QUESTION 7
A 47-year-old male with a history of hypertension and hyperlipidemia presents to the emergency room with complaints of a pressure sensation in his chest that began 45 minutes ago and radiates into his left and right upper extremity and his jaw. Auscultation of his chest reveals a grade II holosystolic murmur that radiates to the apex. Of the following, which process is responsible for his presenting symptoms?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Necrosis
E. Apoptosis
Answer for Question 7
Answer: D (Necrosis).
Explanation: Given his symptoms (pressure sensation in his chest with radiation to the upper extremities and jaw) and his past medical history of hypertension and hyperlipidemia, he is most likely having an acute myocardial infarct. During an acute myocardial infarct, ischemia of the cardiac myocytes leads to necrosis. While his heart would have likely been enlarged (i.e., cardiac hypertrophy) given his history of hypertension, it would not be the cause of his chest pain. The heart essentially does not undergo hyperplasia as the cardiac myocytes are not capable of division. Ischemia represents an uncontrolled mechanism for causing cell death, and apoptosis, while some could be present, would not be a prominent response compared to necrosis. Atrophy of the heart would be more common in an elderly individual and would not necessarily lead to chest pain; also, given the history of hypertension, hypertrophy and not atrophy would be present.
QUESTION 8
A pathologist is examining the ultrastructural detail of a cardiac myocyte and identifies some swelling of the cell, some swelling of the rough endoplasmic reticulum and mitochondria, and a few myelin figures. Given that the insult had run its course, of the following, which scenario would produce the identified change?
A. A plaque producing 10% stenosis of the lumen of a coronary artery
B. An occlusive thrombus of the coronary artery with successful thrombolysis 15 minutes after its occurrence
C. An occlusive thrombus of the coronary artery with no medical treatment
D. A gunshot wound of the heart
E. Massive cyanide overdose
Answer for Question 8
Answer: B (an occlusive thrombus of the coronary artery with successful thrombolysis 15 minutes after its occurrence)
Explanation: the features listed (some swelling of the cell, some swelling of the rough endoplasmic reticulum and mitochondria, and a few myelin figures) are all consistent with a reversible injury. In a reversible injury the damage done is either relatively minor or quickly reversed or short term (i.e., the cell can recover). Although an occlusive thrombus of the coronary artery would cause the downstream myocytes to become ischemic, and thus, injured, if it is resolved quickly, blood flow will return and no permanent damage is done. Answers C-E would all cause permanent damage (i.e., cell death), and A. would not cause significant blockage of blood flow, and thus, most likely, no injury at all.
QUESTION 9
A researcher wishes to acquire tissue to study the mechanism of apoptosis. Their lab is located at a large medical center attached to a busy public hospital with an active Department of Pathology. The researcher approaches one of the pathologists about acquiring tissue for their research. Of the following, which would provide the best source material to study apoptosis?
A. An amputated gangrenous extremity
B. Tissue from squamous cell carcinoma of the lung
C. Infarcted myocardium
D. Endometrial biopsies with menstrual phase endometrium
E. Tissue from an acute appendicitis
Answer for Question 9
Answer: D (endometrial biopsies with menstrual phase endometrium)
Explanation: necrosis is a disorganized breakdown of dead cells whereas apoptosis is an organized breakdown of dead cells. While apoptosis does occur as a result of pathologic processes (e.g., some viral infections, some accumulations), it usually only occurs when the cellular death is on a cellular level; whereas, when the cellular death is on more of an organ level (e.g., a relatively large segment of an organ), necrosis is the predominant form. Apoptosis also occurs as a result of physiologic processes. During growth of an organism, death of cells must take place at times, but, apoptosis does so without inducing inflammation, which is a damaging process. After endometrium thickens in the proliferative phase, if no implantation occurs, the cells must die, and the best way is via apoptosis. A, B, C, and E are organ-level insults, and would trigger predominantly necrosis.