General Pathology Practice Questions

Q: TTF-1 (Thyroid Transcription Factor-1) immunohistochemical marker is most commonly seen in which of the following?

Lung adenocarcinoma. ***Lung adenocarcinoma*** - **TTF-1 (Thyroid Transcription Factor-1)** is a nuclear transcription factor that is highly expressed in adenocarcinomas of the lung. Positivity for TTF-1 is a key marker used in the diagnosis of primary lung adenocarcinoma, distinguishing it from other lung cancers and metastatic tumors. - While TTF-1 can also be positive in thyroid follicular and papillary carcinomas, its strong association with **lung adenocarcinoma** makes it a crucial diagnostic marker in this context, especially when differentiating between primary lung tumors and metastases or other lung cancer types. *Squamous Cell Carcinoma (SCC)* - **Squamous cell carcinoma of the lung** is generally **negative for TTF-1**. It typically expresses markers like p40 and CK5/6. - TTF-1 has very low sensitivity and specificity for squamous cell carcinoma, making it a poor choice for identifying this type of lung cancer. *Large cell lung cancer* - **Large cell lung carcinoma** is a diagnosis of exclusion and is typically **negative for TTF-1**, as well as other specific markers for adenocarcinoma or squamous cell carcinoma. - This type of cancer is characterized by large, anaplastic cells that lack features of other specific lung cancer types when viewed under a microscope. *Papillary thyroid carcinoma* - While **papillary thyroid carcinoma** is also **TTF-1 positive**, the question asks for the most common context in which TTF-1 is seen, and TTF-1 is a highly valuable marker for confirming a lung primary in the setting of lung masses. - TTF-1's utility in lung cancer diagnostics is particularly significant for differentiating primary lung adenocarcinomas from metastatic tumors and other lung cancer subtypes.

Q: Iron in tissues is stained by:

Prussian blue. ***Prussian blue*** - The **Prussian blue reaction**, also known as **Perls' stain**, specifically detects **ferric iron (Fe³⁺)** in tissues [3]. - It forms a **bright blue precipitate** (ferric ferrocyanide) when ferric iron reacts with potassium ferrocyanide in an acidic solution. *Masson's trichrome* - This stain is primarily used to differentiate **collagen fibers** from muscle fibers, which appear blue/green and red, respectively [1]. - It does not specifically stain or identify iron deposits in tissues. *PAS* - The **Periodic acid-Schiff (PAS) stain** is used to identify **carbohydrates** such as glycogen, mucosubstances, and fungal cell walls, which appear magenta. - It is not used for the detection of iron. *Congo red* - **Congo red** is a specialized stain used for identifying **amyloid deposits**, which appear pink-red and show apple-green birefringence under polarized light [2]. - It is not used for staining iron in tissues. **References:** [1] 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. 25-26. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 268-269. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 394-395.

Q: A baby is being evaluated for delayed developmental milestones. On examination, the child has hepatosplenomegaly. A microscopic image of the bone marrow evaluation is shown below. What is the most appropriate treatment?

Biological therapy. ***Biological therapy*** - The image likely shows a **Gaucher cell** (macrophage engorged with glucocerebroside, characterized by a "crinkled paper" or "crumpled tissue paper" cytoplasm) [1]. This is pathognomonic for **Gaucher disease**, which presents with **hepatosplenomegaly** and **developmental delay** in infants. - The standard treatment for Gaucher disease is **enzyme replacement therapy (ERT)**, which is a form of biological therapy replacing the deficient glucocerebrosidase enzyme [2]. *Macrolides for 4 months* - Macrolides are a class of **antibiotics** used to treat bacterial infections. - They are not indicated for lysosomal storage disorders like Gaucher disease, which is a **genetic metabolic disorder** [2]. *Steroid irrigation and antihistamines* - This treatment regimen is typically associated with allergic conditions or localized inflammatory responses, such as **allergic rhinitis** or **sinusitis**. - It bears no relevance to the systemic accumulation of lipids seen in Gaucher disease. *Repeat surgery* - While splenectomy was historically performed for massive splenomegaly in Gaucher disease, it does not address the underlying metabolic defect or systemic manifestations. - Furthermore, this case does not suggest a previous surgical intervention that requires repeating, and surgery is not the primary treatment for the metabolic disorder itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 162-163. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, p. 159.

Q: Abnormal accumulation of misfolded protein is seen in?

