NEET-PG 2023 - Pathology PYQs Practice Questions

Q: A primary structural defect of an organ resulting from an intrinsically abnormal developmental process is termed as:

Malformation. ***Malformation*** - Refers to a **primary structural defect** present at birth, arising during development, leading to abnormal organ structure. - Typically involves intrinsic factors and can affect any organ or system, making it a key category of congenital anomalies. *Association* - Describes a **non-random occurrence** of two or more anomalies but does not indicate a structural defect of a specific organ. - Does not imply a direct defect, as it can occur without an **underlying structural issue** in a particular organ. *Deformation* - Refers to a change in the **shape or structure** of a normally formed organ or body part due to an external force rather than an intrinsic defect [1]. - Examples include clubfoot or positional plagiocephaly, which are not classified as malformations [1]. *Disruption* - Involves the breakdown of an originally normal tissue or organ due to extrinsic factors, leading to secondary structural defects. - Not inherent to the embryological development process itself, differentiating it from intrinsic faults like malformations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 460-462. [Practice more Pathology PYQs on OnCourse]

Q: A five-year-old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most likely be associated with these symptoms?

Multiple localized whorls of connective tissue. ***Multiple localized whorls of connective tissue*** - This constellation of symptoms (precocious puberty, hyperpigmented macules with irregular margins, and bony abnormalities) is characteristic of **McCune-Albright syndrome** [1]. - The bony abnormality associated with McCune-Albright syndrome is **fibrous dysplasia**, which is characterized by the replacement of normal bone with **fibrous tissue** and immature woven bone, often described as localized whorls of connective tissue [1]. *A combination of osteitis fibrosa cystica and osteomalacia* - **Osteitis fibrosa cystica** is associated with severe **hyperparathyroidism**, leading to bone resorption and cyst formation. - **Osteomalacia** results from defective mineralization of bone due to **vitamin D deficiency** or phosphate wasting, neither of which comprehensively explains the given symptoms. *A generalized thinning of bony spicules* - This description is characteristic of **osteoporosis**, a condition of reduced bone mass and structural deterioration, leading to increased fracture risk. - Osteoporosis is typically seen in older adults and is not directly associated with precocious puberty or café-au-lait spots. *Excessive bony deposition with obliteration of marrow* - This describes **osteopetrosis** (Albers-Schönberg disease), a genetic disorder characterized by abnormally dense bones due to defective osteoclast function. - While it affects bone, its presentation does not include precocious puberty or hyperpigmented macules. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1208-1209. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following is a potential complication of blood transfusion?

Hyperkalemia. ***Hyperkalemia*** - Stored red blood cells can release **intracellular potassium** into the storage solution, leading to elevated potassium levels in transfused blood. - Rapid or massive transfusions deliver a significant potassium load, potentially causing **cardiac arrhythmias**. *Hyponatremia* - This is generally not a direct complication of blood transfusions; instead, blood products themselves contain electrolytes, and massive transfusion can disrupt electrolyte balance, but usually not to cause hyponatremia. - Volume overload from transfusion could dilute existing electrolytes, but most commonly, other electrolyte imbalances such as hyperkalemia or hypocalcemia occur. *Hypercalcemia* - Often, the opposite, **hypocalcemia**, is a complication of massive transfusion due to **citrate toxicity**. - Citrate, an anticoagulant in transfused blood, chelates calcium, reducing free calcium levels in the recipient. *Increased serum albumin* - Blood transfusions primarily administer **red blood cells**, plasma, or platelets, not typically albumin in amounts that would significantly increase serum albumin levels in the absence of an albumin-specific infusion [1]. - Low albumin (hypoalbuminemia) is a common finding in critically ill patients, and a blood transfusion usually doesn't correct this unless plasma or albumin is specifically administered [1]. [Practice more Pathology PYQs on OnCourse]

Q: An elderly male is known as a smoker presented with chronic cough, significant weight loss, and fatigue. Serum calcium level is raised. A lung biopsy was done, and it showed large atypical cells with hyperchromasia. What is the probable diagnosis?

