NEET-PG 2013 - Pathology Practice Questions

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: 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: Curschmann's spirals are seen in which condition?

Bronchial asthma. ***Bronchial asthma*** - **Curschmann's spirals** are spiral-shaped mucus plugs found in the sputum of patients with **bronchial asthma**. - They represent casts from small bronchi and are formed from **mucus and cellular debris** within the airways during an asthmatic exacerbation. *Bronchiectasis* - Characterized by **permanent abnormal dilation** of the bronchi due to chronic inflammation and infection, leading to productive cough and recurrent respiratory infections. - While it involves mucous production, it is typically associated with **purulent sputum** due to bacterial colonization, not necessarily Curschmann's spirals. *Chronic bronchitis* - Defined clinically by a **chronic productive cough** for at least three months in each of two successive years, without other causes. - Involves mucus hypersecretion and inflammation, but **Curschmann's spirals are not a characteristic finding** compared to asthma. *Wegener's granulomatosis (Granulomatosis with Polyangiitis)* - This is a systemic **vasculitis** affecting small to medium-sized blood vessels, typically involving the upper and lower respiratory tracts and kidneys. - Its pulmonary manifestations include **nodules, cavities, and diffuse alveolar hemorrhage**, and sputum findings are related to inflammation and bleeding, not Curschmann's spirals.

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 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: 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.

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.

Question 1

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 2

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 3

Curschmann's spirals are seen in which condition?

Accepted Answer

Bronchial asthma

Answer

Bronchiectasis

Answer

Chronic bronchitis

Answer

Wegener's granulomatosis

Question 4

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 5

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 6

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 7

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 8

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

Accepted Answer

Hypertension

Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Aortic regurgitation

Question 9

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 10

Dystrophic calcification is seen in

Accepted Answer

Atheromatous plaque

Answer

Vitamin A intoxication

Answer

Milk alkali syndrome

Answer

Hyperparathyroidism

NEET-PG 2013 — Pathology