NEET-PG 2012 - Pathology PYQs Practice Questions

Q: Malignancy in pheochromocytoma is indicated by:

Metastasis. ***Metastasis*** - The definitive criterion for diagnosing **malignancy in pheochromocytoma** is the presence of **metastatic disease**, meaning tumor cells have spread to sites where chromaffin tissue is not normally found. - The distinction between benign and malignant pheochromocytomas often cannot be made based on histological features alone. *Mitotic figures* - While increased **mitotic activity** can be a feature indicating aggressive tumor behavior, it is not a standalone definitive criterion for malignancy in pheochromocytoma. - Benign pheochromocytomas can occasionally show mitotic figures, and their presence alone does not confirm malignancy. *Capsular invasion* - **Capsular invasion** suggests an aggressive tumor but is not a definitive indicator of malignancy in pheochromocytoma. - Tumors that exhibit capsular invasion without distant spread are still considered to have uncertain malignant potential rather than overt malignancy. *Vascular invasion* - Similar to capsular invasion, **vascular invasion** indicates an increased risk of metastasis but is not a conclusive sign of malignancy. - The presence of tumor cells within blood vessels raises suspicion, but true malignancy is only confirmed by the presence of distant metastases. [Practice more Pathology PYQs on OnCourse]

Q: Renal papillary necrosis is almost always associated with one of the following conditions:

Analgesic-nephropathy. ***Analgesic-nephropathy*** - Chronic use of certain analgesics (especially **phenacetin**, aspirin, and NSAIDs) can lead to **ischemia** and damage to the renal papillae, causing **papillary necrosis**. - This condition is considered the **classic** cause of renal papillary necrosis and is the most frequently emphasized in medical education. - Analgesic nephropathy shows a very **strong and direct association** with papillary necrosis as a hallmark feature. *Diabetes-mellitus* - **Diabetes mellitus** is actually one of the **most common causes** of renal papillary necrosis in clinical practice, particularly when complicated by **infection** or **ischemia** [1]. - While clinically very common, it causes papillary necrosis through multiple mechanisms and is often associated with coexisting factors like **pyelonephritis** [1], [2] or NSAID use. - In the context of "almost always associated," analgesic nephropathy has a more direct and consistent association. *Chronic pyelonephritis* - **Chronic pyelonephritis** involves recurrent bacterial infections of the kidney parenchyma and can lead to scarring and kidney damage. - While it is indeed a recognized cause of **papillary necrosis** (part of the POSTCARDS mnemonic), it is not as consistently associated as analgesic nephropathy [2]. *Post streptococcal GN* - **Post-streptococcal glomerulonephritis (PSGN)** is an immune-mediated inflammatory kidney disease that typically follows a **streptococcal infection**. - It primarily affects the **glomeruli** and does **not** cause necrosis of the renal papillae, making this option incorrect. **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. 543-544. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 937-940. [Practice more Pathology PYQs on OnCourse]

Q: In apoptosis, cytochrome C acts through:

Apaf1. ***Apaf1*** - Cytochrome C released from the mitochondria binds to **Apaf1**, which leads to the formation of the **apoptosome** [1][2]. - This complex activates **caspase-9**, initiating the caspase cascade that leads to apoptosis [2]. *TNF* - Tumor Necrosis Factor (TNF) is involved in **necrosis** and **inflammatory processes**, not directly in the intrinsic pathway of apoptosis. - It activates **caspase-8**, which is part of the **extrinsic pathway**, differing from the role of cytochrome C [1]. *FADD* - FADD (Fas-associated protein with death domain) is part of the **death receptor pathway**, linking to caspase-8, not associated with cytochrome C [1]. - It does not play a role in the assembly of the apoptosome like Apaf1 does. *Bcl_2* - Bcl-2 is an **anti-apoptotic protein** that inhibits apoptosis rather than inducing it or acting through cytochrome C [1]. - It functions by preventing the release of cytochrome C from mitochondria, thereby opposing the apoptotic process [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 310. [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. 64-67. [Practice more Pathology PYQs on OnCourse]

Q: What is the histological appearance of the brain in Creutzfeldt-Jakob disease?

