L9 Cell Injury & Cell Death - III (Apoptosis & Necrosis) Pathology Quiz
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Questions and Answers

Which of the following is NOT a characteristic feature of reversible cell injury?

  • Swelling of the cell
  • Preservation of the cell membrane integrity
  • Fragmentation of the nucleus (correct)
  • Accumulation of lipids within the cell

    • Which of the following light microscopic nuclear changes reflects DNA damage?

  • Pyknosis
  • Karyolysis
  • Karyorrhexis
  • All of the above (correct)

    • Which of the following is NOT a functional abnormality that characterizes irreversibly injured cells?

  • Increased cell division (correct)
  • Impaired cell membrane permeability
  • Disruption of cellular metabolism
  • Inability to maintain ionic gradients

    • Which type of necrosis is associated with the presence of caseous (cheese-like) material?

    <p>Caseous necrosis</p> Signup and view all the answers

    Which of the following is NOT a distinct pathway for initiating apoptosis?

    <p>Necrotic pathway</p> Signup and view all the answers

    The family of intracellular proteins that regulates the rate of apoptosis is known as the:

    <p>Bcl-2 family</p> Signup and view all the answers

    Which mechanism promotes the phagocytosis of apoptotic cells by macrophages?

    <p>Both a and b</p> Signup and view all the answers

    What is the primary characteristic of reversible cell injury caused by ischemia, as shown in the ultrastructural image?

    <p>Loss of microvilli and membrane blebs in the lumen</p> Signup and view all the answers

    Which of the following is a characteristic of the nuclear changes seen in irreversible cell injury (necrosis)?

    <p>Fragmentation of the pyknotic nucleus</p> Signup and view all the answers

    What is the main structural difference between normal and reversibly injured renal tubular epithelial cells, as shown in the light microscopy images?

    <p>Eosinophilic cytoplasm in normal cells, but swelling and blebs in reversibly injured cells</p> Signup and view all the answers

    What is the correct sequence of nuclear changes that occur during irreversible cell injury (necrosis)?

    <p>Karyolysis, pyknosis, karyorrhexis</p> Signup and view all the answers

    Which of the following is a characteristic of the ultrastructural changes seen in normal proximal tubular cells?

    <p>Abundant microvilli and mitochondria</p> Signup and view all the answers

    What is the main difference in the cytoplasmic changes between reversible and irreversible cell injury, as described in the text?

    <p>Reversible injury causes cytoplasmic swelling and eosinophilia, while irreversible injury leads to ruptured cytoplasmic membranes</p> Signup and view all the answers

    Which of the following best describes the ultrastructural changes seen in renal tubular cells undergoing reversible injury due to ischemia?

    <p>Loss of microvilli, membrane blebs in the lumen, and mildly dilated mitochondria</p> Signup and view all the answers

    What is the main mechanism behind coagulative necrosis?

    <p>Denaturation of structural and enzymatic proteins</p> Signup and view all the answers

    Which of the following is a characteristic feature of coagulative necrosis?

    <p>Preserved cellular outlines with loss of nuclei</p> Signup and view all the answers

    What is the most common setting for tissues to undergo coagulative necrosis?

    <p>Tissues irreversibly injured by ischemia</p> Signup and view all the answers

    Which term describes the fading of nuclear basophilia followed by the disappearance of the nucleus?

    <p>Karyolysis</p> Signup and view all the answers

    What distinguishes coagulative necrosis from liquefactive necrosis?

    <p>Preservation of tissue architecture</p> Signup and view all the answers

    Which term refers to the process where dead cells are proteolyzed after coagulative necrosis?

    <p>Autolysis</p> Signup and view all the answers

    What happens to the phospholipid precipitates formed during cell necrosis?

    <p>They are phagocytosed by other cells or further degraded into fatty acids.</p> Signup and view all the answers

    Which of the following is NOT a characteristic of necrotic cells observed under an electron microscope?

    <p>Continuous plasma and organelle membranes.</p> Signup and view all the answers

    Which of the following nuclear changes is NOT observed during necrosis?

    <p>Chromatin condensation due to caspase activation.</p> Signup and view all the answers

    What is the likely cause of the fading basophilia of chromatin observed during karyolysis?

