General Pathology Practice Questions

Q: In a clinical laboratory, when is sample registration typically performed?

When samples are received at the laboratory. ***When samples are received at the laboratory*** - **Sample registration** is a critical step performed immediately upon a sample's arrival to ensure proper identification and tracking throughout its lifecycle in the laboratory. - This initial registration helps prevent **errors**, maintains **sample integrity**, and establishes a clear **audit trail**. *At the end of each working day* - Delaying registration until the end of the day introduces a significant risk of **misidentification**, **loss**, or **degradation** of samples. - Urgent or time-sensitive tests would be unduly **delayed**, potentially impacting patient care. *Once per week during batch processing* - Weekly batch processing for registration is entirely unsuitable for a clinical laboratory, where timely processing of individual samples is paramount. - This practice would lead to a massive backlog, compromise **sample stability**, and make it impossible to provide **prompt results** for patient diagnosis and treatment. *Only during quality control audits* - **Quality control audits** periodically review laboratory processes, including registration, but do not replace the need for real-time, continuous sample registration. - Relying solely on audits for registration would mean unregistered samples are processed, leading to **untraceable results** and potential patient harm.

Q: Which of the following ions is important in irreversible cell injury?

Calcium. ***Calcium*** - An increase in intracellular **calcium** concentration is a critical event in irreversible cell injury, activating various destructive enzymes like **phospholipases**, **proteases**, **endonucleases**, and ATPases [1]. - This influx of calcium can occur due to mitochondrial dysfunction (leading to impaired calcium sequestration) or damage to the plasma membrane [1]. *Sodium* - While important for maintaining **osmotic balance** and cell volume, dysregulation of sodium primarily contributes to **cellular swelling** (hydropic change), which is an early and often reversible sign of cell injury [1]. - Increased intracellular sodium typically leads to water influx, but its direct role in irreversible damage is secondary to calcium. *Chloride* - Changes in chloride ion distribution are often secondary to sodium dysregulation and play a role in maintaining **charge neutrality** and osmotic balance across the cell membrane. - It is not directly implicated as a primary mediator of the **enzyme activation cascade** that leads to irreversible cell damage. *Potassium* - **Potassium** is the major intracellular cation; its leakage out of the cell is a consequence of cell membrane damage, indicating loss of membrane integrity. - While significant **potassium efflux** is a sign of severe injury, it is not the initiator of the irreversible damage pathway, unlike calcium. **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. 57-62.

Q: Main cause of shock is?

Hypoperfusion of tissue. ***Hypoperfusion of tissue*** - **Shock** is fundamentally a state of inadequate cellular energy production due to insufficient delivery of oxygen and nutrients to tissues [1], [2]. - This **tissue hypoperfusion** leads to cellular dysfunction, organ damage, and ultimately, death if not corrected [2]. *Hypotension* - **Hypotension** (low blood pressure) is a common *sign* or *symptom* of shock, but it is not the underlying cause [2]. - While significant hypotension often leads to hypoperfusion, normotensive shock can occur if tissue demands are extremely high or if microcirculation is severely impaired [2]. *Hypoxia* - **Hypoxia** refers to a deficiency in the amount of oxygen reaching the tissues. While hypoxia is a *consequence* of poor tissue perfusion in shock, it is not the main *cause* [2]. - Tissue hypoperfusion results in inadequate oxygen delivery, leading to cellular hypoxia, but the primary deficit is the overall blood flow [2]. *Dehydration* - **Dehydration** is a *cause* of **hypovolemic shock**, which is one *type* of shock [1]. - It leads to reduced intravascular volume, which can cause decreased cardiac output and subsequent tissue hypoperfusion, but it is not the main cause of shock in general.

Q: A 40 year old male patient complains of severe acute abdominal pain. Radiologic examination reveals multiple gall stones. On histologic examination, foci of necrosis containing shadowy outlines of necrotic cells surrounded by basophilic calcium deposits were seen. Which type of necrosis is seen in this patient?

Fat. ***Fat*** - The description of **foci of necrosis** containing **shadowy outlines of necrotic cells** surrounded by **basophilic calcium deposits** is characteristic of **fat necrosis**, specifically enzymatic fat necrosis [1]. - This typically occurs in the **pancreas** during acute pancreatitis, where activated **lipases** released from damaged pancreatic cells digest fat, leading to the formation of **calcium soaps** [1], [2]. *Liquefactive* - This type of necrosis is characterized by the **dissolution of dead cells** into a viscous liquid mass, often seen in **brain infarcts** or **abscesses**. - It does not present with the shadowy outlines of necrotic cells or calcium deposits as described. *Fibrinoid* - **Fibrinoid necrosis** involves immune-mediated damage to blood vessel walls, where **fibrin** and plasma proteins deposit within the vessel wall. - It is typically seen in conditions like **vasculitis** or **malignant hypertension** and does not involve the saponification of fat. *Coagulative* - **Coagulative necrosis** is characterized by the preservation of the **architectural outline** of dead cells for several days, typically due to **ischemia** in solid organs (e.g., heart, kidney) [1]. - While cells are necrotic, there is no mention of **calcium deposits** or the specific fat saponification associated with the described findings. **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. The Pancreas, pp. 889-890.

