Chapter 2 – Cell Injury, Cell Death, and Adaptations

GENERAL PATHOLOGY

The growth factor erythropoietin is activated that stimulate the growth of red blood cell progenitors, allowing red blood cell production to increase as much as eightfold.

True

Telomere attrition. One mechanism of replicative senescence involves progressive shortening of telomeres, which ultimately results in cell cycle arrest.

True

The most common epithelial metaplasia is columnar to squamous as occurs in the respiratory tract in response to chronic irritation.

True

Fibrinoid necrosis is a special form of vascular damage usually seen in immune reactions involving blood vessels

True

Necrotic cells show increased eosinophilia in H&E stains, attributable in part to the loss of cytoplasmic RNA and in part to accumulation of denatured cytoplasmic proteins

True

Apoptosis results from the activation of enzymes called caspases

True

Necrosis-associated leakage of intracellular proteins through damaged plasma membranes and ultimately into the circulation is the basis for blood tests that detect tissue-specific cellular injury

True

Adaptations are reversible functional and structural responses to changes in physiologic states (e.g., pregnancy) and some pathologic stimuli

True

Necroptosis. As the name indicates, this form of cell death is a hybrid that shares aspects of both necrosis and apoptosis

True

Pyroptosis occurs in cells infected by microbes

True

Metaplasia from columnar to squamous type may also occur, as in Barrett esophagus

False

Physiologic hypertrophy is enlargement of the heart in response to pressure overload, usually resulting from hypertension

False

Hypertrophy is purely physiologic and is caused by increased functional demand or stimulation by hormones and growth factors.

False

Hypertrophy is purely physiologic and is caused by increased functional demand or stimulation by hormones and growth factors

False

Cardiac-specific troponins can be detected in the blood as early as 12 hours after myocardial cell necrosis

False

Hyperplasia is an increase in the size of cells in an organ or tissue in response to a stimulus

False

Pathologic hyperplasia constitutes a fertile soil in which benign proliferations may eventually arise

False

Cell injury is always reversible

False

Nutrient deprivation triggers an adaptive cellular response called necrosis that may also culminate in cell death.

False

Metaplasia is an irreversible change in which one differentiated cell type (epithelial or mesenchymal) is replaced by another cell type

False

APOPTOSIS unregulated mechanism of cell death that serves to eliminate unwanted and irreparably damaged cells

False

Apoptosis in Pathologic Conditions

a. pathologic hypertrophy in parenchymal organs after duct obstruction

b. RNA damage

c. Accumulation of folded proteins

d. Apoptosis can be induced during certain infections, particularly viral infections

Apoptosis can be induced during certain infections, particularly viral infections

Pathologic atrophy has several causes

a. Loss of innervation (denervation atrophy)

b. all of the above

c. Decreased workload (disuse atrophy)

d. Inadequate nutrition

e. Diminished blood supply

All of the above

Apoptosis is important in the following physiologic situations:

a. Elimination of potentially harmful self-reactive lymphocytes

b. Involution of hormone-dependent tissues on hormone withdrawal

c. The removal of supernumerary cells

d. All of the above e. Cell turnover in proliferating cell populations

All of the above

Which ONE of the following may stimulate apoptosis via the extrinsic pathway?

a. Cell membrane damage

b. Viral infection

c. DNA damage

d. Binding of tumour necrosis factor (TNF) to the death receptor

e. Mitochondrial damage

Binding of tumour necrosis factor (TNF) to the death receptor

Which of the following are NOT examples of responses to early cellular damage?

a. Steatosis

b. Mitochondrial dilation

c. Karyorrhexis

d. Cloudy swelling

e. Hydropic degeneration

Karyorrhexis

On day 28 of her menstrual cycle, a 23-year-old woman experiences onset of menstrual bleeding that lasts for 6 days. She has had regular cycles since menarche. Which of the following processes most likely occurs in her endometrial cells to initiate the onset of menstrual bleeding?

Apoptosis

In an experiment, a large amount of a drug is administered to experimental organisms and is converted by cytochrome P-450 to a toxic metabolite. Accumulation of this metabolite leads to increased intracellular lipid peroxidation. Depletion of which of the following intracellular substances within the cytosol exacerbates this form of cellular injury by this mechanism?

Glutathione

A 47-year-old man has a lung carcinoma with metastases. He receives chemotherapy. A month later, histologic examination of a metastatic lesion shows many foci in which individual tumor cells appear shrunken and deeply eosinophilic. Their nuclei exhibit condensed aggregates of chromatin under the nuclear membrane. The pathologic process affecting these shrunken tumor cells is most likely triggered by release of which of the following substances into the cytosol?

Cytochrome c

An 11-year-old girl becomes infected with hepatitis A and experiences mild nausea for 1 week. On physical examination, she has minimal right upper quadrant tenderness and scleral icterus. Laboratory findings include a serum AST of 68 U/L, ALT of 75 U/L, and total bilirubin of 5.1 mg/dL. Her laboratory findings most likely result from which of the following changes in her hepatocytes?

