General Pathology Practice Questions

Q: Lines of Zahn are LEAST likely to be seen in -

Lung. ***Lung*** - **Lines of Zahn are LEAST likely in the lungs** because most pulmonary thrombi are actually **emboli that formed elsewhere** (typically in deep leg veins) and then **lodged in pulmonary vessels**. - These pre-formed thrombi developed in **low-flow venous environments** and therefore **lack the characteristic layered appearance** of Lines of Zahn. - Even when thrombi form in situ in pulmonary vessels, the vascular bed characteristics make Lines of Zahn formation less common compared to other sites. *Heart* - **Mural thrombi** in heart chambers (especially post-MI in left ventricle or in atrial fibrillation) commonly show **Lines of Zahn**. - The **high-flow, turbulent environment** with continuous cardiac contractions creates ideal conditions for alternating platelet-fibrin and RBC layer deposition. - These are classic examples of antemortem thrombi with visible Lines of Zahn. *Liver* - **Portal vein thrombosis** and **hepatic vein thrombosis** (Budd-Chiari syndrome) can exhibit **Lines of Zahn**. - Despite being venous, these vessels have **sufficient flow velocity and turbulence** to allow layered thrombus formation. - Lines of Zahn indicate the thrombus formed during life with flowing blood. *Kidney* - **Renal artery thrombosis** and **renal vein thrombosis** frequently show **Lines of Zahn**. - Both arterial and venous renal circulation have adequate flow dynamics for layered thrombus formation. - These represent antemortem thrombi formed in vessels with active blood flow.

Q: Caseating necrosis most commonly occurs in

Lung. ***lung*** - **Caseating necrosis** is classically associated with **tuberculosis**, which primarily affects the lungs [1]. - It is characterized by the presence of **granulomatous inflammation**, often leading to the formation of cavities in pulmonary tissue. *Brain* - While certain infections can lead to necrosis in the brain, they typically do not present as **caseating necrosis**, which is specific to certain conditions like tuberculosis. - The brain may show **liquefactive necrosis** or other types of necrosis, rather than **caseation**. *liver* - The liver usually shows **macrovesicular steatosis** or **apoptosis** in conditions like hepatitis, not caseating necrosis. - **Granulomatous hepatitis** can occur, but it does not typically result in **caseating** type necrosis associated with lung pathology. *kidney* - The kidneys can experience necrosis from various causes, but caseating necrosis is not typical; they are more often involved in **focal segmental glomerulosclerosis** or **acute tubular necrosis**. - Chronic kidney conditions may involve granulomas, but they usually are not characterized by **caseation** similar to that seen in pulmonary tissue. **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, p. 55.

Q: Reversible change from one cell type to another is known as -

Metaplasia. ***Metaplesia*** - Refers to the **reversible change** from one cell type to another in response to chronic irritation or damage [1][2]. - It often occurs as an adaptive response in **epithelial tissues**, such as in the respiratory tract in smokers [1][2]. *Hypertrophy* - Represents an **increase in cell size** rather than a change in cell type [2]. - It is often a response to increased functional demand, as seen in **cardiac muscle** in athletes. *Hyperplesia* - Refers to an **increase in cell number** within a tissue or organ, not a change in cell type [2]. - Common in conditions such as **benign prostatic hyperplasia** but does not involve differentiation into other cell types. *Dysplasia* - Indicates an **abnormal growth or development** of cells, leading to disordered morphology rather than a transformation into another cell type. - It is often a precursor to cancer but does not signify the reversible nature of metaplasia. **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, p. 49. [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. 85-92.

Q: Which of the following cellular changes is reversible?

Bleb formation. ***Bleb formation*** - **Bleb formation** is a reversible cellular injury process, typically indicating the cell is under stress but not necessarily dead [1,3]. - This process can be a result of **cell swelling**, often due to acute cell injury, which can resolve if the stressor is removed [2,4]. *Karyolysis* - **Karyolysis** refers to the dissolution of the cell nucleus, often indicating irreversible injury leading to cell death (necrosis) [1]. - This process is often associated with **loss of nuclear material**, which is not reversible [1]. *Pyknosis* - **Pyknosis** signifies nuclear condensation and is typically an irreversible process, indicating that the cell is undergoing necrosis [1]. - Cells with **pyknosis** have lost their viability and will not return to a healthy state [1]. *Pyknosis* - As mentioned, **pyknosis** indicates nuclear shrinkage and is an irreversible change, consistent with cell death [1]. - It is a common finding in **necrotic cells**, further demonstrating its non-reversible nature [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, p. 53. [2] 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. 49-50. [3] 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. 53-55. [4] 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. 51-53.

