Question: Undisplaced fracture of zygoma is managed by

Zygoma is the second most common bone to be fractured after the nasal bone. Direct trauma is the usual cause. Treatment is required only for the displaced fractures. Open reduction and internal wire fixation is the best option.


Question: Commonest histological finding in benign hypertension is

(C) (Hyaline arteriosclerosis) (495, 96- Robbins 8th) (678- Harshmohan 7th)* Hyaline arteriosclerosis consists of homogenous pink hyaline thickening of the wall of the arterioles with loss of underlying structural detail.* Encountered frequently in elderly patients whether normotensive, or hypertensive hyaline arterioscleroses is more generalized and more severe in patents with hypertensionQ* It is also common in diabetesQ as a part of the characteristic microangiopathy.Pathogenesis* The lesion reflects leakage of plasma components across vascular endothelium and excessive extra cellular matrix production by smooth muscle cells secondary to the chronic hemodynamic stress of hypertension or a metabolic stress in diabetes that accentuates endothelial cell injury.Also knowHyperplastic arteriosclerosis* It is characteristic of malignant hypertensionQ.* There is concentric laminated thickening of arteriolar wall - onion thickening0.* There is mucinous intimal thickening and fibrous intimal thickening.* There may be accompanied fibrinoid deposite with necrosis of the vessel wall - fibrinoid necrosisThe characteristic histological finding in Benign Hypertension is Hyaline arteriosclerosisBenign NephrosclerosisMalignant NephrosclerosisThis term is used do describe the charges in kidney associated with benign phase of hypertensionThis term is used to describe the changes in kidney associated with malignant or accelerated hypertensionGrossGross* Kidney size is normal 0 or may be moderately reduced 0* Kidnev size is variable0 mav be smaller in size0 (when superimposed on benign nephrosclerosis) or Larger in size (enlarged)0 than normal (patents who develop malignant hypertension in pure form* Grain leather appearance0. The cortical surface has a fine even granularity* Flen bitten appearance0The cortical surface may show multiple small peticheal haemorrhages0 from rupture of arterioles or glomerular capillariesMicroscopic (vascular changes & parenchymal (changes)Microscopic (cascular changes & parenchymal changes)* Hvaline Arteriosclerosis0 Narrowing of the lumens of arterioles and small arteries caused by thickening and hyalinization of the walls* Fibrinoid necrosis of arterioles (Necrotizing arteriolitis0)The vessel wall showa fibrinoid necrosis.Represents an acute event and necrosis is usually not accompanied by intense inflammation* Fibroelastic Hyperplasia, In the intima (intimal thickenningQ). duplication of elastic lamina and hypertrophy of the 'media'* Hyperplastic intimal sclerosis /onion - Skinning Concentric laminae of proliferated smooth muscle cells collagen and basement membrane (producing intimal thickening)* Parenchymal chances (due to ischaemic) Variable degree of Atrophy of parenchyma & due to ischaemia* Parenchymal chances (due to ischaemia)Variable degree of atrophy of parenchyma due to ischaemia infarction necrosis distalQ abnormal vessels may be seen* Fibroid necrosis may be seen in- Polyarteritis nodosa (PAN)- Aschoff's nodule- Malignant hypertension


Question: Definite markers for hepatoblablastoma is

Hepatoblastoma is a rare malignant tumour arising from primitive hepatic parenchymal cells. It presents before the age of 2 years as progressive abdominal distension with anorexia, failure to thrive, fever and jaundice. It is more common in boys. The concentration of serum AFP is high. Microscopy: two variants, epithelial type and mixed epithelial and mesenchymal type. TEXT BOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PGNO.637


Question: M.C. site of Ca esophagus is

tumors of oesophagus usually occurs in distal third of oesophagus and may invade gastric cardia ROBBINS TEXT BOOK OF PATHOLOGY 9TH EDITION PD NO.662


Question: Clara cells are seen in


Question: Magenta tongue is found in the deficiency of the vitamin


Question: Kissing disease is also known as


Question: Receptors of LDL is/are

The Low-Density Lipoprotein (LDL) Receptor (LDL-R) is a mosaic protein of 839 amino acids (after removal of 21-amino acid signal peptide) that mediates the endocytosis of cholesterol-rich LDL. It is a cell-surface receptor that recognizes the apoprotein B100, which is embedded in the outer phospholipid layer of LDL paicles. The receptor also recognizes the apoE protein found in chylomicron remnants and VLDL remnants (IDL). In humans, the LDL receptor protein is encoded by the LDLR gene on chromosome 19. It belongs to the Low density lipoprotein receptor gene family. It is most significantly expressed in bronchial epithelial cells and adrenal gland and coex tissue. Ref Robbins 9/e p264


Question: "Macropolycyte" in peripheral smear is a feature of

(D) Megaloblastic anaemia # Certain morphologic features are common to all forms of MEGALOBLASTIC ANEMIA.> The peripheral blood reveals marked variation in the size & shape of red cells (Anisocytosis), which are nonetheless normochromic.> Many erythrocytes are macrocytic & oval (macroovalocytes), with mean corpuscular volumes above 100 mm3 (normal, 82 to 92).> Neutrophils too are larger than normal (macro polymorphonuclear) & are hypersegmented, that is, have five to six or more nuclear lobules.


Question: The typical appearance of 'Granulation tissue' is due to

The term granulation tissue derives from its pink, so, granular appearance on the surface of wounds, and the characteristic histological features include the formation of the new vessels (angiogenesis) with budding ends of capillaries and proliferation of fibroblast.


Question: Type I RPGN is seen in

Type I RPGN is anti - GBM mediated and it is seen in Goodpasture's syndrome.


Question: Chronic subdural haematonia is caused by

(C) Rupture of bridging veins # Subdural hematoma also known as a subdural haemorrhage (SDH), is a type of hematoma, usually associated with traumatic brain injury.> Blood gathers between the inner layer of the dura mater and the arachnoid mater.> Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue.> Subdural hematomas are often life-threatening when acute.> Chronic subdural hematomas, however, have a better prognosis if properly managed.> A remarkable macroscopic characteristic of an organized subdural hematoma is that the lesion is firmly attached by fibrous tissue only to the inner surface of the dura and is not at all adherent to the underlying smooth arachnoid, which does not contribute to its formation.> Lesion can eventually retract as the granulation tissue matures.> Lesions that evolve to this stage of healing are referred to as chronic subdural hematomas.> A common finding in subdural hematomas, however, is the occurrence of multiple episodes of re-bleeding, presumably from the thin-walled vessels of the granulation tissue.


Question: Splenic macrophages in Gaucher's disease differ from those in ceroid histiocytosis by staining positive for for

Gaucher disease results from mutation in the gene that encodes glucocerebrosidase. This deficit leads to an accumulation of glucocerebroside, an intermediate in glycolipid metabolism, in the mononuclear phagocytic cells and their transformation into so-called Gaucher cells. Gaucher cells contain abundant lipid-laden granular cytoplasm. (Robbins Basic Pathology, 9 th edition. page : 231)


Question: A chromosomal aberration that results in a disturbance in the normal gene balance is termed

Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division. There are three forms of nondisjunction: failure of a pair of homologous chromosomes to separate in meiosis I, failure of sister chromatids to separate during meiosis II, and failure of sister chromatids to separate during mitosis. Nondisjunction results in daughter cells with abnormal chromosome numbers (aneuploidy). Calvin Bridges and Thomas Hunt Morgan are credited with discovering nondisjunction in Drosophila melanogaster sex chromosomes in the spring of 1910, while working in the Zoological Laboratory of Columbia University.


Question: Rheumatoid factor is directed against

Rheumatoid factor is IgM directed against Fc portions of IgG


Question: Bence Jones proteinuria is not seen in

Ans: b (Chronic interstitial nephritis)Ref: Henry's clinical diagnosis and management by laboratory methods, 21st ed Pg. 399Bence Jones proteinuria:1. Refers to urinary excretion of monoclonal light chains.1. It occurs due to exclusive production of one light chain, being in excess.2. Free light chain - diffuse freely to extracellular compartment - filtered through glomeruli - reabsorbed in PCT by receptor mediated endocytosis - appear in urine when the metabolising capacity of the nephron is exceeded.3. BJP - low molecular weight protein- Screening - sulphosalicylic acid test- Not detected by dip stick test- Alpha 2 mobility on electrophorectic techniques.BJP is produced in:1. Multiple myeloma2. AL amyloidosis3. Waldenstrom's macroglobulinaemia4. Chronic lymphocytic leukaemia5. Papular mucinosis.Electrophoresis and immunofixation electrophoresis methods are the best detection and quantification methods respectively.


Question: Gene involved in Cowden syndrome is

(B) PTENo"Phosphatase and Tensin'' homolog (PTEN) - protein in humans encoded by the PTEN gene. Gene mutations promotes development of cancers.[?]Cowden's disease/Multiple Hamartoma Syndrome:-Part of PTEN hamartoma tumor syndrome-An autosomal dominant syndrome-Trichilemmomas - Numerous tumors of hair follicles in face-Multiple hamartomatous polyps in GI tract, Lipomas, Granulomas-Very high risk of breast, Follicular endometrail carcinoma & thyroid carcinomaoTreatment: Bilateral mastectomies recommended-Contraindicated are mammography & other radiation exposure of breast tissue.-Mean age at presentation <10 years-Very high risk of breast, follicular carcinoma of thyroid & Endometrial carcinomaoPTEN (phosphatase and tensin homologue) is a membrane-associated phosphatase encoded by a gene on chromosome 10q23 that is mutated in Cowden syndrome, an autosomal dominant disorder marked by frequent benign growths, such as skin appendage tumors, and an increased incidence of epithelial cancers, particularly of the breast, endometrium, and thyroid.oPTEN acts as a tumor suppressor by serving as a brake on the PI3K/AKT arm of the receptor tyrosine kinase pathway.oPTEN gene function is lost in many cancers through deletion, deleterious point mutations, or epigenetic silencing.SELECTED TUMOR SUPPRESSOR GENES & ASSOCIATED FAMILIAL SYNDROMES & CANCERS, SORTED BY CANCER HALLMARKS*Gene (Protein)Familial SyndromesAssociated CancersInhibitors of Mitogenic Signaling PathwaysAPC (Adenomatous polyposis coli protein)Familial colonic polyps and carcinomasCarcinomas of stomach, colon, pancreas; melanoma*. NF1 (Neurofibromin-1)Neurofibromatosis type 1 (neurofibromas and malignant peripheral nerve sheath tumors)Neuroblastoma, juvenile myeloid leukemia*. NF2 (Merlin)Neurofibromatosis type 2 (acoustic schwannoma and meningioma)Schwannoma, meningioma*. PTCH (Patched)Gorlin syndrome (basal cell carcinoma, medulloblastoma, several benign tumors)Basal cell carcinoma, medulloblastoma*. PTEN (Phosphatase and tension homologue)Cowden syndrome (variety of benign skin, GI, and CNS growths; breast, endometrial, and thyroid carcinoma)Diverse cancers, particularly carcinomas and lymphoid tumors*. SMAD2, SMAD4 (SMAD2, SMAD4)Juvenile polyposisFrequently mutated (along with other components of TGFb signaling pathway) in colonic & pancreatic CaInhibitors of Ceil Cycle Progression*. RB Retinoblastoma (RB) proteinFamilial retinoblastoma syndrome (retinoblastoma, osteosarcoma, other sarcomas)Retinoblastoma; osteosarcoma carcinomas of breast, colon, lung*. CDKN2A p16/INK4a & pU/ARFFamilial melanomaPancreatic, breast, and esophageal carcinoma, melanoma, certain leukemiasInhibitors of "Pro-growth" Programs of Metabolism and Angiogenesis*. VHL (Von Hippel Lindau (VHL) protein)Von Hippel Lindau syndrome (cerebellar hemangioblastoma, retinal angioma, renal cell carcinoma)Renal cell carcinoma*. STK11 (Liver kinase B1 (LKB1) or STK11)Peutz-Jeghers syndrome (GI polyps, GI cancers, pancreatic carcinoma and other carcinomas)Diverse carcinomas (5%-20% of cases, depending on type)*. SDHB, SDHD (Succinate dehydrogenase complex subunits B & D)Familial paraganglioma, familial pheochromocytomaParaganglioma