Q: True about eschar is all except

Sensitive to touch. ***Sensitive to touch*** - An eschar forms in **full-thickness burns** where nerve endings are destroyed, rendering the tissue **insensate** or numb to touch. - The presence of sensitivity would indicate a more superficial burn, not a full-thickness injury characterized by an eschar. *Thrombosed superficial veins* - **Thrombosed superficial veins** are a characteristic finding within an eschar, indicating the extent of vascular damage in a full-thickness burn. - The extreme heat causes coagulation of blood within vessels, leading to their obstruction and contributing to the avascular nature of the eschar. *Charred, denatured full thickness burn* - An eschar is indeed a defining feature of a **full-thickness burn**, where the skin is extensively damaged, often appearing **charred** or leathery. - The denaturing of proteins and destruction of cellular structures contribute to the characteristic appearance and consistency of the eschar. *Contracted dermis* - The **dermis** within an eschar becomes **contracted** and rigid due to the thermal injury, leading to a loss of elasticity [1]. - This contraction can result in a tourniquet effect, impairing circulation to underlying or distal tissues, especially in circumferential burns [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 119.

Q: Which of the following is the karyotype of male who is sexually under developed with rudimentary testes and prostate glands, sparse pubic and facial hair, long arms and legs and large hands & feet?

47, XXY. 47, XXY - This karyotype describes **Klinefelter syndrome**, the most common chromosomal disorder affecting males. - The extra X chromosome leads to **primary hypogonadism** with testicular dysgenesis, causing rudimentary testes with small, firm consistency and azoospermia (infertility) [1]. - Clinical features include **sparse body hair** (pubic, facial, and axillary), **eunuchoid body proportions** (long limbs, large hands and feet due to delayed epiphyseal closure), **gynecomastia**, and elevated gonadotropins (FSH/LH) [1]. - Patients have **decreased testosterone** levels and are at increased risk of metabolic syndrome, osteoporosis, and breast cancer [1]. *Incorrect: 45, X* - This karyotype describes **Turner syndrome**, which affects phenotypic females, not males [1]. - Characterized by **short stature** (opposite of the long limbs described), webbed neck, shield chest, and **gonadal dysgenesis** with streak ovaries. - Does not present with male characteristics or testicular development. *Incorrect: 47, XYY* - This karyotype describes **XYY syndrome** (Jacob's syndrome). - Individuals are typically **tall with normal male sexual development** and normal fertility. - May have mild learning difficulties or behavioral issues, but do NOT present with hypogonadism, sparse body hair, or rudimentary testes. *Incorrect: 46, XY* - This is the **normal male karyotype** with standard male sexual development. - Would present with normal secondary sexual characteristics, normal testicular size, and normal testosterone levels—completely contrary to the clinical picture described. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-175.

Question 1

A 42 year-old female patient presents with cough, low-grade fever, and hemoptysis.
Investigations reveal a cavitary lesion on her right lung apex, which on biopsy reveals caseous necrosis. The underlying pathophysiology is:

Accepted Answer

Type 4 hypersensitivity reaction

Answer

Sudden cut off of blood supply

Answer

Enzyme degradation

Answer

Fibrinoid deposition

Question 2

Virchow's triad includes all except:-

Accepted Answer

Platelet thrombus

Answer

Stasis of blood flow

Answer

Endothelial injury

Answer

Hypercoagulability

Question 3

In a clinical laboratory, when is sample registration typically performed?

Accepted Answer

When samples are received at the laboratory

Answer

At the end of each working day

Answer

Once per week during batch processing

Answer

Only during quality control audits

Question 4

Which of the following ions is important in irreversible cell injury?

Accepted Answer

Calcium

Answer

Sodium

Answer

Chloride

Answer

Potassium

Question 5

Main cause of shock is?

Accepted Answer

Hypoperfusion of tissue

Answer

Hypotension

Answer

Hypoxia

Answer

Dehydration

Question 6

Cell most sensitive to radiation –

Accepted Answer

Lymphocytes

Answer

Platelets

Answer

Neutrophils

Answer

Basophils

Question 7

White infarct is not seen in which of the following

Accepted Answer

Heart

Answer

Liver

Answer

Kidney

Answer

Spleen

Question 8

A 40 year old male patient complains of severe acute abdominal pain. Radiologic examination reveals multiple gall stones. On histologic examination, foci of necrosis containing shadowy outlines of necrotic cells surrounded by basophilic calcium deposits were seen. Which type of necrosis is seen in this patient?

Accepted Answer

Fat

Answer

Liquefactive

Answer

Fibrinoid

Answer

Coagulative

Question 9

True about eschar is all except

Accepted Answer

Sensitive to touch

Answer

Thrombosed superficial veins

Answer

Charred, denatured full thickness burn

Answer

Contracted dermis

Question 10

Which of the following is the karyotype of male who is sexually under developed with rudimentary testes and prostate glands, sparse pubic and facial hair, long arms and legs and large hands & feet?

Accepted Answer

47, XXY

Answer

45, X

Answer

47, XYY

Answer

46, XY

General Pathology — MCQs

General Pathology — MCQs

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