General Pathology — MCQs

A 25-year-old woman is concerned about a lump on the left side of her neck that has remained the same size for the past year. Physical examination shows a painless, movable, 3-cm nodule beneath the skin of the left lateral neck just above the level of the thyroid cartilage. There are no other remarkable findings. Fine-needle aspiration of the mass is performed. The pathology report notes the presence of cellular debris. Based on the clinical presentation and pathology findings, which of the following terms best describes this nodule?

Q1462

Which of the following is known as the old age pigment?

Q1463

Which of the following is an example of programmed cell death?

Q1464

Acidophilia in necrotic tissue is due to?

Q1465

Which type of amyloid is associated with long-term hemodialysis?

Q1466

Perifascicular atrophy of muscle fibers is seen in?

Q1467

What is the most common site and type of metaplasia in the human body?

Q1468

Size of fibrillary proteins in amyloidosis is:

Q1469

A young lady presented with bilateral nodular lesions on the shins and bilateral hilar lymphadenopathy on chest X-ray. The Mantoux test reveals indurations of 5 mm. What would a skin biopsy reveal?

Q1470

Irreversible cell injury is indicated by

General Pathology Indian Medical PG Practice Questions and MCQs

Question 1461: A 25-year-old woman is concerned about a lump on the left side of her neck that has remained the same size for the past year. Physical examination shows a painless, movable, 3-cm nodule beneath the skin of the left lateral neck just above the level of the thyroid cartilage. There are no other remarkable findings. Fine-needle aspiration of the mass is performed. The pathology report notes the presence of cellular debris. Based on the clinical presentation and pathology findings, which of the following terms best describes this nodule?

A. Branchial cyst (Correct Answer)
B. Metastatic thyroid carcinoma
C. Thyroglossal duct cyst
D. Mucoepidermoid tumor

Explanation: ***Branchial cyst*** - A **branchial cyst** typically presents as a **painless, movable lateral neck mass** in young adults, often just anterior to the sternocleidomastoid muscle at the junction of the upper and middle third of the neck. - The presence of **cellular debris** in the fine-needle aspiration (FNA) is consistent with the benign, fluid-filled nature of a branchial cyst, which contains watery or mucoid material with desquamated epithelial cells. - The **stable size over one year** supports a benign congenital lesion rather than malignancy. *Metastatic thyroid carcinoma* - This would typically present as a **hard, fixed mass**, possibly associated with other symptoms like **hoarseness or dysphagia**. - FNA would show **malignant follicular cells** consistent with thyroid origin, not just cellular debris. - A metastatic lesion would be unlikely to remain stable in size for a year. *Thyroglossal duct cyst* - This is the most common **midline neck mass** in children and young adults, typically located at or near the **midline** between the base of tongue and thyroid gland. - It characteristically **moves with swallowing and tongue protrusion**, unlike branchial cysts. - The **lateral location** in this case makes thyroglossal duct cyst incorrect. *Mucoepidermoid tumor* - This is a **malignant salivary gland tumor** that can occur in the parotid or submandibular regions. - It usually presents as a **firm, progressively growing mass** and would not remain stable at 3 cm for a year. - FNA would show **malignant epithelial and mucous-producing cells**, not just bland cellular debris.

Question 1462: Which of the following is known as the old age pigment?

A. Melanin
B. Lipofuscin (Correct Answer)
C. Bilirubin
D. Hemosiderin

Explanation: ***Lipofuscin*** - Known as **"old age pigment,"** lipofuscin accumulates in cells as a byproduct of lipid peroxidation, particularly in aged tissues [1]. - It is a marker of **cellular aging** and is particularly prominent in long-lived cells like neurons and cardiac myocytes [1]. *Hemosiderin* - A pigment associated with **iron storage**, hemosiderin accumulates in conditions like hemochromatosis or hemosiderosis. - It does not specifically indicate **aging** or the typical accumulation seen with lipofuscin. *Bilirubin* - Bilirubin is the product of **hemoglobin breakdown** and is primarily associated with jaundice and liver function. - It does not represent an age-related pigment and typically indicates **liver dysfunction** or hemolysis. *Melanin* - Melanin is the pigment responsible for **skin color** and protection against UV radiation but is not related to aging. - Its accumulation can occur with sun exposure but does not represent the physiological changes associated with **cellular aging** like lipofuscin. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 75-77.

Question 1463: Which of the following is an example of programmed cell death?

A. Apoptosis (Correct Answer)
B. Cytolysis
C. Necrosis
D. Autophagy

Explanation: ***Apoptosis*** - Apoptosis is a form of **programmed cell death** [1], essential for normal cellular turnover and development. - It is characterized by cellular shrinkage, chromatin condensation, and membrane blebbing, without provoking an inflammatory response [4]. *Cytolysis* - Cytolysis refers to the **destruction of cells by external agents**, such as toxins or pathogens, leading to membrane rupture. - It typically results in **inflammation** and is not a programmed or controlled process like apoptosis. *Necrosis* - Necrosis is an **uncontrolled form of cell death** resulting from acute cellular injury, leading to inflammation and damage to surrounding tissues. - Unlike apoptosis, necrosis involves rapid cell swelling and bursting of cell membranes, causing inflammation. However, some forms of necrosis can be programmed, such as necroptosis [2][3]. *Proptosis* - Proptosis refers to **eye bulging** (exophthalmos), often due to thyroid disease or certain tumors, and is not related to cell death. - It does not involve a process of cell death but rather anatomical displacement of the eyeball. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 63-64. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 71. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 69-71. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 67-69.

