Cytopathology Practice Questions

Q: All of the following are associated with Multiple Endocrine Neoplasia type 2 (MEN-2) except:

Islet cell hyperplasia. **Explanation:** The question tests your knowledge of **Multiple Endocrine Neoplasia (MEN)** syndromes, which are autosomal dominant disorders characterized by tumors involving two or more endocrine glands. **Why "Islet cell hyperplasia" is the correct answer:** Islet cell hyperplasia (or pancreatic endocrine tumors like gastrinomas and insulinomas) is a hallmark of **MEN-1 (Wermer Syndrome)**, not MEN-2 [1]. MEN-1 is characterized by the "3 Ps": **P**ituitary adenoma, **P**arathyroid hyperplasia/adenoma, and **P**ancreatic islet cell tumors [1]. **Analysis of incorrect options (Features of MEN-2):** * **Medullary Carcinoma of Thyroid (MTC):** This is the most consistent feature of both MEN-2A and MEN-2B (occurring in nearly 100% of cases) [1]. It arises from parafollicular C-cells. * **Pheochromocytoma:** This occurs in approximately 50% of patients with both MEN-2A and MEN-2B [1]. It is often bilateral and extra-adrenal. * **Parathyroid Adenoma/Hyperplasia:** This is a component of **MEN-2A (Sipple Syndrome)** [1]. It is notably absent in MEN-2B. **Clinical Pearls for NEET-PG:** 1. **Genetic Mutation:** MEN-1 is caused by mutations in the *MEN1* gene (Menin protein). MEN-2 (both 2A and 2B) is caused by gain-of-function mutations in the **RET proto-oncogene** [1]. 2. **MEN-2B Distinctive Features:** Unlike MEN-2A, MEN-2B includes **mucosal neuromas** (lips/tongue) and a **Marfanoid habitus**, but lacks parathyroid involvement [1]. 3. **Prophylactic Thyroidectomy:** Due to the high penetrance of MTC, prophylactic thyroidectomy is often recommended for RET mutation carriers. 4. **Screening:** In a patient with MTC, always screen for Pheochromocytoma before surgery to prevent a hypertensive crisis during anesthesia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1137-1140.

Q: What is the recommended needle size for Fine Needle Aspiration Cytology (FNAC)?

24 gauge needle. **Explanation:** The primary goal of **Fine Needle Aspiration Cytology (FNAC)** is to obtain a representative sample of cells for microscopic examination while minimizing patient discomfort and tissue trauma. **1. Why 24 Gauge is Correct:** The standard needle size for FNAC typically ranges from **22 to 25 gauge**. A **24 gauge needle** is considered ideal because it is thin enough to minimize blood contamination (hemodilution) of the smear, yet wide enough to allow cells to pass through the lumen via capillary action or negative pressure. Using a finer needle preserves the cellular architecture and prevents the formation of large hematomas, which can obscure diagnostic details. **2. Analysis of Incorrect Options:** * **A (16 Gauge) & B (18 Gauge):** These are "large-bore" needles. They are used for **Core Needle Biopsies (CNB)** or fluid aspiration (e.g., ascites), not cytology. Using these for FNAC causes significant bleeding, which dilutes the cellular sample and makes the slide "bloody" and non-diagnostic. * **C (20 Gauge):** While occasionally used for very firm or deep-seated lesions, it is generally too thick for routine FNAC and increases the risk of trauma and pain compared to the 24G standard. **3. High-Yield Clinical Pearls for NEET-PG:** * **The "French Technique":** Also known as the non-aspiration technique, it relies on capillary action alone and is often preferred for vascular organs like the thyroid to reduce blood contamination. * **Complications:** The most common complication of FNAC is a **local hematoma**. * **Contraindication:** FNAC is generally avoided in suspected **Haemangiomas** or **Pheochromocytomas** (risk of hypertensive crisis) and **Hydatid cysts** (risk of anaphylaxis). * **Fixative:** The standard fixative for FNAC smears is **95% Ethyl Alcohol**.

Q: A 10-year-old boy presents with increasing left hip pain and a limp after playing baseball. He is afebrile. An X-ray of the femoral head shows a fracture and irregular densities of the cancellous bone. The suspected diagnosis is Legg-Calve-Perthes disease. Which of the following best describes the underlying pathological findings?

