FMGE 2018 - Pathology PYQs Practice Questions

Q: AFP is a tumour marker for which of the following?

HCC. ***Correct Option: HCC*** - **Alpha-fetoprotein (AFP)** is the most widely recognized tumor marker for **Hepatocellular Carcinoma (HCC)**, the most common primary liver cancer [1] - Elevated AFP levels (>400 ng/mL) are highly suggestive of HCC and are used for **diagnosis, monitoring treatment response, and surveillance for recurrence** [1] - AFP is also elevated in **yolk sac tumors** and some **non-seminomatous germ cell tumors**, but HCC remains the primary clinical association [1] *Incorrect: Chordoma* - **Chordomas** are rare malignant bone tumors arising from notochord remnants, typically in the skull base or sacrum - **No specific tumor marker** is routinely used; brachyury (transcription factor) may be used as an immunohistochemical marker for diagnosis - AFP is not associated with chordomas *Incorrect: RCC* - **Renal Cell Carcinoma (RCC)** is the most common kidney malignancy - No highly specific tumor markers exist for RCC; occasionally **elevated LDH, alkaline phosphatase, or calcium** may be seen - AFP is not a marker for RCC *Incorrect: Oncocytoma* - **Renal oncocytoma** is a **benign** renal tumor composed of oncocytes (cells with abundant mitochondria) - Diagnosed primarily by **imaging and histology**, not serum markers - AFP has no role in oncocytoma diagnosis or monitoring **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400. [Practice more Pathology PYQs on OnCourse]

Q: Germ cell tumour not seen in males:

Sertoli cell tumour. ***Correct: Sertoli cell tumour*** - Sertoli cell tumours are **sex cord-stromal tumours**, NOT germ cell tumours - They arise from specialized supporting cells in the testes (Sertoli cells) that normally nurture developing germ cells - These tumours produce hormones (estrogen, inhibin) and are distinct from germ cell neoplasias - Account for <1% of testicular tumours *Incorrect: Seminoma* - Seminoma IS a germ cell tumour - the **most common type** in males (40-50% of testicular germ cell tumours) [1] - Originates from malignant germ cells in the testes [1] - Characterized by uniform cells, lymphocytic infiltrate, and excellent prognosis with radiation sensitivity [3] *Incorrect: Choriocarcinoma* - Choriocarcinoma IS a highly aggressive **germ cell tumour** that occurs in males (testicular origin) [1] - Produces **human chorionic gonadotropin (hCG)** - important tumor marker [2] - Can occur as pure choriocarcinoma or as part of mixed germ cell tumour [2] - Characterized by syncytiotrophoblast and cytotrophoblast cells [2] *Incorrect: Teratoma* - Teratoma IS a germ cell tumour composed of tissues from all three embryonic germ layers (ectoderm, mesoderm, endoderm) [1] - Common in males (testicular teratoma) - can be mature or immature [1] - In adult males, even mature teratomas have malignant potential unlike in children [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 980-982. [Practice more Pathology PYQs on OnCourse]

Q: Crescent forming glomerulonephritis is:-

RPGN. ***RPGN*** - **Rapidly progressive glomerulonephritis (RPGN)** is a clinical syndrome characterized by a rapid decline in **renal function** over weeks to months, often due to severe glomerular injury. - The hallmark **histological feature** of RPGN is the formation of **crescents** in more than 50% of the glomeruli, which are proliferations of parietal epithelial cells and infiltrating macrophages [1]. *MCN* - **Minimal change nephropathy (MCN)** is characterized by **diffuse effacement of podocyte foot processes** on electron microscopy, with normal findings on light microscopy. - It typically presents as **nephrotic syndrome** and does not involve crescent formation. *MPGN* - **Membranoproliferative glomerulonephritis (MPGN)** involves thickening of the glomerular basement membrane with a "tram-track" appearance and mesangial proliferation [2]. - While MPGN can occasionally have focal crescents in some cases, **crescent formation is not a defining or characteristic feature** of MPGN [2]. - MPGN typically presents with nephritic-nephrotic syndrome. *All of the options* - This option is incorrect because only RPGN is characterized by **crescent formation** as a defining feature. - MCN does not involve crescents, and MPGN does not characteristically present with extensive crescent formation, thus invalidating this choice. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 528-529. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 925-926. [Practice more Pathology PYQs on OnCourse]

