NEET-PG 2024 - Pathology Practice Questions

Q: The skin biopsy shown below is most consistent with which of the following conditions? ![img-28.jpeg](img-28.jpeg)

Lichen planus. ***Lichen planus*** - The image shows **basal cell degeneration** (liquefaction degeneration), a **sawtooth rete ridge pattern**, and a band-like inflammatory infiltrate primarily composed of lymphocytes at the dermo-epidermal junction, which are classic histological features of **lichen planus**. - **Civatte bodies** (apoptotic keratinocytes forming colloid bodies) are typically present, resulting from keratinocyte damage at the basal layer. - These features make lichen planus the most consistent diagnosis. *Lichen nitidus* - Characterized by **"ball and claw" lesions**, which are small, localized epidermal invaginations enclosing a central infiltrate of lymphocytes and histiocytes. - The granulomatous infiltrate is more focal and circumscribed compared to the band-like pattern of lichen planus. - While both are interface dermatitides, the architectural pattern differs significantly. *Morphea* - This is a localized form of **scleroderma**, characterized by increased **collagen deposition**, thickening of the dermis, and loss of adnexal structures like hair follicles and sweat glands. - The inflammatory infiltrate is typically perivascular and interstitial, not band-like at the dermo-epidermal junction. - The image does not show features of dermal fibrosis or homogenization of collagen bundles expected in morphea. *Lupus erythematosus* - Also shows **interface dermatitis** with basal vacuolar changes and lymphocytic infiltrate. - However, lupus typically shows a **perivascular and periappendageal pattern** of infiltrate rather than the dense band-like pattern of lichen planus. - Additional features in lupus include dermal mucin deposition, thickened basement membrane (PAS-positive), and follicular plugging. - The dense, continuous band-like infiltrate and sawtooth rete ridges favor lichen planus over lupus.

Q: Identify the image and the disease it is associated with: ![img-30.jpeg](img-30.jpeg)

Gaucher's disease. ***Gaucher's disease*** - The image shows **Gaucher cells** - characteristic lipid-laden macrophages with a distinctive **"crumpled tissue paper" or "wrinkled silk" cytoplasmic appearance** and eccentric nuclei [1] - These cells are pathognomonic for **Gaucher's disease**, an **autosomal recessive lysosomal storage disorder** caused by **glucocerebrosidase deficiency** [1] - Accumulation of **glucocerebroside** in macrophages creates the characteristic morphology seen in bone marrow, spleen, and liver [1] - Caused by mutations in the *GBA* gene on chromosome 1 [1] *Tay-Sachs disease* - Autosomal recessive disorder caused by **hexosaminidase A deficiency** leading to **GM2 ganglioside accumulation** [2] - Characteristic findings include **cherry-red spot on macula** and neuronal ballooning, not the macrophage changes seen in this image [2] - Does not produce Gaucher cells *Sandhoff's disease* - Caused by deficiency of both **hexosaminidase A and B** due to *HEXB* gene mutations - Similar to Tay-Sachs with GM2 ganglioside accumulation affecting neurons - Does not produce the characteristic macrophage morphology shown in the image *Fabry's disease* - **X-linked recessive** disorder caused by **alpha-galactosidase A deficiency** - Accumulation of **globotriaosylceramide** in vascular endothelial cells - Histology may show lipid deposits in vessels and kidney, not the distinctive Gaucher cells seen here **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 162-163. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, p. 161.

Q: A male patient is not responding to oxygen therapy and has been diagnosed with ARDS (Acute Respiratory Distress Syndrome). What is the role of IL-8 in ARDS?

Recruitment of neutrophils. Recruitment of neutrophils - **Interleukin-8 (IL-8)**, also known as **CXCL8**, is a powerful **chemotactic cytokine** that primarily attracts and activates neutrophils [3]. - In **ARDS**, this recruitment leads to an influx of neutrophils into the pulmonary interstitium and alveolar spaces, contributing to inflammation and lung injury [1]. *Endothelial cell activation* - While other **cytokines** and inflammatory mediators can activate **endothelial cells** in ARDS [2], IL-8's primary role is not direct endothelial activation but rather **neutrophil chemotaxis** [3]. - **Endothelial cell activation** leads to increased vascular permeability and leukocyte adherence, which is often a consequence of overall inflammation, not solely IL-8 [4]. *Macrophage activation* - **Macrophages** are activated by various stimuli and other **cytokines**, such as **TNF-alpha** and **IFN-gamma**, as part of the inflammatory response. - While macrophages produce IL-8, its main function is not to activate macrophages themselves but to attract **neutrophils**. *Promote surfactant production* - **Surfactant production** is primarily regulated by **Type II pneumocytes** and is often impaired in ARDS due to damage to these cells [1]. - IL-8 is a **pro-inflammatory cytokine** and plays no direct role in promoting surfactant synthesis; in fact, its inflammatory effects can indirectly worsen surfactant dysfunction. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 681. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 679. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Migration in the tissues toward a chemotactic stimulus, pp. 86-87.

