MCQs in Objective Pathology with Explanations Sumant Sharma, Yogesh Chhabra
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Introduction to PathologyChapter 1

Including Cell Pathology and Immunopathology
(Including Special Diagnostic Techniques)
 
PRETEST
1. Which of the following are correctly matched? (R-1)
  1. Virchow—Invention of microscope.
  2. Celsius—Work on naked eye appearance of diseased organs.
  3. Pasteur—Showed the way to active immunization.
  4. Jenner—Laid foundation of bacteriology.
  5. Mendel—Discovered principles of inheritence.
1. A. False: Inventor of microscope was Leeuwenhoek.
B. True
C. False: Pasteur laid the foundation of bacteriology.
D. False: Jenner showed the way to active immunization.
E. True
2. Which of the following are pathology subspecialities!?
  1. Histopathology—The diagnosis of disease by examining altered histology of tissue sections.
  2. Exfoliate cytology—Diagnosis of disease by studying body fluids secretion and excretions.
  3. Toxicology—Study of defence processes in the body
  4. Hematology—Study of infectious processes.
  5. Forensic pathology—Use of pathology for legal purposes.
2. A. True
B. True
C. False: Toxicology is study of effect of poisons.
D. False: Hematology is study of blood disorders.
E. True
3. Which of the following definitions are correct?
  1. Allophenic mouse—A mouse in which two types of cells form clones of varying number in different organs.
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  2. In paraffin wax technique, tissue is fixed usually in 10 percent formalin, dehydrated graded alcohols, cleared in xylol, chloroform or other solvent which is mixable with both alcohol and wax.
  3. Pathogenesis—The cause of disease.
  4. Etiology—The mechanism by which disease is caused
  5. Recombinant DNA—Artificial joining of DNA of one species (e.g. humans) to that of others (e.g. bacteria).
3. A. True: Alophenic mice are produced by implantation into a psuedopregnant female a combined embryo developed in vitro by fusing two developing eggs from two pregnant mice.
B. True
C. False: Pathogenesis is the mechanism by which disease is caused.
D. False: Etiology is the cause of disease.
E. True
4. Which of the following are true about electron microhyplum scopy?
  1. Can differentiate between lymphoma and carcinoma as well as between adenocarcinoma and mesothelioma.
  2. Can be used to classify lymphomas.
  3. Can employ osmium tetraoxide as a fixative as well as special stain for lipids.
  4. Can differentiate between prostate cancer and gastric cancer.
  5. Can locate the primary site of a squamous cell carcinoma (SCC).
4. A. True
B. False: Immunohistochemistry (IHC) or gene rearrangement studies are required.
C. True
D. False: Immunohistochemical studies for prostate specific antigen are required.
E. False
5. Which of the following are true about cytology?
  1. FNAC preserves cellular and tissue architecture.
  2. Urinary cytology detects transitional cell carcinoma
  3. Diagnosis is not very accurate.
  4. Exfoliate cytology is performed on cells aspirated by fine needle.
5. A. False: Cellular morphology is preserved but not the tissue architecture.
B. True
C. False: FNAC can be used to diagnose tumors in some situations and may eliminate the need for surgery.
D. False: In exfoliate cytology cells shed or scraped from a epithelium surface are examined.
6. Which of the following are true?
  1. A biopsy should be sent to pathology ideally fresh in saline, but is sent in 10 percent formalin 10 to 20 times the volume of specimen.
  2. For immunohistochemical (IHC) analysis using immunoflouresence of immunoperoxide method, the latter (IP) method is less advantageous.
  3. A biopsy can be sent to laboratory without any information.
  4. Cloning involves isolation of a particular fragments of DNA (usually a gene) and obtaining multiple copies.
  5. Vectors used for cloning can be plasmid vectors or artificial yeast chromosomes (YACS).
6. A. True
B. False: The immunoperoxide method provides a permanent slide–a major advantage over immunofluorescene.
C. False: The request form should tell the site of biopsy and patient's age and sex besides other operative details.
D. True
E. True
37. Which of the following prefixes and suffixes are correctly defined?
  1. Hypo—deficient
  2. It'is—Inflammation
  3. Plasia—Growth abnormality
  4. Hetero—Dissimilar in composition
  5. Meta—In excess
7. A. True
B. True
C. True
D. True
E. False: Meta denotes a change from one form to another. Excess is denoted as hyper.
 
ANSWERS
1. Which of the following are correctly matched? (R-1)
  1. Virchow—Invention of microscope.
  2. Celsius—Work on naked eye appearance of diseased organs.
  3. Pasteur—Showed the way to active immunization.
  4. Jenner—Laid foundation of bacteriology.
  5. Mendel—Discovered principles of inheritence.
1. A. False: Inventor of microscope was Leeuwenhoek.
B. True
C. False: Pasteur laid the foundation of bacteriology.
D. False: Jenner showed the way to active immunization.
E. True
2. Which of the following are pathology subspecialities!?
  1. Histopathology—The diagnosis of disease by examining altered histology of tissue sections.
  2. Exfoliate cytology—Diagnosis of disease by studying body fluids secretion and excretions.
  3. Toxicology—Study of defence processes in the body
  4. Hematology—Study of infectious processes.
  5. Forensic pathology—Use of pathology for legal purposes.
2. A. True
B. True
C. False: Toxicology is study of effect of poisons.
D. False: Hematology is study of blood disorders.
E. True
3. Which of the following definitions are correct?
  1. Allophenic mouse—A mouse in which two types of cells form clones of varying number in different organs.
  2. In paraffin wax technique, tissue is fixed usually in 10 percent formalin, dehydrated graded alcohols, cleared in xylol, chloroform or other solvent which is mixable with both alcohol and wax.
  3. Pathogenesis—The cause of disease.
  4. Etiology—The mechanism by which disease is caused
  5. Recombinant DNA—Artificial joining of DNA of one species (e.g. humans) to that of others (e.g. bacteria).
3. A. True: Alophenic mice are produced by implantation into a psuedopregnant female a combined embryo developed in vitro by fusing two developing eggs from two pregnant mice.
B. True
C. False: Pathogenesis is the mechanism by which disease is caused.
D. False: Etiology is the cause of disease.
E. True
4. Which of the following are true about electron microhyplum scopy?
  1. Can differentiate between lymphoma and carcinoma as well as between adenocarcinoma and mesothelioma.
  2. Can be used to classify lymphomas.
  3. Can employ osmium tetraoxide as a fixative as well as special stain for lipids.
  4. Can differentiate between prostate cancer and gastric cancer.
  5. Can locate the primary site of a squamous cell carcinoma (SCC).
4. A. True
B. False: Immunohistochemistry (IHC) or gene rearrangement studies are required.
C. True
D. False: Immunohistochemical studies for prostate specific antigen are required.
E. False
5. Which of the following are true about cytology?
  1. FNAC preserves cellular and tissue architecture.
  2. Urinary cytology detects transitional cell carcinoma
  3. Diagnosis is not very accurate.
  4. Exfoliate cytology is performed on cells aspirated by fine needle.
5. A. False: Cellular morphology is preserved but not the tissue architecture.
B. True
C. False: FNAC can be used to diagnose tumors in some situations and may eliminate the need for surgery.
4D. False: In exfoliate cytology cells shed or scraped from a epithelium surface are examined.
6. Which of the following are true?
  1. A biopsy should be sent to pathology ideally fresh in saline, but is sent in 10 percent formalin 10 to 20 times the volume of specimen.
  2. For immunohistochemical (IHC) analysis using immunoflouresence of immunoperoxide method, the latter (IP) method is less advantageous.
  3. A biopsy can be sent to laboratory without any information.
  4. Cloning involves isolation of a particular fragments of DNA (usually a gene) and obtaining multiple copies.
  5. Vectors used for cloning can be plasmid vectors or artificial yeast chromosomes (YACS).
6. A. True
B. False: The immunoperoxide method provides a permanent slide–a major advantage over immunofluorescene.
C. False: The request form should tell the site of biopsy and patient's age and sex besides other operative details.
D. True
E. True
7. Which of the following prefixes and suffixes are correctly defined?
  1. Hypo—deficient
  2. It'is—Inflammation
  3. Plasia—Growth abnormality
  4. Hetero—Dissimilar in composition
  5. Meta—In excess
7. A. True
B. True
C. True
D. True
E. False: Meta denotes a change from one form to another. Excess is denoted as hyper.
 
CONCEPTS
Q.1. Which of the following are true about cell-cell interactions?
