NEET-PG 2013 - Pathology Practice Questions

Q: Amyloidosis is associated with all of the following conditions except?

Chronic bronchitis. ***Chronic bronchitis*** - Chronic bronchitis is primarily characterized by **inflammation of the airways** and **excess mucus production**, not typically associated with amyloidosis [1]. - Amyloidosis more commonly relates to chronic inflammatory states but does not directly result from the long-term exposure seen in chronic bronchitis [1]. *Tuberculosis* - Tuberculosis can lead to chronic inflammation, which may precipitate **secondary amyloidosis** due to persistent infection [1]. - It often causes systemic effects, including weight loss and fever, which can result in **amyloid deposition** [1]. *Osteomyelitis* - Osteomyelitis, as a chronic bone infection, can trigger an inflammatory response leading to **secondary amyloidosis** [1]. - The ongoing inflammation can result in the accumulation of amyloid proteins in the bone and surrounding tissues [1]. *Bronchiectasis* - Bronchiectasis often results from persistent lung infections leading to chronic inflammation, which can cause **amyloid deposition** [1,3]. - It is associated with recurrent lung infections and can lead to systemic complications, including amyloidosis [1,3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 135-136. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 269-270.

Q: Which of the following is a sign of reversible injury in alcoholic liver disease?

Cytoplasmic vacuole. ***Cytoplasmic vacuole*** - The presence of **cytoplasmic vacuoles** in liver cells indicates fatty change, which is a **reversible injury** in alcoholic liver disease [1][2]. - This injury allows the liver to recover if **alcohol consumption** is ceased, highlighting its reversible nature [1]. *Nuclear karyolysis* - **Nuclear karyolysis** signifies severe cellular damage and necrosis, indicating an irreversible process [2]. - This feature involves the dissolution of the nucleus, which does not align with reversible injury. *Loss of cell membrane* - Loss of the **cell membrane** indicates irreversible damage, leading to cell death rather than a reversible condition [2]. - This change is associated with significant cellular impairment, contrary to the concept of recovery. *Pyknosis* - **Pyknosis**, the condensation of chromatin in the nucleus, suggests irreversible cellular injury and impending necrosis [2]. - It is often a precursor to cell death and is not indicative of reversible damage in liver pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 848-850. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 51-53.

Q: Caseous necrosis is seen in -

Tuberculosis. ***Tuberculosis*** - **Caseous necrosis** is the **pathognomonic** and **most characteristic** form of necrosis seen in **tuberculosis (TB)** caused by *Mycobacterium tuberculosis* [1]. - It appears as a **cheesy, friable, granular material** in the center of **tuberculous granulomas** (tubercles) [1], [2]. - The unique **lipid-rich cell wall** of *M. tuberculosis* combined with the host's **type IV hypersensitivity reaction** results in this distinctive pattern of tissue destruction [2]. - This is a **classic histopathological hallmark** of TB and is essential for diagnosis [2]. *Treponemal infection* - **Syphilis**, caused by *Treponema pallidum*, causes **gummatous necrosis**, NOT caseous necrosis [3]. - Gummas have a **rubbery consistency** and different histological appearance compared to the cheesy, friable caseous necrosis. - While syphilis produces granulomatous inflammation, the necrosis pattern is distinctly different from TB [3]. *CMV infection* - **Cytomegalovirus (CMV)** infection typically causes **coagulative necrosis** with **cytopathic effects** (enlarged cells with intranuclear and intracytoplasmic inclusions - "owl's eye" appearance) [3]. - Does NOT produce caseous necrosis. *Staphylococcal infection* - **Staphylococcal infections** (e.g., *Staphylococcus aureus*) cause **liquefactive necrosis** leading to **abscess formation** [3]. - Dead cells are enzymatically digested into **liquid pus**, completely different from the solid, cheesy appearance of caseous necrosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 55. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 383-384. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360.

Q: Which of the following cell types is classified as a labile cell?

