Cell injury & adaptive response

Question 1

Necrosis:
Gangrenous (Wet & Dry)

Answer 1

Wet: Seen in ischemia & is coagulative in nature

Dry: Seen in super infections (i.e clostridium perfringens) & is liquefactive in nature

Both present in distal limbs, testis & Gi tract

Question 2

Necrosis:

Fat (Enzymatic vs Non-enzymatic)

Answer 2

Leaves dead fat cell outlines without peripheral nuclei

Seen in fat saponification (fat turns chalky white, looks dark blue on H&E)

Enzymatic: due to acute pancreatitis
Non-enzymatic: due to trauma

Question 3

Necrosis:

Fibrinoid (Immune vs non-immune mediated)

Answer 3

Vessel walls are outlined by an eosinophilic layer of protein

Seen in type 3 hypersensitivity reactions or from plasma leaking out of blood vessels

Immune vascular reactions (PAN)
Non-immune (Preeclampsia or a hypertensive emergency)

Question 4

Necrosis:

Coagulative

Answer 4

Outlines of cells with no nuclei and cytoplasmic eosinophilia are seen

Happens in ischemia or infarcts (not in brain)

Question 5

Necrosis:

Liquefactive

Answer 5

Early stages show neutrophil/macrophage infiltration & cell debris
Late stages show cystic spaces

Common in bacterial abscesses & brain infarcts

Question 6

Necrosis:

Caseous

Answer 6

Fragmented cells and lymph/macrophages (granuloma) that looks like cheese.

Seen in TB, systemic fungal infections, & nocardiosis

Question 7

Rheumatic arthritis
Peptic ulcers
Immune vasculitis
Preeclampsia
Hypertensive emergency

Are all examples of:

Answer 7

Fibrinoid necrosis

Question 8

Tuberculosis
Systemic fungal infection (Histoplasmosis)
Nocardiosis

Are all examples of:

Answer 8

Caseous necrosis

Question 9

Peripheral arterial disease
Acute limb ischemia
Intestinal ischemia
Clostridium prefringes
Sepsis

All examples of:

Answer 9

Gas gangrenous necrosis

Question 10

Ischemia & causes

Answer 10

Lack of/insufficient blood supply to tissues

Causes:
Low arterial perfusion (atherosclerosis)
Low venous drainage (Testicular torsion or Budd-Chiari syndrome)
Shock

Question 11

Risky areas for ischemia

Answer 11

Brain (ACA, MCA, PCA)

Heart (Sub endocardium of the LV)

Kidney (Proximal tubule & thick ascending limb of renal medulla)

Liver (Zone 3 around the central vein)

Colon (Splenic flexure aka Griffith’s point & Rectosigmoid junction)

Question 12

Red vs Pale infarcts

Answer 12

Red: Seen in venous occlusion & tissues with multiple blood supply (liver, lungs, intestines, & testes) with a reperfusion injury (usually from free radicals)

Pale: Happens in solid organs with a single blood supply (heart & kidneys)

Question 13

What type of necrosis is shown here:

Answer 13

Fibrinoid necrosis

Question 14

Necrosis:

Fibrinoid

Answer 14

Is associated with immune complex vasculitis and hypertension

ex. Hypersensitivity reactions 2 & 3 and Vascular hypertensive damage

Question 15

What is the type of necrosis shown:

Answer 15

Fat necrosis

Question 16

Outlines of necrotic fat cells with basophilic calcium deposits, surrounded with inflammation

Answer 16

Fat necrosis

Question 17

Infection with mycobacterium tuberculosis, systemic fungi (histoplasma capsulatum) and nocardia can cause what type of necrosis

Answer 17

Caseous necrosis

Question 18

Necrosis:

Caseous

Answer 18

Caseous (cheese like) with a granuloma (lysed cells and amorphous granular debris walled off by macrophages

Question 19

Patient is an alcoholic and presents with a lung infection what should you automatically presume they have and what type of necrosis does it progress to?

Answer 19

Patient probably has aspiration which can develop into liquefactive necrosis

Question 20

Nuclear shrinkage and more basophilia

Answer 20

Pyknosis

Question 21

Nucleus undergoes fragmentation

Answer 21

Karyorrhexis

Question 22

Fading/disappearing chromatin (loss of DNA vie endonucleases)

Answer 22

Karyolysis

Question 23

60 Yr old patient presents with left lower quadrant pain and chronic constipation what is the next step of action for the test and the possible results?

