Histology — MCQs

Histology Indian Medical PG Practice Questions and MCQs

Question 111: A 10-mm calculus in the right lower ureter associated with proximal hydroureteronephrosis is best treated with?

A. Extracorporeal shockwave lithotripsy
B. Antegrade percutaneous access
C. Open ureterolithotomy
D. Ureteroscopic retrieval (Correct Answer)

Explanation: The management of ureteral calculi is determined by the size, location, and presence of complications. In this case, the patient has a **10-mm calculus** in the **lower (distal) ureter** with associated **hydroureteronephrosis**, indicating significant obstruction. **Why Ureteroscopic Retrieval (URS) is correct:** For distal ureteral stones >10 mm, **Ureteroscopy (URS)** with laser lithotripsy or basket retrieval is the gold standard. It offers the highest stone-free rate (SFR) for the lower ureter compared to other modalities. Since there is proximal hydroureteronephrosis, URS allows for both immediate stone clearance and the placement of a Double-J (DJ) stent to relieve the obstruction. **Analysis of Incorrect Options:** * **A. Extracorporeal Shockwave Lithotripsy (ESWL):** While ESWL is non-invasive, its efficacy decreases for stones >10 mm and for those located in the distal ureter due to the "pelvic bone shield" effect, which makes targeting difficult. * **B. Antegrade Percutaneous Access:** This approach (PCNL) is typically reserved for large renal calculi (>2 cm) or proximal ureteral stones that cannot be reached retrogradely. It is unnecessarily invasive for a distal stone. * **C. Open Ureterolithotomy:** This is now considered a "last resort" procedure, reserved only for cases where endoscopic or laparoscopic methods fail or for exceptionally large, impacted complex stones. **Clinical Pearls for NEET-PG:** * **Stone Size:** Stones <5 mm usually pass spontaneously; stones >10 mm rarely do [1]. * **Location Matters:** ESWL is preferred for upper ureteral stones <1 cm; URS is preferred for all distal ureteral stones. * **Medical Expulsive Therapy (MET):** Tamsulosin (Alpha-1 blocker) is the drug of choice to facilitate the passage of small distal stones by relaxing ureteral smooth muscle [1]. * **Narrowest part of the ureter:** The Vesicoureteric Junction (VUJ) is the most common site for stone impaction.

Question 112: Transurethral resection (T.U.R.) syndrome is due to which of the following electrolyte imbalances?

A. Hyponatremia (Correct Answer)
B. Hypokalemia
C. Hypovolemia
D. Hypoxia

Explanation: ### Explanation **TUR Syndrome** is a clinical complication that occurs during Transurethral Resection of the Prostate (TURP) due to the systemic absorption of large volumes of non-conductive irrigation fluids (such as Glycine, Sorbitol, or Mannitol) through opened prostatic venous sinuses [1]. #### 1. Why Hyponatremia is Correct The primary mechanism is **dilutional hyponatremia**. As the irrigation fluid enters the circulation, it expands the intravascular volume and dilutes the serum sodium concentration [1]. If glycine is used, its metabolism into ammonia can further contribute to neurological symptoms (encephalopathy). The rapid drop in sodium leads to cerebral edema, manifesting as confusion, seizures, and visual disturbances. #### 2. Analysis of Incorrect Options * **Hypokalemia:** While electrolyte shifts occur, potassium levels are generally stable or may even rise (hyperkalemia) if significant hemolysis occurs. It is not the hallmark of TUR syndrome. * **Hypovolemia:** TUR syndrome is characterized by **hypervolemia** (fluid overload) due to the massive absorption of irrigation fluid, which can lead to hypertension and pulmonary edema [1]. * **Hypoxia:** While hypoxia can occur secondary to pulmonary edema (left heart failure from fluid overload), it is a late-stage complication rather than the primary electrolyte trigger. #### 3. NEET-PG High-Yield Pearls * **Classic Triad:** Hypertension (with bradycardia), mental status changes, and visual disturbances. * **Fluid Choice:** Glycine 1.5% is most commonly used but carries the risk of ammonia toxicity and transient blindness. * **Prevention:** Limit resection time to <60 minutes and keep the irrigation bag height <60 cm above the patient. * **Treatment:** Fluid restriction and loop diuretics for mild cases; **Hypertonic saline (3% NaCl)** for severe, symptomatic hyponatremia [1].

