NEET-PG 2013 - Pathology Practice Questions

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: What is a hamartoma?

Developmental malformation. ***Development malformation*** - A **hamartoma** is a type of **benign tumor** that consists of an overgrowth of mature cells, representing a **developmental malformation** [1]. - It is formed from tissues that are normally present in the affected organ but are disorganized, leading to a characteristic appearance. *Malignant tumor* - Hamartomas are classified as **benign tumors** [1], not malignant, as they do not invade surrounding tissues or metastasize. - Despite being a growth, they do not exhibit the aggressive characteristics of malignant tumors. *Hemorrhage in vessel* - Hemorrhage refers to bleeding within a vessel and is unrelated to the definition or nature of a **hamartoma**. - Hamartomas do not consist of blood or bleeding; instead, they involve disorganized tissue growth. *Metastatic tissue* - Metastatic tissue refers to cancerous cells that have spread from their original site, which contrasts with the **non-cancerous** nature of hamartomas [1]. - Hamartomas do not involve the spread of cancer cells, but rather a **local abnormality** in tissue arrangement. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482.

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: Flexner-Wintersteiner rosette is seen in-

Retinoblastoma. ***Retinoblastoma*** - Flexner-Wintersteiner rosettes are **characteristic histological features** seen in retinoblastoma, indicating retinal differentiation [1]. - These rosettes reflect the **presence of photoreceptor-like structures**, which are specific to this type of tumor [1]. *Hepatoblastoma* - Histologically, hepatoblastoma shows **primitive epithelial cells** and **mixed patterns**, not Flexner-Wintersteiner rosettes. - It is primarily associated with **liver** and does not present with retinal differentiation. *Nephroblastoma* - Nephroblastoma, or Wilms tumor, typically exhibits **triphasic histology** (epithelial, stromal, and blastemal components) without rosette formation. - It primarily affects the **kidney** and does not involve the retina. *Neuroblastoma* - Neuroblastoma is characterized by **small round blue cells** and **neuroid differentiation** but lacks Flexner-Wintersteiner rosettes. - This tumor usually arises in the **adrenal glands** or sympathetic nervous system, not in retinal tissue. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, p. 1342.

Q: All of the following are true regarding fibromuscular dysplasia EXCEPT:

OCPs predispose. ***OCPs predispose*** - **Oral contraceptive pills (OCPs)** are not identified as a predisposing factor for fibromuscular dysplasia (FMD). FMD is largely considered a sporadic condition with some genetic predisposition, but not linked to OCP use [1]. - While hormonal influences are suspected given its higher prevalence in women, direct causation or exacerbation by OCPs has not been established [1]. *Medium size vessels are affected* - Fibromuscular dysplasia (FMD) predominantly affects **medium-sized arteries**, most commonly the renal and carotid arteries [1]. - This involvement leads to characteristic stenoses, aneurysms, or dissections in those vessels. *Aneurysm may occur* - The abnormal arterial wall architecture in FMD, characterized by alternating areas of stenosis and dilation, can lead to the formation of **aneurysms**. - These aneurysms are usually **intracranial** or within the affected renal and carotid arteries, and represent a significant risk of rupture or dissection. *Irregular hyperplasia* - FMD involves **irregular fibrous or fibromuscular hyperplasia** of the arterial wall layers (intima, media, or adventitia). - This abnormal cellular proliferation and connective tissue deposition result in the characteristic "string of beads" appearance on angiography. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 493-494.

Q: Thalassemia gives protection against ?