Q: A patient presents with respiratory distress and is diagnosed with panacinar emphysema. Which of the following is deficient?

Alpha-1 antitrypsin. **Alpha-1 antitrypsin** * **Alpha-1 antitrypsin (A1AT) deficiency** is a genetic disorder that leads to the development of panacinar emphysema, especially in non-smokers or at a young age [1], [2]. * A1AT protects the lung tissue from destruction by **elastase** released by neutrophils; without it, this enzyme breaks down alveolar walls [1], [2]. *Surfactant* * **Surfactant** is responsible for reducing surface tension in the alveoli, preventing their collapse in the lungs. * A deficiency primarily causes **neonatal respiratory distress syndrome** or adult respiratory distress syndrome, not predominantly emphysema. *Albumin* * **Albumin** is a primary protein in plasma that maintains oncotic pressure and transports various substances in the blood. * A deficiency in albumin (e.g., in liver disease or malnutrition) typically leads to **edema** and impaired drug transport, not emphysema. *Type II pneumocytes* * **Type II pneumocytes** are responsible for producing and secreting surfactant, as well as acting as progenitor cells for Type I pneumocytes. * While abnormalities in these cells can lead to surfactant deficiency, the direct cause of genetic panacinar emphysema is the lack of protection against elastase, not a primary defect in pneumocyte number or function in this context.

Q: A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis?

Clear Cell Carcinoma. ***Clear Cell Carcinoma*** - **Clear cell carcinoma** is the most common type of renal cell carcinoma, classically presenting with a triad of **hematuria**, **flank pain**, and a **palpable mass**. - Histologically, it is characterized by cells with **clear cytoplasm** due to lipid and glycogen accumulation, forming nests or cords, often with a rich **vascular network** [1]. *Chromophobe Renal Cell Carcinoma (RCC)* - This subtype typically presents with **eosinophilic cytoplasm** and prominent cell membranes, often with perinuclear halos, which is distinct from the clear cytoplasm seen in the image [1]. - It generally has a **better prognosis** and differs genetically from clear cell carcinoma [1]. *Bellini Duct Carcinoma* - Also known as **collecting duct carcinoma**, this is a rare and aggressive subtype originating from the medullary collecting ducts. - It usually presents with a **poorly differentiated infiltrative growth pattern** and high-grade nuclear features, which are not typical of the image provided. *Papillary Cell Carcinoma* - Histologically, **papillary renal cell carcinoma** is characterized by cells arranged in a papillary or tubulopapillary architecture with fibrovascular cores [1]. - The cells typically have basophilic cytoplasm and are not noted for the prominent clear cell appearance seen in the image. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961.

Q: An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

Multiple myeloma with increased IgG. ***Multiple myeloma with increased IgG*** - The immunofixation image shows a distinct, *monoclonal band (M spike)* in the **IgG lane (G)**, corresponding to the initial electrophoresis (ELP) M spike [1]. There is also a corresponding band in the **kappa light chain (K)** lane [1]. - The presence of a dominant band in IgG, along with a matching light chain (either kappa or lambda), indicates an **IgG monoclonal gammopathy**, which is characteristic of the most common type of multiple myeloma [1]. *Multiple myeloma with increased IgM* - This option would correspond to a strong, monoclonal band in the **IgM lane (M)**, which is not the case here. The 'M' lane in the image shows a faint/normal band, not an increased M spike. - Increased IgM monoclonal protein (M spike) is characteristic of **Waldenström macroglobulinemia**, not typically multiple myeloma [2]. *Multiple myeloma with increased IgA* - If the patient had IgA multiple myeloma, there would be a prominent monoclonal band in the **IgA lane (A)**, which is not observed in this immunofixation result. The 'A' lane shows a considerably smaller band compared to IgG. - IgA multiple myeloma is a less common subtype than IgG myeloma and would present with an IgA M spike [1]. *Waldenström macroglobulinemia* - Waldenström macroglobulinemia is characterized by a monoclonal gammopathy of the **IgM type**, which would present as a distinct M spike in the IgM lane [2]. - The immunofixation clearly shows an **IgG M spike**, ruling out Waldenström macroglobulinemia based on the type of monoclonal gammopathy [2]. **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. 608-609. [2] 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. 606-607.

