1. A 20 -year-old boy sustained blunt trauma to the abdomen when the vehicle he was driving struck a bridge abutment at high speed. Peritoneal lavage shows a hemoperitoneum, and at laparotomy, a small portion of the left lobe of the liver is removed because of the injury. Several weeks later, a CT scan of the abdomen shows that the liver has nearly regained its size before the injury. Which of the following processes best explains this CT scan finding?
(C) Fatty change
CORRECT ANSWER : OPTION D : HYPERPLASIA. Ref: Robbins and Cotran Pathologic Basis of Disease. SouthAsia Edition ,Volume I : Page 36 The question is regarding the adaptations of cell following injury. Hyperplasia is increase in the number of cells in an organ or tissue in response to a stimulus. The liver is one of the few organs in the human body that can partially regenerate. This is a form of compensatory physiological hyperplasia. Hyperplasia is the result of growth factor driven proliferation of mature surviving cells. The stimuli to hepatocyte mitotic activity cease when the liver has attained its normal size.
Option A : Apoptosis (INCORRECT). Apoptosis is programmed cell death. In certain viral infections, the loss of infected cells is due to apoptosis induced by the virus , frequently occurs in viral hepatitis. Option
B:Dysplasia (INCORRECT). Dysplasia is disordered epithelial cell growth that can be premalignant. Option
C: Fatty change. Fatty change can lead to hepatomegaly. This is not a regenerative process, but as a result of toxic hepatocyte injury.
2. A 50-year-old man, smoker, had undifferentiated carcinoma of the lung. Despite chemotherapy, the man died of widespread metastases. At autopsy, tumors were found in many organs. Histologic examination showed many foci in which individual tumor cells appeared shrunken and deeply eosinophilic. Their nuclei exhibited condensed aggregates of chromatin under the nuclear membrane. The process affecting these shrunken tumor cells was most likely triggered by the release of which of the following substances into the cytosol?
(B) Cytochrome c
CORRECT ANSWER : OPTION B: CYTOCHROME C. Ref: Robbins and Cotran Pathologic Basis of Disease. SouthAsia Edition ,Volume I : Page 55 This histologic picture- (cell shrinkage, deeply eosinophilic cytoplasm and chromatin condensation) is typical of apoptosis produced by chemotherapeutic agents. The release of cytochrome c from the mitochondria into cytosol is a key step in many forms of apoptosis, and it leads to the activation of caspases.Release of cytochrome C is the initiator of apoptosis.
Option A : lipofuscin (INCORRECT). Lipofuscin is a pigmented residue representing undigested cellular organelles in autophagic vacuoles. Lipofuscin is a “wear-and-tear” pigment that increases with aging, particularly in liver and myocardiumand in patients with severe malnutrition. Histologically it appears as yellowbrown, finely granular cytoplasmic pigment.
Option C: BCL-2 (INCORRECT). BCL-2 is an antiapoptotic protein that prevents cytochrome c release by keeping mitochondrial outer membrane impermeable and prevents caspase activation.
Option D :Phospholipase (INCORRECT). Phospholipases are activated during necrosis. Phospholipase activation is calcium dependent and results in phospholipid breakdown → lipid breakdown products→ membrane damage.
3. A 71-year-old man diagnosed with pancreatic cancer is noted to have decreasing body mass index. His normal cells comprising skeletal muscle undergo atrophy by sequestering organelles and cytosol in a vacuole followed by fusion with a lysosome. However, the cancer continues to increase in size. Which of the following processes is most likely occurring in the normal cells but inhibited in the cancer cells of this man?
(D) Hyaline change
CORRECT ANSWER : OPTION C : AUTOPHAGY Ref: Robbins and Cotran Pathologic Basis of Disease. SouthAsia Edition ,Volume I : Page 60 The process of sequestration of organelles and followed by lysosomal fusion suggests autophagy. Autophagy is a form of cellular downsizing in response to stress, as the cell eats its own contents by upregulating Atgs(autophagy related genes) genes. Cell death triggered by autophagy has different mechanism than apoptosis, a form of single cell necrosis in which cell fragmentation occurs.Cancer cells acquire the ability to avoid autophagy ,by downregulating PTEN gene expression, and maintain a survival advantage even as the patient is dying.Autophagy can promote cancer growth and acts as a defence against cancer.
Option A : Aging (INCORRECT). There is slow autophagy with aging, but autophagy is accelerated with stressors such as malnutrition and chronic disease.
Option B : Apoptosis (INCORRECT).apoptosis removes cells that are damaged beyond repair .
Option D : hyaline change (INCORRECT). Hyaline is a generic term for intracellular or extracellular protein accumulations appearing as homogenous glassy pink with H&E staining
4. A 38 year old man with his body mass index is <22 .He fully expects to live long because he has read that caloric restriction prolongs life.He has read that red wine promotes longevity and lifestyle modification promotes increased insulin sensitivity and glucose utilization In this man, which of the following proteins will most likely mediate the effect of calorie restriction upon increased longevity?
CORRECT ANSWER : OPTION C : SIRTUINS Ref: Robbins and Cotran Pathologic Basis of Disease. SouthAsia Edition ,Volume I : Page 67 The one way for increased longevity is calorie restriction. Dietary excesses lead to increased morbidity with reduced quality of life, as well as mortality, from chronic diseases such as diabetes mellitus. The histone deacetylase activity of sirtuins may promote transcription of genes encoding for proteins that increase metabolic activity and inhibit effects of free radicals. Red wines have been shown to increase sirtuins when taken in moderate amounts.
Option A : caspase (INCORRECT). Caspases are the enzymes that trigger apoptosis and promotes cell death.
Option B : glutathione(INCORRECT) Glutathione promotes free radical breakdown, though chronic excessive alcohol consumption depletes hepatocyte glutathione.
Option D : telomerase(INCORRECT) Telomerases aid in promoting continued cell division, but cannot be altered by lifestyle, and turning them on is one feature of neoplasia.
5. A 40-year-old man has had midepigastric abdominal pain for the past 3 months. An upper gastrointestinal endoscopy shows a 2-cm, sharply demarcated, shallow ulceration of the gastric antrum. A biopsy specimen of the ulcer base shows angiogenesis, fibrosis, and mononuclear cell infiltrates with lymphocytes, macrophages, and plasma cells. Which of the following terms best describes this pathologic process?
(A) Acute inflammation
(B) Serous inflammation
(C) Granulomatous inflammation
(D) chronic inflammation
CORRECT ANSWER : OPTION D : CHRONIC INFLAMMATION. Ref: Robbins and Cotran Pathologic Basis of Disease. SouthAsia Edition ,Volume I : Page 93 The clues for diagnosis – pain for 3 months and the histopathological findings characteristics of chronic inflammation is tissue destruction, mononuclear cell infiltration and healing (fibrosis and angiogenesis).Mononuclear cell infiltration includes macrophages and lymphocytes. Chronic inflammation is one of the outcome of the acute inflammation.
Option A : acute inflammation (INCORRECT). In acute inflammation, the healing process of fibrosis and angiogenesis has not begun.Acute inflammation is characterised by vasodilatation and increased vascular permeability and leucocytes (predominantly neutrophils ) are recruited.
Option B : serous inflammation (INCORRECT). Serous inflammation is the mildest form of acute inflammation. A blister is a good example of serous inflammation. It is associated primarily with exudation of less protein fluid into the subcorneal or subepidermal space.
Option C: granulomatous inflammation (INCORRECT). Granulomatous inflammation is characterized by collections of transformed macrophages called epithelioid cell along with lymphocytes with central necrosis.It is a form of chronic inflammation