NEET-PG 2015 - Pathology Practice Questions

Q: Basket weave appearance of glomerular basement membrane on electron microscopy is seen in

Alport syndrome. ***Alport syndrome*** - **Alport syndrome** is characterized by a "basket weave" appearance of the **glomerular basement membrane (GBM)** on electron microscopy due to irregular thickening, thinning, and splitting of the lamina densa. - This structural abnormality results from mutations in genes encoding **Type IV collagen**, particularly **COL4A5**, leading to progressive kidney disease, hearing loss, and ocular abnormalities. *Polyarteritis nodosa* - This is a **necrotizing vasculitis** primarily affecting medium-sized arteries, and its renal involvement typically manifests as a focal or diffuse necrotizing glomerulonephritis, often without specific GBM changes. - The electron microscopic findings would generally show inflammatory cell infiltration and fibrinoid necrosis of vessel walls, not a characteristic GBM pattern. *Giant cell arteritis* - **Giant cell arteritis** is a vasculitis affecting large- and medium-sized arteries, typically in the elderly, and often involves the temporal arteries. - Renal involvement is rare, and the characteristic pathological finding is **granulomatous inflammation** within the arterial wall with giant cells, not GBM changes. *Acute post-streptococcal glomerulonephritis* - This condition is characterized by **subepithelial immune deposits ("humps")** on electron microscopy, not a "basket weave" pattern of the GBM. - The GBM itself may show minor changes but does not exhibit the lamellated and split appearance seen in Alport syndrome.

Q: Which is a hormone dependent liver tumor?

Adenoma. ***Adenoma*** - Hepatic adenomas are **hormone-dependent tumors** commonly associated with conditions like **oral contraceptive use** and are influenced by estrogen [1]. - These tumors can present as **benign liver masses**, but they have a risk of hemorrhage and malignant transformation [1]. *Hepatocellular carcinoma* - This is a **malignant tumor** of the liver primarily associated with cirrhosis and chronic liver disease, not directly hormone-dependent. - Risk factors include **viral hepatitis** and **alcohol exposure**, rather than hormonal influences. *Hemangioma* - Liver hemangiomas are **vascular lesions** that are usually asymptomatic and are **not hormone-dependent**. - They are the most common benign liver tumors, often discovered incidentally during imaging. *Hemangiopericytoma* - A rare tumor, hemangiopericytoma originates from **pericytes** around blood vessels and is not specifically associated with liver tissue or hormones. - It can arise in various organs but lacks the dependency on hormones seen in hepatic adenomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 874.

Q: Which type of anemia is most commonly characterized by marked poikilocytosis and anisocytosis on peripheral blood smear?

Iron deficiency anemia. ***Iron deficiency anaemia*** - Characterized by **poikilocytosis** (abnormal shapes) and **anisocytosis** (variation in red blood cell sizes), which are common findings in iron deficiency [1]. - Typically results in **microcytic hypochromic anemia** [1], distinguishing it from other types of anemia. *Nutritional deficiency anaemia* - May present with various blood cell morphology but does not specifically exhibit **poikilocytosis** and **anisocytosis** characteristic of iron deficiency anemia. - Usually includes deficiencies like **vitamin B12** or **folate**, which result in **macrocytic anemia** instead. *Megaloblastic anaemia* - Primarily caused by deficiency of **vitamin B12** or **folate**, leading to large, immature red blood cells (megaloblasts) rather than varied shapes and sizes. - Associated with **hypersegmented neutrophils** in the blood smear, which differentiates it from iron deficiency anemia. *Thalassemia* - Characterized by **microcytic hypochromic red blood cells** and often involves **target cells** rather than generalized poikilocytosis and anisocytosis. - Typically presents with **hemolytic anemia** but does not show the same variability in cell shapes and sizes as seen in iron deficiency anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: The Ham test is specifically used for diagnosing paroxysmal nocturnal hemoglobinuria (PNH) and is based upon:

Complement. ***Complement*** - The HAM test is based on the activation of the **complement system** which enhances the opsonization and clearance of immune complexes [1]. - It is used in the diagnosis of certain conditions, notably those associated with **hemolytic anemia** due to complement fixation. *GPI Anchor Proteins* - GPI anchor proteins are involved in anchoring proteins to cell membranes but are **not related to the HAM test**. - This oes not explain the **mechanism** or purpose of the HAM test. *Mannose binding proteins* - Mannose binding lectins play a role in **innate immunity** but are not the basis of the HAM test. - They function in the **opsonization of pathogens**, which is unrelated to the complement activation aspect of the HAM test. *Spectrin protein* - Spectrin is a cytoskeletal protein that contributes to the integrity of cell membranes, particularly in red blood cells. - It does not relate to the **mechanism of the HAM test**, which focuses on complement involvement. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 99-100.