Surface epithelium. ***Surface epithelium*** - Surface epithelium is classified as **labile tissue**, meaning it undergoes constant regeneration due to its high turnover rate [1]. - Cells in this tissue are typically found in areas that experience frequent damage or abrasion, such as the skin and lining of the intestines. *Cardiac cell* - Cardiac cells are considered **permanent cells**, as they do not undergo significant regeneration after injury or damage. - Damage to cardiac cells typically leads to **fibrosis** rather than repair of the original tissue. *Liver parenchymal cell* - Liver parenchymal cells are categorized as **stable cells**, which can regenerate but do so under specific circumstances, such as injury. - They have a slower turnover rate compared to labile cells and do not constantly renew under normal conditions. *Vascular endothelial cells* - Vascular endothelial cells are considered **stable cells** as well, typically maintaining a stable population but capable of regeneration following injury. - They do not have the same rapid turnover and regeneration capability as labile cells do, especially under normal physiological conditions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 113-115.

Q: Which of the following changes is NOT seen in atherosclerotic plaque at the time of rupture?

Thick fibrous cap. ***Smooth muscle cell hypertrophy*** - **Smooth muscle cell hypertrophy** is generally associated with stable plaques and does not typically occur in ruptured atherosclerotic plaques [2]. - At rupture, there is **loss of smooth muscle cells** and thinning of the fibrous cap, leading to plaque instability [2]. *Thin fibrosis cap* - A **thin fibrous cap** is a critical feature of vulnerable plaques, making them prone to rupture [2]. - It indicates a **weakened structure** that can no longer withstand the pressure of the underlying lipid core [2]. *Cell debris* - **Cell debris** is often found at the site of rupture, resulting from the necrosis of foam cells and smooth muscle cells. - This indicates **plaque instability** and contributes to the thrombus formation at the rupture site. *Multiple foam cap* - The presence of **multiple foam cells** reflectsing lipid accumulation in the plaque but does not contribute to the phenomenon of plaque rupture directly. - While foam cells are associated with rupture, a **foam cap** is not a recognized pathological finding at the time of rupture. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 271-272. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 268-270.

Q: All are true about non-bacterial thrombotic endocarditis, except?

Vegetation > 5 mm. ***Vegetation > 5 mm*** - Non-bacterial thrombotic endocarditis (NBTE) typically features **small vegetations**, often less than 5 mm, associated with conditions like **cancer** or **hypercoagulable states** [1]. - The presence of larger vegetations is more characteristic of **infective endocarditis**, making this statement false regarding NBTE. *Cause emboli* - NBTE is known to cause **embolic phenomena** due to small vegetations that dislodge, leading to **ischemia** in distant organs. - It is associated with conditions such as **adenocarcinoma**, contributing to possible embolic events. *No inflammatory reaction* - Although inflammatory cells are sparse, NBTE can produce a **minimal inflammatory response** in the tissues. - The presence of fibrin deposits and small vegetations has implications for **thrombus formation**, suggesting a mild inflammatory component. *Locally nondestructive* - NBTE vegetations are primarily **nondestructive** to the underlying valves [1], contrasting with infected vegetations that can cause significant **valvular damage**. - However, this characteristic still does not undermine that these vegetations can lead to systemic embolism despite being locally nondestructive. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Q: The MOST COMMON cause of concentric hypertrophy of left ventricle is?

Hypertension. ***Hypertension*** - Chronic **hypertension** is the most common cause of **pressure overload** on the left ventricle, leading to concentric hypertrophy [1]. - In response to the increased afterload, the ventricular wall thickens uniformly inward, reducing the chamber size while maintaining normal wall stress [2]. - Due to its high prevalence (30-40% of adults), hypertension is epidemiologically the most frequent cause of concentric LVH [1]. *Aortic stenosis* - While **aortic stenosis** is the classic pathological cause of **pressure overload** and concentric hypertrophy [2], **hypertension** is more prevalent in the population. - Aortic stenosis causes fixed outflow obstruction, leading to significant pressure work for the left ventricle. - This is the second most common cause but occurs in only 2-5% of elderly patients. *Mitral stenosis* - **Mitral stenosis** primarily causes pressure overload on the **left atrium** and **pulmonary circulation**, not the left ventricle. - It doesn't typically lead to **left ventricular hypertrophy** directly; instead, it causes left atrial enlargement and right ventricular hypertrophy. *Aortic regurgitation* - **Aortic regurgitation** results in **volume overload** of the left ventricle due to blood flowing back into the chamber during diastole. - This typically leads to **eccentric hypertrophy**, where the chamber dilates and the wall thickens proportionally, rather than concentric hypertrophy [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 560-562. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 536.

