,Test Bank: Principles of Rubin’s Pathology,
7th Edition
Authors: Rubin & Reisner
,Contents
Chapter 1: Cell Adaptation, Injury, Death, and Aging ................................................................................6
Chapter Summary ................................................................................................................................................6
Multiple Choice Questions (MCQs) ...............................................................................................................6
Chapter 2: Inflammation and Repair ............................................................................................................. 16
Chapter Summary ............................................................................................................................................. 16
Multiple Choice Questions (MCQs) ............................................................................................................ 16
Chapter 3: Immunopathology........................................................................................................................... 26
Chapter Summary ............................................................................................................................................. 26
Multiple Choice Questions (MCQs) ............................................................................................................ 26
Chapter 4: Neoplasia ............................................................................................................................................ 36
Chapter Summary ............................................................................................................................................. 36
Multiple Choice Questions (MCQs) ............................................................................................................ 36
Chapter 5: Developmental and Genetic Diseases ..................................................................................... 45
Chapter Summary ............................................................................................................................................. 45
Multiple Choice Questions (MCQs) ............................................................................................................ 46
Chapter 6: Infectious and Parasitic Diseases ............................................................................................. 54
Chapter Summary ............................................................................................................................................. 54
Multiple Choice Questions (MCQs) ............................................................................................................ 55
Chapter 7: The Amyloidoses ............................................................................................................................. 64
Chapter Summary ............................................................................................................................................. 64
Multiple Choice Questions (MCQs) ............................................................................................................ 64
Chapter 8: Blood Vessels and Hemodynamic Disorders ....................................................................... 73
Chapter Summary ............................................................................................................................................. 73
Multiple Choice Questions (MCQs) ............................................................................................................ 74
Chapter 9: Heart ..................................................................................................................................................... 83
Chapter Summary ............................................................................................................................................. 83
Multiple Choice Questions (MCQs) ............................................................................................................ 83
Chapter 10: The Respiratory System............................................................................................................. 92
Chapter Summary ............................................................................................................................................. 92
Multiple Choice Questions (MCQs) ............................................................................................................ 92
Chapter 11: The Gastrointestinal Tract ..................................................................................................... 101
Chapter Summary .......................................................................................................................................... 101
, Multiple Choice Questions (MCQs) ......................................................................................................... 102
Chapter 12: The Liver and Biliary System ................................................................................................ 112
Chapter Summary .......................................................................................................................................... 112
Multiple Choice Questions (MCQs) ......................................................................................................... 112
Chapter 13: The Exocrine Pancreas ............................................................................................................ 121
Chapter Summary .......................................................................................................................................... 121
Multiple Choice Questions (MCQs) ......................................................................................................... 122
Chapter 14: The Kidney ................................................................................................................................... 131
Chapter Summary .......................................................................................................................................... 131
Multiple Choice Questions (MCQs) ......................................................................................................... 131
Chapter 15: The Lower Urinary Tract and Male Reproductive System ....................................... 140
Chapter Summary .......................................................................................................................................... 140
Multiple Choice Questions (MCQs) ......................................................................................................... 141
Chapter 16: The Female Reproductive Tract .......................................................................................... 150
Chapter Summary .......................................................................................................................................... 150
Multiple Choice Questions (MCQs) ......................................................................................................... 150
Chapter 17: The Breast..................................................................................................................................... 159
Chapter Summary .......................................................................................................................................... 159
Multiple Choice Questions (MCQs) ......................................................................................................... 160
Chapter 18: Hematopathology ...................................................................................................................... 169
Chapter Summary .......................................................................................................................................... 169
Multiple Choice Questions (MCQs) ......................................................................................................... 170
Chapter 19: Endocrine System, Diabetes, and Nutritional Diseases ............................................. 179
Chapter Summary .......................................................................................................................................... 179
