BRS PATHOLOGY ALL QUESTIONS
WITH CORRECT ANSWERS
The answer is A. Yellowing of the sclerae, skin, and oral mucosa are all characteristic of
jaundice, the accumulation of bilirubin, the catabolic product of the heme moiety of
hemoglobin. Jaundice can occur by diverse mechanisms: hemolytic (see Chapter 11),
hepatocellular (see Chapter 16), or obstructive (see Chapter 16). - Answer-A 20-year-
old man presents with yellowing of the sclerae, skin, and oral mucosa. Which of the
following accumulations underlies these findings?
(A) Bilirubin
(B) Hemosiderin
(C) Lead
(D) Melanin
(E) Silver
The answer is B. The figure illustrates general preservation of myocardial architecture
with some fragmentation, more intense cytoplasmic staining corresponding to increased
cellular eosinophilia, and loss of nuclei, all of which are characteristics of coagulative
necrosis. - Answer-This figure illustrates the microscopic appearance of the heart of a
56-year-old man who died after a 24-hour hospitalization for severe "crushing" chest
pain complicated by hypotension and pulmonary edema. The type of necrosis shown is
best described as
(A) caseous.
(B) coagulative.
(C) fibrinoid.
(D) gangrenous.
(E) liquefactive.
The answer is A. The figure illustrates fatty change of the liver, which is characterized
by the accumulation of intracellular parenchymal triglycerides. It is seen most frequently
in the liver, heart, and kidney and is commonly secondary to alcoholism. Fatty change
results from an imbalance between the uptake, utilization, and mobilization of fat from
liver cells. Alcoholic fatty liver may be reversible with complete abstinence from alcohol.
- Answer-The illustration is from a liver biopsy of a 34-year-old woman with a long
history of alcoholism. Which of the following is the best explanation for the changes
shown here?
(A) Accumulation of triglycerides within hepatocytes
(B) Apoptosis with replacement of damaged cells by lipid-laden macrophages
(C) Bilirubin accumulation with mobilization of fat by bile salts
(D) Enzymatic fat necrosis with digestion of liver parenchyma by released enzymes
(E) Irreversible damage to mitochondria
The answer is B. In advanced form, primary (hereditary) hemochromatosis is
characterized by the triad of cirrhosis, diabetes, and hyperpigmentation, or so-called
,bronze diabetes. The disease is most often caused by a mutation in the Hfegene on
chromosome 6 and is characteristically familial rather than sporadic. The manifestations
of the disorder are the result of iron overload and deposition of hemosiderin in tissues
such as the liver, pancreas, skin, joints, and pituitary. Laboratory abnormalities of note
include increased serum iron and decreased TIBC. The skin hyperpigmentation is due
largely to increases in melanin and to lesser accumulations of hemosiderin. - Answer-A
45-year-old man is referred because of a recent diagnosis of hereditary
hemochromatosis. Which of the following is a correct statement about this disorder?
(A) Damage to organs results from abnormal deposition of lead
(B) It can progress to liver cirrhosis, diabetes mellitus, and skin pigmentation
(C) Most cases are due to spontaneous mutations
(D) Skin hyperpigmentation is due to bilirubin accumulation
(E) The TIBC is characteristically increased
The answer is D. Metastatic calcification, or deposition of calcium in previously normal
tissue, is caused by hypercalcemia. In this patient, tumor metastases to the bone with
increased osteolytic activity caused mobilization of calcium and phosphate, resulting in
hypercalcemia. Metastatic calcification should be contrasted with dystrophic
calcification, in which the serum calcium concentration is normal and previously
damaged tissues are the sites of deposition. - Answer-A 60-year-old woman with breast
cancer and widespread bony metastases is found to have calcification of multiple
organs. The calcifications are best described as
(A) dystrophic with decreased serum calcium.
(B) dystrophic with increased serum calcium.
(C) metastatic with decreased serum calcium.
(D) metastatic with increased serum calcium.
The answer is E. Myelin figures, cell blebs, mitochondrial swelling, and glycogen
depletion are all signs of reversible injury. Nuclear changes such as pyknosis,
karyorrhexis, and karyolysis are signs of cell death and are, of course, irreversible. -
Answer-A 56-year-old man dies 24 hours after the onset of substernal chest pain
radiating down his left arm to the ulnar aspect of his fingertips. Which of the following
morphologic myocardial findings is an indicator of irreversible injury?
