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Pathology Technology Series (China) practice questions

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Question 1Tissue structure, injury and diagnostic support

A technical review identifies new capillaries, fibroblasts and repair-associated inflammatory cells in a healing site. Which term fits that pattern rather than a macrophage-rich granuloma?

  1. Metastasis established by any new blood vessel
  2. A granuloma solely because the names sound similar
  3. Granulation tissue Correct answer.
  4. A final tumor stage established by repair-cell counts

Explanation

Granulation tissue is a repair-associated tissue containing new vessels and fibroblasts with relevant inflammatory cells. It differs from the organized macrophage-rich pattern called a granuloma. The observed repair components do not by themselves establish malignancy, metastasis or a tumor stage.

Question 2Fixation, specimen preservation and decalcification

A specimen has reached fixative at the outer surface, but its center remains poorly preserved. Which distinction most directly explains why surface penetration alone does not prove the specimen is fully fixed?

  1. Reagent penetration and completion of fixation reactions are different processes. Correct answer.
  2. Fixation is complete whenever the container label says formalin.
  3. All tissue dimensions produce identical fixation kinetics.
  4. A firm surface proves every molecular target is preserved.

Explanation

Reagent must reach the relevant material and the required preservation reactions must occur under suitable conditions. A surface appearance cannot establish complete central preservation or downstream assay suitability. Review the actual dimensions, delay and validated process rather than infer success from a single external feature.

Question 3Fixation, specimen preservation and decalcification

A request includes molecular testing, but a mineralized specimen is about to enter an unreviewed strong-acid decalcification schedule. What is the most appropriate technical decision before this irreversible step?

  1. Assume sectioning ease proves all nucleic acids will remain intact.
  2. Clarify allocation and method suitability with the responsible service. Correct answer.
  3. Commit all material because every decalcifier preserves targets equally.
  4. Replace the request with an unrelated stain that is easier to perform.

Explanation

Decalcification can change nucleic-acid and antigen preservation. The actual request, material and validated method should be reviewed before consuming or irreversibly treating all of the specimen. This is a technical allocation decision within the responsible service, not permission to improvise a new chemical protocol.

Question 4Fixation, specimen preservation and decalcification

Two tissue blocks have the same final fixation duration, but one had a much longer delay before entering fixative. Why may their molecular results still differ?

  1. Only slide labels influence molecular integrity.
  2. The final duration automatically erases every earlier change.
  3. The pre-fixation interval can alter the biological material before preservation. Correct answer.
  4. All molecular analytes respond identically to every handling history.

Explanation

Changes before preservation can affect molecular stability and measured biological signals. Equal final fixation duration does not recreate the earlier condition of the specimen. Record and interpret relevant handling intervals rather than treat one shared final timestamp as proof of equivalent preanalytical history.

Question 5Fixation, specimen preservation and decalcification

A fictional method specifies a 6-hour preservation interval after recorded immersion at 09:30. Ignoring all other real method requirements, when does that stipulated interval end?

  1. 15:30 the same day Correct answer.
  2. 12:30 the same day
  3. 09:36 the same day
  4. 09:30 the next day

Explanation

Adding the supplied six hours to nine-thirty gives fifteen-thirty on the same day. This is time arithmetic for a fictional specification, not a universal tissue-fixation duration or proof that the actual specimen is sufficiently preserved. Real methods require their own validated conditions and records.

Question 6Processing, infiltration and orientation

In a supplied paraffin-processing workflow, dehydration is complete but the compatible clearing stage is accidentally omitted. Why is direct transfer into paraffin not automatically acceptable?

  1. The block identifier determines solvent compatibility.
  2. Hot paraffin guarantees removal of every incompatible liquid.
  3. Clearing is only a color-changing decorative step.
  4. The missing compatible transition can prevent adequate replacement of the dehydrating medium. Correct answer.

Explanation

Conventional processing uses compatible transitions to replace water and later introduce a support medium. Omitting a required clearing stage can compromise infiltration. Heat, a correct label or a superficially firm block does not establish that the validated chemical transition occurred successfully.

Question 7Processing, infiltration and orientation

After a run, a clearing reagent is unexpectedly cloudy and several blocks infiltrate poorly. Which investigation is most directly relevant?

  1. Review dehydration performance, reagent condition and possible water carryover. Correct answer.
  2. Assume every patient developed the same new tissue disease.
  3. Increase staining contrast without examining processing records.
  4. Discard the labels because cloudiness proves misidentification.

Explanation

Water carryover and exhausted or unsuitable reagents can interfere with clearing and infiltration. The pattern warrants review of the actual processing chain and equipment rather than a diagnosis from reagent appearance. Preserve identification and records while investigating the affected material.

