First Aid Express 2018 workbook: PATHOLOGY page 1

Pathology
Questions

CELLULAR INJURY
1. Define the following terms. (p 206)

A. Hyperplasia________________________________________________________________

__________________________________________________________________________

B. Metaplasia _________________________________________________________________

__________________________________________________________________________

C. Dysplasia __________________________________________________________________

__________________________________________________________________________

2. Describe the fundamental differences between the intrinsic and extrinsic pathways of apoptosis.
Name two important similarities between the pathways. (p 208) ___________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

3. Describe the fundamental differences between apoptosis and necrosis. What are the six types of
necrosis? List an example of each. (pp 208-209)
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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page 2 First Aid Express 2018 workbook: PATHOLOGY

4. Name three organs that manifest irreversible ischemia with red infarcts. Name three that show pale
infarcts. (p 210) _________________________________________________________________

______________________________________________________________________________

5. What conditions are associated with a low erythrocyte sedimentation rate? (p 212) ____________

______________________________________________________________________________

6. Which cells and proteins mediate the acute phase of inflammation? (p 212) __________________

______________________________________________________________________________

______________________________________________________________________________

7. In the chart, compare and contrast the ligand-receptor interactions required for each step of leukocyte
extravasation. (p 213)

Ligand-Receptor
Endothelial Cells Leukocytes
Interaction

Rolling

Tight binding

Diapedesis

Migration

8. In cases of chronic inflammation, what types of cells infiltrate tissue? (p 214) What is the key cell of
granulomas? _________________

______________________________________________________________________________

9. What are the four ways that free radicals can be eliminated? Under what conditions might these
mechanisms fail? (p 216) _________________________________________________________

______________________________________________________________________________

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 First Aid Express 2018 workbook: PATHOLOGY page 3

10. In the chart, compare and contrast the characteristics of transudates and exudates. (p 217)

Transudate Exudate

Causes

Cellularity

Protein level

NEOPLASIA
11. Compare and contrast the characteristics of benign vs malignant tumors. (p 220)

Characteristic Benign Tumor Metastatic Tumor

Differentiated?

Growth

Distinct boundaries?

Metastatic potential?

12. Describe the differences between tumor grade and tumor stage. (p 220) ____________________

______________________________________________________________________________

13. Match the neoplasm(s) to the condition(s) with which it is most commonly associated. (p 221)

_____ A. Anti-NMDA receptor encephalitis 1. Acanthosis nigricans

_____ B. Cushing syndrome 2. Lymphoma

_____ C. Gastric adenocarcinoma 3. Neuroblastoma in children

_____ D. Hypercalcemia + elevated calcitriol level 4. Ovarian teratoma

_____ E. Myasthenia gravis 5. Pancreatic adenocarcinioma

_____ F. Opsoclonus-myoclonus ataxia syndrome 6. Renal cell carcinoma

_____ G. Polycythemia 7. Small cell lung cancer

_____ H. Trousseau syndrome 8. Thymoma

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page 4 First Aid Express 2018 workbook: PATHOLOGY

14. Oncogenes are associated with a ______ (gain/loss) of function and require damage to ______

(one/both) allele(s); examples include ________________________________________________.

In contrast, tumor suppressor genes are associated with a ______ (gain/loss) of function and require

damage to ______ (one/both) allele(s); examples include __________________________. (p 222)

15. A 40-year-old otherwise healthy man is diagnosed with nasopharyngeal carcinoma. He does not

smoke or drink. What is the most likely cause of his cancer? (p 223) _______________________

16. A 70-year-old who eats smoked salmon every day presents with abdominal pain and loss of appetite.

Which diagnosis should be high on the differential? (p 223) _______________________________

17. A 55-year-old woman with a 40-pack-year history of cigarette smoking presents with new-onset
cough, hemoptysis, and oliguria. What diagnosis should be high on the differential? (pp 221, 223)

______________________________________________________________________________

18. How are tumor markers best used? (p 224) ___________________________________________

______________________________________________________________________________

19. An IV drug abuser who is being monitored for cirrhosis shows a sudden increase in his α-fetoprotein
level. For which disease is he at increased risk? (p 224) _________________________________

______________________________________________________________________________

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 First Aid Express 2018 workbook: PATHOLOGY page 5

20. Match the site of metastatic tumor with the immunohistochemical stain used to locate its origin.
(p 225)

_____ A. Chromogranin and synaptophysin 1. Astrocytes

_____ B. Cytokeratin 2. Epithelial cells

_____ C. Desmin 3. Mesenchymal tissue

_____ D. GFAP 4. Muscle

_____ E. Neurofilament 5. Neural crest cells

_____ F. PSA 6. Neuroendocrine cells

_____ G. S-100 7. Neurons


_____ H. TRAP 8. Prostatic epithelium

_____ I. Vimentin 9. Tartrate-resistant acid phosphatase

21. Which cancers are most common in men? In women? What is the overall leading cause of death in

the United States? (p 226) ________________________________________________________

______________________________________________________________________________

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page 6 First Aid Express 2018 workbook: PATHOLOGY

Answers

CELLULAR INJURY
1. A. Hyperplasia: increase in the number of cells.