Question: Crescent forming Glomerulunephritis is

Refer Robbins page no 9/e 912kidneys are enlarged and pale, often with petechial hemor- rhages on the coical surfaces. Depending on the underlying cause, the glomeruli often show focal and segmental necrosis, and variably show diffuse or focal endothelial proliferation, and mesangial proliferation. Segmental glomerular necrosis adja- cent to glomerular segments uninvolved by inflammatory or proliferative changes is the feature most typical of pauci- immune RPGN. The histologic picture, however, is dominated by distinctive crescents (Fig. 20-10). Crescents are formed by proliferation of parietal cells and by migration of monocytes and macrophages into the urinary space. Neutrophils and lym- phocytes may be present. The crescents may obliterate the urinary space and compress the glomerular tuft. Fibrin strands are frequently prominent between the cellular layers in the crescents;


Question: Fish hook pattern of capillaries is seen in

Ans. (d) Hemangiopericytoma(Ref: Sternberg's Diagnostic Surgical Pathology, 5th Edition, table 511)HemangiopericytomaTumor derived from pericytes Q - perivascular cells that wrap around blood capillariesThese tumors most commonly arise from pelvic retroperitoneum Q or the limbs Q (particularly thighs).Capillaries are arranged in 'fish-hook pattern;' Q seen best with silver stains Q


Question: Programmed cell death is known as

Apoptosis is a pathway of cell death in which cells activate enzymes that degrade the cells' own nuclear DNA and nuclear and cytoplasmic proteins. Fragments of the apoptotic cells then break off, giving the appearance that is responsible for the name (apoptosis, "falling off"). The plasma membrane of the apoptotic cell remains intact Apoptotic cell death does not elicit an inflammatory reaction in the host ( Robbins Basic Pathology, 9 th edition, page 18 )


Question: The anticoagulant of choice for anticoagulation testing is

MOA - Removes calcium Preferred uses - platelets studies, coagulation studies, ESR Advantages - preserves labile coagulation factors


Question: Metastatic calcification is most commonly seen in

Metastatic calcification may occur in normal tissues whenever there is hypercalcemia. Metastatic calcification may occur widely throughout the body but principally affects the interstitial tissues of the gastric mucosa, kidneys, lungs, systemic aeries, and pulmonary veinsReference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 2; Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death


Question: Turners tooth is seen in

enamel hypoplasia due to congenital syphilis

enamel hypoplasia due to local infection or local trauma


Question: 'Canker sore' is otherwise commonly known as


Question: Mucin is not secreted by

Paneth cells are a specific type of cell within the crypts of Lieberkuhn.
These cells have atypically oriented bright eosinophilic granules containing a variety of antimicrobial proteins and play a role in mucosal immunity (and not mucin secretion)

Brunner's glands: are sub-mucosal mucus gland within the duodenum.
Goblet cells: are mucin-secreting cells.
Crypts of Lieberkuhn: are lined by goblet cells besides other cell types.

These are thus also involved in mucin secretion.


Question: Ash leaf macules are characteristic of

Ash leaf macules are hypopigmental off - white coloured macules 1 - 3 cm in zise.It is seen is tuberous sclerosis (also known as Bournville's disease).


Question: RBC's appear to have bite of cytoplasm ("Bite cells") in

Ans. d (G-6PD deficiency) (Ref. Harrison's medicine 18th/ch. 106)The most typical feature is the presence of bizarre poikilocytes with red cells that appear to have unevenly distributed hemoglobin (hemighosts) and red cells that appear to have had parts of them bitten away (bite cells or blister cells).G6PD deficiency# In G6PD deficient individuals, acute HA can develop as a result of three types of triggers:(1) Fava beans,(2) Infections, and(3) Drugs.# Typically, a hemolytic attack starts with malaise, weakness, and abdominal or lumbar pain.# After an interval of several hours to 2-3 days, the patient develops jaundice and dark urine, due to hemoglobinuria.# The anemia is moderate to extremely severe, usually normocytic and normochromic, and due partly to intravascular hemolysis; hence, it is associated with hemoglobinemia, hemoglobinuria, and low or absent plasma haptoglobin.# The blood film shows anisocytosis, polychromasia, and spherocytes with typical bite cells.# A classic test, now rarely carried out, is supravital staining with methyl violet, which, if done promptly, reveals the Heinz bodies, consisting of precipitates of denatured Hb and regarded as a signature of oxidative damage to RBCs.# LDH is high and so is the unconjugated bilirubin, indicating that there is also extravascular hemolysis.# The most serious threat from acute HA in adults is the development of ARF (exceedingly rare in children).# Once threat of acute anemia is over, and with no comorbidity, full recovery from acute HA asso with G6PD is the rule.Peripheral SmearAssociated DiseaseBiconcaveNormal1Ring sideroblastsMyelodysplasia2NormoblastsIDA, hemolytic anemia, anemia of chronic disease like CRF3MicrocytesIDA, Thalassemia4MacrocytesMegaloblastic anemia5Burr cellsAplastic anemia, azotemia6Spur cellsSevere hemolytic anemia with cirrhosis7ElliptocytesHereditary elliptocytosis, hereditary hemorrhagic telangiectasia, thalassemia, SCA8EchinoctesSevere renal disease9StomatocytesHereditary stomatocytes, ethanol abuse10Target cellsThalassemia, HbC disease, liver disease11Howell Jolly bodiesPernicious anemia, hemolytic anemia, sprue, leukemia, after splenectomy12Cabot's ringSevere megaloblastic anemia13Heinz bodiesDrug-induced hemolytic anemia, splenectomy, HMP deficiency14Dohle bodiesSevere infections, thermal burns, cytotoxic drugs15Auer rods in myeloblastsAML type 316Punctate basophiliaLead poisoning,megaloblastic anemia, thalassemia17Rod like, spectacle likePelger Huet anomaly of granulocytes18Alder Reilly anomalyGorgoylism19SpherocytesHereditary spherocytosis, autoimmune hemolysis20Macro-ovalocyteMegaloblastic anemia (also hypersegmented PMNs), marrow failure21Helmet cell, schistocyteDIC, traumatic hemolysis22Bite cellG6PD deficiency23Teardrop cellMyeloid metaplasia with myelofibrosis24AcanthocyteSpiny appearance in abetalipoproteinemia25Target cellHbC diseaseAspleniaLiver diseaseThalassemia26PoikilocytesNonuniform shapes in TTP/HUS, microvascular damage, DIC27Burr cellTTP/HUS28Basophilic stipplingThalassemiasAnemia of chronic diseaseIron deficiencyLead poisoningEducational Points:Drugs that Carry Risk of clinical Hemolysis in Persons with G6PD Deficiency Definite RiskPossible RiskDoubtful RiskAntimalarialsPrimaquineChloroquineQuinine Dapsone/ chlorproguanil SuiphamethoxazoleSulfasalazineSulfisoxazole DapsoneSulfadimidineSulfadiazineAntibacterial antibioticsCotrimoxazoleNiridazoleCiprofloxacinChloramphenicolNalidixic acidNitrofurantoinNorfloxacinp-Aminosalicylic acidAntipyreticsAcetanilidePhenazopyridine (Pyridium)Acety Isa 1 icy lie acid high dose (<3 g/d)Acetylsalicylic acid<3 g/dAcetaminophen,PhenacetinOthersNaphthaleneMethylene blueVitamin K analoguesAscorbic acid >1 gRasburicaseDoxorubicinProbenecid


Question: The second costochondral joint is a


Question: The recurrence of pleomorphic adenoma is attributed


Question: The tumour suppressor gene p53 induces cell arrest at


Question: Eosinophil production is increased by

TH1 cells produce the cytokine IFN-g, which activates macrophages in the classical pathway. TH2 cells secrete IL-4, IL-5, and IL-13, which recruit and activate eosinophils and are responsible for the alternative pathway of macrophage activation TH17 cells secrete IL-17 and other cytokines that induce the secretion of chemokines responsible for recruiting neutrophils and monocytes into the reaction. TNF induces acute inflammation by acting on neutrophils and endothelial cells. ref robbins 9th ed page 55


Question: Ewing's sarcoma is associated with

(A) CD-56 # Tumor cells in Ewing's sarcoma show diffuse membrane positivity for CD-56. Tumor cells are also positive for neuron-specific enolase.# Ewing's sarcoma (or Endothelial sarcoma of bone):> It is a highly malignant tumour, occurring between the age of 10-20 years.> Multicentric in origin.> Cytogenetic abnormalities associated with Ewing's sarcoma is the reciprocal translocation of the long arm of chromosomes 11 and 22> It arise in the diaphysis of long bone> Subperiosteal bone formation> Histopathologically -- Pseudo rosette formation.> The tumour grow fast and metastasises through the blood stream to the lungs and to other bones.# Clinical Features -- Pain, swelling and Fever, so it may be confused with osteomyelitis> X-Ray show - Onion peel appearance> Treatment - Highly radio sensitive tumour, so Radiotherapy is highly effective for control of the local tumour and chemotherapy for control of the metastasis.


Question: The congenital abnormality of the ileum illustrated below

Meckel's diveiculum occurs in the ileum, usually within 30 cm of the ileocecal valve, and is present in approximately 2% of normal persons. It represents incomplete involution of the vitellointestinal duct and always arises from the antimesenteric border of the intestine. Heterotopic gastric or pancreatic tissue may be present in about one-half of cases. Peptic ulceration, which occurs as a result of acid secretion by heterotopic gastric mucosa, is usually located in the adjacent ileum. Complications include perforation, ulceration, intestinal obstruction, intussusception, and neoplasms, including carcinoid tumors. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

Is present in approximately 20% of normal persons

Is lined by heterotopic gastric mucosa in less than 2% of cases

Is related to persistence of the vitellointestinal duct


Question: Terminal stage of pneumonia is

Ans. is 'd' i.e., Resolution In the usual course of pneumonia, final stage is resolution. However, in some neglected cases following complications may develop - Abscess formation Pleural effusion, pleuritis Empyema Becteremic dissemination Brain abscess, endocarditis, meningitis, Organization supurrative ahritis. Pathological changes of bacterial pneumonia A.Lobar pneumonia Large confluent area of the lung or entire lobes are consolidated. The lower lobes are affected most commonly. There are four stages of the inflammatory response (Laennec's stages) ? 1. Stage of congestion (initial phase) The affected lobe is enlarged, heavy, dark red and congested. Cut surface exudes blood-stained frothy fluid. There is dilatation and congestion of alveolar capillaries. There are few neutrophils and numerous bacteria in the alveolar fluid. 2. Stage of red hepatization (early consolidation) The term hepatization refers to liver-like consistency of the affected lobe on cut section. The affected lobe is red and firm. The edema fluid of preceding stage is replaced by strands of fibrin. There is marked cellular exudate of neutrophils with extravasation of red cells. 3. Stage of gray hepatizatioa (late consolidation) The affected lobe is grayish brown, firm and dry. The fibrin strand are dense and more numerous. There is progressive disintigration of red cells and neutrophils. The macrophages begin to appear in the exudate. The organisms are less numerous and appear as degenerated forms. 4. Resolution The previously solid and fibrinous constituent is liquefied by enzymatic action. Granular and fragmented strands of fibrin in the alveolar spaces are seen due to progressive enzymatic digestion. There is progressive removal of fluid content as well as cellular exudate from the air spaces, resulting in restoration of normal lung parenchyma with areation. B.Bronchopneumonia Patchy areas of red or grey consolidation, more often multilobar and frequently bilateral and basal (lower zones) because of tendency of secretions to gravitate into lower lobes.. There is suppurative exudate, consisting chiefly neutrophils, filling bronchi, bronchioles and adjacent alveolar spaces. Alveolar septa thicken due to congested capillaries and leucocytic infiltration.