(A) Cell blebs
(B) Depletion of glycogen
(C) Mitochondrial swelling
(D) Myelin figures
(E) Pyknotic nuclei
The answer is E. The patient has bacterial pneumonia due to Streptococcus
pneumoniae, a classic example of severe acute inflammation. In the early stages of
acute inflammation, the neutrophil is the most prominent inflammatory cell. It is
noteworthy that, in many instances, bacterial infections are characterized by neutrophilic
infiltrates. It is also noteworthy that S. pneumoniae(also known as the "pneumococcus")
is the most common etiologic agent of lobar pneumonia (see Chapter 14). - Answer-A
72-year-old man presents with a 3-day history of progressively worsening productive
,cough, fever, chills, and signs of toxicity. Prominent physical findings include signs of
consolidation and rales over the right lung base. Sputum culture is positive for
Streptococcus pneumoniae.An intra-alveolar exudate filling the alveoli of the involved
portion of the lung is present. Which of the following types of inflammatory cells is most
likely a prominent feature of this exudate?
(A) Basophils
(B) Eosinophils
(c) Lymphocytes
(d) Monocytes-macrophages
(e) Neutrophils
The answer is B. This type of reaction is primarily mediated by the release of histamine
from tissue mast cells, and the associated cellular infiltrate and peripheral blood findings
represent mobilization and increased numbers of eosinophils. The symptoms reported
are those of seasonal rhinitis, better known as "hay fever," a manifestation of type I
hypersensitivity (see Chapter 5). - Answer-A routine complete blood count performed on
a 22-year-old medical student reveals an abnormality in the differential leukocyte count.
She has been complaining of frequent sneezing and "watery" eyes during the past
several weeks and reports that she frequently had such episodes in the spring and
summer. Which of the following cell types is most likely to be increased?
(A) Basophils
(B) Eosinophils
(c) Lymphocytes
(d) Monocytes
(e) Neutrophils
The answer is E. The clinical findings are typical of acute appendicitis, another example
of severe acute inflammation. Because the danger of perforation is great, early
appendectomy is the treatment of choice. Suppurative or purulent inflammation is
characterized by the prominent areas of edema resulting from increased vascular
permeability, congestion, and a purulent (pus-containing) exudate consisting of necrotic
cells and large numbers of neutrophils. In addition, other signs of acute inflammation,
such as congestion, are prominent. The patient responds with the sensation of pain
(induced by increased hydrostatic pressure in tissue and by chemical mediators such as
bradykinin) and the acute phase reaction (in this instance, fever and neutrophilic
leukocytosis with a "shift to the left"). - Answer-A 16-year-old boy presents with a 24-
hour history of severe abdominal pain, nausea, vomiting, and low-grade fever. The pain
is initially periumbilical in location but has migrated to the right lower quadrant of the
abdomen, with maximal tenderness elicited at a site one-third of the way between the
crest of the ileum and the umbilicus (McBurney point). The leukocyte count is
14,000/mm3, with 74% segmented neutrophils and 12% bands. Surgery is performed.
Which of the following describes the expected findings at the affected site?
(A) Fistula (abnormal duct or passage) connecting to the abdominal wall
(B) Granulation tissue (new vessels and young fibroblasts) with a prominent infiltrate of
eosinophils
, (c) Granulomatous inflammation with prominent aggregates of epithelioid cells and
multinucleated giant cells
(d) Massive infiltration of lymphocytes and plasma cells
(e) Prominent areas of edema, congestion, and a purulent reaction with localized areas
of abscess formation
The answer is B. Chronic granulomatous disease of childhood, a condition
characterized by repeated infections and most commonly X-linked inheritance, is
marked by failure of the myeloperoxidase-halide system of killing within phagocytic
cells. It is caused by the deficiency of NADPH oxidase activity. This results in a
secondary deficiency of reactive oxygen metabolites, including H2O2, which, along with
halide ions, functions as a substrate for myeloperoxidase. A hallmark of the disorder is
the failure of intracellular killing of catalase-positive organisms, exemplified by
staphylococci. These organisms are ingested but not killed. The impaired phagocytic
cell is incapable of producing H2O2, and any H2O2 produced by the microorganism
itself is inactivated by endogenous catalase. In contrast, catalase-negative
microorganisms, such as streptococci, are ingested and killed. They too produce
endogenous H2O2, which is thu - Answer-A 2-year-old boy presents with recurrent
infections involving multiple organ systems. Extensive investigation results in a
diagnosis of chronic granulomatous disease of childhood. Which of the following most
closely characterizes the abnormality in this patient's phagocytic cells?
