UPSC-CMS 2023 — Pathology
9 Previous Year Questions with Answers & Explanations
The histological grade best correlates with the prognosis in which one of the following malignancies?
Basophilic stippling of the RBCs is a sensitive index of
The term "Gompertzian curve" is related to which one of the following ?
"Collar-stud" abscess is seen in :
Which of the following statements are correct with regard to Familial Adenomatous Polyposis ? 1. It is associated with mutation of APC gene located on the long arm of chromosome 5. 2. It is inherited as an autosomal recessive condition. 3. It is associated with 100% lifetime risk for development of Colorectal carcinoma. 4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis. Select the correct answer using the code given below :
Masaoka staging is used for staging:
Ischemia-Reperfusion syndrome is characterized by:
'Schiller-Duval body' is a characteristic histological feature of which one of the following cancers?
Which among the following has two general phases - first, simple pneumoconiosis and a second phase characterized by progressive massive fibrosis (PMF)?
UPSC-CMS 2023 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: The histological grade best correlates with the prognosis in which one of the following malignancies?
- A. Soft tissue sarcoma (Correct Answer)
- B. Melanoma
- C. Colonic adenocarcinoma
- D. Prostate cancer
Explanation: ***Soft tissue sarcoma*** - **Histological grade is THE MOST IMPORTANT prognostic factor** for soft tissue sarcomas, more significant than size or depth in many cases. - The **FNCLCC (French Federation of Cancer Centers) grading system** is the gold standard, which grades tumors based on differentiation, mitotic count, and necrosis. - Grade directly predicts metastatic potential and survival - high-grade sarcomas have significantly worse prognosis than low-grade tumors [2]. - This is consistently emphasized in **WHO classification of soft tissue tumors** and oncology guidelines. *Colonic adenocarcinoma* - While histological grade (well, moderate, poorly differentiated) is assessed, **TNM staging** (particularly T stage - depth of invasion, and N stage - lymph node involvement) is far more important for prognosis. - Stage is the primary determinant of treatment and survival, not grade. *Melanoma* - Prognosis is primarily determined by **Breslow thickness** (tumor depth in mm), presence of **ulceration**, and **mitotic rate**. - Histological grade per se is not the primary prognostic factor - tumor thickness is paramount. *Prostate cancer* - Uses the **Gleason score/Grade Group system**, which assesses architectural patterns rather than traditional cytological differentiation [1]. - While the Gleason score is crucial, this is a specific grading system, not conventional "histological grade" as understood in general pathology. **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. 993-994. [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. 207-208.
Question 2: Basophilic stippling of the RBCs is a sensitive index of
- A. Silicosis
- B. Asbestosis
- C. Arsenic poisoning
- D. Lead poisoning (Correct Answer)
Explanation: ***Correct: Lead poisoning*** - **Basophilic stippling** is a classic and sensitive hematologic finding in lead poisoning [1] - Results from inhibition of **pyrimidine 5'-nucleotidase**, which impairs RNA degradation in red blood cells - The presence of these **ribonucleoprotein granules** indicates defective heme synthesis and red cell maturation due to lead toxicity [1] - Other findings in lead poisoning include microcytic anemia and increased zinc protoporphyrin [1] *Incorrect: Silicosis* - A **lung disease** caused by inhaling **silica dust**, leading to pulmonary fibrosis and nodular lesions [2] - Does not primarily affect red blood cell morphology or cause basophilic stippling - Findings are limited to the respiratory system *Incorrect: Asbestosis* - A chronic **lung disease** caused by inhaling **asbestos fibers**, resulting in pulmonary fibrosis [2] - Does not directly cause changes in red blood cell morphology such as basophilic stippling - Associated with pleural plaques and increased risk of mesothelioma [2] *Incorrect: Arsenic poisoning* - Can cause various hematologic abnormalities including **anemia** and **pancytopenia** - **Not typically associated** with prominent basophilic stippling as a key diagnostic feature - Neurological symptoms (peripheral neuropathy), gastrointestinal symptoms, and dermatological findings (Mees' lines, hyperpigmentation) are more characteristic **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-420. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 695-699.
Question 3: The term "Gompertzian curve" is related to which one of the following ?
