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MCQs in Objective Pathology PDF
MCQs in Objective Pathology PDF
Objective Pathology
with Explanations
MCQs in
Objective Pathology
with Explanations
Second Edition
Sumant Sharma MD
Laboratory Director/ Director of Infection Control
Prince Sultan Kidney and Heart Center
Najran, Kingdom of Saudi Arabia
Yogesh Chhabra
MD
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
2012, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book may be reproduced in any form or by any means without
the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the authors
contained herein are original, and is intended for educational purposes only. While every
effort is made to ensure accuracy of information, the publisher and the authors specifically
disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are
courtesy of the authors.
MCQs in Objective Pathology with Explanations
First Edition: 2000
Second Edition: 2012
ISBN: 978-93-5025-904-7
Printed at
Dedicated to
Dr Swarn Kanta Sharma
and
Dr Smita
Sumant Sharma
Yogesh Chhabra
Sumant Sharma
Acknowledgments
I am extremely thankful to Shri Jitendar P Vij (Chairman and
Managing Director) for his patient support to the project. I must
also mention the support given by the publishing team of M/s Jaypee
Brothers Medical Publishers, New Delhi, India, especially Ms Samina
Khan and Mr Gurnam Singh.
Lastly, I thank the past and future students of this great subject who have served as lamp-posts all throughout.
Contents
1. Introduction to Pathology ............................................. 1
2. Genetic and Environmental
Causes of Diseases ...................................................... 37
3. Miscellaneous Topics in General Pathology .............. 42
4. Disorders of Growth and Differentiation .................... 45
5. Disorders of Metabolism and Homeostasis ................ 48
6. Cardiovascular System ................................................. 52
7. Blood and Bone Marrow ............................................. 56
8. Respiratory System ...................................................... 61
9. Liver, Biliary Tract and Exocrine Pancreas ............... 65
10. Alimentary Tract ........................................................... 67
11. Male and Female Genital Tract and
Endocrine System ......................................................... 73
12. Breast ............................................................................ 76
13. Male Genital Tract ........................................................ 78
14. Kidney and Urinary Tract ............................................ 81
15. Skin, Soft Tissue and Skeletal System ...................... 84
16. Nervous System ............................................................ 87
Chapter 1
Intr
oduction tto
o PPat
at
hology
Introduction
athology
Introduction to Pathology
ANSWERS
1. A.
B.
C.
D.
E.
2. A.
B.
C.
D.
E.
3. A.
B.
C.
D.
E.
4. A.
B.
C.
D.
E.
5. A.
B.
C.
CONCEPTS
Q.1. Which of the following are true about cell-cell interactions?
A. Occluding junctions and zona adherence are the same.
B. Macula densa are also called nexus.
C. Integrins and selectins share a common role of leukocyteendothelial cell interaction.
D. Cadherins prevent cancers from becoming invasive.
E. Immunoglobulin superfamily molecules have a role in
recognizing and binding immunological molecules.
F. Cytokines are secreted by hemopoietic cells only.
G. Tyrosine kinase associated receptors cause synthesis
and secretion of various hormones.
H. G-proteins are also called guanosine nucleotide binding
regulatory proteins.
Ans. A. False: Occluding junctions are called zonula occludens
and adhering junctions are called zonula adherence.
B. False: Macula densa is another name for desmosomes
and gap junctions are called nexus.
C. True: Besides the selectins also cause movement of
leukocytes and platelets.
D. True: Cadherins are calcium dependent adhesion mole-
Introduction to Pathology
E.
F.
G.
H.
B. True
C. True
D. False: Failure of energy dependent sodium potassium
pump causes intracellular accumulation of Sodium.
E. False: Myelin figures seen in cell injury are disintegrated
membrane blebs containing water and dissociated lipoproteins between lamellae of membranes.They can be
found both intracellularly and extracellularly.
Q.4. Which of the following are true?
A. Phospholipid rich amorphous densities are seen in
mitochondria in irreversible cell injury.
B. Ischemia-reperfusion injury is mainly because of oxidative damage to cell.
C. Generation of oxygen free radicals occurs in cytoplasm.
D. Superoxide oxygen is the most reactive of the oxygen
free radicals.
E. Cyanide kills by poisoning mitochondrial cytochrome
oxidase.
F. Ionising radiation can injure the DNA and the cell by
radiolysis of water and production of oxygen free radicals.
Ans. A. False: These are characteristic of reversible injury. In
irreversible injury, calcium rich densities are seen.
B. True
C. False: It begins within mitochondrial inner membrane.
D. False: Hydroxyl radical is the most reactive.
E. True
F. True
Q.5. Which of the following are true?
A. Cloudy swelling and hydropic swelling are the same.
B. Russells bodies representing excessive immunoglobin
in plasma cells rough endoplasmic reticulum represent
a form of hyalin change.
C. Hyalin degeneration occurs in rectus abdomins muscle
in typhoid fever.
D. Mallorys hyalin is seen in hepatocytes in cholestasis.
E. Corpora amylacea represent a form of intracellular hyaline.
Ans. A. False: Cloudy swelling involves excessive accumulation
of sodium and water whereas in hydropic swelling mainly
only water accumulates (vacuolar degeneration).
Introduction to Pathology
B.
C.
D.
E.
True
True: This is called Zenkers degeneration.
False: It is seen in alcoholic hepatitis.
False: It is an example of extracellular hyaline.
