NEET-PG 2013 - Pathology Practice Questions

Q: Which of the following is a premalignant lesion for carcinoma of the rectum?

Adenomatous polyps. ***Familial polyposis*** - Familial adenomatous polyposis (FAP) is characterized by numerous **adenomatous polyps** in the colon and rectum, which have a high risk of progressing to colorectal cancer [1]. - Individuals with FAP are at significant risk for developing **carcinoma rectum** at a young age if the condition is not managed properly [1]. *Juvenile polyp* - Juvenile polyps are generally **benign** and occur in children, with a very low risk of malignancy. - They do not contribute significantly to the risk of **carcinoma rectum** like adenomatous polyps do. *Adenomatous polyp* - While adenomatous polyps are indeed premalignant [1], the term **Familial polyposis** indicates a hereditary condition that specifically has a higher and more defined risk for rectal carcinoma. - Adenomatous polyps can occur sporadically and do not imply a genetic syndrome like familial polyposis. *FAP* - FAP refers specifically to **familial adenomatous polyposis** [1], which is the same concept as familial polyposis but less encompassed in terms of broad assessment in this context. - It is important to note that **familial polyposis** is a broader term that includes conditions like FAP and indicates a significant risk factor for rectal cancer [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 817, 821-822.

Q: Most significant risk factor for development of gastric carcinoma is

Intestinal metaplasia. ***Intestinal metaplasia*** - **Intestinal metaplasia** is a precursor lesion where gastric epithelium is replaced by intestinal-type epithelium, significantly increasing the risk for **gastric carcinoma** [1][2]. - It is a recognized **high-risk factor**, especially in cases of chronic gastritis and atrophic changes in the stomach lining [1][2]. *Ciliated metaplasia* - This condition is generally associated with **respiratory epithelium** and is not linked to gastric carcinoma risk. - It does not involve gastric epithelial changes, therefore, it does not influence **gastric cancer development**. *Pyloric metaplasia* - Pyloric metaplasia typically occurs in chronic gastritis but does not confer a significant **risk** of gastric carcinoma. - It is more related to gastric mucosa adaptation and does not show the same risk association as **intestinal metaplasia**. *Paneth cell metaplasia* - Paneth cell metaplasia is primarily seen in **intestinal disorders** and does not serve as an indicator for gastric carcinoma. - It does not reflect changes in gastric epithelium that are related to cancer risk in the stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 777-778. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 354-355.

Q: Which of the following is a major feature of Alagille syndrome?

Bile duct paucity. ***Bile duct paucity*** - **Bile duct paucity** is a hallmark histologic finding in Alagille syndrome, leading to **cholestasis** and liver disease. - This results from the reduced number of **intrahepatic bile ducts**, which are crucial for bile flow. *IHBR dilation* - **Intrahepatic biliary radical (IHBR) dilation** is characteristic of biliary obstruction, which is not the primary feature of Alagille syndrome. - Alagille syndrome is primarily a genetic condition leading to **hypoplasia or paucity** of bile ducts, not dilation. *PBC* - **Primary Biliary Cholangitis (PBC)** is an autoimmune disease primarily affecting **small intrahepatic bile ducts**, leading to their destruction and fibrosis [1]. - It is typically seen in middle-aged women and is characterized by **antimitochondrial antibodies (AMA)**, which are not features of Alagille syndrome. *PSC* - **Primary Sclerosing Cholangitis (PSC)** is a chronic cholestatic liver disease characterized by **inflammation and fibrosis** of both intrahepatic and extrahepatic bile ducts [2]. - PSC is strongly associated with **inflammatory bowel disease (IBD)** and **ANCA positivity**, which are distinct from the genetic basis and features of Alagille syndrome [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 864-865. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 865-866.

