NEET-PG 2013 - Pathology Practice Questions

Q: Gastric carcinoma is associated with all of the following EXCEPT:

Activation of RAS. ***Activation of RAS*** - **RAS mutations** are relatively uncommon in gastric carcinoma compared to other gastrointestinal malignancies. While KRAS mutations can occur in approximately 10-15% of gastric cancers (particularly intestinal type), they are **far less frequent** than in **pancreatic adenocarcinoma** (~90%) or **colorectal carcinoma** (~40%). - In the context of gastric carcinoma, RAS pathway alterations are **not considered a major oncogenic driver** compared to the other molecular changes listed, making this the **LEAST characteristically associated** alteration. *Inactivation of p53* - **Inactivation of the p53 tumor suppressor gene** is one of the most frequent molecular events in gastric carcinoma, occurring in approximately **50-60% of cases**. - Loss of p53 function leads to genomic instability, uncontrolled cell proliferation, and resistance to apoptosis, contributing significantly to **tumorigenesis** and **poor prognosis**. *Over expression of C-met* - **Overexpression of C-MET**, a receptor tyrosine kinase for hepatocyte growth factor (HGF), is commonly observed in gastric carcinoma (30-40% of cases) and is strongly linked to **tumor growth**, **invasion**, and **metastasis**. - C-MET amplification and overexpression promote cell proliferation, survival, migration, and angiogenesis, making it an important **therapeutic target** in advanced gastric cancer. *Over expression of C-erb* - **Overexpression of C-erbB-2 (HER2/neu)** is found in approximately **10-20% of gastric adenocarcinomas**, particularly the intestinal type. - HER2 amplification or overexpression is a significant **prognostic and predictive biomarker**, and is specifically targeted by **trastuzumab** (Herceptin) therapy in HER2-positive advanced gastric cancer, improving survival outcomes.

Q: HLA is located on ?

Short arm of chr-6. ***Short arm of chr-6*** - The **Human Leukocyte Antigen (HLA)** complex, crucial for immune recognition, is located on the **short arm of chromosome 6**. [1] - This region, specifically 6p21.3, contains highly polymorphic genes encoding MHC (Major Histocompatibility Complex) proteins. [2] *Long arm of chr-6* - The **long arm of chromosome 6** contains many genes, but the primary HLA complex is not located here. - Genes on the long arm are involved in various cellular functions, but not central to immune recognition via HLA. *Short arm of chr-3* - Genes on **chromosome 3**, including its short arm, are not associated with the primary HLA complex. - Chromosome 3 is known for genes related to conditions such as von Hippel-Lindau disease. *Long arm of chr-3* - The **long arm of chromosome 3** is not the location for the HLA complex. - This region contains genes involved in diverse cellular processes and disease associations, but not immune recognition via HLA molecules. **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. 55-56. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 239-240.

Q: Which is not a feature of paroxysmal nocturnal hemoglobinuria?

Increased LAP score. ***Increased LAP score*** - In paroxysmal nocturnal hemoglobinuria, the **LAP score** is typically **low** due to ineffective hematopoiesis and not elevated. - The presence of a low LAP score is inconsistent with the features of this condition, making it the correct choice. *Thrombosis* - Paroxysmal nocturnal hemoglobinuria is **associated with a high risk of thrombosis**, particularly in the **venous system** [2]. - This is due to **increased platelet activation** and excessive thrombin generation resulting from hemolysis. *Hemolysis* - **Hemolysis** is a hallmark feature of paroxysmal nocturnal hemoglobinuria, where there is **destruction of red blood cells** [2,3]. - Patients often present with signs of hemolytic anemia including **elevated bilirubin** and **low haptoglobin** levels. *Thrombocytopenia* - **Thrombocytopenia** is a common finding in paroxysmal nocturnal hemoglobinuria due to **expanded consumption** of platelets during episodes of hemolysis. - This can lead to an **increased risk of bleeding** in affected patients. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 601-602. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 650-651.

Q: Hurthle cell carcinoma is a variant of which type of carcinoma?

