General Pathology Practice Questions

Q: Which cluster of differentiation (CD) molecule serves as a marker for T lymphocytes?

CD 8. **Explanation:** The correct answer is **CD 8**. Cluster of Differentiation (CD) molecules are cell surface markers used to identify and classify leukocytes. **Why CD 8 is correct:** T lymphocytes are primarily divided into two subsets: Helper T cells and Cytotoxic T cells [1]. **CD 8** is the definitive marker for **Cytotoxic T lymphocytes**, which play a crucial role in cell-mediated immunity by killing virally infected or tumor cells [1]. While CD 3 is the pan-T cell marker [2], CD 8 (along with CD 4) is a standard marker used to identify T cell subpopulations in clinical pathology [2]. **Analysis of Incorrect Options:** * **CD 19 & CD 20:** These are primary markers for **B lymphocytes** [3]. CD 19 is expressed from the earliest stages of B-cell development, while CD 20 is a target for the monoclonal antibody Rituximab. * **CD 45:** Known as the **Leukocyte Common Antigen (LCA)**, it is expressed on all hematopoietic cells (except mature erythrocytes). It is used in immunohistochemistry to differentiate lymphomas from carcinomas, but it is not specific to T cells. **High-Yield Clinical Pearls for NEET-PG:** * **Pan-T cell markers:** CD 1, CD 2, **CD 3** (most specific), CD 5, and CD 7 [2]. * **MHC Restriction:** CD 4 cells interact with MHC Class II, while **CD 8 cells interact with MHC Class I** (Rule of 8: 4×2=8 and 8×1=8) [1]. * **NK Cell markers:** CD 16 (FcγRIII) and CD 56 [3]. * **Reed-Sternberg Cells (Hodgkin Lymphoma):** Characteristically **CD 15+ and CD 30+**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 240. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 198-199. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 207-208.

Q: All of the following genetic conditions are associated with an increased risk for cancers except?

None of the above. **Explanation:** The correct answer is **None of the above** because all three listed genetic conditions—Down syndrome, Turner syndrome, and Neurofibromatosis type I—are well-documented to have a significantly increased predisposition to specific malignancies. 1. **Down Syndrome (Trisomy 21):** Individuals with Down syndrome have a 10- to 20-fold increased risk of developing acute leukemia. Specifically, they are prone to **Acute Megakaryoblastic Leukemia (AML-M7)** before the age of 3 and **Acute Lymphoblastic Leukemia (ALL)** after the age of 3. 2. **Turner Syndrome (45, XO):** While the overall cancer risk is not as high as in other syndromes, there is a specific increased risk for **Gonadoblastoma** (especially if Y-chromosome mosaicism is present) and a higher incidence of certain solid tumors like meningiomas and childhood brain tumors. 3. **Neurofibromatosis Type I (NF1):** Caused by a mutation in the *NF1* tumor suppressor gene (encoding Neurofibromin), this condition is characterized by a high risk of **Optic Nerve Gliomas**, **Malignant Peripheral Nerve Sheath Tumors (MPNST)**, Pheochromocytomas, and Juvenile Myelomonocytic Leukemia (JMML) [1]. **Clinical Pearls for NEET-PG:** * **GATA1 Mutation:** Highly associated with Transient Abnormal Myelopoiesis (TAM) and AML-M7 in Down syndrome patients. * **NF1 vs. NF2:** NF1 is associated with Lisch nodules and Optic gliomas; NF2 is associated with bilateral Acoustic Neuromas (Schwannomas). * **DNA Repair Defects:** Remember that conditions like Xeroderma Pigmentosum and Bloom Syndrome also carry high cancer risks due to defective DNA repair mechanisms [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1249-1250. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 322-323.

Q: All are features of apoptosis EXCEPT?

Disruption of plasma membrane. Apoptosis is a pathway of programmed cell death induced by a tightly regulated intracellular program. The hallmark of apoptosis is that the cell dies without spilling its contents, thereby avoiding an inflammatory response [1]. **Why Option C is the Correct Answer:** In **apoptosis**, the plasma membrane remains **intact** but undergoes structural alterations (like phosphatidylserine flipping to the outer leaflet) to signal phagocytes [1]. **Disruption of the plasma membrane** is a characteristic feature of **necrosis**, where the loss of membrane integrity leads to the leakage of cellular contents and subsequent inflammation [1]. **Analysis of Incorrect Options:** * **A. Absence of adjacent inflammation:** Since apoptotic bodies are membrane-bound and rapidly cleared by macrophages, there is no release of inflammatory mediators [1]. * **B. Fragmentation of nuclei:** This is a classic feature. The nucleus undergoes pyknosis (condensation), followed by karyorrhexis (fragmentation) into nucleosome-sized pieces due to internucleosomal DNA cleavage by endonucleases [1]. * **D. Shrinkage of cell size:** Unlike necrosis (where cells swell), apoptotic cells shrink, and the cytoplasm becomes dense with tightly packed organelles [1]. **High-Yield Pearls for NEET-PG:** * **Gold Standard for Detection:** DNA Laddering on electrophoresis (represents internucleosomal cleavage). * **Morphological Hallmark:** Formation of membrane-bound **apoptotic bodies** [1]. * **Key Enzymes:** **Caspases** (Cysteine aspartate-specific proteases) [1]. * **Most Characteristic Feature:** Chromatin condensation (Pyknosis). * **Marker for Phagocytosis:** Presence of **Phosphatidylserine** on the outer layer of the plasma membrane (detected by Annexin V) [1]. **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. 53-71.

