General Pathology Practice Questions

Q: A 22-year-old woman with an uncomplicated pregnancy develops sudden dyspnea with cyanosis and hypotension intrapartum during routine vaginal delivery of a term infant. She has a generalized seizure and becomes comatose. Her condition does not improve over the next 2 days. Which of the following findings is most likely to be present in her peripheral pulmonary arteries?

Amniotic fluid. ### Explanation The clinical presentation described—**sudden onset dyspnea, cyanosis, hypotension, seizures, and coma** during labor—is the classic triad of **Amniotic Fluid Embolism (AFE)**. #### Why Amniotic Fluid is Correct AFE occurs when amniotic fluid (containing fetal debris like squamous cells, lanugo hair, and mucin) enters the maternal circulation through a breach in the placental membranes or uterine veins. This triggers a catastrophic biphasic response: 1. **Phase 1:** Pulmonary vasospasm leading to acute right heart failure and respiratory distress. 2. **Phase 2:** Left heart failure and a massive inflammatory response resembling systemic inflammatory response syndrome (SIRS), often leading to **Disseminated Intravascular Coagulation (DIC)**. Histologically, the presence of **fetal squamous cells** or mucin within the maternal peripheral pulmonary arteries confirms the diagnosis. #### Why Other Options are Incorrect * **A. Aggregates of platelets:** Suggests a thromboembolism. While DIC occurs in AFE, the primary inciting event is the entry of amniotic fluid, not a simple blood clot. * **C. Fat globules:** Characteristic of **Fat Embolism Syndrome**, typically seen after long-bone fractures or orthopedic surgery, not routine vaginal delivery. * **D. Gas bubbles:** Indicates **Air Embolism**, which can occur during procedures like manual removal of the placenta or deep-sea diving (decompression sickness), but is less likely than AFE in this specific clinical context. #### NEET-PG High-Yield Pearls * **Risk Factors:** Advanced maternal age, multiparity, hypertonic uterine contractions, and instrumental delivery. * **Classic Triad:** Hypoxia, Hypotension, and Coagulopathy (DIC). * **Diagnosis:** Primarily clinical; definitive diagnosis is often made post-mortem by finding fetal elements in the pulmonary vasculature. * **Management:** Supportive (A-B-C: Airway, Breathing, Circulation). There is no specific antidote.

Question 1

Cloudy swelling occurs in which of the following organs, EXCEPT?

Accepted Answer

Lungs

Answer

Kidney

Answer

Liver

Answer

Adrenals

Question 2

Amyloidosis of the kidney may be seen in which of the following conditions, except?

Accepted Answer

Enteric fever

Answer

Ulcerative colitis

Answer

Suppurative lung disease

Answer

Hansen's disease

Question 3

Which apoptotic gene is also associated with autophagy?

Accepted Answer

BCL-2

Answer

p53

Answer

BAX

Answer

BID

Question 4

A 40-year-old man is pulled from the ocean after a boating accident and resuscitated. Six hours later, the patient develops acute renal failure. Kidney biopsy reveals evidence of karyorrhexis and karyolysis in renal tubular epithelial cells. Which of the following biochemical events preceded these pathologic changes?

Accepted Answer

Decrease in intracellular pH

Answer

Activation of Na+/K+ ATPase

Answer

Decrease in intracellular calcium

Answer

Increase in ATP production

Question 5

Metastatic calcification does not occur in which of the following locations?

Accepted Answer

Fundal glands of intestine

Answer

Renal tubules

Answer

Lungs alveoli

Answer

Blood vessels

Question 6

All of the following are hypercoagulable conditions EXCEPT?

Accepted Answer

Antiphospholipid antibody syndrome (associated with lupus anticoagulant)

Answer

Antithrombin III deficiency

Answer

Protein C deficiency

Answer

Protein S deficiency

Question 7

A 22-year-old woman with an uncomplicated pregnancy develops sudden dyspnea with cyanosis and hypotension intrapartum during routine vaginal delivery of a term infant. She has a generalized seizure and becomes comatose. Her condition does not improve over the next 2 days. Which of the following findings is most likely to be present in her peripheral pulmonary arteries?

Accepted Answer

Amniotic fluid

Answer

Aggregates of platelets

Answer

Fat globules

Answer

Gas bubbles

Question 8

Which of the following statements is NOT true regarding cystic fibrosis?

Accepted Answer

Normal CFTR is an ion channel specific for calcium.

Answer

The defective gene encodes for the membrane protein called cystic fibrosis transmembrane conductance regulator.

Answer

It is an autosomal recessive disorder.

Answer

Altered pH of the surface secretions decreases bactericidal activity.

Question 9

A patient presented with chest pain to the emergency room and dies within 12 hours of arrival. Autopsy performed 5 days later shows necrosis in the myocardium. What is the type of necrosis?

Accepted Answer

Coagulative

Answer

Fibrinoid

Answer

Caseous

Answer

Liquefactive

Question 10

Basal cell carcinoma commonly spreads by which route?

Accepted Answer

Direct spread

Answer

Lymphatics

Answer

Haematogenous

Answer

All the above

General Pathology — MCQs

General Pathology — MCQs

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