NEET-PG 2023 — Pathology

Q: A primary structural defect of an organ resulting from an intrinsically abnormal developmental process is termed as:

Malformation. ***Malformation*** - Refers to a **primary structural defect** present at birth, arising during development, leading to abnormal organ structure. - Typically involves intrinsic factors and can affect any organ or system, making it a key category of congenital anomalies. *Association* - Describes a **non-random occurrence** of two or more anomalies but does not indicate a structural defect of a specific organ. - Does not imply a direct defect, as it can occur without an **underlying structural issue** in a particular organ. *Deformation* - Refers to a change in the **shape or structure** of a normally formed organ or body part due to an external force rather than an intrinsic defect [1]. - Examples include clubfoot or positional plagiocephaly, which are not classified as malformations [1]. *Disruption* - Involves the breakdown of an originally normal tissue or organ due to extrinsic factors, leading to secondary structural defects. - Not inherent to the embryological development process itself, differentiating it from intrinsic faults like malformations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 460-462. [Practice more Pathology PYQs on OnCourse]

Q: A five-year-old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most likely be associated with these symptoms?

Multiple localized whorls of connective tissue. ***Multiple localized whorls of connective tissue*** - This constellation of symptoms (precocious puberty, hyperpigmented macules with irregular margins, and bony abnormalities) is characteristic of **McCune-Albright syndrome** [1]. - The bony abnormality associated with McCune-Albright syndrome is **fibrous dysplasia**, which is characterized by the replacement of normal bone with **fibrous tissue** and immature woven bone, often described as localized whorls of connective tissue [1]. *A combination of osteitis fibrosa cystica and osteomalacia* - **Osteitis fibrosa cystica** is associated with severe **hyperparathyroidism**, leading to bone resorption and cyst formation. - **Osteomalacia** results from defective mineralization of bone due to **vitamin D deficiency** or phosphate wasting, neither of which comprehensively explains the given symptoms. *A generalized thinning of bony spicules* - This description is characteristic of **osteoporosis**, a condition of reduced bone mass and structural deterioration, leading to increased fracture risk. - Osteoporosis is typically seen in older adults and is not directly associated with precocious puberty or café-au-lait spots. *Excessive bony deposition with obliteration of marrow* - This describes **osteopetrosis** (Albers-Schönberg disease), a genetic disorder characterized by abnormally dense bones due to defective osteoclast function. - While it affects bone, its presentation does not include precocious puberty or hyperpigmented macules. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1208-1209. [Practice more Pathology PYQs on OnCourse]

Q: An elderly male is known as a smoker presented with chronic cough, significant weight loss, and fatigue. Serum calcium level is raised. A lung biopsy was done, and it showed large atypical cells with hyperchromasia. What is the probable diagnosis?

Large cell carcinoma. ***Squamous cell carcinoma*** - The presence of **hyperchromatic atypical cells** in the lung biopsy [2] and **elevated serum calcium levels** are indicative of paraneoplastic hypercalcemia often seen in squamous cell carcinoma. - This type of lung cancer typically occurs in **smokers** [1] and is associated with **chronic cough** and **weight loss**. *Large cell neuroendocrine tumor* - While it may show large atypical cells, this tumor type is less commonly associated with **hypercalcemia** or the smoking history highlighted here. - Characteristically, it tends to have a more aggressive course and distinct histological features not indicated in the vignette. *Small cell carcinoma* - This type typically presents with **central lung lesions** and is associated with secretory syndromes like **SIADH**, not hypercalcemia. - Histologically, it features small round blue cells rather than the large atypical cells described in this case. *Adenocarcinoma* - Often arises peripherally in the lung and typically does not present with hypercalcemia. - Histological features include **gland formation**, which contrasts with the **large atypical cells** noted in the biopsy. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 723-724. [Practice more Pathology PYQs on OnCourse]

Q: A 5-year-old child was admitted to the hospital for a prolapsing rectal mass and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. What is the likely diagnosis?

Juvenile polyp (Hamartoma). ***Juvenile polyp (Hamartoma)*** - **Juvenile polyps** are the most common cause of rectal bleeding in children, often presenting as a **prolapsing rectal mass** and **painless bleeding**. - Histologically, they are characterized by **enlarged, inflamed glands filled with mucin**, consistent with a hamartomatous origin. *Adenoma (precancerous lesion in adults)* - While adenomas can cause rectal bleeding and prolapse, they are typically found in **adults** and are considered **precancerous lesions** [1]. - The patient's young age (5-year-old) makes an adenoma highly unlikely [1]. *Carcinoma (malignant tumor, rare in children)* - **Colorectal carcinoma** is exceedingly **rare in children** and usually presents with more aggressive symptoms than painless bleeding, such as weight loss or anemia [2]. - The histological description of inflamed, mucin-filled glands is not typical for carcinoma [2]. *Choristoma (benign growth of normal tissue in an abnormal location)* - A **choristoma** is a benign growth of normal tissue in an abnormal location, but it does not typically present as a rectal mass or cause rectal bleeding. - The microscopic findings of enlarged and inflamed glands filled with mucin are not characteristic of a choristoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822. [Practice more Pathology PYQs on OnCourse]

4 Previous Year Questions with Answers & Explanations

Questions

A primary structural defect of an organ resulting from an intrinsically abnormal developmental process is termed as:

A five-year-old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most likely be associated with these symptoms?

An elderly male is known as a smoker presented with chronic cough, significant weight loss, and fatigue. Serum calcium level is raised. A lung biopsy was done, and it showed large atypical cells with hyperchromasia. What is the probable diagnosis?

A 5-year-old child was admitted to the hospital for a prolapsing rectal mass and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. What is the likely diagnosis?

