1) Correct Ans E: A type of necrosis with liquefaction/softening of the affected

tissue, transformation into a liquid ,viscous mass, caused by neutrophilic release of

lysosomal enzymes that digest tissue. Histologically characterised by macrophages
and cellular debris ( early) followed by cystic spaces ( late) . Seen in bacterial
abscesses and brain infarcts.
7) Correct Ans B: Hemartoma a benign mass composed of mature cells that
Are native to the tissue of origin but have abnormal tissue organization e.g.,
pulmonary hemartoma , iris hemartoma while choristoma is the presence of normal tissue at
a site where this tissue is not normally found e.g.,the presence of gastric tissue in ileum
17) Correct Ans E : Hypertrophy; increases tissue size via enlargement of cells
due to an increase in organelles and
structural proteins. Hypertrophy can be physiological (e.g,. Increased muscle mass through
sports and uterus enlargement due to hormonal
changes) or pathological (e.g., hypertrophic cardiomyopathy due to arterial
hypertension). Changes occurs in the wall stress when there is increases afterload e.g
High BP 150/95 mmHg, which produces concentric hypertrophy of the ventricular wall
19) Correct Ans B: Necrosis is an irreversible injury that results in cellular
death and inflammation
28) Correct Ans A; Ulcer is a rounded or irregular shaped deeper lesions. In
dermatology it results from loss of the epidermis and some portion of the dermis. In
gastroenterology it refers to lesion that extends beyond the mucosa( disrupts the muscularis
mucose) to involve the submucosa and beyond.Ulcer usually leave a scar unlike erosion
which usually heal without scar
33) Correct Ans B: Reperfusion injury; Reintroduction of oxygen into a
previously ischemic environment typically > 6 h for most tissues » activation of endothelial

cells»generation of free radicals by leukocytes »damage.

34) Correct Ans C: Sequestered calcium stores in mitochondria and

Endoplasmic reticulum.calcium plays a key role in irreversible membrane damage and cell
death. Cytoplasmic calcium activates many enzymes:e.g., Activated endonuclease produces
nuclear changes .Activated phospholipase damages plasma membrane.
Cytoplasmic calcium also enters mitochondria which increases mitochondrial membrane
permeability » release of cytochrome c from mitochondria » activation of apoptosis »
cytoplasmic vacuolization

35) Correct Ans E: NADPH oxidase converts oxygen into superoxide radicals,
a reactive oxygen species important for the neutrophilic respiratory burst to fight pathogens.
Defect in NADPH oxidase causes chronic granulomatous disease.
(D) Superoxide dismutase scavanges oxygen radicals and converts them into hydrogen
peroxide. Defects in this enzyme are associated with Amyotrophic Lateral Sclerosis.
(B) Catalase converts Hydrogen peroxide into H2O ans O2 , used to protect cells from ROS.
(A) Glutathione is an antioxidant, it neutralizes many free radicals
© Vitamin C and E both are antioxidants
36) Correct Ans C: ROS are highly reactive due to its unpaired electrons. When it
targets plasma membrane it produces fatty acid free radicals which react with molecular
oxygen to produce peroxyl-fatty acid free radicals called lipid peroxidation

37) Correct Ans E: Alcohol is the most common cause of fatty changes in liver.
Alcoholic fatty liver is reversible. In reversible cell injury NA+/K+ ATPase pump is impaired
due to lack of ATP. Diffusion of NA+ and water into the cell »decreased passive calcium
efflux and expansion of the cell with swelling of mitochondria , cytosol , ER , and Golgi
Apparatus called Hydropic degeneration. It is the first visible sign of hypoxia.