Protection against malaria. Protection against malaria - Individuals with thalassemia, particularly thalassemia trait, have some degree of protection against severe forms of malaria, specifically Plasmodium falciparum [1]. - The altered red blood cell structure and reduced hemoglobin content in thalassemia make the red blood cells less hospitable for the parasites, hindering their replication and survival [1]. Protection against filaria - Filaria is caused by parasitic worms (nematodes) transmitted by mosquitoes, leading to lymphatic filariasis (elephantiasis) or onchocerciasis (river blindness). - Thalassemia's primary impact is on red blood cell health and oxygen transport, offering no known protective effect against nematode infections or their associated pathology. Protection against kala-azar - Kala-azar (visceral leishmaniasis) is caused by Leishmania parasites transmitted by sandflies, primarily affecting the reticuloendothelial system (spleen, liver, bone marrow). - There is no established scientific evidence indicating that thalassemia provides protection against Leishmania infections or their clinical manifestations. Protection against leptospirosis - Leptospirosis is a bacterial infection caused by Leptospira bacteria, typically acquired through contact with contaminated water or animal urine. - Thalassemia is a genetic blood disorder; its physiological effects are unrelated to the mechanisms of infection or immunity against bacterial pathogens like Leptospira.

Q: Which HLA antigen is associated with thromboangitis obliterans?

HLA-B5. HLA-B5 - **HLA-B5** (specifically **HLA-B51**) has been associated with an increased risk of **thromboangiitis obliterans (Buerger's disease)** in some populations. - This association suggests a potential genetic predisposition, although the disease's primary risk factor remains **smoking**. *HLA-B27* - **HLA-B27** is strongly associated with **spondyloarthropathies**, such as **ankylosing spondylitis** and **reactive arthritis**, not thromboangiitis obliterans [1]. - Its presence indicates a genetic susceptibility to inflammatory arthritic conditions primarily affecting the spine and sacroiliac joints [1]. *HLA-DR4* - **HLA-DR4** is a well-known genetic marker associated with **rheumatoid arthritis**, particularly severe forms. - It is also linked to other autoimmune diseases like **Type 1 Diabetes**, but not thromboangiitis obliterans. *HLA-DR2* - **HLA-DR2** is associated with an increased risk of several autoimmune diseases, most notably **multiple sclerosis** and **narcolepsy**. - While it plays a role in immune regulation, it is not specifically linked to thromboangiitis obliterans.

Q: MALT lymphoma is positive for which of the following markers?

CD20. ***CD20*** - MALT lymphoma is a type of **B-cell non-Hodgkin lymphoma**, and CD20 is a **pan B-cell marker consistently expressed** in MALT lymphomas. - CD20 positivity is **crucial for diagnosis** and is the **primary therapeutic target** for anti-CD20 monoclonal antibody therapy (Rituximab). - In diagnostic practice, **CD20 is the most important B-cell marker** for identifying MALT lymphoma and guiding treatment decisions. *CD19* - CD19 is also a **pan B-cell marker** and is **typically positive in MALT lymphoma** along with CD20. - However, in the context of this question, **CD20 is the preferred answer** because it is the **standard diagnostic marker emphasized in clinical practice** and the **primary therapeutic target**. - Both markers are positive, but CD20 has greater **clinical and therapeutic significance** in MALT lymphoma management. *CD43* - CD43 is primarily a **T-cell and myeloid marker**, but can show **aberrant expression in 40-50% of MALT lymphomas**. - While it may be positive in some cases, it is **not a defining B-cell lineage marker** and is not used as a primary diagnostic criterion for MALT lymphoma. - Its variable expression makes it **less reliable** than consistent B-cell markers like CD20. *CD5* - CD5 is typically associated with **T-cells** and certain B-cell lymphomas, particularly **chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)** and **mantle cell lymphoma**. - **MALT lymphoma is characteristically CD5-negative**, which is an important feature for **differentiating it from CD5+ B-cell lymphomas**.

Q: Amyloidosis is associated with all of the following conditions except?

