NEET-PG 2015 - Pathology PYQs Practice Questions

Q: Absence of the intrahepatic bile ducts leads to which syndrome?

Alagille Syndrome. ***Alagille Syndrome*** - Characterized by the **absence of intrahepatic bile ducts**, leading to cholestasis and liver dysfunction. - Often associated with **cardiac defects** and **skeletal abnormalities**, as well as distinct **facial features**. *Von Meyenburg Complexes* - Refers to **bile duct hamartomas**, which are developmental abnormalities but do not lead to complete absence of ducts. - Typically discovered incidentally and are not associated with syndromic presentations like Alagille syndrome. *Caroli Disease* - Involves **dilated intrahepatic bile ducts** [1] and does not result in their absence; thus, it leads to **recurrent cholangitis**. - More associated with **cysts** and can lead to biliary complications rather than complete duct loss. *Polycystic Liver Disease* - Characterized by the presence of multiple **cysts** in the liver, but the intrahepatic bile ducts are typically present. - It is often associated with **kidney cysts** and systemic manifestations, not the absence of bile ducts. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following is the MOST SIGNIFICANT modifiable predisposing factor for arterial thrombosis?

Cigarette smoking. ***Cigarette smoking*** - **Cigarette smoking** is a major modifiable risk factor for **atherosclerosis** and arterial thrombosis, primarily by promoting endothelial dysfunction, inflammation, and hypercoagulability. [1] - It damages the **endothelium**, leading to plaque formation and increasing the risk of **thrombotic events** such as myocardial infarction and stroke. [1] *Antiphospholipid syndrome* - This is an **autoimmune disorder** causing recurrent arterial and venous thromboses, but it is not a modifiable lifestyle factor. - While it dramatically increases thrombosis risk, therapeutic management focuses on anticoagulation rather than lifestyle modification. *Hyperlipidemia* - **Hyperlipidemia**, particularly elevated LDL cholesterol, is a significant risk factor for **atherosclerosis**, which can lead to thrombosis. [1] - However, while modifiable through diet and medication, its immediate thrombotic impact is often mediated through chronic plaque formation, whereas smoking has more direct prothrombotic effects on endothelium and platelet function. *Homocystinuria* - This is a rare, inherited **metabolic disorder** causing elevated homocysteine levels, leading to severe premature atherosclerosis and **thrombotic disease**. - It is a genetic condition and therefore not a modifiable risk factor in the same way as lifestyle choices. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following is not found in DiGeorge's syndrome?

Eczema. ***Eczema*** - **Eczema** is NOT a recognized feature of **DiGeorge syndrome** (22q11.2 deletion syndrome). - While individuals with immunodeficiencies may experience various skin conditions, eczema is specifically associated with conditions like **Hyper-IgE syndrome, Wiskott-Aldrich syndrome**, or atopic disorders, not DiGeorge's. - DiGeorge's follows the **CATCH-22 mnemonic**: Cardiac defects, Abnormal facies, Thymic hypoplasia, Cleft palate, Hypocalcemia, 22q11 deletion. *Tetany* - **Tetany IS found** in DiGeorge's syndrome due to **hypocalcemia** from parathyroid gland hypoplasia or aplasia. - The lack of parathyroid hormone leads to **low serum calcium levels**, resulting in increased neuromuscular excitability and tetany. *T cell lymphopenia* - **T-cell lymphopenia IS found** in DiGeorge's syndrome due to **thymic hypoplasia or aplasia**. - The primary immunological defect is **T-cell deficiency**, leading to increased susceptibility to viral, fungal, and intracellular bacterial infections. - B-cell numbers are typically normal, though antibody responses may be impaired due to lack of T-cell help. *Mucocutaneous candidiasis* - **This IS found** in patients with DiGeorge's syndrome as an opportunistic infection due to **T-cell immunodeficiency**. - The impaired **cellular immunity** makes individuals highly susceptible to fungal infections like *Candida albicans* affecting mucous membranes and skin. [Practice more Pathology PYQs on OnCourse]

Q: Gastric carcinoma is associated with all of the following EXCEPT:

