Neuropathology Practice Questions

Q: In which of the following conditions are neurons predominantly affected?

Spinocerebellar ataxia. ***Spinocerebellar ataxia*** - Spinocerebellar ataxias are a group of **neurodegenerative disorders** characterized by progressive dysfunction and loss of **neurons** in the cerebellum, brainstem, and spinal cord [1]. - The primary pathology involves **neuronal degeneration** leading to ataxia, dysarthria, and ocular motor abnormalities [1]. *Supranuclear palsy* - This condition is characterized by the degeneration of structures above the ocular motor nuclei, affecting movements of the eyes, neck, and trunk . - While it involves neuronal loss, it primarily affects specific brain regions involved in motor control, rather than a broad, predominant neuronal destruction across multiple systems like SCAs. *Corticobasal degeneration* - This neurodegenerative disorder is characterized by asymmetric motor dysfunction, often affecting one limb with rigidity and dystonia. - It involves the accumulation of **tau protein** in neurons and glial cells in the cerebral cortex and basal ganglia, leading to widespread cellular damage, but not exclusively neuronal death. *Multisystem Atrophy* - Multisystem atrophy is a **synucleinopathy** that involves degeneration of neurons and glial cells in multiple parts of the central nervous system, including the cerebellum, brainstem, basal ganglia, and spinal cord. - It is often characterized by **glial cytoplasmic inclusions** leading to prominent autonomic dysfunction, parkinsonism, and cerebellar ataxia.

Q: Which of the following is not a characteristic feature of Alzheimer's disease?

Lewy bodies. ***Correct Answer: Lewy bodies*** - **Lewy bodies** are abnormal aggregates of protein, primarily **alpha-synuclein**, found in the brains of individuals with **Parkinson's disease** and **Lewy body dementia**, but **not typically in Alzheimer's disease** [1]. - While there can be overlap in pathologies, the presence of Lewy bodies as a primary feature suggests a different neurodegenerative process than Alzheimer's. - This is the correct answer because it is **NOT a characteristic feature** of Alzheimer's disease. *Incorrect: Neurofibrillary tangles* - **Neurofibrillary tangles** are intracellular aggregates of hyperphosphorylated **tau protein** and are a **hallmark pathological feature** of Alzheimer's disease. - These tangles disrupt neuronal function and axonal transport, leading to neuronal death. - This IS a characteristic feature of Alzheimer's disease. *Incorrect: Senile (neuritic) plaques* - **Senile plaques**, also known as **neuritic plaques**, are extracellular deposits of **beta-amyloid protein** that are a **characteristic pathological feature** of Alzheimer's disease. - These plaques accumulate outside neurons, leading to inflammation and neuronal dysfunction. - This IS a characteristic feature of Alzheimer's disease. *Incorrect: Amyloid Angiopathy* - **Cerebral amyloid angiopathy** (CAA) is the deposition of **amyloid-beta protein** in the walls of small and medium-sized blood vessels in the central nervous system, particularly the cerebral cortex and leptomeninges. - It is present in **over 90% of Alzheimer's disease cases** and is a significant contributor to cognitive decline and hemorrhagic events in these patients. - This IS a characteristic feature of Alzheimer's disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1296-1298.

Q: Complex granular corpuscles are produced by?

Microglia. ***Microglia*** - **Microglia** are the primary **immune cells** of the central nervous system (CNS) and play a key role in clearing cellular debris and pathogens. - In response to damage or infection, microglia become activated, proliferate, and can form **complex granular corpuscles** (also known as **gitter cells**), which are phagocytic cells filled with lipid-rich debris. *Oligodendrocytes* - **Oligodendrocytes** are responsible for producing **myelin** in the CNS, which insulates axons and facilitates rapid nerve impulse conduction. - They are not primarily involved in phagocytosis or the formation of granular corpuscles. *Astrocytes* - **Astrocytes** are star-shaped glial cells that provide structural and metabolic support to neurons, regulate the **blood-brain barrier**, and maintain the extracellular environment. - While they can be reactive in injury, they do not typically form phagocytic granular corpuscles like microglia. *Vascular endothelium* - **Vascular endothelial cells** form the inner lining of blood vessels, including those in the brain, and are crucial for regulating blood flow and forming the **blood-brain barrier**. - They are not considered a source of complex granular corpuscles, which are a product of intrinsic CNS immune response.

Q: Absence of lymph nodes is characteristic of which type of cancer?