43) Correct Ans D:Mallory bodies occur most commonly in alcoholic liver disease.
Mallory bodies are hyaline inclusion bodies that contain keratin filament and appear
eosinophilic on HE staining.
Some other types of inclusion bodies having intracellular accumulation of hyalin are ;
(a) Councilman bodies: An eosinophilic remnant of apoptotic hepatocytes resulting
from pyknosis, seen in yellow fever and viral hepatitis.
(b) Russel bodies: Accumulation of immunoglobulin within the cytoplasm of plasma
membrane , occurs in Multiple myeloma.
(c) Lewy bodies: Accumulation of Alpha-synuclein, hyaline cytoplasmic inclusion in
neurons, occurs in lewy body dementia and Parkinson disease

44) Correct Ans B: All are irreversible changes except cytoplasmic vacuoles. In
reversible stage Hyropic degeneration occurs due to dysfunction of NA+/K+ APase pump.

45) Correct Ans C: Gangrenous necrosis is a subtype of coagulative necrosis,

divided into two types
(a) Dry gangrene: caused by ischemia
Shows coagulative necrosis
(b) Wet gangrene: caused by superinfection of dry gangrene
Shows coagulative and liquefactive necrosis

46) Correct Ans C: Dysplasia is disordered growth of epithelium , not regarded as a

true adaptive response. Characterized by number of cellular changes , e.g., mitotic figures ,
pleomorphism , increased nuclear/cytoplasmic ratio, clumped chromatin

47) Correct Ans C: 2 kinds of atrophy

1.Hypotrophy(simple atrophy): Tissue degeneration caused by a decrease in
protein synthesis and cell contents
2. Numerical atrophy: Reduction in number of cells , e.g., due to apoptosis
49) Correct Ans E: Bacterial meningitis is the purulent infection of meninges.
Neutrophils are predominantly seen in early stages ( acute bacterial meningitis)

50) Correct Ans A : The hallmark cell of acute inflammation is the neutrophil. They
are attracted to the site of injury immediately after the insult. The hallmark signs of
inflammation are redness, swelling, warmth , and pain.

51) Correct Ans E : When the immune system is unable to completely eliminate a
foreign stimulus, (e.g,. Persistent pathogen , foreign body , infections such as TB) , the
resulting granulomatous inflammation attempts to wall off the foreign substance with
granulomas without completely degrading or eradicating it. This results in persistent
inflamation.

52) Correct Ans B: Caseous necrosis; Tb is the MCC of granulomas with caseous
necrosis. It is an acellular material produced by the release of lipid from the cell wall of
Mycobacterium tuberculosis. On gross examination acellular cheese-like material is present.
Other examples of caseous necrosis are Histoplasmosis and Nocardiosis
NOTE: Caseating tuberculous granulomas are pathognomonic of reactivation (
secondary) tuberculosis

64) Correct Ans E: when there is increased afterload ( high BP ) changes occur in
wall stress. If this condition occurs for years then it will produce concentric hypertrophy in the
ventricular wall. E.g., sarcomeres duplicate parallel to the long axis of the cells

65) Correct Ans B : This is called neurogenic atrophy in which muscular atrophy
occurs due to degeneration of neuromuscular transmission

66) Correct Ans A : fatty changes in liver is caused by increased hepatic synthesis of
TGs
For example; Alcohol is the most common cause of fatty change . Hepatic
degradation of ethanol to acetyl-CoA by alcohol dehydrogenase results in NADH excess »
increase NADH drives the formation of G3P from DHAP » increase in both G3P and fatty
acids causes increases TGs synthesis in the liver

67) Correct Ans B : Coagulative necrosis is caused by tissue ischemia that occurs
in most tissues except the brain. Appears eosinophilic due to binding of eosin stain to
denatured intracellular proteins. Preserved, anuclear , eosinophilic cellular architecture.
68) Correct Ans D: Dystrophic calcification is a localized calcification of otherwise
noncalcified tissue, tissues involved are degenerative or necrotic tissues or degenerative
inflammatory sites. In atherosclerosis the atherosclerotic plaques become dystrophically
calcified.
Dystrophic calcification does not occur in normal tissue, metastatic deposition refers to
deposition of calcium in normal tissue. Metastatic calcification is associated with
hypercalcemia

70) Correct Ans E: Apoptosis can be both physiologic and pathalogic. In this
question all are pathalogic apoptosis except E because programmed destruction of cells
during embryogenesis is a normal process , e.g., normal removal of tissues between fingers.

