NEET-PG 2015 - Pathology Practice Questions

Q: Which is the most common type of male breast cancer?

Invasive Ductal Carcinoma. ***Invasive Ductal Carcinoma*** - This is by far the most common type of breast cancer in men, accounting for approximately **80-90%** of all male breast cancer cases. - It originates in the **milk ducts** and then invades the surrounding breast tissue. *Invasive Lobular Carcinoma* - This type of cancer originates in the **milk-producing glands (lobules)**. - It is **extremely rare** in men due to the underdeveloped and non-functional lobules in the male breast. *Mucinous Carcinoma* - This is a **rare subtype** of invasive ductal carcinoma characterized by cancer cells that produce **mucin**. - It accounts for only a small percentage of male breast cancers, typically **2-3%** of cases. *Inflammatory Breast Cancer* - This is a **rare and aggressive** form of breast cancer characterized by rapid onset of redness, swelling, and warmth in the breast, often mistaken for an infection. - Although it can occur in men, it is not the most common type and represents a very small fraction of male breast cancer diagnoses.

Q: Medulloblastoma arises exclusively from the cells of

Immature embryonal cells. ***Immature embryonal cells*** - **Medulloblastoma** is a malignant **embryonal tumor** of the cerebellum, exclusively arising from primitive neuroectodermal cells. - These tumors are thought to originate from remnants of the **external granular layer** of the cerebellum or other primitive neuroectodermal cells. *Ependymal cells* - Tumors arising from **ependymal cells** are called **ependymomas**, which typically occur within the ventricles of the brain or spinal cord. - Ependymomas have distinct histological features and clinical behavior compared to medulloblastomas. *Neurons* - Tumors primarily composed of neurons or with significant neuronal differentiation include **gangliogliomas** and **central neurocytomas**. - **Medulloblastomas** largely consist of undifferentiated, small round cells with minimal evidence of neuronal maturation. *Spindle-shaped cells* - **Spindle-shaped cells** are characteristic of various tumor types, including some **gliomas** (e.g., pilocytic astrocytoma) or mesenchymal tumors. - While some medulloblastoma variants can show desmoplastic features, the hallmark cell type is a small, round, blue embryonal cell.

Q: Which one of the following statements is false about Xanthogranulomatous pyelonephritis in children?

Boys are affected more frequently. ***Boys are affected more frequently*** - This statement is **false** for xanthogranulomatous pyelonephritis (XGP) in children. XGP typically shows a **female predominance** in children, similar to adults. - The disease is more common in girls due to the higher incidence of **urinary tract infections** and **urinary obstruction** in females. *It affects the kidney diffusely more frequently than focally* - This statement is **true**. XGP predominantly presents as a **diffuse disease** affecting the entire kidney in approximately **80-90% of cases**. - **Focal XGP** (10-20% of cases) can occur and may mimic a renal tumor, but diffuse involvement is the classic and more common presentation in both adults and children [1]. *Clinical presentation in children is the same as in adults* - This statement is **true**. Children with XGP often present with similar symptoms to adults, including **fever**, **flank pain**, **recurrent urinary tract infections**, and a **palpable abdominal mass** [1]. - **Failure to thrive** and **anemia** are also common in pediatric cases, reflecting the chronic nature of the infection. *Often affects those younger than 8 years of age* - This statement is **true**. XGP, when it occurs in children, often presents in the **younger age group**, typically before 8 years of age. - This demographic observation highlights the importance of considering XGP in young children with persistent urinary tract symptoms and imaging abnormalities. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 939-940.

Q: Blebs are associated with which type of cell injury?

