Cytopathology Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Cytopathology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cytopathology Indian Medical PG Question 1: Fine Needle Aspiration Cytology (FNAC) is NOT conclusive in which one of the following thyroid swellings?
- A. Papillary carcinoma thyroid
- B. Follicular carcinoma thyroid (Correct Answer)
- C. Thyroiditis
- D. Medullary carcinoma thyroid
Cytopathology Explanation: ***Follicular carcinoma thyroid***
- FNAC cannot definitively distinguish between a **follicular adenoma** and a **follicular carcinoma** [1].
- This is because the diagnosis of follicular carcinoma relies on the presence of **capsular invasion** or **vascular invasion**, which can only be assessed on **histopathological examination** of the resected specimen, not cytology [1].
*Papillary carcinoma thyroid*
- FNAC is highly effective in diagnosing papillary carcinoma due to characteristic **nuclear features** such as **Orphan Annie eye nuclei**, nuclear grooves, and intranuclear inclusions [3].
- These distinct cytological findings allow for a confident diagnosis without needing to assess invasion [3].
*Thyroiditis*
- FNAC is typically conclusive for diagnosing various forms of thyroiditis (e.g., Hashimoto's thyroiditis, subacute thyroiditis).
- It identifies characteristic inflammatory cells, giant cells, and changes in follicular cells consistent with the diagnosis.
*Medullary carcinoma thyroid*
- Medullary thyroid carcinoma can be reliably diagnosed by FNAC due to its characteristic **polygonal or spindle-shaped cells**, **amyloid deposition**, and presence of **calcitonin** in the aspirate [2].
- Immunocytochemical staining for calcitonin further confirms the diagnosis.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.
[3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.
Cytopathology Indian Medical PG Question 2: Radiation exposure can lead to which type of thyroid carcinoma?
- A. Lymphoma
- B. Papillary carcinoma (Correct Answer)
- C. Medullary carcinoma
- D. Follicular carcinoma
Cytopathology Explanation: ***Papillary carcinoma***
- Papillary thyroid carcinoma is strongly associated with **radiation exposure**, particularly during childhood [1].
- It is the most prevalent type of thyroid cancer and typically has a **good prognosis** [1].
*Lymphoma*
- Thyroid lymphoma is rare and generally not linked to **radiation exposure**; it often presents as a **rapidly enlarging goiter**.
- It is more commonly associated with **autoimmune thyroiditis**, not primary radiation effects.
*Follicular carcinoma*
- Follicular carcinoma shows a correlation with **iodine deficiency** rather than radiation exposure [1].
- Its presentation is more subtle, compared to the classical association of **radiation with papillary carcinoma**.
*Medullary carcinoma*
- Medullary thyroid carcinoma is primarily linked to **familial syndromes** like MEN 2 and not radiation exposure.
- It arises from **parafollicular C cells**, making it clinically distinct from radiation-related types.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099.
Cytopathology Indian Medical PG Question 3: Which statement is incorrect about the pathology of the bone tumor?
- A. Tumor has distinct margin
- B. Tumor arises from epiphyseal to metaphyseal region
- C. Eccentric lesion
- D. Chemotherapy is the treatment of choice for all bone tumors. (Correct Answer)
Cytopathology Explanation: ***Tumor has distinct margin***
- A **distinct margin** often indicates a benign tumor, while malignant tumors typically show **infiltrative margins**.
- In bone tumors, particularly malignant ones, the lack of clear demarcation is a key pathological feature.
*Chemotherapy is the treatment of choice*
- While chemotherapy may be used for certain **malignant bone tumors**, it is not the first-line treatment for most bone tumors [1].
- The primary treatment is often **surgical excision**, especially for localized lesions [1].
*Tumor arise from epiphyseal to metaphyseal region*
- While some tumors can originate in these areas, many actually arise from the **diaphyseal** region in bone tumors like osteosarcoma.
- This option misrepresents the common locations where various tumors develop, as osteochondromas tend to develop near the epiphyses of limb bones [2].
*Eccentric lesion*
- Many bone tumors do indeed present as **eccentric lesions**, especially benign ones like **osteochondromas**.
- However, this feature does not apply universally, as some malignant tumors can also be **central or infiltrative** in nature.
**References:**
[1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 672-673.
Cytopathology Indian Medical PG Question 4: The histological grade best correlates with the prognosis in which one of the following malignancies?
- A. Soft tissue sarcoma (Correct Answer)
- B. Melanoma
- C. Colonic adenocarcinoma
- D. Prostate cancer
Cytopathology Explanation: ***Soft tissue sarcoma***
- **Histological grade is THE MOST IMPORTANT prognostic factor** for soft tissue sarcomas, more significant than size or depth in many cases.
- The **FNCLCC (French Federation of Cancer Centers) grading system** is the gold standard, which grades tumors based on differentiation, mitotic count, and necrosis.
- Grade directly predicts metastatic potential and survival - high-grade sarcomas have significantly worse prognosis than low-grade tumors [2].
- This is consistently emphasized in **WHO classification of soft tissue tumors** and oncology guidelines.
*Colonic adenocarcinoma*
- While histological grade (well, moderate, poorly differentiated) is assessed, **TNM staging** (particularly T stage - depth of invasion, and N stage - lymph node involvement) is far more important for prognosis.
- Stage is the primary determinant of treatment and survival, not grade.
*Melanoma*
- Prognosis is primarily determined by **Breslow thickness** (tumor depth in mm), presence of **ulceration**, and **mitotic rate**.
- Histological grade per se is not the primary prognostic factor - tumor thickness is paramount.
*Prostate cancer*
- Uses the **Gleason score/Grade Group system**, which assesses architectural patterns rather than traditional cytological differentiation [1].
- While the Gleason score is crucial, this is a specific grading system, not conventional "histological grade" as understood in general pathology.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 993-994.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 207-208.
Cytopathology Indian Medical PG Question 5: Which of the following is true about prostate cancer?
- A. Most common region involved is central zone
- B. It is not a hormone dependent cancer
- C. Most common type is squamous cell Carcinoma
- D. Grading is based on Gleason score (Correct Answer)
Cytopathology Explanation: ***Grading is based on Gleason score***
- The **Gleason score** is a widely used system to grade the aggressiveness of prostate cancer based on its microscopic appearance [1].
- It assesses the architectural patterns of the tumor, assigning a grade from 1 to 5 to the two most prevalent patterns, which are then summed to yield a final score (ranging from 2-10), indicating the **prognosis** and guiding treatment [1].
*Most common region involved is central zone*
- The most common region for prostate cancer to develop is the **peripheral zone**, accounting for about 70-80% of cases [1].
- The **central zone** accounts for less than 5% of prostate cancers.
*It is not a hormone dependent cancer*
- Prostate cancer is largely a **hormone-dependent cancer**, with its growth stimulated by androgens like testosterone [1].
- **Androgen deprivation therapy (ADT)** is a cornerstone of prostate cancer treatment, demonstrating its dependency on hormones [1].
*Most common type is squamous cell Carcinoma*
- The most common type of prostate cancer is **adenocarcinoma**, which originates from the glandular cells of the prostate [1].
- **Squamous cell carcinoma** of the prostate is exceedingly rare, accounting for less than 1% of all prostate malignancies.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 988-994.
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