Q. 8. What is oncosis?
Ans. Irreversibly impaired metabolism (generally oxidative metabolism) brings about the death of cells with subsequent
vacuolar swelling of cell and reactive inflammation in the
absence of programmed cell death. The morphologic result
is necrosis
Note: Cell death and necrosis are not identical. A once-living cell
submerged and fixed in formaldehyde is chemically dead
although from a structural standpoint it remains intact and
animate.
Types
1. Ribosome-layer complexes: These are layered aggregates
of RER cisterns with interposed rows of ribosomes.
2. Annulated lamellae complexes: These are layered aggregates of perinuclear RER cisterns with nuclear pores.
3. Mitochondrial-lamellar-layer complexes: These are layered
aggregates of longitudinally compressed mitochondria and
RER cisterns.
Q.2. What are cytoplasmic nuclei?
Ans. This is the histological correlate of onion-layered aggregation of smooth endoplasmic reticulum (fingerprint degeneration).
Cytoplasmic nuclei are a sign of blocked enzyme synthesis, such as is occasionally seen in blocked or degenerative protein synthesis.
Q.3. Why is golgi apparatus atrophied in erythroblasts?
Ans. Atrophy of golgi apparatus is the ultrastructural correlate of
disturbed protein synthesis with or without impaired posttranslational protein modification. So it is typical in cells that
Introduction to Pathology
10
Introduction to Pathology 11
G. Molecular techniques like DNA microassays and immunological approaches for analysis diseases are no more
helpful in studying diseases than traditional morphological methods.
H. Rudolf Virchow has no contribution to modern pathology.
I. Study of origins, molecular mechanisms and structural
changes of cell injury alone are enough to understand
morphological and clinical patterns of tissue and organ
injury.
Ans. A. True.
B. False: Special or systemic pathology is concerned with
specific responses of specialized organs or tissues to
more or less well-defined stimuli.
C. False: Etiology is the cause of a disease. Pathogenesis
refers to sequences of events in the response of cells
or tissues to the etiological agent. It is the mechanism
of disease. So even if the genes and their mutant forms
underlying a great number of diseases and the entire
human gename have been mapped, functions of encoded proteins and how mutations induce disease are
often still obscure. The latter part forms pathogenesis
of a disease.
D. True: Though there are two major classes of etiological
agents, concept of one cause for one disease is obsolete. Almost all diseases known today have both genetic
and environmental etiologies combined.
E. False: To know full mechanism (pathogenesis) and
manifestations (Morphology) of cystic fibrosis, besides
the knowledge of defective gene and gene product, the
biochemical immunological and thus the morphological
events leading to formation of cysts and fibrosis in lungs,
pancreas and organs are required.
F. False: Molecular changes in a disease refer to structural
alterations in cells or tissues that are either characteristic of the disease or diagnostic of etiologic process.
Diagnostic pathology is devoted to identify nature and
progression of disease by studying morphological changes in tissues and chemical alterations in patients.
G. False: Molecular analyses have begun to reveal genetic
differences that bear on behavior of tumors. Examples
12
KEY WORDS
Etiology, pathogenesis, morphological changes, clinical significance,
molecular biology, tissue, cell and organ injury, Father of modern
pathology.
Q.2. Which of the following are true?
A. Atrophy involves decrease in number of cells of an organ.
B. Adaptation, reversible injury and cell death are separate
events not interlinked and can occur independently or
each other.
C. Cell death can be normal.
D. Necrosis can be physiological as apoptosis can be
pathological (abnormal).
E. Calcification is always pathological.
F. Cells exposed to even sublethal or chronic stimuli are
always damaged.
G. Cellular aging occurs with cumulative sublethal injury
with increasing life span.
Ans. A. False: Atrophy involves decrease in function and size of
cells.
B. False: Adaptation, reversible injury and cell death can
be considered stages of progressive impairment of cells
normal function and structure. For instance in response
Introduction to Pathology 13
C.
D.
E.
F.
G.
14
B. 1. Direct: Stimulation of cells by factors produced by responding cells or other cells in environment.
2. Activation of various cell surface receptors and downstream signalling pathways.
C. 1. Yes: Hormone induced growth of uterus involves increase in both number (hyperplasia)( DNA synth.)
and size (hypertrophy) ( Str Comp.) of smooth
muscle cells and epithelial cells. Abnormal endometrial hyperplasia is an example of pathological
hyperplasia and the consequence is mainly hyperplasia of endometrial glands though both hypertrophy
and hyperplasia of epithelial and endomyometrial
cells takes place to some extent. This is a common
cause of abnormal menstrual bleeding.
2. After normal menstruation, there is a rapid burst of
proliferative activity that is stimulated by pituitary
hormones and ovarian estrogen. It is brought to a halt
by rising level of progesterone usually about 10 to 14
days before anticipated menstrual period. If by any
cause the balance between estrogen and progesterone is tripped, there is absolute or relative increase
in estrogen with consequent hyperplasia of endometrial glands.
D. True: Hyperplasia is caused by increased local production of growth factors, increased levels of growth factor
receptors on responding cells, or activation of particular
intracellular signalling pathways. These changes cause
production of transcription factors that turn an may cellular genes including those envolving growth factors,
growth factor receptors and cell cycle regulators-net
result being cellular proliferation. Hormones themselves
can act as growth factors and trigger source of growth
factors in compensatory hyperplasia is not clear transcription of cellular genes.
