NEET-PG 2013 Practice Questions

Q: Which subtype of Acute Myeloid Leukemia (AML) is most commonly associated with gum hypertrophy?

Acute Myeloid Leukemia M4. ***M4*** - **Acute Myeloid Leukemia (AML) M4** is associated with **monocytic differentiation**, leading to gum hypertrophy due to infiltration of the gums by leukemic cells [1]. - Patients may present with **gingival bleeding**, pain, and swelling in addition to other systemic symptoms of leukemia. *M3* - Known as **acute promyelocytic leukemia**, it typically presents with **coagulopathy** and not gum hypertrophy [1]. - Characterized by **promyelocytes** with heavy granulation and the presence of **faggot cells** (auer rods) [1]. *M2* - Represents a **myeloblastic type** of acute leukemia but is less commonly associated with **gingival hyperplasia**. - Associated with **more typical myeloid features** and presents with **anemia** and **thrombocytopenia**. *M1* - This is a **minimally differentiated type** of acute myeloid leukemia with **myeloblasts** and no significant differentiating features like gum hypertrophy. - Often presents with **rapid onset of symptoms** related to bone marrow failure, rather than localized gum issues. **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. 620-622.

Q: Which of the following statements about Alport's syndrome is incorrect?

Autosomal dominant. ***Autosomal dominant*** - While there are rare autosomal dominant forms, the most common and classic presentation of **Alport's syndrome is X-linked recessive**, affecting males more severely. - This statement is incorrect because it implies that autosomal dominant inheritance is the primary or typical mode, which is not true for the majority of cases. *Nerve deafness* - **Sensorineural hearing loss**, particularly for high frequencies, is a common and characteristic extra-renal manifestation of Alport's syndrome. - This symptom typically progresses with age and is a key diagnostic feature. *Glomerulonephritis* - **Progressive glomerulonephritis** is the hallmark renal feature of Alport's syndrome, leading to hematuria, proteinuria, and eventually end-stage renal disease. - It is caused by mutations in collagen type IV genes, which disrupt the integrity of the glomerular basement membrane. *X-linked* - The majority of Alport's syndrome cases (about 85%) are **X-linked recessive**, caused by mutations in the *COL4A5* gene located on the X chromosome. - This explains why males are more severely affected and typically present with earlier onset and more rapid progression of renal disease.

Q: Which one of the following is the most common CNS tumor associated with type I neurofibromatosis?

Optic nerve glioma. ***Optic nerve glioma*** - **Optic nerve gliomas** are the most frequently encountered central nervous system tumors in patients with **Type 1 neurofibromatosis (NF1)**, occurring in about 15% of individuals. - They are typically low-grade **astrocytomas** and can cause vision loss and proptosis depending on their size and location. *Meningioma* - While more common in **Type 2 neurofibromatosis (NF2)**, meningiomas can occur in NF1, but are not the most common CNS tumor. - Meningiomas are tumors that arise from the **meninges**, the membranes surrounding the brain and spinal cord. *Acoustic schwannoma* - **Bilateral acoustic schwannomas (vestibular schwannomas)** are the hallmark feature of **Type 2 neurofibromatosis (NF2)**, not NF1 [1]. - These tumors arise from the Schwann cells of the **vestibulocochlear nerve** and can cause hearing loss and balance issues [1]. *Low grade astrocytoma* - While optic nerve gliomas are a type of low-grade astrocytoma, this option is too general; **optic nerve glioma** is the specific and most common presentation in NF1. - Other forms of low-grade astrocytomas can occur in NF1 but are not as universally characteristic as optic nerve gliomas.

Q: Which of the following glands is NOT typically involved in Multiple Endocrine Neoplasia type II A (MEN II A)?

Pituitary gland. ***Pituitary gland*** - The **pituitary gland** is not a characteristic component of **MEN II A**. It is, however, associated with **Multiple Endocrine Neoplasia type I (MEN I)**, which involves the 3 Ps: **pituitary**, **parathyroid**, and **pancreas** [1]. - **MEN IIA** classically involves **medullary thyroid carcinoma**, **pheochromocytoma**, and **parathyroid hyperplasia** [1]. *Thyroid gland* - The **thyroid gland** is centrally involved in MEN IIA, specifically through the development of **medullary thyroid carcinoma (MTC)**, a hallmark feature. - MTC arises from the parafollicular C cells of the thyroid and secretes **calcitonin**. *Parathyroid gland* - The **parathyroid gland** is often involved in MEN IIA, typically presenting as **parathyroid hyperplasia** or adenoma, leading to **primary hyperparathyroidism**. - This typically results in elevated **parathyroid hormone** levels and **hypercalcemia**. *Adrenal gland* - The **adrenal gland** is a key player in MEN IIA due to the occurrence of **pheochromocytoma**, a tumor of the adrenal medulla. - Pheochromocytomas can be bilateral and secrete **catecholamines**, leading to hypertension and other symptoms.

