Neuropathology Practice Questions

Q: What is the most common intracranial tumour?

Metastatic tumours. ### Explanation **Correct Answer: D. Metastatic tumours** **Why it is correct:** In the general population, **metastatic tumors** are the most common intracranial neoplasms, outnumbering primary brain tumors by a ratio of approximately 10:1. They typically reach the brain via hematogenous spread and are most frequently found at the **gray-white matter junction** due to the narrowing of blood vessels in this region. The most common primary sources are the lung (most common overall), breast, melanoma, renal cell carcinoma, and colon. **Why the other options are incorrect:** * **A. Astrocytoma:** While Glioblastoma (a Grade IV Astrocytoma) is the most common *primary malignant* brain tumor in adults, it is still less frequent than secondary metastases. * **B. Medulloblastoma:** This is the most common *primary malignant* brain tumor in **children**, typically arising in the cerebellum (posterior fossa). * **C. Meningioma:** This is the most common *primary benign* intracranial tumor. While highly prevalent, the incidence of metastatic disease remains higher in clinical practice. **High-Yield Clinical Pearls for NEET-PG:** * **Most common primary source of brain metastasis:** Lung cancer (Small cell > Non-small cell). * **Most common source of hemorrhagic metastasis:** Melanoma, Choriocarcinoma, Renal Cell Carcinoma, and Thyroid cancer (Mnemonic: **MCRT**). * **Imaging Hallmark:** Metastases often present as multiple, well-circumscribed lesions with significant **perilesional vasogenic edema** out of proportion to the size of the lesion. * **Single vs. Multiple:** While metastases are usually multiple, Bronchogenic carcinoma and RCC are known to frequently present as solitary brain metastases.

Q: What is true about the etiopathogenesis of Alzheimer's disease?

Involvement of Apolipoprotein E. ### Explanation Alzheimer’s Disease (AD) is a neurodegenerative disorder characterized by the accumulation of amyloid-beta (Aβ) plaques and neurofibrillary tangles [1]. **Why Option B is Correct:** **Apolipoprotein E (ApoE)** is the most significant genetic risk factor for **sporadic (late-onset)** Alzheimer’s disease. There are three isoforms: ε2, ε3, and ε4. * **ApoE ε4** increases the risk and lowers the age of onset by decreasing the clearance of Aβ. * **ApoE ε2** is considered protective. **Analysis of Incorrect Options:** * **Option A:** Tau protein is **not absent**; rather, it is **hyperphosphorylated**. This leads to the formation of **Neurofibrillary Tangles (NFTs)**, which correlate more closely with cognitive decline than plaques. * **Option C & D:** While mutations in **Presenilin-1 (Chr 14)**, **Presenilin-2 (Chr 1)**, and the **APP gene (Chr 21)** are indeed involved in AD, they are specifically associated with **Familial (Early-onset)** Alzheimer’s Disease, which accounts for <5% of cases. In the context of general etiopathogenesis, ApoE involvement is a broader and more frequent association in clinical practice. **High-Yield Clinical Pearls for NEET-PG:** * **Amyloid Cascade Hypothesis:** Central to AD; Aβ42 is the most toxic/amyloidogenic form. * **Brain Atrophy:** Characteristically starts in the **Hippocampus** and Entorhinal cortex (causing early memory loss). * **Down Syndrome Connection:** Patients with Trisomy 21 have an extra copy of the APP gene, leading to AD-like pathology by age 40. * **Histology:** Silver stains (Bielschowsky) are used to visualize plaques and tangles. Hirano bodies and Granulovacuolar degeneration are also seen.

Q: What is the most common intracranial neoplasm in adults?

Meningioma. **Explanation:** The classification of intracranial neoplasms depends heavily on whether one considers **primary** tumors or **all** tumors (including secondary/metastatic). However, among primary intracranial tumors in adults, **Meningioma** is now recognized as the most common. **1. Why Meningioma is correct:** According to recent CBTRUS (Central Brain Tumor Registry of the United States) data, meningiomas account for approximately **37–39%** of all primary brain tumors, making them the most frequent. They arise from the arachnoid cap cells of the leptomeninges. While often benign (WHO Grade I), their high prevalence in the aging population secures their position as the most common primary intracranial neoplasm. **2. Why the other options are incorrect:** * **Astrocytoma:** While Glioblastoma Multiforme (GBM, a Grade IV astrocytoma) is the most common *malignant* primary brain tumor, it is less frequent than meningiomas overall. * **Posterior fossa tumors:** These are more characteristic of the **pediatric** population (e.g., Medulloblastoma, Pilocytic Astrocytoma). In adults, the majority of tumors are supratentorial. * **Ganglioneuroma:** These are rare, slow-growing tumors typically found in the peripheral nervous system (sympathetic chain) rather than being a common intracranial neoplasm. **High-Yield Clinical Pearls for NEET-PG:** * **Most common intracranial tumor (Overall):** Metastasis (usually from Lung > Breast > Melanoma). * **Most common Primary Intracranial tumor:** Meningioma. * **Most common Malignant Primary tumor:** Glioblastoma Multiforme (GBM). * **Radiology Hint:** Meningiomas show a characteristic **"Dural Tail Sign"** on contrast MRI and are usually extra-axial. * **Histology Hint:** Look for **Psammoma bodies** (concentric calcifications) and whorled patterns.

