NEET-PG 2017 Practice Questions

Q: All are true about Helicobacter pylori on special stain preparation of stomach except:

S shaped non-flagellated bacteria. ***S shaped non-flagellated bacteria*** - *H. pylori* are generally **spiral-shaped** or **curved rods**, not typically S-shaped, and are characterized by their **polar flagella** which are essential for their motility in the viscous gastric mucus. - The presence of flagella is a key feature distinguishing *H. pylori* and enabling its survival in the stomach environment. *Steiner stain preparation* - The **Steiner silver stain** is commonly used to visualize *H. pylori* in gastric biopsies, demonstrating them as dark, helical organisms. - While effective, other stains like Giemsa or Warthin-Starry are also used, but Steiner stain is a valid method for detection. *Dormant stage is coccoid form* - Under stressful conditions, such as antibiotic exposure or prolonged culture, *H. pylori* can transform into a **coccoid form**. - This coccoid form is considered a **viable but non-culturable** dormant stage, potentially contributing to persistence and recurrence of infection. *Attaches but does not invade the cells* - *H. pylori* colonizes the **mucus layer** and attaches to the apical surface of gastric epithelial cells but generally **does not invade** the cells. - Its effects are mediated by toxins and enzymes released into the extracellular space, leading to inflammation and cellular damage without direct intracellular invasion.

Q: Identify the cell.

Monocyte. ***Monocyte*** - Monocytes are characterized by their **large size** (12-20 µm), **kidney-shaped or horseshoe-shaped nucleus**, and **abundant, often grayish-blue cytoplasm** with fine azurophilic granules [1]. - They are precursors to **macrophages** and play a crucial role in phagocytosis and antigen presentation [1]. *Eosinophil* - Eosinophils have a **bilobed nucleus** and prominent **red-orange granules** in their cytoplasm, which stain with eosin [1]. - They are primarily involved in allergic reactions and defense against **parasitic infections** [1]. *Basophil* - Basophils are characterized by a **lobed nucleus** often obscured by large, coarse, **dark purple-blue granules** that contain histamine and heparin [1]. - They are the least common granulocyte and are involved in **allergic and inflammatory responses** [1]. *Lymphocyte* - Lymphocytes are typically **smaller** than monocytes, with a **large, round, or slightly indented nucleus** that occupies most of the cell [1]. - Their cytoplasm is usually **scanty and pale blue**, often appearing as a thin rim around the nucleus [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-580.

Q: Identify the cell.

Basophil. ***Basophil*** - The cell has **large, coarse, and dense basophilic (dark purple-blue) granules** in its cytoplasm, which often obscure the multi-lobed nucleus. - This characteristic appearance, with the **prominent dark granules that obscure the nucleus**, is distinctive of a **basophil** on a peripheral blood smear. - Basophils contain histamine and heparin, and their granules stain intensely with basic dyes. *Eosinophil* - Would have **bright red-orange granules** that are uniform in size and do NOT obscure the nucleus. - The nucleus is typically bilobed and clearly visible. *Neutrophil* - Would have a **multilobed nucleus** (2-5 lobes) that is clearly visible. - Contains fine, light pink or neutral-staining granules in the cytoplasm. - Most common white blood cell (50-70% of WBCs). *Monocyte* - Largest white blood cell with abundant **grayish-blue cytoplasm**. - Has a **kidney-shaped or horseshoe-shaped nucleus** that is clearly visible. - Lacks prominent granules. *Lymphocyte* - Small cell with a **large, round, dark-staining nucleus** that occupies most of the cell. - Scant cytoplasm, typically appearing as a thin rim around the nucleus. - No cytoplasmic granules.

Q: Name the test given.