Question 113: Uterus, before menarche, is lined by which type of epithelium?

A. Ciliated columnar epithelium (Correct Answer)
B. Stratified squamous non-keratinized epithelium
C. Stratified squamous keratinized epithelium
D. Cuboidal epithelium

Explanation: The lining of the uterus (endometrium) undergoes significant histological changes based on age and hormonal status. **1. Why Ciliated Columnar Epithelium is correct:** Before menarche, the endometrium is relatively thin and inactive. It is lined by a **simple ciliated columnar epithelium** [1]. These cilia are essential during early development and prepubertal stages. After menarche, under the influence of estrogen and progesterone, the epithelium remains columnar but the proportion of ciliated cells fluctuates; they are most prominent during the proliferative phase and decrease after ovulation [2]. **2. Analysis of Incorrect Options:** * **B & C (Stratified Squamous):** This epithelium is designed for protection against mechanical stress. Non-keratinized stratified squamous epithelium lines the **vagina** and the **ectocervix**. Keratinized epithelium is found on the skin. The presence of squamous cells inside the uterine cavity is pathological (e.g., squamous metaplasia). * **D (Cuboidal Epithelium):** While some inactive or atrophic endometrial glands may appear low-columnar or cuboidal (especially in post-menopausal states), the surface lining is characteristically columnar. **3. High-Yield Clinical Pearls for NEET-PG:** * **Fallopian Tube:** Also lined by ciliated columnar epithelium (highest concentration of cilia in the infundibulum and ampulla to facilitate ovum transport). * **Endocervix:** Lined by simple columnar epithelium (mucin-secreting) [1]. * **Transformation Zone:** The junction where the simple columnar epithelium of the endocervix meets the stratified squamous epithelium of the ectocervix; this is the most common site for cervical cancer. * **Post-menopause:** The endometrium becomes atrophic, and the epithelium may lose its cilia and become low columnar.

Question 114: Which of the following is NOT a B cell marker?

A. CD 19
B. CD 20
C. CD 10
D. CD 135 (Correct Answer)

Explanation: The identification of lymphocytes via **Cluster of Differentiation (CD)** markers is a high-yield topic in histology and pathology. B cells express specific surface antigens at various stages of their development [1], which are used clinically for immunophenotyping. **Why CD 135 is the correct answer:** **CD 135** (also known as Flt3) is a cytokine receptor expressed on **multipotent hematopoietic stem cells** and common lymphoid/myeloid progenitors. While it plays a role in the early commitment of cells to the lymphoid lineage, it is not a specific marker for B cells. It is primarily associated with early hematopoiesis and is often overexpressed in **Acute Myeloid Leukemia (AML)**. **Analysis of incorrect options (B cell markers):** * **CD 19:** This is the most specific and reliable pan-B cell marker. It is expressed from the earliest pro-B cell stage until just before terminal differentiation into plasma cells. * **CD 20:** A classic pan-B cell marker expressed on mature B cells. It is the clinical target for the monoclonal antibody **Rituximab**. Like CD 19, it is lost during the transition to plasma cells. * **CD 10:** Also known as **CALLA** (Common Acute Lymphoblastic Leukemia Antigen). It is expressed on pre-B cells and germinal center B cells. It is a crucial marker for diagnosing Childhood Acute Lymphoblastic Leukemia (ALL). **High-Yield Clinical Pearls for NEET-PG:** * **Pan-B cell markers:** CD 19, CD 20, CD 21, CD 22, and CD 79a. * **Plasma Cell markers:** CD 138 (Syndecan-1) and CD 38. (Note: Plasma cells usually lose CD 19 and CD 20). * **T-cell markers:** CD 3 (universal), CD 4 (Helper), CD 8 (Cytotoxic). * **NK cell markers:** CD 16 and CD 56.

