PA1.1-3,PA2.1-8 | Cell Injury, Adaptation & Cell Death — Graded Quiz

A 62-year-old man with a 3-day history of central chest pain is brought to the emergency department. ECG shows ST-elevation in leads V1–V4. Troponin I is markedly elevated. He is taken for primary PCI, which successfully restores coronary flow. Two hours post-reperfusion, echocardiography shows a new zone of akinesia larger than predicted by the occluded territory alone. Which mechanism BEST explains the zone of additional injury after reperfusion?

A 19-year-old woman is prescribed isoniazid and rifampicin for pulmonary tuberculosis. After 6 weeks she develops jaundice. Liver biopsy shows ballooning degeneration of centrilobular hepatocytes with large, clear cytoplasmic vacuoles that displace nuclei peripherally on H&E. Oil Red O staining on a frozen section is strongly positive. Which cellular adaptation or accumulation does this pattern represent, and what is the primary pathological mechanism here?

A 55-year-old smoker with COPD undergoes bronchoscopic biopsy of the left main bronchus after a CT scan shows mucosal thickening. Histology reveals replacement of the normal pseudostratified ciliated columnar epithelium by stratified squamous epithelium. There is no nuclear pleomorphism, and the basement membrane is intact. Which statement BEST explains the clinical significance of this finding?

A 78-year-old woman with advanced renal cell carcinoma is found at autopsy to have calcium deposits in the walls of medium-sized arteries throughout the body and in the myocardium. Serum calcium pre-mortem was 3.8 mmol/L and phosphate was 2.1 mmol/L. The arterial walls are otherwise intact on H&E without necrosis. Which type of pathological calcification does this represent, and what is the MOST likely mechanism?

During an autopsy on a 66-year-old woman who died of sepsis, a pathologist removes a section of liver. Microscopically, hepatocytes show pyknosis of nuclei, dense eosinophilic cytoplasm, and loss of normal cellular architecture, while the overall tissue framework (reticulin scaffold) is preserved. Which of the following CORRECTLY identifies the necrosis pattern and explains why the reticulin scaffold is intact?

A 42-year-old woman with systemic lupus erythematosus (SLE) is treated with high-dose corticosteroids for a flare. Over 18 months, repeat ultrasound shows bilateral adrenal cortical thinning to 30% of normal volume. A biopsy shows markedly reduced cell size with increased autophagic vacuoles. Electron microscopy reveals loss of smooth endoplasmic reticulum and mitochondria. Which adaptive mechanism BEST explains the adrenal cortical thinning?

A pathologist receives a liver biopsy from a 49-year-old woman with suspected Wilson disease. H&E shows hepatocyte nuclei with glycogenated (pale, vacuolated) centres and occasional Mallory-Denk bodies. Rhodanine stain is positive (copper accumulation). A second biopsy from a 55-year-old non-alcoholic woman with non-alcoholic steatohepatitis (NASH) shows similar Mallory-Denk bodies but no copper. Which statement BEST explains why Mallory-Denk bodies appear in both conditions?

A 25-year-old medical student studies a slide showing cells with condensed, deeply basophilic, crescentic nuclear fragments at the cell periphery, cell shrinkage, and dense eosinophilic cytoplasm. No surrounding inflammatory cells are visible. Which cell death mode is depicted, and which molecular event INITIATES this process via the intrinsic pathway?

A 72-year-old woman with a long history of poorly controlled type 2 diabetes has an HbA1c of 11.2%. She undergoes a renal biopsy that shows marked thickening of tubular basement membranes, glomerulosclerosis, and tubular atrophy with fibrosis. Electron microscopy shows shortened telomeres in tubular epithelial cells. Which mechanism of cellular aging MOST directly explains the tubular atrophy seen in this patient's kidneys?

A 50-year-old male smoker with a 30-pack-year history presents with haemoptysis and weight loss. Bronchoscopic biopsy of a right upper lobe mass shows stratified squamous epithelium with evidence of invasion through the basement membrane and into the bronchial cartilage. A second biopsy from a 45-year-old woman with only cervical mucus metaplasia (non-invasive squamous change, intact basement membrane) is also submitted. A histopathology student correctly identifies the DIFFERENCE between the two biopsies. Which SINGLE feature is MOST critical?

A 38-year-old woman with a known BRCA1 mutation undergoes prophylactic mastectomy. The pathologist notices lobules with cells that appear smaller than normal, with decreased cytoplasm and inactive-appearing nuclei. There is no increase in fibrous stroma. Biochemically, these cells show increased activity of the ubiquitin-proteasome system and LC3-II positivity on Western blot (a marker of autophagy). Which adaptive change is occurring in these lobular cells?

On histological examination of a post-operative wound excision specimen from a 60-year-old man who had a sigmoid colon resection for carcinoma complicated by wound infection, the following are seen: extensive neutrophil infiltration, areas of liquefaction, and no residual organised stroma in the affected zone. The wound has not healed after 3 weeks. The surgeon asks the pathologist which local factor is MOST responsible for delayed healing. Which answer is MOST correct?