Neuropathology Practice Questions

Q: Homer Wright rosettes are seen in which of the following neoplasms?

Neuroblastoma. **Explanation:** **Homer Wright Rosettes** are a hallmark histopathological feature of primitive neuroectodermal tumors. They consist of a circular cluster of tumor cells surrounding a central **fibrillar core** (neuropil), without a central lumen or blood vessel [1]. 1. **Neuroblastoma (Correct):** This is a classic example of a small round blue cell tumor where Homer Wright rosettes are frequently seen [1]. The central "pinkish" area represents neuritic processes (neuropil). These rosettes are also characteristic of **Medulloblastoma** and **Retinoblastoma**. 2. **Incorrect Options:** * **Astrocytoma:** Characterized by fibrillary backgrounds and Rosenthal fibers (in pilocytic types), but not Homer Wright rosettes. * **Meningioma:** Classically shows **Psammoma bodies** (laminated calcifications) and whorled patterns of spindle cells. * **Pinealoma:** While Pineoblastomas can show Homer Wright rosettes, "Pinealoma" is a non-specific term; Pineocytomas typically show larger, more irregular **Pineocytomatous rosettes**. **High-Yield Clinical Pearls for NEET-PG:** * **True Rosettes (Flexner-Wintersteiner):** Contain a central **lumen**; pathognomonic for **Retinoblastoma**. * **Pseudorosettes (Perivascular):** Cells arrange around a **blood vessel**; characteristic of **Ependymoma** [2]. * **Neuroblastoma Markers:** Elevated urinary catecholamines (VMA/HVA) and N-myc amplification (poor prognosis) [1]. * **Bombesin & NSE:** Positive immunohistochemical markers for Neuroblastoma [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-485. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1312-1313.

Q: Which of the following statements about Craniopharyngioma is FALSE?

It commonly calcifies in adults.. **Explanation:** Craniopharyngiomas are benign, slow-growing tumors arising from the remnants of **Rathke’s pouch**. Understanding the distinction between its two histological subtypes is crucial for NEET-PG. **Why Option B is the Correct (False) Statement:** Calcification is a hallmark of Craniopharyngioma, but its frequency varies significantly with age. It is seen in over **90% of pediatric cases** (Adamantinomatous type) but is relatively **uncommon in adults** (Papillary type), occurring in only about 40-50% of cases. Therefore, stating it "commonly calcifies in adults" is inaccurate compared to the pediatric population. **Analysis of Other Options:** * **Option A (Solid-cystic lesion):** This is a classic imaging finding. On MRI/CT, these tumors typically present as complex masses with both solid components and large cystic areas. * **Option C (Adamantinomatous type):** This subtype follows a bimodal distribution but is predominantly seen in **children**. It is characterized by the "wet keratin" and the "90% rule" (90% cystic, 90% calcified). * **Option D (Machine oil content):** The cysts in the adamantinomatous type contain a thick, brownish-yellow fluid rich in cholesterol crystals, often described as **"motor oil" or "machine oil"** appearance. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most common suprasellar tumor in children. * **Visual Deficit:** Bitemporal hemianopia (due to compression of the optic chiasm). * **Endocrine Issues:** Growth retardation and Diabetes Insipidus are common presentations. * **Imaging Sign:** "Eggshell calcification" on CT. * **Papillary Type:** Seen almost exclusively in adults; usually solid, lacks calcification, and lacks the "machine oil" fluid.

Q: Subdural hematoma most commonly results from which of the following?

