INI-CET 2026 Practice Questions

Q: Which of the following is an INCORRECT pairing of virus and associated malignancy?

CMV - Nasopharyngeal carcinoma. ***CMV - Nasopharyngeal carcinoma*** - **Cytomegalovirus (CMV)** is a herpesvirus that commonly causes **mononucleosis-like syndrome** in immunocompromised patients but is not oncogenic and not associated with **nasopharyngeal carcinoma**. - The correct association for **nasopharyngeal carcinoma** is **Epstein-Barr virus (EBV)**, which is strongly linked to this malignancy, especially in endemic regions. *HTLV-1 - Adult T-cell lymphoma* - **HTLV-1 (Human T-cell lymphotropic virus type 1)** is an **oncovirus** that carries the Tax gene, leading to the proliferation of specific T-cells. - This is a well-established oncogenic relationship, where chronic infection progresses to **Adult T-cell leukemia/lymphoma (ATLL)**. *EBV - Burkitt lymphoma* - **Epstein-Barr virus (EBV)** is known to drive the translocation of the **c-myc oncogene** into the immunoglobulin heavy chain locus, characteristic of **Burkitt lymphoma**. - This association is particularly strong in the endemic (African) form of the disease, often seen alongside **chronic malaria** co-infection. *HHV-8 - Kaposi sarcoma* - **Human Herpesvirus 8 (HHV-8)**, also known as **Kaposi sarcoma-associated herpesvirus (KSHV)**, is the causative agent of **Kaposi sarcoma**. - This vascular neoplasm is commonly seen in patients with advanced **AIDS** or other forms of severe **immunosuppression**.

Q: Histopathological examination of cardiac tissue from a post-MI patient shows a predominant neutrophilic infiltrate. This finding corresponds to which post-infarction time window?

1-3 days. ***1-3 days*** - During this period, the infarcted myocardium undergoes **coagulative necrosis**, which recruits robust **neutrophilic** infiltration into the interstitium. - This inflammatory response peaks around 48-72 hours, marking the transition from acute ischemia to an established inflammatory process. *2-3 months* - By this stage, the heart tissue is characterized by a fully formed **dense collagenous scar**. - All acute inflammatory cells have disappeared, and the area is stable with **fibrosis**. *12-24 hours* - Histology shows early signs of **coagulative necrosis** with loss of nuclei and striations. - The inflammatory infiltrate is minimal at this stage, with only initial recruitment beginning. *7-10 days* - This timeframe is characterized by the appearance of **macrophages** that clear the necrotic debris, rather than neutrophils. - Proliferation of **granulation tissue** begins at the margins of the infarct.

Q: A patient diagnosed with beta-thalassemia major is being evaluated. Which of the following is characteristically associated with this condition?

Intravascular hemolysis. ***Intravascular hemolysis*** - In beta-thalassemia major, the accumulation of **unpaired alpha-globin chains** results in the formation of insoluble precipitates within red blood cell precursors. - This leads to **intramedullary hemolysis** and damage to the red cell membrane, which manifests as significant hemolysis, often both intramedullary and peripheral. *Iron overload* - While **iron overload** is a hallmark clinical complication of beta-thalassemia major, it is a **secondary phenomenon** resulting from repeated transfusions and increased intestinal absorption, rather than the primary hematologic mechanism. - It leads to **hemosiderosis** in organs like the liver, heart, and endocrine glands, but is distinct from the primary defect of effective erythropoiesis. *Leukopoiesis* - **Leukopoiesis** refers to the production of white blood cells and is not the primary process affected in beta-thalassemia major. - The bone marrow in this condition preferentially expands its **erythroid lineage** to compensate for anemia, rather than increasing leukopoiesis. *Ineffective hematopoiesis* - This refers to the **premature destruction of erythroid precursors** within the bone marrow, which is a key feature of the disease. - However, while **ineffective erythropoiesis** is a central component, the question specifically asks for a characteristic associated phenomenon; the **hemolysis** caused by globin chain imbalance is the fundamental driver of the hematologic phenotype.

Q: Which of the following statements regarding wound healing is correct?

Angiogenesis occurs during the proliferative phase. ***Angiogenesis occurs during the proliferative phase*** - The **proliferative phase**, occurring roughly between days 3 and 21, is defined by the formation of **granulation tissue** fueled by **angiogenesis** to supply oxygen and nutrients to the healing wound. - Key cells such as **fibroblasts** proliferate and deposit new extracellular matrix to bridge the wound gap. *The inflammatory phase is directly followed by the exudative phase* - The standard phases of wound healing are **hemostasis, inflammation, proliferation, and remodeling**; the exudative phase is not a distinct, sequential stage in this timeline. - **Inflammation** (which involves exudate) is followed directly by the **proliferative phase**, not an independent exudative phase. *Type I collagen is deposited in early wound healing in a random haphazard manner* - **Type III collagen** (immature collagen) is the initial type deposited during the early proliferative phase, not Type I. - Type III collagen is eventually replaced by the stronger, more organized **Type I collagen** during the **remodeling** phase. *Type III collagen replaces Type I collagen in a 3:1 ratio* - It is the other way around; during the **remodeling phase**, the initial scaffold of **Type III collagen** is enzymatically degraded and replaced by **Type I collagen**. - The final mature scar is composed mostly of **Type I collagen**.

