Clinical Pathology Question Bank

Read the Clinical Pathology Question Bank sample questions

1. 1.A 50-year old man has blood pressure of 150/90 mm Hg. If this person remains untreated for years, which of the following cellular alterations will be seen in the myocardium?

   • A.atrophy
   • B.metaplasia
   • C.hypertrophyCorrect
   • D.dysplasia

   Why: Chronic pressure overload from hypertension forces cardiac myocytes to add sarcomeres and protein, increasing cell size. Because adult cardiac muscle is permanent (non-dividing), it adapts by hypertrophy, producing left ventricular hypertrophy.

2. 2.On day 28 of her menstrual cycle, a 26-year old woman experiences menstrual bleeding which lasts for 5 days. She has had regular cycles for many years. Which of the following processes is most likely occurring in the endometrium just before onset of bleeding?

   • A.apoptosisCorrect
   • B.heterophagocytosis
   • C.liquefactive necrosis
   • D.hyperplasia

   Why: Just before menstruation, falling progesterone and estrogen from the regressing corpus luteum withdraw hormonal support, triggering apoptosis of the secretory endometrium. This programmed, non-inflammatory cell deletion, with ischemia, precedes shedding of the functional layer.

3. 3.At autopsy, a 60-year old man has an enlarged (2500 g) liver with yellow cut surface. Before death, his total serum cholesterol and triglyceride levels were normal, but he had decreased serum albumin concentration and prolonged prothrombin time. Which of the following activities most likely lead to these findings?

   • A.playing golf
   • B.cigarette smoking
   • C.drinking ginCorrect
   • D.aspirin ingestion

   Why: A large fatty (yellow) liver with low albumin and prolonged prothrombin time but normal lipids indicates alcoholic fatty liver disease. Chronic ethanol (gin) intake causes hepatic steatosis and reduced synthesis of albumin and clotting factors.

4. 4.A 70-year old woman suddenly lost consciousness and on awakening one hour later, she could not speak nor move her right arm and leg. Two months later, a head MRI showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in the brain?

   • A.karyolysis
   • B.fat necrosis
   • C.apoptosis
   • D.liquefactive necrosisCorrect

   Why: Sudden loss of consciousness with later contralateral hemiparesis and aphasia indicates a cerebral infarct. The brain undergoes liquefactive necrosis because abundant hydrolytic enzymes and high lipid content liquefy the dead tissue, eventually leaving a fluid-filled cyst.

5. 5.A 21-year old woman complains of pain during menses (dysmenorrhea). To treat this symptom, she was advised to take indomethacin. This drug may help reduce her pain because it interferes with the production of which one of the following substances?

   • A.bradykininCorrect
   • B.histamine
   • C.leukotrienes
   • D.estrogen

   Why: Indomethacin inhibits cyclooxygenase, reducing prostaglandin synthesis. Lower uterine prostaglandins relieve the painful contractions of primary dysmenorrhea. [REVIEW: keyed answer may be incorrect - the actual mechanism is reduced prostaglandin production; among the options leukotrienes (c) is the closest arachidonic-acid mediator, whereas the keyed bradykinin (a) is not arachidonic-acid derived.]

6. 6.What type of leukocyte actively participates in acute inflammatory processes and contains myeloperoxidase within its primary (azurophilic) granules and alkaline phosphates in its secondary (specific) granules?

   • A.lymphocytes
   • B.neutrophilsCorrect
   • C.eosinophils
   • D.monocytes

   Why: Neutrophils are the principal acute inflammatory leukocyte. Their primary (azurophilic) granules contain myeloperoxidase, while their secondary (specific) granules contain alkaline phosphatase, lysozyme, and lactoferrin.

7. 7.A woman who is allergic to cats visits a friend who keeps several pet cats. During the visit, she inhales cat dander and within minutes, she develops nasal congestion and abundant nasal secretions. Which of the following substances is most likely to produce these findings?

   • A.tumor necrosis factor
   • B.bradykinin
   • C.histamineCorrect
   • D.complement C5a

   Why: Inhaled cat allergen cross-links IgE on sensitized mast cells, causing rapid degranulation. Preformed histamine produces the immediate vasodilation, vascular leakage, and mucus secretion seen as congestion and rhinorrhea in this type I hypersensitivity reaction.

8. 8.After receiving incompatible blood, a patient develops a transfusion reaction in the form of back pain, fever, shortness of breath and hematuria. Which of the following statements best classifies this type of immunologic reaction?

   • A.systemic anaphylactic reaction
   • B.complement-mediated cytotoxicity reactionCorrect
   • C.systemic immune complex reaction
   • D.delayed type hypersensitivity reaction

   Why: An incompatible transfusion lets preformed antibodies bind donor red cell antigens and activate complement, causing intravascular hemolysis. This is a type II (complement-mediated cytotoxic) hypersensitivity reaction, explaining the fever, back pain, and hematuria.

9. 9.A patient presents with a large wound on the left leg as a result of a vehicular accident. Initially his wound is filled with granulation tissue, which is composed of proliferating fibroblasts and new blood vessels (angiogenesis). Which of the following is a growth factor that is capable of inducing all the steps necessary for angiogenesis?

   • A.vascular endothelial growth factorCorrect
   • B.platelet-derived growth factor
   • C.epidermal growth factor
   • D.transforming growth factor

   Why: Vascular endothelial growth factor (VEGF) is the key angiogenic factor driving all steps of new vessel formation: endothelial proliferation, migration, tube formation, and increased permeability.

10. 10.A 16-year old patient has lacerations on his hand which required sutures. The sutures were removed after 10 days. Wound healing continued but the site was disfigured by a prominent, raised nodular scar which developed over the next 2 months. Which of the following terms best describes the process that occurred within this 2- month period?

    • A.organization
    • B.resolution
    • C.keloid formationCorrect
    • D.dehiscence

    Why: A raised, nodular scar extending beyond the original wound margins is a keloid, caused by excessive collagen deposition during healing.