Multiple Choice Questions (MCQs) ......................................................................................................... 179
Chapter 20: The Skin ......................................................................................................................................... 189
Chapter Summary .......................................................................................................................................... 189
Multiple Choice Questions (MCQs) ......................................................................................................... 189
Chapter 21: The Head and Neck ................................................................................................................... 198
Chapter Summary .......................................................................................................................................... 198
Multiple Choice Questions (MCQs) ......................................................................................................... 199
Chapter 22: Bones, Joints, and Soft Tissue ............................................................................................... 208
Chapter Summary .......................................................................................................................................... 208
, Multiple Choice Questions (MCQs) ......................................................................................................... 208
Chapter 23: Skeletal Muscle ........................................................................................................................... 218
Chapter Summary .......................................................................................................................................... 218
Multiple Choice Questions (MCQs) ......................................................................................................... 218
Chapter 24: The Central Nervous System and Eye ............................................................................... 228
Chapter Summary .......................................................................................................................................... 228
Multiple Choice Questions (MCQs) ......................................................................................................... 228
Chapter 25: Traumatic and Environmental Injury ............................................................................... 237
Chapter Summary .......................................................................................................................................... 237
Multiple Choice Questions (MCQs) ......................................................................................................... 238
Chapter 26: The Cardiovascular System ................................................................................................... 247
Chapter Summary .......................................................................................................................................... 247
Multiple Choice Questions (MCQs) ......................................................................................................... 247
Chapter 27: The Respiratory System.......................................................................................................... 257
Chapter Summary .......................................................................................................................................... 257
Multiple Choice Questions (MCQs) ......................................................................................................... 257
Chapter 28: The Ear, Nose, and Throat...................................................................................................... 266
Chapter Summary .......................................................................................................................................... 266
Multiple Choice Questions (MCQs) ......................................................................................................... 267
Chapter 29: The Endocrine System, Part 2 .............................................................................................. 276
Chapter Summary .......................................................................................................................................... 276
Multiple Choice Questions (MCQs) ......................................................................................................... 276
Chapter 30: The Nervous System, Part 2 .................................................................................................. 286
Chapter Summary .......................................................................................................................................... 286
Multiple Choice Questions (MCQs) ......................................................................................................... 286
,Chapter 1: Cell Adaptation, Injury, Death, and Aging
Chapter Summary
Chapter 1 explores the fundamental ways cells respond to stress and
injury. It covers cellular adaptations such as hypertrophy, hyperplasia,
atrophy, and metaplasia. The chapter details the mechanisms of cell
injury, including hypoxia, ischemia, and oxidative stress, and
distinguishes between reversible and irreversible injury. It provides an
in-depth look at the two main pathways of cell death: necrosis (and its
various types like coagulative, liquefactive, and caseous) and apoptosis
(the programmed cell death). Additionally, it discusses intracellular
accumulations (like lipofuscin and hemosiderin), pathologic
calcification, and the biological processes involved in cellular aging.
Multiple Choice Questions (MCQs)
1. A 65-year-old man with long-standing hypertension has an enlarged
heart. This increase in the size of the heart is primarily due to which
cellular adaptation?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
**Correct Answer: B**
**Rationale:** **Hypertrophy** is an increase in the size of cells, resulting
in an increase in the size of the organ. In the heart, cardiac myocytes are
,permanent cells and cannot divide; therefore, they respond to increased
workload (stress) by increasing their size (hypertrophy) rather than their
number. Hyperplasia is an increase in the number of cells.
2. Which of the following is a classic example of "Pathologic
Metaplasia"?
A. The enlargement of the uterus during pregnancy
B. The replacement of columnar epithelium by squamous epithelium
in the respiratory tract of a chronic smoker
C. The decrease in muscle mass in a limb immobilized in a cast
D. The formation of a callus on the skin
**Correct Answer: B**
**Rationale:** **Metaplasia** is a reversible change in which one adult
cell type (epithelial or mesenchymal) is replaced by another adult cell
type. In smokers, the normal ciliated columnar epithelium of the trachea
and bronchi is replaced by stratified squamous epithelium, which is better
able to withstand the irritation of cigarette smoke but loses the protective
mucus-secreting and ciliary functions.
3. "Apoptosis" is characterized by all of the following EXCEPT:
A. Cell shrinkage
B. Chromatin condensation
C. Massive inflammatory response
, D. Formation of apoptotic bodies
**Correct Answer: C**
**Rationale:** **Apoptosis** is programmed cell death and is a highly
regulated process. Unlike necrosis, apoptosis does **not** typically elicit
an inflammatory response because the cell membrane remains intact, and
the cellular contents are neatly packaged into apoptotic bodies that are
quickly phagocytosed by neighboring cells or macrophages.
4. The "Intrinsic (Mitochondrial) Pathway" of apoptosis is primarily
triggered by:
A. Activation of death receptors (like Fas or TNF receptor)
B. Increased permeability of the mitochondrial outer membrane and
release of cytochrome c
C. Direct damage to the cell membrane by toxins
D. Bacterial invasion
**Correct Answer: B**
**Rationale:** The **intrinsic pathway** is the major mechanism of
apoptosis in mammalian cells. It is triggered by internal stimuli like DNA
damage or protein misfolding. This leads to the release of **cytochrome
c** from the mitochondria into the cytoplasm, which then activates
caspases (specifically caspase-9) to execute cell death.