Q: Which of the following is an intracellular marker or deposition found in Alzheimer's disease?

Tau protein. ***Tau protein*** - **Tau protein** forms **neurofibrillary tangles** within the neurons, which is a hallmark intracellular lesion in Alzheimer's disease [1]. - These tangles disrupt neuronal transport systems, leading to **synaptic dysfunction** and cell death [1]. *A ̢ 40 / 42 (Amyloid-beta 40/42)* - **Amyloid-beta** peptides aggregate to form **extracellular amyloid plaques**, not intracellular deposits, in Alzheimer's disease [2]. - While central to the pathology, these **plaques** are found outside of the neurons in the brain parenchyma [2]. *Alpha-synuclein* - **Alpha-synuclein** is the primary component of **Lewy bodies**, which are intracellular inclusions characteristic of Parkinson's disease and Lewy body dementia. - It is not a primary marker for Alzheimer's disease pathology. *TDP-43* - **TDP-43 (TAR DNA-binding protein 43)** inclusions are characteristic of **frontotemporal lobar degeneration (FTLD)** and amyotrophic lateral sclerosis (ALS). - While sometimes co-occurs with Alzheimer's, it is not a primary or defining intracellular marker for Alzheimer's disease itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1294. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1290-1292.

Question 1

A 30-year-old football player presented to the emergency department with sudden cardiac arrest/collapse. Based on the histological image provided, what is the most likely cause of his death?

Accepted Answer

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Answer

Dilated Cardiomyopathy (DCM)

Answer

Restrictive Cardiomyopathy (RCM)

Answer

Arrhythmogenic cardiomyopathy

Question 2

The skin biopsy shown below is most consistent with which of the following conditions?
![img-28.jpeg](img-28.jpeg)

Accepted Answer

Lichen planus

Answer

Lichen nitidus

Answer

Morphea

Answer

Lupus erythematosus

Question 3

A 23-year-old female with a height of 4 feet has a karyotype as shown in the image below. Which among the following indicates the correct etiology?

Accepted Answer

Turner syndrome

Answer

Klinefelter's syndrome

Answer

Down syndrome

Answer

Edward's syndrome

Question 4

Identify the image and the disease it is associated with:
![img-30.jpeg](img-30.jpeg)

Accepted Answer

Gaucher's disease

Answer

Tay-Sachs disease

Answer

Sandhoff's disease

Answer

Fabry's disease

Question 5

A male patient is not responding to oxygen therapy and has been diagnosed with ARDS (Acute Respiratory Distress Syndrome). What is the role of IL-8 in ARDS?

Accepted Answer

Recruitment of neutrophils

Answer

Endothelial cell activation

Answer

Macrophage activation

Answer

Promote surfactant production

Question 6

A patient presents with respiratory distress and is diagnosed with panacinar emphysema. Which of the following is deficient?

Accepted Answer

Alpha-1 antitrypsin

Answer

Surfactant

Answer

Albumin

Answer

Type II pneumocytes

Question 7

A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis?

Accepted Answer

Clear Cell Carcinoma

Answer

Chromophobe Renal Cell Carcinoma (RCC)

Answer

Bellini Duct Carcinoma

Answer

Papillary Cell Carcinoma

Question 8

Identify the diagnosis from the given image

Accepted Answer

Malakoplakia

Answer

TB

Answer

BCC

Answer

Drug induced lesion

Question 9

An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

Accepted Answer

Multiple myeloma with increased IgG

Answer

Multiple myeloma with increased IgM

Answer

Multiple myeloma with increased IgA

Answer

Waldenström macroglobulinemia

Question 10

Which of the following is an intracellular marker or deposition found in Alzheimer's disease?

Accepted Answer

Tau protein

Answer

A β 40 / 42 (Amyloid-beta 40/42)

Answer

Alpha-synuclein

Answer

TDP-43

NEET-PG 2024 — Pathology