INI-CET 2017 - Pathology PYQs Practice Questions

Q: The following brain biopsy of patient who presented with marked psychomotor agitation is diagnostic of?

Rabies encephalitis. ***Correct: Rabies encephalitis*** - The brain biopsy showing **Negri bodies** (pathognomonic eosinophilic intracytoplasmic inclusions in pyramidal neurons of hippocampus and Purkinje cells of cerebellum) is diagnostic of **rabies encephalitis** - Clinical presentation of **marked psychomotor agitation** is characteristic of the furious form of rabies - Histopathology shows **perivascular lymphocytic cuffing** and neuronal degeneration along with Negri bodies - Rabies is caused by a **neurotropic RNA rhabdovirus** transmitted through animal bites *Incorrect: Herpes simplex encephalitis* - HSV encephalitis primarily affects the **temporal lobes** (hemorrhagic necrotizing encephalitis) - Histology shows **Cowdry type A intranuclear inclusions**, not cytoplasmic Negri bodies - Clinical features include fever, altered sensorium, and temporal lobe signs (olfactory/gustatory hallucinations) *Incorrect: Creutzfeldt-Jakob disease* - CJD is a **prion disease** showing **spongiform changes** (vacuolation) in the brain parenchyma - No viral inclusion bodies are seen - Clinical presentation includes rapidly progressive dementia, myoclonus, and ataxia *Incorrect: Japanese encephalitis* - JE causes **basal ganglia and thalamic involvement** (seen on neuroimaging) - Histology shows **neuronal necrosis and neuronophagia** but no characteristic inclusion bodies like Negri bodies - Clinical features include parkinsonian features and movement disorders *Incorrect: Acute disseminated encephalomyelitis* - ADEM is a **post-infectious demyelinating disease** showing perivenular demyelination - Histology shows demyelination with preservation of axons, not viral inclusions - Usually follows viral infection or vaccination [Practice more Pathology PYQs on OnCourse]

Q: The following is a picture from scrapping of genital ulcer. Comment on the diagnosis. (AIIMS May 2017)

Haemophilus ducreyi. ***Hemophilus ducreyi*** - *Hemophilus ducreyi* causes **chancroid**, characterized by painful genital ulcers with ragged, undermined borders and often associated with painful inguinal lymphadenopathy. - Microscopic examination of a smear from the ulcer typically shows **Gram-negative coccobacillary rods** arranged in "school of fish" or "railroad track" patterns. *Klebsiella granulomatosis* - *Klebsiella granulomatosis* (formerly *Calymmatobacterium granulomatis*) causes **donovanosis** (granuloma inguinale), which presents as painless, beefy red, friable ulcers [1]. - Diagnosis is made by identifying **Donovan bodies** (intracellular bipolar-staining rods) in tissue smears or biopsies [1]. *Neisseria gonorrhoea* - *Neisseria gonorrhoea* primarily causes **urethritis** in men and **cervicitis** in women, with purulent discharge. - While it can cause disseminated infection, it typically does not present as a primary genital ulcer. *Chlamydia trachomatis* - *Chlamydia trachomatis* causes **lymphogranuloma venereum (LGV)**, which initially presents as a transient, painless papule or ulcer, often unnoticed. - The characteristic feature of LGV is the subsequent development of **painful inguinal lymphadenopathy** (buboes) and proctitis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 378-379. [Practice more Pathology PYQs on OnCourse]

Q: The vacutainer shown below is used for collecting sample for? (AIIMS Nov 2017)

Serum electrolytes. ***Serum electrolytes*** - The image shows a **green-top vacutainer**, which typically contains **lithium heparin** as an anticoagulant. - **Lithium heparin** is the preferred anticoagulant for collecting samples for **serum electrolyte** measurements, as it does not interfere with the analysis of ions like sodium, potassium, and chloride. *Serum lactate* - Serum lactate measurements usually require a **gray-top tube** containing **sodium fluoride** and **potassium oxalate** to inhibit glycolysis and stabilize lactate levels. - A green-top tube with lithium heparin is not ideal for lactate analysis due to continued glycolysis in the absence of a glycolysis inhibitor. *Serum cholesterol* - Serum cholesterol, along with other lipid profiles, is typically collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**, which has a gel barrier. - While cholesterol can be measured from a heparinized plasma sample, a plain red-top or SST is more commonly used for routine lipid panels. *Serum uric acid* - Serum uric acid measurement can be performed on a sample collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**. - Although lithium heparin tubes can sometimes be used, plain serum tubes are generally preferred as they yield serum directly without an anticoagulant. *Coagulation studies* - Coagulation studies (PT, PTT, INR) require a **blue-top tube** containing **sodium citrate** as the anticoagulant. - The citrate-to-blood ratio must be precise (1:9) for accurate coagulation testing, making the blue-top tube specifically designed for this purpose. - A green-top tube with heparin cannot be used for coagulation studies as heparin itself is an anticoagulant that would interfere with the test results. [Practice more Pathology PYQs on OnCourse]

Question 1

The following brain biopsy of patient who presented with marked psychomotor agitation is diagnostic of?

Accepted Answer

Rabies encephalitis

Answer

Herpes simplex encephalitis

Answer

Creutzfeldt-Jakob disease

Answer

Japanese encephalitis

Answer

Acute disseminated encephalomyelitis

Question 2

A 70-year-old man presents with history of intractable diarrhea. His bone marrow and kidney biopsy are shown below. Which of the following is the most appropriate diagnosis?

Accepted Answer

Multiple myeloma

Answer

Leishmaniasis

Answer

Lymphoma

Answer

Urate nephropathy

Answer

Amyloidosis

Question 3

A 35-year-old presented with fever. On examination he had enlarged and ulcerated tonsils. Since peripheral smear shows lymphocytosis, monospot test was done which is negative. Tonsillectomy was done and stained section is shown below. Large cells mixed with lymphocytes are seen. The cells are positive for CD20, EBVLMP-1, MUM1, CD 79a and CD 15 negative. The background cells are positive for CD3. Diagnosis is: (AIIMS May 2017)

Accepted Answer

EBV positive- mucocutaneous ulcer

Answer

Infectious mononucleosis

Answer

Hodgkin lymphoma

Answer

EBV positive- DLBCL

Answer

Burkitt lymphoma

Question 4

The following is a picture from scrapping of genital ulcer. Comment on the diagnosis. (AIIMS May 2017)

Accepted Answer

Haemophilus ducreyi

Answer

Klebsiella granulomatosis

Answer

Neisseria gonorrhoea

Answer

Chlamydia trachomatis

Answer

Treponema pallidum

Question 5

The vacutainer shown below is used for collecting sample for? (AIIMS Nov 2017)

Accepted Answer

Serum electrolytes

Answer

Serum lactate

Answer

Serum cholesterol

Answer

Serum uric acid

Answer

Coagulation studies

INI-CET 2017 — Pathology