Q: In glomerulus subendothelial deposits are seen in?

MPGN type I (subendothelial deposits). ***MPGN type I*** - **Subendothelial deposits** are a hallmark of MPGN type I, often associated with **immune complex deposition** [1]. - This condition can present with **hematuria**, **proteinuria**, and can be triggered by infections or autoimmune diseases [1]. *Good pasture syndrome* - Primarily involves **anti-GBM antibodies** leading to **glomerulonephritis** and pulmonary hemorrhage, not subendothelial deposits. - Typically, it presents with **crescent formation** in the glomeruli rather than deposits. *MPGN type II* - Characterized by **dense deposit disease**, it features **intramembranous** rather than subendothelial deposits [1]. - It is often associated with **C3 nephritic factor** and does not show classic subendothelial pathology. *IgA nephropathy* - Characterized by **IgA deposits** primarily in the **mesangium**, not subendothelially. - It presents with **hematuria** and recurrent episodes of **macrohematuria**, especially after infections. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 925-927.

Q: Peliosis hepatis is caused by all except?

Analgesics. ***Analgesics*** - While various drugs can cause liver injury, **analgesics** are not typically associated with the development of **peliosis hepatis**. [1] - **Peliosis hepatis** involves blood-filled cysts in the liver and is linked to specific agents, not common pain relievers. *Anabolic steroids* - **Anabolic steroids** are a well-known cause of **peliosis hepatis**, especially with prolonged high-dose use. - They can induce sinusoidal dilation and hemorrhage, leading to **blood-filled cysts** in the liver. *OC pills* - **Oral contraceptive pills** (OCPs) containing estrogen have been implicated in the development of **peliosis hepatis**, though it is rare. - The estrogen component is thought to affect the **vascular endothelium** and sinusoidal integrity of the liver. *Danazol* - **Danazol**, an attenuated androgen, is strongly associated with **peliosis hepatis** and other liver complications. - It can cause severe damage to the **hepatic sinusoids**, leading to the characteristic blood-filled cavities. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 847-848.

Q: In which condition are Michaelis Gutmann bodies typically seen?

Malakoplakia. ***Malakoplakia*** - **Michaelis-Gutmann bodies** are pathognomonic histological features of malakoplakia, representing calcified concretions containing **iron and calcium** within macrophages. - These are formed around **partially digested bacteria** within defective macrophages, appearing as basophilic inclusions with a "target-like" or "owl's eye" appearance. - Malakoplakia is a chronic granulomatous inflammatory condition most commonly affecting the **urinary tract** (bladder, kidney), but can occur in other organs. *Xanthogranulomatous* - This condition is characterized by an infiltrate of **lipid-laden macrophages** (xanthoma cells, foam cells) and occasional giant cells, but **not** Michaelis-Gutmann bodies. - It most commonly affects the kidney (**xanthogranulomatous pyelonephritis**) and is a destructive inflammatory process with a mass-like appearance. *Pyelonephritis* - Refers to **inflammation of the kidney and renal pelvis**, usually due to bacterial infection (commonly E. coli). - Histologically, it is characterized by acute or chronic inflammatory cells, neutrophil infiltration, and potential abscess formation, **without** Michaelis-Gutmann bodies. *Nail patella syndrome* - This is a **genetic disorder** (autosomal dominant) affecting primarily the **nails, bones** (absent/hypoplastic patella, elbow dysplasia), and sometimes the kidneys (glomerular disease). - It is associated with developmental abnormalities and has **no association** with Michaelis-Gutmann bodies or malakoplakia.

Q: What is the typical bone marrow finding in myelofibrosis?

Dry tap (hypocellular). ***Dry tap (hypocellular)*** - In myelofibrosis, the bone marrow is often **hypocellular** due to fibrosis [1][2], leading to a **dry tap** during aspiration. - The presence of **reticulin** and collagen deposition replaces normal hematopoietic cells [2], resulting in ineffective hematopoiesis. *Thrombocytosis* - Myelofibrosis typically leads to **thrombocytopenia**, not thrombocytosis, due to ineffective megakaryopoiesis and splenic sequestration. - Though elevated platelets can occur, they are generally a **secondary response** to the disease and not a hallmark finding. *Megaloblastic cells* - Megaloblastic changes are associated with **vitamin B12** or **folate deficiencies**, which do not occur in myelofibrosis. - In myelofibrosis, the predominant issue is **marrow fibrosis** [1][2], which does not lead to megaloblastosis. *Microcytic cells* - Microcytic cells are commonly linked to **iron deficiency anemia**, not myelofibrosis. - Myelofibrosis typically results in **variable red cell morphology** [1], but microcytic anemia is not a primary characteristic. **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. 628-629. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 615-616.