Q: The tissue of origin of the Kaposi's sarcoma is

Vascular. ***Vascular*** - Kaposi's sarcoma originates from the **vascular tissue**, specifically from endothelial cells lining blood vessels [2]. - The lesions are characterized by **angiogenesis**, leading to the formation of vascular tumors with dilated endothelial cell-lined vascular spaces [1]. *Muscular* - Muscular tissue is involved in **voluntary** and **involuntary movements** but is not related to the etiology of Kaposi's sarcoma. - This condition does not arise from **muscle cells** or any muscular components. *Neural* - Neural tissue consists of **neurons** and **glial cells**, which are not implicated in Kaposi's sarcoma. - Kaposi's sarcoma does not originate from any **neural structures** or pathologies. *Lymphoid* - Lymphoid tissue primarily concerns the immune system, particularly the **lymphatic system**, and does not give rise to Kaposi's sarcoma. - This malignancy does not derive from **lymphoid components** like lymphocytes or lymph nodes. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 526-527. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 282-283.

Q: Which viral proteins are known to act as carcinogens in causing carcinoma cervix?

E - gene. ***E - gene*** - The **E - gene** in human papillomavirus (HPV) is known to play a crucial role in the **transformation of cervical cells**, leading to cancer development [1]. - Specifically, the **E6 and E7 proteins** encoded by this gene interfere with tumor suppressor functions, contributing to cervical carcinoma [1,2]. *L - gene* - The **L - gene** is associated with the virus's structural proteins, primarily aiding in the formation of the viral capsid. - It does not have a direct role in the oncogenic process leading to cervical cancer. *H - gene* - The **H - gene** is not specifically linked to the oncogenic effects of HPV; it is not recognized for contributing to cancer development. - It is often confused in discussions but doesn't directly influence the carcinogenic pathway like the E gene does. *P 24 - gene* - The **P 24 - gene** is not related to HPV; instead, it is associated with **HIV** and its structural components. - This gene does not play any role in the development of cervical carcinoma or transformation of cervical cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1007. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335.

Q: Which of the following statements about cross-matching of blood is false?

Donor serum is tested against recipient packed cells. ***Donor serum is tested against recipient packed cells*** - This statement is **FALSE** and describes a **minor crossmatch**, which is rarely performed in modern transfusion practice. - The minor crossmatch tests donor antibodies against recipient cells, but this is not standard practice because donor plasma is significantly diluted during transfusion, making clinically significant reactions rare. - Modern blood banking focuses on the **major crossmatch** as the critical safety measure. *Recipient serum is tested against donor packed cells* - This statement is **TRUE** and accurately describes the **major crossmatch**, which is the standard and most critical pre-transfusion compatibility test. - The major crossmatch detects antibodies in the recipient's serum that could react with donor red blood cell antigens, preventing potentially fatal hemolytic transfusion reactions. *Mandatory in all cases except emergency* - This statement is **TRUE**. Crossmatching is mandatory for safe transfusion practice. - In life-threatening emergencies where delay could be fatal, uncrossmatched O-negative (universal donor) blood may be given, but this is a rare exception. *Involves visible agglutination* - This statement is **TRUE**. A positive crossmatch indicating incompatibility is identified by **visible agglutination** or **hemolysis**. - These visible reactions occur when recipient antibodies bind to donor red blood cell antigens, signaling that transfusion would cause a severe reaction.

Q: Most common site of hypertensive intraparenchymal hemorrhage in the brain?

Putamen. ***Putamen*** - The **putamen** is the most frequent site for **hypertensive intraparenchymal hemorrhages** [1] due to the presence of numerous small, thin-walled arterioles (lenticulostriate arteries) that are highly susceptible to damage from chronic hypertension [1]. - Hemorrhages in this region often cause **contralateral hemiparesis**, **hemianesthesia**, and **gaze deviation** towards the side of the lesion due to involvement of nearby motor and sensory pathways [1]. *Thalamus* - While the **thalamus** is a common site for hypertensive hemorrhages, it is less common than the putamen [1], [2]. - Thalamic hemorrhages typically cause **contralateral sensory loss**, **oculomotor dysfunction**, and sometimes **aphasia** if the dominant hemisphere is affected. *Cerebellum* - **Cerebellar hemorrhages** are less frequent than those in the basal ganglia or thalamus [1]. - Symptoms usually include **ataxia**, **nystagmus**, vomiting, and potential brainstem compression if large. *Pons* - **Pontine hemorrhages** are among the most severe and are often rapidly fatal due to damage to vital brainstem structures [1], [2]. - They typically present with **coma**, **quadriparesis**, **pinpoint pupils**, and rapid progression to respiratory arrest.

