Placental Pathology — MCQs
Non-immune hydrops fetalis is caused by
Which of the following antenatal complications may cause placentomegaly?
Which of the following statements is true regarding placental site trophoblastic disease?
Which is the most common complication of molar pregnancy?
The given image depicts:
A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?
A lady with 38 weeks of pregnancy is admitted due to a first episode of painless bleeding yesterday. On examination, her hemoglobin level is 10.5 g%, blood pressure is 124/78 mmHg, the uterus is relaxed, the head is unengaged and floating, and the fetal heart sounds are regular. Ultrasound confirms placenta previa. The next line of management is:
Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:
What visual disturbance is caused by an optic tract lesion?
The following pathological features are associated with Plasmodium falciparum except-
Placental Pathology Indian Medical PG Practice Questions and MCQs
Question 1: Non-immune hydrops fetalis is caused by
- A. HIV
- B. CMV
- C. Parvovirus B19 (Correct Answer)
- D. HSV
Explanation: ***Parvovirus B19*** - **Parvovirus B19** infection in the fetus can lead to severe **anemia** due to its tropism for erythroid progenitor cells, causing heart failure and subsequently **non-immune hydrops fetalis**. - The resulting **fetal anemia** is a direct cause of high-output cardiac failure, leading to generalized edema and effusions. *HIV* - **HIV** infection in utero can lead to various complications for the fetus and neonate, but it is not a direct cause of **non-immune hydrops fetalis**. - While HIV can cause **immunodeficiency** and increased susceptibility to other infections, it does not typically lead to the profound anemia or cardiac dysfunction that characterizes hydrops. *CMV* - **Cytomegalovirus (CMV)** is a common congenital infection that can cause a wide range of fetal abnormalities, including **microcephaly**, **hepatosplenomegaly**, and **sensorineural hearing loss**. - While severe CMV can rarely lead to hydrops, it is less common as a direct cause compared to parvovirus and generally associated with other overt cytomegalic features. *HSV* - **Herpes Simplex Virus (HSV)** infection in neonates is typically acquired during delivery and can cause **disseminated disease**, **encephalitis**, and **cutaneous lesions**. - While severe HSV can be life-threatening, it is not a recognized cause of **non-immune hydrops fetalis** due to its primary mechanism of fetal harm.
Question 2: Which of the following antenatal complications may cause placentomegaly?
- A. Diabetes (Correct Answer)
- B. Abruption
- C. HIV
- D. Hypertension
Explanation: ***Diabetes*** - Maternal **diabetes** (both pre-existing and gestational) is the **most common antenatal complication** causing **placentomegaly** (increased placental weight). - Mechanisms include **villous edema**, **increased cellularity** (hyperplasia), **chorangiosis**, and **vasculopathy**, which are compensatory responses to altered nutrient transfer and chronic hyperglycemia. - The placenta may appear **large, thick, and boggy** in diabetic pregnancies, reflecting chronic metabolic stress and inflammation. *Hypertension* - **Hypertension** (especially chronic hypertension or pre-eclampsia) is typically associated with **smaller, infarcted placentas** rather than placentomegaly, due to impaired uteroplacental blood flow and ischemia. - Conditions like **pre-eclampsia** lead to **placental insufficiency**, infarctions, and often fetal growth restriction—the opposite of placentomegaly. *Abruption* - **Placental abruption** is the premature separation of the placenta from the uterine wall characterized by **retroplacental hemorrhage**, not an increase in placental size. - While abruption creates a **retroplacental hematoma**, this is a localized hemorrhagic event and does not cause generalized placentomegaly (increased placental parenchymal mass). *HIV* - **HIV infection** in pregnancy is **not a typical cause of placentomegaly** among the options listed, though chronic **placental villitis** can occasionally increase placental mass. - However, compared to diabetes, HIV is a **far less common** and less clinically significant cause of placentomegaly. - The primary placental concerns with HIV are **vertical transmission risk** and inflammatory changes, not placental enlargement.
