NEET-PG 2015 Practice Questions

Q: B cells are located in which region of lymph nodes?

Cortical follicles. ***Cortical follicles*** - **B cells** are predominantly found within the **cortical follicles** of lymph nodes, where they mature and become activated upon encountering antigens [2]. - These follicles can be primary (inactive) or secondary (active, containing **germinal centers** for B cell proliferation and differentiation). *Paracortical region* - The **paracortical region** is primarily occupied by **T cells** and is the site where T cells interact with antigen-presenting cells [1]. - While it's adjacent to B cell areas, it's not the primary location for B cells. *Medullary sinuses* - **Medullary sinuses** are channels in the medulla of the lymph node, containing macrophages and plasma cells, which are *differentiated B cells*. - They are not the primary residence for undifferentiated B cells. *Subcapsular region* - **Subcapsular region** is the space immediately beneath the capsule of the lymph node where lymph initially enters. - It contains macrophages and dendritic cells that sample antigens but is not a primary B cell zone.

Q: Transport of lipids from the intestine to other tissues is by -

Chylomicrons. ***Chylomicrons*** - **Chylomicrons** are the **largest lipoprotein particles** that transport **dietary (exogenous) lipids** from the **intestine** to peripheral tissues - They are synthesized in **intestinal enterocytes** after fat absorption and enter the bloodstream via the **lymphatic system (thoracic duct)** - They carry **triglycerides (85-95%), cholesterol, phospholipids, and fat-soluble vitamins** (A, D, E, K) - **Apolipoprotein B-48** is the characteristic structural protein of chylomicrons - After delivering triglycerides to tissues (via lipoprotein lipase), chylomicron remnants are taken up by the **liver** *LDL (Low-Density Lipoprotein)* - LDL transports **cholesterol from the liver to peripheral tissues** (not from intestine) - It carries **endogenous cholesterol**, not dietary lipids from the intestine - Often called "**bad cholesterol**" due to its role in atherosclerosis - Contains **Apolipoprotein B-100** *HDL (High-Density Lipoprotein)* - HDL performs **reverse cholesterol transport** - moving excess cholesterol from peripheral tissues **back to the liver** - It does **not transport lipids from the intestine** to tissues - Called "**good cholesterol**" for its protective cardiovascular role - Contains **Apolipoprotein A-I and A-II** *VLDL (Very-Low-Density Lipoprotein)* - VLDL is synthesized in the **liver** (not intestine) and transports **endogenous triglycerides** to peripheral tissues - It carries lipids **from the liver**, not from the intestine - VLDL is converted to IDL and then LDL after losing triglycerides - Contains **Apolipoprotein B-100**

Q: Which method is used to separate a mixture of lipids?

Chromatography. ***Chromatography*** - **Chromatography** (e.g., thin-layer chromatography, gas chromatography, high-performance liquid chromatography) is widely used to separate lipids based on differences in their **polarity**, **molecular weight**, or **solubility** in various solvents. - This method allows for the isolation and identification of different lipid classes and individual lipid species from a complex mixture. *Electrophoresis* - **Electrophoresis** separates molecules based on their **charge** and **size** in an electric field, making it more commonly used for proteins and nucleic acids. - Lipids are generally **uncharged** or have very low charge, which makes them poorly suited for separation by standard electrophoretic methods without modification. *Isoelectric focusing* - **Isoelectric focusing** is a type of electrophoresis that separates molecules based on their **isoelectric point (pI)**, which is the pH at which a molecule has no net charge. - This technique is primarily used for **proteins** and **peptides**, as lipids typically lack ionizable groups necessary for establishing a distinct pI. *PAGE* - **PAGE** (Polyacrylamide Gel Electrophoresis) is a common method used to separate **proteins** and **nucleic acids** based on their size and charge. - Lipids are **hydrophobic** and do not readily migrate through an aqueous polyacrylamide gel matrix, making PAGE unsuitable for their direct separation.

Q: Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Normal C3 level. ***Normal C3 level*** - In Post-streptococcal glomerulonephritis (PSGN), **C3 levels are typically decreased** due to complement consumption during the inflammatory process. [1] - A **normal C3 level** would not be consistent with PSGN, as it suggests no significant complement activation. *Increased urea* - Increased urea can occur due to **impaired renal function**, which is common in PSGN due to glomerular inflammation. [1] - It's a typical finding reflecting the kidneys' inability to excrete waste products properly. *HTN* - Hypertension is frequently associated with PSGN due to **volume overload** and activation of the renin-angiotensin system. [1] [2] - It is a common clinical feature that results from increased fluid retention. *Increased creatinine* - Increased creatinine levels indicate **renal impairment**, which is characteristic of PSGN as kidney function is affected during this condition. [1] - This finding highlights the reduction in glomerular filtration rate (GFR), typical in glomerulonephritis. [2]

