NEET-PG 2013 - Pathology PYQs Practice Questions

Q: Clear cell variety of renal cell carcinoma is related to a gene located on which chromosome?

3. ***3*** - The **clear cell variety of renal cell carcinoma** (RCC) is associated with **mutations in the VHL gene**, which is located on chromosome **3** [1]. - This gene plays a crucial role in the **regulation of angiogenesis**, and its inactivation leads to tumor development. *22* - Chromosome **22** is associated with other disorders but not specifically with clear cell RCC or its genetic mutations. - Renal cell carcinoma primarily relates to **chromosome 3**, not chromosome 22 [1]. *X* - The **X chromosome** has other oncogenes and tumor suppressor genes but is not linked to clear cell RCC specifically. - Mutations in the **VHL gene** on chromosome 3 are the key factors, not those found on the X chromosome. *20* - Chromosome **20** does not contain significant genes linked to clear cell renal cell carcinoma. - The notable genetic association is with chromosome **3**, specifically the VHL gene [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959. [Practice more Pathology PYQs on OnCourse]

Q: Job's syndrome is which of the following types of immunodeficiency disease?

Disorder of phagocytosis. ***Disorder of phagocytosis*** - Job's syndrome (Hyper-IgE syndrome) is primarily classified as a **disorder of phagocytosis** due to defective **neutrophil chemotaxis** - The hallmark feature is **impaired neutrophil migration** to sites of infection, leading to recurrent **staphylococcal skin abscesses** and **pneumonias with pneumatocele formation** - Caused by **STAT3 mutations** (autosomal dominant form), which affect multiple immune pathways but clinically manifest predominantly as phagocyte dysfunction - Classic triad: **elevated IgE** (>2000 IU/mL), **recurrent skin and lung infections**, and **characteristic facies** *Cellular immunodeficiency* - While STAT3 mutations do affect T-cell function (particularly Th17 differentiation), the **primary clinical manifestation** is phagocyte dysfunction - Pure cellular immunodeficiencies like **DiGeorge syndrome** present with viral and fungal infections, which are not the predominant feature in Job's syndrome - The classification is based on the **dominant clinical defect**, which in Job's syndrome is impaired neutrophil chemotaxis *humoral immunodeficiency* - Despite markedly elevated IgE levels, patients have relatively preserved **antibody production** against most pathogens - Humoral deficiencies like **X-linked agammaglobulinemia** present with low immunoglobulin levels and recurrent encapsulated bacterial infections - The elevated IgE in Job's syndrome is a consequence of dysregulated cytokine signaling, not a primary antibody production defect *Disorder of complement* - Complement disorders result from defects in the **complement cascade proteins** (C1-C9) - These typically present with recurrent **Neisseria infections** or autoimmune phenomena like SLE - Job's syndrome does not involve complement pathway defects and presents with characteristic staphylococcal infections [Practice more Pathology PYQs on OnCourse]

Q: Heart failure cells are

Pigmented alveolar macrophages. ***Pigmented alveolar macrophages*** - These macrophages engulf **hemosiderin** (iron-rich pigment from degraded red blood cells) that leaks into the alveoli due to increased capillary pressure in left-sided **heart failure**. - The presence of **hemosiderin-laden macrophages** in the sputum or lung tissue is diagnostic for chronic pulmonary congestion caused by heart failure. *Lipofuscin granules in cardiac cells* - **Lipofuscin** is a "wear-and-tear" pigment that accumulates in aging cells, including cardiac cells. - While present in older hearts, its presence does not specifically indicate **heart failure** or represent "heart failure cells" in the described context. *Pigmented pancreatic acinar cells* - Pancreatic acinar cells primarily produce digestive enzymes and are not typically associated with **pigment accumulation** in the context of heart failure. - Pigmentation in pancreatic cells would suggest other pathologies, such as **hemochromatosis** affecting the pancreas. *Pigment cells seen in liver* - The liver can accumulate various pigments, such as **hemosiderin** in hemochromatosis or **bilirubin** in cholestasis. - While liver congestion can occur in right-sided heart failure, the specific "heart failure cells" refer to the **pulmonary macrophages**. [Practice more Pathology PYQs on OnCourse]

Q: During angiogenesis, what factors are responsible for the recruitment of pericytes and periendothelial cells?

