1. A 34-year-old obese woman has experienced heartburn from gastric reflux for the past 5 years.

She undergoes upper gastrointestinal endoscopy, and a biopsy specimen of the distal esophagus
is obtained. Which of the following microscopic changes has most likely occurred?
a. Columnar metaplasia
b. Goblet cell hyperplasia
c. Lamina propria atrophy
d. Squamous dysplasia
e. Mucosal hypertrophy
2. A 20-year-old woman breastfeeds her infant. On examination, her breasts are slightly increased
in size. Which of the following processes that occurred in her breasts during pregnancy enables
her to breastfeed the infant?
a. Ductal metaplasia
b. Epithelial dysplasia
c. Intracellular lipid deposition
d. Lobular hyperplasia
e. Stromal hypertrophy
3. A CT scan of a 43-year-old woman with a parathyroid adenoma and hyperparathyroidism reveals
extensive calcium deposits in the lungs and kidney parenchyma. These radiologic findings are
best explained by which of the following mechanisms of disease?
a. Arteriosclerosis
b. Dystrophic calcification
c. Granulomatous inflammation
d. Metastatic calcification
e. Tumor embolism
4. A 65-year-old coal mine worker suffers a heart attack and expires. Examination of the lungs at
autopsy reveals numerous black pigmented nodules scattered throughout the parenchyma.
What is the appropriate diagnosis?
a. Anthracosis
b. Asbestosis
c. Hemosiderosis
d. Sarcoidosis
e. Silicosis
5. A 59-year-old female dies of respiratory failure. A pulmonary abscess is identified at autopsy.
Histologic examination of this lesion would most likely demonstrate which of the following
pathologic changes?
a. Caseous necrosis
b. Coagulative necrosis
c. Fat necrosis
d. Fibrinoid necrosis
e. Liquefactive necrosis
6. Which of the following histologic features would provide definitive evidence of necrosis in the
myocardium of a patient suffering from myocardial infarction?
a. Disaggregation of polyribosomes
b. Increased intracellular volume
 c. Influx of lymphocytes
d. Mitochondrial swelling and calcification
e. Nuclear fragmentation
7. A 22-year-old woman suffers from a scaling skin rash. A skin biopsy is obtained, and on
microscopic examination, it has the cellular change of apoptosis. This change most likely results
from which of the following biochemical reactions?
a. Activation of caspases
b. Elaboration of lipases
c. Increase in glycolysis
d. Peroxidation of lipids
e. Reduction of ATP synthesis
8. A 40-year-old man is pulled from the ocean after a boating accident and resuscitated. Six hours
later, the patient develops acute renal failure. Kidney biopsy reveals evidence of karyorrhexis
and karyolysis in renal tubular epithelial cells. Which of the following biochemical events
preceded these pathologic changes?
a. Activation of Na+/K+ ATPase
b. Decrease in intracellular calcium
c. Decrease in intracellular pH
d. Increase in ATP production
e. Increase in intracellular pH
9. Skin biopsy of a 43 yrs old man reveals atypical keratinocytes and apoptotic bodies. Which of the
following protein mediates programmed cell death in this patient?
a. Catalase
b. Cytochrome c
c. Cytokeratins
d. Myeloperoxidase
e. Superoxide dismutase
10. An 11-year-old child falls and cuts his hand. The wound becomes infected. Bacteria extend into
the extracellular matrix around capillaries. In the inflammatory response to this infection, which
of the following cells removes the bacteria?
a. B lymphocyte
b. Fibroblast
c. Macrophage
d. Mast cell
e. T lymphocyte
11. A 5 yrs old boy punctures his thumb with a rusty nail. 4 hrs later the thumb appears red and
swollen. Initial swelling of the boy’s thumb is primarily due to which of the following
mechanisms?
a. Decreased intravascular hydrostatic pressure
b. Decreased intravascular oncotic pressure
c. Increased intravascular oncotic pressure
d. Increased capillary permeability
e. Vasoconstriction of arterioles
12. Which of the following proteins present in the neutrophils generate the reactive oxygen
species?
a. Catalase
b. Cytochrome P450
c. Myeloperoxidase
d. NADPH oxidase
e. Superoxide dismutase
13. 58 yrs old man presents with lobar pneumonia. His sputum reveals numerous neutrophils.