Chronic bronchitis. ***Chronic bronchitis*** - Chronic bronchitis is primarily characterized by **inflammation of the airways** and **excess mucus production**, not typically associated with amyloidosis [1]. - Amyloidosis more commonly relates to chronic inflammatory states but does not directly result from the long-term exposure seen in chronic bronchitis [1]. *Tuberculosis* - Tuberculosis can lead to chronic inflammation, which may precipitate **secondary amyloidosis** due to persistent infection [1]. - It often causes systemic effects, including weight loss and fever, which can result in **amyloid deposition** [1]. *Osteomyelitis* - Osteomyelitis, as a chronic bone infection, can trigger an inflammatory response leading to **secondary amyloidosis** [1]. - The ongoing inflammation can result in the accumulation of amyloid proteins in the bone and surrounding tissues [1]. *Bronchiectasis* - Bronchiectasis often results from persistent lung infections leading to chronic inflammation, which can cause **amyloid deposition** [1,3]. - It is associated with recurrent lung infections and can lead to systemic complications, including amyloidosis [1,3]. **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. 135-136. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 269-270.

Q: Anemia with reticulocytosis is seen in -

Hemolysis. ***Hemolysis*** - Reticulocytosis indicates a compensatory response to anemia, often occurring in hemolytic processes where the **bone marrow increases red blood cell production** in response to red blood cell destruction. - Conditions like **sickle cell disease** or **autoimmune hemolytic anemia** lead to hemolysis, further confirming increased reticulocyte count. *Iron deficiency anemia* - Typically presents with a **low reticulocyte count** as the bone marrow does not have sufficient iron to produce new red blood cells. - This condition is characterized by **microcytic, hypochromic** red blood cells due to inadequate iron stores. *Vitamin B12 deficiency* - Often results in a **macrocytic anemia** with a variable reticulocyte count; however, reticulocytosis is generally not seen initially. - This deficiency affects DNA synthesis, leading to ineffective erythropoiesis and the presence of **megaloblastic changes**. *Aplastic anemia* - Characterized by a **decrease in all types of blood cells** (pancytopenia) and typically has a **low reticulocyte count** due to bone marrow failure. - There is insufficient production of red blood cells, hence **reticulocytosis is not observed**.

Question 1

Peliosis hepatis is caused by all except?

Accepted Answer

Analgesics

Answer

OC pills

Answer

Danazol

Answer

Anabolic steroids

Question 2

What is a hamartoma?

Accepted Answer

Developmental malformation

Answer

Malignant tumor

Answer

Metastatic tissue

Answer

Hemorrhage in vessel

Question 3

What is the typical bone marrow finding in myelofibrosis?

Accepted Answer

Dry tap (hypocellular)

Answer

Megaloblastic cells

Answer

Microcytic cells

Answer

Thrombocytosis

Question 4

Flexner-Wintersteiner rosette is seen in-

Accepted Answer

Retinoblastoma

Answer

Hepatoblastoma

Answer

Nephroblastoma

Answer

Neuroblastoma

Question 5

All of the following are true regarding fibromuscular dysplasia EXCEPT:

Accepted Answer

OCPs predispose

Answer

Medium size vessels are affected

Answer

Aneurysm may occur

Answer

Irregular hyperplasia

Question 6

Thalassemia gives protection against ?

Accepted Answer

Protection against malaria

Answer

Protection against filaria

Answer

Protection against kala-azar

Answer

Protection against leptospirosis

Question 7

Which HLA antigen is associated with thromboangitis obliterans?

Accepted Answer

HLA-B5

Answer

HLA-B27

Answer

HLA-DR4

Answer

HLA-DR2

Question 8

MALT lymphoma is positive for which of the following markers?

Accepted Answer

CD20

Answer

CD19

Answer

CD43

Answer

CD5

Question 9

Amyloidosis is associated with all of the following conditions except?

Accepted Answer

Chronic bronchitis

Answer

Osteomyelitis

Answer

Bronchiectasis

Answer

Tuberculosis

Question 10

Anemia with reticulocytosis is seen in -

Accepted Answer

Hemolysis

Answer

Iron deficiency anemia

Answer

Vitamin B12 deficiency

Answer

Aplastic anemia

NEET-PG 2013 — Pathology