NEET-PG 2012 - Pathology Practice Questions

Q: Which condition is characterized by spongiform degeneration of the cerebral cortex?

Creutzfeldt-Jakob disease. ***Creutzfeldt-Jakob disease*** - This is a **prion disease** characterized by rapid cognitive decline, myoclonus, and distinctive EEG changes, with **spongiform degeneration of the cerebral cortex** as the hallmark neuropathological feature [1]. - The spongiform changes are due to intracellular vacuoles within neurons and astrocytes, giving the brain tissue a **spongy appearance** [2]. - CJD shows **widespread cortical involvement**, making it the classic answer for cortical spongiform degeneration [2]. *Subacute sclerosing panencephalitis* - This condition is a rare, **chronic, progressive encephalitis** caused by persistent measles virus infection. - It is characterized by widespread **demyelination, gliosis, and intranuclear inclusion bodies**, but not spongiform degeneration. *Fatal familial insomnia* - This is another **prion disease** that also exhibits spongiform degeneration, but the key difference is **anatomical distribution** [2]. - FFI primarily affects the **thalamus** (a subcortical structure) and causes severe insomnia, dysautonomia, and motor signs [2]. - While spongiform changes occur in FFI, they are most prominent in the **thalamus rather than the cerebral cortex**, making CJD the better answer for cortical spongiform degeneration [2]. *Cerebral toxoplasmosis* - This is an **opportunistic infection of the brain** caused by **_Toxoplasma gondii_**, primarily seen in immunocompromised individuals. - It typically results in the formation of **abscesses or ring-enhancing lesions**, rather than spongiform degeneration. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 712-713. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1284-1286.

Q: Nutmeg liver is associated with which condition?

Right sided heart failure. ***Right sided heart failure*** - **Nutmeg liver** is a classic finding associated with **congestion** in the liver due to **right-sided heart failure**, leading to the characteristic mottled appearance [1][2]. - **Impaired venous return** from the systemic circulation causes hepatic congestion, resulting in **enlargement and fibrosis** of the liver over time [2]. *Left sided heart failure* - Left-sided heart failure primarily affects the **lungs**, leading to pulmonary congestion rather than hepatic changes. - While it can cause secondary effects on the liver over time, it does not directly cause **nutmeg liver**. *Increased pulmonary pressure* - Increased pulmonary pressure is generally associated with conditions like **pulmonary hypertension**, affecting primarily the **lungs** rather than the liver directly. - It does not lead to the **congestive changes** observed in nutmeg liver [1], which is related to right heart function. *Decreased pulmonary pressure* - Decreased pulmonary pressure would typically improve pulmonary blood flow, therefore having no association with liver congestion. - It does not contribute to the **venous stasis** seen in right heart failure, which is pivotal for nutmeg liver. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, p. 126. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 870-872.

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: 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: Perivascular lymphocytes & microglial nodules are seen in -

HIV encephalitis. ***HIV encephalitis*** - **Perivascular lymphocytes** and **microglial nodules** are the characteristic histopathological hallmarks of **HIV encephalitis (HIV-associated dementia complex)** [1][2]. - Microglial nodules are formed by activated microglia and macrophages, often accompanied by **multinucleated giant cells** (the classic triad) [2]. - These features reflect chronic CNS inflammation and neuronal damage caused by HIV infection. *CMV meningitis* - Cytomegalovirus (CMV) infection in immunocompromised patients causes meningoencephalitis with characteristic **intranuclear ("owl's eye") inclusion bodies** and necrotizing inflammation. - The histological pattern differs from the microglial nodules and perivascular lymphocytes seen in HIV encephalitis. *Bacterial meningitis* - Characterized by prominent **neutrophilic infiltrate** in the subarachnoid space, fibrinopurulent exudate, and potential vasculitis. - Acute bacterial meningitis does not show the lymphocytic and microglial nodular pattern characteristic of viral encephalitis. *Multiple sclerosis* - An autoimmune demyelinating disease with **perivenular demyelinating plaques** containing lymphocytes and macrophages. - While perivascular inflammation occurs, **microglial nodules** are not a characteristic feature; instead, MS shows demyelination with reactive gliosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, p. 1278. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 711-712.

Q: Orphan Annie nuclei are characteristic of which of the following?

Papillary thyroid carcinoma. ***Papillary carcinoma thyroid***[1][2] - Characterized by **Orphan Annie nuclei**[1], which are large and round with a clear or empty appearance due to the presence of intranuclear cytoplasmic inclusions[1]. - Often associated with **thyroid follicular structures** and is the most common type of thyroid cancer[2]. *Meningioma* - Typically presents with **dural-based tumors** and does not exhibit Orphan Annie nuclei. - Histologically, it may demonstrate **whorled patterns** or calcifications instead. *Carcinoma pituitary* - Involves **adenomatous changes** in the pituitary gland but does not demonstrate the characteristic Orphan Annie nuclei. - More commonly shows **varied cellular morphology** depending on the type of secretory cells (e.g., prolactin, ACTH). *Paraganglioma* - Derived from **neuroendocrine cells**, and presents with **zellballen pattern** rather than Orphan Annie nuclei. - Often shows **chromaffin cells** and is typically associated with catecholamine secretion. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.