  1. Occluding junctions and zona adherence are the same.
  2. Macula densa are also called nexus.
  3. Integrins and selectins share a common role of leukocyte—endothelial cell interaction.
  4. Cadherins prevent cancers from becoming invasive.
  5. Immunoglobulin superfamily molecules have a role in recognizing and binding immunological molecules.
  6. Cytokines are secreted by hemopoietic cells only.
  7. Tyrosine kinase associated receptors cause synthesis and secretion of various hormones.
  8. G-proteins are also called guanosine nucleotide binding regulatory proteins.
Ans. A. False: Occluding junctions are called zonula occludens and adhering junctions are called zonula adherence.
B. False: Macula densa is another name for desmosomes and gap junctions are called nexus.
C. True: Besides the selectins also cause movement of leukocytes and platelets.
D. True: Cadherins are calcium dependent adhesion molecules 5which bind adjacent cells and prevent invasion of ECM by cancer cells.
E. True: These act through other adhesion molecules and cytokines.
F. False: Cytokines can be secreted by nonhemopoietic cells too. So far about 50 cytokines have been recognized.
G. True: This is an example of enzyme-linked receptors which are involved in cell growth.
H. True
Q.2. Which of the following are true?
  1. Cyclin E controls synthesis of mRNA and proteins required for DNA synthesis; cyclin A controls DNA replication, and cyclin B controls correct daughter DNA synthesis.
  2. After mitosis cyclins and cyclin dependent kinases are degraded in peroxisomes.
Ans. A. True
B. Caretaker proteins—Ubiquitins are responsible for this.
Q.3. Which of the following are true?
  1. Hypoxia and Ischemia result in same type of reversible injury.
  2. Inability to reverse mitochondrial function after removal of causative agent and membrane damage are two defining differences between reversible and irreversible injury.
  3. Intracellular accumulation of lactic acidosis is a cause of chromatin clumping.
  4. Intracellular accumulation of potassium causes hydropic swelling of cell.
  5. Myelin figures are found only intracellularly in reversible injury.
Ans. A. False: Reversible injury due to ischemia blocks the nutrient supply to cells too and thus both aerobic and anaerobic respiration in the cell is compromised, resulting in more severe cell injury. Furthermore, highly specialized cells like myocardium, proximal tubular cells of kidney and neurons are specially dependent on aerobic respiration and are thus more severely and rapidly affected by ischemia than hypoxia alone.
6B. True
C. True
D. False: Failure of energy dependent sodium potassium pump causes intracellular accumulation of Sodium.
E. False: Myelin figures seen in cell injury are disintegrated membrane blebs containing water and dissociated lipoproteins between lamellae of membranes. They can be found both intracellularly and extracellularly.
Q.4. Which of the following are true?
  1. Phospholipid rich amorphous densities are seen in mitochondria in irreversible cell injury.
  2. Ischemia-reperfusion injury is mainly because of oxidative damage to cell.
  3. Generation of oxygen free radicals occurs in cytoplasm.
  4. Superoxide oxygen is the most reactive of the oxygen free radicals.
  5. Cyanide kills by poisoning mitochondrial cytochrome oxidase.
  6. Ionising radiation can injure the DNA and the cell by radiolysis of water and production of oxygen free radicals.
Ans. A. False: These are characteristic of reversible injury. In irreversible injury, calcium rich densities are seen.
B. True
C. False: It begins within mitochondrial inner membrane.
D. False: Hydroxyl radical is the most reactive.
E. True
F. True
Q.5. Which of the following are true?
  1. Cloudy swelling and hydropic swelling are the same.
  2. Russell's bodies representing excessive immunoglobin in plasma cells' rough endoplasmic reticulum represent a form of hyalin change.
  3. Hyalin degeneration occurs in rectus abdomin's muscle in typhoid fever.
  4. Mallory's hyalin is seen in hepatocytes in cholestasis.
  5. Corpora amylacea represent a form of intracellular hyaline.
Ans. A. False: Cloudy swelling involves excessive accumulation of sodium and water whereas in hydropic swelling mainly only water accumulates (vacuolar degeneration).
7B. True
C. True: This is called Zenker's degeneration.
D. False: It is seen in alcoholic hepatitis.
E. False: It is an example of extracellular hyaline.
Q.6. Which of the following are true?
  1. In hepatic Steatosis, granulomas may be found in the liver.
  2. In hepatic steatosis, neutral fat accumulates both inside the hepatocytes and outside.
  3. Mallory's hyaline bodies are basically proteins.
  4. Albinos are more prone to skin cancers.
  5. Ochronosis and alkaptonuria are synonymous.
Ans. A. True: Lipogranulomas may appear consisting of collections of lymphocytes, macrophages and some multinucleated giant cells.
B. False: There is only intracellular accumulation. Stromal infiltration by mature adipose cells is sometimes seen in obesity; most common organs affected being the heart and pancreas.
C. True: These are intermediate filaments of cytokeratin
D. True: Albinos are deficient in tyrosinase activity in skin and have generalized hypopigmentation. This makes them more prone to develop basal cell and squamous cell cancers on excessive exposure to sun.
E. False: Ochronosis is a rare condition marked by dark pigmentation of ligaments, cartilage, fibrous tissue skin and urine. It may be caused by an inborn error of metabolism, alkaptonuria. This allows formation of Homogentisic acid, part of which is excreted in the urine and part of which is stored in tissues. But ochronosis may also be caused by chronic phenol poisoning.
Q.7. In which cases are the number of cisterns of rough endoplasmic reticulum increased and in which conditions are they decreased?
Ans. 1. Increased number of cisterns: In all cells with high protein production and secretion, e.g. plasma cells.
2. Decreased number of cisterns: Inactive cells with decreased protein synthesis, e.g. in liver of undernourished patients.
8Q. 8. What is oncosis?
Ans. Irreversibly impaired metabolism (generally oxidative metabolism) brings about the death of cells with subsequent vacuolar swelling of cell and reactive inflammation in the absence of programmed cell death. The morphologic result is necrosis
Note: Cell death and necrosis are not identical. A once-living cell submerged and fixed in formaldehyde is chemically dead although from a structural standpoint it remains intact and “animate”.
 
SYNONYM OF ONCOSIS IS ACCIDENTAL CELL DEATH
Q.1. What are oncofetal lesions of rough endoplasmic reticulum (RER)?
Ans. Deranged cisterns of RER, which occur in this form only in fetal and tumor tissue.
Types
1. Ribosome-layer complexes: These are layered aggregates of RER cisterns with interposed rows of ribosomes.
2. Annulated lamellae complexes: These are layered aggregates of perinuclear RER cisterns with nuclear pores.
3. Mitochondrial-lamellar-layer complexes: These are layered aggregates of longitudinally compressed mitochondria and RER cisterns.
Q.2. What are cytoplasmic nuclei?
Ans. This is the histological correlate of onion-layered aggregation of smooth endoplasmic reticulum (“fingerprint degeneration”).
Cytoplasmic nuclei are a sign of blocked enzyme synthesis, such as is occasionally seen in blocked or degenerative protein synthesis.
Q.3. Why is golgi apparatus atrophied in erythroblasts?
Ans. Atrophy of golgi apparatus is the ultrastructural correlate of disturbed protein synthesis with or without impaired post-translational protein modification. So it is typical in cells that 9lose their nuclei, e.g. erythroblasts and undifferentiated malignant tumors.
Q. 4. Give examples in which various substances accumulate in the golgi apparatus.
Ans. Several disorders are attributed to disturbed secretion and therefore to dysfunctioning of golgi apparatus. Examples are:
  1. Cholestasis: Gall drainage disorders in which gall is blocked up into cisterns of the golgi apparatus.
  2. Fatty liver: Hereditary or acquired disorders of lipoprotein metabolism, lipoprotein component accumulates in cisterns of golgi of hepatocytes.
  3. Achondroplasia: (Chondrodystrophica fetalis, dwarfism) Impaired proteoglycan synthesis causes proteoglycan accumulation in golgi cisterns of chondrocytes.
