Chapter review

Bring the chapter together

Start with the case synthesis, answered in 3 separate parts, then work through mixed case-based questions. Every answer explains the clue that matters and why the closest alternative fails.

Case synthesis

Bringing it together: one stroke, from minutes to weeks

A 66-year-old man with hypertension and atrial fibrillation suddenly develops weakness of his left leg. An embolus has blocked a branch of his right anterior cerebral artery. Within minutes the neurons in the affected cortex enlarge. He survives, and a scan several weeks later shows a fluid-filled cavity in the same territory.

  1. 1. Trigger

    What initiated the injury?

  2. 2. Early cellular response

    Why did the neurons enlarge within minutes?

  3. 3. Later tissue outcome

    Why is the territory a fluid-filled cavity weeks later?

Answer all 3 parts to see how they connect.L1 p.17–18, 35, 52, 54

Mixed case review

Morphology, mechanism and application. Some items need two sections at once.

0 of 15 correct
  1. Q1Enzymatic fat necrosisConnects 1.6 + 1.8L1 p.39–40Midterm sim. p.1

    A 47-year-old man with a long history of heavy drinking dies of acute pancreatitis. At autopsy, the fat around the pancreas contains scattered chalky, white, opaque patches.

    Which process produced the chalky patches?

  2. Q2Compensatory hypertrophyConnects 1.2 + 1.4L1 p.24–25Midterm sim. p.1

    A healthy 31-year-old woman donates her left kidney to her brother. A year later her remaining kidney is noticeably larger, and its tubular cells are larger than before, with more cytoplasm and organelles. Her renal function is normal.

    Which process best explains the change in her remaining kidney?

  3. Q3Timeline of cells after myocardial infarctionConnects 1.6L1 p.33Ch. II cases p.11Midterm sim. p.1, 3Ref. · infarct timeline (approximate)

    A 64-year-old man dies three days after an acute myocardial infarction. Sections from the infarcted wall are examined.

    Which picture is most likely?

  4. Q4Cells and cavitation after brain infarctionConnects 1.6L1 p.35, 52Ch. II cases p.9

    A 72-year-old woman dies three weeks after an ischemic stroke in the territory of the middle cerebral artery.

    Which cells dominate the infarcted tissue at this stage?

  5. Q5Cervical dysplasiaConnects 1.2L1 p.28Midterm sim. p.2Ch. II cases p.18

    A 33-year-old woman has a positive test for HPV type 16. A cervical biopsy shows atypical cells with enlarged, hyperchromatic nuclei and loss of maturation through the full thickness of the epithelium. Mitoses appear near the surface. The basement membrane is intact.

    Which description is correct?

  6. Q6Carbon monoxide and oxygen contentConnects 1.3L1 p.12–14

    A family is brought to the emergency department after a night in a house with a faulty gas heater. One adult is confused and has a headache. A standard pulse oximeter reads 98%.

    Which combination of findings is expected?

  7. Q7Delayed neurologic injury after COConnects 1.3L1 p.13–14Ref. · delayed neurologic sequelae

    Two weeks after apparently recovering from carbon monoxide poisoning, a 58-year-old man develops memory loss and slowed, stiff movements.

    deep white matterglobus pallidusSchematic coronal section · not to scale

    Which regions of the brain are classically damaged?

  8. Q8Oxidized LDL and foam cellsConnects 1.5 + 1.8L1 p.19–22

    How do free radicals contribute to the earliest lesion of atherosclerosis?

  9. Q9Hypertrophy versus hydropic swellingConnects 1.2 + 1.4L1 p.17–18, 24

    Two heart-muscle biopsies both show cells larger than normal. Patient A has had aortic stenosis for years. Patient B's sample was taken 30 minutes after a coronary artery was blocked.

    Which finding identifies the cells from patient B?

  10. Q10Apoptosis versus necrosisConnects 1.4 + 1.6 + 1.7L1 p.4, 32, 45

    Which single finding cannot, on its own, tell apoptosis from necrosis?

  11. Q11Watershed vulnerabilityConnects 1.3 + 1.6L1 p.16

    A 70-year-old man is resuscitated after a prolonged period of very low blood pressure during cardiac surgery. MRI later shows wedge-shaped infarcts along the border between the anterior and middle cerebral artery territories.

    Why did injury concentrate in these areas?

  12. Q12Barrett metaplasia and cancer riskConnects 1.2L1 p.26–27

    A 55-year-old man with years of acid reflux has an endoscopy. A biopsy from the lower esophagus shows columnar epithelium with goblet cells instead of squamous epithelium. The cells are orderly with uniform nuclei.

    What is the finding, and why is he kept under surveillance?

  13. Q13Senile cardiac (ATTR) amyloidosisConnects 1.8L1 p.46–48

    An 82-year-old man has heart failure with thick, stiff ventricular walls. An endomyocardial biopsy shows extracellular pink material that shows apple-green birefringence under polarized light after Congo red staining. He has no plasma cell disorder.

    Which protein most likely forms the deposits?

  14. Q14High-altitude adaptationConnects 1.2 + 1.3L1 p.11, 25

    A trekker spends three weeks at 4,500 m. Her hemoglobin rises from 13.5 to 15.5 g/dL.

    Which chain best explains the rise?

  15. Q15Dystrophic calcificationConnects 1.6 + 1.8L1 p.39–40

    An 84-year-old woman with normal serum calcium and phosphate has a stiff aortic valve. The cusps contain nodular calcium deposits.

    What type of calcification is this?

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Timed practice