Question: Hyperacute graft rejection is seen within

(A) 24 hoursTRANSPLANT REJECTION TypeOnsetMechanism & Vessel HistologyType of HypersensitivityHost vs GraftHyperacuteImmediatePreformed antibodies directed against the donor tissue. Caused by accidental ABO blood type incompatibility which is very rare. Presents while still in surgery with thrombosis and occlusion of graft vessels.II AcuteWeeks to monthsT-cell mediated immune response directed against the foreign MHC. Inflammation & leukocyte infiltration of graft vessels results. Most common typeIV ChronicMonths to yearsT-Cell mediated process resulting from the foreign MHC 'looking like' a self MHC carrying an antigen. Results in intimal thickening & fibrosis of graft vessels as well as graft atrophy.III & IVGraft vs HostVariesDonor T-cells in the graft proliferate and attack the recipient's tissue. Most commonly seen in bone marrow transplants. Presents with diarrhea, rash & jaundice.IVThe most important thing to remember is the time-frame for the onset of symptoms as you can often determine what type of rejection it is based on time alone.[?]Hyperacute Rejection:oThis form of rejection occurs within minutes or hours after transplantation & can be recognized by the surgeon soon after the graft vasculature is anastomosed to the recipient's.oHyperacutely rejecting kidney rapidly becomes cyanotic, mottled & flaccid and may excrete few drops of bloody urine.oThis form of rejection is due to the presence of preformed antidonor Ab's in the host circulation.oThis form of rejection is rarely seen in today's practice.Hyperacute Transplant Rejection Antibody-Mediated Type II Hypersensitivity ReactionHyperacute Transplant Rejection Antibody-Mediated Type II Hypersensitivity ReactionMost dramatic form of tissue incompatibility, begins within minutes to hours.Blood Group Antigens are expressed by endothelial cells of blood vessels (solid vascularized organs).Antibodies (IgM) - Complement Fixation - Neutrophil, Platelet activation - Intravascular consulation - Irreversible Ischemic Necrosis. Cannot be reversed, should be avoided.Today, Hyperaucte rejection by anti-ABO antibodies is extremely rare. HLA I is expressed on vascular endothelium cells, preexisting antibodies (IgG) against HLA class I variants can also cause hyperacute rejection.[?]Transplant Rejection Mechanism[?]Antibody-Mediated Reactions:[?]Ab's produced against donor Ag can also mediate rejection through two forms:oHyperacute rejection: Immediate rejection soon after transplantation.-Occurs when preformed antidonor Ab's are present in the circulation of the recipient.


Question: A manual labourer moves in March from Kashmir to Delhi and becomes acclimatized by working outdoors for a month. Compared with his responses on the first few days in the Delhi, for the same activity level after acclimatize on one would expect higher

The classic changes observed in heat acclimatization are lower hea rate during exercise; an increased sweating response; a lower core temperature during exercise, which is due to both the increased sweating response a lower thermoregulatory set point.


Question: The enzyme glucosyl transferase secreted by Streptococcus mutans synthesizes glucans from


Question: Electron dense deposits in the region of hyalinosis and sclerosis with diffuse loss of foot processes seen in electron microscope are featurea of

Refer Robbins page no 919By light microscopy the focal and segmental lesions may involve only a minority of the glomeruli and may be missed if the biopsy specimen contains an insufficient number of glom- eruli (Fig. 20-14A). In the sclerotic segments there is collapse of capillary loops, increase in matrix and segmental deposition of plasma proteins along the capillary wall (hyalinosis), which may become so pronounced as to occlude capillary lumens. Lipid droplets and foam cells are often present (Fig. 20-14B). Glomeruli that do not show segmental lesions usually appear normal on light microscopy but may show increased mesangial matrix. On electron microscopy both sclerotic and nonsclerotic areas show diffuse effacement of foot processes, and there may also be focal detachment of the epithelial cells and denu- dation of the underlying GBM. By immunofluorescence micros- copy IgM and C3 may be present in the sclerotic areas and/or in the mesangium. In addition to the focal sclerosis, there may be pronounced hyalinosis and thickening of afferent aerioles. With the progression of the disease, increased numbers of glomeruli become involved and sclerosis spreads within each glomerulus. In time, this leads to total (i.e., global) sclerosis of glomeruli, with pronounced tubular atrophy


Question: Metaplasia arises from reprograming of

Ans. (a) Stem cells(Ref: 9th/pg 36; 8th/pg 8)Mechanism of metaplasia: Reprogramming of stem cellsQ in normal tissues or of undifferentiated mesenchymal cells present in connective tissue.Q


Question: PAN is associated with

Polyaeritis nodosa (PAN) is a systemic vasculitis of small or medium-sized muscular aeries that typically involves the renal and visceral vessels and spares the pulmonary circulation. There is no association with ANCAs, but a third of the patients have chronic hepatitis B infection, which leads to the formation of immune complexes containing hepatitis B antigens that deposit in affected vessels. The cause is unknown in the remaining cases. (Robbins Basic Pathology,9th edition,pg no.352)


Question: Red velvety appearance of stomach mucosa is seen in the poisoning of

(Refer: Rajesh Bardale - Principle of Forensic Medicine & Toxicology, 1st edition, pg no: 430)


Question: Sago spleen is a feature of

Ans. c (Amyloidosis). (Ref. Robbin, Pathology 6th ed., 255)# Amyloidosis is deposition of a pathologic proteinacieous substance between cells in various tissues of the body.# In spleen it is characterized by splenomegaly, sagospleen (deposit largely limited to splenic follicles, producing tapioca-like granules on gross inspection), lardaceous spleen (2nd pattern in which amyloid appears to spare the follicles and instead involves the wall of splenic sinuses and connective tissue framework in red pulp, giving rise to large fused map-like areas of amyloidosis). Important pathologic featuresCondition1Lardaceous & Sago spleenAmyloidosis2"Onion skin" spleenSLE3Shrinking lungSLE4Nutmeg liverChronic passive congestion5"Flea bitten" kidneyLocal GN6Thyroidization of kidneyChronic pyelonephritis


Question: Saddle embolus causes sudden death by blocking


Question: Renal papillary necrosis is seen in

Necrotizing papillitis (or papillary necrosis): It is one special pattern of acute pyelonephritis and is much more frequent in diabetics Hyaline aeriolosclerosis narrows blood vessels -> reduces the blood supply to the renal medulla -> ischemia ->causes necrosis of the tips of papillae (papillary necrosis). Causes of necrotizing papillitis: Diabetes mellitus Sickle cell anemia Analgesic nephropathy Obstructive uropathy. Ref: RAM DAS NAYAK EXAM PREPARATORY MANUAL FOR UNDERGRADUATES 2nd ed. pg no: 615


Question: Finnish of nephrotic syndrome is caused by defect in following protein aEUR'

Nephrin The glomerular capillary wall is a filtering membrane and consists of the following structures i) Endothelial cells ii) Glomerular basement membrane iii) Visceral epithelial cells (podocytes) iv) Mesangial cells The visceral epithelial cell known as podocyte is impoant for the maintenance of glomerular harrier function. They are structurally complex cells that possess interdigitating foot processes (pedicels). The adjacent foot processes are separated by 20-30 nm wide filtration slits. The filtration slit or slit diaphragm maintains glomerular barrier function. They present a size selective distal diffusion harrier to the filtration of proteins and it is the cell type that is largely responsible for the synthesis of GBM components. Proteins located in the slit diaphragm control glomerular permeability. Impoant proteins have been identified in this regard Nephrin - Podocin - CD2 associated protein and - Actin cytoskeleton The impoance of these proteins in maintaining glomerular permeability is demonstrated by the observation that mutations in the gene encoding them give rise to nephrotic syndrome sclerosis . The mutations in these genes commonly lead to focal segmental glomerulosilerosis. Gene Chromosome in Prote encoded Disease NPHS1 19q13 Nephrin Congenitial nephritic syndrome of the finnish type NPHS2 lq 25-31 Podocin Steroid resistant nephritic syndrome 30% cases Mutations in the podocyte action-binding protein a actinin 4 also produce FSGS 96.


Question: Interleukin 2 is produced by

A) T helper -1 (TH1) secretes → IL-2 and interferon - γ
B) T helper - 2 (TH2) secretes → IL-4, IL-5, IL-6, IL-13


Question: Linitis plastica is seen in

(Carcinoma stomach) (557-Harsh Mohan 6th ,786-Robbin-Pathologic-Basis of disease 8th)Leather bottle appearance termed linitis plastica seen in gastric adenocarcinoma. Breast and lung cancers that metastasize to the stomach may also creat a linitis plastica- like appearanceSCIRRHOUS CARCINOMA (Linitis plastica) - the stomach wall is thickened due to extensive desmoplasia giving the appearance as 'leather-bottle stomach' or 'linitis plastica, The lumen of the stomach is reduced. There are no ulcer but rugae are prominent (mother-of-pearl in appearance)* Gastric carcinoma is most commonly located into region of gastric canal (prepyloric region)**_* Ulcerative carcinoma*** is the most common pattern* Most common complication of gastric cancer is haemorrhage (haematemesis or melaena)* Pre malignant changes in gastric mucosa(i) Hypo or achlorhydria in atrophic gastritis of gastric mucosa with intestinal metaplasia***(ii) Adenomatous (neoplastic) polyp of the stomach(iii) Chronic gastric ulcer (Ulcer-cancer) and its association with achlorhydria(iv) Stump carcinoma in patients who have undergone partial gastrectomy* Superficial spreading or 'early' gastric cancer-confined to the mucosa or sub mucosa (with or without lymph node metastasis) are associated with an excellent prognosis* Trossier's si2n - The metastasis through lymphatic spread presents as left supraclavicular lymphnode enlargement* The depth of invasion and the extent of nodal and distant metastasis at the time of diagnosis remain the most powerful prognostic indicators for gastric cancers (786- Robbins- Basis of disease 8th)* Most common cause of gastric outlet obstruction in India is - Carcinoma stomach*** Sister Mary Joseph nodule (Metastatic involvement of the para umbilical nodes*** is most commonly seen with stomach carcinoma)* Early gastric cancer. Defined as a primary lesion confined to the mucosa and submucosa with or without lymph node metastasis*** There is one dictum that "Anterior ulcer perforates & posterior ulcer bleeds"* Stomach reveal fat-laden cells in post gastrectomy**** Watermelon stomach is seen in Scleroderma* Blood group A is associated with(i) Carcinoma stomach, cervix, salivary gland & pancreas(ii) Pernicious anemia(iii) Thrombosis in OCP users


