NEET-PG 2020 - Pathology PYQs Practice Questions

Q: What is the main feature of chemotaxis as observed in white blood cells?

Unidirectional locomotion of neutrophils. ***Unidirectional locomotion of neutrophils*** - **Chemotaxis** refers to the **directional movement** of cells, such as neutrophils, towards a chemical attractant. - This process is crucial for recruiting immune cells to sites of infection or inflammation. *Increased random movement of neutrophils* - While neutrophils do exhibit random movement, **chemotaxis** specifically describes **directed movement** along a chemical gradient, not merely an increase in random motion. - **Random movement** without a specific direction does not effectively guide immune cells to a specific target. *Increased adhesiveness to intima* - **Adhesion to the intima** (endothelial cells) is an initial step in the process of leukocyte extravasation, allowing cells to roll and stick to vessel walls. - However, it is primarily mediated by adhesion molecules and is distinct from the **directional migration** defined by chemotaxis. *Increased phagocytosis* - **Phagocytosis** is the process by which cells engulf pathogens or cellular debris. - While essential for immune function, it is a separate function that occurs **after** the cell has migrated to its target via chemotaxis. [Practice more Pathology PYQs on OnCourse]

Q: A 40-year-old person presented with a swelling in the retroperitoneal area. A biopsy from the lesion is as shown below. Molecular analysis demonstrated t(12;16). What is the most probable diagnosis?

Myxoid liposarcoma. ***Myxoid liposarcoma*** - The presence of **t(12;16)** translocation is characteristic of myxoid liposarcoma, which is crucial for diagnosis [1]. - Typically presents as a **soft tissue mass**, often in the retroperitoneum, consistent with the patient's swelling [1]. *Pleomorphic sarcoma* - Does not specifically associate with **t(12;16)** translocation; it is more commonly associated with various genetic alterations [1]. - Typically presents as a **heterogeneous** and highly aggressive neoplasm, lacking the specific features noted in this case. *Synovial sarcoma* - More commonly associated with a **t(X;18)** translocation, not t(12;16), which rules it out in this context. - Usually presents around the **joints** and has a different histological pattern compared to liposarcoma. *Lipoma* - A benign tumor that typically does not involve significant genetic mutations like **t(12;16)** [1]. - Presents as a **soft, mobile mass** and does not generally occur in a retroperitoneal setting with this size [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1222-1223. [Practice more Pathology PYQs on OnCourse]

Q: A 33-year-old man presents with a 5-week history of calf pain, swelling, and low-grade fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous eosinophils and he also has peripheral blood eosinophilia. Which of the following interleukins is primarily responsible for the increase in eosinophils in this patient?

IL-5. ***IL-5*** - **Interleukin-5 (IL-5)** is the **most potent and direct cytokine** responsible for the **differentiation, maturation, activation, and survival of eosinophils**. - IL-5 is produced primarily by **Th2 cells**, mast cells, and eosinophils themselves, and acts directly on eosinophil progenitors in the bone marrow. - In this patient with eosinophilic myositis (likely parasitic infection such as trichinosis), **IL-5 is the primary mediator** of the peripheral blood eosinophilia and tissue eosinophil infiltration. - **Clinical correlation:** Anti-IL-5 therapies (mepolizumab, reslizumab) are used to treat hypereosinophilic conditions, confirming IL-5's central role. *IL-4* - **Interleukin-4 (IL-4)** is produced by Th2 cells and mast cells and promotes the **differentiation of naive T cells into Th2 cells**. - While IL-4 initiates the Th2 immune response that eventually leads to IL-5 production, it does **not directly stimulate eosinophil production or recruitment**. - IL-4 is more involved in IgE class switching and allergic inflammation rather than direct eosinophil regulation. *IL-6* - **Interleukin-6 (IL-6)** is a pleiotropic cytokine involved in the **acute phase response**, inflammation, and hematopoiesis. - While it has broad effects on immune cells, it is **not primarily responsible** for eosinophil production or recruitment. - Elevated in many inflammatory conditions but not specific for eosinophilia. *IL-2* - **Interleukin-2 (IL-2)** is primarily involved in the **proliferation and differentiation of T lymphocytes** and activation of natural killer (NK) cells. - It plays no significant direct role in eosinophil production or recruitment. - More important for T cell-mediated immunity rather than eosinophilic responses. [Practice more Pathology PYQs on OnCourse]

Q: A 30-year-old woman presents with thyroid swelling. On investigations, her TSH levels are found to be elevated. Postoperative reports showed lymphocytic infiltration and Hurthle cells. A most probable diagnosis is?

