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: Which of the following is an Anti-apoptotic gene?

MCL-1. ***MCL-1*** - **MCL-1 (myeloid cell leukemia sequence 1)** is a pro-survival protein belonging to the **Bcl-2 family**, which inhibits apoptosis by binding to and sequestering pro-apoptotic proteins [1]. - Its overexpression is frequently observed in various cancers, contributing to **chemoresistance** and tumor survival [2]. *BAK* - **BAK (Bcl-2 antagonist killer 1)** is a **pro-apoptotic protein** that belongs to the Bcl-2 family. - Upon activation, BAK undergoes **oligomerization** on the mitochondrial outer membrane, leading to its permeabilization and the release of pro-apoptotic factors into the cytoplasm. *BIN* - **BIN1 (Bridging Integrator 1)** is a **tumor suppressor gene** that can promote apoptosis in certain contexts, particularly when associated with DNA damage or cellular stress. - It is not primarily known as an anti-apoptotic gene but rather as a protein involved in **membrane dynamics** and cellular signaling, with roles in endocytosis and cytoskeletal regulation. *NOX-Q* - **NOX-Q** is not a commonly recognized or established gene in the context of apoptosis regulation. - The **NOX (NADPH oxidase) family** of enzymes is primarily involved in the production of **reactive oxygen species (ROS)**, which can either induce or inhibit apoptosis depending on the cellular context and concentration. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 310. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 310-311.

Q: In a clinical laboratory, when is sample registration typically performed?

When samples are received at the laboratory. ***When samples are received at the laboratory*** - **Sample registration** is a critical step performed immediately upon a sample's arrival to ensure proper identification and tracking throughout its lifecycle in the laboratory. - This initial registration helps prevent **errors**, maintains **sample integrity**, and establishes a clear **audit trail**. *At the end of each working day* - Delaying registration until the end of the day introduces a significant risk of **misidentification**, **loss**, or **degradation** of samples. - Urgent or time-sensitive tests would be unduly **delayed**, potentially impacting patient care. *Once per week during batch processing* - Weekly batch processing for registration is entirely unsuitable for a clinical laboratory, where timely processing of individual samples is paramount. - This practice would lead to a massive backlog, compromise **sample stability**, and make it impossible to provide **prompt results** for patient diagnosis and treatment. *Only during quality control audits* - **Quality control audits** periodically review laboratory processes, including registration, but do not replace the need for real-time, continuous sample registration. - Relying solely on audits for registration would mean unregistered samples are processed, leading to **untraceable results** and potential patient harm.

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: Main cause of shock is?

Hypoperfusion of tissue. ***Hypoperfusion of tissue*** - **Shock** is fundamentally a state of inadequate cellular energy production due to insufficient delivery of oxygen and nutrients to tissues [1], [2]. - This **tissue hypoperfusion** leads to cellular dysfunction, organ damage, and ultimately, death if not corrected [2]. *Hypotension* - **Hypotension** (low blood pressure) is a common *sign* or *symptom* of shock, but it is not the underlying cause [2]. - While significant hypotension often leads to hypoperfusion, normotensive shock can occur if tissue demands are extremely high or if microcirculation is severely impaired [2]. *Hypoxia* - **Hypoxia** refers to a deficiency in the amount of oxygen reaching the tissues. While hypoxia is a *consequence* of poor tissue perfusion in shock, it is not the main *cause* [2]. - Tissue hypoperfusion results in inadequate oxygen delivery, leading to cellular hypoxia, but the primary deficit is the overall blood flow [2]. *Dehydration* - **Dehydration** is a *cause* of **hypovolemic shock**, which is one *type* of shock [1]. - It leads to reduced intravascular volume, which can cause decreased cardiac output and subsequent tissue hypoperfusion, but it is not the main cause of shock in general.

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

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 3

Which of the following is an Anti-apoptotic gene?

Accepted Answer

MCL-1

Answer

BAK

Answer

BIN

Answer

NOX-Q

Question 4

A 42 year-old female patient presents with cough, low-grade fever, and hemoptysis.
Investigations reveal a cavitary lesion on her right lung apex, which on biopsy reveals caseous necrosis. The underlying pathophysiology is:

Accepted Answer

Type 4 hypersensitivity reaction

Answer

Sudden cut off of blood supply

Answer

Enzyme degradation

Answer

Fibrinoid deposition

Question 5

Virchow's triad includes all except:-

Accepted Answer

Platelet thrombus

Answer

Stasis of blood flow

Answer

Endothelial injury

Answer

Hypercoagulability

Question 6

In a clinical laboratory, when is sample registration typically performed?

Accepted Answer

When samples are received at the laboratory

Answer

At the end of each working day

Answer

Once per week during batch processing

Answer

Only during quality control audits

Question 7

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

Accepted Answer

Calcium

Answer

Sodium

Answer

Chloride

Answer

Potassium

Question 8

Main cause of shock is?

Accepted Answer

Hypoperfusion of tissue

Answer

Hypotension

Answer

Hypoxia

Answer

Dehydration

Question 9

Cell most sensitive to radiation –

Accepted Answer

Lymphocytes

Answer

Platelets

Answer

Neutrophils

Answer

Basophils

Question 10

White infarct is not seen in which of the following

Accepted Answer

Heart

Answer

Liver

Answer

Kidney

Answer

Spleen

General Pathology — MCQs

General Pathology — MCQs

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