General Pathology Practice Questions

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

Blood culture → Citrate → Plain → EDTA → Fluoride. ***Blood culture → Citrate → Plain → EDTA → Fluoride*** - This sequence is the recommended order of draw to prevent **cross-contamination** between different additives, which could interfere with laboratory test results. - Starting with **blood cultures** minimizes contamination risk for microbiological analysis [1], followed by tubes containing anticoagulants like **citrate** (for coagulation studies), then **plain** tubes (for serum), followed by **EDTA** (for hematology), and finally **fluoride** (for glucose). - This order prevents carryover of additives that could affect subsequent test results. *Plain → Blood culture → Citrate → EDTA → Fluoride* - Drawing a **plain tube** first is incorrect as it might introduce skin flora into the blood culture bottle if performed later. - **Blood culture** should always be drawn first to ensure sterility and prevent contamination from other tube additives [1]. *Citrate → Blood culture → Plain → EDTA → Fluoride* - Drawing the **citrate tube** before blood culture is incorrect due to the risk of introducing citrate anticoagulant into the blood culture, which could inhibit bacterial growth. - The **blood culture** bottle requires the highest priority for sterility [1]. *Blood culture → Plain → EDTA → Citrate → Fluoride* - Placing the **plain tube** before **citrate tube** is incorrect according to CLSI guidelines. - Drawing the **EDTA tube** before the **citrate tube** can lead to contamination of the citrate sample with EDTA, potentially affecting coagulation tests by chelating calcium. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 296-297.

Q: An electron microscopy of muscle biopsy shows 'parking lot' appearance. Which additional finding would confirm myotonic dystrophy?

Ring fibers. ***Ring fibers*** - **Ring fibers** are a classic histopathological feature seen in **myotonic dystrophy**, characterized by peripheral myofibrils arranged circularly around a central core [1]. - The "parking lot" appearance on electron microscopy refers to collections of **sarcoplasmic reticulum** and **T-tubules**, which can be seen in various myopathies but are often prominent in myotonic dystrophy, complementing the presence of ring fibers [1]. *Ragged red fibers* - **Ragged red fibers** are characteristic of **mitochondrial myopathies**, indicating abnormal proliferation of mitochondria beneath the sarcolemma. - They are typically identified with **Gomori trichrome stain** and are not a feature of myotonic dystrophy. *Central cores* - **Central cores** are a hallmark of **central core disease**, a congenital myopathy, and are regions within muscle fibers where oxidative enzyme activity is absent. - These are not typically associated with myotonic dystrophy; rather, they suggest a different underlying genetic defect affecting muscle structure. *Nemaline rods* - **Nemaline rods** are rod-like inclusions observed in muscle fibers in **nemaline myopathy**, an inherited disorder often associated with mutations in genes encoding components of the thin filament. - They are distinct from the pathological findings in myotonic dystrophy and point to a specific type of congenital myopathy. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 732-733.

Q: Which of the following ions is important in irreversible cell injury?

Calcium. ***Calcium*** - An increase in intracellular **calcium** concentration is a critical event in irreversible cell injury, activating various destructive enzymes like **phospholipases**, **proteases**, **endonucleases**, and ATPases [1]. - This influx of calcium can occur due to mitochondrial dysfunction (leading to impaired calcium sequestration) or damage to the plasma membrane [1]. *Sodium* - While important for maintaining **osmotic balance** and cell volume, dysregulation of sodium primarily contributes to **cellular swelling** (hydropic change), which is an early and often reversible sign of cell injury [1]. - Increased intracellular sodium typically leads to water influx, but its direct role in irreversible damage is secondary to calcium. *Chloride* - Changes in chloride ion distribution are often secondary to sodium dysregulation and play a role in maintaining **charge neutrality** and osmotic balance across the cell membrane. - It is not directly implicated as a primary mediator of the **enzyme activation cascade** that leads to irreversible cell damage. *Potassium* - **Potassium** is the major intracellular cation; its leakage out of the cell is a consequence of cell membrane damage, indicating loss of membrane integrity. - While significant **potassium efflux** is a sign of severe injury, it is not the initiator of the irreversible damage pathway, unlike calcium. **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. 57-62.

Q: Michaelis-Gutmann bodies are seen in:

Malakoplakia. ***Malakoplakia*** - **Michaelis-Gutmann bodies** are pathognomonic cytoplasmic inclusions found in histiocytes (von Hansemann cells) in **malakoplakia**. - These bodies represent partially digested bacterial fragments, particularly from *E. coli*, and are rich in iron and calcium. *Xanthogranulomatous pyelonephritis* - This condition is characterized by a destructive inflammatory process in the kidney with **foamy macrophages** (xanthoma cells) and often associated with chronic obstruction and infection [1]. - It does **not** feature Michaelis-Gutmann bodies; rather, it often shows a collection of lipid-laden macrophages. *Renal osteodystrophy* - This refers to a spectrum of **bone abnormalities** that occur in patients with **chronic kidney disease** [2], [3]. - It involves disruptions in bone turnover and mineralization due to metabolic disturbances, not the presence of specific bacterial inclusions [2]. *Nail patella syndrome* - This is a rare **autosomal dominant genetic disorder** affecting bone, joint, and kidney development. - It is characterized by small or absent **patellae**, fingernail and toenail abnormalities, and is associated with mutations in the *LMX1B* gene. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 939-940. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 668-669. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1194-1195.

Q: Which of the following is not true regarding Whipple's Disease ?