Question 115: Which of the following statements about testicular torsion is NOT true?

A. Presents with sudden onset of testicular pain.
B. Is commonly associated with pyuria. (Correct Answer)
C. Doppler ultrasound shows decreased blood flow to the testis.
D. Simultaneous orchidopexy of the contralateral testis should be performed.

Explanation: Testicular torsion is a surgical emergency caused by the twisting of the spermatic cord, leading to ischemia and potential infarction of the testis. **Why Option B is the Correct Answer (The False Statement):** Pyuria (pus cells in the urine) is a hallmark of **infectious** processes like acute epididymo-orchitis or urinary tract infections. Testicular torsion is a **mechanical/vascular** event, not an inflammatory or infectious one. Therefore, the urinalysis in torsion is typically normal. The presence of pyuria would actually point *away* from torsion and toward a diagnosis of epididymitis. **Analysis of Other Options:** * **Option A:** Sudden, severe onset of unilateral scrotal pain is the classic clinical presentation of torsion, often occurring during sleep or physical activity. * **Option C:** Color Doppler Ultrasound is the gold standard imaging modality. It reveals decreased or absent arterial blood flow to the affected testis, distinguishing it from epididymitis (where flow is increased). * **Option D:** Torsion often occurs due to a congenital "bell-clapper deformity" (high tunica vaginalis attachment). Since this anatomical defect is usually bilateral, the contralateral testis must be fixed (orchidopexy) to prevent future torsion. **NEET-PG High-Yield Pearls:** * **Golden Period:** Salvage rate is nearly 100% if detorsion occurs within 6 hours; it drops to <10% after 24 hours. * **Prehn’s Sign:** Negative in torsion (pain is not relieved by lifting the scrotum), but positive in epididymitis. * **Cremasteric Reflex:** Typically **absent** in testicular torsion (highly sensitive clinical sign). * **Deformity:** The "Bell-clapper deformity" is the most common predisposing factor.

Question 116: A child presents with complaints of abdominal colic and hematuria. USG showed a renal stone 2.5 cm in diameter in the renal pelvis. What is the next step in management?

A. Percutaneous nephrolithotomy (PCNL) (Correct Answer)
B. Extracorporeal shock wave lithotripsy (ESWL)
C. Nephroureterostomy
D. Conservative management

Explanation: **Explanation:** The management of pediatric renal stones is primarily guided by the size, location, and composition of the stone. **1. Why PCNL is the Correct Answer:** According to the European Association of Urology (EAU) and American Urological Association (AUA) guidelines, **Percutaneous Nephrolithotomy (PCNL)** is the gold standard for renal stones **>2 cm** in diameter. In this case, the child has a 2.5 cm stone in the renal pelvis. PCNL offers the highest stone-free rate (SFR) for large stones in a single session compared to other modalities. In children, "mini-PCNL" is often preferred to reduce parenchymal damage. **2. Why Other Options are Incorrect:** * **ESWL (Option B):** While ESWL is non-invasive and effective for smaller stones, its efficacy drops significantly for stones **>1.5–2 cm**. Large stones often require multiple sessions and carry a high risk of "Steinstrasse" (stone street), where fragments block the ureter. * **Nephroureterostomy (Option C):** This is a diversion procedure used to drain an obstructed system; it is not a definitive treatment for stone removal. * **Conservative Management (Option D):** Stones >5–7 mm are unlikely to pass spontaneously, especially a 2.5 cm stone [1]. Delaying treatment in a symptomatic child (colic, hematuria) risks infection and renal damage [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Stone <1 cm:** ESWL is the first-line treatment for most renal stones. * **Stone 1–2 cm:** Choice between ESWL, RIRS (Retrograde Intrarenal Surgery), or PCNL based on location (Lower pole stones >1 cm favor PCNL/RIRS). * **Stone >2 cm:** PCNL is the treatment of choice. * **Staghorn Calculus:** PCNL is the gold standard. * **Cystine/Calcium Oxalate Monohydrate stones:** These are "hard" stones and are relatively resistant to ESWL; PCNL is preferred.