    <p>Deoxyribonuclease (DNase) activity.</p> Signup and view all the answers

    What is the appearance of the cytoplasm in necrotic cells?

    <p>Vacuolated and 'moth-eaten'.</p> Signup and view all the answers

    What is the fate of the nucleus in a necrotic cell over time?

    <p>It completely disappears within 1-2 days.</p> Signup and view all the answers

    What is the likely composition of the 'fluffy material' observed in necrotic cells under an electron microscope?

    <p>Denatured proteins.</p> Signup and view all the answers

    What is the characteristic appearance of dry gangrene?

    <p>Pink-red areas corresponding to early ischemic necrosis, and blue-black areas indicating more advanced necrosis</p> Signup and view all the answers

    What is the cause of wet gangrene?

    <p>Bacterial superinfection of long-standing ischemic necrosis, causing liquefactive changes</p> Signup and view all the answers

    What is the mechanism behind the formation of chalky white deposits in fat necrosis?

    <p>Lipase from inflamed pancreas destroys membranes of adipocytes, converting triglycerides to fatty acids that combine with calcium</p> Signup and view all the answers

    What is the characteristic finding in fat necrosis?

    <p>White foci of dead fat cells in the retroperitoneum</p> Signup and view all the answers

    Which of the following is the mechanism behind fat necrosis?

    <p>Release of activated pancreatic lipases into the substance of the pancreas and the peritoneal cavity</p> Signup and view all the answers

    What is the characteristic histologic finding in fat necrosis?

    <p>Necrotic adipocytes without peripheral nuclei, and phagocytosis of dead cells by macrophages and multinucleated giant cells</p> Signup and view all the answers

    In which condition is fat necrosis commonly observed?

    <p>Acute pancreatitis</p> Signup and view all the answers

    Where can fat necrosis occur?

    <p>In the adipose tissue of the pancreas, breast tissue, abdomen, and subcutaneous fat</p> Signup and view all the answers

    Which type of necrosis is characterized by a 'cheesy' (yellow, friable) gross appearance?

    <p>Caseous necrosis</p> Signup and view all the answers

    Which organism is most likely to be detected by performing an acid-fast stain on a lesion exhibiting caseous necrosis?

    <p>Mycobacterium tuberculosis</p> Signup and view all the answers

    What is the main difference between dry gangrene and wet gangrene?

    <p>Dry gangrene has no superimposed infection, while wet gangrene has a superimposed infection.</p> Signup and view all the answers

    What is the main structural difference between normal and reversibly injured renal tubular epithelial cells, as shown in the light microscopy images?

    <p>Normal cells have a more basophilic cytoplasm, while reversibly injured cells have a more eosinophilic cytoplasm.</p> Signup and view all the answers

    What is the main mechanism behind the formation of chalky white deposits in fat necrosis?

    <p>Precipitation of calcium salts</p> Signup and view all the answers

    What is the characteristic appearance of dry gangrene?

    <p>Dry, shrunken, and leathery</p> Signup and view all the answers

    What is the primary mechanism behind the formation of calcium soaps during cell necrosis?

    <p>Calcification of fatty acid residues</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the ultrastructural changes seen in normal proximal tubular cells?

    <p>Dilated endoplasmic reticulum</p> Signup and view all the answers

    Which of the following is the most accurate description of the nuclear changes observed during karyorrhexis?

    <p>Fragmentation of the pyknotic nucleus</p> Signup and view all the answers

    What is the likely cause of the fading basophilia of chromatin observed during karyolysis?

    <p>Deoxyribonuclease (DNase) activity</p> Signup and view all the answers

    Which ultrastructural feature is NOT characteristic of necrotic cells observed under an electron microscope?

    <p>Presence of intracytoplasmic lipid droplets</p> Signup and view all the answers

    What is the likely composition of the 'fluffy material' observed in the cytoplasm of necrotic cells under an electron microscope?

    <p>Denatured proteins</p> Signup and view all the answers

    What is the most common setting for tissues to undergo coagulative necrosis?

    <p>Ischemic injury</p> Signup and view all the answers

    What is the characteristic histologic finding in fat necrosis?

