NEET-PG 2017 Practice Questions

Q: A 38-year-old man presents with the manifestation shown in the image. He has a number of family members suffering from the same condition, though the severity is different in different members. Which of the following statements is false regarding this condition?

Basal cell carcinoma. ***Basal cell carcinoma*** - Basal cell carcinoma is a type of skin cancer that is **not typically a primary manifestation** of Neurofibromatosis Type 1 (NF1). - While individuals with NF1 may have an increased risk of certain cancers, basal cell carcinoma is **not one of the characteristic features** of the condition. - **This statement is FALSE**, making it the correct answer to this question. *Autosomal dominant condition* - Neurofibromatosis Type 1 (NF1) is inherited in an **autosomal dominant pattern**, meaning only one copy of the mutated gene is needed to cause the disorder. - The patient's history of **multiple family members** suffering from the same condition with varying severity is consistent with autosomal dominant inheritance. - **This statement is TRUE.** *Chromosomal abnormality seen in chromosome 17* - Neurofibromatosis Type 1 is caused by a mutation in the **NF1 gene**, located on **chromosome 17 (17q11.2)**. - This gene encodes for **neurofibromin**, a tumor suppressor protein, and its dysfunction leads to the characteristic features of NF1. - **This statement is TRUE.** *Café-au-lait spots and neurofibromas are characteristic features* - The image displays characteristic features of NF1, including **café-au-lait spots** (large, hyperpigmented macules) and **neurofibromas** (benign tumors of nerve sheath cells). - These are classic diagnostic findings in Neurofibromatosis Type 1, along with axillary/inguinal freckling and Lisch nodules. - **This statement is TRUE.**

Q: Comment on type of glomerulonephritis present in the kidney biopsy slide. (Recent NEET Pattern 2016-17)

Crescentic glomerulonephritis. ***Crescentic glomerulonephritis*** - The presence of **crescents** in the glomeruli is the hallmark of **crescentic glomerulonephritis**, indicating severe glomerular injury [1]. - Crescents are formed by the proliferation of **parietal epithelial cells** and infiltration of macrophages, leading to rapid decline in renal function [1]. *Acute glomerulonephritis* - This is a broad term that can encompass various forms of glomerulonephritis, but it does not specifically describe the **morphological finding of crescents**. - Acute glomerulonephritis often presents with **nephritic syndrome** (hematuria, proteinuria, hypertension), but the biopsy finding of crescents is more specific [1]. *Focal segmental glomerulosclerosis* - Characterized by **sclerosis** (scarring) affecting **some glomeruli** (focal) and **only parts of the glomerular tuft** (segmental). - It typically presents with **nephrotic syndrome** (heavy proteinuria, edema, hypoalbuminemia), which is distinct from the rapid renal failure seen with crescents. *Diffuse glomerulosclerosis* - This term implies widespread **sclerosis** affecting **all glomeruli**, often seen in advanced chronic kidney disease. - It does not specifically describe the **active inflammatory process** and crescent formation characteristic of crescentic glomerulonephritis [2]. **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] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 536-537.

Q: All are causes of this glomerular presentation except: (Recent NEET Pattern 2016-17)

Reflux nephropathy. ***Reflux nephropathy*** - This condition primarily causes **tubulointerstitial damage** and **scarring**, leading to chronic kidney disease, but it is not a direct cause of a primary glomerular presentation like **focal segmental glomerulosclerosis (FSGS)**. - While it can lead to proteinuria, it's usually due to secondary glomerular changes from chronic damage rather than a primary glomerular disease. *HIV* - **HIV-associated nephropathy (HIVAN)** is a common cause of **collapsing FSGS**, a specific glomerular presentation [1] [2]. - It is characterized by rapid progression to end-stage renal disease and often presents with heavy proteinuria [1]. *Hepatitis B* - Hepatitis B infection is strongly associated with **membranous nephropathy** and, less commonly, with **membranoproliferative glomerulonephritis (MPGN)**, both of which are distinct glomerular presentations [1]. - These conditions involve immune complex deposition in the glomeruli. *Heroin abuse* - Heroin abuse is a well-known cause of **focal segmental glomerulosclerosis (FSGS)**, often presenting as **heroin-associated nephropathy** [3] [4]. - This condition typically leads to significant proteinuria and progressive renal failure [3] [4]. **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. 531-532. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 924-925. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 530-531.

Q: Comment on the diagnosis of light microscopy finding in kidney biopsy. (Recent NEET Pattern 2016-17)

Nodular glomerulosclerosis. ***Nodular glomerulosclerosis*** - This finding is characteristic of **diabetic nephropathy**, specifically the **Kimmelstiel-Wilson lesions** [1]. - It involves the formation of **nodular deposits** in the mesangium, leading to glomerulosclerosis. *Focal segmental glomerulosclerosis* - Characterized by **sclerosis** affecting only **some glomeruli** (focal) and only **parts of the glomerular tuft** (segmental). - It is a common cause of **nephrotic syndrome** and is often associated with HIV, heroin abuse, or genetic mutations. *Diffuse glomerulosclerosis* - Implies widespread sclerosis affecting **most or all glomeruli diffusely**. - This is a general term and can be seen in various end-stage renal diseases, not specific to a single primary diagnosis like nodular glomerulosclerosis. *Minimal change disease* - On light microscopy, the glomeruli appear **normal**, hence the term "minimal change" [2]. - The characteristic finding is **effacement of foot processes** on electron microscopy [2], and it is a common cause of nephrotic syndrome in children. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1121. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-923.