  4. Alveolar proteinosis: Surfactant proteins accumulate in golgi cisterns of type II alveolar surface cells.
Q.5. What are oncocytes?
Ans. These are swollen cells with grainy eosinophilic cytoplasm. Pathogenesis: Mitochondrial DNA mutation disturbs ATP synthesis. This in turn causes compensatory mitochondrial proliferation. So oncocyte is a descripitive term for a cell rich in mitochondria. This is not a tumor cell. Carcinomas of salivary and thyroid glands, though, may exhibit total or partial oncocytic transformation (Oncocytic thyroid ca., Oncocytic salivary gland ca.) These tumors have mahogany brown color because of high cytochrome content.
Q.6. What are megamitochondria?
Ans. These occur in severe deficiencies (Vitamin B complex deficiency or alcoholism) as a result of defective mitochondrial division or fusion. They are not caused by toxic swelling.
Q.7. What is “turbid swelling of parenchymal organs”?
Ans. First described by R Virchow in 1852, this implies swelling of internal organs with enlarged, doughy, turbid cut surface. Microscopically, cells are swollen with granular light cytoplasm. Ultrastructurally, swelling begins in response to the change in osmotic pressure with condensation of matrix and swelling of space between the cristae (crista type). This is followed by distribution of mitochondrial matrix and mitochondrial 10cristae (matrix type). There is usually generalized cytoplasmic degeneration with formation of vacuoles.
Q.8. Which of the following are true about dysplasia?
  1. It rarely occurs in epithelial tissue.
  2. It can be called atypical hyperplasia.
  3. Loss of polarity in dysplasia means disorderly arrangement of cells from basal layer to surface layer.
  4. Dysplasia always progresses to carcinoma.
  5. Anaplasia is a hallmark of dysplasia.
Ans. A. False: Dysplasia means disordered cellular development and often is accompanied with metaplasia and hyperplasia. It occurs most commonly in epithelial tissue.
B. True: Epithelial dysplasia is a characterized by cellular proliferation and cytological changes.
C. False: Loss of basal polarity means nuclei lying away from basement membrane. Of course in dysplasia, disorderly arrangement of cells in different layers is also seen but it is not termed ‘loss of basal polarity’.
D. False: On removal of inciting stimulus which is usually chronic irritation or prolonged inflammation, changes may disappear.
E. False: Anaplasia is loss of cellular differentiation and functions is a feature of frank cancer.
 
SUPPLEMENTARY TOPICS—GENERAL PATHOLOGY
Q.1. Which of the following are true/false?
  1. General pathology is related to basic reactions of cells and tissues to abnormal stimuli that underlie all diseases.
  2. Specific responses to all stimuli of specialized organs and tissues are examined under special or systemic pathology.
  3. Etiology and pathogenesis are synonymous.
  4. In modern terms, intrinsic or genetic and environmental are the two groups of etiological agents of diseases.
  5. Understanding pathogenesis of cystic fibrosis involves knowing the gene responsible for its causation.
  6. Morphological changes in a diseased organ have nothing to do with diagnosis of etiological process.
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  7. Molecular techniques like DNA microassays and immunological approaches for analysis diseases are no more helpful in studying diseases than traditional morphological methods.
  8. Rudolf Virchow has no contribution to modern pathology.
  9. Study of origins, molecular mechanisms and structural changes of cell injury alone are enough to understand morphological and clinical patterns of tissue and organ injury.
Ans. A. True.
B. False: Special or systemic pathology is concerned with specific responses of specialized organs or tissues to more or less well-defined stimuli.
C. False: Etiology is the cause of a disease. Pathogenesis refers to sequences of events in the response of cells or tissues to the etiological agent. It is the mechanism of disease. So even if the genes and their mutant forms underlying a great number of diseases and the entire human gename have been mapped, functions of encoded proteins and how mutations induce disease are often still obscure. The latter part forms pathogenesis of a disease.
D. True: Though there are two major classes of etiological agents, concept of one cause for one disease is obsolete. Almost all diseases known today have both genetic and environmental etiologies combined.
E. False: To know full mechanism (pathogenesis) and manifestations (Morphology) of cystic fibrosis, besides the knowledge of defective gene and gene product, the biochemical immunological and thus the morphological events leading to formation of cysts and fibrosis in lungs, pancreas and organs are required.
F. False: Molecular changes in a disease refer to structural alterations in cells or tissues that are either characteristic of the disease or diagnostic of etiologic process. Diagnostic pathology is devoted to identify nature and progression of disease by studying morphological changes in tissues and chemical alterations in patients.
G. False: Molecular analyses have begun to reveal genetic differences that bear on behavior of tumors. Examples 12are breast cancers and tumors of lymphocytes that look morphologically identical but may have widely different courses, therapeutic responses and widely different courses, therapeutic responses and prognosis. Increasingly, such techniques extend and even supplant traditional morphological methods.
H. False: Rudolf Virchow, known as the father of modern pathology first put forth a concept in nineteenth century that virtually all forms of organ injury start with molecular or structural alterations in cells.
I. False: Different cells in tissue constantly interact with each other and an elaborate system of extracellular-matrix is necessary for integrity of organs. Cell-cell and cell-matrix interactions contribute significantly to response to injury which are as important as cell injury in defining the morphologic and clinical patterns of disease.
 
KEY WORDS
Etiology, pathogenesis, morphological changes, clinical significance, molecular biology, tissue, cell and organ injury, Father of modern pathology.
Q.2. Which of the following are true?
  1. Atrophy involves decrease in number of cells of an organ.
  2. Adaptation, reversible injury and cell death are separate events not interlinked and can occur independently or each other.
  3. Cell death can be normal.
  4. Necrosis can be physiological as apoptosis can be pathological (abnormal).
  5. Calcification is always pathological.
  6. Cells exposed to even sublethal or chronic stimuli are always damaged.
  7. Cellular aging occurs with cumulative sublethal injury with increasing life span.
Ans. A. False: Atrophy involves decrease in function and size of cells.
B. False: Adaptation, reversible injury and cell death can be considered stages of progressive impairment of cell's normal function and structure. For instance in response 13to increased hemodynamic loads, heart muscle first becomes enlarged—an adaptation. If blood supply to myocardium is insufficient to meet with demand, muscle becomes reversibly injured and finally cell death occurs.
C. True: Cell death is a normal and essential part of embryogenesis, the development of organs, maintenance of homeostasis and is aim of cancer therapy.
D. False: Necrosis is a cell death that is always pathologic. Apoptosis can be pathological too when cells are damaged beyond repair and especially, if cell's nuclear DNA is damaged.
E. False: Metabolic derangements can cause some intracellular accumulations of which calcium is one. However calcification also occurs normally during skeletal mineralization.
F. False: Damage might not occur in sublethal, chronic stimuli but cells may show subcellular alterations.
G. True.
Q.3. A. Give an example of cellular adaptation involving alterations in protein synthesis.
  1. What are the major molecular mechanisms of cellular adaptations?
  2. Do estrogens have any effect on (1) DNA synthesis of uterine epithelial cells (2) Structural components of myometrial cells?
  3. In hormonal hyperplasia of physiological type, some hormones may themselves act as growth factors—True or false.
  4. Compensatory hyperplasia of physiological type in liver occurs only by proliferation of remaining cells—True or false.
  5. Some bone marrow cells can give rise to liver cells—True or false.
Ans. A. Example 1: induction of new protein synthesis by target cells as in response of muscle cells to increased physical exercise. Example 2: Switch from one type of protein synthesis to another—Or, markedly overproducing on type of protein—cells producing various collagen types and extracellular matrix proteins in chronic inflammation and fibrosis.
14B. 1. Direct: Stimulation of cells by factors produced by responding cells or other cells in environment.
2. Activation of various cell surface receptors and downstream signalling pathways.
C. 1. Yes: Hormone induced growth of uterus involves increase in both number (hyperplasia)(→↑ DNA synth.) and size (hypertrophy) (↑ Str Comp.) of smooth muscle cells and epithelial cells. Abnormal endometrial hyperplasia is an example of pathological hyperplasia and the consequence is mainly hyperplasia of endometrial glands though both hypertrophy and hyperplasia of epithelial and endomyometrial cells takes place to some extent. This is a common cause of abnormal menstrual bleeding.