Q: A peripheral blood smear is shown below. Which supravital stain was used?

New Methylene Blue. ***New Methylene Blue*** - This is a **supravital stain** used to visualize **reticulocytes** in peripheral blood by precipitating residual ribosomal RNA into distinct blue granules. - Unlike routine Romanowsky stains, it stains living red blood cells before fixation, allowing for an accurate identification of these immature cells to assess bone marrow output. *Giemsa stain* - This is a **Romanowsky stain** commonly used for identifying **malaria parasites** and other blood-borne pathogens. - It is a permanent fixative stain, not a **supravital stain**, and does not effectively visualize the ribosomal aggregates characteristic of reticulocytes. *Leishman stain* - Leishman stain is a standard **Romanowsky stain** used for routine differential counts of peripheral blood leucocytes. - It utilizes an alcohol-based fixative, prohibiting the observation of living cell processes, making it unsuitable for **supravital** staining purposes. *Diff-Quik stain* - This is a rapid, modified **Romanowsky stain** often used in cytology and hematology laboratories for quick assessment of cell morphology. - As a fixative-dependent stain, it lacks the specific chemical properties required to demonstrate **reticulocyte** RNA, which requires a vital dye.

Q: On histopathological examination of the gastro-esophageal junction, the following image is observed. What is the probable diagnosis?

Barrett's esophagus. ***Barrett's esophagus*** - Characterized by the presence of **intestinal metaplasia** (columnar epithelium with **goblet cells**) replacing the normal stratified squamous epithelium of the distal esophagus. - Clinically, this is a distinct complication of chronic **gastroesophageal reflux disease (GERD)** and is a recognized precursor lesion for esophageal adenocarcinoma. *Low grade dysplasia* - Refers to a higher level of architectural and cytologic atypia than simple metaplasia but does not show the invasive features of carcinoma. - While Barrett's esophagus can progress to dysplasia, the defining histologic feature of Barrett's itself is the presence of **intestinal metaplasia**. *Squamous cell carcinoma* - Typically originates from the **stratified squamous epithelium** lining the mid-esophagus rather than the gastro-esophageal junction. - Histopathologically presents with **keratin pearls** and intercellular bridges, which are distinct from the glandular metaplasia seen in Barrett's. *Adenocarcinoma* - This malignancy arises directly from glandular tissue, often within a background of Barrett's esophagus. - Unlike Barrett's which is a metaplastic change, adenocarcinoma is defined by **invasive glandular structures** infiltrating into the submucosa or deeper layers.

Q: A pathologist receives a formalin-fixed paraffin-embedded (FFPE) tissue section. Which technique is most appropriate to identify and localize specific proteins within this section in situ?

Immunohistochemistry (IHC). ***Immunohistochemistry (IHC)*** - This technique utilizes **specific antibodies** to detect and visualize target proteins directly within tissue sections, maintaining the **tissue architecture**. - It is the gold standard for **in situ protein localization** in formalin-fixed paraffin-embedded (FFPE) tissue, allowing pathologists to correlate protein expression with specific histological features. *Fluorescence in situ hybridisation (FISH)* - This molecular technique is specifically designed to detect **DNA or RNA sequences** rather than proteins within a cell. - It relies on **fluorescent probes** that bind to specific chromosomal or genetic targets, not the localization of proteins. *Flow cytometry* - While it can analyze protein expression, this technique requires the tissue to be dissociated into a **single-cell suspension**. - Because it destroys the **tissue architecture** and spatial relationships between cells, it is not used to localize proteins within an intact tissue section. *Western blot* - This technique is used to measure the **size and quantity** of a specific protein within a sample. - It requires total protein extraction from the sample, which destroys the **morphology and spatial distribution** of proteins, making it unsuitable for in situ localization.

Q: A patient from North-East India presents with pulmonary cavitary lesions and hepatic nodules. Sputum AFB smear is negative. Biopsy shows caseating granulomas with Langhans-type giant cells and raised ESR. What is the most probable diagnosis?

Tuberculosis. ***Tuberculosis*** - Pulmonary **cavitary lesions** combined with **hepatic granulomas** in an endemic region like North-East India are highly characteristic of **disseminated tuberculosis**. - The biopsy finding of **caseating granulomas** with **Langhans-type giant cells** is the gold-standard histological hallmark of **Mycobacterium tuberculosis** infection. *Toxoplasmosis* - Typically presents as an opportunistic infection in **immunocompromised hosts** (e.g., HIV), manifesting as **ring-enhancing brain lesions** rather than pulmonary cavities. - Histologically shows **cysts** containing bradyzoites or free tachyzoites, not **caseating granulomas**. *Histoplasmosis* - Though it can mimic tuberculosis with pulmonary nodules and cavitary disease, it is classically associated with **yeast forms** within macrophages. - Biopsy would reveal **non-caseating** or poorly formed granulomas and classic **narrow-based budding yeasts**, which are distinct from the caseation seen here. *Sarcoidosis* - Classically presents with **bilateral hilar lymphadenopathy** and pulmonary infiltrates rather than destructive **cavitary lesions**. - Histology demonstrates **non-caseating granulomas** (naked granulomas), whereas the presence of **caseation** strongly points toward an infectious etiology like TB.

