NEET-PG 2018 - Pathology Practice Questions

Q: Anaplasia is

Lack of differentiation. ***Lack of differentiation*** - Anaplasia refers to a **loss of differentiation** in cells, making them more primitive and less specialized [1]. - It is often seen in **malignant tumors**, indicating a poor prognosis and aggressive behavior [1]. *Morphological changes* - While anaplasia involves **morphological changes**, this term is too broad and can relate to various cellular alterations, not exclusively anaplasia [1]. - Anaplasia specifically emphasizes **lack of differentiation**, distinct from general changes in cell appearance [1]. *Changing one type of epithelium to another* - This describes a process known as **metaplasia**, where one adult cell type transforms into another, not anaplasia. - Anaplasia signifies a **de-differentiation** rather than a change to a different epithelial type [1]. *Nuclear chromatin* - While changes in **nuclear chromatin** can occur in anaplastic cells, this does not define anaplasia itself [1]. - Anaplasia primarily refers to **loss of cell differentiation**, making this option insufficient to describe the concept [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-280.

Q: TRALI occurs within how many hours of transfusion?

6 hours. ***6 hours*** - **Transfusion-related acute lung injury (TRALI)** is defined as new acute lung injury occurring during or within **6 hours** after the completion of a blood transfusion [1]. - It is a severe and potentially life-threatening transfusion reaction characterized by **acute respiratory distress**, **hypoxemia**, and **bilateral pulmonary infiltrates** on chest imaging [1]. *48 hours* - While other transfusion reactions or complications may manifest within 48 hours, TRALI has a more **acute onset**, typically within the first 6 hours. - A pulmonary event occurring between 6 and 48 hours post-transfusion might be considered **delayed TRALI** or another diagnosis like **transfusion-associated circulatory overload (TACO)**, but the classic definition refers to the 6-hour window. *72 hours* - Reactions occurring 72 hours after transfusion are generally considered **delayed transfusion reactions**, which include conditions like **delayed hemolytic transfusion reactions** or **post-transfusion purpura**. - This timeframe is too long for the typical presentation of TRALI, which is characterized by rapid onset. *12 hours* - Although 12 hours falls within an acute window, the most commonly accepted and diagnostically crucial timeframe for TRALI is **within 6 hours** of transfusion. - A reaction occurring between 6 and 12 hours would still be considered suspiciously TRALI, but the strict definition emphasizes the earlier onset.

Q: A red soft to firm swelling on the sternum shows proliferation of endothelial cells forming vascular channels on biopsy. What is the most likely diagnosis?

Hemangioma. ***Hemangioma*** - The soft to firm swelling and histological findings indicative of vascular spaces are characteristic of a **hemangioma**, often presenting as a benign vascular tumor [1][2]. - Commonly found in the **sternum**, it may show red or bluish discoloration and typically undergoes a **biopsy** revealing endothelial cell proliferation [2]. *Osteochondroma* - This is a **benign bone tumor** that arises from the growth plate but typically presents as a hard, bony mass rather than a soft swelling. - Histologically, it shows **cartilaginous cap** and is associated with bone rather than vascular structures. *Osteoid osteoma* - Usually presents as a **painful, small bone lesion** often found in the long bones, generally not in the sternum and characterized by a **nidus** of osteoid. - The biopsy would show a **central nidus** with osteoid and woven bone, not consistent with soft swellings. *Paget disease* - This chronic bone disorder involves excessive bone remodeling, leading to enlarged and deformed bones rather than a discrete swelling. - Histologically, it would show **disorganized bone** formation and is not associated with soft or firm masses like hemangiomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 523-524.

Q: Identify the condition represented in the image of a testicular tumor.

Seminoma. ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.

Q: Positive periodic acid-Schiff (PAS) macrophages are seen in which of the following conditions?

Whipple's disease. ***Whipple's disease*** - **Whipple's disease** is caused by the bacterium *Tropheryma whipplei*, which is ingested by macrophages and accumulates in their lysosomes [1]. - The bacterial cell wall contains **glycoproteins** and **proteoglycans** that stain magenta (red-purple) with the **periodic acid-Schiff (PAS)** stain. - PAS-positive, diastase-resistant macrophages in the lamina propria of the small intestine are **pathognomonic** for Whipple's disease [1]. *Crohn's disease* - Crohn's disease is an **inflammatory bowel disease** characterized by transmural inflammation and non-caseating granulomas. - While it involves macrophages in the inflammatory process, they do not typically show **PAS-positive inclusions**. *HIV/AIDS* - HIV/AIDS is a **viral infection** that primarily targets CD4+ T lymphocytes and macrophages. - Although macrophages are involved in HIV infection and can be found in intestinal tissue, they do not exhibit **PAS-positive inclusions** characteristic of Whipple's disease. *Celiac disease* - Celiac disease is an **autoimmune enteropathy** triggered by gluten, causing villous atrophy and malabsorption. - The histology shows increased intraepithelial lymphocytes and crypt hyperplasia, but **macrophages are not PAS-positive**. - Both Whipple's and celiac disease can present with malabsorption, making clinical differentiation important [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 798-799.

Q: In Rheumatoid arthritis, which type of cells are prominently present ?