Q: Which of the following is the most likely proliferating breast mass?

Fibroadenoma. **Fibroadenoma** - A **fibroadenoma** is a benign **biphasic breast tumor** composed of both glandular and stromal tissue, making it a common proliferating mass [3]. - It is often seen in **young women** and typically presents as a firm, movable, non-tender lump [3]. *Duct ectasia* - **Duct ectasia** is a non-proliferative condition characterized by dilation of the **subareolar ducts**, often with inflammation and fibrosis. - It is more commonly associated with **nipple discharge** and **periductal inflammation** rather than being a primary proliferating mass. *Adenosis* - **Adenosis** refers to an increase in the number of **glands or lobules** within the breast parenchyma, which can be sclerosing or florid [2]. - While it involves increased glandular elements, it is generally considered a **benign proliferative change** and less likely to form a distinct, palpable mass compared to a fibroadenoma [1], [4]. *Papilloma* - A **papilloma** is a benign epithelial proliferation within a **duct**, characterized by a central fibrovascular core [2]. - It commonly presents with **nipple discharge**, often bloody, and is typically a smaller lesion within the ductal system rather than a large, palpable proliferating mass [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1054. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 446-447. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Q: Which of the following germ cell tumors is benign?

Dermoid cyst. ***Seminoma*** - Seminomas are well-known malignant **germ cell tumors**, primarily affecting young males [2]. - They are associated with elevated **human chorionic gonadotropin (hCG)** and can spread to lymph nodes [3]. *Leydig cell tumor* - These tumors are usually **benign** and arise from Leydig cells in the testes. - While they can produce **testosterone**, they do not typically exhibit malignancy. *Sertoli cell tumor* - Sertoli cell tumors are also generally **benign** and arise from Sertoli cells in the testes. - They lack the malignant behavior seen in seminomas and have a low rate of metastasis [1]. *Dermoid cyst* - Dermoid cysts are **benign** mature teratomas, commonly found in the ovaries or testicles. - They can contain different tissue types (like hair, fat, and teeth) but are not malignant. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 980-982.

Q: Ewing's sarcoma arises from which type of cells?

Primitive neuroectodermal cells. ***Primitive neuroectodermal cells*** - **Ewing's sarcoma** is a malignant small round blue cell tumor largely believed to arise from **primitive neuroectodermal cells**. - This cellular origin explains why it's often grouped under the term **PNET (Primitive Neuroectodermal Tumor)**. *G cells* - **G cells** are specialized **enteroendocrine cells** found in the stomach and duodenum that secrete **gastrin**. - They are involved in regulating gastric acid secretion and have no association with Ewing's sarcoma. *Totipotent cells* - **Totipotent cells** have the ability to differentiate into **any type of cell**, including embryonic and extraembryonic tissues. - While all cancers originate from cellular changes, Ewing's sarcoma originates from a more specific, committed cell lineage, not totipotent stem cells. *Neurons* - **Neurons** are the basic functional units of the nervous system, responsible for transmitting electrical and chemical signals. - While Ewing's sarcoma has neuroectodermal characteristics, it does not arise from fully differentiated neurons but rather from more **primitive precursors**.

Question 1

Which condition is characterized by spongiform degeneration of the cerebral cortex?

Accepted Answer

Creutzfeldt-Jakob disease

Answer

Subacute sclerosing panencephalitis

Answer

Fatal familial insomnia

Answer

Cerebral toxoplasmosis

Question 2

Nutmeg liver is associated with which condition?

Accepted Answer

Right sided heart failure

Answer

Increased pulmonary pressure

Answer

Decreased pulmonary pressure

Answer

Left sided heart failure

Question 3

Which of the following statements about desmoid tumors is incorrect?

Accepted Answer

Highly radiosensitive

Answer

Show infiltrative growth pattern

Answer

Often seen below the umbilicus

Answer

More common in women

Question 4

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

Accepted Answer

IgM

Answer

IgG

Answer

IgA

Answer

IgD

Question 5

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

Accepted Answer

CEA

Answer

hCG

Answer

AFP

Answer

CA-15-3

Question 6

Perivascular lymphocytes & microglial nodules are seen in -

Accepted Answer

HIV encephalitis

Answer

CMV meningitis

Answer

Bacterial meningitis

Answer

Multiple sclerosis

Question 7

Orphan Annie nuclei are characteristic of which of the following?

Accepted Answer

Papillary thyroid carcinoma

Answer

Paraganglioma with Zellballen pattern

Answer

Meningioma with psammoma bodies

Answer

Pituitary adenoma with atypical nuclei

Question 8

Which of the following is the most likely proliferating breast mass?

Accepted Answer

Fibroadenoma

Answer

Duct ectasia

Answer

Adenosis

Answer

Papilloma

Question 9

Which of the following germ cell tumors is benign?

Accepted Answer

Dermoid cyst

Answer

Seminoma

Answer

Embryonal carcinoma

Answer

Yolk sac tumor

Question 10

Ewing's sarcoma arises from which type of cells?

Accepted Answer

Primitive neuroectodermal cells

Answer

G cells

Answer

Totipotent cells

Answer

Neurons

NEET-PG 2012 — Pathology