NEET-PG 2018 - Pathology Practice Questions

Q: A teenager has a progressively increasing soft reddish swelling on his chest. Its histological appearance is given below. Which of the following is the likely diagnosis?

Hemangioma. ***Hemangioma*** - The image displays numerous **blood-filled vascular channels** lined by endothelial cells, which is characteristic of a hemangioma [1]. - The clinical presentation of a **soft, reddish swelling** aligns with the typical appearance of a hemangioma, which is a benign proliferation of blood vessels [1]. *Fibroadenoma* - Fibroadenomas are benign tumors composed of both **glandular and stromal tissue**, primarily found in the breast. - Histologically, they show **proliferating ducts and surrounding connective tissue**, not blood-filled spaces. *Fibroma* - A fibroma is a benign tumor of **fibrous connective tissue**, characterized by abundant collagen. - Histologically, it would consist of **spindle-shaped cells and collagen fibers**, lacking the vascular spaces seen in the image. *Lipoma* - A lipoma is a benign tumor composed of **mature fat cells** (adipocytes). - Histologically, it would show a collection of **uniform fat cells** with small nuclei, which is distinctly different from the image provided. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482, 523-525.

Q: Which of the following is true about factor V leiden mutation?

Factor V becomes resistant to cleavage by protein C. **Factor V becomes resistant to cleavage by protein C** - The **Factor V Leiden mutation** involves a substitution in the Factor V gene, rendering the **activated Factor V (FVa)** resistant to inactivation by **activated protein C (APC)** [1]. - This resistance leads to prolonged activity of FVa, which is a cofactor in the formation of thrombin, thereby increasing the risk of **thrombosis** [1]. *Increased bleeding tendency* - The Factor V Leiden mutation leads to a **hypercoagulable state**, which means an **increased tendency to form blood clots**, not an increased bleeding tendency [1]. - Bleeding disorders are typically associated with deficiencies or dysfunctions in clotting factors or platelets that impair clot formation. *Deficiency of factor V* - The Factor V Leiden mutation is a **gain-of-function mutation** that results in a modified, more active Factor V, not a deficiency of Factor V [1]. - Deficiency of Factor V (known as **parahemophilia**) is a rare bleeding disorder. *Arginine to glycine substitution* - The Factor V Leiden mutation specifically involves a single nucleotide polymorphism leading to an **arginine to glutamine substitution at position 506** (Arg506Gln) in the Factor V protein [1]. - This specific amino acid change alters the cleavage site for activated protein C, making it less effective at inactivating Factor V [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, pp. 133-134.

Q: Which of the following is the most common epithelial tumor of the stomach?

Gastric adenocarcinoma. ***Gastric adenocarcinoma*** - This is the **most common** malignant epithelial tumor of the stomach, accounting for over 90% of all gastric cancers [1], [2]. - It arises from the **glandular epithelial cells** lining the stomach [1]. *GIST* - **Gastrointestinal Stromal Tumors (GISTs)** are mesenchymal tumors, originating from the interstitial cells of Cajal, not epithelial cells [2]. - While they are common **non-epithelial** tumors of the stomach, they are far less frequent than gastric adenocarcinoma [2]. *Sarcoma* - **Sarcomas** are rare **mesenchymal tumors** of the stomach, arising from connective tissues like muscle or fat, not epithelial cells. - They constitute a very small percentage of gastric malignancies. *Carcinoid tumor* - **Carcinoid tumors** are **neuroendocrine tumors** that originate from enterochromaffin-like cells in the stomach. - While they are epithelial in origin, they are much less common than gastric adenocarcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 354-355.

