NEET-PG 2012 - Pathology Practice Questions

Q: In which type of Hodgkin's Lymphoma are lacunar cells typically observed?

Nodular Sclerosis type. ***Nodular Sclerosis Type*** - **Lacunar cells** are characteristically seen in **Nodular Sclerosis Hodgkin lymphoma**, which is the most common subtype [1][3]. - These cells are large **Reed-Sternberg cells** with a distinctive morphology, typically found in **fibrous areas** of the lymph node [1]. *Mixed cellularity type* - This subtype is associated with a diverse cell population but does not primarily feature **lacunar cells** [2][4]. - It predominantly contains **Reed-Sternberg cells** without the specific morphology seen in nodular sclerosis [2]. *Lymphocyte predominant* - Lymphocyte predominant type mainly consists of **lymphocytes** with few Reed-Sternberg cells, and lacks **lacunar cells** [5]. - The histology is significantly different, exhibiting a more lymphocytic composition and not the classic lucent spaces [5]. *All of the above* - This option is incorrect as neither **Mixed cellularity** nor **Lymphocyte predominant** types contain **lacunar cells** [2][4][5]. - Lacunar cells are a distinctive feature solely of the **Nodular Sclerosis type** in Hodgkin lymphoma [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 616. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 616-618. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 558-559. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 559-560. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 618.

Q: What change is seen in the vessels during the initial stage of Raynaud's phenomenon?

No pathological changes (functional vasospasm only). ***No pathological changes (functional vasospasm only)*** - Raynaud's phenomenon, particularly **primary Raynaud's** (Raynaud's disease), is characterized by **functional vasospasm** of arterioles, especially in fingers and toes, in response to cold or stress [1]. - In its initial stages, there are no structural changes or pathological alterations within the vessel walls; the vasoconstriction is entirely **functional** [1]. *Thrombosis* - **Thrombosis** involves the formation of a blood clot within a vessel, obstructing blood flow. - While severe Raynaud's can, in rare cases, lead to digital ischemia and microthrombosis, it is **not the primary or initial change** seen in typical Raynaud's phenomenon. *Fibrinoid necrosis* - **Fibrinoid necrosis** is a type of vascular damage associated with severe autoimmune diseases or malignant hypertension, where fibrin and plasma proteins deposit in the vessel wall. - This is a **structural, irreversible change** and is not characteristic of the initial, functional vasospasm seen in Raynaud's phenomenon. *Hyaline sclerosis* - **Hyaline sclerosis** is a change in small arteries and arterioles, often seen in benign essential hypertension or as part of the aging process, where the vessel wall thickens and becomes hyaline (glassy) due to plasma protein leakage and fibrosis. - This represents a **chronic structural change** and is not the acute, intermittent, functional vasoconstriction defining the initial stage of Raynaud's. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 520-522.

Q: Which tumor marker is most commonly associated with lung and breast carcinoma?

CEA. ***CEA*** - **Carcinoembryonic antigen (CEA)** is a tumor marker commonly associated with **lung** and **breast cancers** [1]. - Elevated levels of CEA are often observed in **various malignancies**, making it useful for monitoring treatment response and recurrence. *CA-15-3* - While **CA-15-3** is a breast cancer marker, it is less specific than CEA and often used primarily for **monitoring** but not for initial diagnosis. - It is primarily elevated in **breast carcinoma**, not typically associated with **lung cancer**. *11CG* - This ppears to be incorrectly referenced and may not exist as a recognized tumor marker for lung or breast cancer. - There are no clinical associations with lung or breast cancer, making it irrelevant in this context. *AFP* - **Alpha-fetoprotein (AFP)** is primarily associated with **liver** and **germ cell tumors**, not commonly associated with lung or breast cancers [1]. - Elevated AFP levels do not correlate with lung or breast carcinomas, distinguishing it from CEA's relevance. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 346.

Q: Helmet cells are characteristic of anemia of?

Hemolytic uremic syndrome (HUS). ***Hemolytic uremic syndrome*** - Helmet cells are **fragmented red blood cells** associated with **microangiopathic hemolytic anemia** [1], commonly seen in hemolytic uremic syndrome. - This condition frequently results in **thrombocytopenia** and acute renal failure. *Acanthocytosis* - Acanthocytosis is characterized by **spiky red blood cells** (acanthocytes) rather than helmet cells. - It is commonly associated with **liver disease** and **abetalipoproteinemia**, not hemolytic anemia. *Polysplenia* - Polysplenia is a condition involving multiple spleens but does not typically relate to the **formation of helmet cells**. - It may cause **asplenic complications**, but anemia characteristics do not include helmet cells. *Spherocytosis* - Spherocytosis involves the presence of **spherical red blood cells** rather than fragmented (helmet) cells. - It is associated with **hereditary conditions** like hereditary spherocytosis, which leads to increased hemolysis but not typically to helmet cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 596-597.

