Neuropathology Practice Questions

Q: All of the following are true about the microscopic appearance of pilocytic astrocytoma, EXCEPT:

Decrease in the number of blood vessels. ### Explanation **Pilocytic Astrocytoma (WHO Grade 1)** is the most common primary brain tumor in children, typically occurring in the cerebellum. **Why Option D is the Correct Answer:** Contrary to the option, Pilocytic Astrocytoma is characterized by **prominent vascularity**. It often exhibits **vascular endothelial proliferation** (glomeruloid bodies). While in other gliomas (like Glioblastoma) this indicates high-grade malignancy, in Pilocytic Astrocytoma, it is a benign feature and does not imply a poor prognosis. Therefore, a "decrease" in blood vessels is incorrect. **Analysis of Incorrect Options:** * **A. Bipolar cells:** These are the hallmark "piloid" (hair-like) cells. They are elongated cells with thin, hair-like bipolar processes, giving the tumor its name. * **B. Rosenthal fibers:** These are thick, elongated, eosinophilic, "corkscrew" shaped structures found within astrocytic processes. They represent degenerated intermediate filaments (ubiquitin and αB-crystallin). * **C. Eosinophilic granular bodies (EGBs):** These are small, proteinaceous droplets found in the tumor. Their presence is a classic marker of slow-growing, low-grade tumors. **NEET-PG High-Yield Pearls:** * **Biphasic Pattern:** Microscopic examination shows a mix of dense (Rosenthal fibers) and loose/microcystic (EGBs) areas. * **Genetics:** Strongly associated with **BRAF gene** alterations (KIAA1549-BRAF fusion). * **Imaging:** Classically presents as a **cystic lesion with an enhancing mural nodule** in the cerebellum. * **Prognosis:** Excellent; usually curable by surgical resection.

Q: Which of the following is NOT true about berry aneurysms?

The wall contains smooth muscle and fibroblasts.. **Explanation:** Berry (saccular) aneurysms are acquired lesions resulting from a structural defect in the arterial wall. **1. Why Option C is the correct answer (The False Statement):** The hallmark of a berry aneurysm is the **absence of the tunica media (smooth muscle) and the internal elastic lamina** at the site of the aneurysm. The wall of the sac is composed only of thickened hyalinized intima and adventitia. Therefore, the statement that the wall contains smooth muscle is histologically incorrect. **2. Analysis of Incorrect Options (True Statements):** * **Option A:** They are associated with genetic conditions, most notably **Autosomal Dominant Polycystic Kidney Disease (ADPKD)**, Ehlers-Danlos syndrome (Type IV), and Marfan syndrome. * **Option B:** Rupture typically occurs at the **apex (dome)** of the sac because it is the thinnest part. This leads to blood entering the subarachnoid space, causing a **Subarachnoid Hemorrhage (SAH)**. * **Option C:** Approximately **90%** of berry aneurysms occur in the **anterior circulation** (Circle of Willis), specifically at arterial branching points where hemodynamic stress is highest. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Junction of the **Anterior Communicating Artery (ACoA)** and Anterior Cerebral Artery. * **Clinical Presentation:** "Worst headache of my life" (Thunderclap headache). * **Risk Factors:** Hypertension and smoking are the most important modifiable risk factors. * **Associated Nerve Palsy:** Aneurysms at the **Posterior Communicating Artery (PCoA)** can cause 3rd Cranial Nerve palsy (dilated pupil, ptosis).

Question 1

Neurofibrillary tangles with senile plaques are seen in which of the following conditions?

Accepted Answer

Alzheimer's disease

Answer

Parkinson's disease

Answer

Schizophrenia

Answer

Tuberous sclerosis

Question 2

Laminar necrosis and watershed infarcts are most suggestive of which of the following conditions?

Accepted Answer

Shock

Answer

Hypertension

Answer

Fat emboli

Answer

Vascular thrombosis

Question 3

What are the pathological lesions in the CNS in rabies?

Accepted Answer

Brainstem encephalitis

Answer

Cranial nerve arteritis

Answer

Neuronal loss

Answer

Neurofibrillary tangles

Question 4

Which type of herniation leads to brain stem injury?

Accepted Answer

Cerebellar tonsils

Answer

Cingulate

Answer

Hippocampal

Answer

Subfalcine

Question 5

Neuronophagia is seen in which of the following conditions?

Accepted Answer

Poliomyelitis

Answer

Amoebic encephalitis

Answer

Tuberculer meningoencephalitis

Answer

Cerebral malaria

Question 6

A 50-year-old woman undergoes neurosurgery for resection of a well-circumscribed intracranial neoplasm attached to the dura. The tumor compressed the underlying brain parenchyma without infiltration. Which of the following is the most likely diagnosis?

Accepted Answer

Meningioma

Answer

Arteriovenous malformation

Answer

Glioblastoma multiforme

Answer

Medulloblastoma

Question 7

All of the following are true about the microscopic appearance of pilocytic astrocytoma, EXCEPT:

Accepted Answer

Decrease in the number of blood vessels

Answer

Bipolar cells

Answer

Rosenthal fibers

Answer

Eosinophilic granular bodies

Question 8

All of the following are true about meningiomas EXCEPT:

Accepted Answer

They are attached to the pia mater.

Answer

Meningiomas are predominantly benign tumors of adults.

Answer

They arise from the meningothelial cell of the arachnoid.

Answer

They occur in association with eighth nerve schwannomas.

Question 9

Which of the following is NOT true about berry aneurysms?

Accepted Answer

The wall contains smooth muscle and fibroblasts.

Answer

Associated with familial syndromes.

Answer

The most common site of rupture is the apex, causing subarachnoid hemorrhage (SAH).

Answer

90% occur at the anterior circulation at branching points.

Question 10

Which of the following is considered a low-grade Central Nervous System tumor?

Accepted Answer

Meningioma

Answer

Diffuse astrocytoma

Answer

Anaplastic astrocytoma

Answer

Glioblastoma multiforme

Neuropathology — MCQs

Neuropathology — MCQs

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