94) Correct Ans B 94: X-Rays are ionizing radiation. Free radicals are generated
by ionizing radiation. Glutathione peroxidase is a key antioxidant in the metabolism of ROS.

95) Correct Ans A: Disuse atrophy occurs when a muscle is no longer as active as
usual. Immobility of the joints such as arm being in a cast for a long period of time can
cause disuse atrophy.

101) Correct Ans D: As a response to chronic stress , stem cells get reprogrammed
into another type of epithelium that is more tolerable to the adverse environment. In Barrett's
Oesophagus chronic exposure to gastric acid (stress) damages mucosa of distal
oesophagus, the nonkeratinized stratified squamous epithelium is replaced by nonciliated
columnar epithelium and goblet cells,which can better tolerate this adverse environment

102) Correct Ans D: TB is the most common cause of granulomas with caseating
necrosis. It is an acellular material produced by the release of lipids from the cell wall of
Mycobacterium tuberculosis

103) Correct Ans C: see Qs No 68

104) Correct Ans D: Sudan stain or Oil red O staining has high affinity for lipids,
often used to evaluate for steatorrhea

115) Correct Ans B:This should be BCL-2 not BCL-2 family because BCL-2 family is
composed of numerous proteins that can have pro apoptotic ( e.g,. Bad,Bax, and Bak) or
antiapoptotic (e.g., Bcl-2 , Bcl-xL) effect. Bcl-2 lends its name to the protein family , it is an
antiapoptotic protein that inhibits the intrinsic pathway of apoptosis by maintaining
impermeability of the mitochondrial membrane.
116) Correct Ans D: Ultrasound waves are non-ionizing. It can not produce free
radicals

117) Correct Ans A: in cell injury protein synthesis decreases due to detachment of
ribosomes and polysomes.
B. In the late stages of cell injury ( irreversible stage) development of
amorphous densities/inclusions in the mitochondrial matrix occurs.
C.Mitochondrial swelling occurs in early stage of cell injury due to decreased
function of Na+/K+ ATPase pump called hydropic degeneration.
E.Karyorrhexis is fragmentation of nucleus occurs in the late irreversible
stage of cell injury

119) Correct Ans C

120) correct AnsA: Psammoma bodies are concentric, intracellular calcium

collections seen in dystrophic calcification in certain neoplasms such as papillary carcinoma
of thyroid, mesothelioma, meningioma. Can also appear in chronically inflamed tissue.

121) Correct Ans D: Lipofuscin can be an indicator of cell injury formed by the
peroxidation of polyunsaturated lipids of subcellular membranes. Accumulates over time in
cell due to wear and tear.

133) Correct Ans C: Ionizing radiation induces free radical injury. Leukaemia is the
most common overall cancer due to ionizing radiation (e.g., AML and CML) but it can not
induce chronic lymphocytic leukaemia(CLL)

142) Correct Ans B : Metastatic pulmonary calcification occurs secondary to

hypercalcemia due to hyperparathyroidism. Calcium deposits in the normal tissues (wall of
alveoli ). In thrombi , haematoma and tuberculous granuloma dystrophic calcification occurs.

147) Correct Ans D : Vitamin D toxicity can occur due to Oversupplementation . It

can also occur in Sarcoidosis due to increased 1alpha-hydroxylase activation.
Hypervitaminosis D causes metastatic calcification secondary to hypercalcemia.

148) Correct AnsA : There are endogenous(e.g., replication error ) and

exogenous(e.g., radiation) sources of DNA damage. The cell usually repair DNA damage but
if the cell is unable to repair its DNA damage then it is removed through a programmed ,
enzyme mediated process called apoptosis.
149) Correct Ans C: Leakage of lysosomal enzymes occurs in ischemic injury not in
free radical injury. Free radicals can cause damage to a variety of structures:
● DNA: induce breakage
● Cell membrane: Direct damage and lipid peroxidation
● Mitochondrial membrane: Lipid peroxidation and formation of transition pore
which will increase permeability , cytochrome c will release from mitochondria into
cytoplasm which will activate caspases.
● Cellular proteins : Modification
● Microvasculature: increase permeability of capillaries

152) Correct Ans D : Hypoxia leads to decreased ATP production.

