General Pathology Practice Questions

Q: Which of the following disease processes best accounts for the arterial blood gas (ABG) abnormality shown in the image?

Vomiting. ***Vomiting*** - Causes **metabolic alkalosis** due to loss of **hydrochloric acid (HCl)** from gastric secretions, leading to elevated **pH** and **bicarbonate (HCO3⁻)** levels. - Results in **hypokalemia** and **hypochloremia** as additional electrolyte abnormalities commonly seen with prolonged vomiting. *Ethylene glycol poisoning* - Produces **high-anion-gap metabolic acidosis** with decreased pH and bicarbonate due to formation of toxic metabolites like **glycolic acid** and **oxalic acid**. - Associated with **osmolar gap** elevation and potential **calcium oxalate crystals** in urine, not alkalosis. *Chronic obstructive pulmonary disease* - Causes **respiratory acidosis** with elevated **CO2** retention and compensatory rise in bicarbonate, but with **decreased pH**. - Results from **impaired ventilation** and CO2 elimination, opposite pattern from metabolic alkalosis. *Congestive heart failure* - Can present with **mixed acid-base disorders** including respiratory acidosis from pulmonary edema or metabolic acidosis from poor perfusion. - Does not typically cause isolated **metabolic alkalosis** unless complicated by diuretic use or other factors.

Q: The disease process that best accounts for this problem?

Vomiting. ***Vomiting*** - Can cause **Mallory-Weiss tears** in the esophagus due to sudden increase in intragastric pressure during forceful retching. - May lead to **hypokalemic vacuolar nephropathy** from electrolyte losses, causing characteristic **vacuolar changes** in renal tubular epithelium. *Ethylene glycol poisoning* - Causes **oxalate crystal nephropathy** with pathognomonic **calcium oxalate crystals** in renal tubules and interstitium. - Results in **acute tubular necrosis** and **metabolic acidosis** with anion gap, not the pathological changes described. *Chronic obstructive pulmonary disease* - Characterized by **emphysema** (alveolar destruction) and **chronic bronchitis** (mucus gland hyperplasia). - Primarily affects the **respiratory system** with **air trapping** and **hyperinflation**, not the pathological process in question. *Congestive heart failure* - Causes **pulmonary congestion** with **hemosiderin-laden macrophages** (heart failure cells) in lungs. - Results in **cardiac cachexia** and **hepatic congestion** with **nutmeg liver** pattern, distinct from the described pathology.

Q: What term best describes nuclear dissolution?

Karyolysis. **Explanation:** The correct answer is **Karyolysis**. This term refers to the fading and eventual **dissolution of the nucleus** during cell death (necrosis) [1]. **1. Why Karyolysis is correct:** Karyolysis (from Greek *karyon* = kernel/nucleus and *lysis* = loosening/dissolution) occurs when the chromatin fades due to the action of DNAse and RNAse enzymes. These enzymes degrade the nuclear DNA, leading to a loss of basophilia (the nucleus loses its purple/blue staining on H&E) until it eventually disappears entirely [1]. **2. Why other options are incorrect:** * **Pyknosis:** This is the first stage of nuclear change in necrosis. It is characterized by **nuclear shrinkage** and increased basophilia (the nucleus becomes a small, dense, dark mass) [1]. * **Karyorrhexis:** This follows pyknosis. It involves **nuclear fragmentation**, where the pyknotic nucleus breaks apart into many small, dust-like granules [1]. **3. NEET-PG High-Yield Pearls:** * **Sequence of Nuclear Changes:** The typical progression in necrosis is **Pyknosis → Karyorrhexis → Karyolysis** [1]. * **Mechanism:** These changes are irreversible and signify **cell death** [1]. * **Staining:** In karyolysis, the cell becomes increasingly **eosinophilic** (pinker) because the loss of acidic DNA means there is less binding of the basic dye (Hematoxylin) [1]. * **Apoptosis vs. Necrosis:** While pyknosis and karyorrhexis occur in both, **karyolysis is characteristic of necrosis**. In apoptosis, the nucleus fragments into membrane-bound "apoptotic bodies" without total enzymatic dissolution of the DNA in the same manner. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 53-55.

Q: In amyloidosis of the tongue, where is the amyloid deposited primarily?

