NEET-PG 2015 - Pathology Practice Questions

Q: All of the following are features of granulomatous thyroiditis except?

Painless. ***Painless*** - Granulomatous thyroiditis is characterized by **painful** thyroid gland inflammation, which is a distinguishing feature. - Thus, describing it as **painless** contradicts the typical clinical presentation. *Hyperthyroidism* - Granulomatous thyroiditis may lead to **hyperthyroidism** initially due to the release of thyroid hormones from damaged follicles [1]. - However, this condition can also lead to transient thyroid function changes or even permanent hypothyroidism later on [1]. *Hypothyroidism* - While **hypothyroidism** can occur post-thyroiditis, it is not a feature of granulomatous thyroiditis at the outset like the **painless** descriptor. - This condition often starts with hyperthyroid symptoms and may evolve later, differing from primary hypothyroid disorders. *Giant cells on histology* - Histological examination typically reveals **multinucleated giant cells**, a hallmark of granulomatous inflammation, as seen in this thyroid condition. - This significant finding helps in differentiating it from other thyroid disorders. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1091-1092.

Q: Sezary cells show which type of nucleus?

Cerebriform. ***Cerebriform*** - **Sezary cells** are characterized by their distinctive **cerebriform nuclei**, giving them an irregular, convoluted appearance [1,2]. - This finding is a hallmark of **cutaneous T-cell lymphoma** and emphasizes their potential malignancy [1,2]. *Round* - Round nuclei do not reflect the typical morphology of **Sezary cells**, which are noted for their **irregular shape**. - Other lymphocytes may exhibit round nuclei, but this does not specifically indicate a **Sezary cell** presence. *Pleomorphic* - While some malignant cells might show **pleomorphic nuclei**, Sezary cells uniquely showcase **cerebriform nuclei** rather than varying shapes [1,2]. - Pleomorphic is not a defining characteristic of **Sezary cells**, making this description inaccurate. *Eosinophillic* - Eosinophilic refers to cells that stain positively for **eosin**, typically associated with **eosinophils**, which is not relevant to **Sezary cells**. - Sezary cells are more about their **nuclear morphology** and less about eosinophilic staining characteristics. **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. 564-565. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 613-614.

Q: What does Prussian blue staining specifically detect in histology?

Ferric iron. ***Ferric iron*** - The **Prussian blue reaction**, also known as Perls' stain, specifically identifies **ferric iron (Fe3+)** in tissue sections. - This stain is crucial for diagnosing conditions involving **iron overload**, such as hemochromatosis or hemosiderosis, by highlighting iron deposits as blue. *Ferrous iron* - The Prussian blue stain does **not react with ferrous iron (Fe2+)**; it specifically targets the ferric (oxidized) state of iron. - While ferrous iron is present in the body, it is not detected by this particular staining method for routine histological assessment of iron stores. *Glycogen* - **Glycogen** is a polysaccharide storage molecule and is typically stained using the **Periodic Acid-Schiff (PAS) stain**, which produces a magenta color. - Prussian blue staining is entirely unrelated to the detection of glycogen and would not highlight these molecules in tissue. *Lipids* - **Lipids** are fats and are typically stained with lipid-soluble dyes like **Oil Red O** or **Sudan Black**, especially in frozen sections to preserve their structure. - Prussian blue stain has no affinity for lipids and therefore cannot be used to detect them in histological samples.

Q: Homer-Wright rosette is seen in -

Neuroblastoma. ***Neuroblastoma*** - **Homer rosettes** are characteristic histopathological findings associated with neuroblastoma, indicating differentiation [1]. - This type of cancer typically occurs in **children**, primarily arising from the **adrenal glands** or sympathetic nervous system [1]. *Hepatoma* - Primarily affects the **liver** and is characterized by the presence of **hepatocytes** rather than Homer rosettes. - Typically associated with underlying **chronic liver disease** such as cirrhosis or hepatitis B/C. *Ependymoma* - Consists of cells arising from **ependymal cells** lining the ventricles of the brain and spinal cord, mainly involves **perivascular pseudorosettes**, not Homer rosettes. - Often presents with symptoms related to **increased intracranial pressure** due to obstruction. *Nephroblastoma* - Commonly known as **Wilms tumor**, it typically presents with a **palpable abdominal mass** in children and does not feature Homer rosettes. - Characterized by a triphasic histological pattern (blastemal, epithelial, and stromal components) rather than neuroblastic differentiation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-485.