Q: The process by which antigen-specific B lymphocytes are selected and activated to proliferate and produce antibodies is called:

Clonal selection. ***Clonal selection*** - **Clonal selection** is the fundamental process by which an antigen-specific B lymphocyte is **selected** when its B cell receptor (BCR) recognizes and binds to a matching antigen. - This binding triggers the B cell to become **activated**, **proliferate** (undergo clonal expansion), and **differentiate** into plasma cells that produce antibodies specific to that antigen. - This process is the cornerstone of **adaptive immunity**, ensuring that only B cells with receptors matching the encountered antigen are stimulated to respond. *Class switching* - **Class switching** (isotype switching) occurs AFTER clonal selection and activation. - It allows already-activated B cells to change the **antibody class** they produce (from IgM to IgG, IgA, or IgE) while maintaining the **same antigen specificity**. - This process modifies effector functions but does NOT involve the initial selection and activation of antigen-specific B cells. *Group switching* - This is not a recognized term in immunology. - It does not describe any standard process of B cell activation or antibody production. *Hybridisation* - **Hybridization** refers to the formation of double-stranded nucleic acids from complementary strands or the creation of hybrid cells (e.g., hybridomas for monoclonal antibody production). - It is not the physiological process by which B lymphocytes are selected and activated in response to antigen exposure.

Q: In the context of immune response, which of the following cell types does not express MHC class II molecules?

NK cells. ***NK cells*** - **Natural Killer (NK) cells)** are innate lymphocytes that do **NOT express MHC class II molecules** under any circumstances. - NK cells use alternative recognition mechanisms (KIRs, activating receptors) to detect target cells, primarily recognizing the **absence of MHC class I** or stress-induced ligands. - They function in innate immunity without antigen presentation capability. - **This is the best answer** as NK cells never express MHC class II, making them distinctly different from professional APCs. *Cortical macrophages* - **Cortical macrophages** in lymphoid organs are professional **antigen-presenting cells (APCs)** that constitutively express **MHC class II molecules**. - They present processed antigens to CD4+ T helper cells, playing a crucial role in initiating adaptive immune responses. *Medullary macrophages* - **Medullary macrophages** are also professional APCs that constitutively express **MHC class II molecules**. - They participate in antigen presentation and immune surveillance within the medullary regions of lymphoid tissues. *Neutrophils* - Neutrophils are granulocytes that **typically do not constitutively express MHC class II molecules** in their resting state. - However, under certain inflammatory conditions with prolonged stimulation (IFN-γ, GM-CSF), neutrophils can be induced to express low levels of MHC class II. - While neutrophils generally lack MHC class II, **NK cells are the more definitive answer** as they never express MHC class II under any physiological or pathological conditions.

Q: Irregular scarred kidney with pelvic dilatation is seen with?

Chronic pyelonephritis. ***Chronic pyelonephritis*** - Characterized by irregular scarring of the kidney and often leads to **pelvic dilatation** due to recurrent infections and obstruction [1]. - The damage from inflammation results in **cortical scarring** and can affect kidney function significantly over time [1]. *Renal artery stenosis* - Typically presents with **hypertension** and may lead to ischemic atrophy, but does not cause significant **pelvic dilatation**. - The kidney appears small and often asymmetric, but not typically irregular and scarred. *Tuberculosis of kidney* - Can cause damage to the kidney, but usually leads to **caseating granulomas** and can cause abscesses, not specifically irregular scarring with pelvic dilation. - Often presents with systemic symptoms such as fever and night sweats, along with hematuria. *Polycystic kidney* - Characterized by multiple cysts in both kidneys leading to enlarged kidneys, but does not typically present as **irregularly scarred kidneys**. - Usually associated with **hemodynamic issues** and hypertension but not pelvic dilatation in the sense of scarring or fibrosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 937-939.

Q: Post-streptococcal glomerulonephritis (PSGN) is an example of which type of hypersensitivity?

Type -3 hypersensitivity. ***Type -3 hypersensitivity*** - Post-streptococcal glomerulonephritis (PSGN) is caused by **immune complex deposition**, a hallmark of type III hypersensitivity reactions [1][2][3]. - It involves the formation of **antigen-antibody complexes** following a streptococcal infection, leading to inflammation in the kidneys [1][2]. *Type -1 hypersensitivity* - Characterized by **IgE-mediated** reactions, such as allergies and anaphylaxis, which do not apply to PSGN. - It typically involves **mast cells** and histamine release, notably absent in PSGN cases. *Type -4 hypersensitivity* - Involves **T-cell mediated** responses and is related to delayed-type reactions, not applicable to PSGN. - Common examples include **contact dermatitis** and graft-versus-host disease, differing fundamentally from PSGN's mechanism. *Type -2 hypersensitivity* - Characterized by **antibody-mediated cytotoxicity**, such as in hemolytic anemia, unrelated to immune complexes in PSGN. - Typically involves direct damage to cells, contrasting with the immune complex mechanism observed in PSGN [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-215. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 910-915. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 215-216.