Stromal connective tissue. **Explanation:** **1. Why the correct answer is right:** Amyloidosis is a disorder characterized by the extracellular deposition of misfolded, insoluble fibrillar proteins [1]. By definition, amyloid is an **extracellular** substance. In the tongue (and other solid organs), these deposits occur primarily in the **stromal connective tissue** between functional cells and within the walls of small blood vessels [1]. As the amyloid accumulates in the stroma, it causes pressure atrophy of the surrounding structures, leading to the characteristic clinical presentation of macroglossia (enlarged tongue) [1]. **2. Why the incorrect options are wrong:** * **Option B:** Amyloid is never deposited within the surface epithelium. Epithelial cells are cellular components, whereas amyloid is an interstitial, extracellular deposit [1]. * **Options C & D:** Amyloid is not an intracellular protein. It does not deposit within the nuclei or the cytoplasm of striated muscle cells. While amyloidosis of the tongue causes the destruction of muscle fibers, this is due to **extrinsic compression** from the expanding stromal deposits, not internal accumulation within the myocytes [1]. **3. NEET-PG High-Yield Pearls:** * **Macroglossia:** This is a classic physical sign of **AL (Primary) Amyloidosis** [1]. It is rarely seen in AA (Secondary) Amyloidosis. * **Staining Characteristics:** Amyloid shows **Apple-green birefringence** under polarized light when stained with **Congo Red** [1]. * **Morphology:** On H&E stain, it appears as an extracellular, amorphous, eosinophilic (pink), hyaline-like material [1]. * **Common Sites:** Apart from the tongue, common sites for biopsy include the gingiva, rectal mucosa, and abdominal fat pad. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 264-270.

Question 1

Which of the following disease processes best accounts for the arterial blood gas (ABG) abnormality shown in the image?

Accepted Answer

Vomiting

Answer

Ethylene glycol poisoning

Answer

Chronic obstructive pulmonary disease

Answer

Congestive heart failure

Question 2

Autopsy of a specimen shows pale infarction. Pale infarct is seen in all of the following organs, EXCEPT:

Accepted Answer

Lung

Answer

Heart

Answer

Spleen

Answer

Kidney

Question 3

The disease process that best accounts for this problem?

Accepted Answer

Vomiting

Answer

Ethylene glycol poisoning

Answer

Chronic obstructive pulmonary disease

Answer

Congestive heart failure

Question 4

Autopsy of a specimen shows pale infarction. Pale infarct is seen in all of the following organs, EXCEPT:

Accepted Answer

Lung

Answer

Heart

Answer

Spleen

Answer

Kidney

Question 5

Why do fetal cells continue to divide while terminally differentiated adult cells do not?

Accepted Answer

Fetal cells lack sufficient cyclin inhibitors that would prevent entry into the S phase, unlike adult cells.

Answer

Adult cells have phosphatases absent in fetal cells.

Answer

Proteinase is absent in the fetus.

Answer

Adult cells lack CD kinases necessary for cell division.

Question 6

Which of the following cell types differentiates into a macrophage?

Accepted Answer

Monocytes

Answer

Eosinophils

Answer

Neutrophils

Answer

Lymphocytes

Question 7

What term best describes nuclear dissolution?

Accepted Answer

Karyolysis

Answer

Pyknosis

Answer

Karyorrhexis

Answer

None of the above

Question 8

All of the following are functions of CD4 helper cells, except?

Accepted Answer

Produce immunoglobulins

Answer

Immunogenic memory

Answer

Activate macrophages

Answer

Activate cytotoxic cells

Question 9

A 40-year-old female patient complains of excessive bleeding and drowsiness following a road traffic accident 5 hours ago, with a lacerated wound on the lower back region. General physical examination reveals: Blood pressure - 80/60 mmHg, Jugular venous pressure - low, Pulsus paradoxus - present, Cardiac output - Increased. The patient is in which type of shock?

Accepted Answer

Distributive

Answer

Neurogenic

Answer

Obstructive

Answer

Hypovolemic

Question 10

In amyloidosis of the tongue, where is the amyloid deposited primarily?

Accepted Answer

Stromal connective tissue

Answer

Cells of the surface epithelium

Answer

Nuclei of the striated muscle cells

Answer

Cytoplasm of the striated muscle cells

General Pathology — MCQs

General Pathology — MCQs

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