NEET-PG 2018 - Pathology PYQs Practice Questions

Q: A 50-year-old lady with thyroid swelling underwent total thyroidectomy. The gross specimen and histopathological slide is shown below. Diagnosis is:

Medullary carcinoma of thyroid. ***Medullary carcinoma of thyroid*** - The gross specimen of medullary carcinoma often shows a **firm, grey-white, ill-defined mass**, which can be seen in the provided image. - Histopathologically, it is characterized by nests or cords of **polygonal or spindle cells** with **amyloid deposition** in the stroma, which stains positive with Congo red. *Hashimoto thyroiditis* - Grossly, Hashimoto thyroiditis typically presents as a **diffusely enlarged, firm, pale gland**, not a discrete mass. - Histologically, it is characterized by **lymphocytic infiltration**, **germinal centers**, and **Hurthle cell change**, without amyloid deposition or the specific cellular architecture of medullary carcinoma. *Follicular carcinoma* - Grossly, follicular carcinoma often appears as a **solitary, well-circumscribed nodule** with a fibrous capsule, which may show areas of hemorrhage or necrosis [1]. - Histologically, the diagnosis of follicular carcinoma relies on evidence of **capsular and/or vascular invasion** by follicular cells, which is not the primary feature suggested by the image [1]. *Anaplastic carcinoma* - Grossly, anaplastic carcinoma is typically a **rapidly growing, large, invasive mass** that often extends beyond the thyroid capsule [2]. - Histologically, it is characterized by highly **pleomorphic, bizarre giant cells** and/or spindle cells with frequent mitoses and necrosis, lacking the specific features of medullary carcinoma [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1101-1102. [Practice more Pathology PYQs on OnCourse]

Q: All are correct about the condition shown in the image except: (NEET Pattern 2018)

Most common site is middle esophagus. ***Most common site is middle esophagus*** - The question asks for the incorrect statement, and this statement is actually **correct** for esophageal squamous cell carcinoma (SCC), which is the most common type of esophageal cancer globally. - **Squamous cell carcinoma** of the esophagus most frequently occurs in the **middle third** of the esophagus [1]. *Most common gross presentation is fungating subtype* - This statement is incorrect. The most common gross presentation of esophageal carcinoma is the **ulcerative type**, followed by fungating and infiltrative types [1]. - **Fungating tumors** are exophytic and protrude into the lumen, but they are not the most common gross morphology. *Stage 3 cancer oesophagus has 25 % survival rate* - This statement is incorrect. The 5-year survival rate for **Stage III esophageal cancer** is significantly lower, typically ranging from **10-15%**, not 25% [2][3]. - Survival rates for esophageal cancer are generally poor, especially in advanced stages due to early metastasis and late presentation. *Vomiting of previous day food items* - This statement is incorrect. Vomiting of previous day's food items is characteristic of **pyloric stenosis** or **gastric outlet obstruction**, not typically esophageal cancer. - Esophageal cancer usually presents with **dysphagia** (difficulty swallowing) and **regurgitation** of recently ingested food, not undigested food from the previous day [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 766-767. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 349-350. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 765-766. [Practice more Pathology PYQs on OnCourse]

Q: Which is not a true statement about this anomaly of kidney?

No risk of Wilms tumor. ***No risk of Wilms tumor*** - Horseshoe kidney, the anomaly described, actually has an **increased risk of Wilms tumor**, not no risk. - The risk is about 2-8 times higher than in the general population. *Fusion of lower poles of the kidneys* - This is the **classic anatomical description** of a horseshoe kidney, where the lower poles are fused across the midline [1]. - The fusion typically occurs at the **isthmus**, which can be fibrous or parenchymatous. *Association with Turner syndrome* - Horseshoe kidney is indeed **commonly associated with Turner syndrome** (XO karyotype). - Approximately 15-20% of individuals with Turner syndrome have a horseshoe kidney. *Renal function usually is normal* - In most cases, the **renal function of a horseshoe kidney is normal** [1], provided there are no other associated anomalies or complications. - However, they are more prone to complications like **hydronephrosis**, **calculi**, and infections due to altered anatomy. **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. 545-546. [Practice more Pathology PYQs on OnCourse]

Question 1

A 50-year-old lady with thyroid swelling underwent total thyroidectomy. The gross specimen and histopathological slide is shown below. Diagnosis is:

Accepted Answer

Medullary carcinoma of thyroid

Answer

Hashimoto thyroiditis

Answer

Follicular carcinoma

Answer

Anaplastic carcinoma

Answer

Papillary carcinoma

Question 2

Which of the following hematological condition is shown below?

Accepted Answer

Megaloblastic anemia

Answer

Multiple myeloma

Answer

CML

Answer

Metastasis

Answer

Myelodysplastic syndrome

Question 3

All are correct about the condition shown in the image except: (NEET Pattern 2018)

Accepted Answer

Most common site is middle esophagus

Answer

Most common gross presentation is fungating subtype

Answer

Stage 3 cancer oesophagus has 25 % survival rate

Answer

Vomiting of previous day food items

Answer

Loss of ganglion cells in myenteric plexus

Question 4

Which is not a true statement about this anomaly of kidney?

Accepted Answer

No risk of Wilms tumor

Answer

Fusion of lower poles of the kidneys

Answer

Association with Turner syndrome

Answer

Renal function usually is normal

Answer

Associated with increased risk of renal calculi

NEET-PG 2018 — Pathology