NEET-PG 2023 - Pathology NEET-PG Practice Questions and MCQs

Question 1: A primary structural defect of an organ resulting from an intrinsically abnormal developmental process is termed as:

A. Malformation (Correct Answer)
B. Disruption
C. Deformation
D. Association

Explanation: ***Malformation*** - Refers to a **primary structural defect** present at birth, arising during development, leading to abnormal organ structure. - Typically involves intrinsic factors and can affect any organ or system, making it a key category of congenital anomalies. *Association* - Describes a **non-random occurrence** of two or more anomalies but does not indicate a structural defect of a specific organ. - Does not imply a direct defect, as it can occur without an **underlying structural issue** in a particular organ. *Deformation* - Refers to a change in the **shape or structure** of a normally formed organ or body part due to an external force rather than an intrinsic defect [1]. - Examples include clubfoot or positional plagiocephaly, which are not classified as malformations [1]. *Disruption* - Involves the breakdown of an originally normal tissue or organ due to extrinsic factors, leading to secondary structural defects. - Not inherent to the embryological development process itself, differentiating it from intrinsic faults like malformations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 460-462.

Question 2: A five-year-old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most likely be associated with these symptoms?

A. Excessive bony deposition with obliteration of marrow
B. A combination of osteitis fibrosa cystica and osteomalacia
C. A generalized thinning of bony spicules
D. Multiple localized whorls of connective tissue (Correct Answer)

Explanation: ***Multiple localized whorls of connective tissue*** - This constellation of symptoms (precocious puberty, hyperpigmented macules with irregular margins, and bony abnormalities) is characteristic of **McCune-Albright syndrome** [1]. - The bony abnormality associated with McCune-Albright syndrome is **fibrous dysplasia**, which is characterized by the replacement of normal bone with **fibrous tissue** and immature woven bone, often described as localized whorls of connective tissue [1]. *A combination of osteitis fibrosa cystica and osteomalacia* - **Osteitis fibrosa cystica** is associated with severe **hyperparathyroidism**, leading to bone resorption and cyst formation. - **Osteomalacia** results from defective mineralization of bone due to **vitamin D deficiency** or phosphate wasting, neither of which comprehensively explains the given symptoms. *A generalized thinning of bony spicules* - This description is characteristic of **osteoporosis**, a condition of reduced bone mass and structural deterioration, leading to increased fracture risk. - Osteoporosis is typically seen in older adults and is not directly associated with precocious puberty or café-au-lait spots. *Excessive bony deposition with obliteration of marrow* - This describes **osteopetrosis** (Albers-Schönberg disease), a genetic disorder characterized by abnormally dense bones due to defective osteoclast function. - While it affects bone, its presentation does not include precocious puberty or hyperpigmented macules. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1208-1209.

Question 3: An elderly male is known as a smoker presented with chronic cough, significant weight loss, and fatigue. Serum calcium level is raised. A lung biopsy was done, and it showed large atypical cells with hyperchromasia. What is the probable diagnosis?

A. Large cell carcinoma (Correct Answer)
B. Small cell lung carcinoma
C. Squamous cell carcinoma
D. Lung adenocarcinoma

Explanation: ***Squamous cell carcinoma*** - The presence of **hyperchromatic atypical cells** in the lung biopsy [2] and **elevated serum calcium levels** are indicative of paraneoplastic hypercalcemia often seen in squamous cell carcinoma. - This type of lung cancer typically occurs in **smokers** [1] and is associated with **chronic cough** and **weight loss**. *Large cell neuroendocrine tumor* - While it may show large atypical cells, this tumor type is less commonly associated with **hypercalcemia** or the smoking history highlighted here. - Characteristically, it tends to have a more aggressive course and distinct histological features not indicated in the vignette. *Small cell carcinoma* - This type typically presents with **central lung lesions** and is associated with secretory syndromes like **SIADH**, not hypercalcemia. - Histologically, it features small round blue cells rather than the large atypical cells described in this case. *Adenocarcinoma* - Often arises peripherally in the lung and typically does not present with hypercalcemia. - Histological features include **gland formation**, which contrasts with the **large atypical cells** noted in the biopsy. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 723-724.

Question 4: A 5-year-old child was admitted to the hospital for a prolapsing rectal mass and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. What is the likely diagnosis?

A. Adenoma (precancerous lesion in adults)
B. Juvenile polyp (Hamartoma) (Correct Answer)
C. Carcinoma (malignant tumor, rare in children)
D. Choristoma (benign growth of normal tissue in an abnormal location)

Explanation: ***Juvenile polyp (Hamartoma)*** - **Juvenile polyps** are the most common cause of rectal bleeding in children, often presenting as a **prolapsing rectal mass** and **painless bleeding**. - Histologically, they are characterized by **enlarged, inflamed glands filled with mucin**, consistent with a hamartomatous origin. *Adenoma (precancerous lesion in adults)* - While adenomas can cause rectal bleeding and prolapse, they are typically found in **adults** and are considered **precancerous lesions** [1]. - The patient's young age (5-year-old) makes an adenoma highly unlikely [1]. *Carcinoma (malignant tumor, rare in children)* - **Colorectal carcinoma** is exceedingly **rare in children** and usually presents with more aggressive symptoms than painless bleeding, such as weight loss or anemia [2]. - The histological description of inflamed, mucin-filled glands is not typical for carcinoma [2]. *Choristoma (benign growth of normal tissue in an abnormal location)* - A **choristoma** is a benign growth of normal tissue in an abnormal location, but it does not typically present as a rectal mass or cause rectal bleeding. - The microscopic findings of enlarged and inflamed glands filled with mucin are not characteristic of a choristoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.