Question 8Processing, infiltration and orientation

A diagnostic request needs a transverse view of a tubular segment. Which embedding choice best preserves that requested relationship?

  1. Choose the longitudinal plane because every tube requires it.
  2. Orient the segment so the sectioning plane crosses the lumen and surrounding wall. Correct answer.
  3. Orient randomly and assume staining will restore missing geometry.
  4. Remove the entire wall so only an empty wax channel remains.

Explanation

The requested transverse view requires a cutting plane across the tube so the lumen and surrounding wall can be assessed together. Orientation is selected for the diagnostic relationship, not by a universal rule for every tube. Staining cannot recreate a plane that was not sampled.

Question 9Processing, infiltration and orientation

Several tiny fragments should be visible together in initial sections. Which approach most directly supports that goal while following the actual embedding procedure?

  1. Trim deeply before checking whether all fragments are present.
  2. Stack fragments vertically so most are initially buried at different depths.
  3. Arrange useful fragment surfaces in a common cutting plane and retain their identity. Correct answer.
  4. Combine fragments from unrelated patients to make a larger block.

Explanation

A common useful plane can improve simultaneous representation and reduce unnecessary trimming. The actual orientation and handling must also preserve identity and diagnostic requirements. It is never appropriate to combine unrelated specimens merely to create a convenient larger block.

Question 10Processing, infiltration and orientation

A hypothetical quality audit finds 9 blocks requiring repeat processing among 180 blocks. Using repeat proportion = repeat blocks/total blocks, what is the proportion?

  1. 95 percent
  2. 20 percent
  3. 0.5 percent
  4. 5 percent Correct answer.

Explanation

Nine divided by 180 equals 0.05, or five percent. The result describes the supplied audit denominator and does not identify a cause or establish an acceptable universal benchmark. Further analysis should examine specimen mix, process stages and the reason for each repeat.

Question 11Processing, infiltration and orientation

A supplied mock audit defines complete traceability as all three records being linked: cassette, block and slide. Of 80 cases, 72 meet that definition. What is the complete-traceability proportion under this exercise?

  1. 72 percent
  2. 10 percent
  3. 111.1 percent
  4. 90 percent Correct answer.

Explanation

Seventy-two divided by eighty equals 0.90, or ninety percent. The result follows the supplied completeness definition and denominator. It does not establish that the remaining cases are clinically harmless or define an acceptable real laboratory benchmark. The missing links require appropriate investigation.

Question 12Section quality, cytology and frozen material

A straight score line recurs at the same blade position across several sections. Which technical action is most directly justified before changing unrelated stain reagents?

  1. Inspect the blade edge and associated cutting conditions for a localized defect. Correct answer.
  2. Diagnose a vessel lesion in every unrelated specimen.
  3. Increase eosin because color intensity determines blade damage.
  4. Ignore the line because repeated location proves normal anatomy.

Explanation

A repeatable line associated with a cutting position is consistent with a localized blade or related technical defect. Inspect the relevant equipment and procedure systematically. The pattern is a troubleshooting clue, not a diagnosis or proof that staining reagents caused the problem.

Question 13Section quality, cytology and frozen material

A small biopsy is near the block face, but a trainee keeps trimming large advances without examining the exposed material. What is the principal diagnostic risk?

  1. Automatic improvement of every downstream molecular assay.
  2. Loss of a small relevant focus before useful sections are retained. Correct answer.
  3. Creation of additional original tissue without sampling.
  4. Elimination of every identification error through deeper cutting.

Explanation

Excessive facing can consume a small specimen or diagnostic focus before it is represented on retained slides. Trimming should follow the actual method with attention to the material and requested levels. Deeper cutting does not automatically improve all assays or establish specimen identity.

Question 14Section quality, cytology and frozen material

A cytology method specifically requires an air-dried preparation. A trainee immediately wet-fixes every slide because another method used ethanol. What is the error?

  1. Demonstrating that a fixative name determines specimen identity.
  2. Recognizing that every cytology preparation has the same validated fixation.
  3. Transferring preservation instructions between methods with different requirements. Correct answer.
  4. Improving every stain by ignoring the intended preparation.

Explanation

Different cytological methods can require wet-fixed or intentionally air-dried material. The preparation must match the intended validated method. Instructions from another technique cannot be transferred simply because both examine cells or use slides. Review suitability and communicate limitations through the responsible process.

Question 15Section quality, cytology and frozen material

A cryostat section comes from unfixed tissue. Which safety statement is correct?

  1. A colder temperature removes the need for a procedure-specific risk assessment.
  2. Every infectious agent is destroyed by ordinary cryostat freezing.
  3. A visually clean section proves complete decontamination.
  4. Freezing does not establish that the tissue is noninfectious. Correct answer.