Question 117: Which of the following is not a connective tissue?

A. Blood
B. Muscle (Correct Answer)
C. Bone
D. Cartilage

Explanation: In histology, tissues are classified into four primary types: Epithelial, Connective, Muscular, and Nervous. **Why Muscle is the correct answer:** Muscle is a primary tissue type, not a subtype of connective tissue. While connective tissues are characterized by an abundant **extracellular matrix (ECM)** that separates cells, muscle tissue consists of closely packed cells (myocytes) specialized for **contraction** and excitability [1]. Muscle tissue is derived from the mesoderm (except for the muscles of the iris) and is categorized into skeletal, cardiac, and smooth types. **Why the other options are incorrect:** Connective tissue is defined by cells embedded within an ECM consisting of ground substance and fibers. * **Blood:** Known as "Fluid Connective Tissue." It possesses a liquid matrix (plasma) and lacks fibers under normal conditions (fibers only appear during clotting as fibrin). * **Bone:** Known as "Specialized/Supportive Connective Tissue." It has a mineralized, hard matrix impregnated with calcium salts [2]. The constituents of bone include an extracellular matrix and specialized cells responsible for production and maintenance of the matrix [2]. * **Cartilage:** Another "Specialized Connective Tissue" with a semi-rigid, pliable matrix containing chondrocytes. **High-Yield Facts for NEET-PG:** * **Origin:** Most connective tissues and all muscle types originate from the **mesoderm**. * **Wharton’s Jelly:** A mucous connective tissue found in the umbilical cord (rich in hyaluronic acid). * **Most abundant protein:** **Collagen** is the most abundant protein in the human body and a key component of connective tissue. Bone matrix predominantly contains type I collagen [2]. * **Plasma Cells:** Derived from B-lymphocytes, these are "cartwheel" appearance cells found in connective tissue responsible for antibody production.

Question 118: A patient presented with acute abdominal pain. On clinical suspicion, the patient underwent cholecystectomy. Histopathological examination revealed normal findings. Which type of cells lines the gallbladder?

A. Squamous epithelium
B. Simple columnar epithelium with brush border (Correct Answer)
C. Simple columnar epithelium
D. Simple columnar epithelium with stereocilia

Explanation: The gallbladder is a storage organ responsible for concentrating bile. To achieve this, the mucosa is lined by a **Simple Columnar Epithelium** characterized by numerous **microvilli** on the apical surface. These microvilli are collectively referred to as a **"brush border"** (or striated border), which significantly increases the surface area for the absorption of water and electrolytes from the bile. **Analysis of Options:** * **Option B (Correct):** The presence of a brush border is the defining histological feature that allows the gallbladder to concentrate bile up to 10-fold. * **Option A:** Squamous epithelium is found in areas requiring protection (stratified) or rapid diffusion (simple, like alveoli), not in absorptive visceral organs. * **Option C:** While the cells are columnar, "Simple columnar epithelium" is an incomplete description. In the context of competitive exams like NEET-PG, the specific presence of the brush border is the preferred, more accurate histological detail. * **Option D:** Stereocilia are long, non-motile microvilli found primarily in the epididymis and the sensory hair cells of the inner ear. **High-Yield NEET-PG Pearls:** 1. **Absence of Submucosa:** The gallbladder wall is unique because it **lacks a muscularis mucosae and a submucosa**. The lamina propria rests directly on the muscularis externa. 2. **Rokitansky-Aschoff Sinuses:** These are mucosal herniations into the muscular layer, often seen in chronic cholecystitis. 3. **Luschka’s Ducts:** Accessory bile ducts found in the connective tissue between the liver and gallbladder; they are a common cause of bile leaks post-cholecystectomy. 4. **No Goblet Cells:** Unlike the rest of the GI tract, the normal gallbladder mucosa does not contain goblet cells.