2. After normal menstruation, there is a rapid burst of proliferative activity that is stimulated by pituitary hormones and ovarian estrogen. It is brought to a halt by rising level of progesterone usually about 10 to 14 days before anticipated menstrual period. If by any cause the balance between estrogen and progesterone is tripped, there is absolute or relative increase in estrogen with consequent hyperplasia of endometrial glands.
D. True: Hyperplasia is caused by increased local production of growth factors, increased levels of growth factor receptors on responding cells, or activation of particular intracellular signalling pathways. These changes cause production of transcription factors that turn an may cellular genes including those envolving growth factors, growth factor receptors and cell cycle regulators-net result being cellular proliferation. Hormones themselves can act as growth factors and trigger source of growth factors in compensatory hyperplasia is not clear transcription of cellular genes.
E. False: Not only remaining cells but some new cells are also formed from stem cells. In liver, intrahepatic stem cells don not play a role in hyperplasia after hepatectomy but contribute to regeneration after some forms of liver injury like chronic hepatitis in which proliferative capacity of hepatocytes is compromised.
15F. True: Recent clinical and experimental data suggests that some bone marrow stem cells may be able to give rise to many types of differentiated, specialized cell types including hepatocytes. Then these bone marrow stem cells have a potential to repopulate damaged tissues.
Q.4. A. What is the difference between cell proliferation that occurs pathological benign hyperplasia and cancer?
B. What role does tissue hyperplasia play in wound healing?
C. Skin and mucosal tissue can be stimulated by growth factors. True or false.
Ans. A. Pathological hyperplasia (alone) regresses, if the stimulus for growth is taken off. Whereas growth in number of cells in cancer is because of loss of normal growth control mechanisms and goes on occurring after particular phase of initiation. Most forms of pathological hyperplasias are caused by excessive hormonal or growth factor stimulation of target organs. Benign prostatic hyperplasia, e.g. occurs because of stimulation by androgens.
Pathological hyperplasia however, provides a fertile soil on which cancer can arise. Thus patients of endometrial hyperplasia are more prone to endometrial cancer.
B. Hyperplasia is an important connection tissue response in wound healing in which proliferation of fibroblasts and blood vessels and in repair growth factors are responsible for this hyperplasia.
C. True: Stimulation of skin epithelium can occur by growth factors in papilloma viral infections leading to skin warts. Same viruses and other viruses can also cause similar mucosal lesions.
Q.5. A. In nondividing cells like myocardial cells, both hyperplasia and hypertrophy can occur. True or false?
B. Why is nuclear DNA content of hypertrophied cells higher than the rest of cells?
C. There's a similarity in mechanisms of production of bulging muscles of men engaged in ‘pumping iron’ and cardiac hypertrophy in hypertension. True or false.
16D. When do uterus and breast physiologically grow in size?
Ans. A. False: Cells capable of division can respond to stress by both hyperplasia and hypertrophy but in nondividing cells only hypertrophy occurs. Hypertrophy refers to increase in individual cell size leading to increase in size of whole organ.
B. Because of arrest at some stage of cell cycle in these cells without undergoing metosis.
C. True: Most common stimulus for hypertrophy of muscles is increased workload. In both the examples given, the increase workload is shared by greater mass of cellular components and each muscle false is spared of excess work and so escapes injury. The enlarged muscle cell achieves a new equilibrium, permitting it to function at a higher activity level. The striated skeletal and heart muscle are able to respond to increased workload (and thus ! metabolic demands) by tremendous hypertrophy as there is no mitotic response. In chronic hemodynamic load like faulty values or HT, an imbalance occurs between demand and response of cell's functional capacity. Greater number of myofilaments per cell permits an increase workload with a level of metabolic activity per unit volume of cell not different from that borne by normal cell.
D. Uterus: During pregnancy, uterus grows massively because of hypertrophy and hyperplasia both caused by hormonal influence of estrogens on smooth muscles. Oestrogens act on hormone receptors on individual myometrial cells leading to hypertrophy—increase in smooth muscle protein synthesis and increase in cell size.
Breast: During lactation again the stimulus is hormonal. This time it is estrogen and prolactin.
Q.6. A. Is these a conclusive and substantial evidence that during stress, hypertrophy and hyperplasia occur together?
B. For a patient in cardiac failure decompensation because of previous MI, coronary and peripheral vascular atherosclerosis is a common setting. Previous to decompensation, peripheral vascular atherosclerosis might have caused gene induction of which genes in heart muscle?
17C. When do the genes in heart muscle fibers switch to similar to fetal or meonatal forms from adult forms expression.
Ans. A. Hyperplasia and hypertrophy often occur together. The conclusive evidence comes from the fact that cardiac and skeletal muscles, under stress, undergo an increase in their individual fiber size as well as (a recent discovery) repopulation from some existing and precursor cells. So neither hyperplasia nor hypertrophy is ever absolute.
B. Blood pressure (arterial) increase is a common disease caused by atherosclerosis of peripheral and visceral vessels leading to increased risk of ischemic heart disease, if untreated for long. Hypertension causes hypertrophy (by definition only hypertrophy) of cardiac muscle fibers. During this increase in individed fiber mass of cardiac muscles, three types of genes are induced:
  1. Those coding transcription factors (C-fos, C-jun)
  2. These coding growths factors (TGF-b, insulin like GF-1, IGF-1) fibrolast growth factor.
  3. These coding vasoactive agents (alfa-adrenergic agonist, endothelin-1, angiotensin II)
C. During muscle hypertrophy, e.g.
  1. In hypertrophied cardiac muscle fibers, b myosin chain production mostly replaces alpha-myosin heavy chain production. This leads to decreased myosin ATP-ase activity. This leads to slow utilization of ATP by myosin and then slower contraction of individual fibers. So in a given time lesser ATP's are used and heart rate decreases (efficiency of myosin is more).
  2. Re-exprasion of early developmental gives like atrial natriuretic peptide in ventrides occur. (In embryo, ANP gene is expressed in both atrium and ventricle. After birth, oly in atrium). ANP is a peptide hormone that causes increased slat and water loss by kidneys leading to decreased hemodynamic load on stressed heart.
    18
 
QUESTIONS AND ANSWERS
Q.1. Why two classes of etiology's theory is considered obsolete?
Ans. Some single gene disorders on one hand and infections on the other gave rise two one disease—once cause concept. Two types of etiological types suggested were genetic and acquired; recent data supports role of genetic factors in acquired diseases like hypertension and DM similarly even infectious are prove to genetic susceptibility, e.g. lower repiratory tract infections in cystic fibrosis.
Q.2. Does pathogenesis involve knowing the earliest molecular event in a disease?
Ans. Yes but not only this. Pathogenesis means the full course of immmunological, biochemical and morphological processes besides the initial infectious or molecular cause. It involves the whole process from the first stimulus to ultimate manifestation of a disease. Some of the processes in many diseases like the mechanism of manifestation of alteration in genes'structure are still a subject of research.
Q.3. Why is morphological diagnosis of tumors not enough for management?
Ans. Tumor behavior also depends on its genetic profile. So studies in molecular biology of tumors which may be morphologically similar but behave differently in therapeutic response are required, e.g. slymphomas.
Q.4. What was the most pioneering concept put forth by Rudolph Virchow?
Ans. Virchow, called the father of modern pathology, put forth the cell theory. All forms of organ injury starts with molecular or structural cell injury. Though cells interact with each other and extracellular matrix ECM. ECM also maintains cells in themselves.
Q.5. What are the two types of pathogenesis identified?
Ans. Casual and formal pathogenesis. Causal pathogenesis tells why a pathogen causes a disease. This considers the environmental factors, host's bodily disposition (susceptibility without regard to adaptability) and the interplay of nonspecific immune responses in producing resistance to 19some diseases. Formal pathogenesis describes the structural changes observed during clinical course of a disease which culminate in the altered structural and functional state of diseased organ/body.
Q.6. Define health and disease.
Ans. WHO defines health as a condition of complete bodily, mental and social well-being. Disease is defined as a dysfunction in life-processing that alter the body or a part of body in a manner that the affected individual requires help for subjective, clinical or social reasons.
Q.7. In what way is the type of clinical course of a disease defined as regards to its development.