Explanation

Ordinary freezing is a preparation condition, not a validated universal sterilization process. Unfixed tissue can retain biological hazards. Appropriate containment, technique, training and decontamination follow the actual risk assessment rather than assumptions based on the temperature or appearance of a section.

Question 16Section quality, cytology and frozen material

A supplied illustrative sectioning plan retains 12 sections at a nominal 4 micrometres each. Ignoring all intervening trimming and compression, what nominal tissue depth do those sections represent?

  1. 48 micrometres Correct answer.
  2. 3 micrometres
  3. 16 micrometres
  4. 480 micrometres

Explanation

Twelve multiplied by four gives forty-eight micrometres under the supplied nominal model. Actual depth accounting must include any omitted trimming, lost sections or compression when those matter. The calculation does not establish a universal clinical section thickness or complete three-dimensional representation.

Question 17Section quality, cytology and frozen material

In a fictional quality check, 18 of 24 retained sections meet the predefined usability criterion. What fraction meets that criterion?

  1. 25 percent
  2. 75 percent Correct answer.
  3. 133.3 percent
  4. 18 percent

Explanation

Eighteen divided by twenty-four equals 0.75, or seventy-five percent. This measures the stipulated usability definition and does not define a universal acceptable section yield. Review why other sections failed rather than infer the cause from the proportion alone.

Question 18Histochemistry, controls and optical interpretation

PAS staining disappears from cytoplasm after validated diastase digestion, while an appropriate control behaves as expected. What does this comparison support?

  1. Every PAS-positive structure in the original section must be glycogen.
  2. A digestion-sensitive component consistent with glycogen in that context. Correct answer.
  3. The specimen is definitively one named storage disease without other evidence.
  4. The digestion must have removed every organism and every membrane.

Explanation

The paired comparison supports a digestion-sensitive PAS-reactive component consistent with glycogen. Other PAS-positive structures can persist, and diagnosis requires the full context. Appropriate controls establish whether the technical comparison is valid rather than making every original magenta structure chemically identical.

Question 19Histochemistry, controls and optical interpretation

A lipid demonstration is requested after all tissue has undergone a routine solvent-processing method known to remove the target neutral lipid. Why may the eventual stain be falsely unrevealing?

  1. All lipid preparations are necessarily identical after any solvent history.
  2. The missing target can always be recreated by stronger counterstain.
  3. The requested target may already have been extracted during processing. Correct answer.
  4. A negative patient section proves no lipid was present before processing.

Explanation

A stain cannot reliably demonstrate a target that the preceding preparation removed. The specimen allocation and preservation must suit the actual analytical question. A negative result after unsuitable processing cannot establish that the original tissue lacked the target or be repaired simply by stronger background color.

Question 20Histochemistry, controls and optical interpretation

A positive control fails to show its expected special-stain reaction, and the patient slide is also negative. Which conclusion is justified?

  1. Adding a diagnosis to the report validates the technical reaction.
  2. The patient target is certainly absent because both slides are blank.
  3. The failed control can be ignored if the patient history is persuasive.
  4. The run does not establish absence of the patient target. Correct answer.

Explanation

A failed positive control means the run has not demonstrated its ability to show the intended target under those conditions. Investigate and resolve the technical issue before inferring absence. Clinical expectations cannot substitute for a functioning assay or justify unsupported reporting.

Question 21Histochemistry, controls and optical interpretation

An observer sees a suspicious deposit on Congo-red staining but has not checked the appropriate polarized-light appearance or controls. What is the best interpretation?

  1. Further method-appropriate optical and control evaluation is required. Correct answer.
  2. A red deposit alone proves every amyloid subtype.
  3. Polarization can establish the patient identity even with a wrong label.
  4. Any red dye is interchangeable with the validated Congo-red method.

Explanation

Interpretation requires the appropriate staining, optical examination, morphology and controls. A color alone does not establish the nature or subtype of a deposit. Neither microscopy nor a substituted dye can repair specimen misidentification or replace the actual validated method.

Question 22Immunohistochemistry and molecular tissue methods

An IHC detection system uses no biotin-binding step. Which specific background mechanism does this design avoid compared with a biotin-dependent system?

  1. Every possible primary-antibody cross-reaction.
  2. Signal arising through endogenous tissue biotin in that detection pathway. Correct answer.
  3. Every effect of poor fixation on antigen detection.
  4. All specimen-label mismatches.

Explanation

Removing the biotin-dependent detection pathway avoids that particular endogenous-biotin mechanism. Nonspecific binding, endogenous enzyme effects, fixation problems and identity errors remain separate concerns. A design improvement does not guarantee every positive signal is specific or every negative signal biologically meaningful.