Question 119: Microscopic examination of the articular surface of a synovial joint demonstrates what type of tissue?

A. Hyaline cartilage (Correct Answer)
B. Adipocytes
C. Endothelial cells
D. Periosteum

Explanation: **Explanation:** The articular surfaces of synovial joints are covered by **Hyaline cartilage** (specifically termed **Articular Cartilage**) [1]. This tissue provides a smooth, low-friction surface for joint movement and acts as a shock absorber [1]. Structurally, it is unique because it lacks a perichondrium, nerves, and blood vessels, receiving its nutrition primarily via diffusion from the synovial fluid [1]. **Analysis of Options:** * **Hyaline Cartilage (Correct):** It is characterized by a glassy, bluish-white appearance. The matrix contains Type II collagen fibers and proteoglycans (like aggrecan), which provide the necessary tensile strength and hydration to withstand compressive forces [1]. * **Adipocytes:** These are fat cells found in the subcutaneous layer or "fat pads" (e.g., infrapatellar fat pad) within the joint capsule, but they do not form the articular surface itself. * **Endothelial Cells:** These line the blood vessels. While the synovial membrane is vascular, the actual articular surface is avascular [1]. * **Periosteum:** This is the dense connective tissue covering the outer surface of bones. Crucially, the periosteum **stops** at the junction where the bone becomes the articular surface; its presence on the joint surface would cause extreme pain and friction. **High-Yield Clinical Pearls for NEET-PG:** * **Collagen Type:** Articular cartilage is predominantly **Type II collagen** ("Two" for "Car-ti-la-ge") [1]. * **Osteoarthritis:** This condition involves the progressive degeneration of this hyaline cartilage, leading to bone-on-bone contact and osteophyte formation [2]. * **Nutrition:** Since articular cartilage is **avascular**, joint movement (the "pump" mechanism) is essential for the diffusion of nutrients from synovial fluid into the chondrocytes [1].

Question 120: Which statement about articular cartilage is true?

A. It is a very vascular structure.
B. It is surrounded by a thick perichondrium.
C. It has no nerve supply. (Correct Answer)
D. It is fibrocartilage.

Explanation: **Explanation:** Articular cartilage is a specialized type of **hyaline cartilage** that covers the weight-bearing surfaces of bones within synovial joints [1]. Its primary function is to provide a smooth, lubricated surface for low-friction articulation and to facilitate the transmission of loads to the underlying bone [1]. **1. Why the correct answer is right:** Articular cartilage is unique because it is **aneural, avascular, and alymphatic** [1]. It lacks a nerve supply, which is why initial stages of cartilage degeneration (like early osteoarthritis) are often painless. Pain in joint diseases typically arises only when the underlying subchondral bone (which is highly innervated) or the surrounding synovium is affected [2]. **2. Why the incorrect options are wrong:** * **Option A:** It is **avascular**. Chondrocytes receive their nutrition via diffusion from the synovial fluid and the subchondral bone [1]. * **Option B:** Unlike most hyaline cartilage, articular cartilage **lacks a perichondrium**. The absence of perichondrium allows for a smooth friction-free surface but also results in a very limited capacity for regeneration and repair. * **Option D:** It is **hyaline cartilage**, not fibrocartilage. Fibrocartilage (found in intervertebral discs and symphysis pubis) contains thick bundles of Type I collagen, whereas articular cartilage primarily contains **Type II collagen** [1]. **High-Yield NEET-PG Pearls:** * **Composition:** 70-80% water, Type II collagen, and Proteoglycans (Aggrecan) [1]. * **Growth:** It grows via interstitial and appositional growth (though appositional growth is absent in articular cartilage due to lack of perichondrium). * **Calcification:** It is the only cartilage that does not readily calcify except in the "tidemark" zone bordering subchondral bone.

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Histology — MCQs

Histology — MCQs

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