTION 45
A forensic pathologist is examining a section of skin under the microscope. In the dermis is a collection of pigment, which appears as yellow-brown granules of various sizes. Of the following, what was the source of the pigment?
A. A tattoo
B. Undiagnosed melanoma
C. Healed bruise
D. Advanced age
E. Parathyroid adenoma
Answer for Question 45
Answer: C (healed bruise)
Explanation: the pigment described is hemosiderin, which accumulates due to the breakdown of red blood cells. A collection of hemosiderin would be associated with a healed bruise (due to the breakdown of red blood cells that would have accumulated at the site). While tattoo pigment can occur in the dermis, it would be more of a finely stippled black coloration, as would melanin, which would be finely stippled and brown to black in color. Lipofuscin, which is a finely stippled yellow-brown pigment, is associated with increasing age; however, the dermis is not a location where it is identified, instead it is commonly found in the heart, liver, and neurons. A parathyroid adenoma would be associated with metastatic calcification; however, deposits of calcium are basophilic.