Low oxygen and ATP»anaerobic respiration»increased lactate and decreased
intracellular pH»denaturation of proteins and clumping of nuclear chromatin.

159) Correct Ans C: Ionizing radiation produces free radicals , e.g., hydroxyl free
radical. Glutathione peroxidase enhances glutathione. Glutathione is an antioxidant which
neutralizes free radicals, hence plays a protective role against radiant energy.

160) Correct Ans D : Apoptosis does not associate with an inflammatory reaction in
contrast to necrosis which is always associated with inflammatory reaction.

170) Correct Ans D: BCL-2 family is composed of numerous proteins that can have
pro apoptotic ( e.g,. Bad,Bax, and Bak) or antiapoptotic (e.g., Bcl-2 , Bcl-xL) effect.

175) Correct Ans E: See Qs No 68

176) Correct Ans B: See Qs No 47

178) Correct Ans D :Coagulative necrosis is caused by tissue ischemia that occurs
in most tissues except the brain.
180) Correct Ans C : Infarction is a condition of tissue necrosis that results from
insufficient blood and oxygen supply to the affected region. It can be of two types
(a) Hemorrhagic infarct: infarction in organs with dual blood supply ( e.g., lung,
intestine, testes and liver). Commonly due to occlusion of vessels and subsequent
extravasation of RBCs into the ischemic tissue.
(b) Pale infarct : Tissue death as a result of inadequate perfusion. Predominantly
affects solid organs with single blood supply (e.g., heart, kidney, spleen ).
Characterized by the absence of hemorrhage and red blood cells accumulation in
contrast to hemorrhagic infarct.
182) Correct Ans D: Decompression sickness is the formation of air bubbles in the
tissue and venous circulation caused by a rapid decline in barometric pressure within the
body.During descent the ambient pressure increases with diving depth» gases (Nitrogen)
dissolve into the blood and tissue. In rapid ascent ambient pressure rapidly decreases » gas
tension exceeds the surrounding pressure » gas quickly come out of solution in the blood
and tissue » insufficient time for the gas to be progressively breathed out through the
lungs»formation of gas bubbles»gaseous obstruction of blood flow.

190) Correct Ans C: Fat necrosis can be either enzymatic or nonenzymatic(

traumatic injury ) . In pancreatitis release of lipase from cytoplasm of damaged cells occurs,
lipase breakdown TGs into fatty acids » fatty acids binds to calcium » saponification »
chalky-white appearance.

199) Correct Ans C : The patient most likely has myocardial infarction, which is
acute onset of chest pain associated with occlusion of coronary arteries that leads to
coagulative necrosis of myocardial tissue. Creatine kinase is a cardiac biomarker , its level
increases in MI.

208) Correct Ans D: All of the above are examples of apoptosis except myocardial
infarction which results from necrosis of myocardial tissue and is associated with
inflammatory cells(in contrast to apoptosis).

209) Correct Ans A: Psammoma bodies are concentric lamellar calcifications seen in
many neoplasms e.g., papillary thyroid carcinoma.
Sarcoid granuloma has no calcification, seen in sarcoidosis.
Corpora amylacea is a small laminated structure composed of sulfated glycosaminoglycans,
found in BPH.

211) Correct AnsA: The enzyme catalysing this reaction is catalase which degrades
peroxide. .

