NEET-PG 2012 - Pathology Practice Questions

Q: Which histopathological feature is characteristic of chronic hepatitis?

Bridging necrosis. ***Bridging necrosis*** - Commonly seen in chronic hepatitis, bridging necrosis indicates severe liver injury and loss of hepatocyte integrity [1]. - Represents a critical finding in liver biopsy, reflecting ongoing inflammation and necrosis between portal areas and central veins [1]. *Councilman bodies* - These are apoptotic hepatocytes observed primarily in acute hepatitis, not chronic hepatitis. - They are indicative of **viral hepatitis** but are less specific for chronic conditions. *Balloning* - Refers to the ballooning degeneration of hepatocytes, commonly seen in fatty liver disease or acute hepatitis rather than chronic hepatitis. - Although it can occur in chronic conditions, it is not a definitive hallmark for chronic hepatitis specifically. *All* - This option is misleading as it suggests that all the listed features are definitive for chronic hepatitis, which is not accurate. - Individual features like **Councilman bodies** and **balloning** are more related to acute or different liver conditions, rather than chronic hepatitis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 842-844.

Q: What is a Klatskin tumor?

Hilar cholangiocarcinoma. ***Nodular type of cholangiocarcinoma*** - Klatskin tumors are a specific form of **cholangiocarcinoma** occurring at the junction of the left and right hepatic bile ducts [1]. - These tumors are characterized by **biliary obstruction** and often present with **jaundice** as a prominent clinical feature. *Fibrolamellar hepatocellular carcinoma* - This is a variant of **hepatocellular carcinoma** known for its fibrous stroma, distinct from Klatskin tumors which arise from bile ducts. - **Fibrolamellar** is more common in younger patients and typically does not cause **biliary obstruction** characteristic of Klatskin tumors. *Gall bladder carcinoma* - Gall bladder carcinoma originates from the **gallbladder epithelium**, not the bile ducts, differentiating it from Klatskin tumors. - It may present with symptoms such as **abdominal pain** and **weight loss**, rather than the specific obstructive jaundice seen in Klatskin cases. *Hepatocellular carcinoma* - This cancer arises directly from hepatocytes and is unrelated to bile duct tumors like Klatskin tumors. - Commonly linked to **chronic liver disease** and liver cirrhosis, it does not typically present with **obstructive jaundice** as seen in cholangiocarcinomas [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 880-881.

Q: Which of the following is NOT a pathological manifestation of chronic alcoholism?

Piecemeal necrosis. ***Piecemeal necrosis*** - Piecemeal necrosis is not a common manifestation of chronic alcoholism but is instead more typical of **autoimmune hepatitis** or **chronic viral hepatitis**. - Chronic alcoholism primarily leads to different types of liver damage, such as **steatosis** or **apoptosis**, rather than piecemeal necrosis. *Balloning degeneration* - Balloning degeneration reflects **swelling** of hepatocytes, often associated with **alcoholic liver disease** and represents liver cell injury [1]. - It is a recognized feature seen in chronic alcohol exposure indicating the effect of toxicity on liver cells [1]. *Microvesicular fatty changes* - Microvesicular fatty changes, characterized by small fat vacuoles in liver cells, can be induced by chronic alcohol use and is commonly noted in **steatosis** [2]. - This finding is also seen in conditions like **reye syndrome** and is closely related to alcohol-induced liver injury. *Central hyaline sclerosis* - Central hyaline sclerosis refers to fibrosis and is often related to chronic liver disease but is not a direct pathological manifestation seen in chronic alcoholism. - However, chronic alcohol abuse contributes to **cirrhosis**, which can lead to various forms of liver scarring, but this is not specific to alcohol alone [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 389-390. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 848-850. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 848.

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: 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 tumor marker is most commonly associated with lung and breast carcinoma?

CEA. ***CEA*** - **Carcinoembryonic antigen (CEA)** is a tumor marker commonly associated with **lung** and **breast cancers** [1]. - Elevated levels of CEA are often observed in **various malignancies**, making it useful for monitoring treatment response and recurrence. *CA-15-3* - While **CA-15-3** is a breast cancer marker, it is less specific than CEA and often used primarily for **monitoring** but not for initial diagnosis. - It is primarily elevated in **breast carcinoma**, not typically associated with **lung cancer**. *11CG* - This ppears to be incorrectly referenced and may not exist as a recognized tumor marker for lung or breast cancer. - There are no clinical associations with lung or breast cancer, making it irrelevant in this context. *AFP* - **Alpha-fetoprotein (AFP)** is primarily associated with **liver** and **germ cell tumors**, not commonly associated with lung or breast cancers [1]. - Elevated AFP levels do not correlate with lung or breast carcinomas, distinguishing it from CEA's relevance. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 346.

Q: Vegetations in Libman-Sacks endocarditis are:

Small or medium sized on either or both sides of valve. ***Small or medium sized on either or both sides of valve*** - **Libman-Sacks endocarditis** typically presents with vegetations that are **small to medium in size**, found on either aspect of the valve leaflets [1][2][3]. - These vegetations are **sterile**, non-infectious, and often associated with systemic lupus erythematosus (SLE) [2][3]. *Large and fragile* - Vegetations in Libman-Sacks endocarditis are not typically **large**; they are small or medium [1]. - The term **fragile** is misleading, as the vegetations are not characterized by fragility but by being sturdy yet non-infectious. *Small warty along the line of closure of valve* - While the vegetations are small, they are **not warty** and do not primarily form along the line of closure, which is common in infective endocarditis [1]. - Libman-Sacks vegetations can be found on either side of the valve, unlike warty vegetations [1]. *Small bland vegetations* - Vegetations in Libman-Sacks endocarditis are bland but not solely described as **small and bland**; their presence on either or both sides of the valve is critical [1]. - This option fails to capture the significance of their size and localization in the endocardial lesions associated with SLE. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 232-233. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 570.