Q: Plaques jaunes are seen in which condition?

Atherosclerosis. ***Head injury*** - **Plaques jaunes**, or yellow plaques, are primarily associated with brain injuries, particularly in areas of **contusion** or **hemorrhage** [1]. - These plaques may represent **lipid-laden macrophages** and indicate areas of *necrosis* and inflammation in the brain [1]. *Endocarditis* - Endocarditis is characterized by **vegetations** on heart valves rather than plaques in the brain. - Symptoms typically include **fever**, **murmurs**, and **embolization**, which do not involve yellow plaques. *Syphilis* - Syphilis may cause *gummatous lesions* but is not associated with yellow plaques in the brain. - Typical findings include **rash** and **ulcerative lesions**, particularly during the secondary stage. *Atherosclerosis* - Atherosclerosis involves **plaque formation** in blood vessels but these are not the same as **plaques jaunes** in neurological contexts. - It is characterized by **cholesterol** deposits and plaque rupture leading to cardiovascular events, not plaques seen in head injuries. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1262-1264.

Q: Alzheimer type II astrocytes are seen in which condition?

Hepatic encephalopathy. ***Hepatic encephalopathy*** - **Alzheimer type II astrocytes** are characteristic histological findings in cases of **hepatic encephalopathy**, reflecting the brain's response to elevated ammonia levels. - These astrocytes show enlarged, pale nuclei with prominent nucleoli and marginal chromatin, indicating cellular stress from metabolic dysfunction in the setting of liver failure. *Alzheimer's* - Alzheimer's disease is characterized by the presence of **neurofibrillary tangles** (tau protein) and **amyloid plaques** (beta-amyloid protein), not Alzheimer type II astrocytes. - Astrocytes in Alzheimer's disease may show reactive changes, but they do not typically manifest as the specific "Alzheimer type II" morphology. *Parkinsonism* - Parkinsonism is primarily characterized by the degeneration of **dopaminergic neurons** in the substantia nigra and the presence of **Lewy bodies** (alpha-synuclein aggregates). - While glial cells (astrocytes and microglia) do play a role in neuroinflammation in Parkinson's, they do not exhibit the specific Alzheimer type II astrocytic change. *Binswanger disease* - Binswanger disease is a form of **vascular dementia** characterized by diffuse white matter lesions due to chronic ischemia and damage to small cerebral blood vessels. - The pathology primarily involves demyelination and axonal loss in the white matter, with reactive gliosis, but not the specific changes seen in Alzheimer type II astrocytes.

Question 1

Basket weave appearance of glomerular basement membrane on electron microscopy is seen in

Accepted Answer

Alport syndrome

Answer

Polyarteritis nodosa

Answer

Giant cell arteritis

Answer

Acute post-streptococcal glomerulonephritis

Question 2

Which is a hormone dependent liver tumor?

Accepted Answer

Adenoma

Answer

Hemangioma

Answer

Hepatocellular carcinoma

Answer

Hemangiopericytoma

Question 3

Which type of anemia is most commonly characterized by marked poikilocytosis and anisocytosis on peripheral blood smear?

Accepted Answer

Iron deficiency anemia

Answer

Megaloblastic anemia

Answer

Nutritional anemia

Answer

Thalassemia

Question 4

The Ham test is specifically used for diagnosing paroxysmal nocturnal hemoglobinuria (PNH) and is based upon:

Accepted Answer

Complement

Answer

GPI Anchor Proteins

Answer

Spectrin protein

Answer

Mannose binding proteins

Question 5

The tissue of origin of the Kaposi's sarcoma is

Accepted Answer

Vascular

Answer

Lymphoid

Answer

Neural

Answer

Muscular

Question 6

Which viral proteins are known to act as carcinogens in causing carcinoma cervix?

Accepted Answer

E - gene

Answer

P 24 - gene

Answer

L - gene

Answer

H - gene

Question 7

Which of the following statements about cross-matching of blood is false?

Accepted Answer

Donor serum is tested against recipient packed cells

Answer

Mandatory in all cases except emergency

Answer

Involves visible agglutination

Answer

Recipient serum is tested against donor packed cells

Question 8

Most common site of hypertensive intraparenchymal hemorrhage in the brain?

Accepted Answer

Putamen

Answer

Thalamus

Answer

Cerebellum

Answer

Pons

Question 9

Plaques jaunes are seen in which condition?

Accepted Answer

Atherosclerosis

Answer

Syphilis

Answer

Head injury

Answer

Endocarditis

Question 10

Alzheimer type II astrocytes are seen in which condition?

Accepted Answer

Hepatic encephalopathy

Answer

Parkinsonism

Answer

Alzheimer's

Answer

Binswanger disease

NEET-PG 2015 — Pathology