Test Bank for Robbins and Cotran
Pathologic Basis of Disease 9th Edition
Kumar | Chapter 2 - 29 | Updated Guide
2022
Chapter 1: The Cell as a Unit of Health and Disease
1. A 28-year-old man was found to have cirrhosis of the liver and pulmonary emphysema.
Liver biopsy shows globular inclusions within the cytoplasm of hepatocytes. By electron
microscopy, these inclusions are located within which organelle?
A. Golgi apparatus
B. Smooth endoplasmic reticulum
C. Rough endoplasmic reticulum
D. Mitochondria
E. Peroxisomes
Correct Answer: C
Rationale: The concurrence of cirrhosis and emphysema in a young man suggests α1-
antitrypsin deficiency. Misfolded α1-antitrypsin accumulates within the dilated cisterns of the
rough endoplasmic reticulum because it cannot be properly secreted .
2. A 90-year-old man with a 10-year history of progressive dementia dies. At autopsy, neurons
contain numerous neurofibrillary tangles. These cytoplasmic structures are formed primarily
from which component?
A. Nucleus
B. Rough endoplasmic reticulum
C. Smooth endoplasmic reticulum
D. Mitochondria
E. Cytoskeleton
, Correct Answer: E
Rationale: Neurofibrillary tangles are composed of hyperphosphorylated tau protein, a
microtubule-associated protein that forms part of the neuronal cytoskeleton .
3. Continuous expression of the gene for atrial natriuretic factor in left ventricular myocardial
cells is typically a consequence of which condition?
A. Myocardial infarction
B. Angina pectoris
C. Hypertension
D. Hypotension
E. Ventricular fibrillation
Correct Answer: C
Rationale: Atrial natriuretic factor (ANF) is normally produced in atrial myocytes after birth
but can be reactivated in ventricular cells undergoing hypertrophy. Arterial hypertension is the
most common cause of left ventricular hypertrophy .
4. Ubiquitin-proteasome degradation of plasma proteins is opposed by which substance?
A. Insulin
B. Interleukin-1
C. Tumor necrosis factor α
D. Glucocorticoids
E. Thyroid hormones
Correct Answer: A
Rationale: Insulin opposes ubiquitin-proteasome degradation of plasma proteins, whereas
inflammatory mediators such as IL-1, TNF-α, and glucocorticoids accelerate this process .
5. A 60-year-old obese man with alcoholism and diabetes mellitus undergoes liver biopsy. The
specimen most likely shows increased amounts of which substance within hepatocytes?
A. Hemosiderin
B. Bile
C. Triglycerides
,D. Bilirubin
E. Insulin
Correct Answer: C
Rationale: This patient has risk factors for nonalcoholic fatty liver disease (obesity, diabetes)
compounded by alcoholism. The most common intracellular accumulation in this setting is
triglycerides (steatosis) .
6. Which of the following is the primary mechanism by which cells maintain calcium
homeostasis in the cytosol?
A. Passive diffusion across the plasma membrane
B. ATP-dependent calcium pumps and exchangers
C. Simple diffusion through nuclear pores
D. Osmotic gradient-driven transport
E. Facilitated diffusion via aquaporins
Correct Answer: B
Rationale: Cells maintain low cytosolic calcium concentrations through ATP-dependent
calcium pumps (plasma membrane Ca²⁺-ATPase and SERCA) and Na⁺/Ca²⁺ exchangers. Loss of
this regulation is a key event in irreversible cell injury .
7. A 63-year-old man has worsening congestive heart failure with left atrial dilation. A
thrombus is present in the left atrium. One month later, he experiences left flank pain and
hematuria. Laboratory testing shows elevated serum AST. Which pattern of tissue injury is
most likely present in the kidney?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
E. Gangrenous necrosis
Correct Answer: C
Rationale: The patient likely has a left atrial thrombus that embolized to the kidney, causing
a renal infarct. Ischemic infarction in most solid organs (except the brain) produces coagulative
necrosis .
, 8. Which of the following best describes the role of the ubiquitin-proteasome system in
cellular function?
A. Synthesis of new proteins
B. Degradation of damaged or misfolded proteins
C. Transport of proteins across membranes
D. Glycosylation of membrane proteins
E. Replication of mitochondrial DNA
Correct Answer: B
Rationale: The ubiquitin-proteasome system targets damaged, misfolded, or short-lived
proteins for degradation, playing a critical role in protein quality control and cellular
homeostasis .
9. A tissue preparation is subjected to a hypoxic environment. Cells begin to swell, chromatin
clumps in the nucleus, ATPases are activated, and ATP production decreases. Release of which
ion from mitochondria leads to these findings and eventual cell death?
A. Ca²⁺
B. Cl⁻
C. HCO₃⁻
D. K⁺
E. Na⁺
Correct Answer: A
Rationale: Mitochondrial calcium overload during hypoxia triggers opening of the
mitochondrial permeability transition pore, releasing Ca²⁺ into the cytosol and activating
degradative enzymes that lead to cell death .
10. A 40-year-old woman has chronic congestive heart failure and develops a cough
productive of rust-colored sputum. Sputum cytology shows hemosiderin-laden macrophages.
Which subcellular structure is most important for accumulation of this pigment?
