NEET-PG 2012 - Pathology Practice Questions

Q: What do Döhle bodies represent in neutrophils?

Presence of dilated endoplasmic reticulum in neutrophils. ***Presence of dilated endoplasmic reticulum in neutrophils*** - **Döhle bodies** are inclusions found in the cytoplasm of neutrophils, classic hallmarks of **severe infection** or inflammatory conditions. - They represent remnants of dilated **rough endoplasmic reticulum**, which appears as pale-blue, irregular aggregates on stained blood smears. *Increased mitochondria in neutrophils* - An increase in mitochondria is not a characteristic feature associated with Döhle bodies. - While mitochondria are essential for cellular energy production, their proliferation does not form visible inclusions known as Döhle bodies. *Golgi apparatus proliferation in neutrophils* - Proliferation of the Golgi apparatus is not typically observed as a Döhle body. - The Golgi apparatus is involved in protein modification and packaging, but its changes do not manifest as these specific inclusions. *Lysosomal activity in neutrophils* - Lysosomal activity involves the breakdown of cellular debris and pathogens and is not directly related to the formation of Döhle bodies. - Although lysosomes are abundant in neutrophils, their activity does not result in the presence of Döhle bodies.

Q: A mutation in the transthyretin (TTR) protein causes which of the following types of amyloidosis?

Familial amyloidotic polyneuropathy. ***Familial amyloidotic polyneuropathy*** - This condition is specifically caused by **mutations in the transthyretin (TTR) protein**, leading to amyloid deposition primarily in nerves [1]. - It presents with **peripheral neuropathy**, including sensory and autonomic symptoms, which align with TTR mutations [1]. *Familial Mediterranean fever* - This is an autoinflammatory disorder caused by mutations in the **MEFV gene**, unrelated to transthyretin. - It is characterized by recurrent **fever, abdominal pain**, and **serositis**, not amyloidosis caused by TTR. *Prion protein associated amyloidosis* - Relates to prion diseases like **Creutzfeldt-Jakob disease**, caused by abnormal **prion proteins** rather than TTR [1]. - Symptoms are usually **neurodegenerative** in nature, not linked to familial amyloidogenic processes. *Dialysis associated amyloidosis* - This form of amyloidosis is due to the accumulation of **beta-2 microglobulin**, not mutations in TTR [1]. - Commonly presents with **joint pain** and carpal tunnel syndrome associated with long-term dialysis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 266.

Q: Cystic medial necrosis is seen in?

Marfan syndrome. ***Marfans syndrome*** - Cystic medial necrosis is a prominent feature of Marfan syndrome, leading to **aortic dilation** and increased risk of dissection [1] [2]. - It is associated with **connective tissue abnormalities**, specifically affecting elastic fibers in the aorta [2]. *Kawasaki disease* - Primarily affects children, leading to **vasculitis** of medium-sized arteries, especially the coronary arteries. - Does not characteristically cause **cystic medial necrosis** in the aorta. *Friedrichs ataxia Pattern* - An autosomal recessive disorder characterized by degeneration of spinal cord and peripheral nerves, not related to cystic medial necrosis. - Presents with **ataxia**, **scoliosis**, and **diabetes**, lacking cardiovascular changes associated with cystic medial necrosis. *Downs syndrome* - A genetic condition resulting from **trisomy 21**, associated with various congenital anomalies but not specifically with cystic medial necrosis. - Includes features like **heart defects** but does not involve the aortic changes seen in Marfan syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 511-512. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 153-154.

Q: What is the most important prognostic factor of Wilms tumour?