Q: A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Does not invade the tunica. ***Does not invade the tunica*** - This statement is incorrect. **Seminomas**, which are common in undescended testes, often **invade the tunica albuginea** and rete testis. - Invasion of the tunica is a common feature of testicular germ cell tumors, including seminoma, and is an important prognostic factor. *Tumor maintains the testis contour* - **Seminomas** typically grow as a large, homogeneous mass that can **replace the testicular parenchyma** but often maintains the overall contour of the testis. - The tumor expands within the tunica albuginea, leading to an enlarged but often still ovoid shape of the testis. *Necrosis commonly starts from center of tumor* - **Necrosis** is a common feature in larger **seminomas**, and it typically starts in the **center of the tumor** due to inadequate blood supply as the tumor outgrows its vascularization. - This central necrosis can lead to cystic degeneration within the tumor. *PAS positive tumor cells in sheets* - **Seminoma cells** are typically rich in **glycogen**, which stains **PAS (Periodic Acid-Schiff) positive** [1]. - These cells are characteristically arranged in **sheets or lobules** separated by delicate fibrovascular septa, often with a prominent lymphocytic infiltrate [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. 980-982.

Q: All are true about the brain tumour associated with the below mentioned histopathological findings except:

Association with NF-1. ***Association with NF-1*** - The histopathological findings described (likely referring to **meningioma** based on the other options) are not typically associated with **Neurofibromatosis type 1 (NF-1)** [1]. - **NF-1** is more commonly linked to **optic nerve gliomas**, neurofibromas, and other peripheral nerve sheath tumors. *Most frequent cytogenetic abnormality is deletion of 22q* - **Deletion of 22q** is the most common cytogenetic abnormality found in **meningiomas** [2]. - This deletion often involves the **NF2 gene**, which is a tumor suppressor gene [2]. *Intracranial calcification* - **Intracranial calcification** is a common finding in **meningiomas**, particularly in older lesions [2]. - These calcifications can be seen on imaging studies like CT scans. *Psammoma bodies* - **Psammoma bodies** are characteristic histological features of **meningiomas**, especially the meningothelial and transitional subtypes [1][2]. - They are concentric, lamellated calcified structures formed from degenerating cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.

Q: A 50-year-old woman presents with daily early morning frontal headache and projectile vomiting. The image shows:

Meningioma. **Meningioma** - The MRI shows a **well-circumscribed, extra-axial mass** that is significantly enhancing, particularly in the frontal lobe near the convexity. Histopathology of a meningioma characteristically features **whorls of meningothelial cells** and **psammoma bodies** (calcified concentric lamellae), which are visible in the image. - The clinical symptoms of **early morning headaches** and **projectile vomiting** are indicative of **increased intracranial pressure**, which can be caused by any space-occupying lesion, including a meningioma, especially if it grows to a significant size. *Medulloblastoma* - This is a highly malignant brain tumor typically occurring in the **cerebellum of children**, not usually seen in a 50-year-old woman in the frontal lobe. - Histologically, medulloblastomas are composed of small, round, **blue cells** with little cytoplasm (small blue cell tumor), which is distinct from the provided image. *Glioma* - **Gliomas** originate within the brain parenchyma and are often **poorly circumscribed** with an infiltrative growth pattern, which contrasts with the well-defined lesion seen on MRI. - While gliomas can cause increased intracranial pressure, their diverse histological appearances depend on their specific subtype (e.g., astrocytoma, oligodendroglioma), none of which perfectly match the characteristic **whorls and psammoma bodies** seen here. *Glioblastoma multiforme* - **Glioblastoma multiforme** (GBM) is a highly aggressive grade IV astrocytoma, characterized by **ring-enhancing lesions** with central necrosis and significant edema on MRI. - Histologically, GBM exhibits features like **pseudopalisading necrosis**, microvascular proliferation, and pleomorphic tumor cells, which are not depicted in the provided histopathology image.

Q: Cork screw inclusion bodies in brain biopsy specimen are seen in:

Pilocytic astrocytoma. ***Pilocytic astrocytoma*** - **Rosenthal fibers**, which have a **corkscrew appearance**, are characteristic histological findings in pilocytic astrocytomas. - These are **eosinophilic, elongated, glial inclusions** often found in the processes of tumor cells. - Pilocytic astrocytomas are typically **benign (WHO Grade I)** tumors commonly found in children and young adults. *Medulloblastoma* - Characterized by **small, round blue cells** and a high mitotic index, often forming **Homer-Wright rosettes**. - **Rosenthal fibers** are not typically associated with medulloblastoma. *Ependymoma* - Characterized by **ependymal rosettes** (tumor cells arranged around a central lumen) and **perivascular pseudorosettes** (tumor cells radiating around blood vessels). - Lacks the presence of **corkscrew inclusion bodies (Rosenthal fibers)**. *Pinealoma* - This is a general term for tumors of the pineal gland, which can include pineocytomas and pineoblastomas. - While various histological features can be seen depending on the specific type, **Rosenthal fibers** are not a characteristic finding for these tumors. *Glioblastoma* - The most common malignant primary brain tumor in adults, characterized by **pseudopalisading necrosis** and **microvascular proliferation**. - Histologically shows pleomorphic cells, not the organized **Rosenthal fibers** seen in pilocytic astrocytoma.