E. False: Not only remaining cells but some new cells are
also formed from stem cells. In liver, intrahepatic stem
cells don not play a role in hyperplasia after hepatectomy
but contribute to regeneration after some forms of liver
injury like chronic hepatitis in which proliferative capacity
of hepatocytes is compromised.
Introduction to Pathology 15
16
Introduction to Pathology 17
18
Introduction to Pathology 19
some diseases. Formal pathogenesis describes the structural changes observed during clinical course of a disease
which culminate in the altered structural and functional state
of diseased organ/body.
Q.6. Define health and disease.
Ans. WHO defines health as a condition of complete bodily,
mental and social well-being. Disease is defined as a
dysfunction in life-processing that alter the body or a part
of body in a manner that the affected individual requires help
for subjective, clinical or social reasons.
Q.7. In what way is the type of clinical course of a disease
defined as regards to its development.
Ans. Peracute diseases are fulminant and usually lead to death
in several days. Acute diseases are usually intense and last
for a few days or weeks. Recuperation is possible. Subacute
diseases are insidious in onset, clinical course lasting for
weeks with doubtful recuperation. Chronic diseases are mild
and progress in stages over months. Primary chronic diseases begin without a manifest acute phase. Clinical
course is episodic. Recuperation is not possible. Secondary
chronic disorders occur subsequent to acute inflammation
that fails to heal because of complications. Recuperation
in secondary chronic diseases occurs with persisting structured damage and functional deficits after the disease and
subsides. The social and functional adaptability is thus restricted. Recurrence is resurgence of what is basically a
chronic disease after a gap. Remission is temporary disappearance of symptoms of a disease. Death (Exitus letalis
= lethal end)
Q.8. Will it be correct to say that homeostasis is a continuously changing state?
Ans. Yes, but upto some extent only. The normal cell is confined
to a fairly narrow range of function because of:
1. Genetic programming of metabolism, differentiation and
specialization.
2. Constraints because of neighboring cells.
3. Availability of metabolic substracts.
The narrow range of functioning is the steady state or
homeostasis. Within this narrow range there is conti-
20
Introduction to Pathology 21
22
Introduction to Pathology 23
Q.24. Define average life expectancy, morbidity and mortality and lethality.
Ans. Average life expectancy: Time period in which 50 percent
of certain population group have died. The population group
can be, e.g. women.
Morbidity: Number of persons per year per 100,000 population who suffer from a disease.
Mortality: Number of persons per year per 100,000 population who have died of a disease.
Lethality: Quotient obtained by dividing the number of
persons who have died of a certain disease by the number
of persons who have contracted that disease.
Q.25. Define epidemic autopsy, clinical autopsy and insurance autopsy.
Ans. Epidemic autopsy: Performed in equivocal cases involving
chemical suspicious of infectious disease.
Clinical autopsy: Performed on patients who died in hospital
usually a part of hospital quality assurance program.
Requires consent of next of kin.
Insurance autopsy: Done when required by insurance
companies when:
1. Sudden death from uncertain or unnatural causes.
2. Occupational exposure to certain pathogens.
The procedure is ordered by ensurer. This type of insurance
autopsy to resolve insurance claim is almost never refused
by next of kin.
Q.26. What are the two main classes of nuclei seen in cell
cycle?
Ans. Interphase nucleus: Characterized by a nucleolus containing RNA, loosely structured, genetically active euchromatin and densely structured heterochromatin (genetically
inactive)
Mitotic nucleus: Characterised by visible chromosomes.
Q.27. What is the structure of chromosomes in metaphase?
Ans. Two strands of chromatids joined at centromere.
short arm p (for petit)
long arm q.
24
Introduction to Pathology 25
26
Introduction to Pathology 27
28
4. Karyolysis: Fading of nucleus due to chromatin dissolution. Late sign of induced cell death.
5. Karyorrhexis: Nuclear burst due to chromatin fragmentation. Late sign of programmed cell death.
Q.43. What are the different types of nuclear inclusions
seen?
Ans. 1. Cytoplasmic inclusions: Migration of portions of cytoplasm in nucleus, associated with dysfunctional cell division in telephase causes a rounded lucency in nucleus
frosted glass nucleus.
For example papillary thyroid carcinoma.
2. Paraplasmic inclusions: Migration of portions of paraplasm
in nucleus due to imagination of nuclear membrane or
dysfunctional telophase.
3. Glycogen inclusions: Seen as nuclear defects after
alcohol fixationDiabetes.
4. Fatty inclusions: Following paraffin fixation, cause lipid
defects in nucleus. Typical of tumors in the form of fatty
tissueLiposarcoma.
5. Immunoglobulin inclusions: PAS-positive globules (FaheyDutcher bodies). Malignant lymphocytic tumors like
Lympholoplasmacytic lymphoma.
6. Viral inclusion: Viral proteins arranged in paracystalline
configuration.
Q.44. What is the most frequent type of metaplasia seen?
Ans. Metaplasia or an adaptive response to stress in which one
mature cell type (epithelial or mesenchymal) is converted
to another mature cell type is most commonly of columnar
to squamous epithelial type. The commonest form occurs
in smokers respiratory columnar ciliated mucous secreting
epithelium is replaced by more resistant stratified squamous epithelium with loss of mucous secreting function.