215) Correct Ans D: Apoptosis is a programmed cell death. It is not associated with
inflammatory reaction ( in contrast to necrosis )
Histopathalogical Findings:
● Shrunken and irregular shaped cells
● The cell detaches from other cells
● The nucleus undergoes pyknosis and karyorrhexis
● The eosinophilic cytoplasm and cell organelles form small bubbles
and the endonuclease degrade the chromatin in the nucleus, resultig
 in nuclear fragmentation and apoptotic bodies that are phagocytosed
by macrophages
● DNA laddering ( fragments in multiple of 180 base pairs ) is seen on
gel electrophoresis and can be used as a sensitive marker of
apoptosis.
216) Correct Ans A:
Dry gangrene:
● More common in limbs
● Occurs due to arterial occlusion
● Organ is dry , shrunken and black
● Line of demarcation present between gangrenous and healthy
part
● Bacteria fail to survive

Wet gangrene:
● More common in bowel
● Occurs most commonly due to venous occlusion
● Organ is moist, soft, swollen and dark
● No line of demarcation
● Numerous bacteria is present

217) Correct Ans A: Coagulative necrosis occurs when there is lack of blood supply.
E.g ., in coronary artery disease ischemia of myocardial tissue occurs.

218) Correct Ans A: TNF-alpha is a cytokine produced by macrophages that plays a

key role in inflammation , apoptosis and immunity.TNF-alpha activates the apoptotic program
of cells via binding to death receptors in extrinsic pathway of apoptosis called death receptor
pathway. The receptor-ligand complex activates initial caspases such as caspase 8. The
initial caspase activates executioner caspases such as caspase 3.

219) Correct Ans C: Disuse atrophy

220) Correct AnsC:

Changes in reversible cell injury :
● hydropic degeneration
● Denaturation of protein
● Clumping of chromatin
● Plasma membrane blebbing
● Myelin figures
Changes in irreversible cell injury:
● Rupture of cell membrane
 ● Rupture of lysosome
● Release of enzymes
● Increased mitochondrial membrane permeability
● Nuclear degeneration in form of the following effects;
(a) Pyknosis
(b) Karyorrhexis
(c) Karyolysis

223) Correct Ans A: The involvement of microvasculature and ischemic changes in

diabetes cause dry gangrene, characterized by coagulative necrosis on histopathologic
examination.

227) Correct Ans B: Atrophy is defined as a decrease in the size of a tissue or

organ due to cellular shrinkage; the decrease in cell size is caused by the loss of
organelles, cytoplasm and proteins due to activation of proteolytic system. This is
called simple atrophy of hypotrophy. The other type is called numerical atrophy in
which reduction in cell number occurs , E.g., due to apoptosis

228) Correct Ans c : Metaplasia is reversible transformation of mature cell type

into another cell type due to chronic irritation. It is reversible if the irritant is removed.

231) Correct Ans E: See Qs no 220 for reversible and irreversible changes in cell
injury.
238) Correct Ans E: See Qs No 1
252) Correct Ans E: Paraneoplastic syndromes are caused either by substances
produced by tumors or an altered immune response to a systemic malignancy.Small cell
lung cancer is especially notorious for its numerous and distinct paraneoplastic syndromes.
In squamous cell carcinoma of lungs the neoplastic tissue secretes PTHrP which has effect
similar to PTH thus causes hypercalcemia.
254) Correct Ans B: Death receptors are involved in extrinsic pathway of apoptosis,
that's why this pathway is also called death receptor pathway in which extracellular ligands (
e.g., TNF-alpha, TRAIL, or FasL) bind to a death receptor on the cell surface ( e.g., Fas and
TNF receptors). This receptor-ligand complex then activates caspases
257) Correct Ans D : Nitric oxide is unconventional neurotransmitter that is not
stored in synaptic vesicles. Nitric oxide activates guanylyl cyclase thereby increasing cGMP
synthesis, which causes smooth muscle relaxation and subsequent vasodilation. It is also
cytotoxic and kills target pathogen.

275) Correct Ans C : Hyperplasia depends on the regenerative capacity of cell

A. Hyperplasia can be seen in the same tissue as hypertrophy . e.g., in uterus both
hyperplasia and hypertrophy can be seen.
 B. It can never be seen in cardiac muscles as cardiac muscles are permenant cells
they cannot replicate.
D. It can be physiologic, e.g., Estrogen stimulation of endometrium during the menstrual
cycle
E. Complete removal of hormone triggers will cause atrophy.