Question 23Immunohistochemistry and molecular tissue methods

A patient section is negative for a marker, but the required positive-control tissue also fails. Which next step is most appropriate?

  1. Assign positivity because the clinical team expected it.
  2. Conclude the patient has the least differentiated tumor by default.
  3. Investigate the assay failure before interpreting biological target absence. Correct answer.
  4. Average the negative result with an unrelated prior patient slide.

Explanation

The failed positive control prevents a justified negative interpretation for the target in this run. Review the appropriate preparation, retrieval, reagents and detection stages through the validated quality process. Neither expectation nor an unrelated slide establishes the patient’s biological marker status.

Question 24Immunohistochemistry and molecular tissue methods

A chromogen’s validated instructions state that its visible reaction product dissolves in alcohol. What finishing choice follows?

  1. Discard the control because mounting chemistry never affects signal.
  2. Apply extra alcohol to make the dissolving product permanent.
  3. Assume every chromogen has the same solvent resistance as DAB.
  4. Use a compatible validated finishing method rather than routine alcohol dehydration. Correct answer.

Explanation

Finishing chemistry must preserve the actual reaction product. If alcohol dissolves it, a routine alcohol-based sequence can remove the signal, so use the compatible validated method. Chromogen properties differ, and an apparently weak final result may reflect preparation rather than absent target.

Question 25Immunohistochemistry and molecular tissue methods

A no-template PCR control crosses the signal threshold in a run intended to detect a tissue target. What concern requires investigation?

  1. Contamination or another source of background amplification signal. Correct answer.
  2. Proof that every patient sample lacks the target.
  3. Direct confirmation of the patient’s tumor stage.
  4. Evidence that specimen labeling was correct throughout processing.

Explanation

A signal where no intended template was added raises concern for contamination or another assay-background mechanism. It does not establish the status of every patient sample or identify the contamination source by itself. Investigate using the actual control and reporting procedures before interpreting affected results.

Question 26Laboratory quality and safety

A slide carries a different identifier from the block it was reportedly cut from. What is the appropriate technical response?

  1. Choose the more legible label and discard the other record.
  2. Hold the affected interpretation and resolve the identity discrepancy through the documented process. Correct answer.
  3. Assume matching tissue color proves both came from one patient.
  4. Continue reporting because staining controls passed.

Explanation

Identity discrepancy can undermine even a technically excellent slide. Hold affected work and investigate traceability through the approved process, preserving records. Color similarity and analytical controls cannot establish which patient supplied a specimen or justify an unsupported identifier change.

Question 27Laboratory quality and safety

A training record contains only attendance at a microtomy lecture. Which additional evidence most directly addresses practical competence?

  1. Assuming all attendees can operate every microtome safely.
  2. The number of pages printed from the lecture slides alone.
  3. Observed performance and problem-solving assessed against the actual competency requirements. Correct answer.
  4. A declaration that written knowledge eliminates the need for supervised practice.

Explanation

Attendance documents exposure to teaching, not demonstrated bench performance. Appropriate observation and assessment of technical and problem-solving skills address actual competence within the required framework. A lecture or written question bank does not itself authorize independent equipment operation or hazardous specimen handling.

Question 28Tissue structure, injury and diagnostic support

Which type of epithelium (上皮组织) consists of multiple cell layers with flattened superficial cells, designed specifically to withstand mechanical abrasion and chemical friction in organs such as the esophagus, oral cavity, and epidermis?

  1. Stratified Squamous Epithelium (复层扁平上皮) Correct answer.
  2. Simple Columnar Epithelium (单层柱状上皮)
  3. Pseudostratified Ciliated Columnar Epithelium (假复层纤毛柱状上皮)
  4. Transitional Epithelium / Urothelium (变移上皮 / 尿路上皮)

Explanation

Stratified squamous epithelium (复层扁平上皮) consists of multiple protective cell layers where the basal cells undergo active mitosis and the superficial layers become flattened and slough off, providing high resistance to mechanical friction and wear in the esophagus, oral cavity, vagina, and skin epidermis.

Question 29Tissue structure, injury and diagnostic support

In a long-term heavy cigarette smoker, the pseudostratified ciliated columnar epithelium lining the bronchial mucosa is replaced by mature stratified squamous epithelium. Which adaptive cellular process (细胞适应) does this histological transformation represent?