(A) Decreased killing of microorganisms because of enhanced production of hydrogen
peroxide
(B) Deficiency of NADPH oxidase activity
(c) Impaired chemotaxis and migration caused by abnormal microtubule formation
(d) Inability to kill streptococci
(e) Increased myeloperoxidase-halidemediated killing of catalase-positive organisms
when compared with catalase-negative organisms
The answer is C. The clinical description and the figure are both typical of advanced
secondary tuberculosis. Although this disorder is now relatively uncommon, its
incidence is increasing, especially in association with immunodeficiency. Tuberculosis is
a classic cause of granulomatous inflammation, which is characterized by the presence
of "granulomas," which by definition consist of clusters of modified macrophages
referred to as epithelioid cells. Additional features such as caseous necrosis, giant cell
formation, and identifiable etiologic agents may or may not be present and are not
invariable features of this form of inflammation. Granulation tissue is a feature of early
repair and is totally unrelated to granulomatous inflammation. - Answer-The
accompanying figure is representative of the findings in a hilar lymph node from a 54-
year-old man who sought medical care for low-grade fever, anorexia, fatigue, night
sweats, weight loss, and persistent cough with bouts of hemoptysis. A chest x-ray had
revealed a right apical infiltrate with beginning cavitation, and examination of the sputum
had revealed acid-fast bacilli. This condition is typified by a form of inflammation that
invariablyincludes which of the following?
(A) A morphologically identifiable etiologic agent
(B) Caseous necrosis
WITH CORRECT ANSWERS
The answer is A. Yellowing of the sclerae, skin, and oral mucosa are all characteristic of
jaundice, the accumulation of bilirubin, the catabolic product of the heme moiety of
hemoglobin. Jaundice can occur by diverse mechanisms: hemolytic (see Chapter 11),
hepatocellular (see Chapter 16), or obstructive (see Chapter 16). - Answer-A 20-year-
old man presents with yellowing of the sclerae, skin, and oral mucosa. Which of the
following accumulations underlies these findings?
(A) Bilirubin
(B) Hemosiderin
(C) Lead
(D) Melanin
(E) Silver
The answer is B. The figure illustrates general preservation of myocardial architecture
with some fragmentation, more intense cytoplasmic staining corresponding to increased
cellular eosinophilia, and loss of nuclei, all of which are characteristics of coagulative
necrosis. - Answer-This figure illustrates the microscopic appearance of the heart of a
56-year-old man who died after a 24-hour hospitalization for severe "crushing" chest
pain complicated by hypotension and pulmonary edema. The type of necrosis shown is
best described as
(A) caseous.
(B) coagulative.
(C) fibrinoid.
(D) gangrenous.
(E) liquefactive.
The answer is A. The figure illustrates fatty change of the liver, which is characterized
by the accumulation of intracellular parenchymal triglycerides. It is seen most frequently
in the liver, heart, and kidney and is commonly secondary to alcoholism. Fatty change
results from an imbalance between the uptake, utilization, and mobilization of fat from
liver cells. Alcoholic fatty liver may be reversible with complete abstinence from alcohol.
- Answer-The illustration is from a liver biopsy of a 34-year-old woman with a long
history of alcoholism. Which of the following is the best explanation for the changes
shown here?
