General Pathology Practice Questions

Q: Identify the intracellular hyaline body.

Russell bodies. ***Russell bodies*** - The image depicts **plasma cells** containing large, eosinophilic, and homogenous cytoplasmic inclusions, which are characteristic features of **Russell bodies**. - These bodies represent an accumulation of **excess immunoglobulins** within the dilated cisternae of the endoplasmic reticulum in plasma cells [1]. *Corpora amylacea* - These are small, concentrically layered, usually **basophilic bodies** found extracellularly in the prostate, brain, and lung. - They are composed of glycoproteins and often increase with age, not directly seen here as intracellular hyaline bodies in plasma cells. *Hyaline droplets* - These are typically **intracellular protein reabsorption droplets** found in epithelial cells, particularly renal tubular cells, when there is excessive proteinuria [1]. - They are generally smaller and more uniformly distributed compared to Russell bodies and are not pathognomonic for plasma cells. *Mallory Hyaline bodies* - Also known as Mallory bodies, these are **eosinophilic, rope-like cytoplasmic inclusions** found in the hepatocytes of patients with alcoholic liver disease or certain other liver conditions [1]. - They are composed of intermediate filaments and are distinct from the immunoglobulin inclusions seen in plasma cells. **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. 73-74.

Q: Identify the structure marked in the image of cardiac myocyte. (AIIMS Nov 2018)

Lipofuscin granules. ***Lipofuscin granules*** - The image displays electron-dense, irregular structures, characteristic of **lipofuscin granules**, which are wear-and-tear pigments accumulating in aging cardiac myocytes. - They are typically located near the nucleus and appear dark due to their complex lipid-protein composition. *Lysosomes* - Lysosomes are typically smaller, more uniformly shaped, and contain hydrolytic enzymes, which is not clearly depicted. - While involved in cellular waste breakdown, they do not typically accumulate as large, intensely electron-dense, irregular aggregates like those shown. *Phagolysosome* - A phagolysosome forms when a phagosome fuses with a lysosome, containing engulfed material often of foreign or cellular debris origin. - The image does not show evidence of recently engulfed material or the typical morphology of a phagocytic vesicle. *Inflammasome* - An inflammasome is a multi-protein intracellular complex involved in the inflammatory response, not a visibly distinct organelle with this characteristic electron microscopic appearance. - It is a signaling platform, not a storage granule, and would not appear as dense, granular deposits in a routine electron micrograph.

Q: Ischemia-Reperfusion syndrome is characterized by:

Hypoxia and activation of inflammation. **Hypoxia and activation of inflammation** - **Ischemia-reperfusion injury** occurs when blood flow is restored to tissues previously deprived of oxygen, leading to further damage due to the rapid influx of oxygen and inflammatory mediators. - The initial **hypoxia** during ischemia triggers cellular changes, and subsequent reperfusion activates a robust **inflammatory response**, including the recruitment of neutrophils and the release of reactive oxygen species [1]. *Thrombo embolic angiopathy* - While thrombus formation can be a cause of ischemia, **thromboembolic angiopathy** itself is not the primary characteristic of the ischemia-reperfusion syndrome. - The syndrome's defining feature is the injury that occurs *after* the initial ischemic event, upon restoration of blood flow. *Build up of bicarbonate and Na+ ions* - Ischemia typically leads to a buildup of **lactic acid** and a decrease in pH (acidosis), not bicarbonate. - While electrolyte imbalances can occur, a specific buildup of bicarbonate and Na+ ions is not a hallmark characteristic of ischemia-reperfusion injury. *Acute mesenteric thrombosis* - **Acute mesenteric thrombosis** is a *cause* of mesenteric ischemia, not a general characteristic of the ischemia-reperfusion syndrome itself. - The syndrome describes the cellular and tissue injury that results from the initial ischemia and subsequent reperfusion, regardless of the underlying cause of ischemia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 786-787.

Q: A patient presents with tingling sensation in both legs, polyuria, and weight loss. The bone marrow aspirate findings are shown in the image. What is the most likely diagnosis?

Amyloidosis. ***Amyloidosis*** - The image shows **amyloid infiltration** in the bone marrow, characterized by amorphous, eosinophilic deposits that can surround cellular elements. - The clinical symptoms of **tingling sensation** (neuropathy), **polyuria** (renal involvement), and **weight loss** are classic manifestations of systemic amyloidosis due to deposition in nerves, kidneys, and other organs. *Multiple myeloma with renal failure* - While multiple myeloma can cause renal failure and neuropathy, the image provided is more consistent with **amyloid deposition** rather than typical plasma cell proliferation seen in myeloma. - The bone marrow aspirate in multiple myeloma would show a significant increase in **atypical plasma cells**. *Subacute combined degeneration (SACD) with Vitamin B12 deficiency* - SACD causes neurological symptoms like tingling and paresthesia, but it is due to **demyelination** of the spinal cord, not amyloid deposition. - Bone marrow findings in **Vitamin B12 deficiency** would typically show megaloblastic anemia. *Subacute combined degeneration (SACD) with diabetes* - Diabetes can cause neuropathy and polyuria, however, the bone marrow aspirate in this case is not related to diabetes. - SACD is primarily associated with **Vitamin B12 deficiency**, not directly with diabetes, although diabetic neuropathy is common.

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: 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

Identify the intracellular hyaline body.

Accepted Answer

Russell bodies

Answer

Corpora amylacea

Answer

Hyaline droplets

Answer

Mallory Hyaline bodies

Question 2

Identify the structure marked in the image of cardiac myocyte. (AIIMS Nov 2018)

Accepted Answer

Lipofuscin granules

Answer

Lysosomes

Answer

Phagolysosome

Answer

Inflammasome

Question 3

Ischemia-Reperfusion syndrome is characterized by:

Accepted Answer

Hypoxia and activation of inflammation

Answer

Thrombo embolic angiopathy

Answer

Build up of bicarbonate and Na+ ions

Answer

Acute mesenteric thrombosis

Question 4

Autosomal recessive disorders include all except :

Accepted Answer

Retinoblastoma

Answer

Hirschsprung disease

Answer

Albinism

Answer

Sickle cell anaemia

Question 5

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 6

A patient presents with tingling sensation in both legs, polyuria, and weight loss. The bone marrow aspirate findings are shown in the image. What is the most likely diagnosis?

Accepted Answer

Amyloidosis

Answer

Multiple myeloma with renal failure

Answer

Subacute combined degeneration (SACD) with Vitamin B12 deficiency

Answer

Subacute combined degeneration (SACD) with diabetes

Question 7

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 8

Iron in tissues is stained by:

Accepted Answer

Prussian blue

Answer

Masson's trichrome

Answer

PAS

Answer

Congo red

Question 9

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 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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