Both. ***Correct: Both*** - Blebs (surface membrane protrusions) are associated with **both reversible and irreversible cell injury** - In **reversible injury**: cellular swelling causes cytoskeletal disruption leading to bleb formation; these blebs can resolve if the injurious stimulus is removed - In **irreversible injury**: more extensive and widespread blebbing occurs during apoptosis and necrosis, associated with cell death pathways - The key difference is in the **extent and reversibility**, not the presence or absence of blebs *Incorrect: Reversible* - While blebs do occur in reversible injury, this option is incomplete as it excludes their occurrence in irreversible injury - Blebs are seen in both types of cellular injury, making "reversible" alone an inadequate answer *Incorrect: Irreversible* - While blebs are prominent in irreversible injury (apoptosis and necrosis), they also occur in reversible injury - Standard pathology texts (Robbins) describe bleb formation as a feature of cellular swelling in reversible injury - This option is incomplete as it excludes reversible injury *Incorrect: None of the options* - This is incorrect because blebs are definitively associated with cell injury (both reversible and irreversible types) - Bleb formation is a well-recognized morphological change in cellular pathology

Q: Investigation of choice for confirming Henoch Schönlein Purpura is

Renal Biopsy. ***Renal Biopsy*** - **Biopsy (renal or skin)** showing **IgA deposition** is the **confirmatory investigation** for Henoch-Schönlein Purpura (HSP) when histological confirmation is needed [1]. - **Renal biopsy** demonstrates characteristic **IgA-dominant immune deposits** in the mesangium and glomerular capillaries, along with **mesangial proliferation** [1]. - While HSP is primarily a **clinical diagnosis** based on palpable purpura, age < 20 years, abdominal pain, and renal involvement, biopsy provides **definitive confirmation** in atypical presentations or when diagnosis is uncertain. - Immunofluorescence showing **IgA deposition** is the pathognomonic finding [1]. *Serum IgA levels* - Serum IgA levels may be elevated in approximately **50% of HSP cases**, but this is **neither sensitive nor specific**. - **Normal serum IgA does NOT exclude HSP**, making it unreliable as a confirmatory test. - Elevated IgA can occur in many other conditions (IgA nephropathy without vasculitis, liver disease, infections). - Provides only supportive evidence, not confirmation. *CRP levels* - **C-reactive protein (CRP)** is a **non-specific inflammatory marker** that may be elevated in HSP. - Cannot distinguish HSP from other inflammatory or infectious conditions. - Has no role in confirming the diagnosis. *DTPA* - **DTPA scan** assesses **renal perfusion and function** but does not provide diagnostic information about the underlying pathology. - Cannot detect the characteristic **IgA-mediated vasculitis** of HSP. - Not useful for confirming the diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 526-527.

Q: Fat necrosis is common in:

Breast. ***Breast*** - **Fat necrosis** in the breast is a relatively common benign condition, often resulting from trauma, surgery, or radiation. - It presents as a palpable lump that can mimic malignancy, making its differentiation crucial. *Retroperitoneal fat* - While fat necrosis can occur in the retroperitoneum, particularly in cases of **acute pancreatitis**, it is not considered "common" in this location independently [1]. - The primary tissue affected in pancreatitis is the pancreas itself, with necrosis extending to surrounding fat [1]. *Omentum* - **Omental fat necrosis** can occur but is rare and usually associated with torsion of the omentum or, less commonly, blunt abdominal trauma. - It is not a common site for isolated fat necrosis compared to the breast. *All of the options* - Although fat necrosis can occur in all these locations under specific circumstances, it is not "common" in all of them when considering the typical incidence of the condition. - **Breast fat necrosis** is more frequently encountered in clinical practice than in the omentum or retroperitoneal region. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, p. 895.

Q: Which of the following is the most frequent primary malignant tumor of the CNS?