Brain. ***Brain*** - The brain lacks conventional **lymphatic drainage** vessels and **lymph nodes**, making metastasis to regional lymph nodes impossible [1]. - Due to the **blood-brain barrier** and unique immunological environment, brain tumors typically spread via cerebrospinal fluid or direct invasion rather than lymphatic routes [1]. *Liver* - The **liver** has an extensive lymphatic system with numerous **intrahepatic** and **extrahepatic lymph nodes** that can be involved in metastatic spread. - Hepatic malignancies, both primary and secondary, frequently metastasize to regional lymph nodes, such as the **hilar** and **periportal nodes**. *Lung* - The **lungs** are richly supplied with lymphatic vessels and contain a vast network of **bronchopulmonary**, **hilar**, and **mediastinal lymph nodes** [2]. - Lung cancers commonly metastasize to these regional lymph nodes, which is a critical factor in **staging** and treatment planning. *Placenta* - The **placenta** is a highly vascular organ but lacks an intrinsic lymphatic system and associated lymph nodes. - While it can be affected by gestational trophoblastic disease (a type of cancer), its metastatic spread occurs predominantly via **hematogenous routes**, not lymphatic. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314-1315. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725.

Q: Durck's granuloma is primarily associated with which of the following?

Brain. ***Brain*** - **Durck's granulomas** are microglial nodules specifically found in the **brain tissue** of patients with **typhoid fever**. [1] - They are a characteristic neuropathological finding associated with **S. typhi** infection. [1] *Spleen* - The spleen is a common organ affected by bacterial infections like **typhoid fever**, leading to **splenomegaly** and sometimes splenic abscesses. - However, **Durck's granulomas** are not found in the spleen; they are specific to brain lesions in typhoid. *Lymph node* - **Lymph nodes** can show reactive changes and hyperplasia in many systemic infections, including typhoid fever. - While lymphadenopathy might be present, **Durck's granulomas** are not a feature of typhoid infection in lymph nodes. *Skull* - The **skull** is the bony protection for the brain and is not directly involved in the formation of **Durck's granulomas**. - These granulomas are microscopic lesions within the brain parenchyma, not within the skull itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1281-1282.

Q: In which clinicopathologic category of amyloidosis is the deposition of protein 'Aβ (amyloid beta)' primarily observed?

Senile cerebral. ***Senile cerebral*** - **Amyloid-beta (Aβ)** deposition is the hallmark of **Alzheimer's disease** and is found in the brains of individuals with **senile cerebral amyloidosis**. - Aβ plaques accumulate primarily in the **cerebral cortex** and **vessel walls**, contributing to neurodegeneration. *Familial mediterranean fever* - This is an **autoinflammatory disorder** associated with deposition of **AA amyloid** (amyloid A protein). - It leads to **systemic amyloidosis**, affecting organs like the kidneys, rather than cerebral Aβ deposition. *Hemodialysis associated* - This type of amyloidosis is caused by the deposition of **β2-microglobulin** due to its inadequate clearance in patients undergoing long-term hemodialysis. - It primarily affects the **musculoskeletal system**, including joints and tendons, not the brain. *Systemic senile* - **Systemic senile amyloidosis** is characterized by the deposition of **transthyretin (TTR)**, primarily affecting the heart and other organs. - While it occurs in older individuals (senile), it does not involve Aβ deposition in the brain.

Q: Rosenthal fibres are seen in which of the following tumours?

Pilocytic astrocytoma. ***Pilocytic astrocytoma*** - **Rosenthal fibres** are highly characteristic histological findings in pilocytic astrocytomas, appearing as thick, elongated, corkscrew-shaped eosinophilic aggregates. - These are typically **well-circumscribed** tumors, most commonly found in the cerebellum of children and young adults. *Glioblastoma* - Characterized by **necrosis with pseudopalisading cells** and **microvascular proliferation**, not Rosenthal fibres. - It is a highly aggressive, grade IV astrocytoma with a poor prognosis. *Ependymoma (characterized by perivascular rosettes)* - Histologically, ependymomas are known for forming **perivascular pseudorosettes**, where tumor cells arrange around blood vessels. - These tumors arise from ependymal cells lining the ventricles and spinal cord, and do not contain Rosenthal fibres. *Medulloblastoma* - Medulloblastomas are highly malignant embryonic tumors typically found in the **cerebellum**, characterized by **small, round blue cells** and often forming Homer Wright rosettes. - They are not associated with Rosenthal fibres.

Q: Which of the following is diagnostic of rabies?