Q: What does Ghon's focus indicate in the context of tuberculosis?

Primary complex. ***Primary complex*** - A **Ghon's focus** is the initial parenchymal lesion (typically subpleural) that develops during primary tuberculosis infection [1]. - The Ghon's focus, together with an enlarged regional lymph node (usually hilar or mediastinal), forms the **Ghon's complex** or **Primary complex** [2]. - When this complex undergoes calcification and healing, it is called a **Ranke complex**, which indicates past healed primary TB. *Post primary tuberculosis* - Also known as **reactivation tuberculosis** or **secondary tuberculosis**, this typically occurs years after the primary infection, usually in the apices of the lungs [2]. - It represents reactivation of dormant bacilli, not the initial primary infection lesion. - Characterized by cavitary lesions and often more severe pulmonary symptoms. *Miliary tuberculosis* - This is a form of progressive, widespread tuberculosis characterized by the presence of **tiny, millet-seed sized lesions** disseminated throughout the body via hematogenous spread [3]. - It indicates a severe and life-threatening form of TB resulting from massive lymphohematogenous dissemination. - Not related to the localized primary complex. *Tuberculous lymphadenitis* - This refers to **tuberculous infection of lymph nodes**, most commonly in the cervical region (scrofula). - While lymph node involvement is part of the primary complex, Ghon's focus specifically refers to the **parenchymal lung lesion**, not the lymph node component alone [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 379-380. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 319-320. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 320-321.

Q: Fibrosis associated with liver cirrhosis is mediated by -

Transforming Growth Factor-beta (TGF-β). ***PDGF*** - Platelet-Derived Growth Factor (**PDGF**) is a critical mediator in the **fibrogenic response** associated with liver cirrhosis [1]. - It stimulates the **proliferation** and activation of hepatic stellate cells, leading to excessive **collagen deposition** and fibrosis [1][2]. *ICAM-1* - Intercellular Adhesion Molecule-1 (**ICAM-1**) primarily mediates **cell adhesion** and is involved in inflammatory processes, not directly in fibrosis. - While it may play a role in **leukocyte recruitment**, it does not contribute significantly to the fibrogenic pathway in liver cirrhosis. *PcAM-l* - **PCAM-1** (Platelet/endothelial cell adhesion molecule-1) is involved in **cell adhesion** and is primarily expressed on endothelial cells. - Its role is more associated with **angiogenesis** and inflammation, lacking direct involvement in the fibrogenic process of cirrhosis. *IFN-y* - Interferon-gamma (**IFN-y**) is a cytokine that predominantly has a role in **immune modulation** and does not directly induce fibroblast activation. - It may have regulatory effects on inflammation but does not lead to significant fibrosis associated with liver cirrhosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 31-32. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 830-832.

Q: Which of the following markers is specific for gastro-intestinal stromal tumor (GIST)?

CD117. ***CD 117*** - CD 117 (c-KIT) is the **primary marker** for gastrointestinal stromal tumors (GIST), indicating the presence of the **c-KIT gene mutation** [1]. - Its expression is crucial for diagnosing GISTs, as it is found in nearly all cases of these tumors. *CD 34* - While CD 34 is expressed in some GISTs, it is a **more general marker** associated with stem cells and not specific for GISTs. - GISTs can be negative for CD 34, making it unsuitable for definitive diagnosis. *S-100* - S-100 is typically a marker for **melanocytes** and neuroectodermal tumors, not for GISTs. - It is often used to identify **schwannomas** or **melanomas**, which are unrelated to GIST pathology. *CD 23* - CD 23 is primarily a marker for **chronic lymphocytic leukemia (CLL)** and some forms of lymphoma, not associated with GISTs. - Its presence indicates **lymphoid** lineage, further diverging from GISTs, which are **mesenchymal tumors**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 782-783.

Q: What is the initial event in serum sickness?

