CELL INJURY
1. Cell injury
a. Is characterized by increased oxidative phosphorylation – decreased -> anaerobic glycolysis
b. Results in efflux of calcium from the cell – influx and release of mitochondrial
c. May result in free radical induced damage – may result from, or cause it…
d. May be increased by enzymes such as catalase – catalase is free radical scavenger H2O2 -> H2O
and O2
e. Results in increased membrane phospholipid – loss of
2. Tissue
a. Hypertrophy is characterized by increased numbers of cells
b. Hyperplasia is characterized by increased size of cells
c. Necrosis is always pathological - true
d. Response to injury may involve apoptosis, which is never a normal response
e. Reperfusion after ischaemia never results in full cell recovery
3. Hypertrophy
a. occurs after partial hepatectomy - hyperplasia
b. increases function of an organ exponentially
c. is triggered by mechanical and trophic chemicals - true
d. occurs after denervation - atrophy
e. is usually pathological
4. All of the following are features of apoptosis EXCEPT:
a. Cell swelling - shrinkage
b. Chromatin condensation
c. Formation of cytoplasmic blebs
d. Lack of inflammation
e. Phagocytosis of apoptotic bodies
5. Dystrophic calcification
a. Is formed only in coagulative necrosis – occurs is atheroscleosis, damaged heart valves and areas
of necrosis (coagulative, liquefactive and caeseous)
b. Does not occur on heart valves
c. Rarely dauses dysfunction
d. Is rarely found on mitochondria – initiation of intracellular calcification occurs in mitochondrial of
dead or dying cells
e. Is formed by crystalline calcium phosphate mineral – similar to bone hydroxyapatite
6. Irreversible cell injury is characterized by
a. Dispersion of ribosomes
b. Cell swelling
c. Nuclear chromatin clumping
d. Lysosomal rupture
e. Cell membrane defects – characterized by mitochondrial dysfunction and profound disturbances in
membrane function
7. Metaplasia
a. Can be caused by vitamin B12 deficiency – Vit A (retinoic acid)
b. Preserves mucus secretion in the respiratory tract – will affect b/c loss of mucous production and
ciliary action
c. Is typically an irreversible process
d. Is the process that occurs in Barrett’s oesophagitis - sqaumous -> columnar
e. Is an increase in the number and size of cells in a tissue
8. Which of the following is not associated with atrophy
a. Decreased smooth endoplasmic reticulum
b. Decreased rough endoplasmic reticulum
c. ?
d. ?
e. decreased autophagic vacuoles – increased autophagocytosis
9. Metastatic calcification occurs in
a. Old lymph nodes
b. Gastric mucosa – excretes acid, therefore an internal alkaline compartment, also kidneys, lungs,
systemic arteries, pulmonary veins
c. Atherosclerotic vessels
d. Damaged heart valves
e. ?
10. Metaplasia
a. Involves the formation of malignant cells in a tissue - predisposes
b. Of the respiratory tract often involves the replacement of squamous cells with columnar cells –
columnar with squamous
c. Is a reversible change in which one mature cell type is replaced by another mature cell type correct
d. Of the oesophagus, is normally a change from columnar to squamous cell types – squamous ->
columnar in Barrett’s, hence normally glandular cancers
e. Is due to changed gene expression in mature cell types to produce a different mature cell type –
the mature cells don’t change, stem or undifferential cells undergo reprogramming
11. The most important factor in irreversible cell injury is
a. ATP depletion
b. Decreased protein synthesis
c. Decreased pH
d. Membrane damage – profound membrane dysfunction is a hallmark
e. Loss of intracellular K+
12. Morphological and biochemical changes of reversible cell injury include
a. Decrease in anaerobic glycolysis - increase
b. Shrinkage of the endoplasmic reticulum – in atrophy
c. Intracellular accumulation of sodium – true, partly why there is swelling of cells
d. Decreased membrane permeability - increased
e. Lysosomal membrane leakage – swelling and rupture occurs in irreversible
13. Hyperplasia
a. Results in a reversible change to another cell type - metaplasia
b. May be a precursor to malignancy – true, it is the “fertile soil”
c. Is defined as an increase in cell size - hypertophy
d. May occur due to increased functional demand in striated muscle – vast majority is hypertrophy
e. Persists when the stimulus is removed
14. In reversible cell injury, all are true except
a. ATP depletion is responsible for acute cellular swelling - correct, via failure of NA+/K+ ATPase
pump and metabolic products of anaerobic gycloyisis
b. Can cause myocardial cells to cease contraction within 60 seconds
c. ATP is generated anaerobically from creatine phosphate
d. Mitochondrial swelling and degranulation of ER are the hallmarks of irreversible cellular damage –
these occur as result of decreased ATP, but are reversible
e. Is associated with myelin figures - true
15. Metaplasia
a. Is irreversible
b. Is commonly a change from squamous to columnar epithelium
c. An example is the transformation of epithelial cells into chrondroblasts to produce cartilage
d. Retinoids may play a role
e. Even if the stimuli is persistent, it is a benign lesion
16. In apoptosis
a. It involves physiologic and pathologic stimuli
b. Histologically, it involves coagulative necrosis
c. Its DNA breakdown is random and diffuse
d. Its mechanism involves ATP depletion
e. It involves an inflammatory tissue reaction
17. Hyperplasia
a. Occurs after partial hepatectomy
b. Refers to an increases in the size of cells
c. Is always a pathological process
d. Often occurs in cardiac and skeletal muscle
e. Usually progresses to cancerous proliferation
18. Metastatic calcification
a. causes widespread tissue damage - usually
b. occurs with normal calcium levels - elevated
c. can be caused by systemic sarcoidosis – true, Vit D related
d. occurs in hypothyroidism - hyperparathyroidism
e. is caused by drinking large quantities of milk
19. With regard to apoptosis, which of the following is INCORRECT
a. It may be regarded as a normal physiological process
b. It is characterized by chromatin condensation
c. It often elicits a strong inflammatory response – usually does not
d. It is the process by which ovaries atrophy in post menopausal women
e. It is characterized by cell shrinkage
20. With regard to cellular injury, all of the following are reversible EXCEPT
a. Decreased ATP
b. Intracellular release of lysosomal enzymes - irreversible
c. Decreased Na pump activity
d. Detachment of ribosomes
e. ER swelling
21. Metaplasia is seen in all of the following except
a. Respiratory epithelium of cigarette smokers
b. Vitamin A excess – it occurs from deficiency, excess -> cell swelling and rupture
c. Barrett’s oesophagitis
d. Epithelium of a pancreatic duct containing stones
e. Foci of cell injury – connective tissue metaplasia?