It has autoimmune etiology.. ***It has autoimmune etiology.*** - Whipple's disease is caused by the **bacterium *Tropheryma whipplei***, not by an autoimmune process [1]. - While there may be an underlying genetic predisposition affecting the immune response, the disease itself is a **bacterial infection** [1]. *Foamy macrophages are characteristics.* - **Foamy macrophages**, which are macrophages distended with ingested bacteria and cellular debris, are a **hallmark pathological finding** in Whipple's disease [1]. - These cells are abundant in affected tissues, particularly the small intestine lamina propria. *Bacteria laden macrophages are present in lymphatic system.* - The lymphatic system, including **lymph nodes**, is commonly involved in Whipple's disease, with **macrophages laden with *T. whipplei*** found within them [1]. - This lymphatic involvement contributes to the malabsorption and systemic symptoms of the disease [1]. *PAS positive diastase resistant granules are present.* - The bacterial remnants within the macrophages in Whipple's disease stain strongly with **Periodic Acid-Schiff (PAS) stain**. - These PAS-positive granules are **diastase-resistant**, which helps distinguish them from glycogen and other PAS-positive substances. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 798-799.

Q: A small nodule of well-developed and normally organized pancreatic tissue found in the submucosa of the small intestine is an example of __________.

Choristoma. ***Choristoma*** - A **choristoma** is a normal tissue found in an abnormal location, such as pancreatic tissue in the submucosa of the small intestine. - These are typically benign and represent a developmental anomaly where a focus of normal cells develops in an ectopic site. *Papilloma* - A **papilloma** is a benign epithelial tumor growing exophytically (outwardly) in finger-like projections. - It usually arises from the surface epithelium and is not characterized by the presence of normal tissue in an abnormal location. *Hamartoma* - A **hamartoma** is a benign, localized malformation of mature differentiated cells and tissues that are native to the organ in which it arises, but are disorganized and present in abnormal proportions. - While it involves normal tissue components, they are disorganized and typically found in the correct organ, not in an entirely different organ as described. *Teratoma* - A **teratoma** is a tumor composed of several different types of tissue, such as hair, muscle, teeth, or bone, derived from more than one germ layer. - These are typically much more complex and involve tissues not normally associated with the location of development, and often occur in gonads.

Q: True about eschar is all except

Sensitive to touch. ***Sensitive to touch*** - An eschar forms in **full-thickness burns** where nerve endings are destroyed, rendering the tissue **insensate** or numb to touch. - The presence of sensitivity would indicate a more superficial burn, not a full-thickness injury characterized by an eschar. *Thrombosed superficial veins* - **Thrombosed superficial veins** are a characteristic finding within an eschar, indicating the extent of vascular damage in a full-thickness burn. - The extreme heat causes coagulation of blood within vessels, leading to their obstruction and contributing to the avascular nature of the eschar. *Charred, denatured full thickness burn* - An eschar is indeed a defining feature of a **full-thickness burn**, where the skin is extensively damaged, often appearing **charred** or leathery. - The denaturing of proteins and destruction of cellular structures contribute to the characteristic appearance and consistency of the eschar. *Contracted dermis* - The **dermis** within an eschar becomes **contracted** and rigid due to the thermal injury, leading to a loss of elasticity [1]. - This contraction can result in a tourniquet effect, impairing circulation to underlying or distal tissues, especially in circumferential burns [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 119.

Question 1

Identify the correct statement regarding Amyloidosis?

Accepted Answer

Amyloid deposits have beta pleated sheet conformation

Answer

Secondary amyloidosis is AL

Answer

Amyloidosis is called so because of deposition of complex carbohydrates

Answer

All of the options

Question 2

Match the following?
a. Trisomy 13 1. Huntington disease
b. Trisomy 18 2. Patau syndrome
c. Trinucleotide repeat sequence 3. Sickle cell disease
d. Hb point mutation of glutamate to valine 4. Edward syndrome

Accepted Answer

a2-b4-c1-d3

Answer

b1-a3-d2-c4

Answer

a2-b1-c4-d3

Answer

a4-b1-c3-d2

Question 3

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

Accepted Answer

Blood culture → Citrate → Plain → EDTA → Fluoride

Answer

Plain → Blood culture → Citrate → EDTA → Fluoride

Answer

Citrate → Blood culture → Plain → EDTA → Fluoride

Answer

Blood culture → Plain → EDTA → Citrate → Fluoride

Question 4

An electron microscopy of muscle biopsy shows 'parking lot' appearance. Which additional finding would confirm myotonic dystrophy?

Accepted Answer

Ring fibers

Answer

Ragged red fibers

Answer

Central cores

Answer

Nemaline rods

Question 5

Which of the following ions is important in irreversible cell injury?

Accepted Answer

Calcium

Answer

Sodium

Answer

Chloride

Answer

Potassium

Question 6

Michaelis-Gutmann bodies are seen in:

Accepted Answer

Malakoplakia

Answer

Xanthogranulomatous pyelonephritis

Answer

Renal osteodystrophy

Answer

Nail patella syndrome

Question 7

Cell most sensitive to radiation –

Accepted Answer

Lymphocytes

Answer

Platelets

Answer

Neutrophils

Answer

Basophils

Question 8

Which of the following is not true regarding Whipple's Disease ?

Accepted Answer

It has autoimmune etiology.

Answer

Bacteria laden macrophages are present in lymphatic system.

Answer

PAS positive diastase resistant granules are present.

Answer

Foamy macrophages are characteristics.

Question 9

A small nodule of well-developed and normally organized pancreatic tissue found in the submucosa of the small intestine is an example of __________.

Accepted Answer

Choristoma

Answer

Papilloma

Answer

Hamartoma

Answer

Teratoma

Question 10

True about eschar is all except

Accepted Answer

Sensitive to touch

Answer

Thrombosed superficial veins

Answer

Charred, denatured full thickness burn

Answer

Contracted dermis

General Pathology — MCQs

General Pathology — MCQs

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