Question: The main cause of congenital hyperbilirubinemia is

Hereditary hyperbilirubinemiaIndirect hyperbilirubinemiaDirect hyperbilirubinemiaCrigler Najjar types 1 and 2 Gilbe syndrome Dubin Johnson syndrome Rotor's syndrome (Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1389)


Question: Vasculitis involving the Aoic arch is

Takayasu aeritis classically involves the aoic arch. This is a granulomatous vasculitis of medium and larger aeries characterized principally by ocular disturbances and marked weakening of the pulses in the upper extremities (hence the name pulseless disease). Takayasu aeritismanifests with transmural fibrous thickening of the aoa-- paicularly the aoic arch and great vessels--with severe luminal narrowing of the major branch vessels.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 11; Blood vessels; Page no: 508


Question: Syphilis becomes seropositive in


Question: Cilastatin is given along with


Question: Gene responsible for pathogenesis of H pylori

Cytotoxic: products of two genes namely cytotoxin- associated gene A(cagA) and vacuolating agent(vacA) gene cause gastritis, peptic ulceration and cancer GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK FIRST EDITION PAGE 379


Question: Skin cancers develop due to sunlight exposure induced by

Ultraviolet radiation is of 3 types; UV-A, UV-B and UV-C.
• UVA causes melanin oxidation with transient immediate darkening. Repeated exposure to UV radiation cause degenerative changes in elastin and collagen leading to wrinkling increased laxity and a leathery appearance. It is however used therapeutically in PUVA therapy for the management of vitiligo, psoriasis and cutaneous T cell lymphomaQ.
• UVB can cause skin damage by formation of reactive oxygen species and formation of pyrimidine dimmers between adjacent pyrimidines on the same DNA strand. The latter can cause double base substitutions in the p53 resulting in
the development of skin cancers. So, it is the most dangerous for humans. Exposure to UV rays also induces DNA repair, apoptosis or cell cycle arrest. The absence of this protective mechanism is seen in patients of Xeroderma pigmentosum causing high incidence of skin cancers.
• UVC is not reaching earth because it gets filtered by the protective ozone layer.


Question: Copper is mainly transpoed by

Normally, dietary copper is more than body's requirement. Excess copper so absorbed through the stomach and duodenum is transpoed to the liver where it is incorporated into a2-globulin to form ceruloplasmin, which is excreted by the liver bile normally. Most of the plasma copper circulates as ceruloplasmin. Only minute amount of copper is excreted in the urine normally. TEXTBOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PAGE NO:628


Question: In alveolar variant of rhabdomyosarcoma , the resultant fusion protein is believed to function as

In Alveolar rhabdomyosarcoma, there is frequently fusion of the FOXO1 gene to either the PAX3 or the PAX7 gene, rearrangements marked by the presence of (2;13) or(1;13) translocations, respectively. PAX3 is a transcription factor that initiates skeletal muscle differentiation, and it appears that the chimeric PAX3-FOXO1 fusion protein interferes with the gene expression program that drives differentiation.


Question: Senile cardiac amyloid associated protein is

Transthyretin (TTR) is a normal serum protein that binds and transpos thyroxine and retinol. Several distinct mutant forms of TTR (and its fragments) are deposited in a group of genetically determined disorders referred to as familial amyloid polyneuropathies. Normal TTR is also deposited in the hea of aged individuals (senile systemic amyloidosis)Reference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 6; Diseases of the Immune System


Question: Colovesical fistula

Colovesical fistulaA colovesical fistula is the presence of a communication between the lumen of the CausesDiveiculitis:Crohn&;s disease: ~ 10%RadiotherapyTraumaClinical presentationRadiographic featuresIn most instances, the diagnosis is suspected clinically due to pneumaturia, faecaluria, recurrent urinary tract infections, or passage of urine rectally.In some cases, it will be first diagnosed radiologically at the time of investigation for the primary diseaseCT scan - Presence of gas within the lumen of the bladder. Contrast may be instilled into the rectum &;on table&; prior to the acquisition of images in order to demonstrate a fistulaFluoroscopy Treatment and prognosisSurgical resection of the fistula and abnormal segment of bowel is usually required for cure, although in the setting of malignancy this suggests advanced disease (T4) making surgery complex.In such cases, if palliation only is required then de-functioning colostomy, colonic stent placement or a nephrostomy may be required.(Refer:


Question: Uterine blood flow at term

Uterine blood flow is increased from 50 ml per minute in non-pregnant state to about 750 ml near term.


Question: Macrophage, granuloma, erythrophagocytosis are found ina)  Ulcerative colitisb) Necrotising enterocolitisc)  Regional ileitisd)  Typhoid

There is confusion between option c & d because macrophage and granuloma are seen in crohn's disease (Regional ileitis), while erythrophagocytosis is seen in typhoid fever.
- Regional Ileitis or crohn's disease has the histological features of transmural inflammatory cell infiltrate consisting of chronic inflammatory cells (lymphocytes, plasma cells & macrophges) which is the classical microscopic feature. Noncaseating, sarcoid like granulomas are present in all the layers of the affected bowel wall in 60% of cases & may even be seen in the regional lymph nodes. There is also patchy ulceration of the mucosa which may take the form of deep fissures, widening of submucosa due to edema & foci of lymphoid aggregates.
- In typhoid fever, there is hyperemia, edema and cellular proliferation consisting of phagocytic histiocytes, lymphocytes & plasma cells. There is phagocytosis of RBC → erythrophagocytosis.


Question: Glossodynia is


Question: Kveim Slitzbach test is useful in the diagnosis of


Question: Streptococcus mutans produces an adhesive poLymer from sucrose, known as


Question: Common salt can be used as a chemical antidote for washing the stomach in case of oral poisoning by


Question: The most common variant of RCC is

Types of renal cell carcinomaFrequency1.Clear cell carcinoma2.Papillary renal cell carcinoma3.Chromophobe renal cell carcinoma4.Collecting duct carcinoma70-80%10-15%5%1% (Ref: Robbins 8/e p965)


Question: Relative risk can be obtained from

Strength of association in Coho study Strength of associationFormulaRelative risk (Risk ratio)RR = Incidence among exposed Incidence among non exposed RR > 1Positive association RR = 1 No association RR < 1Negative association Attributable riskAR = Incidence among exposed-Incidence among non exposedIncidence among exposed x 100Population attributable risk PAR = = Incidence among total -Incidence among non exposedIncidence among total x 100(Refer: K. Park's Textbook of Preventive and Social Medicine, 24th edition, pg no: 83, 93)


Question: Gene instability associated with malignancy is seen in

Ataxia-telangiectasia (AT or A-T), also referred to as ataxia-telangiectasia syndrome or Louis-Bar syndrome, is a rare, neurodegenerative, autosomal recessive disease causing severe disability. Ataxia refers to poor coordination and telangiectasia to small dilated blood vessels, both of which are hallmarks of the disease. A-T affects many pas of the body: It impairs ceain areas of the brain including the cerebellum, causing difficulty with movement and coordination. It weakens the immune system, causing a predisposition to infection. It prevents repair of broken DNA, increasing the risk of cancer.A-T is caused by a defect in the ATM gene, which is responsible for managing the cell's response to multiple forms of stress including double-strand breaks in DNA. In simple terms, the protein produced by the ATM gene recognizes that there is a break in DNA, recruits other proteins to fix the break, and stops the cell from making new DNA until the repair is complete.


Question: BRAF mutation is seen in

BRAF mutation Ser/Thre protein kinase Belongs to MAPK family HCL, melanoma, benign nevi, ca colon


Question: The feature that differentiate a follicular carcinoma from a follicular adenoma of thyroid is

Follicular adenomas and carcinomas both are composed of well - differentiated follicular epithelial cells;the latter are distinguished by evidence of capsular and/or vascular invasion. They both have fairly uniform cells forming small follicles containing colloid. So there is no reliable cytological difference between them. (ref:ROBBINS Text book of pathology) REf img :


Question: NARP is

Neuropathy, Ataxia, Retinitis pigmentosa (NARP) syndrome is a rare disorder with mitochondrial inheritance pattern


Question: Not seen in children

Answer- D. SeminomaChildhood malignancies areLeukemia (AML' ALL)Brain tumorsSoft tissue sarcoma - RhabdomyosarcomaLymphomaNeuroblastomaWilm's tumorBone tumorRetinoblastomaHepatoblastoma


Question: Metaplasia is induced from

Metaplasia is a reversible change in which one adult cell type (epithelial or mesenchymal) is replaced by another adult cell typeMetaplasia is thought to arise by reprogramming of stem cells to differentiate along a new pathway rather than a phenotypic change (transdifferentiation) of already differentiated cells( Robbins Basic Pathology, 9th edition, page 3 )


Question: Adult Polycystic kidney disease is inherited by

Polycystic kidney disease (PKD or PCKD, also known as polycystic kidney syndrome) is a geneticdisorder in which the renal tubules become structurally abnormal, resulting in the development and growth of multiple cysts within thekidney.


Question: Site of biopsy in amyloidosis

Ans. (d) Rectum(Ref': Robbins 9th/pg 257-260)Sites of biopsy for diagnosis of Amyloidosis:Rectal biopsy-Most specific and best siteAbdominal fat aspirateGingival biopsyOrgan specific biopsy for localized amyloidosis


Question: Thalassaemia major manifests in

Beta thalassemia major manifests 6 to 9 months after bih as Hb synthesis switches from HbF to HbA. Beta thalassemia is caused by the mutation that diminishes the synthesis of beta globin chain seen in HbA. The red cells may completely lack HbA or contain small amounts. Reference: Robbins and Cotran Pathologic basis of disease.South Asia Edition,-9 volume 1.page no. 638-639


Question: Most common site for gastrinoma

Majority of gastrinomas occur in the wall of the duodenum. may be benign or malignant. Gastrinomas are associated with peptic ulcers at usual sites such as the stomach, first and second pa of the duodenum, or sometimes at unusual sites such as in the oesophagus and jejunum. About one-third of patients have multiple endocrine neoplasia--multiple adenomas of the islet cells, pituitary, adrenal and parathyroid glands. TEXTBOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PAGE NO:829 IMAGE REF:


Question: Most common primary malignant tumour of parotid gland

- Most common primary malignant tumor of parotid gland is Mucoepidermoid carcinoma - Mucoepidermoid carcinoma Malignant neoplasm of variable biological aggressiveness Composed of a mixture of squamous, mucous secreting & intermediate cells.


Question: Gleason's classification is used for

Refer Robbins page no Grading and Staging. Grading is of paicular impoance in prostatic cancer, because grade and stage (discussed below) are the best prognostic predictors. Prostate cancer is graded using the Gleason system, which stratifies pros- tate cancer into five grades on the basis of glandular pat- terns of differentiation. Grade 1 represents the most well differentiated tumors, in which the neoplastic glands are uniform and round in appearance and are packed into well-circumscribed nodules (Fig. 21-38A). In contrast, grade 5 tumors show no glandular differentiation, with tumor cells infiltrating the stroma in the form of cords, sheets, and nests (Fig. 21-38C). The other grades fall in between these extremes. Most tumors contain more than one pattern; in such instances, a primary grade is assigned to the dominant pattern and a secondary grade to the second most frequent pattern.