  1. Hyperplasia (增生)
  2. Squamous Metaplasia (鳞状化生) Correct answer.
  3. Dysplasia / Atypical Hyperplasia (异型增生)
  4. Hypertrophy (肥大)

Explanation

Squamous metaplasia (鳞状化生) is a reversible adaptive change in which one adult cell type (e.g., ciliated columnar epithelium of the respiratory tract) is replaced by another adult cell type (e.g., stratified squamous epithelium) that is better able to withstand chronic smoke or chemical irritation.

Question 30Tissue structure, injury and diagnostic support

What is the primary biochemical mechanism responsible for hydropic degeneration / cellular swelling (水变性 / 细胞水肿), one of the earliest morphological manifestations of reversible cell injury?

  1. Direct degradation of nuclear chromatin by activated endonucleases
  2. Excessive accumulation of neutral triglycerides within the cytoplasm
  3. Failure of the plasma membrane ATP-dependent Na+/K+ pump due to hypoxia Correct answer.
  4. Precipitation of misfolded immunoglobulin light chains in lysosomes

Explanation

Hydropic degeneration / cellular swelling (水变性 / 细胞水肿) occurs when hypoxic injury or mitochondrial damage reduces cellular ATP production, leading to dysfunction of the energy-dependent Na+/K+ ATPase pump. Sodium and water accumulate intracellularly while potassium is lost, causing cellular and organelle swelling.

Question 31Tissue structure, injury and diagnostic support

Under light microscopy, liver parenchymal cells from a patient with chronic alcoholism exhibit distinct clear cytoplasmic vacuoles that push the nucleus to the cell periphery. Which histochemical stain performed on frozen sections confirms the lipid nature of these vacuoles?

  1. Periodic Acid-Schiff (PAS 染色)
  2. Masson's Trichrome (Masson三色染色)
  3. Prussian Blue (普鲁士蓝染色)
  4. Oil Red O (油红O染色) Correct answer.

Explanation

Oil Red O (油红O染色) performed on frozen sections (冰冻切片) dissolves selectively into neutral triglycerides and lipid droplets, staining fatty vacuoles bright orange-red and confirming hepatic steatosis / fatty change (脂肪变性). Routine paraffin processing dissolves lipids, leaving empty vacuoles.

Question 32Tissue structure, injury and diagnostic support

Which histological hallmark characteristically distinguishes coagulative necrosis (凝固性坏死) occurring in ischemic myocardial or renal infarcts under hematoxylin and eosin (H&E) staining?

  1. Preservation of basic cellular outlines and tissue architecture as 'ghost cells' with loss of nuclei Correct answer.
  2. Complete enzymatic liquefaction of tissue architecture forming a cystic fluid cavity
  3. Chalky white opaque saponification deposits surrounded by intense foreign-body giant cells
  4. Fibrinoid wall thickening with abundant neutrophilic karyorrhectic nuclear dust

Explanation

In coagulative necrosis (凝固性坏死), protein denaturation predominates over enzymatic digestion. The underlying structural framework and cell boundaries are preserved for several days as eosinophilic 'tombstone' or 'ghost' cells with absent nuclei (karyolysis/pyknosis/karyorrhexis).

Question 33Tissue structure, injury and diagnostic support

Why does ischemic necrosis of brain parenchyma (cerebral infarction / 脑梗死) typically result in liquefactive necrosis (液化性坏死 / 脑软化) rather than coagulative necrosis?

  1. The brain has an exceptionally high collagen content that resists protein coagulation
  2. Brain tissue is rich in hydrolytic lysosomal enzymes and lipids with minimal structural connective stroma Correct answer.
  3. Cerebral blood vessels lack endothelial basement membranes, allowing massive blood leakage
  4. Microglial cells directly calcify surrounding necrotic tissue before coagulation can occur

Explanation

Brain tissue is abundant in lipid content and powerful hydrolytic lysosomal enzymes from autolytic neurons and infiltrating microglia/macrophages, combined with a sparse connective tissue stroma. This results in rapid enzymatic digestion and dissolution of necrotic tissue, producing liquefactive necrosis (脑软化).

Question 34Tissue structure, injury and diagnostic support

A lung biopsy from a patient with active tuberculosis demonstrates a central acellular eosinophilic zone of amorphous granular debris surrounded by epithelioid macrophages and Langhans multinucleated giant cells. What specific type of necrosis is this?

  1. Fibrinoid necrosis (纤维素样坏死)
  2. Wet gangrene (湿性坏疽)
  3. Caseous necrosis (干酪样坏死) Correct answer.
  4. Zenker's waxy necrosis (蜡样坏死)

Explanation

Caseous necrosis (干酪样坏死) is a distinctive form of coagulative necrosis characteristic of tuberculous infection (结核病). Grossly it resembles friable white cheese, and microscopically it appears as a structureless, eosinophilic, granular debris devoid of tissue outlines, encircled by a granulomatous collar.