Spongiform changes. ***Spongiform changes*** - The hallmark histological feature of **Creutzfeldt-Jakob disease (CJD)** is **spongiform degeneration**, characterized by vacuolation of neuronal cell bodies [1]. - It results in a **spongy appearance** of the affected brain regions, particularly in the **cerebral cortex** and **basal ganglia** [1]. *Neuronophagia (can occur in various contexts, not specific to CJD)* - Neuronophagia refers to the phagocytic activity involving **dying neurons**, which can occur in various conditions but is not a defining feature of CJD [2]. - It indicates the presence of **inflammation** or a response to neuronal injury rather than specific changes seen in CJD. *Demyelination (associated with multiple sclerosis)* - Demyelination is primarily associated with conditions like **multiple sclerosis** and is characterized by loss of **myelin sheaths** around neurons. - This is not related to CJD, which involves **prion protein accumulation** and subsequent neuronal degeneration. *Micro abscess (indicative of bacterial infections)* - Micro abscesses indicate localized collections of **pus** typically seen in **bacterial infections**, which is incongruent with the pathophysiology of CJD. - In CJD, there are no signs of **inflammation** or **neutrophilic infiltration** associated with abscess formation [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1284-1286. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1255-1256. [Practice more Pathology PYQs on OnCourse]

Q: Thorium-induced tumor is which of the following?

Angiosarcoma of liver. ***Angiosarcoma of liver*** - Thorium exposure is specifically linked to the development of **angiosarcoma of the liver**, often seen in individuals with a history of thorium dioxide injection [1]. - This type of tumor arises from **vascular endothelial cells** and is highly aggressive, often leading to significant morbidity. *Lymphoma* - Lymphoma is associated with **immune system factors** and typically arises from lymphoid tissues, which do not correlate with thorium exposure. - **Hematological malignancies** such as lymphoma do not have a documented direct association with thorium as a causative agent. *Astrocytoma* - Astrocytomas originate from **glial cells** in the brain and are primarily influenced by genetic predispositions rather than environmental carcinogens like thorium. - There is no established relationship between **thorium exposure** and the incidence of brain tumors such as astrocytomas. *Renal cell carcinoma* - Renal cell carcinoma is commonly linked to **smoking, obesity**, and genetic factors rather than thorium exposure. - It does not have a recognized connection to thorium, which is more specifically associated with liver tumors. **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. 216-217. [Practice more Pathology PYQs on OnCourse]

Question 1

Malignancy in pheochromocytoma is indicated by:

Accepted Answer

Metastasis

Answer

Mitotic figures

Answer

Capsular invasion

Answer

Vascular invasion

Question 2

Renal papillary necrosis is almost always associated with one of the following conditions:

Accepted Answer

Analgesic-nephropathy

Answer

Diabetes-mellitus

Answer

Chronic pyelonephritis

Answer

Post streptococcal GN

Question 3

In apoptosis, cytochrome C acts through:

Accepted Answer

Apaf1

Answer

FADD

Answer

TNF

Answer

Bcl-2

Question 4

What is the histological appearance of the brain in Creutzfeldt-Jakob disease?

Accepted Answer

Spongiform changes

Answer

Neuronophagia

Answer

Micro abscess

Answer

Demyelination

Question 5

Thorium-induced tumor is which of the following?

Accepted Answer

Angiosarcoma of liver

Answer

Lymphoma

Answer

Renal cell carcinoma

Answer

Astrocytoma

Question 6

Transitional cell carcinoma of the bladder is associated with which of the following?

Accepted Answer

None of the options

Answer

Malaria

Answer

Schistosomiasis

Answer

Ascariasis

Question 7

What is the chromosomal translocation associated with Acute Myeloid Leukemia M3?

Accepted Answer

t(15;17)

Answer

t(18;21)

Answer

t(9;11)

Answer

t(8;21)

Question 8

What is the term for the collapse of a lung?

Accepted Answer

Atelectasis

Answer

Emphysema

Answer

Bronchitis

Answer

Bronchiectasis

Question 9

Nutmeg liver is associated with which condition?

Accepted Answer

Right sided heart failure

Answer

Increased pulmonary pressure

Answer

Decreased pulmonary pressure

Answer

Left sided heart failure

Question 10

Which of the following does not belong to the family of selectins?

Accepted Answer

A selectin

Answer

P selectin

Answer

L selectin

Answer

E selectin

NEET-PG 2012 — Pathology