Ans. Peracute diseases are fulminant and usually lead to death in several days. Acute diseases are usually intense and last for a few days or weeks. Recuperation is possible. Subacute diseases are insidious in onset, clinical course lasting for weeks with doubtful recuperation. Chronic diseases are mild and progress in stages over months. Primary chronic diseases begin without a manifest acute phase. Clinical course is episodic. Recuperation is not possible. Secondary chronic disorders occur subsequent to acute inflammation that fails to heal because of complications. Recuperation in secondary chronic diseases occurs with persisting structured damage and functional deficits after the disease and subsides. The social and functional adaptability is thus restricted. Recurrence is resurgence of what is basically a chronic disease after a gap. Remission is temporary disappearance of symptoms of a disease. Death (Exitus letalis = lethal end)
Q.8. Will it be correct to say that homeostasis is a continuously changing state?
Yes, but upto some extent only. The normal cell is confined to a fairly narrow range of function because of:
  1. Genetic programming of metabolism, differentiation and specialization.
  2. Constraints because of neighboring cells.
  3. Availability of metabolic substracts.
    The narrow range of functioning is the steady state or homeostasis. Within this narrow range there is continuous 20change—in one of different metabolites and other substances in the cell.
Q.9. What are the triggers for muscle hypertrophy and for changes in gene expression in cardiac muscle fibers in myocardial hypertrophy?
Ans. Two groups:
  1. Mechanical triggers (stretch).
  2. Trophic triggers.
    The trophic triggers are chiefly growth factors (IGF-α) and vasoactive amines (angiotension II, DC-adrenergic organists). The latter are produced by nonmyocyte cells and myocytes themselves.
Q.10. What ultimately regulates the size of myocardial cells?
Ans. From the above discussion it is clear that environmental cues are important. Nutrients (blood supply to heart muscle) is also a limiting factor.
Q.11. Why don not heart muscles enlarge unlimitedly in response to increase burden?
Ans. There's a limit upto which heart muscle fibers can resond to increase in their size. Any increase in burden after that leads to cardiac failure. Various factors are implicated but not confirmed. These are—limited blood supply, limited oxidative capacity adaptability of mitochondria, changes in number and type of proteins, degradation of proteins and changes in myofibril cytoskeleton. Various ultrastructural manifestations include the myocardial fibers degeneration. There may also be apoptosis or nucleosis of myocardial fibers.
Q.12. Give two examples of physiological atrophy.
Ans. Physiologic decrease in cell size that may ultimately culminate in cell death can lead to decrease in entire tissue or even organ. Physiologically this is seen in (1) embryonic growth—thyroglossal of duct atrophy. (2) in uterus after parturition.
Q.13. When is atrophy accompanied by osteoporosis?
Ans. Atrophy of disuse may be accompanied by osteoporosis of disuse.
21Q.14. In which conditions is cachexia seen?
Ans. Marked muscle wasting or cachexia may be seen in protein energy malnutrition of (1) marasmus type or (2) chronic inflammatory states (because of secretion of TNF) or (3) cancer.
Q.15. What are the causes of widening of sulci and narrowing of gyri in above 50 years persons?
Ans. Aging and compromised blood supply because of atherosclerosis. Aging typically causes cell loss in tissues containing permanent cells: particularly in brain and heart.
Q.16. What are the other causes of atrophy?
Ans. Besides disuse, malnutrition and aging, denervation, ischemia, loss of endocrine stimulation and pressure by expanding mass can cause atrophy.
Q.17. What are the ultrastructural changes seen in atrophy?
Ans. Ultrastructural changes in atrophy represent a new balance between compromised conditions and size of cell upto the limit of its viability. Atrophied muscle fibers have fewer structural and functional components like myofibrils, mitochondria and endoplasmic reticulum.
Q.18. Can atrophy lead to cell death?
Ans. If the conditions are compromised limitlessly, cell death may result in atrophied tissue. Examples include ischemic necrosis and apoptosis in developing embryo.
Q.19. What are the mechanisms involved in atrophy?
Ans. 1. Proteolysis by lysosomal hydrolases and ubiquitin proteasome pathway.
2. Autophagy by autophagic vacuoles.
Lysosomes and proteasomes: Cytosomal hydrolases like cathepsins degrade protein molecules from the intercellular environment, surface of cells, environment. Ubiquitin conjugates cytosolic and nuclear proteins and binds to large proteolytic organelles called proteasomes–leading to proteolysis. Ubiquitin proteasome pathway is involved in cancer cachexia and proteolysis by glucocorticoids and thyroxine. Insulin inhibits this. TNF also stimulates this.
Autophagy: Small membrane bound vacuoles within cell with fragments of organelles form and then fuse with 22lysosomes the latter throwing their proteolytic enzymes in the autophagic vacuoles. Some residual bodies—vascuoles with digested material may remain.
Lipofuscin or aging pigment is a form of these residual bodies causing brown coloration of organs in which it accumulates brown atrophy.
Q.20. What are the equivocal signs of death?
Ans. These are cardiac arrest, lack of pulse, cessation of breathing, areflexia and decreasing body temperature. This is referred to as clinical death.
Q.21. What are the criteria for brain death?
Ans. A patient is regarded as biologically dead where brain death has been diagnosed according to following criteria:
  1. An isoelectric or flat electroencephalogram for 24 hours.
  2. Two angiographic studies performed ½ an hour apart demonstrating absent cerebral circulation.
  3. Irreversible absence of spontaneous respiration.
  4. Aflexia (loss of corneal and papillary reflexes).
Q.22. What are the unequivocal signs of death?
Ans. Livores: After cardiac arrest, gravity causes blood in venous system to collect in lowest part of body. This produces reddish violet skin spots that can be mobilized by applying local process.
Regor mortis: Postmortem rigidity begins 3 to 6 hours after death.
Nystem's law: Rigor mortis begins at head and spreads towards feet. Later subsides in the same manner. Occurs due to lack of ATP and subsequent coagulation of active and myosin filaments.
Antolysis or decomposition: Because of activiation of lysosomal intrinsic protease and extrinsic protease from intestinal bacteria which digest the organic components of body. Failure of tissue respiration causes lysosomal protease activation.
Q.23. The above three types of signs of death can be simulated in which condition?
Ans. In any condition causing reduced vital functions like barbiturate intoxication.(apparent death).
23Q.24. Define average life expectancy, morbidity and mortality and lethality.
Ans. Average life expectancy: Time period in which 50 percent of certain population group have died. The population group can be, e.g. women.
Morbidity: Number of persons per year per 100,000 population who suffer from a disease.
Mortality: Number of persons per year per 100,000 population who have died of a disease.
Lethality: Quotient obtained by dividing the number of persons who have died of a certain disease by the number of persons who have contracted that disease.
Q.25. Define epidemic autopsy, clinical autopsy and insurance autopsy.
Ans. Epidemic autopsy: Performed in equivocal cases involving chemical suspicious of infectious disease.
Clinical autopsy: Performed on patients who died in hospital usually a part of hospital quality assurance program. Requires consent of next of kin.
Insurance autopsy: Done when required by insurance companies when:
  1. Sudden death from uncertain or unnatural causes.
  2. Occupational exposure to certain pathogens.
    The procedure is ordered by ensurer. This type of insurance autopsy to resolve insurance claim is almost never refused by next of kin.
Q.26. What are the two main classes of nuclei seen in cell cycle?
Ans. Interphase nucleus: Characterized by a nucleolus containing RNA, loosely structured, genetically active euchromatin and densely structured heterochromatin (genetically inactive)
Mitotic nucleus: Characterised by visible chromosomes.
Q.27. What is the structure of chromosomes in metaphase?
Ans. Two strands of chromatids joined at centromere.
  • short arm – p (for petit)
  • long arm – q.
24Q.28. What is a karyogram?
Ans. Chromosomes of a cell are shown to be arranged in a karyogram. This is a short formula or description of chromosomes using the following criteria:
  • Total number of chromosomes.
  • Sex chromosome status.
  • Applicable aberrations.
Q.29. Based on a computer model, which part of DNA corresponds to software and which one to hardware?