Avascular osteonecrosis. **Explanation:** **Legg-Calvé-Perthes Disease (LCPD)** is an idiopathic clinical syndrome characterized by **avascular osteonecrosis (AVN)** of the femoral head. It typically affects children aged 4–10 years and presents with an insidious onset of hip pain and a characteristic limp. 1. **Why Option A is correct:** The underlying pathology is a temporary interruption of the blood supply to the capital femoral epiphysis. This leads to bone cell death (necrosis), followed by a process of revascularization and remodeling. On X-ray, this manifests as increased density (sclerosis) of the femoral head, fragmentation, and potential collapse (fracture), as seen in this patient. 2. **Why the other options are incorrect:** * **B. Chondroma:** A benign cartilaginous tumor. While it can cause pathological fractures, it typically presents as a well-defined lucent lesion, not the diffuse irregular densities seen in AVN. * **C. Fibrous Dysplasia:** A condition where normal bone is replaced by fibrous tissue and immature "Chinese-figure" trabeculae. It presents with a "ground-glass" appearance on X-ray. * **D. Osteitis Fibrosa Cystica:** This is the result of hyperparathyroidism (excess PTH), leading to subperiosteal bone resorption and "brown tumors." It is systemic rather than localized to the femoral head. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in boys (4:1 ratio) between 4 and 10 years. * **Radiology:** Look for the **"Crescent sign"** (subchondral fracture line) and increased radiodensity of the femoral head. * **Pathology Stages:** Avascular phase → Fragmentation/Resorption → Re-ossification → Remodeling. * **Differential:** Always rule out Slipped Capital Femoral Epiphysis (SCFE), which typically occurs in obese adolescents.

Question 1

Blood smear is best seen at what pH?

Accepted Answer

6.8

Answer

7.2

Answer

6.6

Answer

7

Question 2

A 17-year-old female presents with a palpable breast lump that is well-defined, non-tender, and mobile. Which of the following pathological features on fine needle aspiration cytology (FNAC) supports a diagnosis of a benign breast lesion?

Accepted Answer

Tightly arranged ductal epithelial cells with dyscohesive bare nuclei

Answer

Dyscohesive ductal epithelial cells without cellular fragments

Answer

Stromal predominance with hyperplasia of spindle cells

Answer

Polymorphism with single or arranged ductal epithelial cells

Question 3

A 17-year-old boy fractures his left tibia in a skiing accident. One year later, an X-ray of the leg discloses reactive bone formation in the calf muscle at the site of injury. Which of the following is the most likely diagnosis?

Accepted Answer

Myositis ossificans

Answer

Fibrous dysplasia

Answer

Malignant fibrous histiocytoma

Answer

Nodular fasciitis

Question 4

All of the following are associated with Multiple Endocrine Neoplasia type 2 (MEN-2) except:

Accepted Answer

Islet cell hyperplasia

Answer

Pheochromocytoma

Answer

Medullary carcinoma of the thyroid

Answer

Parathyroid adenoma

Question 5

Warthin tumour is:

Accepted Answer

Adenolymphoma of parotid gland

Answer

Pleomorphic adenoma of parotid gland

Answer

Carcinoma of parotid gland

Answer

Carcinoma of submandibular salivary gland

Question 6

Exfoliative cytology is indicated in which of the following situations?

Accepted Answer

Mass screening of cervical cancer

Answer

Heavily keratinized lesions of the oral cavity

Answer

Pre-cancerous lesions of the oral cavity

Answer

Cigarette smokers

Question 7

A 35-year-old woman with active lupus nephritis experiences a fall onto her left hand, resulting in immediate pain and crepitus at the wrist on examination. Radiographs reveal radial and navicular fractures along with marked osteopenia. Which of the following medications most likely contributed to the fracture?

Accepted Answer

Hydrocortisone

Answer

Ibuprofen

Answer

Lisinopril

Answer

Losartan

Question 8

What is the recommended needle size for Fine Needle Aspiration Cytology (FNAC)?

Accepted Answer

24 gauge needle

Answer

16 gauge needle

Answer

18 gauge needle

Answer

20 gauge needle

Question 9

Aspiration of fluid around the knee joint in a diabetic patient undergoing dialysis would show which of the following?

Accepted Answer

beta-2 microglobulin

Answer

AA amyloid

Answer

AL amyloid

Answer

Lactoferrin

Question 10

A 10-year-old boy presents with increasing left hip pain and a limp after playing baseball. He is afebrile. An X-ray of the femoral head shows a fracture and irregular densities of the cancellous bone. The suspected diagnosis is Legg-Calve-Perthes disease. Which of the following best describes the underlying pathological findings?

Accepted Answer

Avascular osteonecrosis

Answer

Chondroma

Answer

Fibrous dysplasia

Answer

Osteitis fibrosa cystica

Cytopathology — MCQs

Cytopathology — MCQs

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