Which of the following mediators of inflammation is chiefly responsible for development of
fever in this patient?
a. Arachidonic acid
b. Interleukin I
c. Leukotriene B
d. Prostacyclin PGI2
e. Thromboxane A2
14. Opsonization by complement is an important step in mediating which of the following leukocyte
function?
a. Chemotaxis
b. Diapedesis
c. Margination
d. Phagocytosis
e. Rolling
15. Autopsy of a 68 yrs old coal miner revealed black lung with coal dust nodules in the
parenchyma. The coal dust was sequestered primarily by which of the following cells?
a. Endothelial cells
b. Fibroblasts
c. Lymphocytes
d. Macrophages
e. Plasma cells
16. A 6-year-old child has a history of recurrent infection with pyogenic bacteria. An analysis of
neutrophil function shows a defect in rolling. This child’s increased susceptibility to infection is
most likely caused by a defect involving which of the following molecules?
a. Complement C3b
b. Integrins
c. Leukotriene B4
d. NADPH oxidase
e. Selectins
17. A 95-year-old woman touches a pot of boiling water. Within 2 hours, she has marked erythema
of the skin of the fingers of her hand, and small blisters appear on the finger pads. This has led
to which one of the following inflammatory responses?
a. Fibrinous inflammation
b. Granulomatous inflammation
c. Purulent inflammation
d. Serous inflammation
 e. Ulceration
18. A 37-year-old man has had epigastric pain for the past 3 months. An upper gastrointestinal
endoscopy shows a 2-cm ulcer. Microscopic examination of a biopsy from the ulcer base shows
angiogenesis, fibrosis, and mononuclear cell infiltrates with lymphocytes, macrophages, and
plasma cells. Which of the following terms best describes this pathologic process?
a. Acute inflammation
b. Chronic inflammation
c. Fibrinous inflammation
d. Granulomatous inflammation
e. Serous inflammation
19. A 9-year-old boy has had a chronic cough and fever for the past month. A sputum sample
contains acid-fast bacilli. A transbronchial biopsy specimen shows granulomatous inflammation
with epithelioid macrophages and Langhans giant cells. Which of the following chemical
mediators is most important in the pathogenesis of this lesion?
a. Bradykinin
b. Complement C5a
c. Interferon-γ
d. Nitric oxide
e. Prostaglandins
20. A 70 yrs old woman with diabetes develops an ulcer on her right leg. The ulcer bed is covered
with granulation tissue. Which of the following are the principal cellular components found in
the bed of this wound?
a. Fibroblasts and endothelial cells
b. Myofibroblasts and eosinophils
c. Neutrophils and lymphocytes
d. Plasma cells and macrophages
e. Smooth muscle cells
21. Which of the following best describes the principal function of macrophages that are present at
the wound site 24 to 48 hrs after injury?
a. Antibody production
b. Deposition of collagen
c. Histamine release
d. Phagocytosis
e. Wound contraction
22. A 20-year-old woman undergoes cesarean section to deliver a term infant, and the lower
abdominal incision is sutured. The sutures are removed 1 week later. Which of the following
statements best describes the wound site at the time of suture removal?
a. Collagen degradation exceeds synthesis
b. Granulation tissue is still present
c. No more wound strength will be gained
d. Type IV collagen predominates
e. Wound strength is 80% of normal tissue
23. A 54-year-old man undergoes laparoscopic hernia repair. In spite of the small size of the
incisions, he has poor wound healing. Further history reveals that his usual diet is deficient in
 vitamin C. Synthesis of which of the following extracellular matrix components is most affected
by this deficiency?
a. Collagen
b. Elastin
c. Fibronectin
d. Integrin
e. Laminin
24. A 70 yrs old patient suffers myocardial injury. After 7 days, myocardium show granulation tissue
formation containing numerous capillaries. Which of the following mediators is most likely being
expressed to produce this appearance?
a. Interleukin-2 (IL-2)
b. Leukotriene B4
c. Thromboxane A2
d. Tumor necrosis factor (TNF)
e. Vascular endothelial growth factor
25. An 18-year-old man lacerated his left ear and required sutures. The sutures were removed 1
week later. Wound healing continued, but the site became disfigured by a prominent raised,
nodular scar. Which of the following terms best describes the process that occurred in this man?
a. Dehiscence
b. Keloid formation
c. Organization
d. Resolution
e. Secondary union