NEET-PG 2017 - Pathology PYQs Practice Questions

Q: A 32-year-old male with a history of klebsiella infection presents with right upper quadrant pain and on performing cholecystectomy the following stones were seen. All the following statements are true regarding this condition except: (Recent NEET Pattern 2016-17)

It is composed of calcium palmitate. ***It is composed of calcium palmitate*** - The gallstones formed in the context of **Klebsiella infection** and **beta-glucuronidase** activity are typically **pigment stones**, specifically **brown pigment stones** [1]. - Brown pigment stones are primarily composed of **calcium bilirubinate** and not calcium palmitate . *This condition is a resultant of secretion of beta glucuronidase* - **Bacterial infection**, particularly with *Klebsiella*, can lead to the production of **beta-glucuronidase** [1]. - This enzyme deconjugates **bilirubin glucuronide** in bile, making it insoluble and promoting the formation of **calcium bilirubinate stones** [1]. *Initiating factor could be ascaris worm* - **Parasitic infections**, such as those by **Ascaris lumbricoides**, can act as a nidus for stone formation in the biliary tree. - The presence of the worm or its eggs can lead to **biliary stasis** and recurrent infections, contributing to pigment stone formation. *This is radiolucent in nature* - **Pigment gallstones**, including brown pigment stones, are generally **radiolucent** on plain X-rays. - This is because they contain little to no calcium carbonate, which is required for radiopacity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 882-883. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 882. [Practice more Pathology PYQs on OnCourse]

Q: Identify the types of gastric ulcers labeled A and B in the image below.

A=Benign gastric ulcer, B=Malignant gastric ulcer. ***A=Benign gastric ulcer, B=Malignant gastric ulcer*** - Image A shows a **punched-out**, **clean-based ulcer** with radiating folds, characteristic features of a **benign gastric ulcer**. - Image B depicts an **irregular**, **raised-edge ulcer** with a necrotic base, which is typical of a **malignant gastric ulcer** [1]. *A=Malignant gastric ulcer, B=Benign gastric ulcer* - Image A's features (smooth, punched-out) are inconsistent with a **malignant ulcer**, which is typically irregular and raised [1]. - Image B's features (irregular, raised, necrotic) are not consistent with a **benign ulcer**, which is usually clean and well-demarcated. *A=Leiomyoma, B=Malignant gastric ulcer* - A **leiomyoma** is a submucosal tumor, usually presenting as a smooth, firm mass, not an ulcerated lesion like in Image A. - Image B is consistent with a **malignant gastric ulcer** [1], but Image A is not a leiomyoma. *A=Chronic hyperplastic gastritis, B=Malignant gastric ulcer* - **Chronic hyperplastic gastritis** involves thickened gastric folds and inflammation, not a discrete ulceration as seen in Image A. - While Image B is consistent with a **malignant gastric ulcer** [1], Image A does not represent chronic hyperplastic gastritis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779. [Practice more Pathology PYQs on OnCourse]

Q: A 20-year-old college student presents with 7 day history of nausea and feeling feverish. He has tenderness in right upper quadrant and admits to high risk sexual behavior. The liver biopsy marking $X$ shows:

Councilman body. ***Councilman body*** - The clinical presentation (nausea, fever, RUQ tenderness, high-risk sexual behavior) is highly suggestive of **acute viral hepatitis**, likely **Hepatitis B** given the risk factors. - **Councilman bodies** (also known as **apoptotic bodies**) are characteristic findings in acute viral hepatitis, representing **apoptotic hepatocytes** [1]. *Mallory hyaline body* - **Mallory bodies** (or **Mallory-Denk bodies**) are typically seen in **alcoholic hepatitis** and other forms of **chronic liver injury**, not acute viral hepatitis [2]. - They are composed of **intermediate filaments** (cytokeratins) and other proteins, indicating hepatocyte damage. *Russell body* - **Russell bodies** are **eosinophilic inclusions** found within the cytoplasm of **plasma cells**, representing **accumulations of immunoglobulins**. - They are associated with conditions involving plasma cell proliferation, such as **multiple myeloma**, and are not a feature of acute viral hepatitis. *Normal kupffer cell* - **Kupffer cells** are **resident macrophages** of the liver and are normally present in the sinusoids. - While they play a role in inflammation, their presence alone as "normal" does not represent the specific pathological change expected in acute viral hepatitis, which is hepatocyte apoptosis [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 386-387. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 389-390. [Practice more Pathology PYQs on OnCourse]

Q: A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Does not invade the tunica. ***Does not invade the tunica*** - This statement is incorrect. **Seminomas**, which are common in undescended testes, often **invade the tunica albuginea** and rete testis. - Invasion of the tunica is a common feature of testicular germ cell tumors, including seminoma, and is an important prognostic factor. *Tumor maintains the testis contour* - **Seminomas** typically grow as a large, homogeneous mass that can **replace the testicular parenchyma** but often maintains the overall contour of the testis. - The tumor expands within the tunica albuginea, leading to an enlarged but often still ovoid shape of the testis. *Necrosis commonly starts from center of tumor* - **Necrosis** is a common feature in larger **seminomas**, and it typically starts in the **center of the tumor** due to inadequate blood supply as the tumor outgrows its vascularization. - This central necrosis can lead to cystic degeneration within the tumor. *PAS positive tumor cells in sheets* - **Seminoma cells** are typically rich in **glycogen**, which stains **PAS (Periodic Acid-Schiff) positive** [1]. - These cells are characteristically arranged in **sheets or lobules** separated by delicate fibrovascular septa, often with a prominent lymphocytic infiltrate [1]. **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. 980-982. [Practice more Pathology PYQs on OnCourse]