Question 3: Which of the following statements is true regarding placental site trophoblastic disease?
- A. Has a highly malignant potential
- B. It secretes human placental lactogen (Correct Answer)
- C. Mainly contains syncytiotrophoblasts
- D. The treatment of choice is hysterectomy followed by chemotherapy
Explanation: ***It secretes human placental lactogen*** - Placental site trophoblastic tumor (PSTT) characteristically consists of intermediate trophoblasts which secrete **human placental lactogen (hPL)**. - Unlike choriocarcinoma, PSTT secretes relatively low levels of **human chorionic gonadotropin (hCG)**. *Has a highly malignant potential* - PSTT generally has a **good prognosis** if the disease is confined to the uterus, with a survival rate of over 95%. - It has a low metastatic potential compared to choriocarcinoma, with metastases occurring in only about 15% of cases. *Mainly contains syncytiotrophoblasts* - PSTT is composed predominantly of **intermediate trophoblasts** that infiltrate the myometrium, rather than syncytiotrophoblasts or cytotrophoblasts. - The distinctive feature is the proliferation of these intermediate trophoblasts at the implantation site. *The treatment of choice is hysterectomy followed by chemotherapy* - **Hysterectomy** is generally the primary treatment for PSTT confined to the uterus, and it often cures the disease. - **Chemotherapy** is usually reserved for metastatic or recurrent disease, or in cases of extensive local invasion, and is not a routine follow-up after an uncomplicated hysterectomy.
Question 4: Which is the most common complication of molar pregnancy?
- A. Placenta previa
- B. Ovarian torsion
- C. Choriocarcinoma
- D. Invasive mole (Correct Answer)
Explanation: **Invasive mole** - An **invasive mole** is the most common complication of molar pregnancy, occurring in about 10-15% of complete hydatidiform moles and 1-5% of partial moles. - It involves the trophoblastic tissue invading the myometrium, which can lead to continued **human chorionic gonadotropin (hCG) elevation** and persistent vaginal bleeding. *Placenta previa* - **Placenta previa** is a condition where the placenta partially or totally covers the cervix, which is unrelated to the abnormal trophoblastic proliferation seen in molar pregnancies. - Its primary risk factors differ from those for molar pregnancy complications and include prior C-sections or uterine surgery. *Ovarian torsion* - **Ovarian torsion** is the twisting of the ovary and/or fallopian tube, cutting off blood supply, and although it can occur in pregnancy, it is not a direct complication of molar pregnancy. - It is often associated with ovarian cysts or masses, and while **theca lutein cysts** can be seen with molar pregnancy, torsion of these cysts is less common than invasive mole. *Choriocarcinoma* - While a serious neoplastic complication of molar pregnancy, **choriocarcinoma** is much rarer than an invasive mole, occurring in only 2-3% of complete hydatidiform moles. - It represents a **malignant transformation** of trophoblastic tissue with metastatic potential, distinguishing it from the localized invasion of an invasive mole.
Question 5: The given image depicts:
- A. Normal placenta
- B. Succenturiate lobe
- C. Both succenturiate lobe and velamentous insertion (Correct Answer)
- D. Velamentous insertion of the cord
Explanation: ***Both succenturiate lobe and velamentous insertion*** - The image clearly depicts two distinct placental lobes (**succenturiate lobes**), with a smaller accessory lobe separate from the main placental body. - The **umbilical vessels** are also seen running through the fetal membranes before reaching the placental tissue, which is characteristic of **velamentous insertion**. *Normal placenta* - A normal placenta consists of a **single, unified organ** directly attached to the decidua, with the umbilical cord inserting centrally or eccentrically into this main mass. - The **umbilical cord** in a normal placenta would insert directly into the placental tissue, not into the membranes. *Succenturiate lobe* - A succenturiate lobe (or accessory lobe) refers to one or more small lobes of the placenta located at a distance from the main placental body. - While a succenturiate lobe is present, the image also shows the umbilical vessels traversing the membranes, indicating an additional anomaly known as **velamentous insertion**, making this option incomplete. *Velamentous insertion of the cord* - Velamentous insertion is characterized by the **umbilical blood vessels** separating before reaching the placental disc, traveling through the fetal membranes. - While velamentous insertion is evident, the presence of a **separate accessory lobe** makes this option incomplete as it doesn't account for both depicted abnormalities.
