This is Part 1 of the Pathology
Fundamentals 11th Edition
Comprehensive Test Bank by Robbins
and Cotran.
TABLE OF CONTENTS - PART 1 of 5
Chapter 1: Cell Injury, Cell Death, and Adaptations (Questions 1-25)
Chapter 2: Inflammation and Repair (Questions 26-50)
Chapter 3: Hemodynamic Disorders, Thromboembolism, and Shock (Questions 51-75)
Chapter 4: Genetic Disorders and Pediatric Pathology (Questions 76-100)
CHAPTER 1: CELL INJURY, CELL DEATH, AND ADAPTATIONS
Q1. A 55-year-old man with a history of chronic alcohol use presents with fatigue and hepatomegaly.
Liver biopsy shows hepatocytes with enlarged, pale, vacuolated cytoplasm. Which of the following is
the most likely cellular adaptation?
A. Steatosis
B. Atrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: Steatosis ✓
Rationale: Steatosis, or fatty change, is characterized by the accumulation of triglycerides
within hepatocytes, producing enlarged, pale, vacuolated cytoplasm, and is commonly seen in
chronic alcohol use. Atrophy is a decrease in cell size, hyperplasia is an increase in cell number, and
metaplasia is a reversible change of one differentiated cell type to another. The vacuolated
hepatocytes are classic for steatosis.
,Q2. A 65-year-old woman with long-standing hypertension presents with left ventricular hypertrophy
on echocardiography. Which of the following cellular adaptations best explains this finding?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: Hypertrophy ✓
Rationale: Hypertrophy is an increase in the size of cells, resulting in an increase in the size of
the organ, and is the adaptation seen in cardiac muscle in response to increased workload from
hypertension. Hyperplasia is an increase in cell number, atrophy is a decrease in cell size, and
metaplasia is a change from one cell type to another. The ventricular enlargement is classic for
hypertrophy.
Q3. A 45-year-old woman with a history of gastroesophageal reflux disease undergoes endoscopy.
Biopsy of the distal esophagus shows columnar epithelium replacing squamous epithelium. Which of
the following is the most likely diagnosis?
A. Barrett esophagus
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Esophagitis
Correct Answer: Barrett esophagus ✓
Rationale: Barrett esophagus is characterized by metaplasia of the distal esophageal
squamous epithelium to columnar epithelium, which is a complication of chronic gastroesophageal
reflux disease and a risk factor for adenocarcinoma. Squamous cell carcinoma arises from squamous
epithelium, adenocarcinoma arises from glandular epithelium, and esophagitis is inflammation of the
esophagus. The columnar metaplasia is classic for Barrett esophagus.
Q4. A 70-year-old man dies suddenly. Autopsy shows a wedge-shaped area of coagulative necrosis in
the myocardium with preservation of tissue architecture. Which of the following is the most likely
cause?
A. Myocardial infarction
B. Carbon monoxide poisoning
C. Hypoxic encephalopathy
D. Pancreatitis
Correct Answer: Myocardial infarction ✓
,Rationale: Coagulative necrosis is characterized by preservation of tissue architecture and is
most commonly caused by ischemia, such as myocardial infarction. Carbon monoxide poisoning
causes hypoxic injury, hypoxic encephalopathy causes liquefactive necrosis in the brain, and
pancreatitis causes fat necrosis. The wedge-shaped area of coagulative necrosis in the myocardium is
classic for myocardial infarction.
Q5. A 60-year-old man with a history of diabetes mellitus presents with a non-healing foot ulcer.
Biopsy shows liquefactive necrosis. Which of the following is the most likely cause?
A. Bacterial infection
B. Ischemic heart disease
C. Pancreatitis
D. Tuberculosis
Correct Answer: Bacterial infection ✓
Rationale: Liquefactive necrosis is characterized by enzymatic digestion of tissue, resulting in a
liquid viscous mass, and is most commonly caused by bacterial infection. Ischemic heart disease
causes coagulative necrosis, pancreatitis causes fat necrosis, and tuberculosis causes caseous
necrosis. The liquefactive necrosis in a non-healing ulcer is classic for bacterial infection.
Q6. A 50-year-old woman with a history of tuberculosis presents with a lung cavity. Biopsy shows a
granuloma with a cheese-like, friable center. Which of the following types of necrosis is most likely
present?
