NEET-PG 2015 - Pathology Practice Questions

Q: Which tumor is characterized by the presence of cells that resemble tennis rackets?

Langerhans cell histiocytosis. ***Langerhans cell histiocytosis*** - This condition is characterized by **Birbeck granules** within the Langerhans cells, which have a distinctive **tennis racket-like appearance** on electron microscopy. - The cells are also positive for **CD1a** and **S-100** immunohistochemical markers. *Sarcoma botyroides* - This is a subtype of **embryonal rhabdomyosarcoma** typically found in mucosal sites, presenting as a polypoid, grape-like mass. - Its histology shows small, undifferentiated cells with primitive skeletal muscle differentiation, but **not tennis racket-shaped cells**. *Vaginal adenocarcinoma* - This is a rare malignancy of the vagina, often associated with **diethylstilbestrol (DES) exposure** in utero, presenting as glands. - The cells show glandular differentiation and produce mucin, but **lack Birbeck granules**. *Seminoma* - This is a germ cell tumor of the testis characterized by large, uniform cells with clear cytoplasm and prominent nucleoli, divided into lobules by fibrous septa containing lymphocytes. - There are **no tennis racket-shaped cells** or Birbeck granules associated with seminoma.

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: Most common malignant tumor of the heart in adults

Cardiac Sarcoma. ***Cardiac Sarcoma*** - **Cardiac sarcomas** are the most common type of **primary malignant tumor** of the heart in adults, accounting for about 95% of primary malignant cardiac tumors. - **Angiosarcoma** is the most common subtype (approximately 33-50% of all cardiac sarcomas), typically originating from the **right atrium**. - These tumors are highly aggressive with rapid growth, early metastasis, and poor prognosis. - They commonly present with right-sided heart failure, pericardial effusion, or constitutional symptoms. *Rhabdomyoma* - **Rhabdomyomas** are the most common **primary cardiac tumors in infants and children** (60-80% of pediatric cardiac tumors), not adults. - These tumors are **benign** and strongly associated with tuberous sclerosis. - They often spontaneously regress after birth. *Lipoma* - **Lipomas** are **benign tumors** composed of mature adipocytes and account for about 10% of benign cardiac tumors. - They are typically asymptomatic and found incidentally. - They are not malignant and therefore not relevant to this question about malignant tumors. *Paraganglioma* - **Paragangliomas** (pheochromocytomas of the heart) are rare neuroendocrine tumors. - They are typically **benign** (though can be locally invasive) and may be hormonally active, causing catecholamine-related symptoms. - They represent less than 1% of cardiac tumors and are not the most common malignant cardiac tumor.

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: 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: 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 the most common type of male breast cancer?

Invasive Ductal Carcinoma. ***Invasive Ductal Carcinoma*** - This is by far the most common type of breast cancer in men, accounting for approximately **80-90%** of all male breast cancer cases. - It originates in the **milk ducts** and then invades the surrounding breast tissue. *Invasive Lobular Carcinoma* - This type of cancer originates in the **milk-producing glands (lobules)**. - It is **extremely rare** in men due to the underdeveloped and non-functional lobules in the male breast. *Mucinous Carcinoma* - This is a **rare subtype** of invasive ductal carcinoma characterized by cancer cells that produce **mucin**. - It accounts for only a small percentage of male breast cancers, typically **2-3%** of cases. *Inflammatory Breast Cancer* - This is a **rare and aggressive** form of breast cancer characterized by rapid onset of redness, swelling, and warmth in the breast, often mistaken for an infection. - Although it can occur in men, it is not the most common type and represents a very small fraction of male breast cancer diagnoses.

Q: What is the number of Barr bodies present in Klinefelter's syndrome?

1. ***1*** - **Klinefelter's syndrome** typically has a 47,XXY karyotype, meaning there are two X chromosomes [1]. - The number of Barr bodies is calculated as **N-1**, where N is the total number of X chromosomes. In this case, 2-1 = **1 Barr body** [1]. - This follows the principle that one X chromosome remains active while additional X chromosomes are inactivated [1]. *0* - **No Barr bodies** are found in individuals with a normal male karyotype (46,XY) or in Turner syndrome (45,XO), neither of which describes Klinefelter's syndrome [1]. - The presence of at least one Barr body indicates the presence of at least two X chromosomes. *2* - **Two Barr bodies** would be indicative of a karyotype with three X chromosomes (e.g., 47,XXX syndrome or Triple X syndrome), which is not Klinefelter's syndrome. - This calculation follows the N-1 rule: 3 X chromosomes - 1 = 2 Barr bodies. *3* - **Three Barr bodies** would correspond to a karyotype with four X chromosomes (e.g., 48,XXXX), which is an even rarer sex chromosome aneuploidy not associated with Klinefelter's syndrome. - The N-1 rule applies: 4 X chromosomes - 1 = 3 Barr bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-174.

Q: Which of the following statements about hypernephroma is true?

Not radiosensitive. ***Radiosensitive*** - Hypernephroma, or renal cell carcinoma, is typically resistant to **radiation therapy**, making this statement false. - It is generally treated with **surgery** and targeted therapies rather than radiation. *Usually adenocarcinoma* - Hypernephroma is indeed a type of **adenocarcinoma**, as it originates from the renal tubular epithelium [1]. - It is the most common form of **kidney cancer**, supporting this as a true statement. *May present with rapidly developing varicocele* - Rapidly developing **varicocele** can occur due to **renal vein obstruction** associated with renal tumors [2], so this statement is true. - Varicocele is a recognized clinical feature in renal cell carcinoma due to its anatomical relationships. *Arise from cortex usually from pre existing adenoma* - Hypernephroma does arise from the **renal cortex**, often from pre-existing renal adenomas or other lesions. - This establishes its origin, making the statement accurate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Question 1

Which tumor is characterized by the presence of cells that resemble tennis rackets?

Accepted Answer

Langerhans cell histiocytosis

Answer

Seminoma

Answer

Vaginal adenocarcinoma

Answer

Sarcoma botyroides

Question 2

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 3

Most common malignant tumor of the heart in adults

Accepted Answer

Cardiac Sarcoma

Answer

Paraganglioma

Answer

Rhabdomyoma

Answer

Lipoma

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

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 6

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 7

Which of the following is NOT a recognized cause of Urothelial Carcinomas?

Accepted Answer

Alcohol consumption

Answer

Industrial solvents

Answer

Exposure to thorotrast

Answer

Smoking

Question 8

Which is the most common type of male breast cancer?

Accepted Answer

Invasive Ductal Carcinoma

Answer

Inflammatory Breast Cancer

Answer

Invasive Lobular Carcinoma

Answer

Mucinous Carcinoma

Question 9

What is the number of Barr bodies present in Klinefelter's syndrome?

Accepted Answer

1

Answer

0

Answer

2

Answer

3

Question 10

Which of the following statements about hypernephroma is true?

Accepted Answer

Not radiosensitive

Answer

May present with rapidly developing varicocele

Answer

Usually an adenocarcinoma

Answer

Arises from the cortex, usually from a pre-existing adenoma

NEET-PG 2015 — Pathology