Injury to cortical bridging veins. **Explanation:** **Subdural Hematoma (SDH)** occurs due to the accumulation of blood between the **dura mater** and the **arachnoid mater** [1]. **Why Option C is Correct:** The primary mechanism is the **tearing of cortical bridging veins** as they travel from the surface of the cerebral hemispheres through the subarachnoid space and the subdural space to empty into the superior sagittal sinus [1]. Because veins are under low pressure, the bleeding is typically slow, leading to a gradual onset of symptoms [2]. This is especially common in elderly patients and chronic alcoholics, where brain atrophy increases the distance these veins must travel, making them more susceptible to shear forces during minor trauma [1]. **Why Other Options are Incorrect:** * **Option A & B:** Rupture of an intracranial (Berry) aneurysm or an Arteriovenous Malformation (AVM) typically results in a **Subarachnoid Hemorrhage (SAH)**, characterized by blood in the CSF and a "thunderclap headache." * **Option D:** While Hemophilia is a bleeding diathesis that can predispose a patient to intracranial bleeds, it is a systemic risk factor rather than the direct anatomical cause of the hematoma. **High-Yield Clinical Pearls for NEET-PG:** * **Radiology:** SDH appears as a **crescent-shaped (concave)** opacity on CT that can cross suture lines but is limited by dural reflections (e.g., falx cerebri). * **Demographics:** Most common in the elderly, alcoholics, and "shaken baby syndrome." [1] * **Contrast with Epidural Hematoma (EDH):** EDH is usually arterial (Middle Meningeal Artery), associated with skull fractures, and shows a **biconvex (lens-shaped)** appearance on CT. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, p. 1264. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1264-1265.

Question 1

Homer Wright rosettes are seen in which of the following neoplasms?

Accepted Answer

Neuroblastoma

Answer

Astrocytoma

Answer

Meningioma

Answer

Pinealoma

Question 2

A 55-year-old man has had a foot ulcer for 2 months that has not healed. Physical examination shows a 2-cm shallow, nonhealing ulceration of the left medial malleolus. There is symmetric decreased sensation in the distal regions of the lower extremities. He has a history of multiple urinary tract infections resulting from difficulty in completely emptying the bladder. He is impotent. Which of the following pathologic findings is most likely to be present in the peripheral nerves?

Accepted Answer

Segmental demyelination

Answer

Acute inflammation

Answer

Axonal neuropathy

Answer

Onion bulb formation

Question 3

A 45-year-old male patient with Down syndrome has experienced severe cognitive decline over several years and is now completely dependent on others for basic activities of daily living. What histopathologic findings are most likely to be seen in the cortical neurons of this patient?

Accepted Answer

Neurofibrillary tangles

Answer

Pick bodies

Answer

Psammoma bodies

Answer

Lewy bodies

Question 4

In diffuse axonal injury, what are the typical locations of lesions in the brain?

Accepted Answer

White matter of cerebral hemispheres, corpus callosum, and the upper brainstem

Answer

Para-sagittal region

Answer

Cerebral cortex

Answer

Ventricles

Question 5

Which type of meningioma has the worst prognosis?

Accepted Answer

Anaplastic

Answer

Syncitial

Answer

Fibroblastic

Answer

Atypical

Question 6

Which of the following statements about Craniopharyngioma is FALSE?

Accepted Answer

It commonly calcifies in adults.

Answer

It is a solid-cystic lesion.

Answer

The adamantinomatous type is common in children.

Answer

It contains machine oily protein-rich content.

Question 7

What is the most common glial tumor?

Accepted Answer

Astrocytoma

Answer

Ependymomas

Answer

Meningioma

Answer

Neurofibroma

Question 8

Subdural hematoma most commonly results from which of the following?

Accepted Answer

Injury to cortical bridging veins

Answer

Rupture of intracranial aneurysm

Answer

Rupture of cerebral arteriovenous malformation

Answer

Hemophilia

Question 9

Which of the following are seen in Alzheimer disease?

Accepted Answer

Amyloid angiopathy

Answer

Neurofibrillary tangles

Answer

Neuritic plaques

Answer

Pick's protein

Question 10

What is the cause of myasthenia gravis?

Accepted Answer

Destruction of receptors by antibody

Answer

Decreased release of acetylcholine at the neuromuscular junction

Answer

Loss of muscle fibers

Answer

Destruction of receptors by autolysis

Neuropathology — MCQs

Neuropathology — MCQs

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