    <p>Chalky white deposits</p> Signup and view all the answers

    What is the likely fate of a necrotic nucleus that initially undergoes pyknosis?

    <p>It remains shrunken and fragmented.</p> Signup and view all the answers

    What is a characteristic ultrastructural change observed in normal proximal tubular cells?

    <p>Mildly dilated mitochondria</p> Signup and view all the answers

    Which of the following represents irreversible injury to renal tubular epithelium?

    <p>Ruptured cytoplasmic membranes and increased nuclear basophilia</p> Signup and view all the answers

    What distinguishes reversible cell injury due to ischemia from normal proximal tubular cells?

    <p>Ruptured cytoplasmic membranes</p> Signup and view all the answers

    Which characteristic is indicative of reversible injury due to decreased blood flow in the ultrastructural image?

    <p>Intact microvilli and mitochondriae</p> Signup and view all the answers

    What type of injury is suggested by the presence of blebs, swelling, and eosinophilia in the cytoplasm?

    <p>Reversible injury due to ischemia</p> Signup and view all the answers

    What is the probable outcome for a necrotic nucleus that exhibits karyorrhexis?

    <p>It regains its normal size and structure.</p> Signup and view all the answers

    What is the characteristic appearance of wet gangrene?

    <p>Long-standing ischemic necrosis with bacterial superinfection, causing liquefactive changes</p> Signup and view all the answers

    What is the mechanism behind the formation of chalky white deposits in fat necrosis?

    <p>Lipase from inflamed pancreas destroys membranes of adipocytes, converting triglycerides to fatty acids that combine with calcium</p> Signup and view all the answers

    Where can fat necrosis occur?

    <p>In the adipose tissue of the pancreas, breast tissue, abdomen, and subcutaneous fat</p> Signup and view all the answers

    What is the characteristic histologic finding in fat necrosis?

    <p>Phagocytosis of dead cells by macrophages and multinucleated giant cells</p> Signup and view all the answers

    What is the likely cause of wet gangrene?

    <p>Bacterial superinfection of long-standing ischemic necrosis</p> Signup and view all the answers

    What is the main mechanism behind coagulative necrosis?

    <p>Denaturation and coagulation of cellular proteins</p> Signup and view all the answers

    Which of the following is NOT a characteristic of necrotic cells observed under an electron microscope?

    <p>Peripheral nuclei in adipocytes</p> Signup and view all the answers

    Which term describes the process where dead cells are proteolyzed after coagulative necrosis?

    <p>Autolysis</p> Signup and view all the answers

    What is the primary characteristic of reversible cell injury caused by ischemia, as shown in the ultrastructural image?

    <p>Swelling and disruption of cellular organelles</p> Signup and view all the answers

    Which of the following statements accurately describes the ultrastructural changes seen in irreversible cell injury (necrosis)?

    <p>Ruptured plasma membrane, swollen mitochondria with dense deposits, and nuclear pyknosis</p> Signup and view all the answers

    In the context of reversible cell injury, what is the significance of steatosis?

    <p>It indicates the accumulation of triglycerides within parenchymal cells, which is potentially reversible</p> Signup and view all the answers

    Which of the following is the most likely cause of the rash and symptoms experienced by the 45-year-old woman after applying the moisturizing skin cream?

    <p>Type I hypersensitivity (IgE-mediated) reaction</p> Signup and view all the answers

    What is the main characteristic that distinguishes necrosis from apoptosis?

    <p>Necrosis results in the leakage of cellular contents, while apoptosis does not</p> Signup and view all the answers

    Which of the following best describes the mechanism behind coagulative necrosis?

    <p>Denaturation and coagulation of proteins due to ischemia or toxins</p> Signup and view all the answers

    Which of the following statements accurately describes the nuclear changes observed during karyolysis?

    <p>The chromatin fades and the nucleus disappears</p> Signup and view all the answers

    Which of the following best describes the underlying mechanism behind the formation of chalky white deposits in fat necrosis?

    <p>Precipitation of calcium salts from the breakdown of lipids</p> Signup and view all the answers

    Phospholipid precipitates are phagocytosed by other cells.