The change may be focal or wide. Stones in excretory ducts
of salivary glands, pancreas or bile ducts may also cause
a change from columnar to stratified squamous epithelium.
Q.45. What is the role of Vitamin A in maintaining
respiratory epithelium?
Ans. Vitamin A deficiency (retinoic acid deficiency) may cause
squamous metaplasia of respiratory epithelium and excess
of Vitamin A is protective against keratinization.
Introduction to Pathology 29
30
SUPPLEMENTARY TOPICSCELL
INJURY AND INFLAMMATION
PRETEST
1. Which of the following are true about cell Injury?
A. Hypothyroidism and scurvy cause delayed wound
healing.
B. Ultraviolet light promotes healing.
C. Cerebral cortex and myocardium can regenerate after
injury.
D. Fibrinoid necrosis occurs in TB.
E. Enzymatic lysis of adipose tissue causes fat necrosis.
2. Which of the following are true?
A. The myofibroblastic differentiation of fibroblast causes
contraction of granulation tissue.
B. Endarteritis obliterans and leukemia can be caused by
radiation exposure for a long time.
C. Apoptosis is pathological event.
D. Apoptosis is an energy dependent pigmentation of DNA
by non-lysosomal endonucleases.
3. Which of the following are true?
A. Endothelial cells and plasma cells are capable of
phagocytosis of particulate matter in acute inflammation.
B. Lymphocytes and plasma cells contribute in chromic
inflammation.
C. In vascular phase of inflammatory response, neutrophils
and monocytes move towards periphery of microcirculatory vessels a process called pavementing.
D. T-lymphocytes produce antibodies.
E. Transudate is noninflammatory fluid with few cellular
elements.
Introduction to Pathology 31
32
ANSWERS
1. A.
B.
C.
D.
E.
2. A.
B.
True
False
False
False
True
True
False
Introduction to Pathology 33
C. False
D. False
3. A. False: Neutrophils, macrophages and eosinophil are the
main phagocytes in acute inflammation.
B. True
C. Flase: The process described is called margination.
Pavementing is adhering of inflammatory cells to vascular
endothelium.
D. False: B-lymphocytes produce immunoglobulins.
E. True
4. A. False: The described process is chemotaxis. Diapedesis
is movement of white cells out of the vessel through gaps
in endothelial cells.
B. True
C. True
D. True
5. A. True
B. True
C. True
D. False: This description is that of an abscess. Granuloma
is characterized by chronic inflammation.
E. False: Type neollagen is seen in basement membranes.
Type I is seen in the said places.
6. A. True
B. False: There are two antibody binding fragments.
C. True
7. A. True: IgM appears in a small quantity within 7 days of
exposure to antigen.
B. False: IgA is selected by plasma cells as a dimmer, i.e.
two molecules, linked together by one polypeptide-J
chain.
C. True
D. True
E. True
8. A. True
B. True
C. True
D. False: These are T8 positive cells.
E. True
34
CONCEPTS
IMMUNOPATHOLOGY
Q.1. Which of the following are true?
A. Heparin mediates type I hypersensitivity (Anaphylactic
reaction).
B. Pernicious anemia and Graves disease are examples
of immune complex diseases.
C. Contact dermatitis is an immune complex disease.
D. CREST syndrome is a form of scleroderma.
E. SLE is characterized by primary immune deficiency.
Ans. A. True: Both histamine and heparin mediate anaphylactoid
reaction.
B. False: These are two examples of type II hypersensitivity
reaction (cytotoxic type).
C. False: Contact dermatitis is a type IV hypersensitivity
reaction (cell mediated type). Type III reactions are
exemplified by serum sickness, SLE and glomerulonephritis.
D. False: Scleroderma is progressive systemic sclerosis.
CREST syndrome is localized scleroderma characterized by anticentromere antibodies. It is characterized
by calcinosis, Raynauds phenomenon, esophageal
dysmotility, sclerodactyly and telangiectasia.
Introduction to Pathology 35
E. False: It is characterized by secondary immune deficiency, other examples being diabetes mellitus and
alcohol abuse.
Q.2. Which of the following are true?
A. Pneumocystis carinii infection can present with osteomyelitis.
B. Acquired Immunodeficiency Syndrome (AIDS) can present with CD4 counts more than 200.
C. Common Variable Immunodeficiency (CVI) can present
with recurrent giardial infections.
D. Average duration of latent phase in AIDS is 2 years.
Ans. A. True: P. carinii infection of lungs or bone-marrow can
occur with CD4 counts of 200 to 500 cells/microliter.
With less than 50 calls/microliter countsCMV, MAI
and JC viruse infections result.
B. True: AIDS can still be present with CD4 counts more than
200, if patient is HIV positive with an AIDS defining disease.
C. True: Other diseases seen are bacterial infections, autoimmune disease, lymphoma and gastric cancer.
D. False: Average duration of latent phase in AIDS is
10 years.
INFLAMMATION
Q.1. Which of the following are true?
A. P-selectin is normally present in Weibel-Palade bodies
in endothelial cells.
B. Defects in cell adhesion is found in diabetes and corticosteroid use.
C. Myeloperoxidase deficiency is associated with increased
incidence of bacterial infections.
D. Histamine is produced by mast cells and basophils only.
E. IL-I is responsible for pain and prostaglandin E2 for
pyrexial response.
Ans. A. True.
