NEET-PG 2024 - Pathology Practice Questions

Q: A male patient is not responding to oxygen therapy and has been diagnosed with ARDS (Acute Respiratory Distress Syndrome). What is the role of IL-8 in ARDS?

Recruitment of neutrophils. Recruitment of neutrophils - **Interleukin-8 (IL-8)**, also known as **CXCL8**, is a powerful **chemotactic cytokine** that primarily attracts and activates neutrophils [3]. - In **ARDS**, this recruitment leads to an influx of neutrophils into the pulmonary interstitium and alveolar spaces, contributing to inflammation and lung injury [1]. *Endothelial cell activation* - While other **cytokines** and inflammatory mediators can activate **endothelial cells** in ARDS [2], IL-8's primary role is not direct endothelial activation but rather **neutrophil chemotaxis** [3]. - **Endothelial cell activation** leads to increased vascular permeability and leukocyte adherence, which is often a consequence of overall inflammation, not solely IL-8 [4]. *Macrophage activation* - **Macrophages** are activated by various stimuli and other **cytokines**, such as **TNF-alpha** and **IFN-gamma**, as part of the inflammatory response. - While macrophages produce IL-8, its main function is not to activate macrophages themselves but to attract **neutrophils**. *Promote surfactant production* - **Surfactant production** is primarily regulated by **Type II pneumocytes** and is often impaired in ARDS due to damage to these cells [1]. - IL-8 is a **pro-inflammatory cytokine** and plays no direct role in promoting surfactant synthesis; in fact, its inflammatory effects can indirectly worsen surfactant dysfunction. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 681. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 679. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Migration in the tissues toward a chemotactic stimulus, pp. 86-87.

Q: An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

Multiple myeloma with increased IgG. ***Multiple myeloma with increased IgG*** - The immunofixation image shows a distinct, *monoclonal band (M spike)* in the **IgG lane (G)**, corresponding to the initial electrophoresis (ELP) M spike [1]. There is also a corresponding band in the **kappa light chain (K)** lane [1]. - The presence of a dominant band in IgG, along with a matching light chain (either kappa or lambda), indicates an **IgG monoclonal gammopathy**, which is characteristic of the most common type of multiple myeloma [1]. *Multiple myeloma with increased IgM* - This option would correspond to a strong, monoclonal band in the **IgM lane (M)**, which is not the case here. The 'M' lane in the image shows a faint/normal band, not an increased M spike. - Increased IgM monoclonal protein (M spike) is characteristic of **Waldenström macroglobulinemia**, not typically multiple myeloma [2]. *Multiple myeloma with increased IgA* - If the patient had IgA multiple myeloma, there would be a prominent monoclonal band in the **IgA lane (A)**, which is not observed in this immunofixation result. The 'A' lane shows a considerably smaller band compared to IgG. - IgA multiple myeloma is a less common subtype than IgG myeloma and would present with an IgA M spike [1]. *Waldenström macroglobulinemia* - Waldenström macroglobulinemia is characterized by a monoclonal gammopathy of the **IgM type**, which would present as a distinct M spike in the IgM lane [2]. - The immunofixation clearly shows an **IgG M spike**, ruling out Waldenström macroglobulinemia based on the type of monoclonal gammopathy [2]. **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. 608-609. [2] 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. 606-607.

Q: Which of the following is an intracellular marker or deposition found in Alzheimer's disease?

Tau protein. ***Tau protein*** - **Tau protein** forms **neurofibrillary tangles** within the neurons, which is a hallmark intracellular lesion in Alzheimer's disease [1]. - These tangles disrupt neuronal transport systems, leading to **synaptic dysfunction** and cell death [1]. *A ̢ 40 / 42 (Amyloid-beta 40/42)* - **Amyloid-beta** peptides aggregate to form **extracellular amyloid plaques**, not intracellular deposits, in Alzheimer's disease [2]. - While central to the pathology, these **plaques** are found outside of the neurons in the brain parenchyma [2]. *Alpha-synuclein* - **Alpha-synuclein** is the primary component of **Lewy bodies**, which are intracellular inclusions characteristic of Parkinson's disease and Lewy body dementia. - It is not a primary marker for Alzheimer's disease pathology. *TDP-43* - **TDP-43 (TAR DNA-binding protein 43)** inclusions are characteristic of **frontotemporal lobar degeneration (FTLD)** and amyotrophic lateral sclerosis (ALS). - While sometimes co-occurs with Alzheimer's, it is not a primary or defining intracellular marker for Alzheimer's disease itself. **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. 1290-1292.

Question 1

A male patient is not responding to oxygen therapy and has been diagnosed with ARDS (Acute Respiratory Distress Syndrome). What is the role of IL-8 in ARDS?

Accepted Answer

Recruitment of neutrophils

Answer

Endothelial cell activation

Answer

Macrophage activation

Answer

Promote surfactant production

Question 2

Identify the diagnosis from the given image

Accepted Answer

Malakoplakia

Answer

TB

Answer

BCC

Answer

Drug induced lesion

Question 3

An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

Accepted Answer

Multiple myeloma with increased IgG

Answer

Multiple myeloma with increased IgM

Answer

Multiple myeloma with increased IgA

Answer

Waldenström macroglobulinemia

Question 4

Which of the following is an intracellular marker or deposition found in Alzheimer's disease?

Accepted Answer

Tau protein

Answer

A β 40 / 42 (Amyloid-beta 40/42)

Answer

Alpha-synuclein

Answer

TDP-43

Question 5

A child presenting with leukocoria has an intraocular mass. Microscopic examination shows rosettes with scanty cytoplasm and positive synaptophysin. What is the most likely diagnosis?

Accepted Answer

Retinoblastoma

Answer

Medulloblastoma

Answer

Neuroblastoma

Answer

Ependymoma

Question 6

A 40-year-old female presents with an irregular 5 × 6 cm mass in the right breast. Histopathological examination reveals the image shown. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Invasive ductal carcinoma

Answer

Intraductal papilloma

NEET-PG 2024 — Pathology