It occurs due to exposure to heterologous antigens.. ***Can lead to leukocytoclastic vasculitis*** - Serum sickness is characterized by the formation of **immune complexes**, which can trigger **leukocytoclastic vasculitis** affecting the blood vessels [1][2]. - Symptoms can include **rash, fever, and arthralgia**, typically occurring 1-3 weeks after exposure to the offending antigen [2]. *Can occur due to homologous antigen* - Serum sickness is usually a reaction to **heterologous** antigens, such as those from animal serum, not **homologous** ones. - Homologous antigens do not typically elicit the immune response seen in serum sickness; hence, this statement is incorrect. *Type 2 hypersensitivity* - Serum sickness is classified as a **Type III hypersensitivity** reaction due to the immune complex formation, not Type II [1]. - Type II is characterized by antibody-mediated destruction of **target cells**, which does not apply here. *Hypercomplementemia* - Serum sickness is associated with **hypocomplementemia** due to complement consumption from immune complex formation, not hypercomplementemia. - This can lead to **decreased complement levels** during the response, making this statement incorrect. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-216. [2] 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. 172-173.

Q: What is the first cellular response observed after a sharp nerve cut?

Chromatolysis. ***Chromatolysis*** - **Chromatolysis** is the dissolution of the Nissl bodies (rough endoplasmic reticulum) in the neuron cell body following axonal injury, which is the **first observable cellular response** [1]. - This process is a preparatory step for neuronal regeneration, indicating the cell's attempt to repair the damaged axon [1]. *Polymorphic arrangement* - This term is not typically used to describe an immediate cellular response to a nerve cut; it might refer to diverse cell shapes or arrangements in different contexts but is not a recognized initial post-injury event. - The neuron's immediate response involves changes within the cell body, not a re-arrangement of its cellular structure with other cells. *Increased protein synthesis* - While increased protein synthesis does occur during neuronal repair and regeneration, it is a consequence of chromatolysis and part of a later, more sustained response, not the very first visible cellular change [1]. - **Chromatolysis precedes** and facilitates the subsequent increase in protein synthesis necessary for axonal regrowth [1]. *Macrophage activation* - **Macrophage activation** is a crucial part of the inflammatory response and debris clearance following nerve injury, but it is not the *first cellular response* of the neuron itself [2]. - Macrophages migrate to the site of injury hours to days after the initial insult, whereas chromatolysis begins within the neuron's cell body much earlier [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1254-1256. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 697-698.

Question 1

All of the following are features of granulomatous thyroiditis except?

Accepted Answer

Painless

Answer

Hyperthyroidism

Answer

Giant cells on histology

Answer

Hypothyroidism

Question 2

Sezary cells show which type of nucleus?

Accepted Answer

Cerebriform

Answer

Pleomorphic

Answer

Round

Answer

Eosinophilic

Question 3

What does Prussian blue staining specifically detect in histology?

Accepted Answer

Ferric iron

Answer

Ferrous iron

Answer

Glycogen

Answer

Lipids

Question 4

Homer-Wright rosette is seen in -

Accepted Answer

Neuroblastoma

Answer

Nephroblastoma

Answer

Hepatoma

Answer

Ependymoma

Question 5

What does Ghon's focus indicate in the context of tuberculosis?

Accepted Answer

Primary complex

Answer

Post primary tuberculosis

Answer

Miliary tuberculosis

Answer

Tuberculous lymphadenitis

Question 6

Fibrosis associated with liver cirrhosis is mediated by -

Accepted Answer

Transforming Growth Factor-beta (TGF-β)

Answer

Platelet-Derived Growth Factor (PDGF)

Answer

Vascular Endothelial Growth Factor (VEGF)

Answer

Tumor Necrosis Factor-alpha (TNF-α)

Question 7

Which of the following markers is specific for gastro-intestinal stromal tumor (GIST)?

Accepted Answer

CD117

Answer

CD34

Answer

CD23

Answer

S-100

Question 8

What is the initial event in serum sickness?

Accepted Answer

It occurs due to exposure to heterologous antigens.

Answer

It is associated with hypocomplementemia.

Answer

It is a type III hypersensitivity reaction.

Answer

It can lead to leukocytoclastic vasculitis.

Question 9

What is the first cellular response observed after a sharp nerve cut?

Accepted Answer

Chromatolysis

Answer

Polymorphic arrangement

Answer

Increased protein synthesis

Answer

Macrophage activation

Question 10

Which of the following statements about Niemann-Pick disease is false?

Accepted Answer

Type B Niemann-Pick disease is characterized by severe neurological symptoms.

Answer

Due to deficiency of sphingomyelinase.

Answer

CNS symptoms are present in type A.

Answer

Histiocytes show PAS positive inclusions, and Type A is more severe.

NEET-PG 2015 — Pathology