B. True: Also seen in alcohol intoxication and certain congenital deficiencies of adhesion molecules.
C. False: Although incidence of bacterial infection may be
increased, characteristically candidal infections are increased in myeloperoxidase deficiency.
36
Chapter 2
Genetic and
En
vir
onment
al Causes
vironment
onmental
Envir
of Diseases
PRETEST
1. Which of the following are true about DNA replication?
A. Splicing involves editing out of superfluous information
transcribed from introns of genes from mRNA.
B. Transcription involves production of polypeptide chains
from mRNA.
C. Translation involves not copying superfluous introns.
2. Which of the following are correctly matched as per
their pattern of inheritance?
A. Glycogen storage diseaseAutosomal recessive
B. NeurofibromatosisAutosomal dominant
C. Duchenne muscle dystrophyAutosomal recessive
D. Ataxia telangiectasiaAutosomal dominant
3. Which of the following are true about HLA antigens?
A. Class 1 HLA antigens are expressed in all nucleated
cells.
B. Class 2 HLA antigens are coded for by alleles DP, DQ
and DR.
C. They reside on chromosome 8.
D. HLA DR4 is associated with Hashimotos disease.
4. Which of the following diseases are caused by bacteria?
A. Onchocerciasis
B. Aspergillosis
38
C. Syphilis
D. Toxopalsmosis
E. Rubella.
5. Which of the following are true about bacterial infections?
A. C.Welchi alphatoxin causes digestive damage to cell
membrane.
B. C.Difficile does not produce any toxin.
C. Scaleded skin syndrome and toxic shock syndrome
causing bacteria are of same genus.
D. Vibrio Cholerae produces an enterotoxin.
6. Which of the following are true about environmental
pathogens?
A. A cavity lesion on chest X-ray in a coal worker signifies
superimposed tuberculosis.
B. Liver cannot be damaged by environmental agents.
C. Asbestos-related disease may manifest as bronchogenic carcinoma.
D. Bleomycin and busulfan cause interstitial pulmonary
fibrosis.
E. Both cyanide and carbon monoxide poisoning cause
cherry red coloration of blood.
7. Which of the following is true about congenital
disease?
A. A teratogen cannot act before pregnancy is discovered.
B. Childhood polycystic kidney disease always occur as
a lone entity.
C. Congenital CNS defects are associated with folate
deficiency.
D. Criduchat syndrome is a single gene disorder.
E. Hb Barts (gamma 4 tetramers) can cause intrauterine
death of fetus.
ANSWERS
1. A. True
B. False: Transcription is the process where by mRNA, a
copy of DNA of gene is produced before a polypeptide
is synthesized.
C. True
2. A.
B.
C.
D.
3. A.
B.
C.
D.
4. A.
B.
C.
D.
E.
5. A.
B.
C.
D.
6. A.
B.
C.
D.
E.
7. A.
B.
C.
D.
E.
39
True
True
False
False
True
True
False: Location is at chromosome 6.
False: DR 5 is associated with Hashimotos disease and
DR4 with rheumatoid disease.
False: It is a round worm disease.
False: It is a fungal disease.
True
False: It is a protozoan.
False: It is a togavirus.
True: Welchi alpha-toxin is a lecithinase that digests cell
membrane.
True: The toxin causes pseudomembranous colitis.
True: The genus is Staphylococcus.
True
True
False: A variety of agents including the carbontetrachloride and oral contraceptives damage liver.
False: Mesothelioma is caused by asbestos exposure.
True
True
False: Though usual time when pregnancy is most
susceptible is 3rd-8th week, teratogens can act before
diagnosis of pregnancy.
False: This autosomal recessive disease is usually
associated with multiple liver cysts, congenital hepatic
hibrosis and proliferation of bile ducts.
True
False: The defect is different.
True
GENETIC DISEASES
Q.1. Which of the following are true?
A. Brushfield spots are seen on skin in Mongols.
B. Tumors syndrome patients are usually females and their
somatosomes have Barr bodies.
40
41
Chapter 3
Miscellaneous TTopics
opics in
General Pathology
PRETEST
Q.1. Which of the following are true?
A. In anasarca, edema fluid accumulates in dependent
parts of body.
B. Mechanism behind blushing and response to heat are
same.
C. Tissue factor is activated without any stimulus in
intrinsic pathway.
D. Alpha granules of platelets contain calcium and ATP.
E. Hemolytic uremic syndrome (HUS) is a congenital
syndrome manifesting in adolescence.
Ans. A. False: Anasarca is generalized body edema.
B. True: Both are examples of active hyperemia.
C. False: Collagen activates tissue factor (factor XII) in
intrinsic pathway.
D. False: -granules of platelets contain fibrinogen, fibronectin, factor V and von Willebrands factor, factor IV and
platelet derived growth factor (PDGF). ADP and calcium
alongwith histamine, serotonin and epinephrine are
stored in dense bodies.
E. False: HUS usually follows gastrointestinal infections
with verotoxin producing E. coli 0157:H7 and occurs
most commonly in children.
Q.2. Which of the following are true?
A. Prothrombin Time (PT) can be used to screen liver
disease.
B. PTT tests intrinsic pathway only.
C. Thrombin time tests for adequate clotting factor.
44
Chapter 4
Disor
der
owt
h
Disorder
derss of Gr
Gro
wth
and Dif
entiation
Difffer
erentiation
PRETEST
1. Which of the following are true?
A. In metaplasia, there is reversible change in one mature
cell type to another mature cell type.
