General Pathology Practice Questions

Q: Which of the following translocations is not associated with Down syndrome?

t(11;14). ***t (11: 14)*** - The **t(11;14) translocation** is commonly associated with **mantle cell lymphoma**, a B-cell non-Hodgkin lymphoma, and is not a cause of Down syndrome. - This translocation leads to the overexpression of the **cyclin D1 gene**, located on chromosome 11, which promotes cell growth and proliferation. *t (14; 21)* - This is a common **Robertsonian translocation** involving chromosomes 14 and 21, which results in an extra copy of chromosome 21 material [1]. - Individuals with this translocation can have **Down syndrome** because their cells end up with the equivalent of three copies of chromosome 21 [1]. *t (21; 21)* - This translocation is another type of **Robertsonian translocation** where two chromosome 21s fuse. - This specific translocation is rare and results in an extra copy of chromosome 21, leading to **Down syndrome** with a high recurrence risk in offspring. *t (15: 21)* - This is a **Robertsonian translocation** involving chromosomes 15 and 21, resulting in an extra copy of chromosome 21 material. - This translocation is a known cause of **Down syndrome** due to the dosage imbalance of genes on chromosome 21 [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 169-172.

Q: What condition is the Lendrum stain primarily used to diagnose?

Amniotic fluid embolism. ***Amniotic fluid embolism*** - The **Lendrum stain** (specifically the modified Lendrum stain) is used to detect **fetal squamous cells** and **mucin** in maternal lung tissue, which are markers for amniotic fluid embolism [1]. - It helps confirm the diagnosis of this rare but severe obstetric emergency characterized by the entry of **amniotic fluid** into the maternal circulation [1]. *Air embolism* - Air embolism is diagnosed based on the presence of **gas bubbles** in blood vessels, often visualized by imaging or directly during autopsy, not by a specific tissue stain [1]. - Histologically, air emboli lead to characteristic foam-like structures in vascular lumens, but no specific stain highlights the air itself. *Fat embolism* - Fat embolism is diagnosed by the presence of **fat globules** in pulmonary capillaries and other organs, typically stained with **oil-soluble dyes like Oil Red O** or Sudan stains on frozen sections. - The Lendrum stain is designed for mucin and keratin, not neutral lipids like fat. *Thromboembolism* - Thromboembolism involves **blood clots** that occlude vessels and is diagnosed using routine H&E staining, which shows fibrin, platelets, and red blood cells [1]. - Special stains like **phosphotungstic acid-hematoxylin (PTAH)** or **Martius scarlet blue (MSB)** may be used for fibrin, but the Lendrum stain is specifically designed for amniotic fluid components, not thrombi. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 323-324.

Q: Male to male transmission is seen in -

Autosomal dominant diseases. ***Autosomal dominant diseases*** - **Autosomal dominant** inheritance patterns involve a gene located on one of the **autosomes**, meaning it is not sex-linked. - Therefore, a father carrying an autosomal dominant gene can pass it to both sons and daughters with a **50% probability** for each child. - **Male-to-male transmission** is a hallmark feature that helps distinguish autosomal dominant from X-linked inheritance patterns. *Autosomal recessive* - **Autosomal recessive** diseases require **two copies** of the mutated gene (one from each parent) for the disease to manifest. - While a father can pass a recessive allele to his son, male-to-male transmission of the **disease phenotype** requires the mother to also be at least a carrier, making it not a defining feature of this inheritance pattern. - The key characteristic is horizontal pattern (affected siblings) rather than vertical transmission. *X-linked dominant* - In **X-linked dominant** inheritance, affected fathers **cannot** transmit the trait to their sons because sons inherit their **X chromosome** from their mother and their Y chromosome from their father. - All daughters of an affected father will inherit the affected X chromosome and thus the disease. - **Absence of male-to-male transmission** is a key distinguishing feature. *Mitochondrial disease* - **Mitochondrial diseases** are inherited exclusively from the **mother** to all her children, regardless of their sex. - Fathers with mitochondrial disease cannot transmit the condition to any of their children. - This shows **maternal inheritance only**, with no paternal transmission possible.