Follicular carcinoma. **Follicular carcinoma** - **Hürthle cell carcinoma**, also known as **oxyphilic follicular carcinoma**, is a specific variant of **follicular carcinoma of the thyroid**. - It is characterized by the presence of large polygonal cells with abundant eosinophilic, granular cytoplasm known as **Hürthle cells** (or oxyphil cells) within the neoplastic growth. *Medullary carcinoma* - **Medullary carcinoma** originates from the **parafollicular C cells** of the thyroid, which produce calcitonin. - It is histologically distinct, featuring nests or cords of cells often associated with **amyloid deposits**, and is not related to Hürthle cell morphology. *Papillary carcinoma* - **Papillary carcinoma** is the most common type of thyroid cancer, characterized by distinctive **nuclear features** such as **Orphan Annie eye nuclei**, nuclear grooves, and intranuclear cytoplasmic inclusions. - Its histological origin and morphological appearance are different from Hürthle cell neoplasms, which are follicular in origin. *Anaplastic carcinoma* - **Anaplastic carcinoma** is a highly aggressive and undifferentiated thyroid malignancy with a very poor prognosis. - It is characterized by pleomorphic, giant, and spindle cells and lacks the specific differentiation seen in follicular or Hürthle cell tumors.

Q: Which of the following cell types is classified as a labile cell?

Surface epithelium. ***Surface epithelium*** - Surface epithelium is classified as **labile tissue**, meaning it undergoes constant regeneration due to its high turnover rate [1]. - Cells in this tissue are typically found in areas that experience frequent damage or abrasion, such as the skin and lining of the intestines. *Cardiac cell* - Cardiac cells are considered **permanent cells**, as they do not undergo significant regeneration after injury or damage. - Damage to cardiac cells typically leads to **fibrosis** rather than repair of the original tissue. *Liver parenchymal cell* - Liver parenchymal cells are categorized as **stable cells**, which can regenerate but do so under specific circumstances, such as injury. - They have a slower turnover rate compared to labile cells and do not constantly renew under normal conditions. *Vascular endothelial cells* - Vascular endothelial cells are considered **stable cells** as well, typically maintaining a stable population but capable of regeneration following injury. - They do not have the same rapid turnover and regeneration capability as labile cells do, especially under normal physiological conditions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 113-115.

Q: In which condition are Pseudo-Pelger-Huët cells typically seen?

Myelodysplastic syndrome. ***Mylodysplastic syndrome*** - Pseudo-Pelger-Huet cells are characteristic and often observed in myelodysplastic syndromes, indicating an ineffective hematopoiesis [1]. - These cells appear as **hyposegmented neutrophils** and are associated with dysplastic changes in the bone marrow [1]. *Hairy cell leukemia* - Typically presents with **hairy cells** in peripheral blood and often involves splenomegaly; pseudo-Pelger-Huet cells are not usual in this condition. - Associated with **PANCYTOPENIA** and reticulin fibrosis, differing from myelodysplastic syndrome. *Hodgkin's lymphoma* - Characterized by the presence of **Reed-Sternberg cells** and typically involves lymphadenopathy. - Peripheral blood findings generally do not include pseudo-Pelger-Huet cells; the focus is on lymphatic tissue. *Multiple myeloma* - Commonly presents with **plasma cells** and related symptoms like bone pain and renal failure, not associated with pseudo-Pelger-Huet cells. - It primarily causes an increase in monoclonal proteins rather than dysplastic changes seen in myelodysplastic syndrome. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614.

Q: Which of the following statements is false regarding hereditary spherocytosis?

Decreased MCHC. ***Decreased MCHC*** - Hereditary spherocytosis typically presents with an **increased MCHC** due to the spherocytes being more concentrated. - MCHC is a measure of the hemoglobin concentration in red blood cells, and in spherocytosis, this value is often elevated rather than decreased. *Defect in ankyrin* - This is a true statement; hereditary spherocytosis is associated with a defect in **ankyrin**, a protein that helps maintain the cell's membrane structure [2]. - Mutations in ankyrin lead to instability of the red blood cell membrane, resulting in spherocyte formation [2]. *Decreased MCV* - In hereditary spherocytosis, MCV is often **normal or slightly increased**, as it reflects the volume of red blood cells, which can be misinterpreted due to the presence of spherocytes. - Spherocytes are smaller cells, which can mistakenly suggest a falsely decreased MCV if not properly interpreted [1]. *Reticulocytosis* - This condition typically presents with **reticulocytosis** as a response to hemolysis, indicating the bone marrow is producing more red blood cells to compensate [1]. - The presence of reticulocytosis is a common finding in hereditary spherocytosis due to increased destruction of spherocytes. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 597-598. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 640-641.

Q: What is the major fibril protein associated with Primary Amyloidosis?