Q: A 4-year-old African boy develops a rapidly enlarging mass that involves the right side of his face. Biopsies of this lesion are shown below. Which chromosomal translocation is associated with this neoplasm?

c-myc. ***c-myc*** - The clinical presentation of a rapidly enlarging facial mass in an **African child** is classic for **endemic Burkitt lymphoma**, which is associated with the **t(8;14) translocation** involving the **c-myc oncogene**. - Endemic Burkitt lymphoma characteristically presents as **jaw and facial bone tumors** in children from **malaria-endemic regions** of Africa, with the **c-myc translocation** being the hallmark genetic abnormality. *bcl-2* - The **bcl-2 oncogene** is associated with **follicular lymphoma** and some cases of **diffuse large B-cell lymphoma** through the **t(14;18) translocation**. - **bcl-2** prevents **apoptosis** and is typically seen in **indolent B-cell lymphomas** affecting adults, not rapidly growing pediatric facial masses. *N-myc* - **N-myc amplification** is characteristically associated with **neuroblastoma**, a common pediatric tumor arising from **neural crest cells**. - Neuroblastoma typically presents as **abdominal masses** or **adrenal tumors** in young children, not as facial bone lesions. *erb-B* - The **erb-B (HER2/neu) oncogene** is associated with **breast carcinoma** and **gastric adenocarcinoma** in adults. - **erb-B overexpression** is linked to **epithelial malignancies** and is not associated with **B-cell lymphomas** or pediatric hematologic malignancies.

Q: Multiple epidermoid cysts are seen in which of the following conditions?

Gardner's syndrome. **Explanation:** **Gardner’s Syndrome** is a clinical variant of Familial Adenomatous Polyposis (FAP), inherited in an autosomal dominant fashion due to mutations in the **APC gene** on chromosome 5q21 [1]. It is characterized by a distinct triad of: 1. **Colonic Polyposis:** Thousands of adenomatous polyps with a 100% risk of progression to colorectal carcinoma [1]. 2. **Osteomas:** Benign bony growths, most commonly involving the mandible and skull. 3. **Soft Tissue Tumors:** Specifically **multiple epidermoid cysts**, desmoid tumors, and fibromas. The presence of multiple epidermoid cysts in a young patient is a high-yield clinical marker that should prompt an evaluation for occult colonic polyposis. **Analysis of Incorrect Options:** * **Turcot’s Syndrome:** Also a variant of FAP, but it is characterized by the association of colonic polyps with **Central Nervous System (CNS) tumors** (e.g., Medulloblastoma or Glioblastoma Multiforme), not skin cysts. * **Peutz-Jeghers Syndrome:** An autosomal dominant condition (STK11 mutation) featuring hamartomatous polyps and **mucocutaneous hyperpigmentation** (melanotic macules on lips and oral mucosa) [1]. * **Familial Polyposis Coli (FAP):** While Gardner’s is a subtype of FAP, the term "FAP" typically refers to the isolated colonic manifestation without the extra-colonic features like epidermoid cysts or osteomas [1]. **NEET-PG High-Yield Pearls:** * **CHRPE:** Congenital Hypertrophy of Retinal Pigment Epithelium is often the earliest detectable sign of Gardner’s Syndrome. * **Desmoid Tumors:** These are aggressive fibromatoses that frequently occur post-surgery in Gardner’s patients. * **Mnemonic for Gardner’s:** "**S**oft tissue tumors (Cysts), **O**steomas, **D**esmoids, **A**PC gene" (**SODA**). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.

Question 1

A 40-year-old male patient complains of muscle and joint pain. The patient has a history of systemic lupus erythematosus. Which type of necrosis is typically associated with the vascular changes seen in this condition?

Accepted Answer

Fibrinoid

Answer

Coagulative

Answer

Liquefactive

Answer

Fat

Question 2

Which cluster of differentiation (CD) molecule serves as a marker for T lymphocytes?

Accepted Answer

CD 8

Answer

CD 19

Answer

CD 20

Answer

CD 45

Question 3

The AGE-RAGE signaling axis is related to which of the following processes?

Accepted Answer

Diabetes

Answer

Ageing

Answer

Oncogenesis

Answer

Alzheimer disease

Question 4

All of the following genetic conditions are associated with an increased risk for cancers except?

Accepted Answer

None of the above

Answer

Down syndrome

Answer

Turner syndrome

Answer

Neurofibromatosis type I

Question 5

Apoptosis is inhibited by?

Accepted Answer

Bcl-2

Answer

p53

Answer

N-myc

Answer

RAS

Question 6

All are features of apoptosis EXCEPT?

Accepted Answer

Disruption of plasma membrane

Answer

Absence of adjacent inflammation

Answer

Fragmentation of nuclei

Answer

Shrinkage of cell size

Question 7

ESR is a critical investigation in the diagnosis of TB. Which of the following is true about ESR in TB?

Accepted Answer

ESR is raised due to increased RBC aggregation

Answer

No change in ESR

Answer

Confirms recovery from TB

Answer

ESR is raised due to decreased RBC size

Question 8

A 4-year-old African boy develops a rapidly enlarging mass that involves the right side of his face. Biopsies of this lesion are shown below. Which chromosomal translocation is associated with this neoplasm?

Accepted Answer

c-myc

Answer

bcl-2

Answer

N-myc

Answer

erb-B

Question 9

A 20-year-old female presents for an infertility workup. She has never had a menstrual period. She is short with a broad chest, webbed neck, and low-set ears. It is demonstrated that she has an abnormal karyotype. Which one of the following best describes the cause of this genetic abnormality?

Accepted Answer

Monosomy

Answer

Trisomy

Answer

Trinucleotide repeat

Answer

Translocation

Question 10

Multiple epidermoid cysts are seen in which of the following conditions?

Accepted Answer

Gardner's syndrome

Answer

Turcot's syndrome

Answer

Peutz-Jeghers syndrome

Answer

Familial polyposis coli

General Pathology — MCQs

General Pathology — MCQs

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