Q: Hyperacute rejection occurs within:-

Minutes to hours. ***Minutes to hours*** - **Hyperacute rejection** is a rapidly occurring complication post-transplant, characterized by its onset within minutes to hours after **organ reperfusion** [1]. - This type of rejection is mediated by pre-formed **recipient antibodies** that recognize donor antigens, leading to immediate graft damage [1]. *12 hours* - While plausible, 12 hours is a bit too broad as **hyperacute rejection** primarily begins much sooner, typically within the first few hours [1]. - This timeframe might overlap with the initial stages of **acute cellular rejection**, which typically occurs days to weeks later [1]. *24 hours* - **Hyperacute rejection** is almost always observed and causes graft failure well before the 24-hour mark, if it is going to happen. - Rejection occurring within this extended period is more indicative of **accelerated acute rejection** rather than true hyperacute rejection. *6 hours* - While hyperacute rejection certainly can occur within 6 hours, "minutes to hours" better captures the immediate onset, often within seconds or minutes [1]. - Some cases of **hyperacute rejection** can be so rapid that the 6-hour mark would be considered a late presentation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 241-242.

Q: Which of the following is a pathognomonic feature of Alzheimer's disease?

Plaques and tangles. ***Plaques and tangles*** - The presence of **amyloid plaques** (extracellular deposits of beta-amyloid protein) and **neurofibrillary tangles** (intracellular aggregates of hyperphosphorylated tau protein) are the defining neuropathological hallmarks of Alzheimer's disease [1]. These are considered **pathognomonic** features upon post-mortem examination. - While other neurological conditions can have some tauopathy or amyloid deposition, the specific combination, distribution, and extensive nature of these two pathologies are unique to Alzheimer's [1]. [3] *Presence of Lewy bodies* - **Lewy bodies** are abnormal aggregates of alpha-synuclein protein that are characteristic of **Parkinson's disease** and **Lewy body dementia** [3]. - Their presence indicates a distinct neurodegenerative process, separate from Alzheimer's disease. *Presence of Pick bodies* - **Pick bodies** are cytoplasmic inclusions composed primarily of tau protein, but they are characteristic of **Pick's disease**, a type of frontotemporal dementia [2]. - Pick's disease has a different clinical presentation and neuropathological profile than Alzheimer's disease [2]. *Red neuronal degeneration (general feature)* - **Red neuronal degeneration** refers to the morphological changes seen in neurons undergoing acute irreversible ischemic injury, such as during a **stroke**. - It is a general feature of acute neuronal death and is not specific to, nor a pathognomonic feature of, Alzheimer's disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1294. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1294-1295. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 721-722.

Q: A 40-year-old immunocompromised patient presents with complaints of dysphagia. UGI endoscopy shows multiple ulcers in distal esophagus. Biopsy was performed and histopathology is shown below. Diagnosis is:

CMV esophagitis. ***CMV esophagitis*** - The image shows a classic "owl's eye" inclusion, which is a characteristic cytopathic effect of **Cytomegalovirus (CMV)** infection. - CMV esophagitis typically causes large, linear ulcers in the distal esophagus of **immunocompromised patients**, matching the patient's presentation. *Candida esophagitis* - This condition presents with white plaques and fuzzy exudates on endoscopy, and biopsy reveals **yeast and pseudohyphae**, which are not seen in the image. - While it occurs in immunocompromised patients, the microscopic findings are distinct from those of CMV. *Herpes esophagitis* - Herpes esophagitis is characterized by multiple, small, punched-out ulcers and microscopic findings of **Cowdry A inclusions** and **multinucleated giant cells**. - The "owl's eye" inclusion seen in the image is not typical for herpes simplex virus infection. *Barrett's esophagus* - Barrett's esophagus is a metaplastic change in the esophageal lining where **squamous epithelium** is replaced by **columnar epithelium with goblet cells**, usually due to chronic GERD. - It does not involve viral inclusions or ulcerations in the manner described in the clinical vignette or depicted in the image.

Q: Bone biopsy specimen is shown below. Diagnosis is:

Paget's disease. ***Paget's disease*** - The image shows a **mosaic pattern of woven and lamellar bone**, with prominent **cement lines** (dark wavy lines). This disorganized bone remodeling is characteristic of Paget's disease. - Paget's disease involves excessive and disorganized bone turnover, leading to structurally abnormal and weakened bone. *Osteomalacia* - Characterized by **deficient mineralization of osteoid**, leading to accumulation of unmineralized matrix. - Histologically, this would present as wide, unmineralized osteoid seams, which are not seen in the image. *Osteoporosis* - Defined by a **reduction in bone mass** and microarchitectural deterioration, leading to increased fracture risk. - Histologically, osteoporosis would show **thinner trabeculae** and **larger marrow spaces**, but the bone itself would be normally mineralized, lacking the disorganized mosaic pattern. *Osteosclerosis* - Refers to an **increase in bone density**, often due to increased bone formation or decreased bone resorption. - While Paget's disease can lead to increased bone density in affected areas, osteosclerosis as a primary diagnosis would typically involve uniformly dense, often thickened bone without the classic mosaic pattern seen here.