Question 35Tissue structure, injury and diagnostic support

In acute necrotizing pancreatitis (急性坏死性胰腺炎), pancreatic enzymes escape into peripancreatic adipose tissue. Activated lipases split neutral triglycerides into free fatty acids that combine with which ion to form macroscopic chalky-white deposits (saponification spots / 皂化斑)?

  1. Ferrous ion (Fe2+)
  2. Potassium ion (K+)
  3. Sodium ion (Na+)
  4. Calcium ion (Ca2+) Correct answer.

Explanation

In enzymatic fat necrosis (酶解性脂肪坏死), activated pancreatic lipases hydrolyze neutral fat in adipocytes into fatty acids and glycerol. The released fatty acids combine with ionized calcium (Ca2+) in interstitial fluid to form insoluble calcium soaps (saponification / 皂化斑), seen microscopically as basophilic amorphous deposits.

Question 36Tissue structure, injury and diagnostic support

Which listed combination describes the classic morphological pattern of apoptosis in the supplied comparison with conventional necrosis, rather than a unique feature of every possible cell-death pathway?

  1. Cell shrinkage, chromatin condensation, and formation of membrane-bound apoptotic bodies without surrounding acute inflammation Correct answer.
  2. Massive cellular swelling, rupture of plasma membrane, and extensive recruitment of neutrophilic granulocytes
  3. Formation of an extracellular fluid-filled cyst with complete loss of organ architecture
  4. Rupture of lysosomal membranes releasing acid hydrolases into the intercellular interstitium

Explanation

Apoptosis (细胞凋亡) is an active, energy-dependent programmed cell death process characterized by cell shrinkage, pyknotic chromatin condensation, cellular budding into membrane-enclosed apoptotic bodies (凋亡小体), and rapid phagocytosis by macrophages without inciting an inflammatory response.

Question 37Tissue structure, injury and diagnostic support

In a lung biopsy from a patient suffering from long-standing left-sided congestive heart failure, numerous intra-alveolar macrophages loaded with golden-brown granular pigment are observed. What are these cells specifically termed in surgical pathology?

  1. Langhans giant cells (郎罕氏巨细胞)
  2. Heart failure cells (心力衰竭细胞) Correct answer.
  3. Touton giant cells (杜顿巨细胞)
  4. Aschoff giant cells (阿少夫巨细胞)

Explanation

Heart failure cells (心力衰竭细胞) are alveolar macrophages that have phagocytosed extravasated red blood cells and converted hemoglobin into golden-brown hemosiderin (含铁血黄素) pigment during chronic pulmonary venous congestion (慢性肺淤血).

Question 38Tissue structure, injury and diagnostic support

Gross examination of a liver specimen reveals a variegated, mottled cut surface featuring dark reddish-brown congested central lobular zones alternating with pale yellowish fatty peripheral lobular zones. What is the classic pathological term for this lesion?

  1. Sago spleen (槟榔脾 / 西米脾)
  2. Hobnail liver (毛细结节状肝)
  3. Nutmeg liver (槟榔肝) Correct answer.
  4. Cor bovinum (牛心)

Explanation

Nutmeg liver (槟榔肝) is the classic pathological appearance of chronic passive hepatic congestion (慢性肝淤血) caused by right-sided heart failure. Centrilobular regions undergo intense venous congestion and necrosis (dark red), whereas periportal hepatocytes exhibit fatty degeneration (yellow), mimicking the cut surface of a nutmeg.

Question 39Tissue structure, injury and diagnostic support

Which listed combination describes the conventional Virchow framework of contributing thrombosis risk factors, rather than three features that must all be present in every patient?

  1. Hypocalcemia, arterial hypertension, and metabolic acidosis
  2. Hyperthermia, leukopenia, and increased capillary fragility
  3. Vitamin K deficiency, vascular dilatation, and thrombocytopenia
  4. Endothelial injury, alterations in normal blood flow (stasis/turbulence), and blood hypercoagulability Correct answer.

Explanation

Virchow's Triad (魏尔啸三要素) encompasses: (1) Endothelial injury (内皮损伤 - exposing subendothelial collagen/vWF), (2) Abnormal blood flow (血流状态异常 - stasis or turbulent eddies), and (3) Hypercoagulability of blood (血液高凝状态 - prothrombotic state).

Question 40Tissue structure, injury and diagnostic support

Microscopic examination of a mixed thrombus (混合血栓) reveals alternating pale pink laminations and darker red laminations known as the Lines of Zahn (Zahn 条纹). What are the pale layers primarily composed of?