Q: Cells most sensitive to hypoxia are?

Neurons. ***Neurons*** - Neurons have a very high metabolic rate and an **absolute requirement for oxygen** and glucose to maintain their complex electrochemical functions and ionic gradients. - Due to their lack of significant energy reserves and high metabolic demand, they can sustain **irreversible damage within minutes** (typically 3-5 minutes) of complete oxygen deprivation. *Myocardial cells* - While myocardial cells are highly susceptible to hypoxia and can undergo **ischemic necrosis** (e.g., in a myocardial infarction), they can often tolerate oxygen deprivation for somewhat longer periods than neurons due to some anaerobic metabolic capacity. - Significant damage to myocardial cells usually occurs after **20-30 minutes of severe ischemia**. *Hepatocytes* - Hepatocytes (liver cells) are relatively **resilient to hypoxia** compared to neurons, possessing significant metabolic flexibility and capacity for regeneration. - They can endure **longer periods of oxygen deprivation** before irreversible damage occurs, often hours. *Renal tubular epithelial cells* - Renal tubular epithelial cells are generally **sensitive to hypoxia**, especially those in the medulla, due to their high metabolic activity for reabsorption and secretion. - They are a common target for **acute tubular necrosis** in ischemic injury but generally have a **higher tolerance than neurons**, with damage becoming widespread after tens of minutes to an hour of severe ischemia.

Q: Which condition is most commonly associated with systemic amyloidosis?

Chronic Kidney Disease. Type II DM - Amyloidosis is commonly associated with **chronic diseases** like type II diabetes mellitus due to insulin resistance leading to amyloid deposition [4]. - The presence of **amiloid in the pancreas** often correlates with the complications of this type of diabetes [3]. *Maturity onset DM* - While maturity-onset diabetes can lead to complications, it is often synonymous with **type II DM**, making this distinction inaccurate regarding amyloidosis. - This term is less commonly used and does not emphasize the direct link to amyloidosis seen in type II diabetes. *HTN* - Hypertension itself is not a direct cause of amyloidosis; it typically results from other underlying conditions. - The association of amyloidosis with hypertension is usually **secondary**, not a primary condition leading to amyloid deposits [2]. *Type I DM* - Type I diabetes is primarily **autoimmune**, resulting in insulin-deficient states and does not strongly associate with amyloidosis like type II [1]. - The amyloid deposits seen in type I are much less common compared to type II or associated chronic conditions.

Q: When differentiated cells transform to form cells characteristic of other tissues, the process is called as -

Trans-differentiation. ***Trans-differentiation*** - **Trans-differentiation** refers to the direct conversion of one differentiated cell type into another differentiated cell type without entering a pluripotent stem cell state. - This process is achieved by altering the **gene expression profile** of existing cells to adopt the characteristics of a different lineage. *De-differentiation* - **De-differentiation** is the process where a specialized cell loses its specific characteristics and reverts to a more primitive or stem cell-like state. - This is often observed in certain disease processes, like cancer, or in response to injury where cells regain limited proliferative capacity. *Re-differentiation* - **Re-differentiation** typically describes a cell that has undergone de-differentiation and then differentiates again into a new or its original cell type. - This process is often seen in tissue repair, where progenitor cells proliferate and then re-differentiate to replace damaged tissue. *Sub-differentiation* - **Sub-differentiation** is not a standard or recognized term in cell biology or developmental biology to describe the transformation of stem cells into other tissue types. - The term does not have a defined meaning within the context of cellular lineage alterations.