Glioblastoma multiforme. ***Glioblastoma multiforme*** - **Glioblastoma multiforme (GBM)** is the most common and aggressive primary malignant brain tumor in adults [1]. - It is a **grade IV astrocytoma**, characterized by rapid growth, necrosis, and microvascular proliferation [1]. *Oligodendroglioma* - **Oligodendrogliomas** are primary glial tumors but are less common than GBM. - They typically have a more indolent course than GBM and are often characterized by **IDH mutations** and **1p/19q co-deletion**. *Medulloblastoma* - **Medulloblastoma** is the most common malignant brain tumor in children, but it is rare in adults [2]. - It arises in the **cerebellum** and is a type of embryonal tumor [2]. *Meningioma* - **Meningiomas** are the most common primary brain tumors overall, but they are typically **benign** and originate from the meninges. - While they can be symptomatic due to compression, they are not primarily malignant in the way GBM is. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1308-1310. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 725-726.

Q: Effect of hypoparathyroidism on bones include -

None of the Above. ***None of the Above*** - **Hypoparathyroidism** leads to **decreased parathyroid hormone (PTH)** levels, resulting in **hypocalcemia** and **hyperphosphatemia**. [3] - Unlike hyperparathyroidism, which causes bone resorption, hypoparathyroidism is generally associated with **increased bone density** due to reduced osteoclastic activity. *Brown tumours* - **Brown tumors** are focal lesions caused by **osteoclastic activity** and fibrous tissue replacement in severe **hyperparathyroidism**, which is the opposite of the condition described. [1], [2] - They are a manifestation of **osteitis fibrosa cystica**, a skeletal complication of prolonged excess PTH. [2] *Subperiosteal Resorption of Bone* - **Subperiosteal bone resorption** is a classic radiographic sign of **hyperparathyroidism**, where excessive PTH causes osteoclasts to erode bone, particularly in the phalanges. [1] - This process is driven by **elevated PTH**, which is absent in hypoparathyroidism. *Multiple Cysts in Bone* - **Multiple cysts in bone** (also known as osteitis fibrosa cystica) are characteristic of **severe hyperparathyroidism**, resulting from excessive bone remodeling and fibrous tissue proliferation. [2] - Hypoparathyroidism does not cause bone cysts; instead, it tends to lead to **increased bone mineral density**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1194-1195. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1105-1106. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1106-1107.

Question 1

Which of the following is NOT a recognized cause of Urothelial Carcinomas?

Accepted Answer

Alcohol consumption

Answer

Industrial solvents

Answer

Exposure to thorotrast

Answer

Smoking

Question 2

Which is the most common type of male breast cancer?

Accepted Answer

Invasive Ductal Carcinoma

Answer

Inflammatory Breast Cancer

Answer

Invasive Lobular Carcinoma

Answer

Mucinous Carcinoma

Question 3

Medulloblastoma arises exclusively from the cells of

Accepted Answer

Immature embryonal cells

Answer

Ependymal cells

Answer

Neurons

Answer

Spindle-shaped cells

Question 4

Which one of the following statements is false about Xanthogranulomatous pyelonephritis in children?

Accepted Answer

Boys are affected more frequently

Answer

Clinical presentation in children is the same as in adults

Answer

Often affects those younger than 8 years of age

Answer

It affects the kidney diffusely more frequently than focally

Question 5

Blebs are associated with which type of cell injury?

Accepted Answer

Both

Answer

Reversible

Answer

Irreversible

Answer

None of the options

Question 6

Investigation of choice for confirming Henoch Schönlein Purpura is

Accepted Answer

Renal Biopsy

Answer

Serum IgA levels

Answer

CRP levels

Answer

DTPA

Question 7

Fat necrosis is common in:

Accepted Answer

Breast

Answer

Retroperitoneal fat

Answer

Omentum

Answer

All of the options

Question 8

Which of the following is the most frequent primary malignant tumor of the CNS?

Accepted Answer

Glioblastoma multiforme

Answer

Oligodendroglioma

Answer

Medulloblastoma

Answer

Meningioma

Question 9

Effect of hypoparathyroidism on bones include -

Accepted Answer

None of the Above

Answer

Brown tumours

Answer

Subperiosteal Resorption of Bone

Answer

Multiple Cysts in Bone

NEET-PG 2015 — Pathology