22. Regarding atrophy, all are correct EXCEPT
a. Persistance of residual bodies
b. Decreased myofilaments
c. Decreased rough endoplasmic reticulum
d. Decreased autophagic vacuoles – increased because cell autophages for survival
e. Deceased smooth endoplasmic reticulum
23. Which of the following is an example of hypertrophy
a. Increase in liver size after partial hepatectomy
b. Increase in size of female breast
c. Increased respiratory epithelium in response to vitamin A deficiency
d. Increase in size of female uterus in pregnancy
e. Endometrial proliferation
24. Regarding fatty change which is INCORRECT?
a. May result from protein malnutrition
b. Fatty acids are oxidized in the mitochondria
c. May result from diabetes mellitus
d. May represent unmasking of normal cell fat content
e. In heart is caused by severe anaemia
25. Dystrophic calcification
a. Occurs in normal cells and tissues
b. Occurs in sarcoidosis – vit D increase -> metastatic calcification
c. Occurs in multiple myeloma
d. Often causes organ dysfunction – can be a source of significant pathology
e. ?
26. An example of hypertrophy is
a. The pubertal breast
b. The pregnant uterus
c. Post partial hepatectomy
d. ?
e. ?
27. Fatty change occurs in all of the following EXCEPT:
a. Heart
b. Liver
c. Skeletal muscle
d. Spleen
e. Kidney
28. In the heart fatty change occurs in response to
a. Alcohol consumption
b. Profound anaemia
c. Atherosclerosis
d. Carbon tetrachloride
e. Protein malnutrition
29. Cytosolic calcium in cell injury
a. Only enters by active transport
b. Partially derives from mitochondria
c. Increases ATP
d. Inactivates phospholipase
e. Inactivate protease
30. Metaplasia
a. is an irreversible change in cell type
b. is most commonly a change from squamous to columnar
c. does not occur in mesenchymal cells
d. may progress to cancer transformation
e. is usually accompanies by hypertrophy
31. Irreversible cell injury is characterized by
a. loss of functional polarity in polarized epithelium
b. detachment of ribosomes from endoplasmic reticulum
c. acute cellular swelling
d. severe mitochondrial vacuolization
e. formation of membrane blebs
32. Metaplasia is
a. irreversible
b. commonly squamous changing to columnar epithelium
c. always malignant
d. stimulated by chemicals and growth factors
e. not related to genetic reprogramming of stem cells
33. Apoptosis
a. involves transfer of cytochrome C from the cytosol to the mitochondria – out from mitochondria
b. involves DNA fragmentation – cleaves into 180 – 200 base pair fragments (ladder pattern on EP)
c. is mediated by caspase inactivation - activation
d. is suppressed by Fas-Fas ligand interaction – is activated by
e. is activated by Bcl-2 – Bcl-2 and BCL-x are to main anti-apoptotic proteins
34. Coagulative necrosis:
a. Results from necrosis in which cellular enzymatic digestion predominates over protein denaturation
b. Is characterized by a marked leukocytic infiltrate
c. Is uncommon after myocardial infarction
d. Usually occurs after irreversible ischaemic cellular damage
e. Is not usually seen in association with caseous necrosis
35. Which is incorrect regarding necrosis?
a. Autolysis may follow owing to denaturation of protein - ?
b. Heterolysis is digestion by lysosomal enzymes of immigrant leukocytes
c. Dystrophic calcification is seen particularly in necrotic fat cells -> calcium soaps
d. Coagulation necrosis is the most common pattern of necrosis
e. Liquefaction necrosis occurs when autolysis and heterolysis prevail over protein denaturation
36. Coagulative necrosis:
a. Is the least common manifestation of necrosis
b. Completely obliterates tissue architecture
c. Leads to formation of a liquid viscous mass
d. Is characteristic of hypoxic death of cells in all tissue except the brain
e. Is characteristic of focal bacterial infection
37. Hypoxia results in:
a. Influx of K+ into the cell
b. Decreased intracellular Ca2+
c. Increased intracellular pH
d. Influx of Na+ into the cell
e. Efflux of H20 into the interstitium