(A) Accumulation of triglycerides within hepatocytes
(B) Apoptosis with replacement of damaged cells by lipid-laden macrophages
(C) Bilirubin accumulation with mobilization of fat by bile salts
(D) Enzymatic fat necrosis with digestion of liver parenchyma by released enzymes
(E) Irreversible damage to mitochondria
The answer is B. In advanced form, primary (hereditary) hemochromatosis is
characterized by the triad of cirrhosis, diabetes, and hyperpigmentation, or so-called
,bronze diabetes. The disease is most often caused by a mutation in the Hfegene on
chromosome 6 and is characteristically familial rather than sporadic. The manifestations
of the disorder are the result of iron overload and deposition of hemosiderin in tissues
such as the liver, pancreas, skin, joints, and pituitary. Laboratory abnormalities of note
include increased serum iron and decreased TIBC. The skin hyperpigmentation is due
largely to increases in melanin and to lesser accumulations of hemosiderin. - Answer-A
45-year-old man is referred because of a recent diagnosis of hereditary
hemochromatosis. Which of the following is a correct statement about this disorder?
(A) Damage to organs results from abnormal deposition of lead
(B) It can progress to liver cirrhosis, diabetes mellitus, and skin pigmentation
(C) Most cases are due to spontaneous mutations
(D) Skin hyperpigmentation is due to bilirubin accumulation
(E) The TIBC is characteristically increased
The answer is D. Metastatic calcification, or deposition of calcium in previously normal
tissue, is caused by hypercalcemia. In this patient, tumor metastases to the bone with
increased osteolytic activity caused mobilization of calcium and phosphate, resulting in
hypercalcemia. Metastatic calcification should be contrasted with dystrophic
calcification, in which the serum calcium concentration is normal and previously
damaged tissues are the sites of deposition. - Answer-A 60-year-old woman with breast
cancer and widespread bony metastases is found to have calcification of multiple
organs. The calcifications are best described as
(A) dystrophic with decreased serum calcium.
(B) dystrophic with increased serum calcium.
(C) metastatic with decreased serum calcium.
(D) metastatic with increased serum calcium.
The answer is E. Myelin figures, cell blebs, mitochondrial swelling, and glycogen
depletion are all signs of reversible injury. Nuclear changes such as pyknosis,
karyorrhexis, and karyolysis are signs of cell death and are, of course, irreversible. -
Answer-A 56-year-old man dies 24 hours after the onset of substernal chest pain
radiating down his left arm to the ulnar aspect of his fingertips. Which of the following
morphologic myocardial findings is an indicator of irreversible injury?
(A) Cell blebs
(B) Depletion of glycogen
(C) Mitochondrial swelling
(D) Myelin figures
(E) Pyknotic nuclei
The answer is E. The patient has bacterial pneumonia due to Streptococcus
pneumoniae, a classic example of severe acute inflammation. In the early stages of
acute inflammation, the neutrophil is the most prominent inflammatory cell. It is
noteworthy that, in many instances, bacterial infections are characterized by neutrophilic
infiltrates. It is also noteworthy that S. pneumoniae(also known as the "pneumococcus")
is the most common etiologic agent of lobar pneumonia (see Chapter 14). - Answer-A
72-year-old man presents with a 3-day history of progressively worsening productive
,cough, fever, chills, and signs of toxicity. Prominent physical findings include signs of
consolidation and rales over the right lung base. Sputum culture is positive for
Streptococcus pneumoniae.An intra-alveolar exudate filling the alveoli of the involved
portion of the lung is present. Which of the following types of inflammatory cells is most
likely a prominent feature of this exudate?
(A) Basophils
(B) Eosinophils
(c) Lymphocytes
(d) Monocytes-macrophages
(e) Neutrophils
The answer is B. This type of reaction is primarily mediated by the release of histamine
from tissue mast cells, and the associated cellular infiltrate and peripheral blood findings
represent mobilization and increased numbers of eosinophils. The symptoms reported
are those of seasonal rhinitis, better known as "hay fever," a manifestation of type I
hypersensitivity (see Chapter 5). - Answer-A routine complete blood count performed on
a 22-year-old medical student reveals an abnormality in the differential leukocyte count.
She has been complaining of frequent sneezing and "watery" eyes during the past
several weeks and reports that she frequently had such episodes in the spring and
summer. Which of the following cell types is most likely to be increased?
