UPSC-CMS 2019 — Pathology
5 Previous Year Questions with Answers & Explanations
What is the correct order of the normal phases of wound healing?
Which of the statements regarding Salivary gland neoplasms are correct? 1. 80–90% of parotid tumors are benign 2. 90% of sublingual gland tumors are malignant 3. 60–70% of submandibular gland tumors are benign 4. Parotid gland is most common site for salivary gland tumors Select the correct answer using the code given below:
No increased relative risk of invasive breast carcinoma based on histopathological examination of benign breast tissue is for all of the following EXCEPT:
Which of the following statements regarding Paget's disease of nipple are correct? 1. It represents benign pathology of nipple areola complex 2. It is eczema like condition of nipple and areola 3. Erosion of nipple is seen 4. Nipple biopsy is required for definitive diagnosis Select the correct answer using the code given below:
In diffuse axonal injury all are true EXCEPT:
UPSC-CMS 2019 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: What is the correct order of the normal phases of wound healing?
- A. Haemostatic phase → Inflammatory phase → Proliferative phase → Remodelling phase (Correct Answer)
- B. Proliferative phase → Haemostatic phase → Inflammatory phase → Remodelling phase
- C. Remodelling phase → Proliferative phase → Destructive phase → Inflammatory phase
- D. Destructive phase → Proliferative phase → Remodelling phase → Inflammatory phase
Explanation: ***Haemostatic phase → Inflammatory phase → Proliferative phase → Remodelling phase*** - This sequence accurately describes the well-established biological progression of **wound healing**, starting with immediate injury response and leading to tissue maturation [1], [2]. - Each phase builds upon the previous one, ensuring proper clot formation, immune response, tissue repair, and final strengthening of the wound [1], [2]. *Proliferative phase → Haemostatic phase → Inflammatory phase → Remodelling phase* - This order is incorrect because the **proliferative phase** occurs much later than the initial haemostatic and inflammatory responses [1]. - **Haemostasis** must occur first to stop bleeding before subsequent healing processes can begin effectively [2]. *Remodelling phase → Proliferative phase → Destructive phase → Inflammatory phase* - This option is incorrect as the **remodelling phase** is the final stage of wound healing, not the initial one [1]. - The term "**destructive phase**" is not a standard physiological phase in normal wound healing. *Destructive phase → Proliferative phase → Remodelling phase → Inflammatory phase* - This sequence is incorrect because, similar to the previous option, "**destructive phase**" is not a recognized normal phase of wound healing. - The **inflammatory phase** occurs early in the process, not as the final stage [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 105-108.
Question 2: Which of the statements regarding Salivary gland neoplasms are correct? 1. 80–90% of parotid tumors are benign 2. 90% of sublingual gland tumors are malignant 3. 60–70% of submandibular gland tumors are benign 4. Parotid gland is most common site for salivary gland tumors Select the correct answer using the code given below:
- A. 1, 3 and 4
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - The statement that **80–90% of parotid tumors are benign** is correct; pleomorphic adenoma is the most common benign tumor, and approximately 80% of parotid tumors are benign [1]. - The statement that **90% of sublingual gland tumors are malignant** is correct; sublingual gland tumors have the highest malignancy rate (70-90%) among major salivary glands [1]. - The statement that **60–70% of submandibular gland tumors are benign** is correct; approximately 50-65% of submandibular tumors are benign [1]. - Statement 4, while factually accurate that the parotid is the most common site, when combined with the other three statements may create ambiguity in the context of this specific question stem [1]. *2, 3 and 4* - This option incorrectly excludes statement 1, which accurately reflects that **80–90% of parotid tumors are benign** [1]. - While statements 2, 3, and 4 are individually correct, omitting the well-established benign predominance of parotid tumors makes this combination incomplete. *1, 2 and 4* - This option incorrectly excludes statement 3 about **submandibular gland tumors**, which correctly states that 60–70% are benign [1]. - The submandibular gland malignancy rate is an important epidemiological fact that should not be omitted. *1, 3 and 4* - This option incorrectly excludes statement 2 about **sublingual gland tumors having 90% malignancy** [1]. - The high malignancy rate of sublingual tumors is a crucial high-yield fact for salivary gland pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 750-755.