5. "Coagulative Necrosis" is most commonly associated with:
A. Brain infarcts
, B. Ischemic injury (infarction) in solid organs like the heart, kidney,
or spleen
C. Tuberculosis infection
D. Acute pancreatitis
**Correct Answer: B**
**Rationale:** **Coagulative necrosis** is a form of tissue death in which
the architecture of the dead tissue is preserved for at least a few days. It is
characteristic of infarcts (areas of ischemic necrosis) in all solid organs
except the brain. The proteins are denatured, and the cells become "ghost-
like" without nuclei.
6. Which type of necrosis is characterized by a "cheese-like" appearance
and is classically seen in tuberculosis?
A. Liquefactive necrosis
B. Fat necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
**Correct Answer: C**
**Rationale:** **Caseous necrosis** (from the Latin word for cheese) is a
distinct form of coagulative necrosis. It is found most often in foci of
tuberculous infection. Microscopically, the necrotic area appears as a
structureless, granular, eosinophilic mass surrounded by an inflammatory
border (granuloma).
, 7. "Liquefactive Necrosis" is the characteristic form of cell death in:
A. The heart after a myocardial infarction
B. The brain after an ischemic stroke
C. The lung in tuberculosis
D. A limb with gangrene
**Correct Answer: B**
**Rationale:** **Liquefactive necrosis** occurs when the dead cells are
completely digested by enzymes, turning the tissue into a liquid viscous
mass (pus). This is the standard pattern of necrosis in the **central
nervous system** (brain) and in focal bacterial or fungal infections.
8. "Fat Necrosis" is a specific pattern of cell death that occurs in:
A. The liver due to alcohol
B. Adipose tissue, often following acute pancreatitis or trauma
C. The skin due to UV light
D. The heart due to aging
**Correct Answer: B**
**Rationale:** **Fat necrosis** refers to focal areas of fat destruction,
typically resulting from the release of activated pancreatic lipases into the
substance of the pancreas and the peritoneal cavity. The released fatty
acids combine with calcium to form visible chalky-white areas
(saponification).
7th Edition
Authors: Rubin & Reisner
,Contents
Chapter 1: Cell Adaptation, Injury, Death, and Aging ................................................................................6
Chapter Summary ................................................................................................................................................6
Multiple Choice Questions (MCQs) ...............................................................................................................6
Chapter 2: Inflammation and Repair ............................................................................................................. 16
Chapter Summary ............................................................................................................................................. 16
Multiple Choice Questions (MCQs) ............................................................................................................ 16
Chapter 3: Immunopathology........................................................................................................................... 26
Chapter Summary ............................................................................................................................................. 26
Multiple Choice Questions (MCQs) ............................................................................................................ 26
Chapter 4: Neoplasia ............................................................................................................................................ 36
Chapter Summary ............................................................................................................................................. 36
Multiple Choice Questions (MCQs) ............................................................................................................ 36
Chapter 5: Developmental and Genetic Diseases ..................................................................................... 45
Chapter Summary ............................................................................................................................................. 45
Multiple Choice Questions (MCQs) ............................................................................................................ 46
Chapter 6: Infectious and Parasitic Diseases ............................................................................................. 54
Chapter Summary ............................................................................................................................................. 54
Multiple Choice Questions (MCQs) ............................................................................................................ 55
Chapter 7: The Amyloidoses ............................................................................................................................. 64
Chapter Summary ............................................................................................................................................. 64
Multiple Choice Questions (MCQs) ............................................................................................................ 64
Chapter 8: Blood Vessels and Hemodynamic Disorders ....................................................................... 73
Chapter Summary ............................................................................................................................................. 73
Multiple Choice Questions (MCQs) ............................................................................................................ 74
Chapter 9: Heart ..................................................................................................................................................... 83
Chapter Summary ............................................................................................................................................. 83
Multiple Choice Questions (MCQs) ............................................................................................................ 83
Chapter 10: The Respiratory System............................................................................................................. 92
Chapter Summary ............................................................................................................................................. 92
Multiple Choice Questions (MCQs) ............................................................................................................ 92
Chapter 11: The Gastrointestinal Tract ..................................................................................................... 101
Chapter Summary .......................................................................................................................................... 101
, Multiple Choice Questions (MCQs) ......................................................................................................... 102
Chapter 12: The Liver and Biliary System ................................................................................................ 112
Chapter Summary .......................................................................................................................................... 112
Multiple Choice Questions (MCQs) ......................................................................................................... 112
Chapter 13: The Exocrine Pancreas ............................................................................................................ 121
Chapter Summary .......................................................................................................................................... 121
Multiple Choice Questions (MCQs) ......................................................................................................... 122
Chapter 14: The Kidney ................................................................................................................................... 131