Q: What is the initial event in serum sickness?

It occurs due to exposure to heterologous antigens.. ***Can lead to leukocytoclastic vasculitis*** - Serum sickness is characterized by the formation of **immune complexes**, which can trigger **leukocytoclastic vasculitis** affecting the blood vessels [1][2]. - Symptoms can include **rash, fever, and arthralgia**, typically occurring 1-3 weeks after exposure to the offending antigen [2]. *Can occur due to homologous antigen* - Serum sickness is usually a reaction to **heterologous** antigens, such as those from animal serum, not **homologous** ones. - Homologous antigens do not typically elicit the immune response seen in serum sickness; hence, this statement is incorrect. *Type 2 hypersensitivity* - Serum sickness is classified as a **Type III hypersensitivity** reaction due to the immune complex formation, not Type II [1]. - Type II is characterized by antibody-mediated destruction of **target cells**, which does not apply here. *Hypercomplementemia* - Serum sickness is associated with **hypocomplementemia** due to complement consumption from immune complex formation, not hypercomplementemia. - This can lead to **decreased complement levels** during the response, making this statement incorrect. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-216. [2] 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. 172-173.

Q: Which solid organ is considered to have the lowest risk of rejection during transplantation?

Liver. ***Liver*** - The liver has a unique immunologic environment, often referred to as **immunologic privilege**, which contributes to its lower rates of rejection compared to other transplanted solid organs. - It produces various **immunosuppressive factors** and has a high capacity for regeneration and repair, adapting more readily to the recipient's immune system. - The liver's **dual blood supply** (hepatic artery and portal vein) and tolerogenic properties make it the most immunologically privileged solid organ. *Pancreas* - **Pancreas transplantation** carries a high risk of rejection, with rejection rates significantly higher than liver transplantation. - Pancreatic tissue is highly **immunogenic** due to its endocrine and exocrine functions, requiring aggressive immunosuppression. - Often transplanted with kidney in diabetic patients, and rejection episodes are common. *Kidney* - Kidney transplantation is common, but it carries a significant risk of both **acute and chronic rejection**, requiring lifelong immunosuppression. - The kidney expresses various **MHC antigens** that are readily recognized by the recipient's immune system, making it more immunogenic than the liver. *Heart* - **Heart transplantation** is associated with a high risk of rejection due to the rich vascularity and immunogenicity of cardiac tissue. - It often requires aggressive immunosuppressive regimens to prevent both **acute cellular rejection** and **antibody-mediated rejection**.

Question 1

B cells are located in which region of lymph nodes?

Accepted Answer

Cortical follicles

Answer

Paracortical region

Answer

Subcapsular region

Answer

Medullary sinuses

Question 2

Transport of lipids from the intestine to other tissues is by -

Accepted Answer

Chylomicrons

Answer

LDL

Answer

HDL

Answer

VLDL

Question 3

Which method is used to separate a mixture of lipids?

Accepted Answer

Chromatography

Answer

Electrophoresis

Answer

Isoelectric focusing

Answer

PAGE

Question 4

Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Accepted Answer

Normal C3 level

Answer

HTN

Answer

Increased urea

Answer

Increased creatinine

Question 5

The process by which antigen-specific B lymphocytes are selected and activated to proliferate and produce antibodies is called:

Accepted Answer

Clonal selection

Answer

Class switching

Answer

Group switching

Answer

Hybridisation

Question 6

In the context of immune response, which of the following cell types does not express MHC class II molecules?

Accepted Answer

NK cells

Answer

Cortical macrophages

Answer

Neutrophils

Answer

Medullary macrophages

Question 7

Irregular scarred kidney with pelvic dilatation is seen with?

Accepted Answer

Chronic pyelonephritis

Answer

Polycystic kidney

Answer

Renal artery stenosis

Answer

Tuberculosis of kidney

Question 8

Post-streptococcal glomerulonephritis (PSGN) is an example of which type of hypersensitivity?

Accepted Answer

Type -3 hypersensitivity

Answer

Type -1 hypersensitivity

Answer

Type -2 hypersensitivity

Answer

Type -4 hypersensitivity

Question 9

What is the initial event in serum sickness?

Accepted Answer

It occurs due to exposure to heterologous antigens.

Answer

It is associated with hypocomplementemia.

Answer

It is a type III hypersensitivity reaction.

Answer

It can lead to leukocytoclastic vasculitis.

Question 10

Which solid organ is considered to have the lowest risk of rejection during transplantation?

Accepted Answer

Liver

Answer

Pancreas

Answer

Kidney

Answer

Heart

NEET-PG 2015

Anatomy

Biochemistry

Internal Medicine

Microbiology

Pathology

Surgery