(A) Basophils
(B) Eosinophils
(c) Lymphocytes
(d) Monocytes
(e) Neutrophils
The answer is E. The clinical findings are typical of acute appendicitis, another example
of severe acute inflammation. Because the danger of perforation is great, early
appendectomy is the treatment of choice. Suppurative or purulent inflammation is
characterized by the prominent areas of edema resulting from increased vascular
permeability, congestion, and a purulent (pus-containing) exudate consisting of necrotic
cells and large numbers of neutrophils. In addition, other signs of acute inflammation,
such as congestion, are prominent. The patient responds with the sensation of pain
(induced by increased hydrostatic pressure in tissue and by chemical mediators such as
bradykinin) and the acute phase reaction (in this instance, fever and neutrophilic
leukocytosis with a "shift to the left"). - Answer-A 16-year-old boy presents with a 24-
hour history of severe abdominal pain, nausea, vomiting, and low-grade fever. The pain
is initially periumbilical in location but has migrated to the right lower quadrant of the
abdomen, with maximal tenderness elicited at a site one-third of the way between the
crest of the ileum and the umbilicus (McBurney point). The leukocyte count is
14,000/mm3, with 74% segmented neutrophils and 12% bands. Surgery is performed.
Which of the following describes the expected findings at the affected site?
(A) Fistula (abnormal duct or passage) connecting to the abdominal wall
(B) Granulation tissue (new vessels and young fibroblasts) with a prominent infiltrate of
eosinophils
, (c) Granulomatous inflammation with prominent aggregates of epithelioid cells and
multinucleated giant cells
(d) Massive infiltration of lymphocytes and plasma cells
(e) Prominent areas of edema, congestion, and a purulent reaction with localized areas
of abscess formation
The answer is B. Chronic granulomatous disease of childhood, a condition
characterized by repeated infections and most commonly X-linked inheritance, is
marked by failure of the myeloperoxidase-halide system of killing within phagocytic
cells. It is caused by the deficiency of NADPH oxidase activity. This results in a
secondary deficiency of reactive oxygen metabolites, including H2O2, which, along with
halide ions, functions as a substrate for myeloperoxidase. A hallmark of the disorder is
the failure of intracellular killing of catalase-positive organisms, exemplified by
staphylococci. These organisms are ingested but not killed. The impaired phagocytic
cell is incapable of producing H2O2, and any H2O2 produced by the microorganism
itself is inactivated by endogenous catalase. In contrast, catalase-negative
microorganisms, such as streptococci, are ingested and killed. They too produce
endogenous H2O2, which is thu - Answer-A 2-year-old boy presents with recurrent
infections involving multiple organ systems. Extensive investigation results in a
diagnosis of chronic granulomatous disease of childhood. Which of the following most
closely characterizes the abnormality in this patient's phagocytic cells?
(A) Decreased killing of microorganisms because of enhanced production of hydrogen
peroxide
(B) Deficiency of NADPH oxidase activity
(c) Impaired chemotaxis and migration caused by abnormal microtubule formation
(d) Inability to kill streptococci
(e) Increased myeloperoxidase-halidemediated killing of catalase-positive organisms
when compared with catalase-negative organisms
The answer is C. The clinical description and the figure are both typical of advanced
secondary tuberculosis. Although this disorder is now relatively uncommon, its
incidence is increasing, especially in association with immunodeficiency. Tuberculosis is
a classic cause of granulomatous inflammation, which is characterized by the presence
of "granulomas," which by definition consist of clusters of modified macrophages
referred to as epithelioid cells. Additional features such as caseous necrosis, giant cell
formation, and identifiable etiologic agents may or may not be present and are not
invariable features of this form of inflammation. Granulation tissue is a feature of early
repair and is totally unrelated to granulomatous inflammation. - Answer-The
accompanying figure is representative of the findings in a hilar lymph node from a 54-
year-old man who sought medical care for low-grade fever, anorexia, fatigue, night
sweats, weight loss, and persistent cough with bouts of hemoptysis. A chest x-ray had
revealed a right apical infiltrate with beginning cavitation, and examination of the sputum
had revealed acid-fast bacilli. This condition is typified by a form of inflammation that
invariablyincludes which of the following?
(A) A morphologically identifiable etiologic agent
(B) Caseous necrosis