    <p>False</p> Signup and view all the answers

    Dead cells do not become calcified.

    <p>False</p> Signup and view all the answers

    Mitochondria in necrotic cells exhibit a decrease in size with increased basophilia.

    <p>False</p> Signup and view all the answers

    Nuclear pyknosis is characterized by DNA condensing into a solid shrunken mass.

    <p>True</p> Signup and view all the answers

    Karyorrhexis involves the fusion of pyknotic nuclei.

    <p>False</p> Signup and view all the answers

    The nucleus in a dead cell completely disappears within 1-2 days.

    <p>True</p> Signup and view all the answers

    Karyolysis is primarily due to increased chromatin staining.

    <p>False</p> Signup and view all the answers

    Apoptosis and necrosis are both forms of reversible cell injury.

    <p>False</p> Signup and view all the answers

    Karyolysis is a light microscopic nuclear change that reflects DNA damage.

    <p>False</p> Signup and view all the answers

    Liquefactive necrosis is characterized by a 'cheesy' gross appearance.

    <p>False</p> Signup and view all the answers

    Apoptosis can be initiated through a single pathway.

    <p>False</p> Signup and view all the answers

    Necrosis is a controlled process regulated by intracellular proteins.

    <p>False</p> Signup and view all the answers

    Phagocytosis of apoptotic cells by macrophages does not involve any specific mechanisms.

    <p>False</p> Signup and view all the answers

    Irreversibly injured cells always display the same two functional abnormalities.

    <p>False</p> Signup and view all the answers

    Coagulative necrosis is characterized by the denaturation of structural and enzymatic proteins leading to cell lysis.

    <p>True</p> Signup and view all the answers

    Necrosis can be defined as cell death that occurs due to mild damage to cell membranes and intact cellular contents.

    <p>False</p> Signup and view all the answers

    Caseous necrosis is a morphologic pattern that is typically seen in tissues irreversibly injured by ischemia.

    <p>False</p> Signup and view all the answers

    Gangrenous necrosis is a morphologic pattern characterized by eosinophilic, anucleate cells that may persist for days or weeks.

    <p>False</p> Signup and view all the answers

    The mechanism behind fat necrosis involves the formation of chalky white deposits due to enzymatic destruction of cellular contents.

    <p>False</p> Signup and view all the answers

    Liquefactive necrosis is a morphologic pattern associated with the formation of ghost outlines of dead cells.

    <p>False</p> Signup and view all the answers

    Electron microscopy can reveal profound nuclear changes that end in nuclear dissolution during coagulative necrosis.

    <p>True</p> Signup and view all the answers

    Caseous necrosis is typically seen in wet gangrene.

    <p>False</p> Signup and view all the answers

    Gangrenous necrosis is commonly associated with ischemia.

    <p>True</p> Signup and view all the answers

    Dry gangrene can transition to wet gangrene if an infection occurs.

    <p>True</p> Signup and view all the answers

    Gas gangrene is caused by an acute necrotizing infection with Streptococcus pyogenes.

    <p>False</p> Signup and view all the answers

    Caseating granuloma typically has a peripheral zone of eosinophils and mast cells.

    <p>False</p> Signup and view all the answers

    Necrosis typically involves only the epidermis and dermis layers of the skin.

    <p>False</p> Signup and view all the answers

    Acid-fast stain can be used to detect tuberculosis in lesions exhibiting caseous necrosis.

    <p>True</p> Signup and view all the answers

    Fat necrosis primarily occurs in adipose tissue of the liver.

    <p>False</p> Signup and view all the answers

    Wet gangrene results from long-standing ischemic necrosis without bacterial superinfection.

    <p>False</p> Signup and view all the answers

    Dry gangrene is characterized by pink-red areas indicating advanced necrosis.

    <p>False</p> Signup and view all the answers

    Calcium soaps are formed in fat necrosis due to the action of lipase on triglycerides.

    <p>True</p> Signup and view all the answers

    Phagocytosis of dead cells in fat necrosis is primarily carried out by fibroblasts.

    <p>False</p> Signup and view all the answers

    White foci of dead fat cells in retroperitoneum are a characteristic feature of dry gangrene.