Ans. The software is the program and base sequence containing and instructions for:
  1. Copying the program—DNA replication.
  2. Repairing program defect—DNA repair.
  3. Using subprograms to create protein (Structure and functional).
The replication process and machinery, transcription process and machinery and translation process and machinery can be compared to hardware—computer itself.
Q.30. What is a nucleosome?
Ans. Nucleosome consists of:
1. A histone molecule with 2, H2A, H2B, H3 and H4 polypeptides each.
2. One histolne H1 polypeptide
3. Limker DNA
4. DNA proper.
Diameter of a nucleosome in a solenoid model is 11 cm. A DNA double helix diameter is 2 mm.
Q.31. What are the dimensions or diameter (average) of a chromatid?
Ans. Each chromatid is a supercoil of around 700 mm diameter with each coil of single DNA strand and histone molecules (polynucleosome) being of around 30 mm diameter.
Q.32. Give an example of congenital DNA repair defect.
Ans. Xeroderma pigmentosum.
It is rare. It is hereditary (because of an endonuclease defect).
25
zoom view
Sequelae:
  1. Skin atrophy (→Thinning of skin)→ an adaptive reaction of excessive cornification and hyperpigmentation is induced.
    Mitotic dysfunction in skin cells: Skin cancers. Clinically the→following lesions are seen:
    • Dry scaly skin (Xeroderma) with mottled hyperpigmentation.
    • It is a precusor of skin cancer. Later multiple skin tumors such as basal cell Ca, squamous cell Ca and malignant melanoma develop.
Q.33. What are the types of UV radiation?
Ans. Three wavelength ranges exist in UV portion of solar spectrum:
  1. UVA → 280 to 400 mm
  2. UVB → 280 to 320 mm→ to cause cutaneous cancers.
  3. UVC → 200 to 280 mm filtered by ozone layer.
Q.34. Causation of skin cancers by UV radiation depends upon which factors?
Ans. 1. Type of UV rays.
2. Intensity of exposure.
3. Quantity of light absorbing protective mantle of melanin in skin. Fair shinned Europeans who do not tan their bodies and live near equator, e.g. Queensland Australia, have the highest incidence of cutaneous cancers.
Q.35. What the subcellular level effects of UV rays?
Ans. 1. Inhibition of cell division.
2. Induction of mutations → carcinogenicity of UV rays is attributed to formation of dipyrimidine dimmers in DNA.
3. Cell death.
4. Inactivation of enzymes.
26Q.36. What is NER and discuss its role in UV radiation caused cutaneous tumors?
Ans. NER or nucleotide excision repair is the mechanism of repair of DNA damage such as formation of dispyrimidine dimmers by UV rays in chin cells. Steps of NER are:
  1. Recognition of DNA lesion.
  2. Incision of damaged portion on both sides of lesion.
  3. Removal of damaged nucleotide.
  4. Synthesis of normal nucleotide patch.
  5. It is ligation to DNA.
In mammalian cells upto 30 or more proteins are involved.
It is postulated that in excessive sunlight UV ray damage, NER is overwhelmed leading to large transcriptional errors and thus cancer.
Q.37. How does UVB radiation cause skin cancers in XP?
Ans. There are basically two mechanisms:
  1. Inherited inability to repair UVB damaged DNA.
    XP is a heterogenous disease with at least 7 variants each caused by a defect in one of several genes involved in NER. There is extreme photosensitivity and 2000 fold increased risk of skin cancers in sun exposed skin.
  2. UVB also causes mutations in oncogenes and tumor suppressor genes.
Mutant forms of P53 and RAS are +. The mutations occur mainly at dipyrimidine sequences. In animal models, P53 mutations occur early than appearance of tumors.
In XP, there may also be neurological abnormalities.
Q.38. What does the size of nucleus in a cell depend upon?
Ans. 1. Size of cell.
2. DNA content of nucleus.
3. Functional state of nucleus.
Q.39. In what conditions does nuclear polyploidy occur?
Ans. Multiple complement chromosomes in a cells is called polyploidy. It occurs when:
  1. Proliferating cells double their DNA in synthesis phase and just before mitosis become tetraploid.
  2. Where mitosis fails to occur after the synthesis phase or is followed by several additional synthesis phases. 27This occurs in some endocrine gland cells like thyroid.
    As a morphological sign of stress induced adaptative reactive as in.
    Barbiturate above: Increased liver metabolism results in liver cells polyploidy.
    Cardiac valvular defects: Mycocardium works harder and produces polyploidy.
Haploid cells are normally seen only while spermiogenesis and oogenesis.
Q.40. What is nuclear aneuploidy and what is its morphological sequela?
Ans. Variation from normal euploid complement (Haploid or Diploid) of chromosomes in which individual chromosomes do not exist in their normal quantities. Morphological sequela of aneuploidy are:
  1. Variability in size of nucleus (nuclear polymorphism) larger cell nucleus indicates cellular activity and smaller nucleus indicates cellular inactivity.
  2. Variability in nuclear chromatin content. (Nuclear polychromasia).
Both polymorphism and ploychromasia are important criteria characterizing a malignant tumor.
Q.41. What are the nuclear criteria of malignancy?
Ans. 1. Nuclear polymorphism and nuclear polychromasia.
2. Proliferation measured by mitotic count in a field of vision.
3. Dyskaryosis.
Q.42. What are the chromatin changes seen in nuclear chromatin in different disease states?
Ans. 1. Meterochromatin condensation: Checker board type of chromatin condensation indicates arrested transcription.
2. Dyskaryosis: Irregular pattern of heterochromatin condensation and fine aggregates gives cancer cells a salt and pepper appearance.
3. Perinuclear hyperchromatosis: Chromatin condensation along inner nuclear membrane. Early sign of cell death (apoptosis). Later it leads to total chromatin clumping or nuclear pyknosis.
284. Karyolysis: Fading of nucleus due to chromatin dissolution. Late sign of induced cell death.
5. Karyorrhexis: Nuclear burst due to chromatin fragmentation. Late sign of programmed cell death.
Q.43. What are the different types of nuclear inclusions seen?
Ans. 1. Cytoplasmic inclusions: Migration of portions of cytoplasm in nucleus, associated with dysfunctional cell division in telephase causes a rounded lucency in nucleus → frosted glass nucleus.
For example papillary thyroid carcinoma.
2. Paraplasmic inclusions: Migration of portions of paraplasm in nucleus due to imagination of nuclear membrane or dysfunctional telophase.
3. Glycogen inclusions: Seen as nuclear defects after alcohol fixation—Diabetes.
4. Fatty inclusions: Following paraffin fixation, cause lipid defects in nucleus. Typical of tumors in the form of fatty tissue—Liposarcoma.
5. Immunoglobulin inclusions: PAS-positive globules (Fahey-Dutcher bodies). Malignant lymphocytic tumors like—Lympholoplasmacytic lymphoma.
6. Viral inclusion: Viral proteins arranged in paracystalline configuration.
Q.44. What is the most frequent type of metaplasia seen?
Ans. Metaplasia or an adaptive response to stress in which one mature cell type (epithelial or mesenchymal) is converted to another mature cell type is most commonly of columnar to squamous epithelial type. The commonest form occurs in smokers' respiratory columnar ciliated mucous secreting epithelium is replaced by more resistant stratified squamous epithelium with loss of mucous secreting function. The change may be focal or wide. Stones in excretory ducts of salivary glands, pancreas or bile ducts may also cause a change from columnar to stratified squamous epithelium.
Q.45. What is the role of Vitamin A in maintaining respiratory epithelium?
Ans. Vitamin A deficiency (retinoic acid deficiency) may cause squamous metaplasia of respiratory epithelium and excess of Vitamin A is protective against keratinization.
29Q.46. Is squamous metaplasia beneficial?
Ans. It is a double edged sword as in case of respiratory epithelium important function of mucous secretion is lost. Also malignant cancer can arise in metaplasmic tissue and most common cancer of respiratory epithelium is of squamous type. All this with standing, stratified squamous epithelium is more rugged and causes increased resistance to noxious stimuli.
Q.47. Can metaplasia from squamous to columnar epithelium occur?
Ans. Yes. Barrett's esophagus is a condition in which lower esophagus after increased exposure to acid reflux from stomach converts from stratified squamous to glandular columnar type of epithelium cancer arising in this setting is most commonly adenocarcinoma.