Q: Which of the following statements about Polycythemia vera is false?

Increased LAP score. ***Decrease LAP score*** - In polycythemia vera, the **LAP (leukocyte alkaline phosphatase) score** is typically increased, indicating more mature leukocytes. - A **decrease in LAP score** is not consistent with the disease, making this statement incorrect. *Increased platelets* - Polycythemia vera often results in **thrombocytosis**, characterized by increased platelet counts [1]. - This is a common feature of the disorder, reflecting overproduction of blood cells in the bone marrow. *Leucocytosis* - Patients with polycythemia vera frequently exhibit **leucocytosis**, or increased white blood cell counts, due to hypercellularity of the bone marrow [1]. - This is an important aspect of the disease, often seen alongside increases in red blood cells and platelets. *Increased vit B12* - An elevation in **vitamin B12** levels can occur in polycythemia vera, often due to increased binding proteins. - This is a well-recognized phenomenon associated with the increased cell turnover in this condition. **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. 626-627.

Q: Which of the following substances is not classified as a carcinogen for bladder cancer?

Isopropyl alcohol. ***Isopropyl alcohol*** - Research does not link **isopropyl alcohol** to an increased risk of bladder cancer, making it a non-carcinogenic substance in this context. - It is commonly used as a solvent and antiseptic, but has not shown **urogenic carcinogenicity** in studies. *Phenacetin* - **Phenacetin** is an analgesic that has been associated with an increased risk of bladder cancer, particularly due to its metabolite, which can be nephrotoxic. - Its use has significantly declined due to its carcinogenic effects on the urinary system. *Benzidine* - **Benzidine** is a well-known bladder carcinogen, primarily linked to the dye industry, where exposure has led to increased rates of bladder cancer [1]. - This substance has been implicated in **urothelial carcinoma** due to its mutagenic properties. *Acrolein* - **Acrolein** is a toxic compound that can cause bladder irritation and has been studied for its potential carcinogenic effects related to bladder cancer. - It is released during the combustion of materials and is known to contribute to **chemical injury** in the bladder. **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. 217-218.

Question 1

Which subtype of Acute Myeloid Leukemia (AML) is most commonly associated with gum hypertrophy?

Accepted Answer

Acute Myeloid Leukemia M4

Answer

Acute Myeloid Leukemia M2

Answer

Acute Myeloid Leukemia M3

Answer

Acute Myeloid Leukemia M1

Question 2

Which of the following statements about Alport's syndrome is incorrect?

Accepted Answer

Autosomal dominant

Answer

Nerve deafness

Answer

Glomerulonephritis

Answer

X-linked

Question 3

Which one of the following is the most common CNS tumor associated with type I neurofibromatosis?

Accepted Answer

Optic nerve glioma

Answer

Meningioma

Answer

Acoustic schwannoma

Answer

Low grade astrocytoma

Question 4

Which of the following glands is NOT typically involved in Multiple Endocrine Neoplasia type II A (MEN II A)?

Accepted Answer

Pituitary gland

Answer

Thyroid gland

Answer

Parathyroid gland

Answer

Adrenal gland

Question 5

In glomerulus subendothelial deposits are seen in?

Accepted Answer

MPGN type I (subendothelial deposits)

Answer

Goodpasture syndrome (linear IgG deposits in the basement membrane)

Answer

MPGN type II (intramembranous deposits)

Answer

IgA nephropathy (mesangial IgA deposits)

Question 6

Peliosis hepatis is caused by all except?

Accepted Answer

Analgesics

Answer

OC pills

Answer

Danazol

Answer

Anabolic steroids

Question 7

In which condition are Michaelis Gutmann bodies typically seen?

Accepted Answer

Malakoplakia

Answer

Xanthogranulomatous

Answer

Pyelonephritis

Answer

Nail patella syndrome

Question 8

What is the typical bone marrow finding in myelofibrosis?

Accepted Answer

Dry tap (hypocellular)

Answer

Megaloblastic cells

Answer

Microcytic cells

Answer

Thrombocytosis

Question 9

Which of the following statements about Polycythemia vera is false?

Accepted Answer

Increased LAP score

Answer

Increased vitamin B12 levels

Answer

Leukocytosis is present

Answer

Increased platelet count

Question 10

Which of the following substances is not classified as a carcinogen for bladder cancer?

Accepted Answer

Isopropyl alcohol

Answer

Acrolein

Answer

Phenacetin

Answer

Benzidine

NEET-PG 2013

Dental

Internal Medicine

Pathology