Activation of RAS. ***Activation of RAS*** - **RAS mutations** are relatively uncommon in gastric carcinoma compared to other gastrointestinal malignancies. While KRAS mutations can occur in approximately 10-15% of gastric cancers (particularly intestinal type), they are **far less frequent** than in **pancreatic adenocarcinoma** (~90%) or **colorectal carcinoma** (~40%). - In the context of gastric carcinoma, RAS pathway alterations are **not considered a major oncogenic driver** compared to the other molecular changes listed, making this the **LEAST characteristically associated** alteration. *Inactivation of p53* - **Inactivation of the p53 tumor suppressor gene** is one of the most frequent molecular events in gastric carcinoma, occurring in approximately **50-60% of cases**. - Loss of p53 function leads to genomic instability, uncontrolled cell proliferation, and resistance to apoptosis, contributing significantly to **tumorigenesis** and **poor prognosis**. *Over expression of C-met* - **Overexpression of C-MET**, a receptor tyrosine kinase for hepatocyte growth factor (HGF), is commonly observed in gastric carcinoma (30-40% of cases) and is strongly linked to **tumor growth**, **invasion**, and **metastasis**. - C-MET amplification and overexpression promote cell proliferation, survival, migration, and angiogenesis, making it an important **therapeutic target** in advanced gastric cancer. *Over expression of C-erb* - **Overexpression of C-erbB-2 (HER2/neu)** is found in approximately **10-20% of gastric adenocarcinomas**, particularly the intestinal type. - HER2 amplification or overexpression is a significant **prognostic and predictive biomarker**, and is specifically targeted by **trastuzumab** (Herceptin) therapy in HER2-positive advanced gastric cancer, improving survival outcomes. [Practice more Pathology PYQs on OnCourse]

Q: Most common type of renal carcinoma is:

Clear cell type. ***Clear cell type*** - The **clear cell type** is the most common subtype of renal carcinoma, constituting about **70-80%** of cases [3]. - It is typically associated with **von Hippel-Lindau syndrome** and presents with clear or "foamy" cells due to lipid accumulation [3]. *Chromophobe type* - This type comprises about **5-10%** of renal cell carcinomas and usually has a better prognosis [1]. - Characterized by **pale cells with distinct cell borders** and lacks the common features of clear cell carcinoma [1]. *Tubular type* - The tubular variant is less common and does not represent a major subtype of renal cell carcinoma. - It is often confused with other variants but lacks the distinct characteristics of the clear cell type. *Papillary type* - The papillary type accounts for about **10-15%** of renal carcinomas and is characterized by papillary structures [2]. - This type generally has a distinct chromosomal mutation profile compared to the clear cell type [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 959. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [Practice more Pathology PYQs on OnCourse]

Question 1

Absence of the intrahepatic bile ducts leads to which syndrome?

Accepted Answer

Alagille Syndrome

Answer

Polycystic Liver Disease

Answer

Caroli Disease

Answer

Von Meyenburg Complexes

Question 2

Which of the following is the MOST SIGNIFICANT modifiable predisposing factor for arterial thrombosis?

Accepted Answer

Cigarette smoking

Answer

Antiphospholipid syndrome

Answer

Hyperlipidemia

Answer

Homocystinuria

Question 3

Which of the following is not found in DiGeorge's syndrome?

Accepted Answer

Eczema

Answer

Tetany

Answer

T cell lymphopenia

Answer

Mucocutaneous candidiasis

Question 4

Gastric carcinoma is associated with all of the following EXCEPT:

Accepted Answer

Activation of RAS

Answer

Over expression of C-met

Answer

Inactivation of p53

Answer

Over expression of C-erb

Question 5

Most common type of renal carcinoma is:

Accepted Answer

Clear cell type

Answer

Chromophobe type

Answer

Papillary type

Answer

Collecting duct type

Question 6

IgA nephropathy is not associated with which of the following?

Accepted Answer

Decreased complement level

Answer

Focal mesangial proliferation

Answer

Gross hematuria concurrent with upper respiratory infection

Answer

Immunofluorescence deposits contain IgA and IgG

Question 7

Irregular scarred kidney with pelvic dilatation is seen with?

Accepted Answer

Chronic pyelonephritis

Answer

Polycystic kidney

Answer

Renal artery stenosis

Answer

Tuberculosis of kidney

Question 8

Subepithelial deposits in the kidney are primarily associated with which condition?

Accepted Answer

Post-Streptococcal Glomerulonephritis (PSGN)

Answer

None of these conditions are associated with subepithelial deposits.

Answer

Membranoproliferative Glomerulonephritis (MPGN) Type I

Answer

Goodpasture's Syndrome (GPS)

Question 9

Characteristic feature of IgA nephropathy?

Accepted Answer

Serum complement level is normal

Answer

More common in old age

Answer

It is a type of membranoproliferative GN

Answer

Gross hematuria presents after 10 days

Question 10

What is the most common nephropathy associated with malignancy?

Accepted Answer

Membranous glomerulonephritis

Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

Minimal change disease

Answer

IgA nephropathy

NEET-PG 2015 — Pathology