Q: A 40-year-old male presents with sudden onset right-sided chest pain and breathlessness following a road traffic accident. On examination, breath sounds are diminished on the right side. The chest X-ray is shown below. What is the most likely diagnosis?

Right hydropneumothorax. ***Right hydropneumothorax*** - The X-ray image reveals an **air-fluid level** in the right pleural cavity, characterized by a straight, horizontal line between the air (darker above) and fluid (whiter below). This finding is pathognomonic for a hydropneumothorax. - The **collapsed or compressed lung** is also visible superior to the air-fluid level, further supporting the diagnosis of air and fluid coexisting in the pleural space. *Hydatid cyst right lung* - A hydatid cyst in the lung appears as a **well-defined, rounded opacity (solid mass)**, often with a "water lily" sign if ruptured, but it does not present with a distinct air-fluid level as seen here. - While hydatid cysts can rupture and produce air and fluid, the X-ray findings would typically show a more complex internal structure or a cyst within a cavity, not a simple air-fluid interface across the entire pleural space. *Right pleural effusion* - A pleural effusion would appear as a **homogeneous white (effaced) opacity** blunting the costophrenic angle and, in larger effusions, rising along the lateral chest wall (meniscus sign). - Crucially, a simple pleural effusion **does not show an air-fluid level**; the fluid density would fill the pleural space without an overlying visible air component. *Perforated abdominal viscus* - A perforated abdominal viscus would typically result in **free air under the diaphragm** on an upright chest X-ray (pneumoperitoneum). - While pneumoperitoneum presents as air, it is located below the diaphragm, *not* within the pleural cavity, and would not create an air-fluid level within the lung fields as seen in this image.

Question 1

A 38-year-old man presents with the manifestation shown in the image. He has a number of family members suffering from the same condition, though the severity is different in different members. Which of the following statements is false regarding this condition?

Accepted Answer

Basal cell carcinoma

Answer

Autosomal dominant condition

Answer

Chromosomal abnormality seen in chromosome 17

Answer

Café-au-lait spots and neurofibromas are characteristic features

Question 2

Comment on type of glomerulonephritis present in the kidney biopsy slide. (Recent NEET Pattern 2016-17)

Accepted Answer

Crescentic glomerulonephritis

Answer

Acute glomerulonephritis

Answer

Focal segmental glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Membranous glomerulonephritis

Question 3

All are causes of this glomerular presentation except: (Recent NEET Pattern 2016-17)

Accepted Answer

Reflux nephropathy

Answer

HIV

Answer

Hepatitis B

Answer

Heroin abuse

Answer

Obesity

Question 4

All are true about the presentation in kidney biopsy shown except: (Recent NEET Pattern 2016-17)

Accepted Answer

IgG and properdin deposits

Answer

Loss of foot processes

Answer

Hyalinosis

Answer

Seen with HIV associated nephropathy

Answer

Presents with nephrotic syndrome

Question 5

Comment on the diagnosis of light microscopy finding in kidney biopsy. (Recent NEET Pattern 2016-17)

Accepted Answer

Nodular glomerulosclerosis

Answer

Focal segmental glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Minimal change disease

Answer

Membranoproliferative glomerulonephritis

Question 6

A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Accepted Answer

Does not invade the tunica

Answer

Tumor maintains the testis contour

Answer

Necrosis commonly starts from center of tumor

Answer

PAS positive tumor cells in sheets

Question 7

All are true about the brain tumour associated with the below mentioned histopathological findings except:

Accepted Answer

Association with NF-1

Answer

Most frequent cytogenetic abnormality is deletion of 22q

Answer

Intracranial calcification

Answer

Psammoma bodies

Answer

Most common extra-axial tumor in adults

Question 8

A 50-year-old woman presents with daily early morning frontal headache and projectile vomiting. The image shows:

Accepted Answer

Meningioma

Answer

Medulloblastoma

Answer

Glioma

Answer

Glioblastoma multiforme

Question 9

Cork screw inclusion bodies in brain biopsy specimen are seen in:

Accepted Answer

Pilocytic astrocytoma

Answer

Medulloblastoma

Answer

Ependymoma

Answer

Pinealoma

Answer

Glioblastoma

Question 10

A 40-year-old male presents with sudden onset right-sided chest pain and breathlessness following a road traffic accident. On examination, breath sounds are diminished on the right side. The chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Right hydropneumothorax

Answer

Hydatid cyst right lung

Answer

Right pleural effusion

Answer

Perforated abdominal viscus

NEET-PG 2017

Dermatology

Pathology

Radiology