Q.48. In connective tissue metaplasia also clearly are adaptive response?
Ans. Connective tissue formation of the type which is not indigenous to its site is not clearly adoptive. Example is formation of bone in soft tissue in myositis ossificans in fractures. Fat and cartilage can form sometimes too.
Q.49. What is the role of stem cells in metaplasia?
Ans. Metaplasia results from reprogramming of stem cells present in the tissue or of undifferentiated mesenchymal cells in connective tissue. Precursor cells develop differently there is no change in the phenotype of differentiated, mature cells.
Q.50. What are the mechanisms involved in altered precursor cells development in metaplasia?
Ans. Many tissue specific and differentiation genes are involved in coding for growth factors, cytokines and E (M components which signal for altered development of precursor cells, e.g. bone morphogenic proteins, members of TGF-B superfamily, induce chondrogenic and osteogenic expression in stem cells. While suppressing differentiating into muscle or fat these growth factors act as external triggers induce specific transcription factors that lead the cascade of phenotype specific genes towards a full-developed (of different type) cell. Why the normal pathways are disrupted is not known?
30Examples: Vitamin A → Retinoic acid regulates cell growth, differentiation and tissue pattering.
Certain cytostatic drugs: Cause disruption of DNA methylation patterns and can transform mesenchymal cells from one cell type (fibroblast) to another (muscle, cartilage).
SUPPLEMENTARY TOPICS—CELL INJURY AND INFLAMMATION
 
PRETEST
1. Which of the following are true about cell Injury?
  1. Hypothyroidism and scurvy cause delayed wound healing.
  2. Ultraviolet light promotes healing.
  3. Cerebral cortex and myocardium can regenerate after injury.
  4. Fibrinoid necrosis occurs in TB.
  5. Enzymatic lysis of adipose tissue causes fat necrosis.
1. A. True
B. False
C. False
D. False
E. True
2. Which of the following are true?
  1. The myofibroblastic differentiation of fibroblast causes contraction of granulation tissue.
  2. Endarteritis obliterans and leukemia can be caused by radiation exposure for a long time.
  3. Apoptosis is pathological event.
  4. Apoptosis is an energy dependent pigmentation of DNA by non-lysosomal endonucleases.
2. A. True
B. False
C. False
D. False
3. Which of the following are true?
  1. Endothelial cells and plasma cells are capable of phagocytosis of particulate matter in acute inflammation.
  2. Lymphocytes and plasma cells contribute in chromic inflammation.
  3. In vascular phase of inflammatory response, neutrophils and monocytes move towards periphery of microcirculatory vessels a process called pavementing.
  4. T-lymphocytes produce antibodies.
  5. Transudate is noninflammatory fluid with few cellular elements.
3. A. False: Neutrophils, macrophages and eosinophil are the main phagocytes in acute inflammation.
B. True
C. Flase: The process described is called margination. Pavementing is adhering of inflammatory cells to vascular endothelium.
D. False: B-lymphocytes produce immunoglobulins.
E. True
314. Which of the following are true?
  1. Unidirectional movement of leukocytes towards a stimulus is called diapedesis.
  2. Macrophages are found in glomeruli.
  3. Hepatocytes have greater regenerative capacity than myocardial cells.
  4. Mast cells have metachromatic granules.
4. A. False: The described process is chemotaxis. Diapedesis is movement of white cells out of the vessel through gaps in endothelial cells.
B. True
C. True
D. True
5. Which of the following are true?
  1. Features of acute inflammation are in following chronological order:
    1. Contraction of arterioles
    2. Arteriolar dilatation
    3. Active hyperemia
    4. Inflammatory exudates
    5. Swelling and pain
    6. Slowing of blood flow.
  2. Cytoplasmic micropinocytotic vesicles are increased for increasing membrane permeability in acute inflammation.
  3. C3a, C5a, 5-HT, Kallikrein, PGE2 are involved in increased vascular permeability.
  4. In a granuloma, there is polymorphonuclear leukocytosis, cell debris and fibrin.
  5. Collagen type found in dermis, tendon, bone, cornea, and dentin is type IV.
5. A. True
B. True
C. True
D. False: This description is that of an abscess. Granuloma is characterized by chronic inflammation.
E. False: Type neollagen is seen in basement membranes. Type I is seen in the said places.
6. Which of the following are true?
  1. Fab fragment consists of light chain and part of heavy chain.
  2. Papain digestion of monomeric immunoglobulin results in production of an antibody binding fragment.
  3. Fc, Fragment consists of C-terminal ends of heavy chains.
6. A. True
B. False: There are two antibody binding fragments.
C. True
7. Which of the following are true?
  1. IgM class specific antibody production is a primary antibody response.
  2. IgA class antibody has 4 J-chains.
  3. Mast cells degranulation is a property of IgE.
  4. Lymphocyte surface antigen receptor is a property of IgD. The deep (or para) cortex is the T-lymphocyte zone of lymph node and enlarges during antigenic stimulation.
    32
  5. The deep (or para) cortex is the T-lymphocyte zone of lymph node and enlarges during antigenic stimulation.
7. A. True: IgM appears in a small quantity within 7 days of exposure to antigen.
B. False: IgA is selected by plasma cells as a dimmer, i.e. two molecules, linked together by one polypeptide-J chain.
C. True
D. True
E. True
8. Which of the following are true about T-lymphocytes?
  1. Helper T-lymphocytes and T4 positive cells.
  2. Cells bearing both T4 and T9 are common thymocytes.
  3. Prothymocytes are T10 positive cells.
  4. Suppressor T-lymphocytes are T9 positive cells.
  5. In the unstimulated lymph node, there are localized aggregates of lymphocytes in superficial cortex.
8. A. True
B. True
C. True
D. False: These are T8 positive cells.
E. True
9. Which of the following are true?
  1. Following antigenic stimulation, para cortex enlarges resulting in B-lymphocyte proliferation.
  2. Macrophages have a surface receptor for C3b.
  3. C5a promotes emigration and accumulation of neutrophil polymorphs and macrophages.
  4. Extrinsic allergic alveolitis is an immune complex, Arthus (type 3) reaction to bacterial spores on mouldy hay.
  5. Rheumatoid arthritis is an organ specific autoimmune disease.
9. A. False: Following antigenic stimulation of humoral response type, primary nodules enlarge to become germinal centers where B-lymphocytes proliferate.
B. True
C. True
D. True
E. False: It is a multisystem connective tissue disease.
10. Which of the following are true about autoimmune disease?
  1. In Di-George syndrome, there is defective B-cell function.
  2. In infantile sex-linked agammaglobulinemia there is selective B-cell defect (Bruton type).
  3. In severe combined immuno deficiency, there is defective B-cell and T-cell function.
  4. Wiskott-Aldrich syndrome is characterized by abnormal platelets and defective T-cell function alone.
10. A. False: There is almost complete failure of development of thymus and parathyroid with resultant defective T-cell function.
B. True
C. True
D. False: Alongwith these two abnormalities, IgM and IgA are also abnormal.
 
ANSWERS
1. Which of the following are true about cell Injury?
  1. Hypothyroidism and scurvy cause delayed wound healing.
  2. Ultraviolet light promotes healing.
  3. Cerebral cortex and myocardium can regenerate after injury.
  4. Fibrinoid necrosis occurs in TB.
  5. Enzymatic lysis of adipose tissue causes fat necrosis.
1. A. True
B. False
C. False
D. False
E. True
2. Which of the following are true?
  1. The myofibroblastic differentiation of fibroblast causes contraction of granulation tissue.
  2. Endarteritis obliterans and leukemia can be caused by radiation exposure for a long time.
  3. Apoptosis is pathological event.
  4. Apoptosis is an energy dependent pigmentation of DNA by non-lysosomal endonucleases.
2. A. True
B. False
33C. False
D. False
3. Which of the following are true?
  1. Endothelial cells and plasma cells are capable of phagocytosis of particulate matter in acute inflammation.
  2. Lymphocytes and plasma cells contribute in chromic inflammation.
  3. In vascular phase of inflammatory response, neutrophils and monocytes move towards periphery of microcirculatory vessels a process called pavementing.
