NEET-PG 2015 - Pathology Practice Questions

Q: Radiotherapy induced radiation pneumonitis is mediated by all of the following cytokines and factors except -

PAF. ***PAF*** - **Platelet-activating factor (PAF)** is primarily involved in **anaphylaxis**, **asthma**, and **allergic responses**, mediating inflammation through platelet aggregation and smooth muscle contraction. - While it has pro-inflammatory effects, it is **not a primary mediator** of the specific inflammatory cascade seen in radiotherapy-induced radiation pneumonitis. *TNF-α* - **Tumor Necrosis Factor-alpha (TNF-α)** is a crucial **pro-inflammatory cytokine** that plays a significant role in the initial acute phase of radiation pneumonitis. - It induces **cytotoxicity**, **apoptosis**, and the production of other inflammatory mediators, contributing to lung tissue damage. *TGF-β* - **Transforming Growth Factor-beta (TGF-β)** is a key cytokine involved in the **fibrotic phase** of radiation pneumonitis. - It promotes **fibroblast proliferation**, collagen synthesis, and extracellular matrix deposition, leading to lung scarring. *NF-kB* - **Nuclear Factor kappa-light-chain-enhancer of activated B cells (NF-kB)** is a master **transcription factor** that regulates the expression of numerous genes involved in inflammation and immune responses. - Radiation exposure **activates NF-kB**, leading to the transcription of various pro-inflammatory cytokines, including TNF-α, which contribute to radiation pneumonitis.

Q: Subepithelial deposits in the kidney are primarily associated with which condition?

Post-Streptococcal Glomerulonephritis (PSGN). ***PSGN*** - Post-streptococcal glomerulonephritis (PSGN) is characterized by **subepithelial immune complex deposits** [1], typically after a streptococcal infection [1]. - It is associated with **hematuria**, **edema**, and elevated **anti-streptolysin O (ASO)** titers. *GPS* - Minimal change disease (often referred to as idiopathic nephrotic syndrome) does not primarily feature **subepithelial deposits** but rather **effacement of podocyte foot processes**. - Clinical presentation includes **nephrotic syndrome** symptoms, not glomerulonephritis like PSGN. *MPGN-1* - Membranoproliferative glomerulonephritis type 1 includes **subendothelial deposits** rather than subepithelial deposits associated with PSGN. - Symptoms often include **nephritic syndrome** and is commonly linked with conditions like **HCV infection**. *All* - While several conditions can show **deposits in kidney**, not all are characterized by **subepithelial deposits**, hence this option is inaccurate. - Each type of glomerular disease has specific types of deposits (immune complex vs. complement) associated with their pathophysiology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 914-916.

Q: Hyaline degeneration is found in -

Alcoholic liver disease. ***Alcoholic liver disease*** - **Mallory bodies**, a form of hyaline degeneration, are characteristic histologic findings in hepatocytes in alcoholic liver disease. - They represent aggregates of **intermediate filaments** and other proteins, indicating severe hepatocellular damage. *Acute myocardial infarction* - Characterized by **coagulative necrosis** of cardiac myocytes due to ischemia, not hyaline degeneration. - Inflammation and subsequent repair with **fibrosis** are key features. *Alzheimer's disease* - Defined by the presence of **senile plaques** (amyloid-beta deposits) and **neurofibrillary tangles** (hyperphosphorylated tau protein). - These are specific protein aggregates, distinct from hyaline degeneration of cellular components. *Acute appendicitis* - Involves acute inflammation of the appendix, leading to **neutrophilic infiltration** and often **fibrinopurulent exudate**. - There is no characteristic hyaline degeneration associated with this inflammatory process.

Q: Rolling of leucocytes on endothelial cells is mediated by which of the following?

P-selectin. ***P- selectin*** - P-selectin is a **cell adhesion molecule** crucial for the **rolling** of leukocytes on endothelial cells during the inflammatory response [1]. - It is expressed on activated endothelial cells and binds to **sialylated carbohydrates** on leukocytes, facilitating their transient adhesion [1]. *IL-8* - IL-8 is a **chemokine** that primarily acts as a chemotactic factor for neutrophils rather than mediating rolling on endothelium. - While it attracts leukocytes to sites of inflammation, it does not play a role in the initial contact or rolling process. *ICAM-1* - ICAM-1 is an **intercellular adhesion molecule** that facilitates **firm adhesion** rather than rolling of leukocytes. - It primarily interacts with **integrins** on leukocytes to stabilize their adhesion after rolling has occurred. *(3, integrin* - Integrins play a significant role in **firm adhesion** and not the rolling phase, interacting with receptors like ICAM-1. - The binding of integrins to their ligands occurs after leukocytes have initially rolled on the endothelium. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 87.