- A. Intestinal obstruction
- B. Gallstone
- C. Tumour (Correct Answer)
- D. Hernia
Explanation: ***Correct Option: Tumour*** - The **Gompertzian curve** describes the growth pattern of tumors, characterized by an initial exponential growth phase followed by a deceleration of growth as the tumor size increases - This deceleration occurs due to limiting factors like **nutrient supply, oxygen availability, and accumulation of waste products** - This model is widely used in **oncology** to understand tumor kinetics, predict responses to treatment, and explain why smaller tumors respond better to chemotherapy than larger ones - The concept is fundamental in understanding **tumor doubling time** and **fractional cell kill hypothesis** in cancer therapy *Incorrect Option: Intestinal obstruction* - **Intestinal obstruction** refers to a mechanical or functional blockage in the intestine - Its clinical course is acute and does not follow a growth curve model - The progression is determined by the degree and location of obstruction, not by cellular proliferation kinetics *Incorrect Option: Gallstone* - A **gallstone** is a hardened deposit of digestive fluid that forms in the gallbladder - Gallstone formation involves bile supersaturation and precipitation of cholesterol or bilirubin, not cellular growth - Its development does not follow the Gompertzian pattern of exponential growth followed by plateau *Incorrect Option: Hernia* - A **hernia** occurs when an organ or tissue protrudes through a weakness in the surrounding muscle or connective tissue - Hernia development is a **structural/anatomical defect**, not a process involving cellular proliferation - It does not involve growth kinetics and is unrelated to the Gompertzian curve concept
Question 4: "Collar-stud" abscess is seen in :
- A. Lymphomatous degeneration
- B. Pseudomonas infection
- C. Tuberculosis (Correct Answer)
- D. Streptococcal infection
Explanation: ***Tuberculosis*** - A "**collar-stud**" abscess is a classic presentation of **tuberculous lymphadenitis**, particularly in the neck. - This type of abscess forms when pus from an infected deep lymph node erodes through the deep fascia but is contained by the superficial fascia, creating a dumbbell or "collar-stud" shape. *Lymphomatous degeneration* - **Lymphomatous degeneration** refers to the transformation of a benign lymphoid process into lymphoma. - While lymph nodes are involved, it typically presents as **lymphadenopathy** (enlargement of lymph nodes) and does not characteristically form an abscess with this specific morphology. *Pseudomonas infection* - **Pseudomonas infections** can cause abscesses, especially in immunocompromised individuals or associated with contaminated wounds or medical devices. - However, they do not specifically form a "**collar-stud**" abscess, which is a hallmark of tuberculous infection of lymph nodes. *Streptococcal infection* - **Streptococcal infections** frequently cause cellulitis, erysipelas, and various forms of abscesses, such as peritonsillar or skin abscesses. - While streptococci can cause **suppurative lymphadenitis**, they do not typically produce the distinctive "**collar-stud**" morphology seen in tuberculosis.
Question 5: Which of the following statements are correct with regard to Familial Adenomatous Polyposis ? 1. It is associated with mutation of APC gene located on the long arm of chromosome 5. 2. It is inherited as an autosomal recessive condition. 3. It is associated with 100% lifetime risk for development of Colorectal carcinoma. 4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis. Select the correct answer using the code given below :
- A. 1, 2 and 3
- B. 1, 3 and 4 (Correct Answer)
- C. 2, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 3 and 4*** - Familial Adenomatous Polyposis is indeed associated with a mutation in the **APC gene** located on the **short arm of chromosome 5 (5q21-q22)** and carries a **nearly 100% lifetime risk** of developing colorectal carcinoma if left untreated [1]. - **Congenital hypertrophy of the retinal pigment epithelium (CHRPE)**, also known as bear claw lesions, is a characteristic extracolonic manifestation observed in approximately half of FAP patients, though it does not usually affect vision. *1, 2 and 3* - This option is incorrect because FAP is inherited as an **autosomal dominant** condition, not autosomal recessive. - Statement 2, claiming autosomal recessive inheritance, is false, rendering this combination incorrect. *2, 3 and 4* - This option incorrectly states that FAP is inherited as an **autosomal recessive** condition. It is an autosomal dominant disorder. - While statements 3 and 4 are correct, the inclusion of statement 2 makes this option invalid. *1, 2 and 4* - This option is incorrect due to the assertion that FAP is an **autosomal recessive** condition (statement 2). - FAP is correctly linked to the APC gene mutation (statement 1) and CHRPE (statement 4), but the inheritance pattern given here is wrong. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.
Question 6: Masaoka staging is used for staging:
- A. Thymoma (Correct Answer)
- B. Germ cell tumours
- C. Neurogenic tumours
- D. Lymphoma
Explanation: ***Thymoma*** - The **Masaoka staging system** is specifically designed for evaluating the extent of **thymomas**, a type of tumor originating from the thymus gland [1]. - This system assesses tumor invasion into surrounding structures, such as the mediastinal fat, pleura, pericardium, and great vessels, which is critical for determining prognosis and treatment [1],[2]. *Germ cell tumours* - **Germ cell tumors** are typically staged using systems specific to their primary site (e.g., testicular, ovarian, mediastinal) that often involve imaging, tumor markers (e.g., AFP, beta-hCG), and histopathological findings. - While germ cell tumors can occur in the mediastinum, the Masaoka system is not their primary staging method. *Neurogenic tumours* - **Neurogenic tumors** encompass a broad range of tumors arising from nervous tissue (e.g., neuroblastoma, schwannoma, ganglioneuroma) and are staged using various systems depending on the specific tumor type and location (e.g., INPC staging for neuroblastoma). - The Masaoka system is not applicable to these tumors. *Lymphoma* - **Lymphomas** are staged using the **Ann Arbor classification system** (or modified Lugano classification), which primarily considers the number and location of involved lymph node regions, as well as extranodal involvement. - This system is distinct from the Masaoka staging system, which is anatomically focused on the thymus and its surrounding structures. **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, pp. 634-635. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 572-574.