Question: The best investigation for the diagnosis of amyloidosis is

Diagnosis Microscopic examination - biopsies from kidney, gingiva, rectum Congo red staining on abdominal fat aspirates Serum & urine protein electrophoresis Bone marrow aspiration - to r/o plasmacytosis Scintigraphy with radiolabelled serum amyloid P (SAP) component


Question: A patient aged 50 years presented with a history of jaw expansion and enlargement of maxilla


Question: In comparison to hyperplasia, hypertrophy is

Hypertrophy: Increase in size of cells. There are no new cells just bigger cells containing an increased amount of structural proteins and organelles
Hyperplasia: Increase in cell number
Both results in enlarged organ

Hyperplasia occurs in cells capable of replication
Hypertrophy occurs in cells which have limited capacity to divide

Increase in cell size without increase in number

Increase in cell number without increase in size

Increase in cell size and decrease in number


Question: Angulated body cells are found in


Question: Most important role in apoptosis by


Question: Storiform pattern of fibrous tissue is seen in


Question: Dystrophic gene mutation leads to

Mutation in the Dystrophin gene leads to Duchene muscular dystrophy.
Becker’s muscular dystrophy is also caused by a mutation in the dystrophin gene.
More questions on Duchenne’s muscular dystrophy

It is X-linked recessive disease
Clinical manifestation starts at 3-5 years of age
Loss of muscle strength is progressive with a predilection for proximal limb muscles.*
Gowers' manoeuvre*
On getting up from the door the patient uses his hand to climb up himself.
Pseudohypertrophy of calf muscles is seen
The term pseudohypertrophy is used because it is not true hypertrophy of muscles (the muscle is replaced by fat
and connective tissues)
Intellectual impairment is common in Duchenne muscular dystrophy
Serum creatinine phosphokinase levels are invariably elevated to 20-100 times normal.
Muscle biopsy shows muscle fibres of varying sizes.


Question: A bacterial disease with oral manifestations is


Question: Two siblings with osteogenesis imperfect, but their parents are normal. Mechanism of inheritance is aEUR'

Germ line mosaicism In some autosomal dominant disorders examplifled by osteogenesis imperfecta, phenotypically normal parents have more than one affected child. - This clearly violates the law of inheritance. Studies indicate that gonadal mosaicism may be responsible for such unusual inheritance. Mosaicism It means than an individual has 2 or more different cell lines derived from a single Zygote. - The persons body' is made up of a combination of cells with and without mutation for a paicular disease. - Because the mutation remains limited to a small poion of all of the body's cells, these individuals show no sign of the disease. Germline mosaicism Germline mosacism results from a mutation that occurs postzygotically during early embryonic development. In these a poion of the egg or sperm cells of a parent carries the mutation. - Because the mutation affects only cells destined to form the gonads the gametes carry the mutation but somatic cells of the individual are completely normal. - A phenotypically normal parent who has germ line mosaicism can transmit the disease causing mutation to the offspring through the mutant gamete. - Because the progenitor cells of the gamete carry the mutation there is a definite possibility that more than one child of such a parent would be affected. - Obviously, the likelihood of such an occurrence depends on the propoion of germ cells carrying the mutation. Anticipation The signs and symptoms of some genetic conditions tend to become severe and appear at an earlier age as the disorder is passed from one generation to the next. - This phenomenon is called anticipation. Anticipation is most often seen with ceain genetic disorders of the nervous system such as Huntington's disease, Fragile x-syndrome and myotonic dystrophy. Anticipation typically occurs with disorders that are caused by an unusual type of mutation called a "trinucleotide repeat expansion". - A trinucleotide repeat is a sequence of three DNA building blocks (nucleotide) that is repeated a number of times in a row. - DNA segments with an abnormal number of these repeats are unstable and prone to errors during cell division. - The number of repeats can change as the gene is passed. from parent to child. - If the number of repeats increases it is known as trinucleotide repeat expansion. - In some cases the trinucleotide repeat may expand until the gene stops functioning normally,. - This expansion causes the feature of some disorders to become severe with each successive generation. Genomic imprinting People inherit two copies of their genes - one from their. father and one from their mother. Usually both copies of each gene are active or "turned on" in cells. But with genomic imprinting however, only one of the two copies is normally turned on. Which copy is active depends upon the parent of origin. Some genes are normally active only when they are inherited. from a person's. father, others are active only when inherited from a person's mother. These genes are called "imprinted genes" because the gene was epigenetically silenced or marked in either the egg or sperm. Silencing or imprinting usually happens through the addition of methyl groups during egg or sperm formation. An individual normally has one active copy of an imprinting gene. Improper imprinting can result in individual having two active copies or two inactive copies. - This can lead to severe developmental anomalies, cancer and other problems e.g., - Prader willi - Angelman syndrome - They are both linked to same imprinting region of chromosomes 15.


Question: Hypersensitivity vasculitis affects


Question: A patient presents with Ahritis, hyperpigmentation of skin and hypogonadism, likely diagnosis is.

Answer is A (Hemochromatosis):The association of Ahritis, hyperpigmentation of skin and hypogonadism suggests the diagnosis of hematochromatosis.

Ectopic ACTH secreting tumour of the lung


Question: Coombs test is used for diagnosing

The Coombs test, which is used to detect antibodies or complement bound to red cells in suspected cases of antibody-mediated hemolytic anemia.


Question: Fistula is most common in

Clinical features Fibrosing strictures, paicularly of terminal ileum is common and requires surgical resection. Fistulas develop between loops of bowel and may also involve the urinary bladder, vagina, and abdominal or perianal skin. Perforations and peritoneal abscesses are common. TEXT BOOK O F ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.590


Question: Least concentration of human immunodeficiency virus is seen in

Viral load of HIV is maximum in blood, genital secretions like semen, and CSF

It also found in breast milk, saliva, lymphocytes, cell-free plasma, cervical secretions, saliva, tears, & minimal in urine

Saliva can contain fibronectin & glycoproteins, which prevent transmission of the virus.
A salivary protein called secretory leucocyte protease inhibitor also has anti-HIV activity


Question: With regard to the malignant behavior of leiomyosarcoma, the most impoant criterion is

Option 4 is correct=the number of mitosis per high power field Leiomyosarcomas typically take the form of soft, hemorrhagic, necrotic masses. The diagnostic features of ove leiomyosarcoma include tumor necrosis, cytologic atypia, and mitotic activity. Robbins basic pathology 9th edition page no 694,heading=leiomyosarcomas..box=Morphology ref img

The number of mitoses per high power field


Question: Subepithelial deposits with M spike is seen in

Refer Robbins page no 915 Pathogenesis. Membranous nephropathy is a form of chronic immune complex-mediated disease. In secondary membranous nephropathy, the inciting antigens can some- times be identified in the immune complexes. The antigens may be endogenous or exogenous. The endogenous anti- gens may be renal or non renal. For example, membranous nephropathy in SLE is associated with deposition of complexes of self nuclear proteins and autoantibodies.


Question: Collagen affected in Osteogenesislmperfecta

Ans, is 'a' i.e., Type I o Osteogenesis imperfecta also known as brittle bone disease, or "Labstein syndrome" is a congenital bone disorder.o People with OI are bom with defective connective tissue, or without the ability to make it, usually because of a deficiency of Type-1 collagen.o This deficiency arises from an amino acid substitution of glycine to bulkier amino acids in the collagen triple helix structure.


Question: BRCA1 gene is associated with

Ans is 'b' i.e. Mucinous carcinoma "Medullary carcinomas and mucinous carcinomas histological types are more commonly found in BRCA1 carrier". -- Robbings 1134Familial breast cancero About 25% offamilial cancers (or around 3% of all breast cancer) can be attributed to two highly penetrant autosomal dominant genes BRCA-1 on chromosome 17 (52%) and BRCA-2 on chromosome 13 (32%).o Germ line mutation in p53 also increases the risk of breast cancer along with cancers of colon, leukemia, sarcoma and brain tumors (Li fraumeni syndrome)o Somatic mutation in p53 - Sporadic breast cancero Germ line mutation in BRCA-1, BRCA-2, and p53 - Familial breast cancer.


Question: Psammoma bodies in a thyroid lesion or the adjacent metastatic lymph nodes increase the possibility of

Ans. a (Papillary carcinoma) (Ref. Robbin's pathology 7th ed., 1180)D/d o/Psammoma bodies: Laminated, concentric, calcific spherules seen in:1.Papillary adenocarcinoma of thyroidPapillary (thyroid)2.Serous papillary cystadenocarcinoma of ovarySerous (ovary)3.MeningiomaMeningioma4.Malignant mesotheliomaMesotheliomaEducational Points:Adenomas# Follicular adenoma is most common; may cause pressure symptoms, pain and rarely thyrotoxicosis# Pathology: usually small, well-encapsulated solitary lesionsPapillary# Most common thyroid carcinoma# Incidence higher in women# Pathology: papillary branching pattern; 40% have tumors containing psammoma bodies# Cells with characteristic empty-appearing nuclei are characteristic.# Cells obtained by FNAC may characteristically show intranuclear inclusions# Spread to local nodes in common; hematogenous spread rare# Resection curative in most casesFollicular carcinoma# More malignant than papillary cancer# Pathology: may be encapsulated, with penetration through the capsule; colloid sparse# Local invasion and pressure dysphagia, dyspnea, hoarseness, cough# Hematogenous metastasis to lungs or bones commonAnaplastic carcinoma# Rapid growing, aggressive with poor prognosis, affects older patients# Pathology: tumors usually bulky and invasive with undifferentiated anaplastic cells# Clinical: early, widespread metastasis and death within 2 years


Question: Atropine is contraindicated in


Question: Flea bitten appearance of the kidney is seen in

Refer Robbins page no 9/e 939The kidney size varies depending on the duration and severity of the hypeensive disease. Small, pinpoint petechial hemor- rhages may appear on the coical surface from rupture of aerioles or glomerular capillaries, giving the kidney a peculiar "flea-bitten" appearance. Two histologic alterations characterize blood vessels in malignant hypeension


Question: A patient with nephritic syndrome will not haveSeptember 2009


Question: Most common parotid tumor

Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Refer robbins 9/e p556


Question: Most impoant cytokine responsible for the synthesis of acute phase protein

IL 6 is responsible for the synthesis of acute phase proteinsWintrobe 13th e


Question: Interleukin secreted by macrophages, stimulating lymphocytes is

IL1> IL6

Macrophages release IL – 1 which stimulates the T – helper cells.
The T – cells in response proliferate and release IL – 2 which in turn further stimulates T – cell proliferation and B cell proliferation and differentiation into plasma cells.
Please note that even IL-6 (produced by macrophages) acts on late stages of B cell differentiation enhancing antibody formation. Still, IL-1 being the most important cytokine having systemic effects of inflammation has been chosen as the answer here in preference to IL-6.


