NEET-PG 2012 - Pathology Practice Questions

Q: Glomus tumor is seen in -

Distal portion of digits. ***Distal portion of digits*** - **Glomus tumors** are most commonly found in the **distal extremities**, especially the **subungual region** (under the nail) of the fingers and toes. - This location accounts for over 75% of all glomus tumors, where they originate from specialized **neuromyoarterial glomus bodies** involved in thermoregulation. - The classic clinical triad includes **paroxysmal pain, point tenderness, and cold sensitivity**. *Rare locations such as retroperitoneum* - While glomus tumors can occur in unusual sites, the **retroperitoneum** is an exceptionally rare location for primary glomus tumors. - Extradigital glomus tumors account for approximately 25% of cases and can occur in various soft tissue sites. *Long bones and vertebrae* - Glomus tumors do not typically arise in **bone tissue** as they originate from glomus bodies in soft tissue. - Bone involvement, when present, is usually secondary due to pressure erosion from an adjacent soft tissue tumor rather than primary bone origin. *Proximal portion of digits (less common site)* - While glomus tumors can occasionally be found in less common digital locations, the **proximal portion of digits** is significantly less frequent than the distal, and particularly the subungual, region. - Their primary association remains with the **distal phalanx** and nail bed.

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: 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 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: 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

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**.

Q: Most common CNS tumor associated with NF1

Optic glioma. ***Optic glioma*** - **Optic gliomas** (specifically **pilocytic astrocytomas**) are the most common CNS tumor found in association with **Neurofibromatosis type 1 (NF1)** [1]. - These tumors typically affect the **optic nerve** and can cause vision impairment. *Optic nerve schwannoma* - **Schwannomas** are tumors arising from Schwann cells, and while they can affect cranial nerves, an **optic nerve schwannoma** is very rare and not characteristic of NF1. - The most common schwannoma associated with neurofibromatosis is a **vestibular schwannoma** (acoustic neuroma) in NF2, not NF1 [2]. *Astrocytoma* - While optic gliomas are a type of astrocytoma, simply stating "astrocytoma" is too broad; the specific location (optic nerve) and type (pilocytic) are key in NF1 [1]. - Other types of astrocytomas (e.g., glioblastoma) are not typically associated with NF1 as the *most common* CNS tumor. *Bilateral acoustic neuroma* - **Bilateral acoustic neuromas** (vestibular schwannomas) are the hallmark CNS tumor of **Neurofibromatosis type 2 (NF2)**, not NF1 [2]. - This symptom strongly points to NF2, a distinct genetic disorder from NF1 [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728.

Q: The immunoglobulin most commonly involved in Multiple Myeloma is:

IgG. ***IgG*** - In Multiple Myeloma, the most commonly involved immunoglobulin is **IgG**, which is often produced in excess by malignant plasma cells [1][2]. - The presence of **monoclonal IgG** in serum is a key indicator of this malignancy, evident in diagnostic tests like serum protein electrophoresis. *IgM* - While **elevated IgM** levels can occur in other conditions like Waldenström's macroglobulinemia, it is not typically associated with Multiple Myeloma [2]. - IgM is produced by a different type of plasma cell and does not reflect the classic presentation of Multiple Myeloma. *IgA* - Although **IgA** can be involved in some cases of Multiple Myeloma, it is much less common than IgG [1][2]. - Patients with predominately **IgA Multiple Myeloma** are relatively rare compared to those with IgG. *IgD* - **IgD** myeloma is a very rare type of Multiple Myeloma, accounting for less than 2% of cases [1][2]. - It is not typically associated with the classic symptoms and conditions that characterize the more common IgG or IgA forms. **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, pp. 608-609. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Q: What is the most common type of degeneration observed in uterine fibroids?