    <p>False</p> Signup and view all the answers

    'Wet gangrene' indicates dry, non-infectious necrosis.

    <p>False</p> Signup and view all the answers

    Dead adipocytes in fat necrosis are phagocytosed by lymphocytes.

    <p>False</p> Signup and view all the answers

    'Gangrenous Necrosis' refers to a pattern characterized by liquefactive changes.

    <p>True</p> Signup and view all the answers

    'Fat Necrosis' primarily involves the release of activated pancreatic amylases into the peritoneal cavity.

    <p>False</p> Signup and view all the answers

    What is the primary structural difference between normal and reversibly injured renal tubular epithelial cells, as shown in the light microscopy images?

    <p>Normal cells have abundant microvilli and mitochondria, while reversibly injured cells have loss of microvilli and mildly dilated mitochondria.</p> Signup and view all the answers

    Which of the following is the most likely cause of the characteristic 'cheesy' (yellow, friable) gross appearance in a specific type of necrosis?

    <p>Formation of caseous (cheese-like) material due to coagulative necrosis.</p> Signup and view all the answers

    What is the likely cause of the fading basophilia of chromatin observed during the nuclear change known as karyolysis?

    <p>Dissolution of the nucleus due to the action of DNase enzymes.</p> Signup and view all the answers

    Which of the following is a characteristic of the ultrastructural changes seen in normal proximal tubular cells?

    <p>Abundant microvilli and mitochondria.</p> Signup and view all the answers

    What is the primary mechanism behind the formation of chalky white deposits in fat necrosis?

    <p>Precipitation of calcium soaps and fatty acids due to the action of lipases.</p> Signup and view all the answers

    Which of the following is a characteristic nuclear change observed during irreversible cell injury (necrosis)?

    <p>Nuclear fragmentation (karyorrhexis).</p> Signup and view all the answers

    What is the likely outcome for a necrotic nucleus that exhibits the nuclear change known as karyorrhexis?

    <p>The nucleus will undergo dissolution due to the action of DNase enzymes (karyolysis).</p> Signup and view all the answers

    What is the main characteristic that distinguishes liquefactive necrosis from other forms of necrosis?

    <p>The tissue is transformed into a gelatinous, partly solid and partly liquid mass</p> Signup and view all the answers

    Which bacterial infections are commonly associated with liquefactive necrosis?

    <p>Staphylococcus aureus, Streptococcus pyogenes, and Clostridium perfringens</p> Signup and view all the answers

    Where is liquefactive necrosis most commonly seen in the body?

    <p>In the central nervous system</p> Signup and view all the answers

    What is the likely outcome of a cerebral infarction several years old?

    <p>The tissue is reduced to a cystic cavity with residual scar tissue</p> Signup and view all the answers

    What is the primary cause of the liquefaction observed in cerebral infarctions?

    <p>Intense inflammatory response and release of leukocyte enzymes</p> Signup and view all the answers

    What is the characteristic appearance of an acute ischemic infarction in the middle cerebral artery territory?

    <p>Early necrosis with tissue damage, 1-3 days after injury</p> Signup and view all the answers

    What is the primary mechanism behind the formation of the cystic cavity in a cerebral infarction several years old?

    <p>Encapsulation and organization of the necrotic tissue by astrocytes</p> Signup and view all the answers

    What is the primary mechanism responsible for the digestion of cellular contents during necrosis?

    <p>Autolysis, involving enzymes from the lysosomes of the dying cells themselves</p> Signup and view all the answers

    Which of the following cytoplasmic changes is characteristic of necrotic cells observed under a light microscope?

    <p>Formation of myelin figures, which are whorled phospholipid masses derived from damaged cell membranes</p> Signup and view all the answers

    What is the primary reason for the increased eosinophilia (pink staining) observed in the cytoplasm of necrotic cells?

    <p>Increased binding of eosin dye to denatured cytoplasmic proteins</p> Signup and view all the answers

    What is the primary reason for the glassy, homogeneous appearance of the cytoplasm in necrotic cells?

    <p>Loss of glycogen particles due to enzymatic digestion</p> Signup and view all the answers

    Which of the following statements about the time course of necrosis is correct?