Macrophages. ***Macrophages*** - **Macrophages** are abundant in the inflamed synovial tissue of patients with **rheumatoid arthritis**, contributing significantly to inflammation and joint destruction [1]. - They produce various **pro-inflammatory cytokines** (e.g., TNF-̑, IL-1, IL-6) and enzymes that degrade cartilage and bone. *B cells* - While **B cells** play a role in **rheumatoid arthritis** by producing autoantibodies like **rheumatoid factor (RF)**, they are not the most prominently present immune cell type in the synovium compared to macrophages [2]. - Their presence is often concentrated in lymphocytic aggregates within the synovium [1]. *T cells* - **T cells**, particularly **CD4+ helper T cells**, are important in orchestrating the immune response in **rheumatoid arthritis** and are found in the inflamed synovium [2]. - However, **macrophages** are generally more numerous and critical for the sustained inflammatory destruction. *Dendritic cells* - **Dendritic cells** are **antigen-presenting cells** that initiate and shape immune responses in **rheumatoid arthritis**. - While present in the synovium, their numbers are generally lower than those of **macrophages** and **T cells**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 677-678. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1212-1214.

Q: Identify the condition shown in the image of the lung.

Lobar pneumonia. ***Lobar Pneumonia*** - Characterized by **consolidation of lung lobes** due to infection, commonly seen in cases of **Streptococcus pneumoniae** [1]. - Classic clinical features include **fever, cough, and difficulty breathing**, often with rust-colored sputum. *Congested kidney* - Indicates **kidney enlargement and edema** due to vascular congestion, often associated with heart failure. - Symptoms primarily relate to **renal function decline**, not pulmonary involvement. *Bronchopneumonia* - Typically shows **patchy consolidations** throughout different lung regions [2] [3], rather than a single lobe. - More common in **post-viral infections** and associated with a **sicker patient overall** [3], presenting diffuse symptoms. *Acute glomerulonephritis* - Primarily a **renal condition** resulting in hematuria and proteinuria, with **no respiratory involvement**. - Often follows infections, such as from **streptococci**, manifesting as nephritic syndrome rather than pneumonia symptoms. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 709-712. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 317-318. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 316-317.

Q: Struvite stones are primarily composed of which metal?

Magnesium. ***Magnesium*** - **Struvite stones** are primarily composed of **magnesium ammonium phosphate**, formed in the presence of urease-producing bacteria. - The presence of magnesium is a defining component of these **infection-related stones**. *Calcium* - **Calcium** is the primary component of the most common type of kidney stones, **calcium oxalate** and **calcium phosphate stones**. - These are typically unrelated to bacterial infections, unlike struvite stones. *Sodium* - **Sodium** is not a primary component of any common type of kidney stone. - While high sodium intake can increase the risk of stone formation, it does not directly form the stone matrix. *Potassium* - **Potassium** is not a characteristic component of kidney stones. - It plays a role in urinary pH regulation but is not directly incorporated into stone formation.

Q: Which of the following is the most important infiltrate in rheumatoid arthritis?

Macrophages. ***Macrophages*** - **Macrophages** are crucial in rheumatoid arthritis synovium due to their role in producing **pro-inflammatory cytokines** like TNF-̑, IL-1, and IL-6, which drive joint destruction [1], [2]. - They also contribute to the **pannus formation** and degrade cartilage and bone through the release of proteases [1]. *Dendritic cells* - While present in the synovium, **dendritic cells primarily function as antigen-presenting cells**, initiating T-cell responses. - Their direct contribution to tissue damage and chronic inflammation is less prominent than that of macrophages. *CD4+ Helper cells* - **CD4+ T helper cells** orchestrate the immune response by activating B cells and macrophages, but they are not the primary effector cells causing direct tissue damage [3]. - They secrete cytokines that promote inflammation but do not directly participate in tissue degradation. *Neutrophils* - **Neutrophils are abundant in the synovial fluid** during acute flares, contributing to inflammation and breakdown of cartilage through the release of enzymes. - However, their role in the chronic, sustained synovial inflammation and tissue destruction characteristic of RA is less significant compared to macrophages. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 677-678. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 105-106. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1212.

Question 1

Anaplasia is

Accepted Answer

Lack of differentiation

Answer

Changing one type of epithelium to another

Answer

Nuclear chromatin

Answer

Morphological changes

Question 2

TRALI occurs within how many hours of transfusion?

Accepted Answer

6 hours

Answer

48 hours

Answer

72 hours

Answer

12 hours

Question 3

A red soft to firm swelling on the sternum shows proliferation of endothelial cells forming vascular channels on biopsy. What is the most likely diagnosis?

Accepted Answer

Hemangioma

Answer

Osteochondroma

Answer

Osteoid osteoma

Answer

Paget disease

Question 4

Identify the condition represented in the image of a testicular tumor.

Accepted Answer

Seminoma

Answer

Non-seminomatous germ cell tumor

Answer

Teratoma (testicular tumor)

Answer

Leydig cell tumor

Question 5

Positive periodic acid-Schiff (PAS) macrophages are seen in which of the following conditions?

Accepted Answer

Whipple's disease

Answer

Crohn's disease

Answer

HIV/AIDS

Answer

Celiac disease

Question 6

In Rheumatoid arthritis, which type of cells are prominently present ?

Accepted Answer

Macrophages

Answer

B cells

Answer

T cells

Answer

Dendritic cells

Question 7

Identify the condition shown in the image of the lung.

Accepted Answer

Lobar pneumonia

Answer

Bronchopneumonia

Answer

Pulmonary infarction

Answer

Lung abscess

Question 8

Struvite stones are primarily composed of which metal?

Accepted Answer

Magnesium

Answer

Calcium

Answer

Sodium

Answer

Potassium

Question 9

The following statement about keloid is true:

Accepted Answer

It will have more collagen and vascularity

Answer

Extended excision is the treatment of choice

Answer

Elevated levels of growth factor is not seen

Answer

They do not extend beyond the wound

Question 10

Which of the following is the most important infiltrate in rheumatoid arthritis?

Accepted Answer

Macrophages

Answer

Dendritic cells

Answer

CD4+ Helper cells

Answer

Neutrophils

NEET-PG 2018 — Pathology