Q: First mediator of inflammation to be released is

Histamine. ***Histamine*** - Histamine is the **first mediator of inflammation released** by mast cells and basophils during an allergic or inflammatory response [1][3]. - It promotes **vasodilation** and increased vascular permeability, leading to typical symptoms of inflammation [1][2]. *PAF* - Platelet-activating factor (PAF) is released later in the inflammatory process and is primarily involved in **amplifying** the response rather than initiating it. - It plays a role in **platelet aggregation** and acting on vascular smooth muscle but is not the first released mediator. *Nitric oxide* - Nitric oxide is produced by endothelial cells and plays a role in **vascular relaxation and inflammation**, but it is not among the first mediators released. - It is involved in more **regulatory functions** in the inflammatory response rather than the initial trigger. *IL-1* - Interleukin-1 (IL-1) is a cytokine that is important for the **inflammatory response**, but it is produced after the initial release of mediators like histamine [2]. - It is primarily secreted by **activated macrophages** and contributes to the **amplification** of the immune response [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 84-85. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 101. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-94.

Q: What is a distinguishing feature of reticulocytes?

Presence of residual RNA and ribosomes. ***Presence of residual RNA and ribosomes*** - This is the **defining and most distinguishing feature** of reticulocytes that differentiates them from mature red blood cells. - Reticulocytes contain residual **ribosomal RNA** and other organelles that are lost when they mature into erythrocytes. - This residual RNA forms a **reticular (network-like) pattern** when stained with supravital stains like **new methylene blue** or **brilliant cresyl blue**, which is the basis for their name and identification. - The presence of RNA allows for **reticulocyte counting**, an important marker of bone marrow erythropoietic activity. *Slightly larger in size than RBCs* - While reticulocytes may be slightly larger (polychromatophilic appearance), size variation is **not specific** and overlaps significantly with mature RBCs. - Size is not a reliable distinguishing feature and is not used for identification or counting. *Mature in bone marrow* - Reticulocytes are **released from the bone marrow** as immature red cells and complete their maturation in the **peripheral circulation** over 24-48 hours. - They do not fully mature in the bone marrow; their presence in peripheral blood is normal. *Constitute approximately 1% of the red cells* - Normal reticulocyte count is **0.5-2%** (or approximately 1%) of total red blood cells in healthy adults. - This is a **population characteristic** indicating normal erythropoietic activity, not a distinguishing cellular feature.

Q: All of the following are features of granulomatous thyroiditis except?

Painless. ***Painless*** - Granulomatous thyroiditis is characterized by **painful** thyroid gland inflammation, which is a distinguishing feature. - Thus, describing it as **painless** contradicts the typical clinical presentation. *Hyperthyroidism* - Granulomatous thyroiditis may lead to **hyperthyroidism** initially due to the release of thyroid hormones from damaged follicles [1]. - However, this condition can also lead to transient thyroid function changes or even permanent hypothyroidism later on [1]. *Hypothyroidism* - While **hypothyroidism** can occur post-thyroiditis, it is not a feature of granulomatous thyroiditis at the outset like the **painless** descriptor. - This condition often starts with hyperthyroid symptoms and may evolve later, differing from primary hypothyroid disorders. *Giant cells on histology* - Histological examination typically reveals **multinucleated giant cells**, a hallmark of granulomatous inflammation, as seen in this thyroid condition. - This significant finding helps in differentiating it from other thyroid disorders. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1091-1092.

Q: IgA nephropathy is not associated with which of the following?