Question 1464: Acidophilia in necrotic tissue is due to?

A. Coagulation of proteins
B. Denaturation of enzymes
C. Mitochondrial damage
D. Denaturation of proteins (Correct Answer)

Explanation: ***Denaturation of proteins*** - **Denaturation of proteins** in necrotic tissue leads to increased binding of **acidic dyes** (eosin), resulting in an **acidophilic appearance**. - This process is a hallmark of irreversible cell injury, where the normal protein structure is altered, exposing more basic groups. *Coagulation of proteins* - While **protein coagulation** does occur in some forms of necrosis, it's the **denaturation** that specifically alters the protein's charge, increasing its affinity for acidic stains. - Coagulation refers broadly to the 'clumped' appearance of proteins, but not directly to the staining property. *Denaturation of enzymes* - **Enzyme denaturation** is a component of overall protein denaturation in necrosis and contributes to cellular dysfunction and eventual death. - However, the direct cause of acidophilia is the denaturation of **structural and enzymatic proteins** collectively, altering their staining characteristics. *Mitochondrial damage* - **Mitochondrial damage** is an early and crucial event in irreversible cell injury, leading to ATP depletion and accumulation of reactive oxygen species. - While it initiates the cascade towards necrosis, it does not directly explain the **acidophilic staining property** of the dead tissue itself.

Question 1465: Which type of amyloid is associated with long-term hemodialysis?

A. Beta 2 microglobulin (Correct Answer)
B. AA
C. AL
D. ATTR

Explanation: ***Beta 2 microglobulin*** - Accumulates in patients undergoing **long-term hemodialysis** and is primarily responsible for **dialysis-related amyloidosis** [1][4]. - It forms amyloid deposits, particularly affecting **joints and skin**, due to its impaired clearance during dialysis [1]. *ATTR* - Refers to **transthyretin amyloidosis**, which is primarily associated with familial or age-related amyloid deposits rather than hemodialysis [1]. - This type typically presents with **cardiac and neurological** symptoms, distinct from the findings in hemodialysis-associated conditions. *AL* - Stands for **light chain amyloidosis**, resulting from monoclonal immunoglobulin light chains, often seen in **multiple myeloma** [2]. - It is unrelated to hemodialysis; thus, patients do not typically develop AL amyloidosis due to kidney replacement therapy. *AA* - Associated with **acute phase reactants** like serum amyloid A, typically linked to chronic inflammatory diseases, not hemodialysis [3]. - AA amyloidosis is seen in conditions such as **rheumatoid arthritis**, making it distinct from beta 2 microglobulin's role in dialysis patients [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 266. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 266-267. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 267-268. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 136-140.

Question 1466: Perifascicular atrophy of muscle fibers is seen in?

A. Myopathy due to corticosteroids
B. Dermatomyositis (Correct Answer)
C. Inclusion body myositis
D. Nemaline myopathy

Explanation: ***Dermatomyositis*** - Characterized by **perifascicular atrophy** of muscle fibers, which is a distinct histological feature seen in dermatomyositis [1]. - Additionally associated with **skin manifestations** such as a heliotrope rash and Gottron's papules. *Inclusion body myositis* - Features **rimmed vacuoles** and **inflammatory infiltrate**, but does not show perifascicular atrophy as seen in dermatomyositis. - Typically affects older adults and has a different clinical presentation compared to dermatomyositis. *Nemaline myopathy* - Characterized by **nemaline bodies** on muscle biopsy, not perifascicular atrophy, which is specific to dermatomyositis. - Generally presents with **congenital muscle weakness**, distinctly different from the autoimmune nature of dermatomyositis. *Steroid myopathy* - Results from **chronic corticosteroid use**, leading to muscle weakness but does not feature perifascicular atrophy. - Primarily affects **proximal muscles** and is linked to medication rather than a specific myopathy like dermatomyositis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1240-1241.

Question 1467: What is the most common site and type of metaplasia in the human body?

