INI-CET 2017 - Pathology PYQs Practice Questions

Q: An 18-year-old male with severe effort intolerance and dyspnea is found to have left atrial enlargement on Chest X-ray. Histopathological examination shows:

Aschoff nodules. ***Aschoff nodules*** - The clinical presentation of severe effort intolerance, dyspnea, and left atrial enlargement in an 18-year-old male is highly suggestive of **rheumatic heart disease**, a common cause of **mitral stenosis** leading to left atrial enlargement [1][2]. - **Aschoff nodules** are pathognomonic granulomatous lesions found in the myocardium during the acute phase of **rheumatic fever**, which can lead to rheumatic heart disease [1]. *Sarcoidosis* - While sarcoidosis can cause cardiac involvement (cardiomyopathy, arrhythmias), it typically presents with **non-caseating granulomas** and often affects other organs like lungs, skin, and eyes. - Cardiac sarcoidosis is less common in an 18-year-old and less likely to be the primary cause of isolated left atrial enlargement without other systemic features. *TB* - Tuberculosis can affect the pericardium (constrictive pericarditis) or myocardium, but it typically forms **caseating granulomas**. - Isolated left atrial enlargement due to TB is rare, and the clinical picture does not strongly suggest a tuberculous infection. *Fungal granuloma* - Fungal infections can cause granulomatous inflammation in the heart, especially in immunocompromised individuals. - However, the clinical presentation in an otherwise healthy 18-year-old is not typical for a fungal etiology, and fungal granulomas have distinct morphological features different from Aschoff bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 293-294. [Practice more Pathology PYQs on OnCourse]

Q: Identify the stain shown in the liver section.

Gordon and Sweet's reticulin stain. ***Gordon and Sweet's reticulin stain*** - The image shows **reticular fibers** in the liver, which appear as a delicate, branching network stained in **black**. This pattern is characteristic of a reticulin stain. - Reticulin stains are used to evaluate the **hepatic architecture** and detect its disruption in various liver diseases like cirrhosis. *Warthin starry* - The **Warthin-Starry stain** is primarily used to detect **spirochetes** (e.g., *Treponema pallidum* for syphilis) and certain bacteria like *Helicobacter pylori*. - It would show these organisms as black or brown, usually in a tissue section, but not the widespread network of reticular fibers seen here. *Steiner silver stain* - The **Steiner silver stain** is another type of silver impregnation stain used to detect **spirochetes** and other microorganisms, similar to Warthin-Starry. - It would not highlight the reticular fiber network of the liver in this specific pattern. *Grimelius silver stain* - The **Grimelius silver stain** is used to identify **neuroendocrine cells** and their granules, especially in tumors like carcinoids. - It stains the argyrophilic granules within these cells dark brown or black, which is distinct from the reticular network observed in the image. [Practice more Pathology PYQs on OnCourse]

Q: A 50-year-old male presents with colicky abdominal pain and recurrent bloody diarrhea. Colonoscopy shows geographical ulcers. Histopathology is shown below. Diagnosis is:

Inflammatory bowel disease. ***Inflammatory bowel disease*** - The presentation of **colicky abdominal pain**, **recurrent bloody diarrhea**, and **geographical ulcers** on colonoscopy are classic features of **Inflammatory Bowel Disease (IBD)**, specifically **Crohn's disease** [1]. - Histopathology in Crohn's disease often shows **transmural inflammation**, **non-caseating granulomas**, and **crypt abscesses**, which align with the clinical picture [1,2]. *Pseudomembranous colitis* - This condition is typically caused by **Clostridium difficile infection** and presents with watery diarrhea, fever, and abdominal pain, often after antibiotic use. - Colonoscopy reveals **yellowish-white plaques (pseudomembranes)**, not geographical ulcers. *NHL (Non-Hodgkin Lymphoma)* - While NHL can affect the colon, it usually presents with symptoms like **abdominal mass**, weight loss, and less commonly with recurrent bloody diarrhea as the primary symptom. - Colonoscopy findings would typically show a **mass lesion** or **polypoid growths**, not geographical ulcers. *Adenocarcinoma colon* - **Adenocarcinoma of the colon** is more common in older adults and typically presents with changes in bowel habits, rectal bleeding, and weight loss. - Colonoscopy would reveal a **polypoid mass** or an **ulcerative lesion** that is often solitary and malignant, not widespread geographical ulcers. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-367. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807. [Practice more Pathology PYQs on OnCourse]

Question 1

Endoscopic and Barium swallow findings of a patient are shown below. Select the correct histopathological slide of the patient.

Accepted Answer

Image A

Answer

Image B

Answer

Image C

Answer

Image D

Question 2

A patient with a depressive illness is brought to casualty with acute breathlessness. X-ray shows diffuse infiltrates in right middle lobe and right lower lobe. The patient expired. The lung specimen on biopsy shows:

Accepted Answer

Aspiration pneumonitis

Answer

Pulmonary alveolar proteinosis

Answer

Tuberculosis

Answer

Fat embolism syndrome

Question 3

An 18-year-old male with severe effort intolerance and dyspnea is found to have left atrial enlargement on Chest X-ray. Histopathological examination shows:

Accepted Answer

Aschoff nodules

Answer

Sarcoidosis

Answer

TB

Answer

Fungal granuloma

Question 4

Identify the stain shown in the liver section.

Accepted Answer

Gordon and Sweet's reticulin stain

Answer

Warthin starry

Answer

Steiner silver stain

Answer

Grimelius silver stain

Question 5

A 50-year-old male presents with colicky abdominal pain and recurrent bloody diarrhea. Colonoscopy shows geographical ulcers. Histopathology is shown below. Diagnosis is:

Accepted Answer

Inflammatory bowel disease

Answer

Pseudomembranous colitis

Answer

NHL

Answer

Adenocarcinoma colon

Question 6

A 7-year-old boy presents with fever and weight loss. On examination he had pallor with lymphadenopathy. Peripheral smear is shown below. Diagnosis is: (AIIMS May 2017)

Accepted Answer

ALL

Answer

AML

Answer

Aplastic anemia

Answer

Juvenile myelomonocytic leukemia

Question 7

A 40-year-old patient presents with heart burn and increased salivation. UGI endoscopy was performed and biopsy was taken. What is the diagnosis? (AIIMS May 2017)

Accepted Answer

Barrett's esophagus

Answer

Esophagitis

Answer

Adenocarcinoma esophagus

Answer

Squamous cell carcinoma esophagus

Question 8

A patient presented with mitral valve stenosis, identify the diagnosis from the mitral valve histopathology depicted below. (AIIMS Nov 2017)

Accepted Answer

Rheumatic heart disease

Answer

Tuberculosis

Answer

Myxomatous degeneration

Answer

Viral myocarditis

Question 9

A patient with symptomatic cholecystitis underwent a cholecystectomy. The following specimen was obtained. What is the diagnosis?

Accepted Answer

Gallbladder polyps

Answer

Gallbladder cancer

Answer

Cholesterolosis

Answer

Adenomyomatosis

INI-CET 2017 — Pathology