Question: Study the following carefully.Read the pedigree. Inheritance pattern of the disease in the family is

X-linked recessive inheritance is a mode of inheritance in which a mutation in a gene on the X chromosome causes the phenotype to be expressed in males (who are necessarily hemizygous for the gene mutation because they have one X and one Y chromosome) and in females who are homozygous for the gene mutation, see zygosity. X-linked inheritance means that the gene causing the trait or the disorder is located on the X chromosome. Females have two X chromosomes, while males have one X and one Y chromosome. Carrier females who have only one copy of the mutation do not usually express the phenotype, although differences in X chromosome inactivation can lead to varying degrees of clinical expression in carrier females since some cells will express one X allele and some will express the others Ref Robbins 9/e p 145


Question:
Mural thrombi are thrombi
in


Question: Cystic medial necrosis responsible for aoic dilatation and rupture is seen in

In Marfan syndrome, a connective tissue disorder of autosomal dominant inheritance, the basic biochemical abnormality is a mutation affecting fibrillin. Most serious, however, is the involvement of the cardiovascular system. Fragmentation of the elastic fibers in the tunica media of the aoa predisposes affected patients to aneurysmal dilation and aoic dissection . These changes, called cystic medionecrosis, are not specific for Marfan syndrome. Similar lesions occur in hypeension and with aging. Loss of medial suppo causes dilation of the aoic valve ring, giving rise to aoic incompetence. Robbins Basic pathology,9th edition,pg no.221


Question: Cardinal event of acute inflammation

Vasodilatation and| vascular permeability


Question: In children, Superior quadrantanopia is due to

(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition,pg no: 310-311)


Question: Liquefaction foci of Miller is a histopathoLogical observation in


Question: Most common thyroid Cancer is

Papillary carcinoma of thyroid: - constitutes >85% of all thyroid carcinoma - occurs due to mutation of genes encoding: *RET gene *NTRK1 receptor tyrosine kinases *BRAF gene These tumours may be solitary or multivocal. On microscopy: - branching papillae with fibrovascular stalk lined by cuboidal epithelium - nuclei of cells are optically clear with dispersed chromatin and has Orphan Annie eye nuclei (Ref : ROBBINS Text book of pathology) REF IMG


Question: Most likely precursor to bronchiectasis is

BronchiectasisAbnormal and permanent dilatation of bronchi.The bronchial dilatation of bronchiectasis of is associated with destructive and inflammatory changes in the walls of medium sized airways, often at the level of segmental or subsegmental bronchi.Types of bronchiectasisCylindrical bronchiectasis Varicose bronchiectasis Saccular (cystic) bronchiectasis Etiology & pathogenesisBronchiectasis is a consequence of inflammation and destruction of the structural components of the bronchial wall. Infection is the usual cause of inflammation.Adenovirus and influenza virusImpaired host defense mechanisms Carcinoid tumors or foreign body aspirationPrimary ciliary dyskinesia, Kaagener&;s syndrome and cystic fibrosis are also associated with bronchiectasis.Exposure to toxic substances like inhalation of toxic gases such as ammonia or aspiration of acidic gastric contentsClinical Manifestations:Radiographic findingsPersistent or recurrent cough and purulent sputum productionHemoptysis due to bleeding from friable, inflamed airway mucosa.Massive bleeding from hyperophied bronchial aeries.Physical examination includes crackles, rhonchi, and wheeze may be heard, all of which reflect the damaged airway containing significant secretions HRCT is investigation of choice When seen longitudinally, the airways appears as "tram tracks" ; when seen in cross-section, they produce &;ring shadows" Bronchiectasis of relatively proximal airways suggests ABPA, whereas the presence of multiple small nodules (nodular bronchiectasis) suggest infection with M. avium complex(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2143-2144)


Question: Ohngren's classification is used for

Ohngren's classification: This is done using an imaginary line between medial canthus to the angle of mandible. Growth above this line have poor prognosis


Question: The wasting syndrome associated in cancer is


Question: Caseating granuloma is commonly seen in


Question: Histological finding of Reye's syndrome is

please upload a reason for this question, if anyone..


Question: Overgrowth of the bile duct in a localized region is

The term hamaoma refers to an excessive, focal overgrowth of cells and tissues native to the organ in which it occurs. Although the cellular elements are mature and identical to those found in the remainder of the organ, they do not reproduce the normal architecture of the surrounding tissue. Von Meyenburg complexes are small bile duct hamaomas. Occasional von Meyenburg complexes are common in otherwise normal individuals. When they are diffuse they signal the underlying, more clinically impoant fibropolycystic disease. Reference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 18; Liver and Gallbladder


Question: PG responsible for fever in brain is

(B) PGE2 [?]Fever:-An abnormally elevation of body temperature-Pyrexia, febrile-Results from trauma, infections, drug reactions, brain tumors and other causes.oFever is an adaptive defence mechanism, in moderation, does more good than harm-Promotes interferon activity-Elevates metabolic rate and accelerates tissue repair-Inhibits reproduction of bacteria and viruses.oInitiation of fever by exogenous pyrogens - fever producing agents.-Glycolipids on bacterial and viral surfaces.-Attacking neutrophils & macrophages secrete endogenous pyrogens.-Stimulate neurons in anterior hypothalamus to secrete prostaglandin E2 .-PGE2 raises hypothalamic set point for body temperature.oStages of fever:-Onset, stadium, defervescence[?]Endogenous pyrogensoDerived from the macrophages, small molecule, can pass blood brain barrieroPyrogen cytokines trigger hypothalamus to release PGE2 resulting in resetting of thermostatic temperature, activation of vasomotor center, vasodilatation and heat production.[?]Fever pathogenesisoRegulated like body temperature, at a higher set pointoSet point is reset by endogenous pyrogens (IL-1, IL-6, TNF-a, TNF-b, and IFNg)oEndogenous Pyrogens stimulate Organum Vsculosum Laminae Terminalis (OVLT) surrounding the preoptic nucleus, anterior hypothalamus and septum palusolumoTriggered OVLT synthesis of PG (PGE2 ) - preoptic nucleus - fever


Question: Multiple myeloma on radionuclide scanning presents as

Hot spots' or | distribution is seen inBone tumor or cancerBone metastasis from breast, lung, prostate, thyroid & kidney.Fracture, when it cannot be seen on a regular X-ray Bone injections (osteomyelitis)Cause of bone pain.Metabolic disorders such as osteomalacia, renal osteodystrophy, primary hyperparathyroidism, osteoporosis, complex regional pain syndrome &Paget's disease.(Refer: Sutton's Textbook of Radiology & Imaging, 7th edition, pg no:1251-1255)


Question: Mini mental scale in Psychiatry Interview is

Mini mental state examination The mini-mental state examination (MMSE) or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive impairmentUsed in medicine to screen for dementiaUsed to estimate the severity of cognitive impairment and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an individual&;s response to treatment.Test FeaturesCategoryPossible pointsDescriptionOrientation to time5From broadest to most narrow. Orientation to time has been correlated with future declineOrientation to place5From broadest to most narrow. This is sometimes narrowed down to streets, and sometimes to floorRegistration3Repeating named promptsAttention and calculation5Serial sevens, or spelling "world" backward. It has been suggested that serial sevens may be more appropriate in a population where English is not the first languageRecall3Registration recallLanguage2Naming a pencil and a watchRepetition1Speaking back a phraseComplex commands6Varies. Can involve drawing figure shown.(Refer: Kaplan and Sadock&;s Synopsis of Psychiatry, 10th edition,pg no:187)(Refer: Niraj Ahuja- A Sho Textbook of Psychiatry, 20thedition, pg no:13)


Question: In parathyroid carcinoma

In Parathyroid carcinoma there is excess release of parathormone which results in increased blood calcium levels and decreased bone calcium level. Cytolologic details are unreliable in its diagnosis whereas invasion of surrounding tissue and metastasis are only reliable. Ref: Robbins and cotrans 9e Pg 1102

Increased parathromone, decreased calcium in bone


Question: Memory T Cells can be identified by using the following marker


Question: Basement membrane collagen is

(IV): (170 Harsh mohan 6th edition)Basement membrane are PAS positive amorphous structures that lies underneath epithelia of different organs and endothelial cells, they consist of collagen type IVand laminin**


Question: Histologic sections from a mass originating from the meninges would most likely reveal

Meningiomas arise from arachnoid villi of brain or spinal cord and have a female/male ratio of 3:2. Although they are usually tumors of middle or later life, a small number occur in persons 20 to 40 years of age. They commonly arise along the venous sinuses (parasagittal, sphenoid wings, and olfactory groove). Although meningiomas are benign and usually slowgrowing, some have progesterone receptors and rapid growth in pregnancy occurs occasionally. The rare malignant meningioma may invade or even metastasize. The typical case, however, does not invade the brain, but displaces it, causing headaches and seizures. Histologically, many different patterns can be seen, but psammoma bodies and a whorled pattern of tumor cells are somewhat characteristic. In contrast, Antoni A areas with Verocay bodies are seen in schwannomas, endothelial proliferation and serpentine areas of necrosis are seen in glioblastoma multiformes, a "fried-egg" appearance of tumor cells is characteristic of oligodendrogliomas, and true rosettes and pseudorosettes can be seen in medulloblastomas. Meningioma Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

A whorled pattern and rare psammoma bodies

Endothelial proliferation and serpentine areas of necrosis


Question: In multiple myeloma there is proliferation of

Mulple myeloma  Mulple myeloma is a plasma cell neoplasm characterized by involvement of the skeleton at mulple sites,
Plasma cells proliferate abnormally and the proliferated plasma cells infiltrate various organs, parcularly bone marrow,
but can also spread to lymph nodes and extranodal sites like skin,
 The proliferaon and survival of myeloma cells are dependent on several cytokines, IL-6 is parcularly important,
The neoplasc plasma cells secrete abnormally large amounts of immunoglobulin.
 The immunoglobulin secreted by neoplasc plasma cells are quiet different form the immunoglobulin normally present in the blood.
 The normal immunoglobulin consists of two heavy and two lights chains molecules and the producon of both chain is ghtly balanced.
 The immunoglobulin secreted in this condion may be : - Isolated light chain or heavy chain. May be an intact anbody molecule of any heavy chain subclass.
May be an altered anbody or fragment.


Question: Most common benign tumor of heart in children

Most common benign tumor of heart is Rhabdomyoma in children myxoma in adults.


Question: Receptor on neuronal memebrane that induces development of glioma


Question: MALT is most commonly present in

Ans. (c) Ileum(Ref: Wheaters Functional Histology: A Text and Colour Atlas 6th ed Pg 216)MALT is most commonly present in Peyer's patches in lamina propria of ileum & throughout small intestineComponents of MALT are sometimes subdivided into:GALTGut-associated lymphoid tissue; Eg Peyer's patches found in the lining of the small intestinesBALTBronchus-associated lymphoid tissueNALTNasal-associated lymphoid tissueCALTConjunctival-associated lymphoid tissueO-MALTOrganized mucosa-associated lymphatic tissue; Eg tonsils of Waldeyer's tonsillar ringD-MALTDiffuse mucosa-associated lymphatic tissueLALTLarynx-associated lymphoid tissueSALTSkin-associated lymphoid tissue


Question: In sickle cell anemia change in the amino acid is

(A) valine instead of glutamic acid in the 6th position of beta chain# Molecular basis of Sickle cell hemoglobin:> In case of sickle cell disease, the hemoglobin (HbS) has two normal a chains and two abnormal b chains.> This is due to a difference in a single amino acid. In HbS, glutamate at 6th position b-chain of is replaced by valine.> This occurs due to a change (missense mutation) in the single nucleotide (thymine a adenine) of the b globin gene. This error causes the formation of altered codon (GUG in place of GAG) which leads to the incorporation of valine at the 6th position.

Valine instead of glutamic acid in the 6th position of b chain

Glutamic acid instead of valine in the 6th position of b chain

Valine instead of glutamic acid in the 6th position of a chain

Glutamic acid instead of valine in the 6th position of a chain


Question: Antibodies against phospholipase A2 receptors are seen in

Answer- A. Membranous GNMembranous glomerulonephritis, also known as membranous nephropathy, is a slowly progressive disease of the kidney.Primary (also called idiopathic) membranous nephropathy is considered to be an autoimmune disease linked to ceain HLA alleles such as HLA-DQA1 and caused in most cases by antibodies to a renal autoantigen. In many adult cases the autoantigen is the phospholipase A2 receptor.