Angiopoietins, TGF & PDGF. ***Angiopoietins, TGF & PDGF*** - **Angiopoietins** are crucial for the stabilization of blood vessels and recruitment of **pericytes**, enhancing vessel maturation [1]. - **TGF (Transforming Growth Factor)** and **PDGF (Platelet-Derived Growth Factor)** also play significant roles in the recruitment and proliferation of **pericytes** and periendothelial cells during angiogenesis [1]. *VEGF & PDGF* - While **VEGF (Vascular Endothelial Growth Factor)** is important for endothelial cell migration and proliferation, it does not directly recruit **pericytes** alone. - This combination lacks **angiopoietins**, which are key for the stabilization of newly formed blood vessels [1]. *VEGF, IL-2, IL-6* - **IL-2** and **IL-6** are primarily associated with immune responses and do not directly contribute to pericyte recruitment during angiogenesis. - **VEGF** alone supports endothelial cells but does not effectively recruit **pericytes** without the cooperation of other factors. *TGF, VEGF & PDGF* - Although both **TGF** and **PDGF** are involved in pericyte recruitment [1], the absence of **angiopoietins** limits the effectiveness of this combination for the recruitment process. - **VEGF** alone does not facilitate direct recruitment of **pericytes**, as it mainly focuses on endothelial cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 115-116. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following cancers is associated with osteolytic metastases?

All of the options. ***All of the options*** - **Lung**, **kidney**, and **thyroid** cancers are all known to frequently produce **osteolytic bone metastases** [1]. - These cancers release factors that stimulate **osteoclast activity**, leading to bone destruction rather than new bone formation. *Lung* - **Non-small cell lung cancer** often metastasizes to bone and commonly causes **osteolytic lesions** [2]. - Bone metastases are a frequent complication, particularly in advanced stages, and are associated with **pain** and **pathological fractures**. *Kidney* - **Renal cell carcinoma** is notorious for causing highly vascularized and often **osteolytic metastases** in bone [1]. - These lesions can be aggressive, leading to significant **bone destruction** and **hypercalcemia**. *Thyroid* - **Follicular thyroid carcinoma** and, less commonly, **papillary thyroid carcinoma** are known to cause **osteolytic bone metastases** [1]. - Thyroid cancer metastases in bone can be slow-growing but are typically **destructive** and may cause **pain** or **fractures**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725. [Practice more Pathology PYQs on OnCourse]

Question 1

Clear cell variety of renal cell carcinoma is related to a gene located on which chromosome?

Accepted Answer

3

Answer

X

Answer

22

Answer

20

Question 2

Job's syndrome is which of the following types of immunodeficiency disease?

Accepted Answer

Disorder of phagocytosis

Answer

humoral immunodeficiency

Answer

Cellular immunodeficiency

Answer

Disorder of complement

Question 3

Heart failure cells are

Accepted Answer

Pigmented alveolar macrophages

Answer

Lipofuscin granules in cardiac cells

Answer

Pigmented pancreatic acinar cells

Answer

Pigment cells seen in liver

Question 4

During angiogenesis, what factors are responsible for the recruitment of pericytes and periendothelial cells?

Accepted Answer

Angiopoietins, TGF & PDGF

Answer

VEGF & PDGF

Answer

VEGF, IL-2, IL-6

Answer

TGF, VEGF & PDGF

Question 5

Which of the following cancers is associated with osteolytic metastases?

Accepted Answer

All of the options

Answer

Lung

Answer

Kidney

Answer

Thyroid

Question 6

Which of the following is not seen in Aschoff bodies?

Accepted Answer

Polymorphonuclear cells

Answer

Aschoff cells

Answer

Fibroblasts

Answer

Giant cells

Question 7

Which of the following is not a myeloproliferative disorder?

Accepted Answer

Acute myeloid leukemia

Answer

Chronic myeloid leukemia

Answer

Essential thrombocytosis

Answer

Polycythemia vera

Question 8

Which immunohistochemical marker is primarily associated with glomus tumors?

Accepted Answer

CD-34

Answer

Cytokeratin

Answer

S-100

Answer

CD-57

Question 9

Which one of the following stains is specific for amyloid?

Accepted Answer

Congo red

Answer

Von - Kossa

Answer

Alizarin red

Answer

Periodic Acid Schiff (PAS)

Question 10

What is the primary vascular abnormality associated with intestinal angiodysplasia?

Accepted Answer

Arteriovenous malformation

Answer

Capillary hemangioma (usually superficial)

Answer

Malignant tumor

Answer

Cavernous hemangioma

NEET-PG 2013 — Pathology