Q: All of the following statements about Giant cell arteritis are true except?

Involves large to small sized arteries. ***Involves large to small sized arteries*** - Giant cell arteritis (GCA) predominantly affects **medium to large-sized arteries**, most commonly the branches of the **carotid artery**, such as the temporal arteries [1]. - While it can affect various arteries, it does not typically involve **small-sized arteries**, such as arterioles, directly as a primary site of inflammation. *Granulomatous inflammation* - GCA is characterized histologically by **granulomatous inflammation** within the arterial wall, which includes multinucleated **giant cells** and lymphocytes [2]. - This specific inflammatory pattern is a hallmark feature used in the diagnosis of GCA upon biopsy [2]. *Segmental nature of the involvement* - The arterial inflammation in GCA is often **segmental**, meaning that affected arteries may have inflamed and non-inflamed sections alternating along their length [2]. - This segmental involvement often necessitates **longer biopsies** (e.g., 2-3 cm for temporal artery biopsy) to increase the diagnostic yield. *Can involve the aorta and its major branches* - GCA can indeed affect the **aorta** (aortitis) and its major branches, leading to complications like **aneurysms** or **dissections**. - Involvement of these larger vessels can manifest as symptoms such as **claudication** in the limbs or asymptomatic aneurysms detectable on imaging [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 688-689. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 516-517.

Q: Which histopathological feature is characteristic of chronic hepatitis?

Bridging necrosis. ***Bridging necrosis*** - Commonly seen in chronic hepatitis, bridging necrosis indicates severe liver injury and loss of hepatocyte integrity [1]. - Represents a critical finding in liver biopsy, reflecting ongoing inflammation and necrosis between portal areas and central veins [1]. *Councilman bodies* - These are apoptotic hepatocytes observed primarily in acute hepatitis, not chronic hepatitis. - They are indicative of **viral hepatitis** but are less specific for chronic conditions. *Balloning* - Refers to the ballooning degeneration of hepatocytes, commonly seen in fatty liver disease or acute hepatitis rather than chronic hepatitis. - Although it can occur in chronic conditions, it is not a definitive hallmark for chronic hepatitis specifically. *All* - This option is misleading as it suggests that all the listed features are definitive for chronic hepatitis, which is not accurate. - Individual features like **Councilman bodies** and **balloning** are more related to acute or different liver conditions, rather than chronic hepatitis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 842-844.

Q: Starry sky appearance is seen in which of the following?

Burkitt's Lymphoma. ***Burkitts lymphoma*** - The **starry sky appearance** is a characteristic histopathological finding due to interspersed macrophages containing **phagocytosed apoptotic cells** and necrotic debris in Burkitt's lymphoma [1]. - It is associated with **MYC gene translocation** and presents typically in children or young adults, commonly affecting the **jaw or abdomen**. *CIL* - CIL (chronic inflammatory leukocytosis) does not exhibit a **starry sky appearance**; it typically reflects a reactive process without specific histological features. - The histology is more characterized by **increased white blood cell counts** rather than tissue architecture alterations seen in lymphomas. *Diffuse large B cell lymphoma* - While this lymphoma can show **varied morphology**, it does not have a **starry sky appearance** as a defining feature, rather presenting with **large atypical B-cells**. - The histological appearance is generally of a **diffuse infiltrate**, which lacks the classic starry sky histology. *ALCL* - Anaplastic large cell lymphoma (ALCL) is characterized by **large, pleomorphic cells** but does not show a starry sky appearance. - The histological pattern primarily focuses on **large anaplastic lymphoid cells** rather than the scattered macrophages seen in Burkitt's lymphoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 606.

Q: What type of anaemia is primarily associated with leukaemia?

Myelophthisic anaemia. ***Myelophthisic anaemia*** - This condition arises from the **displacement of normal hematopoietic tissue** in the bone marrow by abnormal cells, like those seen in leukaemia, leading to **extramedullary hematopoiesis**. - Marrow infiltration causes **pancytopenia** and often results in the presence of **immature granulocytes** and **nucleated red blood cells** in the peripheral blood (leukoerythroblastosis). *Iron deficiency anaemia* - This type of anaemia is caused by insufficient iron for **hemoglobin synthesis**, often due to chronic blood loss or inadequate dietary intake. - While leukaemia patients can develop iron deficiency due to bleeding, it is not the **primary type of anaemia** directly resulting from the marrow infiltration by leukaemic cells. *Megaloblastic anaemia* - Characterized by the production of abnormally large, immature red blood cells, primarily due to **vitamin B12** or **folate deficiency**. - There is no direct causal link between leukaemia and the development of megaloblastic anaemia as a **primary haemato-pathological mechanism**. *Aplastic anaemia* - Characterized by **pancytopenia** due to bone marrow failure with hypocellular marrow, not marrow infiltration. - While both leukaemia and aplastic anaemia can present with cytopenias, aplastic anaemia shows a **hypocellular marrow** whereas leukaemia shows a **hypercellular marrow** with infiltration by malignant cells.