Negri bodies. ***Negri bodies*** - **Negri bodies** are eosinophilic, sharply outlined, inclusion bodies found in the cytoplasm of certain nerve cells, particularly in the **hippocampus** and **Purkinje cells** of the cerebellum, in cases of rabies infection [1]. - Their presence in brain tissue is **pathognomonic** for rabies [1]. *Guarneri bodies* - **Guarneri bodies** are acidophilic cytoplasmic inclusion bodies found in cells infected with **variola (smallpox) virus** or **vaccinia virus**. - They are characteristic of poxvirus infections, not rabies. *Cowdry A body* - **Cowdry A bodies** are intranuclear inclusion bodies seen in cells infected with certain viruses like **herpes simplex virus (HSV)**, **varicella-zoster virus (VZV)**, and **cytomegalovirus (CMV)**. - They are not associated with rabies. *Bollinger bodies* - **Bollinger bodies** are eosinophilic cytoplasmic inclusion bodies primarily found in epithelial cells infected with **fowlpox virus**, a type of avian poxvirus. - They are not relevant to human rabies diagnosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1279-1280.

Q: Which of the following is NOT a typical pathologic feature of the brain in AIDS?

Temporal lobe infarction. ***Temporal lobe infarction*** - While infarction can occur due to various causes, **temporal lobe infarction** is not a typical or primary neuropathologic feature directly associated with HIV infection itself. - HIV-related neurological complications more commonly involve widespread inflammation, opportunistic infections, or direct neurotoxic effects, rather than focal ischemic events in the temporal lobe [1]. *Perivascular giant cell invasion* - This is a **hallmark feature of HIV encephalitis (HIVE)**, characterized by the presence of multinucleated giant cells derived from macrophages/microglia, often surrounding blood vessels [1]. - These cells are infected with HIV and contribute to the inflammatory and destructive processes in the brain, representing one of the classic pathologic findings [1]. *Microglial nodules* - **Microglial nodules** are aggregations of activated microglia and macrophages, often found within the brain parenchyma in HIV-infected individuals. - They represent a **typical inflammatory response** to HIV infection and are a characteristic feature of HIV encephalitis along with multinucleated giant cells and white matter changes. *Vasculitis* - HIV infection can occasionally cause CNS vasculitis, leading to inflammation of blood vessels in the brain. - While recognized as a potential complication, it is relatively uncommon compared to the classic triad of microglial nodules, multinucleated giant cells, and white matter pathology that define typical HIV neuropathology. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 711-712.

Question 1

In which of the following conditions are neurons predominantly affected?

Accepted Answer

Spinocerebellar ataxia

Answer

Supranuclear palsy

Answer

Multisystem Atrophy

Answer

Corticobasal degeneration

Question 2

Which of the following is not a characteristic feature of Alzheimer's disease?

Accepted Answer

Lewy bodies

Answer

Neurofibrillary tangles

Answer

Senile (neuritic) plaques

Answer

Amyloid Angiopathy

Question 3

Complex granular corpuscles are produced by?

Accepted Answer

Microglia

Answer

Oligodendrocytes

Answer

Astrocytes

Answer

Vascular endothelium

Question 4

Which of the following lesions shows the most specific anatomic changes in HIV infection?

Accepted Answer

CNS lesions

Answer

Lymph nodes

Answer

Kaposi's sarcoma

Answer

Opportunistic infection

Question 5

Absence of lymph nodes is characteristic of which type of cancer?

Accepted Answer

Brain

Answer

Liver

Answer

Lung

Answer

Placenta

Question 6

Durck's granuloma is primarily associated with which of the following?

Accepted Answer

Brain

Answer

Spleen

Answer

Lymph node

Answer

Skull

Question 7

In which clinicopathologic category of amyloidosis is the deposition of protein 'Aβ (amyloid beta)' primarily observed?

Accepted Answer

Senile cerebral

Answer

Hemodialysis associated

Answer

Familial mediterranean fever

Answer

Systemic senile

Question 8

Rosenthal fibres are seen in which of the following tumours?

Accepted Answer

Pilocytic astrocytoma

Answer

Glioblastoma

Answer

Medulloblastoma

Answer

Ependymoma

Question 9

Which of the following is diagnostic of rabies?

Accepted Answer

Negri bodies

Answer

Guarneri bodies

Answer

Cowdry A body

Answer

Bollinger bodies

Question 10

Which of the following is NOT a typical pathologic feature of the brain in AIDS?

Accepted Answer

Temporal lobe infarction

Answer

Microglial nodules

Answer

Perivascular giant cell invasion

Answer

Vasculitis

Neuropathology — MCQs

Neuropathology — MCQs

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