Histopathology. ***Histopathology*** - The presence of **anaplastic histology**, particularly diffuse anaplasia, is the most significant adverse prognostic factor in Wilms tumor. - Tumors with favorable histology (triphasic, blastemal, stromal, or epithelial predominant) have an excellent prognosis, while those with anaplastic features have significantly worse outcomes [1]. *Ploidy of cells* - While **aneuploidy** (specifically, **hyperdiploidy**) has been associated with improved prognosis in some childhood cancers, its role as an independent prognostic factor in Wilms tumor is less significant than histology [2]. - It is not the most important factor in determining the overall outcome. *Age < 1 yr* - **Younger age** (typically less than 1 year) at diagnosis is generally associated with a **more favorable prognosis** in Wilms tumor. - This is because these tumors are often smaller, less aggressive, and more likely to have favorable histology. *Mutation of WT1 gene* - **WT1 gene mutations** are implicated in the development of Wilms tumor, particularly in syndromes like WAGR (Wilms tumor, aniridia, genitourinary anomalies, intellectual disability). - While critical for pathogenesis, the mere presence of a WT1 mutation is **not the primary determinant** of prognosis compared to tumor histology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 488-490. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 486-487.

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: ER positive status in carcinoma breast indicates?

Prognosis. ***Prognosis*** - **ER positive status** in breast cancer indicates a better prognosis, as these tumors often respond well to hormone therapy [1][2]. - Patients with **ER positive** breast cancer usually have a lower risk of metastasis compared to **ER negative** tumors, making the outcome more favorable [1]. *Site* - ER status does not provide information regarding the **anatomical location** of the breast cancer, as it can be present in different sites of the breast. - It primarily focuses on the **biologic characteristics** of the tumor rather than its site of occurrence [1]. *None* - Selecting 'None' suggests that ER positive status has no relevance, which is incorrect as it is significant for treatment and prognosis [1]. - It is a crucial indicator for deciding on **endocrine therapy**, impacting management strategies in breast cancer patients [1]. *Etiology* - ER positive status does not directly indicate the **cause** of breast cancer, as various genetic and environmental factors contribute to its development. - It mainly reflects tumor behavior and response to therapies, not the **underlying factors** that lead to the disease [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1056. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.

Q: Which gene mutation is commonly associated with malignant melanoma?

CDKN2A. ***CDK2A*** - CDK2A mutations are implicated in malignant melanoma as they disrupt the **cell cycle regulation**, contributing to uncontrolled cell growth [1]. - Loss of CDK2A function leads to reduced **p16INK4A**, a crucial inhibitor of cyclin-dependent kinases involved in **G1/S phase transition** [1,3]. - Germline mutations of p16 (CDKN2A) are present in 25% of melanoma-prone kindreds [2], and germline mutations in CDKN2A are associated with familial forms of melanoma [3]. *RET* - RET mutations are primarily associated with **medullary thyroid carcinoma** and **multiple endocrine neoplasia type 2**, not melanoma. - It is involved in the signaling pathways but does not have a direct link to melanoma pathogenesis. *None* - Suggesting "none" misrepresents the reality that specific mutations do occur in malignant melanoma, including **CDK2A** and **BRAF**. - This option fails to recognize the importance of genetic alterations in cancer development and progression. *N-myc* - N-myc mutations are primarily associated with **neuroblastoma** and not typically linked to malignant melanoma. - In melanoma, mutations of this gene do not play a significant role in its pathophysiology compared to another tumor suppressor gene like **CDK2A**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1150-1151. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 305-306.

Q: Tadpole cells, comma-shaped cells on histopathology are seen in -

Rhabdomyosarcoma. ***Rhabdomyosarcoma*** - **Tadpole cells** and **comma-shaped cells** are characteristic histological features of **rhabdomyosarcoma**, representing primitive mesenchymal cells differentiating towards skeletal muscle. - These cells are often pleomorphic, with eccentric nuclei and fibrillar eosinophilic cytoplasm, giving them their distinctive shapes. *Trichoepithelioma* - This is a benign adnexal tumor of follicular differentiation, characterized by nests of **basaloid cells**, **horn cysts**, and rudimentary hair structures. - It does not typically feature tadpole or comma-shaped cells. *Histiocytoma* - A **benign fibrous histiocytoma** (dermatofibroma) is composed of fibroblasts and histiocytes forming storiform patterns. - **Malignant fibrous histiocytoma** (now often reclassified as undifferentiated pleomorphic sarcoma) features pleomorphic spindle cells and giant cells, but not specifically tadpole or comma-shaped cells. *Leiomyosarcoma* - This is a malignant tumor of **smooth muscle origin**, characterized by spindle cells with blunt-ended nuclei, arranged in fascicles. - It lacks the tadpole or comma-shaped cells seen in rhabdomyosarcoma.

