General Pathology — MCQs
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Identify the correct statement regarding Amyloidosis?
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
Order of drawing blood in vacutainers should be in the following sequence to prevent contamination:
An electron microscopy of muscle biopsy shows 'parking lot' appearance. Which additional finding would confirm myotonic dystrophy?
Which of the following ions is important in irreversible cell injury?
Michaelis-Gutmann bodies are seen in:
Cell most sensitive to radiation –
Which of the following is not true regarding Whipple's Disease ?
A small nodule of well-developed and normally organized pancreatic tissue found in the submucosa of the small intestine is an example of __________.
True about eschar is all except
General Pathology Indian Medical PG Practice Questions and MCQs
Question 1331: Identify the correct statement regarding Amyloidosis?
- A. Secondary amyloidosis is AL
- B. Amyloidosis is called so because of deposition of complex carbohydrates
- C. All of the options
- D. Amyloid deposits have beta pleated sheet conformation (Correct Answer)
Explanation: ### Amyloid deposits have beta-pleated sheet conformation - This **specific protein conformation** is characteristic of all amyloid fibrils, regardless of the precursor protein [1]. - The **beta-pleated sheet structure** is highly stable and resistant to enzymatic degradation, contributing to the pathologic accumulation of amyloid [1]. *Secondary amyloidosis is AL* - **Secondary amyloidosis (AA amyloidosis)** is caused by the deposition of **amyloid A protein**, which is derived from **serum amyloid A (SAA) protein** [3]. - **AL amyloidosis** is primary amyloidosis, resulting from the deposition of **immunoglobulin light chains** [2]. *Amyloidosis is called so because of deposition of complex carbohydrates* - The term "amyloid" was coined because early researchers mistakenly believed these deposits were **complex carbohydrates**, similar to starch [1]. - However, amyloidosis is actually characterized by the deposition of **abnormal proteins** that misfold and aggregate [1]. *All of the options* - This option is incorrect because the first two statements are factually inaccurate regarding the classification of amyloidosis and the composition of amyloid deposits. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 264-266. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 266-267. [3] 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. 136-140.
Question 1332: 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
- A. b1-a3-d2-c4
- B. a2-b4-c1-d3 (Correct Answer)
- C. a2-b1-c4-d3
- D. a4-b1-c3-d2
Explanation: ***a2-b4-c1-d3*** - **Trisomy 13 (Patau syndrome)**: Chromosomal disorder with severe CNS malformations, holoprosencephaly, cleft lip/palate, and polydactyly [3] - **Trisomy 18 (Edward syndrome)**: Chromosomal disorder with clenched fists, rocker-bottom feet, and cardiac defects [3] - **Trinucleotide repeat sequence (Huntington disease)**: CAG repeat expansion in HTT gene causing progressive neurodegeneration with chorea and cognitive decline [2] - **Hb point mutation glutamate to valine (Sickle cell disease)**: Point mutation in β-globin gene (Glu6Val) causing hemoglobin polymerization and sickling [1] *b1-a3-d2-c4* - Incorrectly matches Trisomy 13 with sickle cell disease (point mutation, not trisomy) - Incorrectly matches Trisomy 18 with Huntington disease (trinucleotide repeat, not trisomy) - Incorrectly matches trinucleotide repeats with Edward syndrome (trisomy 18, not repeat expansion) *a2-b1-c4-d3* - Incorrectly matches Trisomy 18 with Huntington disease (trinucleotide repeat disorder, not chromosomal) - Incorrectly matches trinucleotide repeats with Edward syndrome (trisomy, not repeat expansion) *a4-b1-c3-d2* - Incorrectly matches Trisomy 13 with Edward syndrome (Trisomy 13 is Patau, not Edward) - Incorrectly matches Trisomy 18 with Huntington disease (trinucleotide repeat, not trisomy) - Incorrectly matches trinucleotide repeats with sickle cell disease (point mutation, not repeat expansion) **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. 50-51. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, p. 177. [3] 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. 92-93.
Question 1333: Order of drawing blood in vacutainers should be in the following sequence to prevent contamination:
- A. Plain → Blood culture → Citrate → EDTA → Fluoride
- B. Citrate → Blood culture → Plain → EDTA → Fluoride
- C. Blood culture → Plain → EDTA → Citrate → Fluoride
- D. Blood culture → Citrate → Plain → EDTA → Fluoride (Correct Answer)
Explanation: ***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.
Question 1334: An electron microscopy of muscle biopsy shows 'parking lot' appearance. Which additional finding would confirm myotonic dystrophy?
- A. Ragged red fibers
- B. Ring fibers (Correct Answer)
- C. Central cores
- D. Nemaline rods
Explanation: ***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.
Question 1335: Which of the following ions is important in irreversible cell injury?
- A. Sodium
- B. Chloride
- C. Calcium (Correct Answer)
- D. Potassium
Explanation: ***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.
Question 1336: Michaelis-Gutmann bodies are seen in:
- A. Malakoplakia (Correct Answer)
- B. Xanthogranulomatous pyelonephritis
- C. Renal osteodystrophy
- D. Nail patella syndrome
Explanation: ***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.
Question 1337: Cell most sensitive to radiation –
- A. Lymphocytes (Correct Answer)
- B. Platelets
- C. Neutrophils
- D. Basophils
Explanation: ***Lymphocytes*** - **Lymphocytes** are the most sensitive hematopoietic cells to radiation due to their rapid turnover and intrinsic radiosensitivity [1]. - Exposure to even low doses of radiation can lead to rapid **apoptosis** and a decrease in lymphocyte count. *Platelets* - **Platelets** are relatively radioresistant, and their numbers decrease more slowly after radiation exposure compared to lymphocytes. - The primary impact on platelets is often indirect, affecting their production by **megakaryocytes** which are also somewhat radioresistant. *Neutrophils* - **Neutrophils** are more radiosensitive than platelets but less so than lymphocytes. Their numbers typically decline after lymphocytes but before red blood cells [2]. - The lifespan of neutrophils is relatively short, and radiation primarily affects the **myeloid precursors** in the bone marrow [2]. *Basophils* - **Basophils** are present in low numbers in the blood and their radiosensitivity is not as well-documented as other white blood cells. - While sensitive, they are generally considered less radiosensitive than lymphocytes. **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. 111-112. [2] 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. 112-113.
Question 1338: Which of the following is not true regarding Whipple's Disease ?
- A. It has autoimmune etiology. (Correct Answer)
- B. Bacteria laden macrophages are present in lymphatic system.
- C. PAS positive diastase resistant granules are present.
- D. Foamy macrophages are characteristics.
Explanation: ***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.
Question 1339: A small nodule of well-developed and normally organized pancreatic tissue found in the submucosa of the small intestine is an example of __________.
- A. Papilloma
- B. Hamartoma
- C. Teratoma
- D. Choristoma (Correct Answer)
Explanation: ***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.
Question 1340: True about eschar is all except
- A. Thrombosed superficial veins
- B. Charred, denatured full thickness burn
- C. Sensitive to touch (Correct Answer)
- D. Contracted dermis
Explanation: ***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.
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