Question 3: No increased relative risk of invasive breast carcinoma based on histopathological examination of benign breast tissue is for all of the following EXCEPT:
- A. Squamous metaplasia
- B. Solitary papilloma of lactiferous sinus (Correct Answer)
- C. Usual ductal hyperplasia
- D. Periductal mastitis
Explanation: ***Solitary papilloma of lactiferous sinus*** - A **solitary papilloma of the lactiferous sinus** is a proliferative breast lesion that is associated with a **slightly increased relative risk (approximately 1.5-2x)** for subsequent invasive breast carcinoma [2]. - Classified under **proliferative disease without atypia** in WHO classification of breast lesions [2]. - The risk is further elevated if there is associated **atypia** present [3]. - This is the **EXCEPTION** - it DOES carry increased risk, unlike the other options listed. *Squamous metaplasia* - **Squamous metaplasia** is a benign metaplastic change in breast tissue where glandular epithelium is replaced by squamous epithelium. - Typically seen in conditions like **periductal mastitis** or chronic inflammation. - Classified as a **non-proliferative lesion** and is **not associated** with an increased risk of invasive breast carcinoma [1]. *Usual ductal hyperplasia* - **Usual ductal hyperplasia (UDH)**, also known as **mild ductal hyperplasia**, is a proliferative lesion but historically has been considered to confer **minimal to no significantly increased risk** when mild [4]. - However, more recent studies suggest mild UDH may carry a **slight increase (1.3-1.5x)** compared to non-proliferative lesions, though this is **less established** than the risk from papillomas. - For exam purposes, **solitary papilloma** is the more definitive answer as a proliferative lesion with established increased risk. *Periductal mastitis* - **Periductal mastitis** is a chronic inflammatory condition of the breast ducts, often associated with smoking. - Characterized by inflammation, fibrosis, and squamous metaplasia of the ductal epithelium. - It is a **non-proliferative inflammatory condition** and is **not considered a risk factor** for invasive breast carcinoma [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1054. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1054-1056. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 446-447.
Question 4: Which of the following statements regarding Paget's disease of nipple are correct? 1. It represents benign pathology of nipple areola complex 2. It is eczema like condition of nipple and areola 3. Erosion of nipple is seen 4. Nipple biopsy is required for definitive diagnosis Select the correct answer using the code given below:
- A. 2 and 4 only
- B. 1, 2 and 3
- C. 1, 3 and 4
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***2, 3 and 4*** - **Paget's disease** presents as an **eczema-like rash** on the nipple and areola, and is characterized by **nipple erosion** [1] and ulceration. - It is an **intraepithelial adenocarcinoma** of the nipple [1], and a definitive diagnosis requires a **nipple biopsy** [1] to identify Paget's cells [2]. *2 and 4 only* - This option is incomplete as it misses the important clinical feature of **nipple erosion**, which is a common presentation of Paget's disease. - While it correctly identifies the eczema-like appearance and the need for biopsy, it understates the full clinical picture. *1, 2 and 3* - Statement 1 is incorrect because Paget's disease of the nipple is a **malignant condition** [2], not a benign one. - It arises from **ductal carcinoma in situ** [1] or invasive breast cancer extending to the nipple epidermis. *1, 3 and 4* - Statement 1 is incorrect as **Paget's disease is malignant**, representing an underlying breast cancer [2], not a benign pathology. - This option incorrectly classifies the disease as benign, which is a critical misunderstanding of its nature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457.
Question 5: In diffuse axonal injury all are true EXCEPT:
- A. Seen in high energy
- B. Form of primary brain injury
- C. CT scan shows pathognomonic finding (Correct Answer)
- D. Usually causes prolonged coma
Explanation: ***CT scan shows pathognomonic finding*** - While CT scans can sometimes show petechial hemorrhages or small white matter lesions in **diffuse axonal injury (DAI)**, these findings are **not pathognomonic** and can be absent even in severe cases. - **MRI** is more sensitive for detecting microhemorrhages and white matter changes, but even MRI findings are not always definitively diagnostic of DAI, especially in milder forms. - CT scan has **low sensitivity** for DAI, often appearing normal or showing only subtle findings. *Usually causes prolonged coma* - **Diffuse axonal injury (DAI)** is a common cause of **prolonged coma** after traumatic brain injury, as widespread shearing forces disrupt neuronal connections [1]. - The severity and duration of coma correlate with the extent of axonal damage, with severe DAI typically resulting in immediate and prolonged loss of consciousness. *Seen in high energy* - DAI typically results from **high-energy acceleration-deceleration forces**, often seen in motor vehicle accidents or falls from significant heights [1]. - These forces cause differential movement between various parts of the brain, leading to **shearing and stretching of axons** [1]. *Form of primary brain injury* - DAI is considered a **primary brain injury** because the axonal damage occurs at the **moment of impact** due to mechanical forces [1]. - This contrasts with secondary brain injuries, which develop over time due to complications like edema or ischemia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1262-1264.