A. Lysosome
B. Endoplasmic reticulum
C. Ribosome
Pathologic Basis of Disease 9th Edition
Kumar | Chapter 2 - 29 | Updated Guide
2022
Chapter 1: The Cell as a Unit of Health and Disease
1. A 28-year-old man was found to have cirrhosis of the liver and pulmonary emphysema.
Liver biopsy shows globular inclusions within the cytoplasm of hepatocytes. By electron
microscopy, these inclusions are located within which organelle?
A. Golgi apparatus
B. Smooth endoplasmic reticulum
C. Rough endoplasmic reticulum
D. Mitochondria
E. Peroxisomes
Correct Answer: C
Rationale: The concurrence of cirrhosis and emphysema in a young man suggests α1-
antitrypsin deficiency. Misfolded α1-antitrypsin accumulates within the dilated cisterns of the
rough endoplasmic reticulum because it cannot be properly secreted .
2. A 90-year-old man with a 10-year history of progressive dementia dies. At autopsy, neurons
contain numerous neurofibrillary tangles. These cytoplasmic structures are formed primarily
from which component?
A. Nucleus
B. Rough endoplasmic reticulum
C. Smooth endoplasmic reticulum
D. Mitochondria
E. Cytoskeleton
, Correct Answer: E
Rationale: Neurofibrillary tangles are composed of hyperphosphorylated tau protein, a
microtubule-associated protein that forms part of the neuronal cytoskeleton .
3. Continuous expression of the gene for atrial natriuretic factor in left ventricular myocardial
cells is typically a consequence of which condition?
A. Myocardial infarction
B. Angina pectoris
C. Hypertension
D. Hypotension
E. Ventricular fibrillation
Correct Answer: C
Rationale: Atrial natriuretic factor (ANF) is normally produced in atrial myocytes after birth
but can be reactivated in ventricular cells undergoing hypertrophy. Arterial hypertension is the
most common cause of left ventricular hypertrophy .
4. Ubiquitin-proteasome degradation of plasma proteins is opposed by which substance?
A. Insulin
B. Interleukin-1
C. Tumor necrosis factor α
D. Glucocorticoids
E. Thyroid hormones
Correct Answer: A
Rationale: Insulin opposes ubiquitin-proteasome degradation of plasma proteins, whereas
inflammatory mediators such as IL-1, TNF-α, and glucocorticoids accelerate this process .
5. A 60-year-old obese man with alcoholism and diabetes mellitus undergoes liver biopsy. The
specimen most likely shows increased amounts of which substance within hepatocytes?
A. Hemosiderin
B. Bile
C. Triglycerides
,D. Bilirubin
E. Insulin
Correct Answer: C
Rationale: This patient has risk factors for nonalcoholic fatty liver disease (obesity, diabetes)
compounded by alcoholism. The most common intracellular accumulation in this setting is
triglycerides (steatosis) .
6. Which of the following is the primary mechanism by which cells maintain calcium
homeostasis in the cytosol?
A. Passive diffusion across the plasma membrane
B. ATP-dependent calcium pumps and exchangers
C. Simple diffusion through nuclear pores
D. Osmotic gradient-driven transport
E. Facilitated diffusion via aquaporins
Correct Answer: B
Rationale: Cells maintain low cytosolic calcium concentrations through ATP-dependent
calcium pumps (plasma membrane Ca²⁺-ATPase and SERCA) and Na⁺/Ca²⁺ exchangers. Loss of
this regulation is a key event in irreversible cell injury .
7. A 63-year-old man has worsening congestive heart failure with left atrial dilation. A
thrombus is present in the left atrium. One month later, he experiences left flank pain and
hematuria. Laboratory testing shows elevated serum AST. Which pattern of tissue injury is
most likely present in the kidney?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
E. Gangrenous necrosis
Correct Answer: C
Rationale: The patient likely has a left atrial thrombus that embolized to the kidney, causing
a renal infarct. Ischemic infarction in most solid organs (except the brain) produces coagulative
necrosis .
, 8. Which of the following best describes the role of the ubiquitin-proteasome system in
cellular function?
A. Synthesis of new proteins
B. Degradation of damaged or misfolded proteins
C. Transport of proteins across membranes
D. Glycosylation of membrane proteins
E. Replication of mitochondrial DNA
Correct Answer: B
Rationale: The ubiquitin-proteasome system targets damaged, misfolded, or short-lived
proteins for degradation, playing a critical role in protein quality control and cellular
homeostasis .
9. A tissue preparation is subjected to a hypoxic environment. Cells begin to swell, chromatin
clumps in the nucleus, ATPases are activated, and ATP production decreases. Release of which
ion from mitochondria leads to these findings and eventual cell death?
A. Ca²⁺
B. Cl⁻
C. HCO₃⁻
D. K⁺
E. Na⁺
Correct Answer: A
Rationale: Mitochondrial calcium overload during hypoxia triggers opening of the
mitochondrial permeability transition pore, releasing Ca²⁺ into the cytosol and activating
degradative enzymes that lead to cell death .
10. A 40-year-old woman has chronic congestive heart failure and develops a cough
productive of rust-colored sputum. Sputum cytology shows hemosiderin-laden macrophages.
Which subcellular structure is most important for accumulation of this pigment?
A. Lysosome
B. Endoplasmic reticulum
C. Ribosome