Decreased complement level. ***Decreased complement level*** - IgA nephropathy is typically associated with **normal serum complement levels** (C3 and C4), which is an important distinguishing feature. - Unlike post-streptococcal glomerulonephritis or lupus nephritis where complement levels are **low/decreased**, IgA nephropathy does not cause systemic complement consumption. - While complement activation does occur locally in the glomerulus (via lectin and alternative pathways), it does not lead to a decrease in serum complement levels. *Focal mesangial proliferation* - This is a **common histological finding** in IgA nephropathy, reflecting the proliferative response to IgA deposition in the mesangium. - The mesangial cells proliferate in an attempt to clear the immune deposits. *Gross hematuria concurrent with upper respiratory infection* - This is a **classic clinical presentation** of IgA nephropathy, often referred to as **synpharyngitic hematuria**. - The episode of gross hematuria typically occurs **within 1-2 days** of the onset of an upper respiratory tract infection, distinguishing it from post-streptococcal glomerulonephritis where hematuria appears 1-3 weeks later. *Immunofluorescence deposits contain IgA and IgG* - The defining feature of IgA nephropathy on immunofluorescence is the **predominant deposition of IgA**, often accompanied by C3. - While IgA is the primary immunoglobulin, **IgG and IgM can also be present** in variable amounts, but IgA must be the dominant or co-dominant immunoglobulin for the diagnosis.

Q: What is the most common nephropathy associated with malignancy?

Membranous glomerulonephritis. ***Membranous glomerulonephritis*** - **Membranous glomerulonephritis** has the strongest and most frequent association with solid organ malignancies, particularly in older patients. - While other glomerulopathies can be linked to cancer, **membranous nephropathy** is the most common paraneoplastic glomerulopathy in adults. *Focal segmental glomerulosclerosis (FSGS)* - While FSGS can be associated with certain cancers, particularly hematological malignancies and HIV-associated nephropathy, it is **less common** than membranous nephropathy in solid tumors. - The link is often with **HIV-associated nephropathy** or direct tumor effects rather than a paraneoplastic syndrome. *Minimal change disease* - Minimal change disease is predominantly seen in **children** and is less frequently associated with malignancy compared to membranous nephropathy. - When associated with malignancy, it is typically with **lymphoproliferative disorders** like Hodgkin lymphoma. *IgA nephropathy* - **IgA nephropathy** is the most common primary glomerulonephritis worldwide but has a **weak and inconsistent association** with malignancy. - Its presence alongside cancer is often coincidental rather than directly causative.

Question 1

Radiotherapy induced radiation pneumonitis is mediated by all of the following cytokines and factors except -

Accepted Answer

PAF

Answer

NF-kB

Answer

TNF-α

Answer

TGF-β

Question 2

Subepithelial deposits in the kidney are primarily associated with which condition?

Accepted Answer

Post-Streptococcal Glomerulonephritis (PSGN)

Answer

None of these conditions are associated with subepithelial deposits.

Answer

Membranoproliferative Glomerulonephritis (MPGN) Type I

Answer

Goodpasture's Syndrome (GPS)

Question 3

Hyaline degeneration is found in -

Accepted Answer

Alcoholic liver disease

Answer

Alzheimer's disease

Answer

Acute myocardial infarction

Answer

Acute appendicitis

Question 4

Rolling of leucocytes on endothelial cells is mediated by which of the following?

Accepted Answer

P-selectin

Answer

ICAM-1

Answer

Integrin

Answer

IL-8

Question 5

First mediator of inflammation to be released is

Accepted Answer

Histamine

Answer

Nitric oxide

Answer

PAF

Answer

IL-1

Question 6

Which of the following statements about peripheral nerve injury is false?

Accepted Answer

Neuropraxia is irreversible

Answer

Wallerian degeneration starts in axonotmesis

Answer

Neurotmesis is the most severe form of injury

Answer

Epineurium is intact in axonotmesis

Question 7

What is a distinguishing feature of reticulocytes?

Accepted Answer

Presence of residual RNA and ribosomes

Answer

Slightly larger in size than RBCs

Answer

Mature in bone marrow

Answer

Constitute approximately 1% of the red cells

Question 8

All of the following are features of granulomatous thyroiditis except?

Accepted Answer

Painless

Answer

Hyperthyroidism

Answer

Giant cells on histology

Answer

Hypothyroidism

Question 9

IgA nephropathy is not associated with which of the following?

Accepted Answer

Decreased complement level

Answer

Focal mesangial proliferation

Answer

Gross hematuria concurrent with upper respiratory infection

Answer

Immunofluorescence deposits contain IgA and IgG

Question 10

What is the most common nephropathy associated with malignancy?

Accepted Answer

Membranous glomerulonephritis

Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

Minimal change disease

Answer

IgA nephropathy

NEET-PG 2015 — Pathology