NEET-PG 2022 - Pathology PYQs Practice Questions

Q: What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

Immature B cells. ***Immature B cells*** - B acute lymphoblastic leukemia (B ALL) is primarily derived from the **malignant transformation of precursor B lymphocytes** [1]. - The disease is characterized by the presence of **immature B cell blasts** in the bone marrow and peripheral blood [1]. *T cells* - T cells are involved in a different lineage of leukemia known as T-ALL, not B ALL [1]. - The pathophysiology of B ALL specifically relates to **B cell precursors**, not T cell involvement. *Both T & B cells* - This option is incorrect as B ALL specifically originates from **B cell lineage**, and T cells are unrelated to its pathogenesis [1]. - The presence of both T and B cells together characterizes mixed lineage leukemias, which is not the case here. *Immature T cells* - Immature T cells are precursors for **T acute lymphoblastic leukemia (T-ALL)**, not for B ALL [1]. - B ALL does not involve T cell precursors; the focus is solely on **immature B cells** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 596-600. [Practice more Pathology PYQs on OnCourse]

Q: All of the following statements are true regarding neutrophil extracellular trapping (NET) except for which of the following?

Mitochondrial DNA is seen. ***Mitochondrial DNA is seen*** - NETs (Neutrophil Extracellular Traps) are made primarily of **nuclear chromatin**, not mitochondrial DNA [2]. - The main purpose of NETs is to trap and kill pathogens, focusing on **nuclear genetic material** rather than mitochondrial components. *It is detected in blood during sepsis* - NETs can indeed be found in the **circulation during sepsis**, serving as a defense mechanism against infections. - Their presence in blood indicates an **active immune response**, particularly in severe systemic infections. *It is produced in response to bacterial infection* - NET formation is a known response to **bacterial infections**, as neutrophils deploy them to capture and neutralize pathogens. - This process helps in controlling infections, showcasing the importance of NETs in **innate immunity**. *It is chromatin with antibacterial enzymes* - NETs consist primarily of **decondensed chromatin**, embedded with **antimicrobial proteins** and enzymes to combat pathogens [1][2]. - This characteristic underscores their role in targeting and eliminating invading microorganisms effectively. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 91-92. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 92-93. [Practice more Pathology PYQs on OnCourse]

Q: A child presents with recurrent chest infections and abdominal pain. There is a history of 1 blood transfusion in the past. On examination, he had icterus and mild splenomegaly. Electrophoresis shows increased HbA2, HbF, and S spike. What is the likely diagnosis?

Sickle Beta Thalassemia. ***Sickle Beta Thalassemia*** - The combination of **sickle cell disease manifestations** (recurrent chest infections, abdominal pain, icterus, splenomegaly) with **electrophoresis showing increased HbA2, elevated HbF, and S spike** is diagnostic of **Sickle Beta Thalassemia**. - **Increased HbA2 (>3.5%)** is the key distinguishing feature that differentiates this from pure sickle cell disease. It indicates co-inheritance of a **beta-thalassemia gene** along with the **sickle cell gene**. - Clinical presentation is similar to sickle cell disease with **vaso-occlusive crises**, **acute chest syndrome**, hemolytic anemia, and organomegaly. - The severity depends on the type: S/β⁰-thalassemia (no HbA production) is clinically more severe and similar to SS disease, while S/β⁺-thalassemia (reduced HbA) tends to be milder. *Sickle cell disease* - Pure sickle cell disease (HbSS) presents with similar clinical features: recurrent chest infections, abdominal pain, hemolysis, and splenomegaly. - However, electrophoresis would show **normal or only slightly elevated HbA2 (2-3%)**, not the increased HbA2 mentioned in this case. - The presence of significantly increased HbA2 rules out pure sickle cell disease. *HbC disease* - Patients with HbC disease typically have **mild chronic hemolytic anemia** and **splenomegaly** but usually lack severe vaso-occlusive crises. - Electrophoresis would show primarily **HbC**, not an S spike. - The clinical picture is much milder than described in this case. *Aplastic anemia* - Characterized by **pancytopenia** due to bone marrow failure, leading to fatigue, infections, and bleeding tendency. - Does not involve hemolysis, icterus, or abnormal hemoglobin variants on electrophoresis. - The electrophoresis findings completely exclude this diagnosis. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following is most likely to be seen due to the rupture of a saccular aneurysm?