Q: Medial calcification is seen in -

Monckeberg's sclerosis. ***Monckeberg's sclerosis*** - This condition is characterized by **calcific deposits** within the **tunica media** of muscular arteries. - It typically does not occlude the vessel lumen and is often asymptomatic, though severe calcification can lead to vessel rigidity. *Atherosclerosis* - Involves the formation of **atheromatous plaques** in the **tunica intima** of large and medium-sized arteries. - These plaques consist of lipids, inflammatory cells, smooth muscle cells, and fibrous connective tissue, leading to luminal narrowing and hardening of arteries. *Arteriolosclerosis* - Refers to the thickening and hardening of the walls of **arterioles** (small arteries). - It is often associated with hypertension and diabetes, affecting resistance vessels but typically not involving extensive medial calcification. *Dissecting aneurysm* - This condition involves a **tear in the tunica intima** of an artery, allowing blood to enter and dissect between the layers of the arterial wall. - It is a life-threatening condition primarily affecting the aorta and is characterized by a false lumen, not medial calcification.

Q: What is the term for the collapse of a lung?

Atelectasis. ***Atelectasis*** - **Atelectasis** is the technical term for the **collapse of a lung** or a part of a lung, leading to reduced or absent gas exchange. - It can be caused by **obstruction of the airway** (e.g., mucus plug, foreign body) or external compression on the lung [1]. *Emphysema* - **Emphysema** is a chronic lung disease characterized by the **destruction of the alveoli**, leading to permanent enlargement of airspaces [2]. - It results in reduced elastic recoil of the lungs and is a type of **COPD (chronic obstructive pulmonary disease)** [2]. *Bronchiectasis* - **Bronchiectasis** is a chronic condition where the airways (bronchi) become **abnormally widened** and scarred. - This widening leads to a buildup of mucus, making the lungs vulnerable to **recurrent infections**. *Bronchitis* - **Bronchitis** is an inflammation of the lining of the bronchial tubes, which carry air to and from your lungs. - It typically causes a **cough** with mucus production and can be acute or chronic.

Q: Oncocytic carcinoma arises from -

Collecting duct (intercalated cells). ***Collecting duct*** - Oncocytic carcinoma primarily originates from the **collecting ducts** of the kidney, where oncocytes are characteristically found [1]. - It is associated with specific **morphological features**, including abundant eosinophilic cytoplasm. *Loop of henle* - This part of the nephron primarily functions in **concentration of urine** and is not a common site for oncocytic tumors. - Tumors arising here typically do not exhibit **oncocytic features** and are more often linked to different renal cell types. *Glomerulus* - The glomerulus is involved in **filtration of blood** and lacks oncocytic differentiation. - Oncocytic carcinoma does not arise from glomerular structures, as it features distinct cellular characteristics. *Perivascular* - This term refers to the tissue surrounding blood vessels and is not a site for oncocytic carcinoma development. - Such tumors would not align with the histological features or origins typically seen in oncocytic carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 959.

Question 1

Which histopathological feature is characteristic of chronic hepatitis?

Accepted Answer

Bridging necrosis

Answer

Ballooning degeneration

Answer

Councilman bodies

Answer

None of the options

Question 2

What is a Klatskin tumor?

Accepted Answer

Hilar cholangiocarcinoma

Answer

Fibrolamellar hepatocellular carcinoma

Answer

Gall bladder carcinoma

Answer

Hepatocellular carcinoma

Question 3

Which of the following is NOT a pathological manifestation of chronic alcoholism?

Accepted Answer

Piecemeal necrosis

Answer

Microvesicular fatty changes

Answer

Central hyaline sclerosis

Answer

Ballooning degeneration

Question 4

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 5

Cells most sensitive to hypoxia are?

Accepted Answer

Neurons

Answer

Myocardial cells

Answer

Hepatocytes

Answer

Renal tubular epithelial cells

Question 6

Which tumor marker is most commonly associated with lung and breast carcinoma?

Accepted Answer

CEA

Answer

hCG

Answer

AFP

Answer

CA-15-3

Question 7

Vegetations in Libman-Sacks endocarditis are:

Accepted Answer

Small or medium sized on either or both sides of valve

Answer

Large and fragile

Answer

Small warty along the line of closure of valve

Answer

Small bland vegetations

Question 8

Medial calcification is seen in -

Accepted Answer

Monckeberg's sclerosis

Answer

Atherosclerosis

Answer

Arteriolosclerosis

Answer

Dissecting aneurysm

Question 9

What is the term for the collapse of a lung?

Accepted Answer

Atelectasis

Answer

Emphysema

Answer

Bronchitis

Answer

Bronchiectasis

Question 10

Oncocytic carcinoma arises from -

Accepted Answer

Collecting duct (intercalated cells)

Answer

Perivascular region

Answer

Renal glomerulus

Answer

Loop of Henle

NEET-PG 2012 — Pathology