  1. Platelets and fibrin (血小板与纤维蛋白) Correct answer.
  2. Aggregated erythrocytes and neutrophils (红细胞与中性粒细胞)
  3. Endothelial cells and smooth muscle cells (内皮细胞与平滑肌细胞)
  4. Unesterified cholesterol crystals and calcium salts (胆固醇结晶与钙盐)

Explanation

Lines of Zahn (Zahn 条纹) are microscopic and gross hallmarks of arterial or cardiac thrombi formed in moving blood. The pale laminations consist of aggregated platelets and fibrin networks (血小板梁与纤维蛋白), while the darker laminations contain trapped red blood cells (红细胞).

Question 41Tissue structure, injury and diagnostic support

A postoperative orthopedic patient develops sudden dyspnea, chest pain, and cardiovascular collapse. An autopsy reveals a saddle thromboembolus occluding the pulmonary artery bifurcation. Where is the most common anatomical site of origin for such emboli?

  1. Left atrial appendage (左心耳)
  2. Deep veins of the lower extremities / pelvic veins (下肢深静脉 / 盆腔静脉) Correct answer.
  3. Mesenteric superior venous plexus (肠系膜上静脉丛)
  4. Internal carotid artery bifurcation (颈内动脉分叉处)

Explanation

Over 95% of pulmonary thromboemboli (肺动脉栓塞) originate from deep venous thrombosis (DVT / 下肢深静脉血栓形成) in the lower extremities (e.g., femoral, popliteal, iliac veins) or pelvic plexuses, dislodging into the inferior vena cava, right heart chambers, and pulmonary trunk.

Question 42Tissue structure, injury and diagnostic support

Hemorrhagic / Red infarcts (出血性梗死 / 红色梗死) characteristically occur in which of the following organs, owing to its loose tissue architecture, dual arterial blood supply, and pre-existing venous congestion?

  1. Kidney (肾脏)
  2. Spleen (脾脏)
  3. Lung (肺脏) Correct answer.
  4. Myocardium (心肌)

Explanation

Hemorrhagic (red) infarcts (出血性梗死) typically occur in tissues with loose parenchyma and dual blood supplies (such as the lung with pulmonary and bronchial arteries, or the small intestine with rich anastomoses) or when venous occlusion occurs, allowing continuous blood influx into the necrotic zone.

Question 43Tissue structure, injury and diagnostic support

During the first 24 to 48 hours of an acute bacterial inflammatory response (急性细菌性炎症), which type of leukocyte is the predominant inflammatory cell extravasating into the infected tissue?

  1. Plasma cell (浆细胞)
  2. Lymphocyte (淋巴细胞)
  3. Eosinophil (嗜酸性粒细胞)
  4. Neutrophil (中性粒细胞) Correct answer.

Explanation

Neutrophils (中性粒细胞) are the first line of cellular defense in acute inflammation. They respond rapidly to chemotactic stimuli (C5a, LTB4, bacterial peptides), marginate, adhere, and emigrate into the extravascular space within the first 6–24 hours.

Question 44Tissue structure, injury and diagnostic support

A 5-year-old child presents with severe sore throat, fever, and a thick grayish-white pseudomembrane coating the pharyngeal mucosa that bleeds profusely when scraped. Histopathological examination shows abundant fibrin networks, necrotic epithelium, and neutrophils. What type of inflammation is this?

  1. Fibrinous inflammation (纤维素性炎症 / 假膜性炎) Correct answer.
  2. Serous inflammation (浆液性炎症)
  3. Suppurative inflammation (化脓性炎症)
  4. Catarrhal inflammation (卡他性炎)

Explanation

Fibrinous inflammation (纤维素性炎症) occurring on mucosal surfaces (such as in diphtheria or bacterial dysentery) forms a pseudomembrane (假膜性炎) composed of precipitated fibrin, necrotic epithelial cells, and neutrophils. Peeling the adherent membrane damages mucosal capillaries and causes bleeding.

Question 45Tissue structure, injury and diagnostic support

What are the primary specialized cellular components that constitute the hallmark of chronic granulomatous inflammation (肉芽肿性炎) under light microscopy?

  1. Proliferating fibroblasts and abundant newly formed capillary loops
  2. Activated epithelioid macrophages (上皮样细胞) and multinucleated giant cells (多核巨细胞) Correct answer.
  3. Clusters of atypical neoplastic signet-ring cells in extracellular mucus pools
  4. Sheets of eosinophils and Charcot-Leyden crystals

Explanation

Granulomatous inflammation (肉芽肿性炎) is a distinct pattern of chronic inflammation characterized by aggregates of activated epithelioid macrophages (上皮样细胞) with abundant pale pink cytoplasm, accompanied by multinucleated giant cells (Langhans or foreign-body type) and a peripheral rim of lymphocytes.