Hashimoto's thyroiditis. ***Hashimoto's thyroiditis*** - The presence of **lymphocytic infiltration** and **Hurthle cells** on postoperative pathology is characteristic of Hashimoto's thyroiditis [1,2]. - Elevated **TSH levels** indicate hypothyroidism, which aligns with the autoimmune nature of Hashimoto's affecting thyroid hormone production [1]. *Graves disease* - Typically presents with **hyperthyroidism**, leading to suppressed TSH levels rather than elevation. - Characterized by **thyroid enlargement** and the presence of **autoantibodies** like TSI, not lymphocytic infiltration. *Follicular carcinoma* - While it can cause **thyroid swelling**, it is usually associated with **malignant characteristics** rather than Hurthle cells and lymphocytic infiltration. - TSH levels can be normal, as it does not principally engage in autoimmune thyroid destruction like Hashimoto's. *Medullary carcinoma thyroid* - Originates from **C cells** producing calcitonin, and typically presents with elevated calcitonin levels, not TSH. - Characteristic findings include **C-cell hyperplasia** or **neoplastic changes**, which do not match the presented lymphocytic infiltration. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1090-1092. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 427-428. [Practice more Pathology PYQs on OnCourse]

Question 1

What is the main feature of chemotaxis as observed in white blood cells?

Accepted Answer

Unidirectional locomotion of neutrophils

Answer

Increased random movement of neutrophils

Answer

Increased adhesiveness to intima

Answer

Increased phagocytosis

Question 2

Which of the following factors play a major role in the initiation of thrombus formation?

Accepted Answer

Endothelial injury

Answer

Vasoconstriction

Answer

Coagulation cascade activation

Answer

Platelets activation

Question 3

A 40-year-old person presented with a swelling in the retroperitoneal area. A biopsy from the lesion is as shown below. Molecular analysis demonstrated t(12;16). What is the most probable diagnosis?

Accepted Answer

Myxoid liposarcoma

Answer

Benign lipoma

Answer

Synovial sarcoma

Answer

Pleomorphic sarcoma

Question 4

A 33-year-old man presents with a 5-week history of calf pain, swelling, and low-grade fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous eosinophils and he also has peripheral blood eosinophilia. Which of the following interleukins is primarily responsible for the increase in eosinophils in this patient?

Accepted Answer

IL-5

Answer

IL-4

Answer

IL-6

Answer

IL-2

Question 5

A 30-year-old woman presents with thyroid swelling. On investigations, her TSH levels are found to be elevated. Postoperative reports showed lymphocytic infiltration and Hurthle cells. A most probable diagnosis is?

Accepted Answer

Hashimoto's thyroiditis

Answer

Graves' disease

Answer

Follicular thyroid carcinoma

Answer

Medullary thyroid carcinoma

Question 6

A 20-year-old man presented with a complaint of a swelling of the wrist for the last two years. Histopathological examination showed spindle-shaped cells and Verocay bodies. What is the diagnosis?

Accepted Answer

Schwannoma

Answer

Lipoma

Answer

Dermoid cyst

Answer

Neurofibroma

Question 7

A 35-year-old woman with a long history of dyspnea, chronic cough, sputum production, and wheezing dies of respiratory failure following a bout of lobar pneumonia. She was not a smoker or an alcoholic. Which of the following underlying conditions is most likely associated with the pathologic changes shown in the lung autopsy?

Accepted Answer

Alpha-1 antitrypsin deficiency

Answer

Antibodies against type 4 collagen (associated with Goodpasture syndrome)

Answer

Cystic fibrosis (a genetic disorder affecting the lungs)

Answer

Mutation in dynein arms (associated with primary ciliary dyskinesia)

Question 8

A 30-year-old male presents with swelling around the knee joint. Histopathological examination reveals many giant cells interspersed with mononuclear cells. What is the most likely diagnosis?

Accepted Answer

Giant cell tumour

Answer

Osteosarcoma

Answer

Ewing's sarcoma

Answer

Chondrosarcoma

Question 9

A 5-year-old child presented with a history of blood in the stools. On examination, there was a polypoid mass in the rectum, a biopsy of which showed as below. The most probable diagnosis is?

Accepted Answer

Juvenile polyp

Answer

Villous adenoma

Answer

Vascular malformation

Answer

Serrated adenoma

Question 10

Identify the condition shown in the image.

Accepted Answer

Peutz-Jeghers syndrome

Answer

Villous adenoma

Answer

Hyperplastic polyp

Answer

Juvenile polyp

NEET-PG 2020 — Pathology