Q: Marble bone disease is:

Osteopetrosis. ***Osteopetrosis*** - **Osteopetrosis**, also known as **marble bone disease**, is a rare genetic disorder characterized by abnormally dense bones due to a defect in **osteoclast function** [1]. - Impaired bone resorption leads to an accumulation of woven bone, causing bones to be fragile despite their density [1]. *Osteosclerosis* - **Osteosclerosis** is a general term for increased bone density and can be a feature of various conditions, including osteopetrosis. - However, it is a descriptive term rather than a specific disease diagnosis equivalent to marble bone disease. *Histiocytosis X* - **Histiocytosis X**, also known as **Langerhans cell histiocytosis**, is a rare disorder involving the proliferation of Langerhans cells. - It primarily affects bone but can also involve other organs, presenting with lytic lesions rather than increased bone density. *Osteomalacia* - **Osteomalacia** is a condition characterized by inadequate mineralization of bone tissue, leading to soft and weakened bones. - It is typically caused by **vitamin D deficiency** and is the opposite of increased bone density. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1188-1189. [Practice more Pathology PYQs on OnCourse]

Q: Most common benign breast tumour:

Fibroadenoma. ***Fibroadenoma*** - **Fibroadenomas** are the **most common benign breast tumors**, typically presenting as mobile, firm, and non-tender masses [1]. - They are composed of both **glandular and stromal tissue** and are more prevalent in younger women [1]. *Phyllodes tumour* - **Phyllodes tumors** are much **rarer** than fibroadenomas and can be benign, borderline, or malignant [3]. - They tend to grow **rapidly** and are characterized by a leaf-like stromal pattern [3]. *Fibroadenosis* - **Fibroadenosis** (or fibrocystic changes) refers to a collection of **benign changes** in the breast tissue, including cysts, fibrosis, and epithelial hyperplasia, rather than a single tumor [2]. - It is a common condition causing lumpy and painful breasts, especially before menstruation [4]. *DCIS* - **Ductal Carcinoma In Situ (DCIS)** is a **non-invasive form of breast cancer** where abnormal cells are confined to the milk ducts. - It is not a benign tumor and carries a risk of progression to invasive breast cancer. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 445-446. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1074. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052. [Practice more Pathology PYQs on OnCourse]

Question 1

AFP is a tumour marker for which of the following?

Accepted Answer

HCC

Answer

Chordoma

Answer

RCC

Answer

Oncocytoma

Question 2

Germ cell tumour not seen in males:

Accepted Answer

Sertoli cell tumour

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Teratoma

Question 3

Crescent forming glomerulonephritis is:-

Accepted Answer

RPGN

Answer

MCN

Answer

All of the options

Answer

MPGN

Question 4

Marble bone disease is:

Accepted Answer

Osteopetrosis

Answer

Osteosclerosis

Answer

Histiocytosis X

Answer

Osteomalacia

Question 5

Most common benign breast tumour:

Accepted Answer

Fibroadenoma

Answer

Phyllodes tumour

Answer

Fibroadenosis

Answer

DCIS

Question 6

Earliest feature of TB:

Accepted Answer

Lymphocytosis

Answer

Caseation

Answer

Granuloma

Answer

Langerhans' Giant cells

Question 7

Albers-Schönberg disease is:

Accepted Answer

Osteopetrosis

Answer

Osteoporosis

Answer

Paget

Answer

Osteogenesis imperfecta

Question 8

Malignancy in a multinodular goiter is most often:-

Accepted Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Answer

Follicular carcinoma

Answer

Medullary carcinoma

Question 9

Which of the following infectious diseases is the most likely cause of granuloma formation?

Accepted Answer

Leprosy

Answer

Syphilis

Answer

Cat scratch disease

Answer

Trench fever

Question 10

In Goodpasture syndrome, which organ is involved apart from the lung?

Accepted Answer

Kidney

Answer

Heart

Answer

Spleen

Answer

Liver

FMGE 2018 — Pathology