Answer 23

Preform a Guaiac stool test (blood in stool)

+ test could mean Diverticulosis or colon cancer

Preform a colonoscopy:
Herniations(Diverticulosis)
Masses (Colon cancer)

Question 24

Patient presents with cardiac hypertrophy, if no other info is given it’s the _____ side & if lung disease is involved it’s the ____ side

Answer 24

Left ventricular hypertrophy

or

Right ventricular hypertrophy

Question 25

Breasts during puberty (Hyperplasia or Hypertrophy)

Answer 25

Hypeplasia (estrogen)

Question 26

Breast feeding mother (Hyperplasia or Hypertrophy)

Answer 26

Hyperplasia (prolactin)

Question 27

Chronic hypertension in a older man (Hyperplasia or Hypertrophy)

Answer 27

Hypertrophy

Question 28

Blood losses effect on bone marrow (Hyperplasia or Hypertrophy)

Answer 28

Hyperplasia (erythropoietin)

Question 29

Patient receives a partial liver transplant, & the organ regrows to it's original size (Hyperplasia or Hypertrophy)

Answer 29

Hyperplasia (Hepatocyte growth factor)

Question 30

Iron deficient & anemic patient starts taking iron supplements. What happens to the bone marrow? (Hyperplasia or Hypertrophy)

Answer 30

Hyperplasia (Iron increases heme levels which fuel more new RBC production)

Question 31

Iron deficiency in hypothyroidism triggers what (Hyperplasia or Hypertrophy)

Answer 31

Thyroid hyperplasia (TSH)

Question 32

HPV types 6 & 8 warts (Hyperplasia or Hypertrophy)

Answer 32

Hyperplasia

Question 33

Graves disease (autoimmune IgG against thyroid tissue) triggers (Hyperplasia or Hypertrophy)

Answer 33

Thyroid hyperplasia

Question 34

Female patient, 40 yrs old presents with irregular menstruation. Testing shows a normal cervix what is the likely condition and ass risk

Answer 34

Hyperplastic endometrium and high risk of cancer

Question 35

Patient presents with neck fat (buffalo hump), moon face, purple streaks in skin, and osteoporosis. What's the diagnosis and pathology

Answer 35

Cushing's disease due to a pituitary adenoma which increases ACTH secretions from the zona fasciculata in the adrenals

Question 36

Continuous stress reprograms stem cells to differentiate into another cell type

Answer 36

Metaplasia

Question 37

Patient has a positive guaiac test and colonoscopy shows polyps

Answer 37

colon polyps (Hyperplasia of colonic villi) super high risk of cancer (100%)

Question 38

Menstrual period stops & the endometrium sheds (what type of cellular adaptation?)

Answer 38

Apoptosis

Question 39

A breastfeeding mother weans her baby, and her breast size shrinks (What type of cellular adaptation?)

Answer 39

Apoptosis

Question 40

Graft vs. host disease (What type of cellular adaptation)

Answer 40

Apoptosis

Question 41

What characteristic about mycobacterium TB causes caseous necrosis?

Answer 41

the waxy coat (usually presents in the apical lobe)

Question 42

Patient presents with pain in the left lumbar region which radiates to the back, they said a few days prior they attended a Redskins tail gate party and drank their weight in alcohol What's the likely diagnosis?

Answer 42

Pancreatitis

Question 43

Most common cause of pancreatitis?

Answer 43

Alcoholism

Question 44

Patient presents with chronic hepatitis B, fever, and nodules in their hands, upon examination you notice multiple needle stick injuries. What is the type of necrosis they are experiencing?

Answer 44

Fibrinoid

Question 45

Patient presents with stroke and chronic hypertension, what type of necrosis will they have?

Answer 45

Fibrinoid

Question 46

A diabetic patient presents with discolored feet with no distal pedal pulse. What type of necrosis is this? Additionally the same patient later in hospital develops exudate/pus within the discolored tissue what is the necrosis?

Answer 46

Dry gangrene & Wet gangrene