Immunoglobulin Light Chain. ***AL*** - In Primary Amyloidosis, **AL amyloid** is derived from immunoglobulin light chains produced by **plasma cell dyscrasias** [1]. - This type of amyloidosis is commonly associated with conditions like **multiple myeloma** or monoclonal gammopathy [1]. *Transthyretin* - This protein is associated with **Familial Amyloid Polyneuropathy** and **Senile Systemic Amyloidosis**, not Primary Amyloidosis. - Transthyretin amyloidosis (ATTR) results from **mutations** or **aging**, contributing to different clinical presentations than AL. *AA* - AA amyloidosis is secondary and occurs due to **chronic inflammatory** conditions, such as rheumatoid arthritis or chronic infections. - It is not the main fibril protein in **Primary Amyloidosis**, which is specifically linked to **light chains**. *Procalcitonin* - Procalcitonin is a **biomarker** used primarily for diagnosing bacterial infections, particularly sepsis, and is not involved in amyloidogenesis. - It does not relate to amyloidosis and is not a component of amyloid fibrils. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 266-267.

Q: The MOST COMMON cause of concentric hypertrophy of left ventricle is?

Hypertension. ***Hypertension*** - Chronic **hypertension** is the most common cause of **pressure overload** on the left ventricle, leading to concentric hypertrophy [1]. - In response to the increased afterload, the ventricular wall thickens uniformly inward, reducing the chamber size while maintaining normal wall stress [2]. - Due to its high prevalence (30-40% of adults), hypertension is epidemiologically the most frequent cause of concentric LVH [1]. *Aortic stenosis* - While **aortic stenosis** is the classic pathological cause of **pressure overload** and concentric hypertrophy [2], **hypertension** is more prevalent in the population. - Aortic stenosis causes fixed outflow obstruction, leading to significant pressure work for the left ventricle. - This is the second most common cause but occurs in only 2-5% of elderly patients. *Mitral stenosis* - **Mitral stenosis** primarily causes pressure overload on the **left atrium** and **pulmonary circulation**, not the left ventricle. - It doesn't typically lead to **left ventricular hypertrophy** directly; instead, it causes left atrial enlargement and right ventricular hypertrophy. *Aortic regurgitation* - **Aortic regurgitation** results in **volume overload** of the left ventricle due to blood flowing back into the chamber during diastole. - This typically leads to **eccentric hypertrophy**, where the chamber dilates and the wall thickens proportionally, rather than concentric hypertrophy [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 560-562. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 536.

Question 1

Gastric carcinoma is associated with all of the following EXCEPT:

Accepted Answer

Activation of RAS

Answer

Over expression of C-met

Answer

Inactivation of p53

Answer

Over expression of C-erb

Question 2

What is the sequence of events in acute inflammation?

Accepted Answer

Transient vasoconstriction - Vasodilatation - Increased permeability - Stasis

Answer

Transient vasoconstriction - Stasis - Vasodilatation - Increased permeability

Answer

Transient vasoconstriction - Vasodilatation - Stasis - Increased permeability

Answer

Vasodilatation - Stasis - Transient vasoconstriction - Increased permeability

Question 3

HLA is located on ?

Accepted Answer

Short arm of chr-6

Answer

Long arm of chr-6

Answer

Short arm of chr-3

Answer

Long arm of chr-3

Question 4

Which is not a feature of paroxysmal nocturnal hemoglobinuria?

Accepted Answer

Increased LAP score

Answer

Thrombocytopenia

Answer

Hemolysis

Answer

Thrombosis

Question 5

Hurthle cell carcinoma is a variant of which type of carcinoma?

Accepted Answer

Follicular carcinoma

Answer

Medullary carcinoma

Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Question 6

Which of the following cell types is classified as a labile cell?

Accepted Answer

Surface epithelium

Answer

Liver parenchymal cells

Answer

Vascular smooth muscle cells

Answer

Neurons

Question 7

In which condition are Pseudo-Pelger-Huët cells typically seen?

Accepted Answer

Myelodysplastic syndrome

Answer

Hairy cell leukemia

Answer

Multiple myeloma

Answer

Hodgkin's lymphoma

Question 8

Which of the following statements is false regarding hereditary spherocytosis?

Accepted Answer

Decreased MCHC

Answer

Defect in ankyrin

Answer

Reticulocytosis

Answer

Normal to increased MCV

Question 9

What is the major fibril protein associated with Primary Amyloidosis?

Accepted Answer

Immunoglobulin Light Chain

Answer

Amyloid Associated protein (AA)

Answer

Procalcitonin (PCT)

Answer

Transthyretin (TTR)

Question 10

The MOST COMMON cause of concentric hypertrophy of left ventricle is?

Accepted Answer

Hypertension

Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Aortic regurgitation

NEET-PG 2013 — Pathology