A. Caseous necrosis
B. Coagulative necrosis
C. Liquefactive necrosis
D. Fat necrosis
Correct Answer: Caseous necrosis ✓
Rationale: Caseous necrosis is characterized by a cheese-like, friable center and is most
commonly associated with tuberculosis. Coagulative necrosis is caused by ischemia, liquefactive
necrosis is caused by bacterial infection, and fat necrosis is caused by pancreatitis. The granuloma
with a cheese-like center is classic for caseous necrosis.
Q7. A 55-year-old man with a history of acute pancreatitis presents with severe abdominal pain.
Biopsy shows chalky-white deposits in the pancreas. Which of the following types of necrosis is most
likely present?
A. Fat necrosis
, B. Coagulative necrosis
C. Liquefactive necrosis
D. Caseous necrosis
Correct Answer: Fat necrosis ✓
Rationale: Fat necrosis is characterized by chalky-white deposits and is most commonly
associated with acute pancreatitis. Coagulative necrosis is caused by ischemia, liquefactive necrosis is
caused by bacterial infection, and caseous necrosis is associated with tuberculosis. The chalky-white
deposits in the pancreas are classic for fat necrosis.
Q8. A 70-year-old man with a history of atherosclerosis presents with gangrene of the toes. Which of
the following types of necrosis is most likely present?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: Coagulative necrosis ✓
Rationale: Coagulative necrosis is caused by ischemia and is the type of necrosis seen in
gangrene due to atherosclerosis. Liquefactive necrosis is caused by bacterial infection, caseous
necrosis is associated with tuberculosis, and fat necrosis is associated with pancreatitis. The
gangrene of the toes is classic for coagulative necrosis.
Q9. A 45-year-old woman with a history of systemic lupus erythematosus presents with a malar rash.
Biopsy shows deposition of immunoglobulin and complement at the dermal-epidermal junction.
Which of the following types of hypersensitivity reaction is most likely involved?
A. Type III hypersensitivity
B. Type I hypersensitivity
C. Type II hypersensitivity
D. Type IV hypersensitivity
Correct Answer: Type III hypersensitivity ✓
Rationale: Type III hypersensitivity is characterized by the deposition of immune complexes in
tissues, leading to complement activation and inflammation, and is seen in systemic lupus
erythematosus. Type I hypersensitivity is mediated by IgE, type II hypersensitivity is mediated by
antibodies against cell surface antigens, and type IV hypersensitivity is mediated by T cells. The
immune complex deposition is classic for type III hypersensitivity.
Fundamentals 11th Edition
Comprehensive Test Bank by Robbins
and Cotran.
TABLE OF CONTENTS - PART 1 of 5
Chapter 1: Cell Injury, Cell Death, and Adaptations (Questions 1-25)
Chapter 2: Inflammation and Repair (Questions 26-50)
Chapter 3: Hemodynamic Disorders, Thromboembolism, and Shock (Questions 51-75)
Chapter 4: Genetic Disorders and Pediatric Pathology (Questions 76-100)
CHAPTER 1: CELL INJURY, CELL DEATH, AND ADAPTATIONS
Q1. A 55-year-old man with a history of chronic alcohol use presents with fatigue and hepatomegaly.
Liver biopsy shows hepatocytes with enlarged, pale, vacuolated cytoplasm. Which of the following is
the most likely cellular adaptation?
A. Steatosis
B. Atrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: Steatosis ✓
Rationale: Steatosis, or fatty change, is characterized by the accumulation of triglycerides
within hepatocytes, producing enlarged, pale, vacuolated cytoplasm, and is commonly seen in
chronic alcohol use. Atrophy is a decrease in cell size, hyperplasia is an increase in cell number, and
metaplasia is a reversible change of one differentiated cell type to another. The vacuolated
hepatocytes are classic for steatosis.
,Q2. A 65-year-old woman with long-standing hypertension presents with left ventricular hypertrophy
on echocardiography. Which of the following cellular adaptations best explains this finding?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: Hypertrophy ✓
Rationale: Hypertrophy is an increase in the size of cells, resulting in an increase in the size of
the organ, and is the adaptation seen in cardiac muscle in response to increased workload from
hypertension. Hyperplasia is an increase in cell number, atrophy is a decrease in cell size, and
metaplasia is a change from one cell type to another. The ventricular enlargement is classic for
hypertrophy.
Q3. A 45-year-old woman with a history of gastroesophageal reflux disease undergoes endoscopy.
Biopsy of the distal esophagus shows columnar epithelium replacing squamous epithelium. Which of
the following is the most likely diagnosis?