Q: All of the following are features of Pick's disease except?

Hirano bodies. **Pick’s Disease** (a subtype of Frontotemporal Dementia) is characterized by progressive atrophy of the frontal and temporal lobes [1]. ### Why "Hirano bodies" is the correct answer: **Hirano bodies** are eosinophilic, rod-like inclusions found primarily in the pyramidal cells of the hippocampus. While they are associated with aging, they are a hallmark histological feature of **Alzheimer’s disease**, not Pick’s disease. ### Explanation of incorrect options: * **Knife-edge/Blade atrophy (Option A):** This is the classic macroscopic description of Pick’s disease. Severe, asymmetric atrophy of the frontal and temporal gyri leads to thinning so pronounced that the gyri resemble the sharp edge of a knife [1]. * **Walnut brain (Option B):** This refers to the gross appearance of the brain in Pick’s disease. Because the atrophy is sharply circumscribed to the frontal and temporal lobes (sparing the parietal and occipital lobes), the brain takes on the shriveled appearance of a walnut shell. * **Ballooning degeneration (Option C):** Also known as **Pick cells**, these are surviving neurons that appear swollen (ballooned) with cleared-out cytoplasm and displaced nuclei, representing a specific pattern of neuronal injury in this condition. ### High-Yield Clinical Pearls for NEET-PG: * **Pick Bodies:** These are the pathognomonic microscopic findings—spherical, silver-staining (Argyrophilic) cytoplasmic inclusions made of **3R Tau protein**. * **Clinical Presentation:** Unlike Alzheimer’s (which starts with memory loss), Pick’s disease presents early with **personality changes**, social disinhibition, and language impairment. * **Sparing:** Note that the posterior two-thirds of the superior temporal gyrus is typically spared [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1294-1296.

Question 1

What is the most common intracranial tumour?

Accepted Answer

Metastatic tumours

Answer

Astrocytoma

Answer

Medulloblastoma

Answer

Meningioma

Question 2

What is true about the etiopathogenesis of Alzheimer's disease?

Accepted Answer

Involvement of Apolipoprotein E

Answer

Absence of tau protein

Answer

Presenilin-1 and 2 involved

Answer

Mutation in chromosome 21

Question 3

What is the most common intracranial neoplasm in adults?

Accepted Answer

Meningioma

Answer

Astrocytoma

Answer

Posterior fossa tumor

Answer

Ganglioneuroma

Question 4

Antoni type A and type B cells are characteristic of which of the following tumors?

Accepted Answer

Neurilemmoma

Answer

Neurofibroma

Answer

Neurofibrosarcoma

Answer

Traumatic neuroma

Question 5

What is the mode of inheritance for Huntington's chorea?

Accepted Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X-linked recessive

Answer

X-linked dominant

Question 6

Neurofibromatosis is associated with all of the following except?

Accepted Answer

Autosomal recessive inheritance

Answer

Cutaneous fibromas

Answer

Cataract

Answer

Scoliosis

Question 7

Lewy bodies are found in the substantia nigra neurons in which of the following conditions?

Accepted Answer

Parkinson disease

Answer

Alzheimer disease

Answer

Huntington disease

Answer

Pick disease

Question 8

All of the following are features of Pick's disease except?

Accepted Answer

Hirano bodies

Answer

Knife blade atrophy

Answer

Walnut brain

Answer

Ballooning degeneration

Question 9

Kuru plaques are seen in which of the following neurodegenerative disorders?

Accepted Answer

Creutzfeldt-Jakob Disease (CJD)

Answer

Alzheimer disease

Answer

Parkinson disease (PD)

Answer

Multiple system atrophy (MSA)

Question 10

Which part of the brain is most resistant to hypoxia?

Accepted Answer

Structures in the brainstem

Answer

Cerebral cortex

Answer

Basal ganglia

Answer

Thalamus

Neuropathology — MCQs

Neuropathology — MCQs

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