B. Dysplasia is characterized by loss of epithelial polarity
and abnormal mitotic figures.
C. An abnormal nest of adrenals under renal capsule will
be classified as neoplasia.
D. A jumbled up mass of cartilage, respiratory epithelium
and other tissue types indigeneous to lung lying in lung
as a developmental anomaly will be called choristoma.
E. Metaplastic changes can occur in appendix in appendicitis and upper esophagus in esophagitis.
2. Which of the following developmentally abnormal
conditions lead to decrease in physical growth?
A. Down syndrome
B. Turners syndrome
C. Maternal alcohol and tobacco use
D. Maternal diabetes mellitus
3. Which of the following is true about hyperplasia and
hypertrophy?
A. Smooth muscle hypertrophy is seen in pregnancy, urinary obstruction and intestinal stenosis or obstruction.
B. In gynecomastia there is seen in pregnancy, urinary
obstruction and intestinal stenosis or obstruction.
C. Graves disease causes thyroid hyperplasia.
D. Sheehans syndrome can cause thyroid atrophy.
46
ANSWERS
1. A.
B.
C.
D.
E.
2. A.
B.
C.
D.
3. A.
B.
C.
D.
E.
4. A.
B.
C.
D.
E.
5. A.
B.
C.
D.
6. A.
B.
C.
D.
7. A.
B.
C.
D.
E.
True
True
False: This will be called a choristoma.
False: The typical description is of a hamartoma.
False: The typical metaplastic changes are seen in
bronchi of cigarette smokers and in prostate around
areas of infarction.
True: Decreased skeletal growth.
True: Decrease skeletal growth.
True: These cause IUGR.
False: Average birth weight is greater than normal.
True
False: Lobules do not exist in male breast. Gyncomastia
is male breast hypertrophy.
True
True: There is panhypopituitarism and TSH is decreased
or absent.
True
True
True
True
True
True
True
True
True
False
True
False: It is also produced by pancreatic cancers and
also by breast and gastric cancers.
True
True
True
False: All mens are autosomal dominant.
True
True
True
Chapter 5
Disor
der
Disorder
derss of Me
Mettabolism and
Homeos
Homeosttasis
PRETEST
1. Which of the following are true about amyloidosis?
A. Amyloidosis of AA type is a complication of rheumatoid
arthritis.
B. Amyloidosis may occur as a complication of myelomatosis.
C. Rectal mucosal biopsy is positive in 80 percent cases
of myelomatosis.
D. Congored and Van Gieson staining methods are important in detecting amyloid.
E. Hepatic failure is a common cause of death.
2. Which of the following are true?
A. Dystrophic calcification occurs in individuals with abnormal calcium metabolism.
B. Psammoma bodies are found in tumors such as papillary carcinoma of thyroid and meningiomas.
C. Dystrophic calcification is associated with hyperparathyroidism.
D. Phenylketonuria is due to deficiency of phenylalanine
hydroxylase.
E. Cystathione synthetase is deficient in homocystinuria.
3. Which of the following are true?
A. Gout is characterized by hypouricemia.
B. First metatarsophalangeal joint is commonly affected in
gout.
C. Cushings syndrome is characterized by hyponatremia
50
ANSWERS
1. A. True
B. True
C. False: It is done for diagnosing amyloid. The biopsy
should include submucosa and muscle for the maximum
chance of detecting amyloid.
D. True
E. False: Renal failure is a common cause of death in amyloid.
2. A. False: Dystrophic calcium characterized by deposition
of calcium is damaged tissue usually occurs in patients
with normal calcium metabolism.
B. True
C. False: Metastasic calcification occurs in hyperparathyroidism.
D. True
E. True
3. A. False: It is associated with hyperuricemia.
B. True
C. False: Hypernatremia is caused by increased production
of glucorticoids in cushings syndrome.
D. True
E. True: High out put failure can occur in wet Beri-Beri.
4. A. False: Copper accumulates in increasing amounts in
Wilsons disease.
B. True
C. True
D. False: Cerebral boundary zone infarction may follow
hypotension. Superior longitudinal simus thrombosis
may occur in debilitated children causing engorgement
of veins and hemorrhage.
5. A. False: Hay fever is a cause of local edema. Active
hyperemia of acute inflammation being responsible.
B. True: Hemorrhage infarction of intestine may progress
to gangrene.
C. False: It will produce primary hyperaldosteronism
D. False: Burns cause hypovolemic shock.
6. A. False: The characteristics described are those of antemortem thrombus.
Chapter 6
Car
dio
Cardio
diovvascular Sy
Syss tem
Cardiovascular System
53
54
ANSWERS
1. A.
B.
C.
D.
E.
2. A.
B.
C.
D.
3.
4.
5.
6.
Cardiovascular System
55
Chapter 7
Blood and
Bone Mar
Marrrow
PRETEST
1. Which of the following are true?
A. RBC antibodies and enzyme deficiencies always cause
hemolytic anemia.
B. Sickle cell anemia causes protection against malaria.
C. Autoantibodies causing lysis of blood cells are found in
SLE and CLL.
D. Deficiency of spectrin cause spherocytosis.
E. Factor XII is the fibrin stabilizing factor.
2. Which of the following are true?
A. Plasmin derived from plasminogen degrades both fibrinogen and fibrin.
B. Hemophilia A and von Willebrands diseases are characterized by deficiency of factor VIII.
C. A short history of symptoms and signs of anemia, infection and thrombocytopenia indicate AML.
D. Both the thalassemia major and minor are compatible
with normal life span.
