UPSC-CMS 2017 — Pathology

Q: Which of the following is NOT correct for ‘strawberry gall bladder’?

It is a malignant condition of gall bladder. ***It is a malignant condition of gall bladder*** - **Strawberry gallbladder**, also known as **cholesterolosis**, is a **benign** condition where cholesterol esters accumulate in the macrophages within the lamina propria of the gallbladder wall. - It is **not cancerous** and does not lead to malignancy. *It may be associated with cholesterol Stones* - **Cholesterolosis** is often associated with a higher incidence of **cholesterol gallstones (cholelithiasis)**, as both conditions involve abnormal cholesterol metabolism [1]. - The accumulation of cholesterol in the gallbladder wall can sometimes precede or coincide with the formation of cholesterol stones within the lumen [1]. *Simple cholecystectomy is the treatment of choice* - For symptomatic **cholesterolosis**, especially when associated with pain or recurrent biliary colic, **cholecystectomy** (surgical removal of the gallbladder) is the standard and effective treatment. - Asymptomatic cases generally do not require treatment. *It has submucous aggregation of cholesterol crystals* - The characteristic appearance of **"strawberry gallbladder"** is due to the macroscopic visualization of yellow, lipid-laden macrophages aggregated within the **lamina propria** (a layer beneath the mucous membrane), appearing as tiny yellow flecks against a red mucosal background. - These aggregates contain **cholesterol esters**, which can crystallize. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 882. [Practice more Pathology PYQs on OnCourse]

Q: All the following are features of Polycystic disease of kidneys EXCEPT:

Erythrocytosis. ***Erythrocytosis*** - While other renal conditions like **renal cell carcinoma** can cause erythrocytosis due to increased **erythropoietin** production, it is generally **not a typical feature** of Polycystic Kidney Disease (PKD). - Patients with PKD usually have **normal or even low erythropoietin levels** despite compromised kidney function, and anemia is more common, particularly as **renal failure progresses**. *Renal failure* - **Progressive cyst growth** leads to replacement of normal kidney parenchyma, inevitably culminating in **end-stage renal disease** [1] in the majority of patients. - This is a hallmark feature, often necessitating **dialysis or transplant** later in life for individuals with autosomal dominant polycystic kidney disease (ADPKD) [2]. *Haematuria* - **Gross or microscopic hematuria** is a common symptom in PKD, often resulting from **cyst rupture** [1], bleeding into a cyst, or the passage of a calculus due to urinary stasis. - It can be a presenting symptom and can cause significant pain and anxiety for patients. *Hypertension* - **Hypertension** is an early and frequent complication of PKD, often preceding any significant decline in glomerular filtration rate. - It is primarily caused by activation of the **renin-angiotensin-aldosterone system (RAAS)** [3] due to arterial compression and ischemia from expanding cysts. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 951-955. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 544-545. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 520-521. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?

Tumor necrosis factor. ***Tumor necrosis factor*** - **Tumor necrosis factor (TNF-α)** is a prominent pro-inflammatory cytokine and a key mediator in the pathogenesis of **Systemic Inflammatory Response Syndrome (SIRS)** [1]. - It plays a crucial role in initiating and amplifying the inflammatory cascade, leading to systemic effects like fever, increased vascular permeability, and tissue damage [1]. *Leukotrienes* - **Leukotrienes** are lipid mediators derived from arachidonic acid, involved in inflammation and allergic reactions [1]. - They are not classified as **cytokines**, which are protein signaling molecules [1]. *Nitric oxide* - **Nitric oxide (NO)** is a gaseous signaling molecule with various physiological roles, including vasodilation and neurotransmission. - While it contributes to the pathophysiology of SIRS, particularly in regulating vascular tone, it is not a **cytokine**. *Complements* - **Complements** are a system of plasma proteins that are part of the innate immune response, helping to clear pathogens [1]. - They participate in inflammation but are distinct from **cytokines**, which are regulatory proteins [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-101. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

Complex hyperplasia with atypia. ***Complex hyperplasia with atypia*** - This condition carries the highest risk of progression to **endometrial carcinoma**, with approximately a 29% chance of concurrent or subsequent carcinoma [1], [2]. - The presence of **atypia** (abnormal cellular architecture and nuclear features) is the critical factor indicating a high malignant potential [1], [2]. *Complex hyperplasia* - While a form of endometrial hyperplasia, it lacks the **atypical cellular features** that significantly elevate the risk of malignancy [1]. - The risk of progression to endometrial carcinoma is much lower, around 3%, compared to atypical forms [1]. *Simple atypical hyperplasia* - This condition features **atypia** but with a less complex glandular architectural proliferation than complex atypical hyperplasia [2]. - Although it has a lower risk of malignancy than complex atypical hyperplasia (around 8%), it still has a significantly higher risk than non-atypical hyperplasias. *Simple hyperplasia* - This is the **least severe** form of endometrial hyperplasia, characterized by glandular and stromal proliferation without architectural complexity or cellular atypia [1]. - The risk of progression to endometrial carcinoma is very low, approximately 1%, making it far less concerning than atypical forms [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1018. [Practice more Pathology PYQs on OnCourse]

4 Previous Year Questions with Answers & Explanations

Questions

All Subjects Anatomy (4)Anesthesiology (1)Biochemistry (1)Community Medicine (36)Dermatology (2)Internal Medicine (8)Microbiology (2)Obstetrics and Gynecology (26)Ophthalmology (2)Pathology (4)Pediatrics (1)Pharmacology (3)Physiology (2)Surgery (23)

Which of the following is NOT correct for ‘strawberry gall bladder’?

All the following are features of Polycystic disease of kidneys EXCEPT:

Which of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?

Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

UPSC-CMS 2017 - Pathology UPSC-CMS Practice Questions and MCQs

Question 1: Which of the following is NOT correct for ‘strawberry gall bladder’?

A. It may be associated with cholesterol Stones
B. It is a malignant condition of gall bladder (Correct Answer)
C. Simple cholecystectomy is the treatment of choice
D. It has submucous aggregation of cholesterol crystals

Explanation: ***It is a malignant condition of gall bladder*** - **Strawberry gallbladder**, also known as **cholesterolosis**, is a **benign** condition where cholesterol esters accumulate in the macrophages within the lamina propria of the gallbladder wall. - It is **not cancerous** and does not lead to malignancy. *It may be associated with cholesterol Stones* - **Cholesterolosis** is often associated with a higher incidence of **cholesterol gallstones (cholelithiasis)**, as both conditions involve abnormal cholesterol metabolism [1]. - The accumulation of cholesterol in the gallbladder wall can sometimes precede or coincide with the formation of cholesterol stones within the lumen [1]. *Simple cholecystectomy is the treatment of choice* - For symptomatic **cholesterolosis**, especially when associated with pain or recurrent biliary colic, **cholecystectomy** (surgical removal of the gallbladder) is the standard and effective treatment. - Asymptomatic cases generally do not require treatment. *It has submucous aggregation of cholesterol crystals* - The characteristic appearance of **"strawberry gallbladder"** is due to the macroscopic visualization of yellow, lipid-laden macrophages aggregated within the **lamina propria** (a layer beneath the mucous membrane), appearing as tiny yellow flecks against a red mucosal background. - These aggregates contain **cholesterol esters**, which can crystallize. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 882.

Question 2: All the following are features of Polycystic disease of kidneys EXCEPT:

A. Erythrocytosis (Correct Answer)
B. Renal failure
C. Haematuria
D. Hypertension

Explanation: ***Erythrocytosis*** - While other renal conditions like **renal cell carcinoma** can cause erythrocytosis due to increased **erythropoietin** production, it is generally **not a typical feature** of Polycystic Kidney Disease (PKD). - Patients with PKD usually have **normal or even low erythropoietin levels** despite compromised kidney function, and anemia is more common, particularly as **renal failure progresses**. *Renal failure* - **Progressive cyst growth** leads to replacement of normal kidney parenchyma, inevitably culminating in **end-stage renal disease** [1] in the majority of patients. - This is a hallmark feature, often necessitating **dialysis or transplant** later in life for individuals with autosomal dominant polycystic kidney disease (ADPKD) [2]. *Haematuria* - **Gross or microscopic hematuria** is a common symptom in PKD, often resulting from **cyst rupture** [1], bleeding into a cyst, or the passage of a calculus due to urinary stasis. - It can be a presenting symptom and can cause significant pain and anxiety for patients. *Hypertension* - **Hypertension** is an early and frequent complication of PKD, often preceding any significant decline in glomerular filtration rate. - It is primarily caused by activation of the **renin-angiotensin-aldosterone system (RAAS)** [3] due to arterial compression and ischemia from expanding cysts. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 951-955. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 544-545. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 520-521.

Question 3: Which of the following factors is labelled as cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS)?

A. Leukotrienes
B. Nitric oxide
C. Complements
D. Tumor necrosis factor (Correct Answer)

Explanation: ***Tumor necrosis factor*** - **Tumor necrosis factor (TNF-α)** is a prominent pro-inflammatory cytokine and a key mediator in the pathogenesis of **Systemic Inflammatory Response Syndrome (SIRS)** [1]. - It plays a crucial role in initiating and amplifying the inflammatory cascade, leading to systemic effects like fever, increased vascular permeability, and tissue damage [1]. *Leukotrienes* - **Leukotrienes** are lipid mediators derived from arachidonic acid, involved in inflammation and allergic reactions [1]. - They are not classified as **cytokines**, which are protein signaling molecules [1]. *Nitric oxide* - **Nitric oxide (NO)** is a gaseous signaling molecule with various physiological roles, including vasodilation and neurotransmission. - While it contributes to the pathophysiology of SIRS, particularly in regulating vascular tone, it is not a **cytokine**. *Complements* - **Complements** are a system of plasma proteins that are part of the innate immune response, helping to clear pathogens [1]. - They participate in inflammation but are distinct from **cytokines**, which are regulatory proteins [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-101.

Question 4: Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

A. Complex hyperplasia with atypia (Correct Answer)
B. Complex hyperplasia
C. Simple atypical hyperplasia
D. Simple hyperplasia

Explanation: ***Complex hyperplasia with atypia*** - This condition carries the highest risk of progression to **endometrial carcinoma**, with approximately a 29% chance of concurrent or subsequent carcinoma [1], [2]. - The presence of **atypia** (abnormal cellular architecture and nuclear features) is the critical factor indicating a high malignant potential [1], [2]. *Complex hyperplasia* - While a form of endometrial hyperplasia, it lacks the **atypical cellular features** that significantly elevate the risk of malignancy [1]. - The risk of progression to endometrial carcinoma is much lower, around 3%, compared to atypical forms [1]. *Simple atypical hyperplasia* - This condition features **atypia** but with a less complex glandular architectural proliferation than complex atypical hyperplasia [2]. - Although it has a lower risk of malignancy than complex atypical hyperplasia (around 8%), it still has a significantly higher risk than non-atypical hyperplasias. *Simple hyperplasia* - This is the **least severe** form of endometrial hyperplasia, characterized by glandular and stromal proliferation without architectural complexity or cellular atypia [1]. - The risk of progression to endometrial carcinoma is very low, approximately 1%, making it far less concerning than atypical forms [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1018.