B. Metaplasia: one type of cell is replaced by another.

C. Dysplasia: disordered, non-neoplastic cell growth.

2. The intrinsic pathway begins with changes in the levels of anti- and proapoptotic factors, leading to
increased mitochondrial permeability. The extrinsic pathway begins with ligand receptor interactions
or perforin/granzyme release. Similarities: both require ATP, and both ultimately activate caspases.

3. Apoptosis occurs without any inflammation, whereas necrosis causes local inflammation. The six
types of necrosis are coagulative (as occurs in the heart), liquefactive (bacterial abscess), caseous
(eg, due to systemic fungal infection), fat (saponification of pancreas), fibrinoid (as occurs in blood
vessels), and gangrenous (limb gangrene).

4. Red infarcts: liver, lungs, and intestine. Pale infarcts: heart, kidney, and spleen.

5. Sickle cell anemia, polycythemia, heart failure, microcytosis, and hypofibrinogenemia, among others.

6. Neutrophils, eosinophils, mast cells, basophils, toll-like receptors, arachidonic acid metabolites,
complement, and Hageman factor.

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 First Aid Express 2018 workbook: PATHOLOGY page 7

7.
Ligand-Receptor
Endothelial Cells Leukocytes
Interaction
E-selectin Sialyl-LewisX
Rolling P-selectin Sialyl-LewisX
GlyCAM-1 L-selectin

ICAM-1 CD11/18 integrins

Tight binding
VCAM-1 VLA-4 integrins

Diapedesis PECAM-1 PECAM-1

C5a
IL-8
LTB4
Migration Various
Kallikrein
Platelet-activating
factor

8. Mononuclear cells, including macrophages, lymphocytes, and plasma cells. The key cell of
granulomas is epitheloid macrophages.

9. By scavenging enzymes (catalase, superoxide dismutase, and glutathione peroxidase), by

spontaneous decay, by antioxidants (vitamins A, C, and E), and by certain metal carrier proteins
(transferrin and ceruloplasmin). Deficiencies in free radical elimination can occur in individuals with
genetic mutations that result in abnormal/absent enzymes, or with vitamin deficiencies.

10.
Transudate Exudate

Increased hydrostatic pressure Lymphatic obstruction

Causes Decreased oncotic pressure Inflammation
Sodium retention Malignancy

Cellularity Hypocellular Cellular

Protein level Low High

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page 8 First Aid Express 2018 workbook: PATHOLOGY

NEOPLASIA
11.

Characteristic Benign Tumor Metastatic Tumor

May be poorly
Differentiated? Well-differentiated
differentiated
Growth Slow Erratic

Distinct boundaries? Yes Diffuse or locally invasive

Metastatic potential? No Yes

12. Tumor grade is the degree of cellular differentiation within the tumor and is a characteristic of the
tumor itself. In contrast, tumor stage describes the extent of tumor spread within a patient, and thus
is a better indication of a patient’s prognosis than is tumor grade.

13. A-4, B-7, C-1, D-2, E-8, F-3, G-6, H-5.

14. Oncogenes are associated with a gain of function and require damage to only one allele for
expression; examples include c-myc (Burkitt lymphoma) and kras (colon carcinoma). Tumor
suppressor genes are associated with a loss of function and require damage to both alleles for
expression; examples include NF1 (neurofibromatosis type 1) and BRCA2 (breast cancer).

15. Epstein-Barr virus (EBV).

16. Gastric cancer. Smoked foods contain large amounts of nitrosamine.

17. Small cell lung carcinoma with paraneoplastic SIADH secretion.

18. To confirm a diagnosis, to check for tumor recurrence, and to monitor response to therapy.

19. Hepatocellular carcinoma. IV drug use and cirrhosis are associated with HCV, and HCV is associated
with hepatocellular carcinoma.

20. A-6, B-2, C-4, D-1, E-7, F-8, G-5, H-9, I-3

21. Prostate, lung, and colon/rectal cancers are the most common cancers in men; breast, lung, and
colon/rectal cancers are the most common in women. The overall leading cause of death in the
United States is cardiovascular disease.

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