E. Vitamin K dependent coagulation factors are factor II,
VII, IX, XI.
3. Which of the following are true?
A. All slow developing anemias are asymptomatic.
B. Myelophthisis is a reduction in productive capacity of
bone marrow.
C. Polycythemia vera is characterized by high erythropoietin levels.
58
ANSWERS
1. A. False: RBC antibodies or enzyme deficiencies may be
harmless and not cause hemolysis.
B. True
C. True
D. True: There is genetically determined abnormality in a
membrane polypeptide called spectrin.
E. False: Coagulation factor XIII is the fibrin stabilizing
factor.
2. A. True
B. True
C. False: The characteristic picture is seen in AML.
D. False: Thalassemia major patients die in young adulthood
or before.
E. True
3. A. True
B. True
C. False: Erythropoietic levels are high in secondary
polycythemia.
D. True
E. True
4. A. True
B. False: Hyperbilirubinemia is conjugated
C. True
D. False: Red cell fragmentation occurs in microangiopathic hemolysis.
5. A. False: It indicates good response.
B. True
C. False
D. False
E. True
6. A. True
B. True
60
Chapter 8
Respir
at
or
espirat
ator
oryy Sy
Syss tem
62
Respiratory System
63
ANSWERS
1. A. True
B. True
C. False: Asbestos bodies are usually found in underlying
lung tissue.
D. True: Streptococcus pneumoniae is the usally causative
organism.
E. True: CMV or aspergillosis is usually present too.
2. A. False: Clara cells, secreting a proteinaceous fluid are
found in terminal bronchioles pneumocytes are present
in alveoli.
B. False. Type-II pneumocytes may proliferate.
C. True
D. True
E. True
3. A. True: These are neuroendocrine tumorlets seen in
lungs.
B. False: These are usually present in upper lobes in contrast to panlobular emphysema that occurs in lower lobes.
C. True: This feature differentiates it from other granulomatous inflammations.
D. True
E. True: Larger particles cannot reach alveoli.
4. A.
B.
C.
D.
E.
5. A.
B.
C.
D.
E.
True
False: Hypotension can be caused by them.
True
True
False: Lipoid pneumonia can be caused by extrinsic as
well as intrinsic cases.
True
False: Chronic bronchitis causes hyperplasia of mucin
secreting cells.
True
False: Tuberculin test is index of cell mediated immunity.
True
64
6. A. True
B. False: Only lober pneumonia is characterized by sustained rise in pulmonary artery pressure.
C. True
D. True
E. True: After an attack there can be pulmonary collapse
and imperfect resolution of pneumonia causing bronchiectasis.
Chapter 9
Liv
er
Liver
er,, Biliar
Biliaryy TTrract and
Ex
ocr
ine PPancr
ancr
eas
Exocr
ocrine
ancreas
PRETEST
1. Which of the following are true?
A. Acute viral hepatitis can cause fatty liver.
B. Mallory bodies are found in infective hepatitis.
C. Predominant HBsAg expression in serum and hepatocytes is found in a symptomatic HBV carrier.
D. Before cirrhosis could occur, hepatocyte regeneration
with fibrosis has to take place.
E. Enlarged liver pressing on portal vein can cause portal
hypertension.
2. Which of the following are true?
A. In ulcerative colitis, sclerosing cholangitis can occur.
B. Oral contraceptives have been associated with liver cell
adenomas.
C. Typhoid fever organisms can survive in gallbladder in a
carrier state.
D. Serum amylase is reduced in acute pancreatitis.
E. Alpha-1 antitrypsin is due to defect in copper metabolism.
3. Which of the following are true?
A. Cholesterol gallstones are most frequent.
B. Carcinoma pancreas is associated with smoking and
diabetes mellitus.
C. Splenic atrophy occurs in portal hypertension.
D. Jaundice is seen usually when serum bilirubin
concentration exceeds 40 micro mole per liter.
E. Acute pancreatitis may cause hypocalcemia.
66
ANSWERS
1. A. False: Fatty liver is caused by protein, energy, malnutrition, alcoholism and obesity.
B. False: Mallory bodies are found in alcoholic hepatitis and
sometimes in Indian childhood cirrhosis.
C. True
D. True
E. False: Portal hypertension is caused by interference
with hepatic microcirculation.
2. A. True: Patient may develop cholangiocarcinoma.
B. True
C. True
D. False: It is raised
E. False: Wilsons disease is one in which serum ceruloplasmin levels are decreased.
3. A. False: Mixed stones are most frequent.
B. True
C. False: There is splenomegaly due to congestion.
D. True
E. True
Chapter 10
Aliment
ar
Alimentar
aryy TTrract
PRETEST
1 Which of the following are true?
A. Adenolymphoma is a highly malignant tumor of parotids.
B. Heavy alcohol intake is a risk factor for esophageal
carcinoma.
C. Atrophic gastritis is characterized by loss of specialized
gastric mucosal cells especially parietal cells.
D. Prognosis of squamous cells carcinoma of oral cavity
depends on its site.
E. Chronic gastritis starts as chronic superficial gastritis.
2. Which of the following are true?
A. Linitis plastica is a condition in which deep layers of
stomach wall are thickened.
