General Pathology Practice Questions

Q: What is the initiating mechanism in endotoxic shock?

Cytokine release. **Explanation:** Endotoxic shock (a form of septic shock) is primarily triggered by **Lipopolysaccharide (LPS)**, an endotoxin found in the outer membrane of Gram-negative bacteria [1]. **Why Cytokine Release is the Correct Answer:** The initiating event occurs when LPS binds to **Lipopolysaccharide-binding protein (LBP)**, which then interacts with **CD14** and **Toll-like receptor 4 (TLR-4)** on the surface of macrophages and monocytes [1], [2]. This interaction triggers a massive systemic release of pro-inflammatory cytokines, most notably **TNF-alpha** (the primary mediator), **IL-1**, and **IL-6** [1], [2]. This "cytokine storm" is the fundamental trigger that orchestrates the subsequent systemic inflammatory response. **Analysis of Incorrect Options:** * **Peripheral Vasodilation (A):** This is a *result* of the action of inflammatory mediators (like Nitric Oxide) induced by cytokines, not the initiating mechanism [2]. * **Endothelial Injury (B):** This occurs downstream as cytokines and activated neutrophils damage the vessel walls, leading to complications like DIC [3]. * **Increased Vascular Permeability (C):** This is a secondary effect of cytokine action and endothelial damage, leading to the characteristic "third-spacing" and edema seen in shock [1], [2]. **High-Yield Clinical Pearls for NEET-PG:** * **TNF-alpha** is the most important cytokine in the pathogenesis of septic shock [2]. * **TLR-4** is the specific pattern recognition receptor for Gram-negative endotoxin [1]. * **Warm Shock:** Early septic shock is characterized by peripheral vasodilation (decreased SVR) and high cardiac output, making the skin feel warm, unlike hypovolemic shock. * **Nitric Oxide (NO):** The excessive production of NO by inducible Nitric Oxide Synthase (iNOS) is the final common pathway for the profound hypotension seen in this condition.

Question 1

An 11-year-old girl becomes infected with hepatitis A and experiences mild nausea for 1 week. On physical examination, she has minimal right upper quadrant tenderness and scleral icterus. Laboratory findings include a serum AST of 68 U/L, ALT of 75 U/L, and total bilirubin of 5.1 mg/dL. Her laboratory findings most likely result from which of the following changes in her hepatocytes?

Accepted Answer

Cell membrane defects

Answer

Lysosomal autophagy

Answer

Mitochondrial swelling

Answer

Nuclear chromatin clumping

Question 2

Cell-matrix adhesions are mediated by which of the following?

Accepted Answer

Integrins

Answer

Cadherins

Answer

Selectins

Answer

Calmodulin

Question 3

Macroglossia is seen in which of the following conditions?

Accepted Answer

Amyloidosis

Answer

Folic acid deficiency

Answer

Motor neurone disease

Answer

None of the above

Question 4

Which of the following produces irreversible cell injury faster?

Accepted Answer

Ischaemia

Answer

Increased cytosolic Ca2+

Answer

Decreased ATP

Answer

Hypoxia

Question 5

Secondary (AA) amyloidosis is seen in all of the following conditions except?

Accepted Answer

Multiple myeloma

Answer

Rheumatoid arthritis (RA)

Answer

Tuberculosis (TB)

Answer

Renal cell carcinoma (RCC)

Question 6

Which of the following is NOT true about apoptosis?

Accepted Answer

Apoptosis of cells induces an inflammatory reaction.

Answer

Considerable apoptosis may occur in tissues before it becomes apparent in histology.

Answer

Apoptotic cells appear as round masses of intensely eosinophilic cytoplasm with dense nuclear chromatin fragments.

Answer

Macrophages phagocytose the apoptotic cells and degrade them.

Question 7

What is the initiating mechanism in endotoxic shock?

Accepted Answer

Cytokine release

Answer

Peripheral vasodilation

Answer

Endothelial injury

Answer

Increased vascular permeability

Question 8

A 60-year-old farmer presents with multiple patches of discoloration on his face. Biopsy of lesional skin reveals actinic keratosis. Which of the following terms best describes this response of the skin to chronic sunlight exposure?

Accepted Answer

Dysplasia

Answer

Atrophy

Answer

Hyperplasia

Answer

Hypertrophy

Question 9

Which of the following is not a sign of reversible cell injury?

Accepted Answer

Cell shrinkage

Answer

ATP depletion

Answer

Fatty acid deposition

Answer

Reduction of phosphorylation

Question 10

Which of the following is NOT true about apoptosis?

Accepted Answer

Inflammation is typically present.

Answer

Annexin V can be used as a marker.

Answer

Cell shrinkage is a characteristic feature.

Answer

Clumping of chromatin is observed.

General Pathology — MCQs

General Pathology — MCQs

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