Q: A 50-year-old woman presents with daily early morning frontal headache and projectile vomiting. The image shows:

Meningioma. **Meningioma** - The MRI shows a **well-circumscribed, extra-axial mass** that is significantly enhancing, particularly in the frontal lobe near the convexity. Histopathology of a meningioma characteristically features **whorls of meningothelial cells** and **psammoma bodies** (calcified concentric lamellae), which are visible in the image. - The clinical symptoms of **early morning headaches** and **projectile vomiting** are indicative of **increased intracranial pressure**, which can be caused by any space-occupying lesion, including a meningioma, especially if it grows to a significant size. *Medulloblastoma* - This is a highly malignant brain tumor typically occurring in the **cerebellum of children**, not usually seen in a 50-year-old woman in the frontal lobe. - Histologically, medulloblastomas are composed of small, round, **blue cells** with little cytoplasm (small blue cell tumor), which is distinct from the provided image. *Glioma* - **Gliomas** originate within the brain parenchyma and are often **poorly circumscribed** with an infiltrative growth pattern, which contrasts with the well-defined lesion seen on MRI. - While gliomas can cause increased intracranial pressure, their diverse histological appearances depend on their specific subtype (e.g., astrocytoma, oligodendroglioma), none of which perfectly match the characteristic **whorls and psammoma bodies** seen here. *Glioblastoma multiforme* - **Glioblastoma multiforme** (GBM) is a highly aggressive grade IV astrocytoma, characterized by **ring-enhancing lesions** with central necrosis and significant edema on MRI. - Histologically, GBM exhibits features like **pseudopalisading necrosis**, microvascular proliferation, and pleomorphic tumor cells, which are not depicted in the provided histopathology image. [Practice more Pathology PYQs on OnCourse]

Question 1

A 32-year-old male with a history of klebsiella infection presents with right upper quadrant pain and on performing cholecystectomy the following stones were seen. All the following statements are true regarding this condition except: (Recent NEET Pattern 2016-17)

Accepted Answer

It is composed of calcium palmitate

Answer

This condition is a resultant of secretion of beta glucuronidase

Answer

Initiating factor could be ascaris worm

Answer

This is radiolucent in nature

Question 2

Identify the types of gastric ulcers labeled A and B in the image below.

Accepted Answer

A=Benign gastric ulcer, B=Malignant gastric ulcer

Answer

A=Malignant gastric ulcer, B=Benign gastric ulcer

Answer

A=Leiomyoma, B=Malignant gastric ulcer

Answer

A=Chronic hyperplastic gastritis, B=Malignant gastric ulcer

Question 3

A 20-year-old college student presents with 7 day history of nausea and feeling feverish. He has tenderness in right upper quadrant and admits to high risk sexual behavior. The liver biopsy marking $X$ shows:

Accepted Answer

Councilman body

Answer

Mallory hyaline body

Answer

Russell body

Answer

Normal kupffer cell

Question 4

A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Accepted Answer

Does not invade the tunica

Answer

Tumor maintains the testis contour

Answer

Necrosis commonly starts from center of tumor

Answer

PAS positive tumor cells in sheets

Question 5

A 50-year-old woman presents with daily early morning frontal headache and projectile vomiting. The image shows:

Accepted Answer

Meningioma

Answer

Medulloblastoma

Answer

Glioma

Answer

Glioblastoma multiforme

Question 6

A 3-year-old child has presented with abdominal lump and peculiar appearance of eyes. All genes are responsible for development of this condition except:

Accepted Answer

K-ras gene

Answer

WT1

Answer

P53

Answer

Beta-catenin

Question 7

A 3-year-old child presents with bleeding from nose and Periorbital Ecchymosis. Sternal tenderness and bone pain is present. Peripheral smear shows presence of fragmented RBC and helmet cells. The most probable diagnosis is? (Recent NEET Pattern 2016-17)

Accepted Answer

Acute myeloid Leukemia

Answer

Acute Idiopathic thrombocytopenic purpura

Answer

Hemophilia A

Answer

Battered baby syndrome

Question 8

A 2-year-old child presents with growth retardation, pallor, bruising and has palpable spleen 5 cm below left costal margin. Bone marrow examination is shown below. Which is incorrect about the clinical diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Defect on chromosome 3

Answer

Glucosylceramide accumulation in reticulo-endothelial cells

Answer

Bleeding episodes

Answer

Erlenmeyer flask deformity of the distal femur

Question 9

A 30-year-old AIDS patient presents with complaints as shown below. All are true about the condition except?

Accepted Answer

Benign tumor

Answer

Vascular tumor

Answer

Not seen in transfusion related AIDS

Answer

HHV 8

Question 10

A 32-year-old woman with a history of multiple hamartomas scattered throughout the small intestine presents to a physician for follow-up. All are true about her diagnosis except?

Accepted Answer

Autosomal recessive

Answer

STK-11 gene mutation

Answer

Polyps in jejunum

Answer

Morbidity due to intestinal obstruction

NEET-PG 2017 — Pathology