NEET-PG 2017 - Pathology PYQs Practice Questions

Q: A 70-year-old man presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear shows presence of:

CLL. ***CLL*** - The presentation of **painless cervical lymphadenopathy**, progressive **pallor** (due to anemia), and **petechiae** (due to thrombocytopenia) in an elderly patient is highly suggestive of **Chronic Lymphocytic Leukemia (CLL)** [2]. - Peripheral smear in CLL typically shows a proliferation of mature-appearing **small lymphocytes** and characteristic **smudge cells** [1]. *Acute ITP* - Acute ITP is characterized by sudden onset of **thrombocytopenia** and bleeding, often following a viral infection, and is more common in children. - It does not typically present with **lymphadenopathy** or progressive pallor as a primary feature. *Chronic ITP* - Chronic ITP is characterized by isolated **thrombocytopenia** and bleeding symptoms, usually without lymphadenopathy or significant anemia unless bleeding is severe. - The presence of **lymphadenopathy** points away from isolated ITP and towards a systemic hematological malignancy. *Richter syndrome* - Richter syndrome is the transformation of CLL into a more aggressive lymphoma, most commonly **diffuse large B-cell lymphoma (DLBCL)**. - While it can present with rapidly enlarging lymph nodes and systemic symptoms, the initial presentation described (painless lymphadenopathy, progressive pallor, petechiae) is more typical of **untreated CLL** before transformation [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 602. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613. [Practice more Pathology PYQs on OnCourse]

Q: Identify the cell.

Monocyte. ***Monocyte*** - Monocytes are characterized by their **large size** (12-20 µm), **kidney-shaped or horseshoe-shaped nucleus**, and **abundant, often grayish-blue cytoplasm** with fine azurophilic granules [1]. - They are precursors to **macrophages** and play a crucial role in phagocytosis and antigen presentation [1]. *Eosinophil* - Eosinophils have a **bilobed nucleus** and prominent **red-orange granules** in their cytoplasm, which stain with eosin [1]. - They are primarily involved in allergic reactions and defense against **parasitic infections** [1]. *Basophil* - Basophils are characterized by a **lobed nucleus** often obscured by large, coarse, **dark purple-blue granules** that contain histamine and heparin [1]. - They are the least common granulocyte and are involved in **allergic and inflammatory responses** [1]. *Lymphocyte* - Lymphocytes are typically **smaller** than monocytes, with a **large, round, or slightly indented nucleus** that occupies most of the cell [1]. - Their cytoplasm is usually **scanty and pale blue**, often appearing as a thin rim around the nucleus [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-580. [Practice more Pathology PYQs on OnCourse]

Q: Name the test given.

ESR measurement. ***ESR measurement*** - The image displays a **Westergren tube** with a column of blood, showing distinct layers of plasma on top and red blood cells settled below against a calibrated scale. - This setup is characteristic of an **Erythrocyte Sedimentation Rate (ESR)** test, which measures the rate at which red blood cells fall in a standardized tube over a specific time, indicating inflammation. *Osmotic fragility* - This test involves exposing red blood cells to varying concentrations of **hypotonic saline solutions** to assess their resistance to lysis. - The results are typically reported as a curve showing the percentage of hemolysis at different saline concentrations, not a simple sedimentation in a tube. *NESTROFT* - The **Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT)** is a quick screening test for **beta-thalassemia trait**. - It involves mixing blood with a hypotonic saline solution and observing for complete hemolysis or partial hemolysis with a button of red cells, which is different from the image shown. *Sickling test* - A sickling test is used to detect the presence of **sickle hemoglobin**, which causes red blood cells to deform into a sickle shape under low oxygen conditions. - This test is usually performed by adding a reducing agent like **sodium metabisulfite** to a blood sample and observing cell morphology under a microscope or by turbidity, not by sedimentation in a calibrated tube. *Packed cell volume (PCV)* - PCV or **hematocrit** measures the proportion of blood volume occupied by red blood cells after centrifugation in a **microhematocrit tube**. - While it does involve blood in a tube, the tube is much smaller (capillary tube) and requires **centrifugation** to separate components, unlike ESR which relies on natural sedimentation under gravity in a larger calibrated Westergren tube. [Practice more Pathology PYQs on OnCourse]

Q: Name the anticoagulant used in the following method.

Trisodium citrate. ***Trisodium citrate*** - The image displays a method for measuring **Erythrocyte Sedimentation Rate (ESR)**, typically performed using the **Westergren method**. - In the Westergren method, **trisodium citrate** is the standard anticoagulant used to prevent blood coagulation, allowing red blood cells to settle over time. *EDTA* - **EDTA (ethylenediaminetetraacetic acid)** is a common anticoagulant, primarily used for **hematology tests** such as complete blood counts (CBC), as it preserves cell morphology. - While it prevents clotting, it is not the standard anticoagulant for the Westergren ESR method, as it can cause red blood cell shrinkage affecting sedimentation. *Heparin* - **Heparin** acts as an anticoagulant by enhancing the activity of **antithrombin III**, and is commonly used for chemistry and general coagulation studies. - It interferes with the sedimentation rate in ESR measurements, making it unsuitable for this specific test. *Dalteparin* - **Dalteparin** is a type of **low molecular weight heparin (LMWH)** used therapeutically as an anticoagulant to prevent and treat blood clots. - It is not used as an in-vitro anticoagulant for blood collection tubes or lab diagnostic tests like ESR. *Sodium fluoride* - **Sodium fluoride** is an anticoagulant and enzymatic inhibitor primarily used for **glucose measurement**, as it inhibits glycolysis and preserves glucose levels. - It is not appropriate for ESR testing, as it does not provide the optimal conditions for red blood cell sedimentation measurement. [Practice more Pathology PYQs on OnCourse]

Question 1

A 70-year-old man presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear shows presence of:

Accepted Answer

CLL

Answer

Acute ITP

Answer

Chronic ITP

Answer

Richter syndrome

Answer

Hairy cell leukemia

Question 2

The following bone marrow specimen is suggestive of diagnosis of:

Accepted Answer

Aplastic anemia

Answer

Pure red cell aplasia

Answer

Myelodysplasia

Answer

Normal marrow

Answer

Hairy cell leukemia

Question 3

Identify the cell.

Accepted Answer

Monocyte

Answer

Eosinophil

Answer

Basophil

Answer

Lymphocyte

Answer

Neutrophil

Question 4

Name the test given.

Accepted Answer

ESR measurement

Answer

Osmotic fragility

Answer

NESTROFT

Answer

Sickling test

Answer

Packed cell volume (PCV)

Question 5

Name the anticoagulant used in the following method.

Accepted Answer

Trisodium citrate

Answer

EDTA

Answer

Heparin

Answer

Dalteparin

Answer

Sodium fluoride

Question 6

The resected specimen of a kidney is seen below. What is the diagnosis?

Accepted Answer

Flea bitten kidney of malignant hypertension

Answer

Amyloidosis

Answer

Acute poststreptococcal glomerulonephritis

Answer

Chronic glomerulonephritis

Answer

Acute tubular necrosis

Question 7

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 8

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 9

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 10

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

NEET-PG 2017 — Pathology