INI-CET 2026 - Pathology PYQs Practice Questions

Q: Which of the following vasculitis is NOT classified as a medium-vessel disease?

Microscopic polyangiitis (MPA). ***Microscopic polyangiitis (MPA)*** - This condition is classified as a **small-vessel vasculitis** because it primarily affects capillaries, venules, and arterioles. - It is strongly associated with **p-ANCA** and typically presents as a pauci-immune necrotizing vasculitis without granulomatous inflammation. *Polyarteritis nodosa (PAN)* - This is a classic example of a **medium-vessel vasculitis** characterized by necrotizing inflammation of medium-sized muscular arteries. - It typically spares the **pulmonary circulation** and is often associated with **Hepatitis B** infection. *Buerger's disease (Thromboangiitis obliterans)* - This is considered a **medium-vessel vasculitis** (or sometimes small-to-medium) that affects the arteries and veins of the extremities. - It is strongly associated with **tobacco use** and leads to segmental, thrombotic, occlusive inflammation. *Kawasaki disease* - This is a well-known **medium-vessel vasculitis** affecting children, classically causing mucocutaneous lymph node syndrome. - A major clinical concern with this disease is the development of **coronary artery aneurysms** due to its affinity for medium-sized vessels. [Practice more Pathology PYQs on OnCourse]

Q: A 12-year-old presents with hypertension and hematuria. Serum C3 is raised. Renal biopsy shows subepithelial hump deposits on EM. What is the most likely diagnosis?

Post-streptococcal glomerulonephritis (PSGN). ***Post-streptococcal glomerulonephritis (PSGN)*** - The presentation of **hematuria** and **hypertension** in a child, combined with the classic **subepithelial humps** seen on electron microscopy, is pathognomonic for **PSGN**. - While typically associated with low C3, transient elevations can sometimes occur, or perhaps the prompt implies the classic finding of immune complex deposition; however, clinically, the **subepithelial humps** are the hallmark feature. *Goodpasture syndrome* - This condition involves **anti-glomerular basement membrane (anti-GBM) antibodies** targeting type IV collagen, typically presenting with **pulmonary hemorrhage** and **rapidly progressive glomerulonephritis**. - Renal biopsy classically shows **linear IgG deposition** on immunofluorescence rather than the **subepithelial humps** seen in PSGN. *Membranous glomerulonephritis* - This presents as **nephrotic syndrome** (not nephritic) and is characterized by **diffuse capillary wall thickening** and **subepithelial deposits** that form a 'spike and dome' pattern. - It is more common in adults and is frequently associated with conditions like **SLE**, **hepatitis B**, or **malignancy**. *Minimal change disease* - This is the most common cause of **nephrotic syndrome** in children, typically presenting with **edema** and severe proteinuria without hypertension or hematuria. - Renal biopsy shows normal light microscopy and **effacement of podocyte foot processes** on electron microscopy, with no deposits. [Practice more Pathology PYQs on OnCourse]

Q: A patient with long-standing chronic inflammatory disease develops systemic amyloidosis. Which amyloid protein subtype is characteristically deposited?

AA. ***AA amyloidosis*** - Occurs secondary to **chronic inflammatory conditions** (e.g., rheumatoid arthritis, osteomyelitis, inflammatory bowel disease) due to elevated levels of **serum amyloid A (SAA)** protein, an acute-phase reactant. - The SAA protein is synthesized by the liver and undergoes misfolding and deposition in tissues, typically affecting the **kidneys, spleen, and liver**. *ATTR amyloidosis* - This subtype is associated with **transthyretin (TTR)**, a protein produced in the liver that transports thyroxine and retinol binding protein. - It is predominantly linked to **familial amyloid polyneuropathy** or age-related systemic senile amyloidosis, rather than chronic inflammation. *Abeta2m amyloidosis* - Involves the deposition of **beta-2 microglobulin**, a component of the MHC class I molecule. - This subtype is characteristically seen in patients with **end-stage renal disease** who have undergone long-term **hemodialysis**, as the protein is not effectively filtered out. *AL amyloidosis* - Involves the deposition of **amyloid light chain** proteins derived from immunoglobulin light chains. - This is associated with **plasma cell dyscrasias**, such as **multiple myeloma**, rather than chronic inflammation. [Practice more Pathology PYQs on OnCourse]

Q: A patient presents with Hb 8 g/dL, MCV 62 fL, and low serum ferritin. Which type of anemia is most likely?

Iron deficiency anemia. ***Iron deficiency anemia*** - The combination of **microcytic anemia** (low MCV) and **low serum ferritin** is diagnostic for iron deficiency anemia, representing the body's depleted iron stores. - This is the most common cause of microcytic anemia, typically resulting from chronic blood loss, poor dietary intake, or malabsorption. *Sideroblastic anemia* - Characterized by inadequate utilization of iron for heme synthesis, usually leading to **high serum ferritin** and iron overload, rather than low, due to iron deposition in mitochondria. - Often shows **ringed sideroblasts** in the bone marrow, a classic feature that distinguishes it from iron deficiency. *Megaloblastic anemia* - Presents with **macrocytic anemia** (high MCV), not microcytic, due to impaired DNA synthesis (e.g., Vitamin B12 or folate deficiency). - The presence of **hypersegmented neutrophils** on a peripheral blood smear is a hallmark feature, which is not present in microcytic cases. *Aplastic anemia* - A **normocytic (or macrocytic)** anemia caused by bone marrow failure and pancytopenia, not typically microcytic. - Serum ferritin levels in aplastic anemia are usually **elevated** due to ineffective erythropoiesis and frequent blood transfusions. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following is an INCORRECT pairing of virus and associated malignancy?

