FMGE 2023 - Pathology Practice Questions

Q: What type of cell is shown in the image below?

Reed Sternberg cell. ***Reed Sternberg cell*** - This is a classic **Reed-Sternberg cell**, characterized by its large size, bilobed or multinucleated appearance, and prominent eosinophilic nucleoli, which create a pathognomonic "**owl-eye**" look [1], [2]. - These cells are the neoplastic hallmark of **Hodgkin lymphoma** and are crucial for its diagnosis [2]. *Faggot cell* - Faggot cells are malignant promyelocytes containing numerous **Auer rods** that are bundled together, resembling a bundle of sticks. - They are characteristically seen in **Acute Promyelocytic Leukemia (APL)**, a subtype of AML, and are not depicted in the image. *Mott cells* - Mott cells are plasma cells with cytoplasm packed with **Russell bodies**, which are eosinophilic globules of immunoglobulin, giving the cell a "grape-like" appearance. - They are found in conditions with chronic plasma cell stimulation or plasma cell neoplasms like **multiple myeloma**, but their morphology is distinct from the cell shown. *Sézary-Lutzner cells* - These are malignant T-lymphocytes characterized by a highly convoluted, **cerebriform (brain-like) nucleus**. - They are the hallmark cells of cutaneous T-cell lymphomas, such as **Mycosis Fungoides** and **Sézary syndrome**, and lack the "owl-eye" nucleoli seen in the image. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 556-557.

Q: A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?

Psammoma bodies with whorling of tumor cells. ***Psammoma bodies with whorling of tumor cells***- The clinical picture of a **dural-based tumor** [2] causing symptoms of **raised intracranial pressure** (headache) is highly suggestive of a **Meningioma**.- **Psammoma bodies** (laminated calcified concretions) formed by the degeneration of the whorled cell clusters [1] are the classic histological hallmark of the transitional and **meningothelial meningioma** subtypes.*Fried egg appearance*- This histological appearance, characterized by clear perinuclear halos, is the classic finding for **Oligodendroglioma**, a type of parenchymal brain tumor.- Oligodendrogliomas typically arise within the cerebral **white matter** and are usually not primarily dural-based.*Flexner - Wintersteiner rosettes*- These are specialized structures representing an attempt at **retinal differentiation** and are the characteristic feature of **Retinoblastoma**.- They are also sometimes seen in highly aggressive midline CNS tumors, such as **Pineoblastoma**.*Homer - Wright rosettes*- These are seen in tumors exhibiting divergent **neuroectodermal differentiation** but lack a true central lumen or fenestration.- They are the characteristic histological finding in **Medulloblastoma** (a cerebellar tumor) and **Neuroblastoma** (a tumor of the adrenal medulla or sympathetic chain). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.

Q: Which of the following is true about p53?

It inhibits telomerase activity. ***It inhibits telomerase activity*** - **p53 transcriptionally represses hTERT** (telomerase reverse transcriptase), effectively downregulating telomerase activity as part of its tumor suppressor function. - This inhibition prevents **cellular immortalization** and contributes to p53's role as the "**guardian of the genome**" in preventing malignant transformation. *It increases telomere length in the liver* - p53 has **no tissue-specific function** to increase telomere length in any organ, including the liver. - p53 actually **opposes telomere maintenance** by inhibiting telomerase, which would shorten rather than lengthen telomeres. *It synthesizes RNA* - p53 is a **transcription factor** that regulates gene expression but does **not synthesize RNA directly**. - **RNA synthesis** is performed by **RNA polymerase enzymes**, while p53 modulates their activity at specific gene promoters. *It retains the telomerase enzyme in the nucleus* - p53 **represses telomerase activity** by downregulating hTERT expression, rather than retaining the enzyme. - Loss of p53 function in **cancer cells** allows telomerase reactivation, contributing to unlimited replicative potential.

Question 1

The following picture shows a lymph node biopsy of a 30-year-old male with cervical lymphadenopathy. The diagnosis is

Accepted Answer

Hodgkin disease

Answer

Chronic lymphocytic leukemia (CLL)

Answer

Human papillomavirus (HPV)

Answer

Acute myeloid leukemia (AML)

Question 2

What type of cell is shown in the image below?

Accepted Answer

Reed Sternberg cell

Answer

Mott cells

Answer

Faggot cell

Answer

Sézary-Lutzner cells

Question 3

A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?

Accepted Answer

Psammoma bodies with whorling of tumor cells

Answer

Flexner - Wintersteiner rosettes

Answer

Homer - Wright rosettes

Answer

Fried egg appearance

Question 4

A 5-year-old child presented with a history of edema of the face which later progressed to generalized edema. Urine showed massive proteinuria and light microscopy was normal. Electron microscopy showed effacement of podocyte foot processes. What is the diagnosis?

Accepted Answer

Minimal change disease

Answer

Post streptococcal glomerulonephritis

Answer

Focal segmental glomerulo sclerosis

Answer

Membranous glomerulonephritis

Question 5

Which of the following is true about p53?

Accepted Answer

It inhibits telomerase activity

Answer

It retains the telomerase enzyme in the nucleus

Answer

It increases telomere length in the liver.

Answer

It synthesizes RNA

FMGE 2023 — Pathology