Cell membrane defects

A 22-year-old woman becomes pregnant. A fetal ultrasound examination at 13 weeks’ gestation shows her uterus measures 7 × 4 × 3 cm. At delivery of a term infant, her uterus measures 34 × 18 × 12 cm. Which of the following cellular processes has contributed most to the increase in her uterine size?

Myometrial smooth muscle hypertrophy

A study of aging shows that senescent cells have accumulated damage from toxic byproducts of metabolism. There is increased intracellular lipofuscin deposition. Prolonged ingestion of which of the following substances is most likely to counteract this aging mechanism?

Antioxidants

A 53-year-old woman with no prior illnesses has a routine checkup by her physician. On examination she has a blood pressure of 150/95 mm Hg. If her hypertension remains untreated for years, which of the following cellular alterations would most likely be seen in her myocardium?

Hypertrophy

In a study of viral hepatitis infection, it is observed that cytotoxic T lymphocytes (CTLs) induce death in virally infected hepatocytes. The CTLs release perforin to allow entry of their granules. Which of the following substances is found in those granules that directly activates programmed cell death?

Granzyme B

A 45-year-old woman has had worsening dyspnea for the past 5 years. A chest CT scan shows panlobular emphysema. Laboratory studies show a deficiency of α1-antitrypsin (AAT). Her AAT genotype is PiZZ. A liver biopsy specimen examined microscopically shows abundant PAS-positive globules with in periportal hepatocytes. Which of the following molecular mechanisms is most likely responsible for this finding in her hepatocytes?

Retained misfolded AAT in endoplasmic reticulum

A 77-year-old woman has chronic renal failure. Her serum urea nitrogen is 40 mg/dL. She is given a diuretic medication and loses 2 kg (4.4 lb). She reduces the protein in her diet and her serum urea nitrogen decreases to 30 mg/dL. Which of the following terms best describes cellular responses to disease and treatment in this woman?

Adaptation

A 69-year-old woman has had a chronic cough for the past year. A chest radiograph shows a 6-cm mass in the left lung. A needle biopsy specimen of the mass shows carcinoma. A pneumonectomy is performed, and examination of the hilar lymph nodes reveals a uniform, dark black cut surface. Which of the following factors most likely accounts for the appearance of these lymph nodes?

Cigarette smoking

An experiment analyzes cells for enzyme activity associated with sustained cellular proliferation. Which of the following cells is most likely to have the highest telomerase activity?

Germ cells

A 68-year-old woman suddenly lost consciousness and on awakening 1 hour later, she could not speak or move her right arm. Two months later, a head CT scan showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in her brain?

Liquefactive necrosis

A 20-year-old woman breastfeeds her infant. On examination, her breasts are slightly increased in size. Milk can be expressed from both nipples. Which of the following processes that occurred in her breasts during pregnancy enables her to breastfeed the infant?

Lobular hyperplasia

A tissue preparation is experimentally subjected to a hypoxic environment. The cells in this tissue begin to swell, and chromatin begins to clump in cell nuclei. ATPases are activated, and ATP production decreases. Which of the following ions accumulating in mitochondria and the cytosol contributes most to these findings and to eventual cell death?

Ca2+

A 38-year-old woman has experienced severe abdominal pain over the past day. On examination she is hypotensive and in shock. Laboratory studies show elevated serum lipase. From the representative gross appearance of the mesentery shown in the figure, which of the following events has most likely occurred?

Acute pancreatitis

A new drug is developed that binds to cellular microtubules. The function of the microtubules is diminished, so that mitotic spindle formation is inhibited. Which of the following is the most likely use for this drug?

Chemotherapy

In an experiment, metabolically active cells are subject ed to radiant energy in the form of x-rays. This results in cell injury caused by hydrolysis of water. Which of the following intracellular enzymes helps to protect the cells from this type of injury?

Glutathione peroxidase

An experiment introduces a knockout gene mutation into a cell line. The frequency of shrunken cells with chromatin clumping, karyorrhexis, and cytoplasmic blebbing is increased compared with a cell line without the mutation. Overall survival of the mutant cell line is reduced. Which of the following genes is most likely to be affected by this mutation?

BCL2

A 71-year-old man has had difficulty with urination, including hesitancy and increased frequency, for the past 5 years. A digital rectal examination reveals that his prostate gland is palpably enlarged to twice normal size. A transurethral resection of the prostate is performed, and the microscopic appearance of the prostate “chips” obtained is that of nodules of glands with intervening stroma. Which of the following pathologic processes has most likely occurred in his prostate?

Hyperplasia

An experimental drug administered to a tissue preparation is found to inhibit cellular oxidative phosphorylation when given in high doses, and ATP production drops to 5% of normal. Cell membrane function is diminished. Which of the following substances is most likely to be present at increased concentration in culture fluid bathing the tissue?

Potassium

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