CMV - Nasopharyngeal carcinoma. ***CMV - Nasopharyngeal carcinoma*** - **Cytomegalovirus (CMV)** is a herpesvirus that commonly causes **mononucleosis-like syndrome** in immunocompromised patients but is not oncogenic and not associated with **nasopharyngeal carcinoma**. - The correct association for **nasopharyngeal carcinoma** is **Epstein-Barr virus (EBV)**, which is strongly linked to this malignancy, especially in endemic regions. *HTLV-1 - Adult T-cell lymphoma* - **HTLV-1 (Human T-cell lymphotropic virus type 1)** is an **oncovirus** that carries the Tax gene, leading to the proliferation of specific T-cells. - This is a well-established oncogenic relationship, where chronic infection progresses to **Adult T-cell leukemia/lymphoma (ATLL)**. *EBV - Burkitt lymphoma* - **Epstein-Barr virus (EBV)** is known to drive the translocation of the **c-myc oncogene** into the immunoglobulin heavy chain locus, characteristic of **Burkitt lymphoma**. - This association is particularly strong in the endemic (African) form of the disease, often seen alongside **chronic malaria** co-infection. *HHV-8 - Kaposi sarcoma* - **Human Herpesvirus 8 (HHV-8)**, also known as **Kaposi sarcoma-associated herpesvirus (KSHV)**, is the causative agent of **Kaposi sarcoma**. - This vascular neoplasm is commonly seen in patients with advanced **AIDS** or other forms of severe **immunosuppression**. [Practice more Pathology PYQs on OnCourse]

Question 1

Which of the following vasculitis is NOT classified as a medium-vessel disease?

Accepted Answer

Microscopic polyangiitis (MPA)

Answer

Polyarteritis nodosa (PAN)

Answer

Buerger's disease (Thromboangiitis obliterans)

Answer

Kawasaki disease

Question 2

A 12-year-old presents with hypertension and hematuria. Serum C3 is raised. Renal biopsy
shows subepithelial hump deposits on EM. What is the most likely diagnosis?

Accepted Answer

Post-streptococcal glomerulonephritis (PSGN)

Answer

Goodpasture syndrome

Answer

Membranous glomerulonephritis

Answer

Minimal change disease

Question 3

A patient with long-standing chronic inflammatory disease develops systemic amyloidosis.
Which amyloid protein subtype is characteristically deposited?

Accepted Answer

AA

Answer

ATTR

Answer

Abeta2m

Answer

AL

Question 4

A patient presents with Hb 8 g/dL, MCV 62 fL, and low serum ferritin. Which type of anemia is
most likely?

Accepted Answer

Iron deficiency anemia

Answer

Sideroblastic anemia

Answer

Megaloblastic anemia

Answer

Aplastic anemia

Question 5

Which of the following is an INCORRECT pairing of virus and associated malignancy?

Accepted Answer

CMV - Nasopharyngeal carcinoma

Answer

HTLV-1 - Adult T-cell lymphoma

Answer

EBV - Burkitt lymphoma

Answer

HHV-8 - Kaposi sarcoma

Question 6

Histopathological examination of cardiac tissue from a post-MI patient shows a predominant
neutrophilic infiltrate. This finding corresponds to which post-infarction time window?

Accepted Answer

1-3 days

Answer

2-3 months

Answer

12-24 hours

Answer

7-10 days

Question 7

A patient diagnosed with beta-thalassemia major is being evaluated. Which of the following is
characteristically associated with this condition?

Accepted Answer

Intravascular hemolysis

Answer

Iron overload

Answer

Leukopoiesis

Answer

Ineffective hematopoiesis

Question 8

Which of the following statements regarding wound healing is correct?

Accepted Answer

Angiogenesis occurs during the proliferative phase

Answer

The inflammatory phase is directly followed by the exudative phase

Answer

Type I collagen is deposited in early wound healing in a random haphazard manner

Answer

Type III collagen replaces Type I collagen in a 3:1 ratio

Question 9

Which statement correctly describes incomplete penetrance?

Accepted Answer

Multiple individuals in one generation are affected but the next generation is entirely spared

Answer

All children of an affected parent will be clinically affected

Answer

The disease will not manifest in any individual of the next generation

Answer

Alternate generations of pedigree are affected by the condition

Question 10

A peripheral blood smear is shown below. Which supravital stain was used?

Accepted Answer

New Methylene Blue

Answer

Giemsa stain

Answer

Leishman stain

Answer

Diff-Quik stain

INI-CET 2026 — Pathology