  4. T-lymphocytes produce antibodies.
  5. Transudate is noninflammatory fluid with few cellular elements.
3. A. False: Neutrophils, macrophages and eosinophil are the main phagocytes in acute inflammation.
B. True
C. Flase: The process described is called margination. Pavementing is adhering of inflammatory cells to vascular endothelium.
D. False: B-lymphocytes produce immunoglobulins.
E. True
4. Which of the following are true?
  1. Unidirectional movement of leukocytes towards a stimulus is called diapedesis.
  2. Macrophages are found in glomeruli.
  3. Hepatocytes have greater regenerative capacity than myocardial cells.
  4. Mast cells have metachromatic granules.
4. A. False: The described process is chemotaxis. Diapedesis is movement of white cells out of the vessel through gaps in endothelial cells.
B. True
C. True
D. True
5. Which of the following are true?
  1. Features of acute inflammation are in following chronological order:
    1. Contraction of arterioles
    2. Arteriolar dilatation
    3. Active hyperemia
    4. Inflammatory exudates
    5. Swelling and pain
    6. Slowing of blood flow.
  2. Cytoplasmic micropinocytotic vesicles are increased for increasing membrane permeability in acute inflammation.
  3. C3a, C5a, 5-HT, Kallikrein, PGE2 are involved in increased vascular permeability.
  4. In a granuloma, there is polymorphonuclear leukocytosis, cell debris and fibrin.
  5. Collagen type found in dermis, tendon, bone, cornea, and dentin is type IV.
5. A. True
B. True
C. True
D. False: This description is that of an abscess. Granuloma is characterized by chronic inflammation.
E. False: Type neollagen is seen in basement membranes. Type I is seen in the said places.
6. Which of the following are true?
  1. Fab fragment consists of light chain and part of heavy chain.
  2. Papain digestion of monomeric immunoglobulin results in production of an antibody binding fragment.
  3. Fc, Fragment consists of C-terminal ends of heavy chains.
6. A. True
B. False: There are two antibody binding fragments.
C. True
7. Which of the following are true?
  1. IgM class specific antibody production is a primary antibody response.
  2. IgA class antibody has 4 J-chains.
  3. Mast cells degranulation is a property of IgE.
  4. Lymphocyte surface antigen receptor is a property of IgD. The deep (or para) cortex is the T-lymphocyte zone of lymph node and enlarges during antigenic stimulation.
  5. The deep (or para) cortex is the T-lymphocyte zone of lymph node and enlarges during antigenic stimulation.
7. A. True: IgM appears in a small quantity within 7 days of exposure to antigen.
B. False: IgA is selected by plasma cells as a dimmer, i.e. two molecules, linked together by one polypeptide-J chain.
C. True
D. True
E. True
8. Which of the following are true about T-lymphocytes?
  1. Helper T-lymphocytes and T4 positive cells.
  2. Cells bearing both T4 and T9 are common thymocytes.
  3. Prothymocytes are T10 positive cells.
  4. Suppressor T-lymphocytes are T9 positive cells.
  5. In the unstimulated lymph node, there are localized aggregates of lymphocytes in superficial cortex.
8. A. True
B. True
C. True
D. False: These are T8 positive cells.
E. True
9. Which of the following are true?
  1. Following antigenic stimulation, para cortex enlarges resulting in B-lymphocyte proliferation.
  2. Macrophages have a surface receptor for C3b.
  3. C5a promotes emigration and accumulation of neutrophil polymorphs and macrophages.
  4. Extrinsic allergic alveolitis is an immune complex, Arthus (type 3) reaction to bacterial spores on mouldy hay.
  5. Rheumatoid arthritis is an organ specific autoimmune disease.
349. A. False: Following antigenic stimulation of humoral response type, primary nodules enlarge to become germinal centers where B-lymphocytes proliferate.
B. True
C. True
D. True
E. False: It is a multisystem connective tissue disease.
10. Which of the following are true about autoimmune disease?
  1. In Di-George syndrome, there is defective B-cell function.
  2. In infantile sex-linked agammaglobulinemia there is selective B-cell defect (Bruton type).
  3. In severe combined immuno deficiency, there is defective B-cell and T-cell function.
  4. Wiskott-Aldrich syndrome is characterized by abnormal platelets and defective T-cell function alone.
10. A. False: There is almost complete failure of development of thymus and parathyroid with resultant defective T-cell function.
B. True
C. True
D. False: Alongwith these two abnormalities, IgM and IgA are also abnormal.
 
CONCEPTS
 
IMMUNOPATHOLOGY
Q.1. Which of the following are true?
  1. Heparin mediates type I hypersensitivity (Anaphylactic reaction).
  2. Pernicious anemia and Grave's disease are examples of immune complex diseases.
  3. Contact dermatitis is an immune complex disease.
  4. CREST syndrome is a form of scleroderma.
  5. SLE is characterized by primary immune deficiency.
Ans. A. True: Both histamine and heparin mediate anaphylactoid reaction.
B. False: These are two examples of type II hypersensitivity reaction (cytotoxic type).
C. False: Contact dermatitis is a type IV hypersensitivity reaction (cell mediated type). Type III reactions are exemplified by serum sickness, SLE and glomerulonephritis.
D. False: Scleroderma is progressive systemic sclerosis. CREST syndrome is localized scleroderma characterized by anticentromere antibodies. It is characterized by calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia.
35E. False: It is characterized by secondary immune deficiency, other examples being diabetes mellitus and alcohol abuse.
Q.2. Which of the following are true?
  1. Pneumocystis carinii infection can present with osteomyelitis.
  2. Acquired Immunodeficiency Syndrome (AIDS) can present with CD4 counts more than 200.
  3. Common Variable Immunodeficiency (CVI) can present with recurrent giardial infections.
  4. Average duration of latent phase in AIDS is 2 years.
Ans. A. True: P. carinii infection of lungs or bone-marrow can occur with CD4 counts of 200 to 500 cells/microliter. With less than 50 calls/microliter counts—CMV, MAI and JC viruse infections result.
B. True: AIDS can still be present with CD4 counts more than 200, if patient is HIV positive with an AIDS defining disease.
C. True: Other diseases seen are bacterial infections, autoimmune disease, lymphoma and gastric cancer.
D. False: Average duration of latent phase in AIDS is 10 years.
 
INFLAMMATION
Q.1. Which of the following are true?
  1. P-selectin is normally present in Weibel-Palade bodies in endothelial cells.
  2. Defects in cell adhesion is found in diabetes and corticosteroid use.
  3. Myeloperoxidase deficiency is associated with increased incidence of bacterial infections.
  4. Histamine is produced by mast cells and basophils only.
  5. IL-I is responsible for pain and prostaglandin E2 for pyrexial response.
Ans. A. True: Also seen in alcohol intoxication and certain congenital deficiencies of adhesion molecules.
B. False: Although incidence of bacterial infection may be increased, characteristically candidal infections are increased in myeloperoxidase deficiency.
C. False: Along with these two types of cells, platelets also store and release histamine.
36D. False: IL-I is responsible for pyrexial response. Prostaglandin E2 is responsible for pain accompanying acute inflammation.
Q.2. Which of the following are true?
  1. Apoptosis is generally accompanied by inflammatory response.
  2. bcl-2 and P-53 are both proapoptotic genes.
  3. Caspases activate proteases.
  4. Councilman bodies are found in alcoholic hepatitis.
  5. Fat necrosis is also called saponification.
Ans. A. False: Apoptosis is characterized by the lack of inflammatory response.
B. False. bcl-2 inhibits apoptosis.
P-53 stimulate apoptosis.
C. True: Caspases activate proteinase as well as endonucleases.
D. False: Councilman bodies are found in apoptotic liver cells in viral hepatitis.
E. True.
Q.3. Which of the following are true?
  1. Tissue based basophils are called mast cells.
  2. Interstitial infiltration is a common response to viral infectious agents.
  3. Syncytia formation is a response seen in cytopathic/cytoproliferative inflammation.
  4. Keloid is characterized by production of collgen of predominantly type IV.
  5. Basement membrane has a net positive charge.
Ans. A. True.
B. True: For example in viral hepatitis and viral myocarditis.
C. True: The cells are altered in ultrastructure.
D. False: Type III collagen is found in keloid. Type IV collagen is found in basement membrane.
E. False: Basement membrane has a net negative charge.