FMGE 2017 - Pathology PYQs Practice Questions

Q: Meningococcal meningitis is seen with which of the following complement deficiency?

C5. ***C5*** - Deficiencies in terminal complement components (C5-C9) lead to impaired formation of the **membrane attack complex (MAC)**, which is crucial for lysing Neisseria species [1]. - This significantly increases susceptibility to recurrent infections, particularly by **encapsulated bacteria** like *Neisseria meningitidis*, causing diseases such as meningococcal meningitis [2]. *C4* - C4 deficiency is primarily associated with **lupus-like syndromes** and **vasculitis**, due to impaired clearance of immune complexes. - While it can lead to some increased risk of infection, it is not specifically linked to a marked predisposition to meningococcal disease. *C1q* - C1q deficiency also leads to impaired **immune complex clearance** and is strongly associated with **systemic lupus erythematosus (SLE)**. - Like C4 deficiency, it does not typically present with recurrent meningococcal infections as the primary manifestation. *C2* - C2 deficiency is the **most common complement deficiency** and is associated with **lupus-like syndromes** and increased susceptibility to **pyogenic bacterial infections**. - Though it can lead to some increased infection risk, C2 deficiency is not as strongly or specifically linked to recurrent meningococcal meningitis as deficiencies in the terminal complement pathway [2]. [Practice more Pathology PYQs on OnCourse]

Q: Rolling of leucocytes on endothelial cells is mediated by which of the following proteins?

Selectins. **Selectins** - **Selectins** mediate the initial, weak and transient adhesion of **leukocytes** to the **endothelial cells** lining blood vessels [1]. - This interaction slows down the leukocytes, causing them to **roll** along the vascular endothelium as a prerequisite for **extravasation** [1]. *Integrins* - **Integrins** are responsible for the **firm adhesion** of leukocytes to endothelial cells, but not the rolling [1]. - They bind to **ICAM-1 (intercellular adhesion molecule-1)** on endothelial cells, leading to stable arrest of the leukocyte [1]. *PECAM-1* - **PECAM-1 (Platelet Endothelial Cell Adhesion Molecule-1)** plays a role in **diapedesis** or **transmigration**, the movement of leukocytes *through* the endothelial cell junctions [1]. - It facilitates the passage of the leukocyte by interacting with PECAM-1 on the endothelial cells, but does not mediate rolling [1]. *Transferrin* - **Transferrin** is an iron-binding protein found in blood plasma that regulates free **iron levels** in the body. - It is crucial for **iron transport** and metabolic processes but has no direct role in leukocyte adhesion or rolling on endothelial cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following is true about carcinoid tumor?

Can occur throughout the gastrointestinal tract. ***Can occur throughout the gastrointestinal tract*** - Carcinoid tumors (neuroendocrine tumors) are most commonly found in the **gastrointestinal tract**, particularly in the small intestine, appendix, rectum, and stomach [2]. - They arise from **enterochromaffin cells** and can secrete various vasoactive substances. *Presentation is hypotension and diaphoresis* - The classic presentation of **carcinoid syndrome** includes episodes of **flushing**, **diarrhea**, and **bronchospasm**, often accompanied by **hypertension** rather than hypotension due to the release of serotonin and other vasoactive peptides [1]. - While diaphoresis can occur, **hypotension** is not a primary or characteristic feature. *Intestinal carcinoids are of high malignant potential* - The malignant potential of carcinoid tumors varies depending on their primary site and size but is generally considered to be of **low-to-moderate malignant potential**, particularly for appendiceal and rectal carcinoids [2]. - Liver metastases significantly increase morbidity and mortality, but many small intestinal carcinoids may grow slowly or remain localized for extended periods [1]. *Best diagnosed by elevated urinary vanillymandelic acid levels* - Elevated **urinary vanillymandellic acid (VMA)** levels are primarily used to diagnose **pheochromocytoma**, a tumor of the adrenal medulla that secretes catecholamines. - Carcinoid tumors are best diagnosed by measuring **urinary 5-hydroxyindoleacetic acid (5-HIAA)**, a breakdown product of serotonin. [Practice more Pathology PYQs on OnCourse]

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. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following conditions is characterized by the presence of hyaline deposits in alveolar walls?

Hyaline membrane disease. ***Hyaline membrane disease*** - This condition is pathologically characterized by the presence of **eosinophilic (hyaline) membranes** lining the distal airspaces, which are composed of fibrin, cellular debris, and necrotic cells [1]. - These **hyaline deposits obstruct gas exchange** and are a hallmark of **acute lung injury** in neonates due to surfactant deficiency [2]. *Asthma* - Characterized by **bronchoconstriction**, **mucus plugging**, and **airway inflammation**, but not hyaline deposits in alveolar walls. - Pathologically, there is hyperplasia of goblet cells, hypertrophy of bronchial smooth muscle, and eosinophilic infiltration. *Chronic bronchitis* - Defined by **chronic productive cough** due to hypertrophy of mucous glands and increased mucus production in the bronchi, not alveolar hyaline deposits. - It primarily affects the **large airways** and is associated with chronic inflammation and airway obstruction. *Interstitial lung disease* - Involves inflammation and fibrosis of the **interstitium of the lung**, leading to impaired gas exchange. - While it causes architectural distortion, **hyaline deposits** in the alveolar walls are not a defining pathological feature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 679-681. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, p. 466. [Practice more Pathology PYQs on OnCourse]

Question 1

Meningococcal meningitis is seen with which of the following complement deficiency?

Accepted Answer

C5

Answer

C4

Answer

C1q

Answer

C2

Question 2

Rolling of leucocytes on endothelial cells is mediated by which of the following proteins?

Accepted Answer

Selectins

Answer

Integrins

Answer

Transferrin

Answer

PECAM-1

Question 3

Which of the following is true about carcinoid tumor?

Accepted Answer

Can occur throughout the gastrointestinal tract

Answer

Presentation is hypotension and diaphoresis

Answer

Intestinal carcinoids are of high malignant potential

Answer

Best diagnosed by elevated urinary vanillymandelic acid levels

Question 4

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 5

Which of the following conditions is characterized by the presence of hyaline deposits in alveolar walls?

Accepted Answer

Hyaline membrane disease

Answer

Asthma

Answer

Chronic bronchitis

Answer

Interstitial lung disease

Question 6

All of the following special histology stains are used to demonstrate H. pylori in gastric biopsies, except:

Accepted Answer

Fite's stain

Answer

Giemsa stain

Answer

Warthin-Starry stain

Answer

Modified Steiner's stain

Question 7

Fatty liver with hepatomegaly is seen in:

Accepted Answer

Metabolic syndrome

Answer

Marasmus

Answer

Nutmeg liver

Answer

Wilson disease

Question 8

Which of the following breast lesions characteristically shows central necrosis with calcification?

Accepted Answer

Comedo sub type of DCIS

Answer

Cribriform sub type of DCIS

Answer

Lobular carcinoma in situ

Answer

Colloid carcinoma

FMGE 2017 — Pathology