ESR measurement. ***ESR measurement*** - The image displays a **Westergren tube** with a column of blood, showing distinct layers of plasma on top and red blood cells settled below against a calibrated scale. - This setup is characteristic of an **Erythrocyte Sedimentation Rate (ESR)** test, which measures the rate at which red blood cells fall in a standardized tube over a specific time, indicating inflammation. *Osmotic fragility* - This test involves exposing red blood cells to varying concentrations of **hypotonic saline solutions** to assess their resistance to lysis. - The results are typically reported as a curve showing the percentage of hemolysis at different saline concentrations, not a simple sedimentation in a tube. *NESTROFT* - The **Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT)** is a quick screening test for **beta-thalassemia trait**. - It involves mixing blood with a hypotonic saline solution and observing for complete hemolysis or partial hemolysis with a button of red cells, which is different from the image shown. *Sickling test* - A sickling test is used to detect the presence of **sickle hemoglobin**, which causes red blood cells to deform into a sickle shape under low oxygen conditions. - This test is usually performed by adding a reducing agent like **sodium metabisulfite** to a blood sample and observing cell morphology under a microscope or by turbidity, not by sedimentation in a calibrated tube. *Packed cell volume (PCV)* - PCV or **hematocrit** measures the proportion of blood volume occupied by red blood cells after centrifugation in a **microhematocrit tube**. - While it does involve blood in a tube, the tube is much smaller (capillary tube) and requires **centrifugation** to separate components, unlike ESR which relies on natural sedimentation under gravity in a larger calibrated Westergren tube.

Q: Name the anticoagulant used in the following method.

Trisodium citrate. ***Trisodium citrate*** - The image displays a method for measuring **Erythrocyte Sedimentation Rate (ESR)**, typically performed using the **Westergren method**. - In the Westergren method, **trisodium citrate** is the standard anticoagulant used to prevent blood coagulation, allowing red blood cells to settle over time. *EDTA* - **EDTA (ethylenediaminetetraacetic acid)** is a common anticoagulant, primarily used for **hematology tests** such as complete blood counts (CBC), as it preserves cell morphology. - While it prevents clotting, it is not the standard anticoagulant for the Westergren ESR method, as it can cause red blood cell shrinkage affecting sedimentation. *Heparin* - **Heparin** acts as an anticoagulant by enhancing the activity of **antithrombin III**, and is commonly used for chemistry and general coagulation studies. - It interferes with the sedimentation rate in ESR measurements, making it unsuitable for this specific test. *Dalteparin* - **Dalteparin** is a type of **low molecular weight heparin (LMWH)** used therapeutically as an anticoagulant to prevent and treat blood clots. - It is not used as an in-vitro anticoagulant for blood collection tubes or lab diagnostic tests like ESR. *Sodium fluoride* - **Sodium fluoride** is an anticoagulant and enzymatic inhibitor primarily used for **glucose measurement**, as it inhibits glycolysis and preserves glucose levels. - It is not appropriate for ESR testing, as it does not provide the optimal conditions for red blood cell sedimentation measurement.

Q: A 32-year-old male with a history of klebsiella infection presents with right upper quadrant pain and on performing cholecystectomy the following stones were seen. All the following statements are true regarding this condition except: (Recent NEET Pattern 2016-17)

It is composed of calcium palmitate. ***It is composed of calcium palmitate*** - The gallstones formed in the context of **Klebsiella infection** and **beta-glucuronidase** activity are typically **pigment stones**, specifically **brown pigment stones** [1]. - Brown pigment stones are primarily composed of **calcium bilirubinate** and not calcium palmitate . *This condition is a resultant of secretion of beta glucuronidase* - **Bacterial infection**, particularly with *Klebsiella*, can lead to the production of **beta-glucuronidase** [1]. - This enzyme deconjugates **bilirubin glucuronide** in bile, making it insoluble and promoting the formation of **calcium bilirubinate stones** [1]. *Initiating factor could be ascaris worm* - **Parasitic infections**, such as those by **Ascaris lumbricoides**, can act as a nidus for stone formation in the biliary tree. - The presence of the worm or its eggs can lead to **biliary stasis** and recurrent infections, contributing to pigment stone formation. *This is radiolucent in nature* - **Pigment gallstones**, including brown pigment stones, are generally **radiolucent** on plain X-rays. - This is because they contain little to no calcium carbonate, which is required for radiopacity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 882-883. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 882.

Q: Identify the types of gastric ulcers labeled A and B in the image below.