A. Barrett esophagus
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Esophagitis
Correct Answer: Barrett esophagus ✓
Rationale: Barrett esophagus is characterized by metaplasia of the distal esophageal
squamous epithelium to columnar epithelium, which is a complication of chronic gastroesophageal
reflux disease and a risk factor for adenocarcinoma. Squamous cell carcinoma arises from squamous
epithelium, adenocarcinoma arises from glandular epithelium, and esophagitis is inflammation of the
esophagus. The columnar metaplasia is classic for Barrett esophagus.
Q4. A 70-year-old man dies suddenly. Autopsy shows a wedge-shaped area of coagulative necrosis in
the myocardium with preservation of tissue architecture. Which of the following is the most likely
cause?
A. Myocardial infarction
B. Carbon monoxide poisoning
C. Hypoxic encephalopathy
D. Pancreatitis
Correct Answer: Myocardial infarction ✓
,Rationale: Coagulative necrosis is characterized by preservation of tissue architecture and is
most commonly caused by ischemia, such as myocardial infarction. Carbon monoxide poisoning
causes hypoxic injury, hypoxic encephalopathy causes liquefactive necrosis in the brain, and
pancreatitis causes fat necrosis. The wedge-shaped area of coagulative necrosis in the myocardium is
classic for myocardial infarction.
Q5. A 60-year-old man with a history of diabetes mellitus presents with a non-healing foot ulcer.
Biopsy shows liquefactive necrosis. Which of the following is the most likely cause?
A. Bacterial infection
B. Ischemic heart disease
C. Pancreatitis
D. Tuberculosis
Correct Answer: Bacterial infection ✓
Rationale: Liquefactive necrosis is characterized by enzymatic digestion of tissue, resulting in a
liquid viscous mass, and is most commonly caused by bacterial infection. Ischemic heart disease
causes coagulative necrosis, pancreatitis causes fat necrosis, and tuberculosis causes caseous
necrosis. The liquefactive necrosis in a non-healing ulcer is classic for bacterial infection.
Q6. A 50-year-old woman with a history of tuberculosis presents with a lung cavity. Biopsy shows a
granuloma with a cheese-like, friable center. Which of the following types of necrosis is most likely
present?
A. Caseous necrosis
B. Coagulative necrosis
C. Liquefactive necrosis
D. Fat necrosis
Correct Answer: Caseous necrosis ✓
Rationale: Caseous necrosis is characterized by a cheese-like, friable center and is most
commonly associated with tuberculosis. Coagulative necrosis is caused by ischemia, liquefactive
necrosis is caused by bacterial infection, and fat necrosis is caused by pancreatitis. The granuloma
with a cheese-like center is classic for caseous necrosis.
Q7. A 55-year-old man with a history of acute pancreatitis presents with severe abdominal pain.
Biopsy shows chalky-white deposits in the pancreas. Which of the following types of necrosis is most
likely present?
A. Fat necrosis
, B. Coagulative necrosis
C. Liquefactive necrosis
D. Caseous necrosis
Correct Answer: Fat necrosis ✓
Rationale: Fat necrosis is characterized by chalky-white deposits and is most commonly
associated with acute pancreatitis. Coagulative necrosis is caused by ischemia, liquefactive necrosis is
caused by bacterial infection, and caseous necrosis is associated with tuberculosis. The chalky-white
deposits in the pancreas are classic for fat necrosis.
Q8. A 70-year-old man with a history of atherosclerosis presents with gangrene of the toes. Which of
the following types of necrosis is most likely present?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: Coagulative necrosis ✓
Rationale: Coagulative necrosis is caused by ischemia and is the type of necrosis seen in
gangrene due to atherosclerosis. Liquefactive necrosis is caused by bacterial infection, caseous
necrosis is associated with tuberculosis, and fat necrosis is associated with pancreatitis. The
gangrene of the toes is classic for coagulative necrosis.
Q9. A 45-year-old woman with a history of systemic lupus erythematosus presents with a malar rash.
Biopsy shows deposition of immunoglobulin and complement at the dermal-epidermal junction.
Which of the following types of hypersensitivity reaction is most likely involved?
A. Type III hypersensitivity
B. Type I hypersensitivity
C. Type II hypersensitivity
D. Type IV hypersensitivity
Correct Answer: Type III hypersensitivity ✓
Rationale: Type III hypersensitivity is characterized by the deposition of immune complexes in
tissues, leading to complement activation and inflammation, and is seen in systemic lupus
erythematosus. Type I hypersensitivity is mediated by IgE, type II hypersensitivity is mediated by
antibodies against cell surface antigens, and type IV hypersensitivity is mediated by T cells. The
immune complex deposition is classic for type III hypersensitivity.