Question 6: A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?
- A. Placenta accreta (Correct Answer)
- B. Uterine inversion
- C. Placental abruption
- D. Placenta previa
Explanation: ***Placenta accreta*** - A previous **cesarean section** is a strong risk factor for placenta accreta, as it can lead to scarring and defects in the uterine wall, allowing the placenta to implant too deeply. - The image suggests a placenta that is **firmly adhered and possibly invasive** into the uterine wall, making separation difficult, which is characteristic of accreta due to the absence of a proper decidual layer. *Uterine inversion* - This condition involves the **fundus of the uterus collapsing inward** or turning inside out, which is a clinical event during postpartum and not a morphological feature visible in a resected specimen like this. - The image shows an attached placenta within a uterine specimen, not an inverted uterus. *Placental abruption* - Placental abruption is the **premature separation of the placenta** from the uterine wall before delivery, often leading to retroplacental hemorrhage. - While it's a serious complication, the image does not show evidence of a separated placenta or a large retroplacental clot; instead, it depicts an abnormally adherent placenta. *Placenta previa* - Placenta previa occurs when the **placenta implants over the cervical os**, which would be diagnosed prenatally based on its location in the uterus. - The image does not provide information about the placental location relative to the cervix, but rather illustrates the manner of placental attachment.
Question 7: A lady with 38 weeks of pregnancy is admitted due to a first episode of painless bleeding yesterday. On examination, her hemoglobin level is 10.5 g%, blood pressure is 124/78 mmHg, the uterus is relaxed, the head is unengaged and floating, and the fetal heart sounds are regular. Ultrasound confirms placenta previa. The next line of management is:
- A. Caesarean section (Correct Answer)
- B. Induction of labor
- C. Wait and watch
- D. Blood transfusion
Explanation: ***Caesarean section*** - The combination of **painless vaginal bleeding** and an **unengaged, floating fetal head** in a 38-week pregnancy strongly suggests **placenta previa**. - **Placenta previa** is an absolute contraindication to vaginal delivery, necessitating a **Cesarean section** to prevent catastrophic hemorrhage. *Induction of labor* - **Vaginal examination** and, consequently, **induction of labor** are contraindicated in suspected or confirmed placenta previa due to the risk of severe hemorrhage. - Applying pressure to the cervix or performing an artificial rupture of membranes could directly traumatize the placental blood vessels. *Wait and watch* - While initial bleeding might temporarily stop, the risk of a more severe and sudden hemorrhage remains high with **placenta previa**, especially as labor progresses. - At 38 weeks, the fetus is term, and waiting carries unnecessary risks for both mother and fetus without clear benefit. *Blood transfusion* - Although the patient's hemoglobin is slightly low at 10.5 g%, the primary issue is the potential for acute, severe hemorrhage, not chronic anemia requiring immediate transfusion as the definitive management. - A **blood transfusion** might be indicated as supportive care if significant blood loss occurs, but it is not the primary management for placenta previa.