A=Benign gastric ulcer, B=Malignant gastric ulcer. ***A=Benign gastric ulcer, B=Malignant gastric ulcer*** - Image A shows a **punched-out**, **clean-based ulcer** with radiating folds, characteristic features of a **benign gastric ulcer**. - Image B depicts an **irregular**, **raised-edge ulcer** with a necrotic base, which is typical of a **malignant gastric ulcer** [1]. *A=Malignant gastric ulcer, B=Benign gastric ulcer* - Image A's features (smooth, punched-out) are inconsistent with a **malignant ulcer**, which is typically irregular and raised [1]. - Image B's features (irregular, raised, necrotic) are not consistent with a **benign ulcer**, which is usually clean and well-demarcated. *A=Leiomyoma, B=Malignant gastric ulcer* - A **leiomyoma** is a submucosal tumor, usually presenting as a smooth, firm mass, not an ulcerated lesion like in Image A. - Image B is consistent with a **malignant gastric ulcer** [1], but Image A is not a leiomyoma. *A=Chronic hyperplastic gastritis, B=Malignant gastric ulcer* - **Chronic hyperplastic gastritis** involves thickened gastric folds and inflammation, not a discrete ulceration as seen in Image A. - While Image B is consistent with a **malignant gastric ulcer** [1], Image A does not represent chronic hyperplastic gastritis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Q: A 20-year-old college student presents with 7 day history of nausea and feeling feverish. He has tenderness in right upper quadrant and admits to high risk sexual behavior. The liver biopsy marking $X$ shows:

Councilman body. ***Councilman body*** - The clinical presentation (nausea, fever, RUQ tenderness, high-risk sexual behavior) is highly suggestive of **acute viral hepatitis**, likely **Hepatitis B** given the risk factors. - **Councilman bodies** (also known as **apoptotic bodies**) are characteristic findings in acute viral hepatitis, representing **apoptotic hepatocytes** [1]. *Mallory hyaline body* - **Mallory bodies** (or **Mallory-Denk bodies**) are typically seen in **alcoholic hepatitis** and other forms of **chronic liver injury**, not acute viral hepatitis [2]. - They are composed of **intermediate filaments** (cytokeratins) and other proteins, indicating hepatocyte damage. *Russell body* - **Russell bodies** are **eosinophilic inclusions** found within the cytoplasm of **plasma cells**, representing **accumulations of immunoglobulins**. - They are associated with conditions involving plasma cell proliferation, such as **multiple myeloma**, and are not a feature of acute viral hepatitis. *Normal kupffer cell* - **Kupffer cells** are **resident macrophages** of the liver and are normally present in the sinusoids. - While they play a role in inflammation, their presence alone as "normal" does not represent the specific pathological change expected in acute viral hepatitis, which is hepatocyte apoptosis [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 386-387. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 389-390.

Q: The resected specimen of a kidney is seen below. What is the diagnosis?

Flea bitten kidney of malignant hypertension. ***Flea bitten kidney of malignant hypertension*** - The term "flea-bitten kidney" describes the gross appearance of the kidney in **malignant hypertension**, characterized by numerous pinpoint hemorrhages on the cortical surface [1]. - These hemorrhages result from the rupture of **arterioles and capillaries** due to severe, uncontrolled high blood pressure [1]. *Amyloidosis* - In **amyloidosis**, the kidneys typically appear enlarged, pale, and waxy due to the deposition of **amyloid protein**. - It does not typically present with the characteristic pinpoint hemorrhages seen in a "flea-bitten" appearance. *Acute poststreptococcal glomerulonephritis* - In **acute poststreptococcal glomerulonephritis (APSGN)**, the kidneys are usually enlarged and pale, often with a smooth surface. - While there can be some congestion, the classic "flea-bitten" appearance with widespread petechial hemorrhages is not a typical gross finding. *Chronic glomerulonephritis* - **Chronic glomerulonephritis** typically leads to shrunken, granular, and scarred kidneys due to long-standing inflammation and fibrosis. - The gross appearance is usually one of atrophy and scarring, not the acute hemorrhagic spots described as "flea-bitten." **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945.

Q: Identify the lesion shown in kidney biopsy of 6-year-old child with recurrent U.T.I and vesico-ureteric reflux.