Chapter Summary .......................................................................................................................................... 131
Multiple Choice Questions (MCQs) ......................................................................................................... 131
Chapter 15: The Lower Urinary Tract and Male Reproductive System ....................................... 140
Chapter Summary .......................................................................................................................................... 140
Multiple Choice Questions (MCQs) ......................................................................................................... 141
Chapter 16: The Female Reproductive Tract .......................................................................................... 150
Chapter Summary .......................................................................................................................................... 150
Multiple Choice Questions (MCQs) ......................................................................................................... 150
Chapter 17: The Breast..................................................................................................................................... 159
Chapter Summary .......................................................................................................................................... 159
Multiple Choice Questions (MCQs) ......................................................................................................... 160
Chapter 18: Hematopathology ...................................................................................................................... 169
Chapter Summary .......................................................................................................................................... 169
Multiple Choice Questions (MCQs) ......................................................................................................... 170
Chapter 19: Endocrine System, Diabetes, and Nutritional Diseases ............................................. 179
Chapter Summary .......................................................................................................................................... 179
Multiple Choice Questions (MCQs) ......................................................................................................... 179
Chapter 20: The Skin ......................................................................................................................................... 189
Chapter Summary .......................................................................................................................................... 189
Multiple Choice Questions (MCQs) ......................................................................................................... 189
Chapter 21: The Head and Neck ................................................................................................................... 198
Chapter Summary .......................................................................................................................................... 198
Multiple Choice Questions (MCQs) ......................................................................................................... 199
Chapter 22: Bones, Joints, and Soft Tissue ............................................................................................... 208
Chapter Summary .......................................................................................................................................... 208
, Multiple Choice Questions (MCQs) ......................................................................................................... 208
Chapter 23: Skeletal Muscle ........................................................................................................................... 218
Chapter Summary .......................................................................................................................................... 218
Multiple Choice Questions (MCQs) ......................................................................................................... 218
Chapter 24: The Central Nervous System and Eye ............................................................................... 228
Chapter Summary .......................................................................................................................................... 228
Multiple Choice Questions (MCQs) ......................................................................................................... 228
Chapter 25: Traumatic and Environmental Injury ............................................................................... 237
Chapter Summary .......................................................................................................................................... 237
Multiple Choice Questions (MCQs) ......................................................................................................... 238
Chapter 26: The Cardiovascular System ................................................................................................... 247
Chapter Summary .......................................................................................................................................... 247
Multiple Choice Questions (MCQs) ......................................................................................................... 247
Chapter 27: The Respiratory System.......................................................................................................... 257
Chapter Summary .......................................................................................................................................... 257
Multiple Choice Questions (MCQs) ......................................................................................................... 257
Chapter 28: The Ear, Nose, and Throat...................................................................................................... 266
Chapter Summary .......................................................................................................................................... 266
Multiple Choice Questions (MCQs) ......................................................................................................... 267
Chapter 29: The Endocrine System, Part 2 .............................................................................................. 276
Chapter Summary .......................................................................................................................................... 276
Multiple Choice Questions (MCQs) ......................................................................................................... 276
Chapter 30: The Nervous System, Part 2 .................................................................................................. 286
Chapter Summary .......................................................................................................................................... 286
Multiple Choice Questions (MCQs) ......................................................................................................... 286
,Chapter 1: Cell Adaptation, Injury, Death, and Aging
Chapter Summary
Chapter 1 explores the fundamental ways cells respond to stress and
injury. It covers cellular adaptations such as hypertrophy, hyperplasia,
atrophy, and metaplasia. The chapter details the mechanisms of cell
injury, including hypoxia, ischemia, and oxidative stress, and
distinguishes between reversible and irreversible injury. It provides an
in-depth look at the two main pathways of cell death: necrosis (and its
various types like coagulative, liquefactive, and caseous) and apoptosis
(the programmed cell death). Additionally, it discusses intracellular
accumulations (like lipofuscin and hemosiderin), pathologic
calcification, and the biological processes involved in cellular aging.