    <p>Digestion of cellular contents and the host response take hours to develop</p> Signup and view all the answers

    Which of the following statements accurately describes the formation of myelin figures in necrotic cells?

    <p>Myelin figures are derived from damaged cell membranes and their phospholipid content</p> Signup and view all the answers

    What is the primary mechanism responsible for the recruitment of leukocytes during necrosis?

    <p>The local host reaction, called inflammation, that attempts to eliminate dead cells</p> Signup and view all the answers

    What is the primary mechanism behind fat necrosis?

    <p>Release of activated pancreatic lipases into the peritoneal cavity</p> Signup and view all the answers

    What is the characteristic appearance of dry gangrene?

    <p>Pink-red areas indicating early ischemic necrosis and blue-black areas indicating advanced necrosis</p> Signup and view all the answers

    What is the primary cause of wet gangrene?

    <p>Bacterial superinfection of long-standing ischemic necrosis</p> Signup and view all the answers

    Which of the following is the most accurate description of the nuclear changes observed during karyolysis?

    <p>Fading of nuclear basophilia followed by the disappearance of the nucleus</p> Signup and view all the answers

    What is the characteristic histologic finding in fat necrosis?

    <p>White foci of dead fat cells in the retroperitoneum</p> Signup and view all the answers

    Which of the following statements accurately describes the relationship between gangrenous necrosis and ischemia?

    <p>Gangrenous necrosis is commonly associated with ischemia</p> Signup and view all the answers

    What is the likely fate of a necrotic nucleus that initially undergoes pyknosis?

    <p>It will eventually disappear through the process of karyolysis</p> Signup and view all the answers

    What is the primary characteristic of fat necrosis?

    <p>Formation of chalky-white calcium deposits due to fat saponification</p> Signup and view all the answers

    Which of the following conditions is associated with fibrinoid necrosis?

    <p>Polyarteritis nodosa</p> Signup and view all the answers

    What is the characteristic microscopic finding in fibrinoid necrosis?

    <p>Bright pink and amorphous appearance in H&amp;E stains</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of reversible cell injury?

    <p>Irreversible DNA damage and karyolysis</p> Signup and view all the answers

    What is the primary mechanism behind coagulative necrosis?

    <p>Coagulation of intracellular proteins due to ischemia</p> Signup and view all the answers

    Which of the following is a characteristic feature of caseous necrosis?

    <p>Development of cheese-like necrotic material</p> Signup and view all the answers

    What is the primary distinguishing feature of necrosis compared to apoptosis?

    <p>Necrosis results in the release of cellular contents and inflammation</p> Signup and view all the answers

    Study Notes

    • Reversible cell injury due to ischemia in renal tubular epithelium shows cytoplasmic blebs, swelling, and eosinophilia.
    • Irreversible cell injury (necrosis) in renal tubular epithelium is characterized by ruptured cytoplasmic membranes and nuclear changes (karyolysis, pyknosis, karyorrhexis).
    • Coagulative necrosis is the most common setting in tissues irreversibly injured by ischemia, leading to denaturation of structural and enzymatic proteins, cell lysis, and eosinophilic, anucleate cells persisting for days.
    • Gangrenous necrosis is a distinctive form of necrosis usually affecting body parts like the leg, involving epidermis, dermis, subcutis, and deeper tissues, leading to dry or wet gangrene depending on the presence of infection.
    • Fat necrosis is characterized by focal areas of fat destruction and can occur in various tissues like the pancreas, breast, abdomen, and subcutaneous fat, often due to the release of activated pancreatic lipases.
    • Caseous necrosis is a form of coagulation necrosis associated with granulomatous inflammation, seen in tuberculosis and certain fungal infections, presenting with a "cheesy" gross appearance and distinctive histopathologic features like granulomas.
    • Nuclear changes in necrotic cells can present in three patterns: karyolysis (fading of nuclear basophilia), pyknosis (nuclear shrinkage and increased basophilia), and karyorrhexis (fragmentation of pyknotic nucleus).
    • Electron microscopy of necrotic cells reveals discontinuities in plasma and organelle membranes, dilation of mitochondria, disruption of lysosomes, and intracytoplasmic myelin figures.

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