Question 46Tissue structure, injury and diagnostic support

Which of the following describes the fundamental biological composition and function of Granulation Tissue (肉芽组织), distinguishing it clearly from a Granuloma (肉芽肿)?

  1. An avascular dense hyalinized scar tissue that permanently immobilizes moving joints
  2. A localized nodular collection of transformed epithelioid macrophages combating intracellular pathogens
  3. A specialized neoplasm arising from vascular endothelial cells with high metastatic potential
  4. A vascularized repair tissue consisting of newly formed budding capillaries, proliferating fibroblasts, and inflammatory cells Correct answer.

Explanation

Granulation tissue (肉芽组织) is a soft, pink, granular tissue formed during wound healing and tissue repair. It consists of newly formed capillary buds (垂直于表面的毛细血管), proliferating myofibroblasts/fibroblasts, and scattered inflammatory cells that synthesize extracellular matrix to replace tissue defects.

Question 47Tissue structure, injury and diagnostic support

In oncological pathology, what does the term 'Differentiation' (分化程度) refer to regarding tumor cells and neoplastic parenchyma?

  1. The anatomical distance that metastatic tumor cells have migrated from the primary organ site
  2. The total physical volume of the gross surgical tumor specimen in cubic centimeters
  3. The chemical ratio of collagenous stroma to malignant epithelial parenchyma within the tumor
  4. The degree of morphological and functional resemblance of neoplastic cells to their normal counterpart cells Correct answer.

Explanation

Tumor differentiation (分化程度) evaluates how closely neoplastic parenchymal cells morphologically and functionally resemble the normal mature cells of origin. Well-differentiated tumors closely mimic normal tissue, whereas poorly differentiated or undifferentiated (anaplastic) tumors exhibit severe atypia and aggressive behavior.

Question 48Tissue structure, injury and diagnostic support

In a conventional squamous-epithelial comparison, which listed pattern describes full-thickness in-situ atypia with no basement-membrane invasion, rather than invasive carcinoma?

  1. Full-thickness epithelial dysplasia / atypia with an intact, unbreached basement membrane (基底膜完整) Correct answer.
  2. Invasion of malignant tumor cells into superficial subepithelial lymphatics
  3. Presence of widespread lymph node metastases without a detectable primary tumor mass
  4. Proliferation of neoplastic cells confined strictly to the suprabasal third of the epithelium

Explanation

Carcinoma in situ (原位癌 / CIS) is characterized by severe architectural disorder and cytologic atypia involving the full thickness of the epithelium, with the key pathological criterion that the underlying epithelial basement membrane (基底膜) remains entirely intact with no stromal invasion.

Question 49Tissue structure, injury and diagnostic support

Regarding the primary pathways of malignant tumor metastasis, what is the classic distinction between Carcinomas (癌) and Sarcomas (肉瘤)?

  1. Carcinomas metastasize exclusively through cerebrospinal fluid, whereas sarcomas metastasize through perineural spaces
  2. Carcinomas typically metastasize preferentially via lymphatic vessels (淋巴道转移), whereas sarcomas typically metastasize via blood vessels (血道转移) Correct answer.
  3. Carcinomas never metastasize to regional lymph nodes, whereas sarcomas consistently spread to lymph nodes first
  4. Both carcinomas and sarcomas metastasize strictly via body cavity seeding (种植性转移) without vascular involvement

Explanation

Epithelial malignancies (Carcinomas / 癌) characteristically spread first via lymphatic channels (淋巴道转移) to regional draining lymph nodes, whereas mesenchymal malignancies (Sarcomas / 肉瘤) possess rich vascular beds and typically metastasize early via hematogenous routes (血道转移), frequently lodging in the lungs and liver.

Question 50Tissue structure, injury and diagnostic support

A mature cystic ovarian neoplasm is excised from a 25-year-old woman. Microscopic examination demonstrates mature skin with hair follicles, sebaceous glands, respiratory ciliated epithelium, cartilage, and mature neural tissue. From which cell lineage does this Teratoma (畸胎瘤) arise?

  1. Vascular endothelial stem cells
  2. Unipotent mesenchymal fibroblasts
  3. Totipotent germ cells capable of differentiating into all three germ layers (全能生殖细胞) Correct answer.
  4. Mature myeloid hematopoietic stem cells

Explanation

Teratomas (畸胎瘤) originate from totipotent/pluripotent germ cells (全能生殖细胞) typically located in the gonads (ovary, testis) or midline embryonic rests. These cells retain the potential to differentiate into mature tissue components derived from ectoderm, mesoderm, and endoderm.