Creutzfeldt-Jakob disease. ***Creutzfeldt-Jakob disease*** - This is a neurodegenerative disease characterized by the accumulation of **abnormally folded prion proteins (PrPSc)** in the brain, leading to spongiform encephalopathy [1]. - The misfolding of normal cellular prion protein (PrPC) into its infectious and pathogenic form is central to the disease's pathology [2]. *Nephritic syndrome* - This syndrome is characterized by inflammation of the **glomeruli** in the kidneys, leading to hematuria, proteinuria, and hypertension. - It involves immune complex deposition and inflammation, not primarily the accumulation of misfolded proteins. *Sickle cell anemia* - This is a **genetic blood disorder** caused by a mutation in the beta-globin gene, leading to abnormal **hemoglobin S**. - While hemoglobin S can polymerize and deform red blood cells, it is not considered a disease of generalized misfolded protein accumulation in the same sense as prion diseases. *Megaloblastic anemia* - This condition is caused by impaired **DNA synthesis**, often due to **vitamin B12 or folate deficiency**, leading to large, immature red blood cells. - The pathology involves defective cell division and maturation, not the accumulation of misfolded proteins. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1284-1286. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 712-713.

Q: Order of drawing blood in vacutainers should be in the following sequence to prevent contamination?

Blue, Red, Violet, Grey. ***Blue, Red, Violet, Grey*** - This sequence follows the **CLSI (Clinical and Laboratory Standards Institute) order of draw** guidelines, which are critical for preventing **cross-contamination** between additives of different vacutainers. - The order starts with tubes for **coagulation studies** (blue top with sodium citrate), followed by serum tubes (red top), EDTA tubes (violet top for hematology), and finally glycolytic inhibitor tubes (grey top for glucose). - This prevents tissue thromboplastin contamination and anticoagulant carryover that could affect laboratory test results. *Grey, Blue, Red, Violet* - This order is incorrect as it places the **grey top tube** (containing fluoride/oxalate) first, which could contaminate subsequent tubes with its additives and affect tests. - The **blue top tube** for coagulation studies should come early in the sequence to minimize tissue thromboplastin contamination. *Blue, Violet, Red, Grey* - This sequence is incorrect because the **violet top tube** (EDTA) is placed before the **red top tube** (serum). - **EDTA contamination** can chelate calcium and other cations, interfering with chemistry tests performed on serum in the red top tube. *Red, Blue, Violet, Grey* - This order is incorrect as the **red top tube** is placed first, followed by the **blue top tube** (citrate). - The blue top tube should precede tubes with clot activators to **prevent tissue thromboplastin** from contaminating coagulation samples, which would lead to falsely shortened clotting times.

Question 1

Autosomal recessive disorders include all except :

Accepted Answer

Retinoblastoma

Answer

Hirschsprung disease

Answer

Albinism

Answer

Sickle cell anaemia

Question 2

Which one of the following is due to the monosomy of X-chromosome?

Accepted Answer

Turner's syndrome

Answer

Klinefelter's syndrome

Answer

Testicular feminization

Answer

Adrenogenital syndrome

Question 3

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→3  C→2  D→1

Answer

A→3  B→4  C→1  D→2

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→1  D→3

Question 4

Identify the diagnosis from the given image

Accepted Answer

Malakoplakia

Answer

TB

Answer

BCC

Answer

Drug induced lesion

Question 5

TTF-1 (Thyroid Transcription Factor-1) immunohistochemical marker is most commonly seen in which of the following?

Accepted Answer

Lung adenocarcinoma

Answer

Squamous Cell Carcinoma (SCC)

Answer

Large cell lung cancer

Answer

Papillary thyroid carcinoma

Question 6

A child undergoes prophylactic irradiation as preparation for bone marrow transplantation (BMT) for treatment of acute lymphoblastic leukemia (ALL). Which of the following cell types will be least affected by the radiation?

Accepted Answer

Neurons

Answer

Spermatogonia

Answer

Bone marrow

Answer

Intestinal epithelial cells

Question 7

Iron in tissues is stained by:

Accepted Answer

Prussian blue

Answer

Masson's trichrome

Answer

PAS

Answer

Congo red

Question 8

A baby is being evaluated for delayed developmental milestones. On examination, the child has hepatosplenomegaly. A microscopic image of the bone marrow evaluation is shown below. What is the most appropriate treatment?

Accepted Answer

Biological therapy

Answer

Macrolides for 4 months

Answer

Steroid irrigation and antihistamines

Answer

Repeat surgery

Question 9

Abnormal accumulation of misfolded protein is seen in?

Accepted Answer

Creutzfeldt-Jakob disease

Answer

Nephritic syndrome

Answer

Sickle cell anemia

Answer

Megaloblastic anemia

Question 10

Order of drawing blood in vacutainers should be in the following sequence to prevent contamination?

Accepted Answer

Blue, Red, Violet, Grey

Answer

Grey, Blue, Red, Violet

Answer

Blue, Violet, Red, Grey

Answer

Red, Blue, Violet, Grey

General Pathology — MCQs

General Pathology — MCQs

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