Q: Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:

Leiomyoma. ***Leiomyoma*** - Leiomyomas are **benign smooth muscle tumors** of the uterus, characterized by well-demarcated, whorled, and firm cut surfaces [1]. - Histologically, they show bundles of **smooth muscle cells** arranged in fascicles, with minimal atypia and low mitotic activity [1]. *Carcinoma endometrium* - Endometrial carcinoma typically presents as an **irregular, friable mass** originating from the endometrial lining, often with areas of necrosis or hemorrhage. - Histologically, it shows **glandular proliferation** with architectural complexity, nuclear atypia, and often invasion into the myometrium [2]. *Leiomyosarcoma* - Leiomyosarcomas are **malignant smooth muscle tumors** that are often poorly circumscribed, with areas of hemorrhage and necrosis [1]. - Histologically, they exhibit significant **nuclear atypia**, high mitotic activity (often >10 mitoses/10 HPF), and atypical mitoses [1]. *Endometriosis* - Endometriosis involves the presence of **endometrial glands and stroma outside the uterus**, often forming "chocolate cysts" in the ovaries or implants on peritoneal surfaces. - Histology would reveal **endometrial glands and stroma** surrounded by hemosiderin-laden macrophages, not a smooth muscle tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1020-1021.

Question 1

A teenager has a progressively increasing soft reddish swelling on his chest. Its histological appearance is given below. Which of the following is the likely diagnosis?

Accepted Answer

Hemangioma

Answer

Fibroadenoma

Answer

Fibroma

Answer

Lipoma

Question 2

Which of the following is true about factor V leiden mutation?

Accepted Answer

Factor V becomes resistant to cleavage by protein C

Answer

Increased bleeding tendency

Answer

Deficiency of factor V

Answer

Arginine to glutamine substitution

Question 3

Which of the following is the most common epithelial tumor of the stomach?

Accepted Answer

Gastric adenocarcinoma

Answer

GIST

Answer

Sarcoma

Answer

Carcinoid tumor

Question 4

Hyperacute rejection occurs within:-

Accepted Answer

Minutes to hours

Answer

12 hours

Answer

24 hours

Answer

6 hours

Question 5

In rheumatoid arthritis, which type of cells are prominently involved in the pathogenesis?

Accepted Answer

CD4+ helper cells

Answer

Lymphocyte

Answer

Macrophages

Answer

Dendritic cells

Question 6

Absence of differentiation is known as:-

Accepted Answer

Anaplasia

Answer

Dysplasia

Answer

Metaplasia

Answer

Hyperplasia

Question 7

Which of the following is a pathognomonic feature of Alzheimer's disease?

Accepted Answer

Plaques and tangles

Answer

Presence of Lewy bodies

Answer

Presence of Pick bodies

Answer

Red neuronal degeneration

Question 8

A 40-year-old immunocompromised patient presents with complaints of dysphagia. UGI endoscopy shows multiple ulcers in distal esophagus. Biopsy was performed and histopathology is shown below. Diagnosis is:

Accepted Answer

CMV esophagitis

Answer

Candida esophagitis

Answer

Herpes esophagitis

Answer

Barrett's esophagus

Question 9

Bone biopsy specimen is shown below. Diagnosis is:

Accepted Answer

Paget's disease

Answer

Osteomalacia

Answer

Osteoporosis

Answer

Osteosclerosis

Question 10

Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:

Accepted Answer

Leiomyoma

Answer

Carcinoma endometrium

Answer

Leiomyosarcoma

Answer

Endometriosis

NEET-PG 2018 — Pathology