Question 7: Ischemia-Reperfusion syndrome is characterized by:
- A. Thrombo embolic angiopathy
- B. Hypoxia and activation of inflammation (Correct Answer)
- C. Build up of bicarbonate and Na+ ions
- D. Acute mesenteric thrombosis
Explanation: **Hypoxia and activation of inflammation** - **Ischemia-reperfusion injury** occurs when blood flow is restored to tissues previously deprived of oxygen, leading to further damage due to the rapid influx of oxygen and inflammatory mediators. - The initial **hypoxia** during ischemia triggers cellular changes, and subsequent reperfusion activates a robust **inflammatory response**, including the recruitment of neutrophils and the release of reactive oxygen species [1]. *Thrombo embolic angiopathy* - While thrombus formation can be a cause of ischemia, **thromboembolic angiopathy** itself is not the primary characteristic of the ischemia-reperfusion syndrome. - The syndrome's defining feature is the injury that occurs *after* the initial ischemic event, upon restoration of blood flow. *Build up of bicarbonate and Na+ ions* - Ischemia typically leads to a buildup of **lactic acid** and a decrease in pH (acidosis), not bicarbonate. - While electrolyte imbalances can occur, a specific buildup of bicarbonate and Na+ ions is not a hallmark characteristic of ischemia-reperfusion injury. *Acute mesenteric thrombosis* - **Acute mesenteric thrombosis** is a *cause* of mesenteric ischemia, not a general characteristic of the ischemia-reperfusion syndrome itself. - The syndrome describes the cellular and tissue injury that results from the initial ischemia and subsequent reperfusion, regardless of the underlying cause of ischemia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 786-787.
Question 8: 'Schiller-Duval body' is a characteristic histological feature of which one of the following cancers?
- A. Endodermal sinus tumour (Correct Answer)
- B. Non-gestational ovarian choriocarcinoma
- C. Dysgerminoma
- D. Sex cord stromal tumours
Explanation: ***Endodermal sinus tumour*** - **Schiller-Duval bodies** are pathognomonic histological structures found in **endodermal sinus tumours** (also known as yolk sac tumours). - These structures mimic the primitive glomerulus, consisting of a central capillary surrounded by tumour cells within a cyst-like space. *Non-gestational ovarian choriocarcinoma* - Characterized by the presence of **syncytiotrophoblast** and **cytotrophoblast** cells, often arranged in bilaminar structures [2]. - While it can produce **human chorionic gonadotropin (hCG)**, it does not typically feature Schiller-Duval bodies [2], [3]. *Dysgerminoma* - Composed of large, rounded, uniform cells with clear cytoplasm and prominent nuclei, often arranged in cords or nests separated by fibrous septa infiltrated by **lymphocytes**. - This tumour is analogous to testicular seminoma and does not contain Schiller-Duval bodies. *Sex cord stromal tumours* - A diverse group of tumours, including **granulosa cell tumours** and **Sertoli-Leydig cell tumours**, which originate from the ovarian stroma or sex cords [1]. - Histological features vary widely but generally involve granulosa cells, theca cells, Sertoli cells, or Leydig cells, and do not include Schiller-Duval bodies [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.
Question 9: Which among the following has two general phases - first, simple pneumoconiosis and a second phase characterized by progressive massive fibrosis (PMF)?
- A. Bagassosis
- B. Anthracosis (Correct Answer)
- C. Byssinosis
- D. Siderosis
Explanation: ***Anthracosis (Coal Worker's Pneumoconiosis)*** - **Coal Worker's Pneumoconiosis (CWP)**, also known as **anthracosis** or **black lung disease**, is caused by prolonged inhalation of **coal dust** [1]. - It characteristically progresses through **two distinct phases** [2]: - **Simple CWP (Simple Pneumoconiosis)**: Characterized by coal macules and nodules (<1 cm) visible on chest X-ray, usually asymptomatic [2]. - **Complicated CWP (Progressive Massive Fibrosis - PMF)**: Large confluent fibrotic masses (>1 cm), often in upper lobes, leading to significant respiratory impairment [1][2]. - **PMF develops in 10-15%** of cases with simple CWP and represents irreversible progressive fibrosis. *Bagassosis* - **Bagassosis** is a **hypersensitivity pneumonitis** (extrinsic allergic alveolitis) caused by exposure to **bagasse**, the fibrous residue of sugarcane containing thermophilic actinomycetes [1]. - It presents as an **acute or chronic inflammatory response**, not a two-phase pneumoconiosis with PMF. *Byssinosis* - **Byssinosis** is an occupational lung disease caused by exposure to **cotton, flax, or hemp dust** in textile workers. - It manifests as **reversible airway obstruction** with characteristic **"Monday morning" chest tightness** and does not progress to PMF. - It is a reactive airway disease, not a fibrotic pneumoconiosis. *Siderosis* - **Siderosis** is a **benign pneumoconiosis** caused by inhalation of **iron oxide particles** (welders, iron miners) [1]. - It causes **radiographic opacities** but is **non-fibrogenic** and does not cause functional impairment or progress to PMF [1]. - Iron particles are inert and do not trigger significant inflammatory or fibrotic response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 695. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 331-332.