Hyaline. ***Hyaline*** - **Hyaline degeneration** is the most frequent type of degeneration in uterine fibroids, occurring in about **60% of cases** [1]. - It involves the replacement of smooth muscle and connective tissue with **acellular, glassy, eosinophilic hyaline material** [1]. *Calcareous* - **Calcareous degeneration** (calcification) occurs when hyaline degeneration calcifies, typically seen in **postmenopausal women** or older fibroids. - While it can occur, it is a **secondary change** following hyaline degeneration rather than the primary and most common form. *Red* - **Red degeneration** (carneous degeneration) is acute, often occurring during **pregnancy** due to rapid growth and hemorrhagic infarction. - It presents with **acute pain** and is less common than hyaline degeneration. *Cystic* - **Cystic degeneration** is characterized by liquefaction within the fibroid, leading to the formation of **cysts**. - This typically results from advanced **hyaline degeneration** and is less common than hyaline degeneration itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Q: Which of the following is a renal-specific nephropathy associated with HIV?

Focal Segmental Glomerulosclerosis (FSGS). ### Focal Segmental Glomerulosclerosis - It is a common renal complication associated with **HIV infection**, characterized by **podocyte injury** and segmental sclerosis [1]. - Often results in **nephrotic syndrome**, presenting with significant **proteinuria** and edema, making it distinct in HIV renal pathology [1]. ### Membranous Glomerulonephritis - Typically presents with **subepithelial immune complex deposits**, leading to a different pathophysiological mechanism. - More commonly associated with other secondary causes, such as **drugs** or **infection**, rather than being specific to HIV. ### Mesangioproliferative Glomerulonephritis - Characterized by **mesangial cell proliferation and immune complex deposition**, often linked with various infections but not specifically with HIV. - Usually shows **hematuria** and mild proteinuria, lacking the severe nephrotic syndrome seen in focal segmental glomerulosclerosis. ### Membranoproliferative Glomerulonephritis - Features **proliferation of mesangial and endothelial cells**, leading to a distinctive pattern on renal biopsy, not specific to HIV. - Typically presents in other contexts such as **chronic infections** or **autoimmune diseases**, rather than predominantly with HIV.

Question 1

Glomus tumor is seen in -

Accepted Answer

Distal portion of digits

Answer

Rare locations such as retroperitoneum

Answer

Long bones and vertebrae

Answer

Proximal portion of digits (less common site)

Question 2

Which gene mutation is commonly associated with malignant melanoma?

Accepted Answer

CDKN2A

Answer

MYCN

Answer

RET

Answer

BRAF

Question 3

ER positive status in carcinoma breast indicates?

Accepted Answer

Prognosis

Answer

Etiology

Answer

Site

Answer

None of the options

Question 4

Which of the following germ cell tumors is benign?

Accepted Answer

Dermoid cyst

Answer

Seminoma

Answer

Embryonal carcinoma

Answer

Yolk sac tumor

Question 5

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

Accepted Answer

Epstein-Barr Virus (EBV)

Answer

HIV

Answer

HBV

Answer

HCV

Question 6

Ewing's sarcoma arises from which type of cells?

Accepted Answer

Primitive neuroectodermal cells

Answer

G cells

Answer

Totipotent cells

Answer

Neurons

Question 7

Most common CNS tumor associated with NF1

Accepted Answer

Optic glioma

Answer

Astrocytoma

Answer

Bilateral acoustic neuroma

Answer

Optic nerve schwannoma

Question 8

The immunoglobulin most commonly involved in Multiple Myeloma is:

Accepted Answer

IgG

Answer

IgM

Answer

IgA

Answer

IgD

Question 9

What is the most common type of degeneration observed in uterine fibroids?

Accepted Answer

Hyaline

Answer

Calcareous

Answer

Red

Answer

Cystic

Question 10

Which of the following is a renal-specific nephropathy associated with HIV?

Accepted Answer

Focal Segmental Glomerulosclerosis (FSGS)

Answer

Mesangioproliferative Glomerulonephritis

Answer

Membranous Nephropathy

Answer

Membranoproliferative Glomerulonephritis (MPGN)

NEET-PG 2012 — Pathology