Q: An 8-year-old boy presents with freckling in the armpits, soft skin tumors over the back, and learning difficulties. His father has similar skin lesions. The images show findings under slit lamp. What is the most likely diagnosis?

Neurofibromatosis type 1 (NF1). ***Neurofibromatosis type 1 (NF1)*** - Characterized by diagnostic criteria including **axillary freckling (Crowe sign)** and multiple **neurofibromas**, which are soft, flesh-colored peripheral nerve sheath tumors. - The slit lamp examination in individuals with NF1 typically reveals **Lisch nodules** (iris hamartomas), which are pathognomonic for this condition. *Neurofibromatosis type 2 (NF2)* - Manifests primarily with **bilateral vestibular schwannomas**, leading to hearing loss and tinnitus, rather than the cutaneous features described. - It is less commonly associated with the specific combination of axillary freckling and neurofibromas seen in type 1. *Tuberous sclerosis complex* - Presents with **angiofibromas**, ash-leaf spots (hypopigmented macules), and **shagreen patches** instead of neurofibromas. - Commonly associated with neurological manifestations like **seizures** and intellectual disability rather than the classic NF1 signs. *Sturge-Weber syndrome* - Identified by a **port-wine stain (nevus flammeus)** in the distribution of the ophthalmic branch of the trigeminal nerve. - Associated with **leptomeningeal angiomas**, which often cause seizures and glaucoma, distinct from the neurocutaneous tumors of NF1.

Question 1

Which of the following is an INCORRECT pairing of virus and associated malignancy?

Accepted Answer

CMV - Nasopharyngeal carcinoma

Answer

HTLV-1 - Adult T-cell lymphoma

Answer

EBV - Burkitt lymphoma

Answer

HHV-8 - Kaposi sarcoma

Question 2

Histopathological examination of cardiac tissue from a post-MI patient shows a predominant
neutrophilic infiltrate. This finding corresponds to which post-infarction time window?

Accepted Answer

1-3 days

Answer

2-3 months

Answer

12-24 hours

Answer

7-10 days

Question 3

A patient diagnosed with beta-thalassemia major is being evaluated. Which of the following is
characteristically associated with this condition?

Accepted Answer

Intravascular hemolysis

Answer

Iron overload

Answer

Leukopoiesis

Answer

Ineffective hematopoiesis

Question 4

Which of the following statements regarding wound healing is correct?

Accepted Answer

Angiogenesis occurs during the proliferative phase

Answer

The inflammatory phase is directly followed by the exudative phase

Answer

Type I collagen is deposited in early wound healing in a random haphazard manner

Answer

Type III collagen replaces Type I collagen in a 3:1 ratio

Question 5

Which statement correctly describes incomplete penetrance?

Accepted Answer

Multiple individuals in one generation are affected but the next generation is entirely spared

Answer

All children of an affected parent will be clinically affected

Answer

The disease will not manifest in any individual of the next generation

Answer

Alternate generations of pedigree are affected by the condition

Question 6

A peripheral blood smear is shown below. Which supravital stain was used?

Accepted Answer

New Methylene Blue

Answer

Giemsa stain

Answer

Leishman stain

Answer

Diff-Quik stain

Question 7

On histopathological examination of the gastro-esophageal junction, the following image is
observed. What is the probable diagnosis?

Accepted Answer

Barrett's esophagus

Answer

Low grade dysplasia

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Question 8

A pathologist receives a formalin-fixed paraffin-embedded (FFPE) tissue section. Which
technique is most appropriate to identify and localize specific proteins within this section in situ?

Accepted Answer

Immunohistochemistry (IHC)

Answer

Flow cytometry

Answer

Western blot

Answer

Fluorescence in situ hybridisation (FISH)

Question 9

A patient from North-East India presents with pulmonary cavitary lesions and hepatic nodules.
Sputum AFB smear is negative. Biopsy shows caseating granulomas with Langhans-type giant
cells and raised ESR. What is the most probable diagnosis?

Accepted Answer

Tuberculosis

Answer

Toxoplasmosis

Answer

Histoplasmosis

Answer

Sarcoidosis

Question 10

An 8-year-old boy presents with freckling in the armpits, soft skin tumors over the back, and
learning difficulties. His father has similar skin lesions. The images show findings under slit lamp.
What is the most likely diagnosis?

Accepted Answer

Neurofibromatosis type 1 (NF1)

Answer

Neurofibromatosis type 2 (NF2)

Answer

Tuberous sclerosis complex

Answer

Sturge-Weber syndrome

INI-CET 2026

Pathology