Question: Thrombocytosis is seen in


Question: In Huntington chorea the causative mutation in the protein huntingtin is a

Expansion of trinucleotide repeats is an important genetic cause of human disease, particularly neurodegenerative disorders. There are three key mechanisms by which unstable repeats cause diseases:
• Loss of function of the affected gene occurs in fragile X syndrome. In such cases the repeats are generally in noncoding part of the gene.
• A toxic gain of function by alterations of protein structure as in Huntington disease and spinocerebellar ataxias. In such cases the expansions occur in the coding regions of the genes.
• A toxic gain of function mediated by mRNA as is seen in fragile X tremor-ataxia syndrome. In this condition, the non coding parts of the gene are affected.


Question: Most common malignant bone tumor

Primary bone tumors are considerably less common than bone metastases from other primary sites; metastatic disease is discussed at the end of this section. Primary bone tumors exhibit great morphologic diversity and clinical behaviors--from benign to aggressively malignant. ref : Robbins Basic Pathology, 9E,page-774


Question: Increased permeability in acute inflammation is due to

Formation of endothelial gaps in venules, i.e. immediate transient response is the most common mechanism causing increased vascular permeability in acute inflammation,
Mediators involved in this mechanism are

i. Immediate (more important): Histamine, bradykinin, leukotrienes, neuropeptide substance P.
ii. Somewhat delayed: IL-1, TNF, IFNγ


Question: Most preferred technique for painless labour

the lumbar epidural replaced caudal analgesia as the preferred technique. Compared with the caudal route, lumbar epidural analgesia is more comfoable for the patient and easier to perform. The technique required less local anesthetic.. Ideally, an epidural is staed when the woman is at least four centimetres dilated and in active labour (having strong and regular contractions) Ref Robbins 9/e pg 456

Lumbar + sacral epidural (double catheter technique)


Question: TENS therapy is useful in

Passive modalities such as ultrasound, laser and transcutaneous electrical nerve stimulation (TENS) are often used to reduce myofascial pain. TENS uses a low-voltage biphasic current of varied frequency and is designed for sensory counter stimulation for the control of pain. It is thought to increase the action of modulation that occurs in pain processing at the dorsal horn of the spinal cord and the trigeminal nucleus of the brain stem. Ultrasound relies on high-frequency oscillations that are produced and converted to heat as they are transmitted through tissue; it is a method of producing deep heat more effectively than the patient could achieve by using surface warming.


Question: Tooth discolouration due to high biLirubin secretion is seen in the


Question: Sialograhy of normal salivary gland reveals the ductal architecture as having an appearance of


Question: Premature exfoliation of deciduous teeth is seen in


Question: Glycogen containing cells is feature of

Ans. a (Ewing's sarcoma). (Ref. Robbin, Pathology, 6th ed., 1244)EWING'S SARCOMA# Ewing's sarcoma constitutes -10-15% of all bone sarcomas# Is common in adolescence (peak incidence in the second decade of life).# It typically involves the diaphyseal region of long bones, Also has an affinity for flat bones.# X-ray: characteristic 6ionion peel" periosteal reaction with a soft tissue mass (better seen by MRI).# The soft mass is composed of sheets of monotonous, small, round, blue cells and can be confused with lymphoma, embryonal rhabdomyosarcoma, and small-cell carcinoma.# It is composed of sheets of uniform small, round cells that are larger than lymphocytes, rich in glycogen with Homer- Wright rosettes (tumor cells with PAS positive Glycogen-filled cytoplasm characteristic).# The presence of p30/32, the product of the mic-2 gene (which maps to the pseudoautosomal region of the X and Y chromosomes) is a cell-surface marker for Ewing's sarcoma (and other members of PNETs).# In approximately 85% of patients t (11;22) (q24;ql2) translocation is seen.# It is Undifferentiated--high grade tumor (Ewing's is always classed G4).# It is very aggressive, and it is therefore considered a systemic disease.# Common sites of metastases are lung, bones, and bone marrow.# Ewing's sarcoma can be curable, even in the presence of metastatic disease, especially in children <11 years.# Systemic chemotherapy is the mainstay of therapy, often being used before surgery.# Local treatment for this tumor includes surgical resection, usually with limb salvage or radiation therapy.# More PNETs are known to arise in soft tissues; which include -- Peripheral neuroepithelioma,- Askin's tumor (chest wall), and- Esthesioneuroblastoma.Other small round cell tumors includeQ TumorClassic cytogenetic abnormality1.Wilm's tumor11p13deletion/mutation2.Lymphoblastic lymphoma (ALL)t (9;12)3.Rhabdomyosarcomat (2;13), llpdeletion4.Neuroblastomalpdeletion,N-myc amplification,DNA hyperploidy5.Medulloblastoma17q6.Retinoblastoma13q14deletion/mutation7.Ependymoblastoma 8.Burkit's lymphomat (11;22)9.Small cell carcinoma Note: Osteosarcoma is not a round cell tumor.


Question: Commonest histological finding in benign hypeension is aEUR'

Hyaline aeriosclerosis Hyaline aeriosclerosis consists of homogenous pink hyaline thickening of the wall of the aerioles with loss of underlying structural detail. Encountered .frequently in elderly patients whether normotensive or hypeensive, hyaline aeriosclerosis is more generalized and more severe in patients with hypeensiondeg. It is also common in diabetesdeg as a pa of the characteristic microangiopathy. Pathogenesis The lesion reflects leakage of plasma components across vascular endothelium and excessive extracellular matrix production by smooth muscle cells secondary to the chronic hemodynamic stress of hypeension or a metabolic stress in diabetes that accentuates endothelial cell injury. Also know Hyperplastic aeriosclerosis It is characteristic of malignant hypeensionQ. There is concentric laminated thickening of aeriolar wall onion thickenine There is mucinous intimal thickening and fibrous intimal thickening. There may be accompanied .fibrinoid deposite with necrosis of the vessel wall --,vfibrinoid necrosisQ.


Question: Cystosarcoma phylloides is tumor of

Ans. a (Breast). (Ref. Baily & Love, Surgery, 22nd/pg.552)CYSTOSARCOMA PHYLLOIDES# is benign tumor of the breast.# It presents as a huge mass in breast.# Its histological pattern is variegated.# Its a misnomer as its relatively benign, but potentially malignant tumor.


Question: Streak gonads are seen in

Most patients have primary amenorrhea, and morphologic examination reveals transformation of the ovaries into white streaks of fibrous stroma devoid of follicles.the ovaries are reduced to atrophic fibrous strands, devoid of ova and follicles (streak ovaries).It is the defective development of the gonads in an embryo, with reproductive tissue replaced with functionless, fibrous tissue, termed streak gonads. ref : Robbins Basic Pathology, 9E,page-240


Question: Homer Wright rosettes are seen in

Examples of tumors containing these are neuroblastoma, medulloblastoma, Pinealoblastoma, and primitive neuroectodermal tumors of bone(Ewing sarcoma). Refer robbins 9/e p844


Question: Drug used in case of Herpetic lesions


Question: RBC cast in the microscopic examination of the urine is an indicator of

(A) Acute glomerulonephritis THE GLOMERULAR SYNDROMEAcute nephritic syndromeHematuria, azotemia, variable proteinuria, oliguria, edema, and hypertensionRapidly progressive glomerulonephritisAcute nephritis, proteinuria, and acute renal failureNephrotic syndrome>3.5 gm proteinuria, hypoalbuminemia, hyperlipidemia, lipiduriaChronic renal failureAzotemia uremia progressing for yearsAzotemia uremia progressing for yearsGlomerular hematuria; subnephrotic proteinuria


Question: Heck's disease is another name for

Hereditary intestinal polyposis syndrome


Question: Type of inheritance in MEL ASAI

MELAS (mitochondrial encephalopathy with lactic acidosis an stroke) is a mitochondrial disease


Question: Commonest site of liquifactive necrosis is

Ans. a (Brain). (Ref. Robbins, Pathologic Basis of Disease, 8th/pg.7-13)NECROSIS# Enzymatic degradation of a cell resulting from exogenous injury.# Characterized by enzymatic digestion and protein denaturation, with release of intracellular components.# Morphologically occurs as coagulative (heart, liver, kidney), liquefactive (brain), caseous (tuberculosis), fat (pancreas), fibrinoid (blood vessels), or gangrenous (limbs, GI tract).# Kidney infarct exhibiting coagulative necrosis will be seen with loss of nuclei and clumping of cytoplasm but with preservation of basic outlines of glomerular and tubular architecture.# Liquefactive necrosis in the kidney can be caused by fungal infection, which will be seen filled with white cells and cellular debris, creating a renal abscess that obliterates the normal architecture.IRREVERSIBLE INJURY AND CELL DEATHMORPHOLOGIC PATTERNCHARACTERSTICSCOAGULATIVE NECROSISMost common type (e.g. Heart, liver, kidney)LIQUEFACTIVE NECROSISAbscesses, brain infarcts, pancreatic necrosisCellular destruction by hydrolytic enzymesCASEOUS NECROSISSeen in tuberculosisCombination of coagulation and liquefaction necrosis soft, friable, and "cottage-cheese-like" appearanceFAT NECROSISCaused by the action of lipases on fatty tissue (e.g. with pancreatic damage)Chalky white appearanceFIBRINOID NECROSISEosinophilic homogenous appearance - resembles fibrinGANGRENOUS NECROSISCommon sites: lower limbs, gallbladder, Gl tract and testesDry gangrene - coagulative necrosisWet gangrene - liquefactive necrosisAPOPTOSISA specialized form of programmed cell death, an active process under genetic control.Executed in mitochondria.Mediated by a cascade of caspases (digest nuclear and cytoskeletal proteins and active endonucleases).


Question: Plasmacytoid lymphomas may be associated with an increase in

*Lymphoplasmacytic lymphomas are otherwise called as plasmacytoid lymphomas or immunocytomas. *It is a mature B cell neoplasm of older adults (60-70years)*Bone marrow shows small lymphoid cells and admixed plasma cells*These plasma cells secrete monoclonal IgM*IgM can cause a hyperviscosity syndrome called Waldenstrom&;s macroglobulinemia.(Ref: Robbins 8/e p612)


Question: Creeping fat is a feature of

fat may encircle around antimesentric serosal surface producing a pattern known as creeping fat. mnemonic: FIND CASH Fissures Ileum Non-caseating granuloma Distoion of mucosal architecture Creeping fat, Crypt abscess, Cobblestone appearance. Aphthous ulcer Skip lesions Hose pipe like bowel SYSTEMIC AND GENERAL PATHOLOGY RAMDAS NAYAK PG NO.406


Question: Plasminogen domain resembles

REF: ROBBINS pathology 10th edition Phylogeny of the serine proteinase domains and analysis of intron-exon boundaries and Kringle sequences indicate that hepatocyte growth factor/scatter factor (HGF/SF), hepatocyte growth factor-like/macrophage stimulating protein (HGFVMSP), plasminogen, and apolipoprotein (a) have evolved from a common ancestral gene. The name Kringle comes from the Scandinan pastry that these structures resemble them


Question: Mrs. X had a femur fracture following A. On day 3, suddenly she developed tachypnea, dyspnea, and tachycardia and progressed to delirium and coma. Diagnosis is

Microscopic fat globules can be found in the pulmonary vasculature after fractures of long bones or, rarely, in the setting of soft tissue trauma and burns. Fat embolism syndrome is the term applied to the minority of patients who become symptomatic. It is characterized by pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia, and is fatal in about 5% to 15% of cases. Typically, 1 to 3 days after injury there is a sudden onset of tachypnea, dyspnea, and tachycardia; irritability and restlessness can progress to delirium or coma.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 4; Hemodynamic Disorders, Thromboembolic Disease, and Shock; Page no: 128


Question: Not a complication of peussis

Complications of Peussis Pneumonia (most frequent) Atelectasis Subcutaneous emphysema Bronchiectasis Otitis media Reactivation of tuberculosis Convulsions Coma Epistaxis Subconjunc val hemorrhage Rupture of diaphragm Umbilical hernia Rectal prolapse Melena Inguinal hernia Dehydration Ulcer of tongue Protein-energy malnutrition


Question: The most dreadful complication of Kawasaki disease is

Kawasaki disease is an acute, febrile, usually self-limited illness of infancy and childhood (80% of the patients are younger than 4 years of age) associated with an aeritis of mainly large to medium-sized vessels. Its clinical significance stems from the involvement of coronary aeries. Coronary aeritis can cause aneurysms that rupture or thrombose, resulting in myocardial infarction. (Robbins basic pathology,9th edition,pg no.352)


Question: Initiation of dental caries depends upon


Question: Chromosomal translocation characteristic in acute promyelocytic leukemia is

In AML with the + (15;17) acute promyelocytic Leukemia (M3 stage), auer rods present (most common stage associated with DIC).
+ (8;21) AML with maturation stage (M2 Stage)
+ (16;16) associated with best prognosis.