A. Respiratory tract epithelium, Columnar metaplasia
B. Respiratory tract epithelium, Squamous metaplasia (Correct Answer)
C. Esophagus, Squamous metaplasia
D. Esophagus, Columnar metaplasia

Explanation: ***Respiratory tract epithelium, Squeamous metaplasia*** [1][2][4] - Commonly seen in the respiratory tract due to **chronic irritation**, such as from smoking, leading to a change from ciliated columnar to squamous epithelium [1][4]. - This type of metaplasia serves as a protective mechanism against irritants and is highly prevalent in smokers [1][2]. *Esophagus, Squeamous metaplasia* - While squamous metaplasia can occur here, it is not the most common site compared to the respiratory tract. - The more recognized metaplastic change in the esophagus involves **columnar metaplasia**, as seen in Barrett's esophagus [3]. *Esophagus, Columnar metaplasia* [3] - This condition refers to Barrett's esophagus, which is less common than squamous metaplasia seen in the respiratory tract [3]. - It arises due to chronic gastroesophageal reflux, which does not represent the most common site of metaplasia. *Respiratory tract epithelium, Columnar metaplasia* - Columnar metaplasia is less common in the respiratory tract and usually indicates an **abnormal response** to stimulating factors like chronic mucus secretion. - The predominant metaplastic process here is **squamous metaplasia**, not columnar [1][2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 49. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 723. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 348-349. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 91-92.

Question 1468: Size of fibrillary proteins in amyloidosis is:

A. 0-5 nm
B. 7.5-10 nm (Correct Answer)
C. 12-17 nm
D. 18-20 nm

Explanation: ***7.5-10 nm*** - Amyloid fibrils are characteristically **non-branching**, **insoluble protein fibrils** that range in diameter from **7.5 to 10 nm**. - This specific size and morphology are crucial for their identification via **electron microscopy**, which is a key diagnostic tool for amyloidosis. *0-5 nm* - This range is generally too small for the characteristic amyloid fibrils and would likely represent **monomeric proteins** or very small aggregates. - Fibrillary structures typically need to be larger to achieve the stable, ordered beta-pleated sheet conformation seen in amyloid. *12-17 nm* - This diameter is typically **too large** for classic amyloid fibrils, which are known for their consistent size. - Fibrils in this range might suggest different types of protein aggregates or other pathological structures not characteristic of amyloid. *18-20 nm* - Fibrils of this diameter are significantly **larger than the typical amyloid fibrils** and would not be consistent with the ultrastructural definition of amyloid. - This size might be indicative of bundled fibrils or other forms of protein deposits.

Question 1469: A young lady presented with bilateral nodular lesions on the shins and bilateral hilar lymphadenopathy on chest X-ray. The Mantoux test reveals indurations of 5 mm. What would a skin biopsy reveal?

A. Non caseating granuloma (Correct Answer)
B. Vasculitis
C. Caseating granuloma
D. Malignant cells

Explanation: ***Non-caseating granulomas, indicative of sarcoidosis*** - The bilateral **nodular lesions on the shins** and **hilar lymphadenopathy** are classic signs of sarcoidosis, which is characterized by non-caseating granulomas [1]. - A **Mantoux test** showing 5 mm induration supports that the lesions are not due to active tuberculosis but are more suggestive of sarcoidosis. - The granulomas would show activated macrophages (epithelioid cells) with multinucleated giant cells in the dermis [2]. *Malignant cells, indicating neoplasia* - Malignant cells would suggest a diagnosis of **skin cancer** or other neoplasia, which does not align with the presentation of nodular lesions and hilar lymphadenopathy. - The clinical features and **negative Mantoux test** result do not support a malignancy diagnosis. *Vasculitis, which can present with granulomatous inflammation* - While vasculitis can cause skin lesions, the specific characteristics of these lesions and the chest radiograph findings are more aligned with **sarcoidosis** rather than vasculitis. - Vasculitis would typically show **inflammatory changes** and not specifically non-caseating granulomas. *Caseating granulomas, indicative of tuberculosis* - Caseating granulomas are characteristic of tuberculosis (TB), especially with a positive Mantoux test; however, a 5 mm induration indicates **unlikely active TB** in this presentation. - The patient's **chest X-ray findings** and clinical features do not strongly support TB over sarcoidosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.

Question 1470: Irreversible cell injury is indicated by

A. Calcium accumulation in cells (Correct Answer)
B. Myelin figures
C. Decreased ATP levels
D. Loss of ribosomal attachment

Explanation: ***Myelin figures*** - Myelin figures are indicative of **irreversible cell injury** and are formed during **cellular degeneration**, representing the breakdown of cell membranes [3]. - Their presence suggests severe damage, which often leads to **cell death** and loss of function [2]. *ATP depletion* - While **ATP depletion** occurs early in cell injury, it does not solely indicate irreversible damage, as cells may recover if ATP levels are restored [3]. - It's associated with **reversible injury**, particularly in conditions like ischemia [5]. *Shifting of Ribosomes* - The **shifting of ribosomes** from the rough endoplasmic reticulum is a sign of **reversible injury**, indicating stress or sublethal damage rather than irreversible damage [5]. - Cells can return to normal function if the stressor is removed [2]. *Accumulation of calcium in endoplasmic reticulum* - Accumulation of calcium often indicates **cellular stress** or **early injury**, but does not confirm irreversible injury by itself [4]. - It can lead to cell damage, but can also be a part of **reversible injury mechanisms** in certain contexts [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 53-55. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 53. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 61-62. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 60-61. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 51-53.

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