Q: Which of the following is NOT a component of Virchow's triad?

Hypotension. ***Hypotension*** - **Hypotension** (low blood pressure) is not a component of Virchow's triad for thrombosis - While hypotension can affect blood flow, it is not one of the classic three factors described by Rudolf Virchow - Virchow's triad specifically consists of: endothelial injury, stasis/abnormal blood flow, and hypercoagulability *Endothelial injury* - Damage to the **blood vessel wall lining** is a key component of Virchow's triad - Causes include trauma, surgery, inflammation, atherosclerosis, and medical devices (catheters, stents) - Exposed subendothelial collagen triggers platelet adhesion and activation of the coagulation cascade *Stasis* - **Abnormal or stagnant blood flow** is the second component of Virchow's triad - Occurs in prolonged immobility, atrial fibrillation, venous obstruction, or varicose veins - Slow flow prevents dilution of activated clotting factors and allows platelet-endothelial interaction *Hypercoagulability* - **Increased tendency to form blood clots** is the third component of Virchow's triad - Can be inherited (Factor V Leiden, Prothrombin G20210A mutation, Protein C/S deficiency) or acquired - Acquired causes include malignancy, pregnancy, oral contraceptives, smoking, and nephrotic syndrome

Q: Diabetic foot is associated with following type of gangrene -

Wet gangrene. ***Wet gangrene*** - Diabetic foot commonly leads to **ischemia** and **infection** [1], resulting in wet gangrene characterized by moist, necrotic tissue. - This type of gangrene is associated with **rapid progression** and can result in systemic toxicity, making prompt treatment essential. *Fournier's gangrene* - This type of gangrene specifically affects the **perineal** region and is not directly associated with diabetic foot. - It usually arises from infections related to **perineal trauma** or surgical procedures. *Gas gangrene* - Caused by **Clostridium** species and typically follows a traumatic injury or surgical procedure, not specifically related to diabetes. - Presents with **crepitus** and rapid systemic symptoms, different from the chronic nature of diabetic ulcers. *Dry gangrene* - Associated with **chronic ischemia** and necrosis, it occurs in conditions like peripheral arterial disease, not primarily with infections seen in diabetic foot [1]. - It usually develops gradually without the sudden onset of symptoms characteristic of wet gangrene.

Question 1

Lines of Zahn are LEAST likely to be seen in -

Accepted Answer

Lung

Answer

Liver

Answer

Kidney

Answer

Heart

Question 2

Which of the following statements about Niemann-Pick disease is false?

Accepted Answer

Type B Niemann-Pick disease is characterized by severe neurological symptoms.

Answer

Due to deficiency of sphingomyelinase.

Answer

CNS symptoms are present in type A.

Answer

Histiocytes show PAS positive inclusions, and Type A is more severe.

Question 3

Which of the following proteins serves as the PRIMARY executioner in the apoptotic pathway by directly cleaving cellular substrates?

Accepted Answer

Caspases

Answer

Cytochrome C

Answer

Apaf-1

Answer

Bcl-2

Question 4

Caseating necrosis most commonly occurs in

Accepted Answer

Lung

Answer

Brain

Answer

Liver

Answer

Kidney

Question 5

Reversible change from one cell type to another is known as -

Accepted Answer

Metaplasia

Answer

Hypertrophy

Answer

Dysplasia

Answer

Hyperplasia

Question 6

Which of the following cellular changes is reversible?

Accepted Answer

Bleb formation

Answer

Pyknosis

Answer

Karyorrhexis

Answer

Karyolysis

Question 7

Hypertrophy is -

Accepted Answer

Increase in cell size

Answer

Increase in cell number

Answer

Decrease in cell number

Answer

Decrease in cell size

Question 8

Which type of necrosis is most commonly associated with the spread of infection?

Accepted Answer

Liquefactive necrosis

Answer

Fibrinoid necrosis

Answer

Fat necrosis

Answer

Coagulative necrosis

Question 9

Which of the following is NOT a component of Virchow's triad?

Accepted Answer

Hypotension

Answer

Endothelial injury

Answer

Stasis

Answer

Hypercoagulability

Question 10

Diabetic foot is associated with following type of gangrene -

Accepted Answer

Wet gangrene

Answer

Dry gangrene

Answer

Gas gangrene

Answer

Fournier's gangrene

General Pathology — MCQs

General Pathology — MCQs

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