ABPath - American Board of Pathology General Pathology Principles Questions and Answers

Question 1

A 68-year-old male with a long history of hypertension and coronary artery disease dies of a massive myocardial infarction. At autopsy, the heart is enlarged, and the left ventricular wall is notably thickened. Microscopically, the cardiac myocytes are increased in size, but not in number. This cellular alteration is best described as which of the following?

Accepted Answer

Hypertrophy

Answer

Hypertrophy is an increase in the size of cells, resulting in an increase in the size of the organ. [20] It occurs in cells with limited capacity to divide, such as cardiac myocytes, in response to increased workload. [28, 30] In this case, chronic hypertension increased the workload on the heart, leading to an adaptive increase in myocyte size. Hyperplasia is an increase in the number of cells. Atrophy is a decrease in cell size. [20] Metaplasia is the replacement of one mature cell type with another. [28]

Question 2

Which of the following is a key feature that distinguishes apoptosis from necrosis?

Accepted Answer

Caspase activation and formation of apoptotic bodies

Answer

Apoptosis, or programmed cell death, is a tightly regulated process characterized by the activation of a cascade of enzymes called caspases. This leads to the orderly dismantling of the cell and formation of membrane-bound apoptotic bodies, which are phagocytosed without eliciting an inflammatory response. [22] In contrast, necrosis is characterized by cell swelling, loss of membrane integrity, uncontrolled release of cellular contents, and a significant inflammatory response. [15, 24]

Question 3

A 45-year-old woman presents with bilateral lower extremity swelling that has worsened over several months. She has a history of severe congestive heart failure. Physical examination reveals pitting edema to the mid-shin. The primary mechanism responsible for this patient's edema is an increase in which of the following?

Accepted Answer

Capillary hydrostatic pressure

Answer

Edema in congestive heart failure is primarily caused by an increase in capillary hydrostatic pressure. [19] The failing heart cannot pump blood effectively, leading to venous congestion and increased pressure in the capillaries, which forces fluid into the interstitial space. Decreased plasma oncotic pressure, as seen in nephrotic syndrome or liver failure, can also cause edema, but increased hydrostatic pressure is the dominant mechanism in heart failure. [3, 11, 19]

Question 4

Which of the following cellular infiltrates is most characteristic of chronic inflammation?

Accepted Answer

Lymphocytes and macrophages

Answer

Chronic inflammation is characterized by the infiltration of mononuclear cells, primarily lymphocytes, macrophages, and plasma cells. [4, 21, 29] This is in contrast to acute inflammation, which is dominated by neutrophils. [4, 29] Macrophages play a central role in chronic inflammation through phagocytosis, antigen presentation, and secretion of cytokines and growth factors that perpetuate the inflammatory response and promote tissue remodeling. [21]

Question 5

A biopsy of a lung mass in a 60-year-old smoker reveals a malignant neoplasm composed of glandular structures. Based on this histologic finding, what is the most appropriate classification for this tumor?

Accepted Answer

Adenocarcinoma

Answer

A malignant neoplasm of epithelial origin that forms glandular patterns is classified as an adenocarcinoma. [5, 17] Carcinomas are malignant tumors arising from epithelial cells. [5] Squamous cell carcinoma also arises from epithelial cells but is characterized by keratinization and intercellular bridges. Sarcomas are malignant neoplasms arising from mesenchymal tissue (e.g., connective tissue, muscle), and lymphomas are malignancies of lymphocytes. [17]

American Board of Pathology (ABPath) Practice Test

American Board of Pathology (ABPath) Practice Test

ABPath - American Board of Pathology General Pathology Principles Questions and Answers