Q: Fibrinoid necrosis with neutrophilic infiltration is seen in ?

Polyarteritis Nodosa (PAN). ***PAN*** - **Fibrinoid necrosis** with **neutrophilic infiltration** is characteristic of Polyarteritis Nodosa (PAN), which primarily affects medium-sized arteries [1]. - The necrosis is often seen in the context of **systemic vasculitis**, where it leads to damage and inflammation of vessel walls [3]. *Takayasu arteritis* - Primarily affects **large vessels** like the aorta and its major branches, typically presenting with **pulselessness** or **claudication**. - It shows **granulomatous inflammation** rather than fibrinoid necrosis with neutrophilic infiltration. *Giant cell arteritis* - Predominantly affects large and medium arteries, especially the **temporal artery**, often leading to headaches and visual disturbances. - It is associated with **giant cells** and lymphocytic infiltration rather than fibrinoid necrosis. *Wegener's granulomatosis* - Characterized by **granulomatous inflammation** and vasculitis affecting small to medium vessels, particularly in the lungs and kidneys. - It does not typically present with **fibrinoid necrosis**; instead, it shows necrotizing granulomas [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 517-518. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 518-519. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 687-688.

Question 1

Amyloidosis is associated with all of the following conditions except?

Accepted Answer

Chronic bronchitis

Answer

Osteomyelitis

Answer

Bronchiectasis

Answer

Tuberculosis

Question 2

Which of the following is a sign of reversible injury in alcoholic liver disease?

Accepted Answer

Cytoplasmic vacuole

Answer

Pyknosis (nuclear shrinkage)

Answer

Loss of cell membrane integrity

Answer

Nuclear karyolysis (nuclear dissolution)

Question 3

Caseous necrosis is seen in -

Accepted Answer

Tuberculosis

Answer

CMV infection

Answer

Treponemal infection

Answer

Staphylococcal infection

Question 4

Dystrophic calcification is seen in

Accepted Answer

Atheromatous plaque

Answer

Vitamin A intoxication

Answer

Milk alkali syndrome

Answer

Hyperparathyroidism

Question 5

Which of the following cell types is classified as a labile cell?

Accepted Answer

Surface epithelium

Answer

Liver parenchymal cells

Answer

Vascular smooth muscle cells

Answer

Neurons

Question 6

Which of the following changes is NOT seen in atherosclerotic plaque at the time of rupture?

Accepted Answer

Thick fibrous cap

Answer

Inflammatory cell infiltration

Answer

Cell debris

Answer

Smooth muscle cell atrophy

Question 7

Irreversible injury in myocardium occurs at ?

Accepted Answer

30 minutes

Answer

5 hours

Answer

1 minute

Answer

1 hour

Question 8

All are true about non-bacterial thrombotic endocarditis, except?

Accepted Answer

Vegetation > 5 mm

Answer

No inflammatory reaction

Answer

Locally nondestructive

Answer

Cause emboli

Question 9

The MOST COMMON cause of concentric hypertrophy of left ventricle is?

Accepted Answer

Hypertension

Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Aortic regurgitation

Question 10

Fibrinoid necrosis with neutrophilic infiltration is seen in ?

Accepted Answer

Polyarteritis Nodosa (PAN)

Answer

Giant Cell Arteritis

Answer

Takayasu Arteritis

Answer

Wegener's Granulomatosis

NEET-PG 2013 — Pathology