Q: Renal stones which are laminated and irregular in outline are

Calcium oxalate. ***Calcium oxalate*** - **Calcium oxalate stones** are the most common type of kidney stones and characteristically present with a **laminated** (layered) and **irregular, spiculated outline** due to their crystalline structure - They are typically **radio-opaque** on X-rays due to their calcium content - The irregular outline distinguishes them from other stone types *Uric acid* - **Uric acid stones** are often **smooth**, hard, and **yellowish-brown** in appearance - They are **radio-lucent** on standard X-rays and are associated with conditions like gout or acidic urine - Their smooth surface contrasts with the irregular calcium oxalate stones *Struvite* - **Struvite stones** (magnesium ammonium phosphate) are strongly associated with **urinary tract infections** (UTIs) and can form **staghorn calculi**, filling the renal pelvis - They tend to be **friable** and have a **smooth or glistening** surface, often growing quite large - Associated with urease-producing bacteria *Cystine* - **Cystine stones** are caused by a genetic disorder affecting amino acid transport and generally appear **smooth, waxy, and hexagonal crystal-shaped** - They are typically **moderately radio-opaque** but less dense than calcium stones - The smooth, waxy appearance differs from the irregular calcium oxalate stones

Q: Brown tumors are seen in:

Hyperparathyroidism. ***Hypeparathyroidism*** - Brown tumors, also called osteitis fibrosa cystica, are **osteolytic lesions** associated specifically with **hyperparathyroidism** due to increased osteoclastic activity [1][2]. - Elevated levels of **parathyroid hormone (PTH)** lead to bone resorption, giving rise to the characteristic bone changes seen in this condition [1][2]. *Neurofibromatosis* - Neurofibromatosis primarily presents with **neurofibromas**, café-au-lait spots, and skin-related findings, not with brown tumors. - Bone manifestations include **scoliosis** or **plexiform neurofibromas**, but they do not typically lead to brown tumors. *Pigmented villonodular synovitis* - This is a **joint condition** featuring hyperplastic synovial tissue and local joint swelling, but it does not involve **bone changes** typical of brown tumors. - Characterized by **pigmented nodules** in the synovium, it doesn't cause osteolytic lesions seen in hyperparathyroidism. *Osteomalacia* - Osteomalacia is primarily due to **vitamin D deficiency**, leading to softening of the bones, not the formation of **brown tumors**. - It results in bone pain and weakness, with radiological changes such as **Looser's zones** rather than the well-defined lucencies associated with brown tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1105-1106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1194.

Q: What are the common causes of vertebra plana?

All of the options. ***All of the options*** - **Vertebra plana** refers to the severe flattening of a vertebral body, often caused by a destructive lesion, and all listed options are known causes. [5] - While **eosinophilic granuloma** is a classic cause, **metastatic disease** and **tuberculosis** can also lead to significant vertebral collapse. [3], [5] *Eosinophilic granuloma* - This is a benign condition, a form of **Langerhans cell histiocytosis**, which commonly affects children and can cause vertebra plana. [1] - It results from proliferative lesions of **Langerhans cells** that infiltrate the bone, leading to its destruction and collapse. [1] *Metastatic disease* - **Malignant tumors** often spread to the spine, causing osteolytic lesions that weaken the vertebral body. [4], [5] - The destruction caused by metastatic deposits can lead to **vertebral collapse** and associated pain. [5] *Tuberculosis* - **Tuberculosis of the spine (Pott's disease)** is an infectious inflammatory condition that can severely damage vertebral bodies. [2], [3] - The granulomatous inflammation and caseous necrosis can erode the bone, leading to **vertebral collapse** and kyphosis. [2] **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, p. 630. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1197-1198. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 669-670. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725. [5] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672.

Q: Which of the following conditions is associated with male pseudohermaphroditism?

5-alpha reductase deficiency. ***5-alpha reductase deficiency*** - This deficiency prevents the conversion of **testosterone into dihydrotestosterone (DHT)**, which is essential for external male genitalia development. - Individuals with XY chromosomes are born with **ambiguous genitalia** that may appear female-like, leading to male pseudohermaphroditism. *21-hydroxylase deficiency* - This is the most common cause of **congenital adrenal hyperplasia (CAH)**, leading to overproduction of androgens. [1] - In XX individuals, it causes **virilization**, resulting in female pseudohermaphroditism, not male. [1] *17-hydroxylase deficiency* - This leads to impaired synthesis of **cortisol and sex steroids**, thus affecting adrenal and gonadal functions. [1] - XY individuals with this deficiency typically present with **female external genitalia** due to a lack of androgens, but it's a different mechanism than 5-alpha reductase deficiency. [1] *Androgen insensitivity syndrome* - In this condition, individuals with XY chromosomes have **non-functional androgen receptors**, making their bodies unable to respond to testosterone. [1] - They develop **female external genitalia** despite having testes and usually present as phenotypic females. [1]

Q: All the following are true of craniopharyngioma except:

Present in sella or infra-sellar location. ***Present in sella or infra-sellar location*** - Craniopharyngiomas are typically located in the **suprasellar region**, above the **sella turcica**, where they can compress the optic chiasm. - While they can extend into the sella, their primary location is rarely exclusively intrasellar or infrasellar. *Derived from Rathke's pouch* - This statement is true; craniopharyngiomas arise from remnants of **Rathke's pouch**, the embryonic precursor of the anterior pituitary gland. - This origin explains their characteristic location near the pituitary stalk and third ventricle. *Contains epithelial cells* - This statement is true as **craniopharyngiomas** are benign **epithelial tumors**, specifically adamantinomatous or papillary types. - They are composed of stratified squamous epithelium, often with calcifications and cystic components. *Causes visual disturbances* - This statement is true because the **suprasellar location** of a craniopharyngioma often leads to compression of the **optic chiasm**, resulting in characteristic visual field deficits like bitemporal hemianopsia. - Visual disturbances are a common presenting symptom due to their proximity to the visual pathways.

Q: The most common translocation seen in patients with Multiple Myeloma is:

t(11;14). ***t(11;14)*** - This translocation is the **most common cytogenetic abnormality** found in patients with multiple myeloma, occurring in approximately 15-20% of cases. - It results in the juxtaposition of the **IgH gene on chromosome 14** with the **cyclin D1 gene on chromosome 11**, leading to overexpression of cyclin D1. *t(4;14)* - This translocation, occurring in about 5-10% of patients, is associated with a **poor prognosis** in multiple myeloma. - It involves the IgH gene on chromosome 14 and the **FGFR3 and MMSET genes on chromosome 4**, leading to their upregulation. *t(14;16)* - This translocation is also associated with a **poor prognosis** and is less common than t(11;14) or t(4;14), found in about 2-5% of cases. - It involves the **IgH gene on chromosome 14** and the **c-MAF gene on chromosome 16**, leading to overexpression of c-MAF. *t(14;20)* - This translocation is **rarely observed** in multiple myeloma patients, typically occurring in less than 1% of cases. - It involves the **IgH gene on chromosome 14** and the **MAFB gene on chromosome 20**, which can also contribute to disease progression.

Question 1

What is Reifenstein syndrome?

Accepted Answer

Partial androgen insensitivity syndrome due to receptor mutation.

Answer

Complete androgen insensitivity syndrome with female external genitalia

Answer

5-alpha reductase deficiency causing ambiguous genitalia

Answer

Gonadal dysgenesis with streak gonads

Question 2

Which of the following is a premalignant lesion for carcinoma of the rectum?

Accepted Answer

Adenomatous polyps

Answer

Juvenile polyposis

Answer

Familial adenomatous polyposis

Answer

Hyperplastic polyps

Question 3

Most significant risk factor for development of gastric carcinoma is

Accepted Answer

Intestinal metaplasia

Answer

Pyloric metaplasia

Answer

Ciliated metaplasia

Answer

Paneth cell metaplasia

Question 4

Which of the following is a major feature of Alagille syndrome?

Accepted Answer

Bile duct paucity

Answer

IHBR dilation

Answer

PBC

Answer

PSC

Question 5

Renal stones which are laminated and irregular in outline are

Accepted Answer

Calcium oxalate

Answer

Uric acid

Answer

Struvite

Answer

Cystine

Question 6

Brown tumors are seen in:

Accepted Answer

Hyperparathyroidism

Answer

Pigmented villonodular synovitis

Answer

Osteomalacia

Answer

Neurofibromatosis

Question 7

What are the common causes of vertebra plana?

Accepted Answer

All of the options

Answer

Eosinophilic granuloma

Answer

Metastatic disease

Answer

Tuberculosis

Question 8

Which of the following conditions is associated with male pseudohermaphroditism?

Accepted Answer

5-alpha reductase deficiency

Answer

21-hydroxylase deficiency

Answer

Androgen insensitivity syndrome

Answer

17-hydroxylase deficiency

Question 9

All the following are true of craniopharyngioma except:

Accepted Answer

Present in sella or infra-sellar location

Answer

Derived from Rathke's pouch

Answer

Contains epithelial cells

Answer

Causes visual disturbances

Question 10

The most common translocation seen in patients with Multiple Myeloma is:

Accepted Answer

t(11;14)

Answer

t(14;16)

Answer

t(4;14)

Answer

t(14;20)

NEET-PG 2013 — Pathology