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - A **saccular aneurysm** (often a **berry aneurysm**) commonly ruptures into the **subarachnoid space**, causing bleeding around the brain [2]. - This leads to a sudden onset of a "thunderclap headache," **meningeal irritation**, and neurological deficits [1]. *Subdural hemorrhage* - A **subdural hemorrhage** is typically caused by the tearing of **bridging veins** between the dura and arachnoid mater, often due to **trauma** [3]. - While it can occur, it is a less common direct consequence of saccular aneurysm rupture compared to subarachnoid hemorrhage. *Intracerebral hemorrhage* - An **intracerebral hemorrhage** involves bleeding directly into the brain parenchyma, most often due to **hypertension** or **amyloid angiopathy**. - Although a ruptured aneurysm can rarely extend into the brain tissue, the primary initial bleeding is usually into the subarachnspace [4]. *Hydrocephalus* - **Hydrocephalus** can be a *complication* of a subarachnoid hemorrhage, resulting from impaired CSF reabsorption or obstruction of CSF flow due to blood clots. - However, it is not the *initial event* caused directly by the rupture of a saccular aneurysm [4]. [Practice more Pathology PYQs on OnCourse]

Q: A middle aged male patient presents with painless slow growing neck swelling. On examination, lymph nodes are positive. Surgery is done and biopsy is shown in the image below. Which of the following is false regarding the HPE findings?

FNAC is not diagnostic. ***Fine needle aspiration cytology (FNAC) is not diagnostic*** - FNAC can often provide significant insights, but in cases of **specific malignancies** or certain lesions, it may not yield definitive diagnoses [1]. - Diagnostic challenges arise as **cellular architecture** or certain **nuclear features** may not be appreciated in FNAC samples [1]. *It spreads quickly via lymphatics* - This condition can indeed spread via lymphatics, making it **aggressive** in nature [1]. - **Lymphatic spread** is a common pathway for many head and neck conditions, particularly malignancies [1]. *Excellent prognosis is associated with this condition* - While some conditions may have favorable prognoses, many midline neck lesions can have **serious implications** depending on their nature [1]. - Prognosis often varies widely and may not always be classified as **excellent** based solely on initial presentation [1]. *Nuclear characteristics are used for the identification* - Nuclear morphology is critical for identifying various **neoplastic conditions**, aiding in differentiation from benign lesions [1][2]. - Many pathologies, especially those involving **malignancy**, rely heavily on **nuclear features** for accurate diagnosis [1][2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1101-1102. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101. [Practice more Pathology PYQs on OnCourse]

Question 1

What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

Accepted Answer

Immature B cells

Answer

T cells

Answer

Immature T cells

Answer

Both T & B cells

Question 2

All of the following statements are true regarding neutrophil extracellular trapping (NET) except for which of the following?

Accepted Answer

Mitochondrial DNA is seen

Answer

It is detected in blood during sepsis

Answer

It is chromatin with antibacterial enzymes

Answer

It is produced in response to bacterial infection

Question 3

A child presents with recurrent chest infections and abdominal pain. There is a history of 1    blood transfusion in the past. On examination, he had icterus and mild splenomegaly.    Electrophoresis shows increased HbA2, HbF, and S spike. What is the likely diagnosis?

Accepted Answer

Sickle Beta Thalassemia

Answer

HbC disease

Answer

Sickle cell disease

Answer

Aplastic anemia

Question 4

Which of the following is most likely to be seen due to the rupture of a saccular aneurysm?

Accepted Answer

Subarachnoid hemorrhage

Answer

Subdural hemorrhage

Answer

Intracerebral hemorrhage

Answer

Hydrocephalus

Question 5

A middle aged male patient presents with painless slow growing neck swelling. On examination, lymph nodes are positive. Surgery is done and biopsy is shown in the image below. Which of the following is false regarding the HPE findings?

Accepted Answer

FNAC is not diagnostic

Answer

Spread is through lymphatics

Answer

Nuclear features are the characteristic of this tumor

Answer

It has excellent prognosis

NEET-PG 2022 — Pathology