Q: Lines of Zahn occur in -

Thrombus. ***Thrombus*** - **Lines of Zahn** are alternating layers of **platelets** (lighter bands) and **red blood cells** (darker bands) that are characteristic of a **thrombus** formed in flowing blood. - Their presence indicates that the clot was formed in a vessel where there was **blood flow** *Infarct* - An **infarct** is an area of **ischemic necrosis** caused by occlusion of either the arterial supply or venous drainage in a particular tissue. - While a thrombus can cause an infarct, an infarct itself does not contain Lines of Zahn; rather, it is the consequence of the thrombus. *Embolus* - An **embolus** is a detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its origin. - An embolus can be a fragment of a thrombus and therefore could contain Lines of Zahn, but the primary structure where these lines are formed is the stationary thrombus within a vessel. *Postmortem clot* - A **postmortem clot** forms after death and is typically gelatinous, poorly attached to the vessel wall, and has a dark red dependent portion (due to red cell settling) and a yellowish upper portion (like "chicken fat"). - It does not exhibit the layered architecture of platelets and red blood cells seen in **Lines of Zahn**, as there is no active blood flow or coagulation process at play.

Q: In systemic senile amyloidosis, there is deposition of?

ATTR. ***ATTR*** - In systemic senile amyloidosis, there is typical deposition of **ATTR** amyloid, which is derived from **transthyretin**, a protein produced by the liver [1]. - This condition occurs predominantly in **older adults**, leading to systemic effects and involvement of various organs such as the heart and kidneys [1]. *AL* - AL amyloidosis is characterized by the deposition of **light chain immunoglobulins**, not typically associated with senile amyloidosis [2]. - AL amyloidosis is more related to **multiple myeloma** and other plasma cell disorders [2]. *Beta - 2- microglobulin* - This refers to a component often seen in conditions like **chronic kidney disease**, leading to **beta-2-microglobulin amyloidosis**, not systemic senile amyloidosis. - It generally does not cause systemic amyloidosis linked with age-related changes in proteins. *AA* - AA amyloidosis is due to **serum amyloid A protein**, typically associated with chronic inflammatory states, rather than senile amyloidosis. - It is mainly seen in conditions like **rheumatoid arthritis** and chronic infections, differing from the aged-related mechanism in ATTR. **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.

Question 1

Dystrophic calcification is seen in

Accepted Answer

Atheromatous plaque

Answer

Vitamin A intoxication

Answer

Milk alkali syndrome

Answer

Hyperparathyroidism

Question 2

Which of the following translocations is not associated with Down syndrome?

Accepted Answer

t(11;14)

Answer

t(21;21)

Answer

t(14;21)

Answer

t(15;21)

Question 3

What condition is the Lendrum stain primarily used to diagnose?

Accepted Answer

Amniotic fluid embolism

Answer

Air embolism

Answer

Fat embolism

Answer

Thromboembolism

Question 4

Male to male transmission is seen in -

Accepted Answer

Autosomal dominant diseases

Answer

Autosomal recessive

Answer

X-linked dominant

Answer

Mitochondrial disease

Question 5

Cells most sensitive to hypoxia are?

Accepted Answer

Neurons

Answer

Myocardial cells

Answer

Hepatocytes

Answer

Renal tubular epithelial cells

Question 6

Which condition is most commonly associated with systemic amyloidosis?

Accepted Answer

Chronic Kidney Disease

Answer

Multiple Myeloma

Answer

Rheumatoid Arthritis

Answer

Familial Mediterranean Fever

Question 7

When differentiated cells transform to form cells characteristic of other tissues, the process is called as -

Accepted Answer

Trans-differentiation

Answer

De-differentiation

Answer

Re-differentiation

Answer

Sub-differentiation

Question 8

Lines of Zahn occur in -

Accepted Answer

Thrombus

Answer

Embolus

Answer

Infarct

Answer

Postmortem clot

Question 9

In general pathophysiology, the most direct and fundamental mechanism by which death occurs typically involves which of the following?

Accepted Answer

Poisoning of oxidative phosphorylation

Answer

Damage to the plasmalemma

Answer

Decreased oxygen-carrying capacity of blood

Answer

Increased calcium transport into mitochondria

Question 10

In systemic senile amyloidosis, there is deposition of?

Accepted Answer

ATTR

Answer

AA

Answer

AL

Answer

Beta - 2- microglobulin

General Pathology — MCQs

General Pathology — MCQs

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