Q: Which type of immunoglobulin is primarily associated with cold agglutinin disease?

IgM. ***IgM*** - Cold agglutinins are primarily composed of **IgM antibodies** [1] which are produced in response to certain infections, notably Mycoplasma pneumoniae. - They can cause **cold agglutinin disease**, leading to hemolytic anemia when the blood is exposed to cooler temperatures [2]. *IgG* - While IgG is the most abundant antibody in blood, it is not responsible for cold agglutination. - IgG typically functions in **immune memory** and neutralization rather than agglutination at cold temperatures. *IgD* - IgD is mainly found on the surface of **B cells** and has a role in initiating B cell activation. - It plays a minimal role in the antibody response and does not participate in cold agglutination. *IgA* - IgA is primarily involved in mucosal immunity, found in secretions like saliva and tears. - It does not function as a cold agglutinin; hence, it is not associated with cold temperature-related agglutination. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 154-155. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 651-652.

Q: When differentiated cells transform to form cells characteristic of other tissues, the process is called as -

Trans-differentiation. ***Trans-differentiation*** - **Trans-differentiation** refers to the direct conversion of one differentiated cell type into another differentiated cell type without entering a pluripotent stem cell state. - This process is achieved by altering the **gene expression profile** of existing cells to adopt the characteristics of a different lineage. *De-differentiation* - **De-differentiation** is the process where a specialized cell loses its specific characteristics and reverts to a more primitive or stem cell-like state. - This is often observed in certain disease processes, like cancer, or in response to injury where cells regain limited proliferative capacity. *Re-differentiation* - **Re-differentiation** typically describes a cell that has undergone de-differentiation and then differentiates again into a new or its original cell type. - This process is often seen in tissue repair, where progenitor cells proliferate and then re-differentiate to replace damaged tissue. *Sub-differentiation* - **Sub-differentiation** is not a standard or recognized term in cell biology or developmental biology to describe the transformation of stem cells into other tissue types. - The term does not have a defined meaning within the context of cellular lineage alterations.

Question 1

In which type of Hodgkin's Lymphoma are lacunar cells typically observed?

Accepted Answer

Nodular Sclerosis type

Answer

Mixed cellularity type

Answer

Lymphocyte predominant type

Answer

All of the options

Question 2

What change is seen in the vessels during the initial stage of Raynaud's phenomenon?

Accepted Answer

No pathological changes (functional vasospasm only)

Answer

Thrombosis

Answer

Fibrinoid necrosis

Answer

Hyaline sclerosis

Question 3

Which tumor marker is most commonly associated with lung and breast carcinoma?

Accepted Answer

CEA

Answer

hCG

Answer

AFP

Answer

CA-15-3

Question 4

Helmet cells are characteristic of anemia of?

Accepted Answer

Hemolytic uremic syndrome (HUS)

Answer

Disseminated intravascular coagulation (DIC)

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Autoimmune hemolytic anemia (AIHA)

Question 5

All of the following statements about Giant cell arteritis are true except?

Accepted Answer

Involves large to small sized arteries

Answer

Granulomatous inflammation

Answer

Segmental nature of the involvement

Answer

Can involve the aorta and its major branches

Question 6

Which histopathological feature is characteristic of chronic hepatitis?

Accepted Answer

Bridging necrosis

Answer

Ballooning degeneration

Answer

Councilman bodies

Answer

None of the options

Question 7

Starry sky appearance is seen in which of the following?

Accepted Answer

Burkitt's Lymphoma

Answer

Diffuse Large B Cell Lymphoma

Answer

Anaplastic Large Cell Lymphoma (ALCL)

Answer

Follicular Lymphoma

Question 8

What type of anaemia is primarily associated with leukaemia?

Accepted Answer

Myelophthisic anaemia

Answer

Aplastic anaemia

Answer

Iron deficiency anaemia

Answer

Megaloblastic anaemia

Question 9

Which type of immunoglobulin is primarily associated with cold agglutinin disease?

Accepted Answer

IgM

Answer

IgG

Answer

IgA

Answer

IgD

Question 10

When differentiated cells transform to form cells characteristic of other tissues, the process is called as -

Accepted Answer

Trans-differentiation

Answer

De-differentiation

Answer

Re-differentiation

Answer

Sub-differentiation

NEET-PG 2012 — Pathology