Large cell carcinoma. ***Squamous cell carcinoma*** - The presence of **hyperchromatic atypical cells** in the lung biopsy [2] and **elevated serum calcium levels** are indicative of paraneoplastic hypercalcemia often seen in squamous cell carcinoma. - This type of lung cancer typically occurs in **smokers** [1] and is associated with **chronic cough** and **weight loss**. *Large cell neuroendocrine tumor* - While it may show large atypical cells, this tumor type is less commonly associated with **hypercalcemia** or the smoking history highlighted here. - Characteristically, it tends to have a more aggressive course and distinct histological features not indicated in the vignette. *Small cell carcinoma* - This type typically presents with **central lung lesions** and is associated with secretory syndromes like **SIADH**, not hypercalcemia. - Histologically, it features small round blue cells rather than the large atypical cells described in this case. *Adenocarcinoma* - Often arises peripherally in the lung and typically does not present with hypercalcemia. - Histological features include **gland formation**, which contrasts with the **large atypical cells** noted in the biopsy. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 723-724. [Practice more Pathology PYQs on OnCourse]

Q: A child presents with intermittent jaundice and splenomegaly. There is a history of similar complaints in the elder brother. Peripheral smear shows the following finding. What is the most appropriate investigation for this condition?

Osmotic fragility test. ***Osmotic fragility test*** - The image shows **spherocytes** (dense, small red cells lacking central pallor), a hallmark of **hereditary spherocytosis**. The clinical picture of intermittent jaundice, splenomegaly, and a family history further supports this diagnosis. - The **osmotic fragility test** measures the red blood cell's susceptibility to hemolysis in hypotonic solutions and is the most appropriate test to confirm hereditary spherocytosis. *Coombs test* - The Coombs test (direct antiglobulin test) detects **antibodies on the surface of red blood cells** or in the serum. It is primarily used to diagnose **autoimmune hemolytic anemia**. - Hereditary spherocytosis is a membrane defect, not an immune-mediated condition, so the Coombs test would typically be negative. *G6PD deficiency testing* - **Glucose-6-phosphate dehydrogenase (G6PD) deficiency** leads to episodic hemolytic anemia triggered by oxidative stress (e.g., fava beans, certain drugs, infections). - While it causes episodic hemolysis and jaundice, the peripheral smear typically shows **Heinz bodies** and **bite cells** during hemolytic episodes, not spherocytes, and without specific triggers, it doesn't fit the clinical picture as well as hereditary spherocytosis. *Flow cytometry for PNH* - **Flow cytometry** is used to diagnose **paroxysmal nocturnal hemoglobinuria (PNH)** by detecting the absence of GPI-anchored proteins (e.g., CD55, CD59) on blood cells. - PNH is characterized by dark urine (hemoglobinuria), thrombosis, and bone marrow failure, and its peripheral smear does not typically show spherocytes. [Practice more Pathology PYQs on OnCourse]

Question 1

A primary structural defect of an organ resulting from an intrinsically abnormal developmental process is termed as:

Accepted Answer

Malformation

Answer

Disruption

Answer

Deformation

Answer

Association

Question 2

A five-year-old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most likely be associated with these symptoms?

Accepted Answer

Multiple localized whorls of connective tissue

Answer

Excessive bony deposition with obliteration of marrow

Answer

A combination of osteitis fibrosa cystica and osteomalacia

Answer

A generalized thinning of bony spicules

Question 3

Which of the following is a potential complication of blood transfusion?

Accepted Answer

Hyperkalemia

Answer

Hyponatremia

Answer

Hypercalcemia

Answer

Increased serum albumin

Question 4

An elderly male is known as a smoker presented with chronic cough, significant weight loss, and fatigue. Serum calcium level is raised. A lung biopsy was done, and it showed large atypical cells with hyperchromasia. What is the probable diagnosis?

Accepted Answer

Large cell carcinoma

Answer

Small cell lung carcinoma

Answer

Squamous cell carcinoma

Answer

Lung adenocarcinoma

Question 5

A child presents with intermittent jaundice and splenomegaly. There is a history of similar complaints in the elder brother. Peripheral smear shows the following finding. What is the most appropriate investigation for this condition?

Accepted Answer

Osmotic fragility test

Answer

Coombs test

Answer

G6PD deficiency testing

Answer

Flow cytometry for PNH

Question 6

A 5-year-old child was admitted to the hospital for a prolapsing rectal mass and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. What is the likely diagnosis?

Accepted Answer

Juvenile polyp (Hamartoma)

Answer

Adenoma (precancerous lesion in adults)

Answer

Carcinoma (malignant tumor, rare in children)

Answer

Choristoma (benign growth of normal tissue in an abnormal location)

NEET-PG 2023 — Pathology