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: Which of the following is not typically screened for in blood donations?

Epstein-Barr Virus (EBV). ***Epstein-Barr Virus (EBV)*** ✓ - EBV is **NOT routinely screened** for in blood donations in India and most countries - While EBV is a common virus (>90% adults are seropositive), it is **not considered a major transfusion-transmitted infection** - The virus is primarily transmitted through saliva; transfusion-associated EBV transmission is **extremely rare and usually not clinically significant** in immunocompetent recipients - Risk-benefit analysis does not support routine screening due to **high prevalence, low clinical impact, and cost considerations** - EBV screening may only be considered for specific recipients (e.g., severely immunocompromised patients) *HIV* - **Routinely screened** in all blood donations worldwide - Screening includes HIV-1 and HIV-2 antibodies and/or HIV antigen/RNA testing - Transfusion-transmitted HIV causes AIDS with severe consequences - Mandatory screening under the Drugs and Cosmetics Act in India *HBV* - **Routinely screened** in all blood donations - Screening includes HBsAg (Hepatitis B surface antigen) testing, and often anti-HBc or HBV DNA - Can cause acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma - Mandatory screening in India and globally *HCV* - **Routinely screened** in all blood donations - Screening includes anti-HCV antibodies and/or HCV RNA (nucleic acid testing) - Major cause of chronic hepatitis, cirrhosis, and liver cancer - Mandatory screening under blood safety regulations

Question 1

What do Döhle bodies represent in neutrophils?

Accepted Answer

Presence of dilated endoplasmic reticulum in neutrophils

Answer

Increased mitochondria in neutrophils

Answer

Golgi apparatus proliferation in neutrophils

Answer

Lysosomal activity in neutrophils

Question 2

A mutation in the transthyretin (TTR) protein causes which of the following types of amyloidosis?

Accepted Answer

Familial amyloidotic polyneuropathy

Answer

Familial Mediterranean fever

Answer

Dialysis associated amyloidosis

Answer

Prion protein associated amyloidosis

Question 3

Cystic medial necrosis is seen in?

Accepted Answer

Marfan syndrome

Answer

Friedreich's ataxia

Answer

Down syndrome

Answer

Kawasaki disease

Question 4

What is the most important prognostic factor of Wilms tumour?

Accepted Answer

Histopathology

Answer

Mutation of WT1 gene

Answer

Ploidy of cells

Answer

Age < 1 yr

Question 5

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 6

ER positive status in carcinoma breast indicates?

Accepted Answer

Prognosis

Answer

Etiology

Answer

Site

Answer

None of the options

Question 7

Which gene mutation is commonly associated with malignant melanoma?

Accepted Answer

CDKN2A

Answer

MYCN

Answer

RET

Answer

BRAF

Question 8

Tadpole cells, comma-shaped cells on histopathology are seen in -

Accepted Answer

Rhabdomyosarcoma

Answer

Trichoepithelioma

Answer

Histiocytoma

Answer

Leiomyosarcoma

Question 9

Perivascular lymphocytes & microglial nodules are seen in -

Accepted Answer

HIV encephalitis

Answer

CMV meningitis

Answer

Bacterial meningitis

Answer

Multiple sclerosis

Question 10

Which of the following is not typically screened for in blood donations?

Accepted Answer

Epstein-Barr Virus (EBV)

Answer

HIV

Answer

HBV

Answer

HCV

NEET-PG 2012 — Pathology