Multiple Choice Questions (MCQs)
1. A 65-year-old man with long-standing hypertension has an enlarged
heart. This increase in the size of the heart is primarily due to which
cellular adaptation?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
**Correct Answer: B**
**Rationale:** **Hypertrophy** is an increase in the size of cells, resulting
in an increase in the size of the organ. In the heart, cardiac myocytes are
,permanent cells and cannot divide; therefore, they respond to increased
workload (stress) by increasing their size (hypertrophy) rather than their
number. Hyperplasia is an increase in the number of cells.
2. Which of the following is a classic example of "Pathologic
Metaplasia"?
A. The enlargement of the uterus during pregnancy
B. The replacement of columnar epithelium by squamous epithelium
in the respiratory tract of a chronic smoker
C. The decrease in muscle mass in a limb immobilized in a cast
D. The formation of a callus on the skin
**Correct Answer: B**
**Rationale:** **Metaplasia** is a reversible change in which one adult
cell type (epithelial or mesenchymal) is replaced by another adult cell
type. In smokers, the normal ciliated columnar epithelium of the trachea
and bronchi is replaced by stratified squamous epithelium, which is better
able to withstand the irritation of cigarette smoke but loses the protective
mucus-secreting and ciliary functions.
3. "Apoptosis" is characterized by all of the following EXCEPT:
A. Cell shrinkage
B. Chromatin condensation
C. Massive inflammatory response
, D. Formation of apoptotic bodies
**Correct Answer: C**
**Rationale:** **Apoptosis** is programmed cell death and is a highly
regulated process. Unlike necrosis, apoptosis does **not** typically elicit
an inflammatory response because the cell membrane remains intact, and
the cellular contents are neatly packaged into apoptotic bodies that are
quickly phagocytosed by neighboring cells or macrophages.
4. The "Intrinsic (Mitochondrial) Pathway" of apoptosis is primarily
triggered by:
A. Activation of death receptors (like Fas or TNF receptor)
B. Increased permeability of the mitochondrial outer membrane and
release of cytochrome c
C. Direct damage to the cell membrane by toxins
D. Bacterial invasion
**Correct Answer: B**
**Rationale:** The **intrinsic pathway** is the major mechanism of
apoptosis in mammalian cells. It is triggered by internal stimuli like DNA
damage or protein misfolding. This leads to the release of **cytochrome
c** from the mitochondria into the cytoplasm, which then activates
caspases (specifically caspase-9) to execute cell death.
5. "Coagulative Necrosis" is most commonly associated with:
A. Brain infarcts
, B. Ischemic injury (infarction) in solid organs like the heart, kidney,
or spleen
C. Tuberculosis infection
D. Acute pancreatitis
**Correct Answer: B**
**Rationale:** **Coagulative necrosis** is a form of tissue death in which
the architecture of the dead tissue is preserved for at least a few days. It is
characteristic of infarcts (areas of ischemic necrosis) in all solid organs
except the brain. The proteins are denatured, and the cells become "ghost-
like" without nuclei.
6. Which type of necrosis is characterized by a "cheese-like" appearance
and is classically seen in tuberculosis?
A. Liquefactive necrosis
B. Fat necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
**Correct Answer: C**
**Rationale:** **Caseous necrosis** (from the Latin word for cheese) is a
distinct form of coagulative necrosis. It is found most often in foci of
tuberculous infection. Microscopically, the necrotic area appears as a
structureless, granular, eosinophilic mass surrounded by an inflammatory
border (granuloma).
, 7. "Liquefactive Necrosis" is the characteristic form of cell death in:
A. The heart after a myocardial infarction
B. The brain after an ischemic stroke
C. The lung in tuberculosis
D. A limb with gangrene
**Correct Answer: B**
**Rationale:** **Liquefactive necrosis** occurs when the dead cells are
completely digested by enzymes, turning the tissue into a liquid viscous
mass (pus). This is the standard pattern of necrosis in the **central
nervous system** (brain) and in focal bacterial or fungal infections.
8. "Fat Necrosis" is a specific pattern of cell death that occurs in:
A. The liver due to alcohol
B. Adipose tissue, often following acute pancreatitis or trauma
C. The skin due to UV light
D. The heart due to aging
**Correct Answer: B**
**Rationale:** **Fat necrosis** refers to focal areas of fat destruction,
typically resulting from the release of activated pancreatic lipases into the
substance of the pancreas and the peritoneal cavity. The released fatty
acids combine with calcium to form visible chalky-white areas
(saponification).