Question: Lysosomal transpo defect is seen in

Answer- A. CystinosisTwo disorders are caused by a proven defect in carrier-mediated transpo of metabolites: cystinosis end the group of sialic acid storage disorders (SASD).


Question: 'Onion Skin' appearance of radiographs is seen in


Question: PAF does not cause


Question: Perleche is caused by


Question: Pathologic calcification is seen in

Systemic sclerosis:

Characterized by ultimate induration and atrophy of skin and fixation of epidermis to deeper subcutaneous tissues. The skin becomes hardened and atrophic and cannot be wrinkled or picked up because of its firm fixation to the deep connective tissue. This contracture of skin gives a mask-like appearance to the face of claw-like appearance to hands.
Scleroderma can be circumscribed (morphea) or linear (Coup de sabre).
The tongue becomes stiff and board like, causing the patient difficulty in eating and speaking.
Reduced opening of mouth and fixation of jaw as a result of involvement of the peritemporo mandibular joint tissues making dental care very difficult.
Some times deposition of calcium in affected areas is also found.

Radiographic features:
-     Extreme widening of PDL, two to four times normal thickness is diagnostic.
-    Bone resorption of angle of mandibular ramus and partial or complete resorption of condyles and/or coronoid processes of the mandible are also seen.

Overall, increased collagen in tissues is characteristic feature of systemic sclerosis or scleroderma.


Question: Ladder pattern of DNA electrophoresis in apoptosis is caused by the action of following enzyme


Question: Definitive diagnosis of oral cancer is made by


Question: Metastasis is least common with

Also known as endodermal sinus tumor, yolk sac tumor is of interest because it is the most common testicular tumor in infants and children up to 3 years of age. In this age group it has a very good prognosis. In adults the pure form of this tumor is rare; instead, yolk sac elements frequently occur in combination with embryonal carcinoma.


Question: Antithrombin is protein produced by

(Liver): (459- 992 H 18th edition)ANTI THROMBIN (or anti thrombin III) is the major plasma protease inhibitor of thrombin and the other clotting factors in coagulation. Synthesized in the liver and circulating in plasma at a concentration of 2.6 + 0.4mm antithrombin acts as suicide substrate for its target enzymes.


Question: Periglomerular fibrosis is considered typical of

Chronic pyelonephritis is defined here as a morphologic entity in which predominantly interstitial inflammation and scarring of the renal parenchyma are associated with grossly visible scarring and deformity of the pelvicalyceal system. Chronic pyelonephritis is an impoant cause of chronic renal failure. It can be divided into two forms: chronic obstructive pyelonephritis and chronic reflux-associated pyelonephritis Refer robbins 9/e p545


Question: The swollen degenerating epithelial cell due to acantholysis is


Question: The protein found in the amyloid deposits in senile systemic amyloidosis is


Question: The most common infectious agent associated with chronic pyelonephritis is

In most urinary tract infections, the infecting organisms are derived from the patient's own fecal flora. The most common is E.coli, followed by Proteus, Klebsiella, and Enterobacter. Ref: Pathologic basis of disease Robbins, volume 2, Pg no:930


Question: Helmet Cells are characteristic of

Schistocytes are typically irregularly shaped, jagged, and have two pointed ends. A true schistocyte does not have central pallor.
Helmet cells are also known as schistocytes / triangle cells / burr cells are a Feature of microangiopathic diseases including disseminated intravascular coagulation (DIC), thrombotic microomgiopathies (TTP), mechanical artificial heart valves and hemolytic Uremic syndrome (HUS).


Question: Eosinophils are activated by


Question: The following is not a features of  Alzheimer's disease

Lewy bodies are commonly found in Parkinsonism.


Question: Proliferation of nasal masses in Rhinoscleroma produces characteristic configuration typical of the disease


Question: Fetal and maternal blood can be differentiated by

Apt testKleihauer-Betke testSource of SampleMaternal or NeonatalMaternalPrincipleAdding 1% NaOH destroys adult HbA but not fetal HbFAdding acid destroys adult HbA but not fetalHbFAssessment TypeQualitativeQuantitativeResultPositive means blood is of fetal originRepoed in estimated milliliters of fetal bloodNote:When fetal blood needs to be differentiated from maternal bloodApt Test is used (Qualitative estimation)When the amount of fetal blood needs to be estimatedKleihauer-Betke test is used(Quantitative estimation)Approximate volume of fetal blood entering into the maternal circulation is to be estimated by Kleihauer-Betke test using acid elution technique to note the number of fetal red cells per 50 low power fields.If there are 80 fetal erythrocytes in 50 low power fields in maternal peripheral blood films, it represents a transplacental hemorrhage to the extent of 4ml of fetal blood.(Refer: Mudaliar and Menon&;s Clinical Obstetrics, 11th edition, pg no:227)


Question: The following is an activator of LCAT


Question: Anaplasia characterized by

(B) Complete loss of Differentiation[?]When a tumor cell loses its differentiation it gradually gains features of Dysplasia.oDysplacia is a process of gradual loss of differentiation.oIt is an abnormal growth which may precede malignancy.oComplete loss of differentiation = Anaplasia[?]Anaplasia:oIt implies dedifferentiation or loss of structural & functional differentiation of normal cells.oEg., Malignant tumours formed of undifferentiated cells are called anaplastic tumours, anaplasia is a marker of cancer.[?]Differentiation & Anaplasia:oDifferentiation refers to the extent to which the tumour cells resemble their normal counterpart, both morphologically & functionally.oWell-differentiated tumours, whether benign or malignant, tend to retain the functional characteristics of their counterparts such as the product on of hormones in tumours of endocrine origin or keratin in squamous epithelial tumours. Anaplastic tumours have no specialized functional activity.[?]Differentiation & Anaplasia:oDysplasia = disorderly (dys-) growth (-plasia)o'Dysplasia' is used to describe disorderly changes in non-neoplastic epithelial cells.oGraded as mild, moderate or severe.-Mild-moderate: Usually reversible-Severe: Usually progresses to carcinoma in situ (CIS).oNext step after CIS: Invasive carcinomaoAnaplasia = a state of complete un-differentiationoLiterally, 'toform (-paisa) backwards (ana-)'oMisnormer! Cells don't de-differentiate.oJust means cells are very poorly-differentiated.oAlmost always indicates malignancy.[?]Differentiation is defined as the extent of morphological and functional resemblance of parenchyma tumour cells to corresponding normal cells.oIf the deviation of neoplastic cell in structure and function is minimal as compared to normal cell, the to is known as "well differentiated" e.g. Benign tumour.oPoorly differentiated or undifferentiated or de-differ is poor structural and functional resemblance to corresponding normal cell.oAnaplasia is defined as lack of differentiation and is a characteristic feature of most malignant tunoRefers to a lack of differentiation in neoplastic cells.oWell-differentiated tumors resemble their tissue of originoPoorly-differentiated or undifferentiated (anaplastic) tumor cells appear primitive and lack specialization along any particular cell line.

Changing one type of epithelium to another


Question: Annexin V is a marker of aEUR'

Apoptosis Annexin V assays provides simple and effective method to detect apoptosis at a very early stage. This assay makes advantage of the fact that phosphatidylserine (PS) is translocated from the inner (cytoplasmic) leaflet of the plasma membrane to the outer (cell surface) leaflet soon after the induction of apoptosis and that the annexin V protein has strong specific affinity for phosphatidyl serine. Phosphatidyl serine on the outer leaflet is available to bind labelled annexin V providing the basis for a simple staining assay. All of the annexin proteins share the propey of binding calcium and phospholipids. Annexin V is a cause of syndrome called antiphospholipid antibody syndrome. Annexin V normally forms a shield around ceain phospholipid molecules that blocks their entry into coagulation (clotting) reactions. In the antiphospholipid antibody syndrome; the formation of the shield is disrupted by the abnormal antibodies. Without the shield, there is an increased quantity of phospholipid molecules on cell membranes speeding up coagulation reactions and causing the abnormal blood clotting characteristic of antiphospholipid antibody syndrome.


Question: The commonest site for extragonadal germ cell tumor

Reference Robbins page no 475 Extragonadal germ cell tumors form from developing sperm or egg cells that travel from the gonads to other pas of the body. ... These are more common than malignantextragonadal germ cell tumors and often are very large. Malignant extragonadal germ cell tumors are divided into two types, nonseminoma and seminoma In adults, the mediastinum is the most common extragonadal site for the development of germ cell tumors.229-233 The most common tumor in this site is mature teratoma.234 This diagnosis can be suggested by the presence of a large circumscribed anterior mediastinal mass with normal serum HCG and a-fetoprotein. Management of mature teratoma is surgical, and there is no role for chemotherapy or radiotherapy. Although these tumors histologically are benign, removal is often difficult. The tumors are commonly adherent to adjacent structures, such as the pericardium, lung, and great vessels.


Question: A patient has asymptomatic painless burrowing ulcer in the palate. He might be suffering from


Question: Triad of leukoerythroblastosis, tear drop erythrocytes and large platelets is seen in

Ans. (b) Primary myelofibrosis(Ref: Robbins 9th/pg 620/630)The most characteristic peripheral blood finding in PMF is myelophthisis, defined by the presence of leukoerythro- blastosis (presence of nucleated red blood cells, metamyelocytes, myelocytes, myeloblasts, and megakaryocytes) and dacryocytosis (Tear drop RBCs)


Question: Chubby cheeks, eyes are blue and staring at the sky is a feature of


Question: The sensitive indicator for assessment of Iodine deficiency is

Epidemiological assessment of Iodine deficiency Prevalence of goiterPrevalence of cretinism Urinary iodine excretion Measurement of thyroid function by determination of serum levels of thyroxine (T4) and pituitary thyrotropic hormone (TSH)Prevalence of neonatal hypothyroidism Neonatal hypothyroidism is a sensitive indicator of environmental iodine deficiency Serum T4 level is a more sensitive indicator of thyroid insufficiency than T3(Refer: K. Park's Textbook of Preventive and Social medicine, 24th edition, pg no: 662, 663, 681)


Question: Most common site of oral leukoplakia is


Question: HLA is located on

Harshmohan textbook of pathology 7th edition. * HAL located on sho arm of chromosome no 6


Question: Spalding's sign occurs because of