Focal segmental glomerulosclerosis. ***Focal segmental glomerulosclerosis*** - **Focal segmental glomerulosclerosis (FSGS)** can be a secondary complication of conditions causing **glomerular hyperfiltration** and injury, such as long-standing **vesicoureteral reflux (VUR)** and recurrent **urinary tract infections (UTIs)** leading to **reflux nephropathy**. - The chronic inflammation and scarring from recurrent UTIs and VUR can lead to localized areas of **sclerosis** in the glomeruli [1]. *Diffuse glomerulosclerosis* - **Diffuse glomerulosclerosis** implies widespread scarring of most glomeruli, which is less specific for the given clinical scenario. - It is more commonly associated with advanced **diabetic nephropathy** or other widespread chronic kidney diseases. *Kimmelstiel Wilson change* - **Kimmelstiel-Wilson lesions** are specific nodular glomerulosclerosis changes seen in **diabetic nephropathy**. - This finding is highly characteristic of **diabetes mellitus** and would not be expected in a 6-year-old child with recurrent UTIs and VUR. *Wire loop lesions* - **Wire loop lesions** are characteristic of **diffuse proliferative glomerulonephritis**, particularly seen in **lupus nephritis (Class III or IV)**. - These lesions represent **subendothelial immune complex deposits** and are not typically associated with recurrent UTIs and VUR in children. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 913-914.

Question 1

All are true about Helicobacter pylori on special stain preparation of stomach except:

Accepted Answer

S shaped non-flagellated bacteria

Answer

Steiner stain preparation

Answer

Dormant stage is coccoid form

Answer

Attaches but does not invade the cells

Question 2

Identify the cell.

Accepted Answer

Monocyte

Answer

Eosinophil

Answer

Basophil

Answer

Lymphocyte

Answer

Neutrophil

Question 3

Identify the cell.

Accepted Answer

Basophil

Answer

Eosinophil

Answer

Neutrophil

Answer

Monocyte

Answer

Lymphocyte

Question 4

Name the test given.

Accepted Answer

ESR measurement

Answer

Osmotic fragility

Answer

NESTROFT

Answer

Sickling test

Answer

Packed cell volume (PCV)

Question 5

Name the anticoagulant used in the following method.

Accepted Answer

Trisodium citrate

Answer

EDTA

Answer

Heparin

Answer

Dalteparin

Answer

Sodium fluoride

Question 6

A 32-year-old male with a history of klebsiella infection presents with right upper quadrant pain and on performing cholecystectomy the following stones were seen. All the following statements are true regarding this condition except: (Recent NEET Pattern 2016-17)

Accepted Answer

It is composed of calcium palmitate

Answer

This condition is a resultant of secretion of beta glucuronidase

Answer

Initiating factor could be ascaris worm

Answer

This is radiolucent in nature

Question 7

Identify the types of gastric ulcers labeled A and B in the image below.

Accepted Answer

A=Benign gastric ulcer, B=Malignant gastric ulcer

Answer

A=Malignant gastric ulcer, B=Benign gastric ulcer

Answer

A=Leiomyoma, B=Malignant gastric ulcer

Answer

A=Chronic hyperplastic gastritis, B=Malignant gastric ulcer

Question 8

A 20-year-old college student presents with 7 day history of nausea and feeling feverish. He has tenderness in right upper quadrant and admits to high risk sexual behavior. The liver biopsy marking $X$ shows:

Accepted Answer

Councilman body

Answer

Mallory hyaline body

Answer

Russell body

Answer

Normal kupffer cell

Question 9

The resected specimen of a kidney is seen below. What is the diagnosis?

Accepted Answer

Flea bitten kidney of malignant hypertension

Answer

Amyloidosis

Answer

Acute poststreptococcal glomerulonephritis

Answer

Chronic glomerulonephritis

Answer

Acute tubular necrosis

Question 10

Identify the lesion shown in kidney biopsy of 6-year-old child with recurrent U.T.I and vesico-ureteric reflux.

Accepted Answer

Focal segmental glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Kimmelstiel Wilson change

Answer

Wire loop lesions

Answer

Membranous glomerulonephritis

NEET-PG 2017

Microbiology

Pathology