SECTION A: PROBLEM-BASED QUESTIONS

1. A 50-year-old chronic smoker presents with persistent cough.

Chest X ray shows increased bronchial markings and biopsy shows
squamous metaplasia.
a. Explain the mechanism of cellular adaptations
b. Describe metaplasia with examples
c. Add clinical significance and reversibility
2. A 45-year-old woman presents with a gradually enlarging thyroid
welling. FNAC shows features of simple goiter.
a. Describe types of cellular adaptations
b. Explain hypertrophy and hyperplasia with suitable clinical
examples
c. Describe the pathogenesis of this case
3. A 65-year-old hypertensive patient develops sudden chest pain.
ECG changes are seen, and his cardiac enzymes are elevated.
a. Describe the causes and mechanisms of reversible and
irreversible cell injury
b. Discuss the morphological and biochemical changes in
myocardial infarction.
4. A 62-year-old presents with severe chest pain radiating to the left
arm. ECG shows ST elevation and serum troponin is elevated.
a. Define reversible and irreversible cell injury
b. Explain the sequence of biochemical events in ischemic
injury
c. Describe morphological changes in myocardial infarction
 d. Add clinical correlations
5. A 60-year-old hypertensive patient has dyspnea; echo shows LV
hypertrophy.
a. Define hypertrophy and differentiate from hyperplasia
b. Explain mechanisms and molecular pathways
c. Describe morphological changes in myocardium
d. Discuss the complications
6. A patient with hypovolemic shock shows liver hydropic change on
biopsy.
a. Describe reversible cell injury
b. Explain the pathogenesis and morphology of hydropic
change
c. Mention its clinical significance
7. A 40-year-old man with chronic cough undergoes lymph node
biopsy showing caseous necrosis.
a. Define necrosis and classify types
b. Describe caseous necrosis with morphology
c. Explain the pathogenesis
8. A 40-year-old obese female presents with right upper quadrant
pain after a fatty meal. Ultrasound shows gallstones.
a. Explain the biochemical mechanisms that can lead to cell
injury in the liver and gallbladder in this patient
b. Describe the different types of cell death and how they
might manifest in the affected organs
9. A 12-year-old girl notices enlargement of her breasts while taking
bath.
a. What is the main physiological cause of the enlargement of
breast
b. What are its morphological features and types
c. What is the mechanism of this adaptation?
10. Gross examination of brain on autopsy of a 90-year-old man
with history of atherosclerotic disease reveals shrunken brain with
loss of brain substance.
a. Which type of cellular adaptation has occurred?
b. Give the underlying mechanism
c. Give any two other causes of this cellular adaptation with
examples
11. A 21-year-old female gives birth to her 1st baby. She started
to give breast feed right after birth and continued till 1 year with
no difficulties and complications.
a. Name and define the cellular processes that started in breast
during pregnancy that allowed her to nurse the baby during
this period
b. Give three pathological examples of this process and
describe its pathogenicity/mechanism
12. A 60-year-old male, chronic alcoholic dies in a roadside
accident. On autopsy, liver was found to be moderately enlarged,
yellowish, soft and greasy.
a. Discuss pathogenesis of the lesion
 b. Describe microscopic appearance of the condition
13. A 24-year-old male is admitted to the hospital with jaundice
for past one month. His LFTs show a rise in ALT and AST. Serology
confirms the diagnosis of Hepatitis C infection. A liver biopsy is
taken. Histological examination findings are presence of dead
hepatocytes in the form of pink bodies with mild inflammatory
infiltrate.
a. Which pathological process results in the formation of these
bodies?
b. Describe briefly the different pathways of apoptosis
14. A 32 years old habitual cigarette smoker complains of
persistent chronic cough and frequent severe respiratory
infections for the last 15 months.
a. Which type of adaptative changes is most likely to occur in
the respiratory epithelium?
b. Give the mechanisms of this cellular adaptation
c. Enlist three others types of cellular adaptations with one
example for each.
15. A 26-year-old athlete using anabolic steroids has increased
muscle bulk.
a. Define physiological and pathological hypertrophy
b. Describe mechanisms behind this
c. Explain morphology of the condition
d. Discuss risks involved
16. A diabetic man presents with black, dry, shriveled foot.
 a. Define gangrene and classify types
b. Explain pathogenesis of dry gangrene
c. Describe morphology
d. Explain clinical complications

SECTION B : SCENARIO-BASED QUESTIONS

1. A 70-year-old man in shock shows swollen hepatocytes with pale
cytoplasm on biopsy. Write a short note on hydropic change and
its change.
2. An obese woman with diabetes presents with hepatomegaly,
ultrasound shows fatty infiltration. Explain fatty change and its
mechanisms.
3. A patient with HBV hepatitis shows councilman bodies on biopsy.
Write a note on apoptosis and its morphological features.
4. A patient with acute MI undergoes biopsy showing coagulative
necrosis. Discuss coagulative necrosis with morphology.

SECTION C — ANALYTICAL-BASED QUESTIONS

1. A 55-year-old chronic smoker presents with progressive
breathlessness. Chest x-ray shows hyperinflated lungs. Explain the
mechanism of cell injury contributing to this condition.
2. A patient with severe atherosclerosis develops sudden crushing
chest pain. Troponin-I is elevated. Explain the sequence of
reversible and irreversible injury in the myocardium.
3. A 30-year-old farmer accidentally ingests organophosphates.
Discuss how free radicals cause cell injury and how the body
defends against them.
4. A 70-year-old hypertensive patient develops renal failure. Explain
the role of ischemia in cellular ATP depletion and membrane
damage in the kidneys.
5. A newborn with severe jaundice develops kernicterus. Discuss the
mechanism of bilirubin-induced cell injury.