Question 8: Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:
- A. Carcinoma endometrium
- B. Leiomyoma (Correct Answer)
- C. Leiomyosarcoma
- D. Endometriosis
Explanation: ***Leiomyoma*** - Leiomyomas are **benign smooth muscle tumors** of the uterus, characterized by well-demarcated, whorled, and firm cut surfaces [1]. - Histologically, they show bundles of **smooth muscle cells** arranged in fascicles, with minimal atypia and low mitotic activity [1]. *Carcinoma endometrium* - Endometrial carcinoma typically presents as an **irregular, friable mass** originating from the endometrial lining, often with areas of necrosis or hemorrhage. - Histologically, it shows **glandular proliferation** with architectural complexity, nuclear atypia, and often invasion into the myometrium [2]. *Leiomyosarcoma* - Leiomyosarcomas are **malignant smooth muscle tumors** that are often poorly circumscribed, with areas of hemorrhage and necrosis [1]. - Histologically, they exhibit significant **nuclear atypia**, high mitotic activity (often >10 mitoses/10 HPF), and atypical mitoses [1]. *Endometriosis* - Endometriosis involves the presence of **endometrial glands and stroma outside the uterus**, often forming "chocolate cysts" in the ovaries or implants on peritoneal surfaces. - Histology would reveal **endometrial glands and stroma** surrounded by hemosiderin-laden macrophages, not a smooth muscle tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1020-1021.
Question 9: What visual disturbance is caused by an optic tract lesion?
- A. Marcus Gunn pupil
- B. Bilateral blindness
- C. Contralateral homonymous hemianopsia (Correct Answer)
- D. Ipsilateral homonymous hemianopsia
Explanation: ***Contralateral homonymous hemianopsia*** - An **optic tract lesion** interrupts the nerve fibers originating from the contralateral nasal retina and the ipsilateral temporal retina, leading to **vision loss in the contralateral visual field** of both eyes. - This results in a defect where the patient cannot see objects on the **opposite side** of the body from the lesion. *Marcus Gunn pupil* - A **Marcus Gunn pupil**, also known as an **afferent pupillary defect**, indicates asymmetric disease of the **retina** or **optic nerve**, not specifically the optic tract. - It is characterized by paradoxical dilation of the affected pupil when light is swung from the unaffected to the affected eye. *Bilateral blindness* - **Bilateral blindness** typically results from severe damage to both **optic nerves**, the **optic chiasm**, or extensive bilateral lesions in the visual cortex. - An optic tract lesion affects only one side of the visual pathway posterior to the chiasm, thus not causing complete bilateral vision loss. *Ipsilateral homonymous hemianopsia* - **Ipsilateral homonymous hemianopsia** is not a standard neurological visual field defect. Visual field defects are usually described relative to the lesion side as contralateral or ipsilateral based on the specific anatomical location. - An optic tract lesion always produces a **contralateral homonymous hemianopsia** because optic tract fibers cross at the optic chiasm.
Question 10: The following pathological features are associated with Plasmodium falciparum except-
- A. Cytoadherence
- B. Sequestration
- C. Rosetting
- D. Tissue phase (Correct Answer)
Explanation: ***Tissue phase*** (Correct Answer - NOT associated with P. falciparum) - While *Plasmodium falciparum* does have a **hepatic (liver) phase** in its life cycle, the term "**tissue phase**" specifically refers to the **persistent dormant liver stage (hypnozoites)** seen in **relapsing malarias** [1]. - **Hypnozoites** are found in *Plasmodium vivax* and *Plasmodium ovale* but **NOT in *P. falciparum***. - These dormant forms can reactivate months or years later, causing relapse—a feature absent in *P. falciparum* infection. *Cytoadherence* (Incorrect - IS associated with P. falciparum) - This is a **key virulence factor** of *P. falciparum*, where **infected red blood cells (iRBCs)** bind to the **vascular endothelium** via adhesion molecules (PfEMP1) [1]. - This binding leads to **sequestration** in deep capillaries and avoidance of splenic clearance, contributing to severe malaria pathology [1]. *Sequestration* (Incorrect - IS associated with P. falciparum) - Refers to the confinement of **iRBCs** in the **deep microvasculature** of vital organs such as the brain, lungs, and kidneys. - Results from **cytoadherence** and is the primary mechanism behind severe complications like **cerebral malaria** in *P. falciparum*. *Rosetting* (Incorrect - IS associated with P. falciparum) - Involves **iRBCs** binding to uninfected red blood cells, forming **rosette structures**. - This phenomenon impedes blood flow in capillaries and contributes to **microvascular obstruction** and tissue hypoxia in severe *P. falciparum* infections. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 398-400.
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