B. Achlorhydria is a risk factor for peptic ulcer.
C. Crohns disease gives a cobblestone appearance to
colon.
D. Ulcerative colitis causes colonic mucosal pseudopolyps.
E. Pseudomembranous colitis is caused by Vibrio cholerae.
3. Which of the following are true?
A. Primary malabsorption syndromes are celiac disease,
tropical sprue and Whipples disease.
B. Abetalipoproteinemia is primary malabsorption syndrome.
C. Long-standing ulcerative colitis is a risk factor for colonic
carcinoma.
D. Tubular adenomas are usually small rounded nodules on
a stalk.
E. Crohns disease is associated with increased risk of
small bowel cancer.
68
ANSWERS
1 A. False: Adenolymphoma is entirely benign, occurs in
middle aged men.
B. True
C. True
D. True: Prognosis worsens as the site of cancer becomes
further back in oropharynx
E. True
2. A. True
B. False: Risk factors for gastric cancer include blood
group O, cigarette smoking, high gastrin secretion (e.g.
in Zollinger-Ellison syndrome).
C. True
D. True
E. False: The condition is caused by Clostridium difficile.
3 A. True
B. False: It is a biochemical defect using interference of
absorption.
C. True
D. True
E. True: Quite rare though.
Alimentary Tract 69
B.
C.
D.
E.
70
Pancreatic Pathology
Q.1. Which of the following are true?
A. Scorpion stings can cause acute hemorrhagic pancreatitis.
B. Type I D M patients are absolutely dependent on insulin
to prevent ketoacidosis and coma.
Alimentary Tract 71
Liver Pathology
Q.1. Which of the following are true?
A. Clinical jaundice occurs with bilirubin levels >2-3 mg/ml.
72
Chapter 11
Male and FFemale
emale Genit
al TTrract
Genital
and Endocr
ine Sy
Endocrine
Syss tem
PRETEST
1. Which of the following are true?
A. Pregnancy at an earlier age is associated with increased
risk of ovarian carcinoma.
B. Ovarian cancer spreads to contralateral ovary peritoneal
cavity and para-aortic lymph nodes.
C. Endometrial hyperplasia is associated with decreased
estrogen stimulation.
D. Cervical carcinoma is usually squamous cell type.
E. Carcinoma in situ (CIS) cervix is increasing in detected
incidence.
2. Which of the following are true?
A. Estrogen stimulation is increased in endometrial carcinoma.
B. Ruptured ovarian cyst can give rise to granulomatous
inflammation.
C. Carcinoma can arise in ovarian endometriosis.
D. Complete hydatidiform mole is usually triploid on chromosome analysis.
E. Hydatidiform mole can cause hyperthyroidism.
3. Which of the following are true?
A. Multiple peptic ulcers may be seen in islet cell tumor
of pancreas.
B. Parathyroid adenoma may cause nephrocalcinosis.
74
ANSWERS
1. A. False: Pregnancy at an earlier age is associated with
decreased risk.
B. True
C. False: The estrogenic stimulation is increased.
D. True
E. True
75
2. A. True
B. True: Released keratin leads to granulomatous inflammation.
C. True: Commonest form in adenocarcinoma.
D. False: Complete mole is always diploid partial one can
be triploid.
E. True: A thyroid stimulator molecule is part of HCG
secreted by mole.
3. A. True: Excess gastrin secretion is the cause.
B. True
C. False: Virilization is caused by excess of androgens.
D. True
E. True
4. A. True: Enzyme deficient can be a dehalogenase.
B. False: Excess ACTH results in cushing and may cause
hyaline change in anterior pituitary.
C. True: These occurs in suprasellar lesion and may result
in anterior pituitary damage by pressure necrosis.
D. True
E. False: Medullary carcinoma is the one least likely to
have hematogenous metastasis.
5. A. True
B. False: ACTH levels are raised in an attempt to get
adrenals to produce more steroid hormones.
C. False: Adrenal medulla cells are involved.
D. False: Graves disease is caused by autoantibodies
mimicking TSH.
6. A. True: It is synonyms of nodular glomerulosclerosis.
B. True
C. False: Insulin is produced by beta cells and alpha cells
produce glucagons.
D. False: In Di George syndrome, there is congenital
absence of parathyroid glands.
Chapter 12
Br
eas
Breas
eastt
1. Which of the following are true?
A. Most common site of breast cancer is upper quadrant
(50%).
B. Breast cancer has a better prognosis, if it is of tubular
type and is positive for estrogen receptors.
C. Apocrine metaplasia is associated with increased
incidence of breast cancer.
D. Fibroadenomas are usually multiple.
E. Mammary duct ectasia and intraductal papilloma may
cause bloody nipple discharge.
2. Which of the following are true?
A. Gynecomastic occurs in III decade of life.
B. Intralobar carcinoma has a comedo variant.
C. Pagets disease of nipple may effect skeletal system.
D. Phyllodes tumor occurs in younger age group.
3. Which of the following are true?
A. Pagets disease is a feature of cystic mastopathy.
B. Formation of new breast lobules and apocrine metaplasia occur in cystic mastopathy.
C. Giant intracanalicular fibroadenoma may progress to
sarcoma.
D. Medullary carcinoma is characterized by a lymphocyte
infiltrate.
ANSWERS
1. A. True
B. True
C. False: This (pink cell change) is not associated with any
increased risk.
Breast
77
Chapter 13
Male Genit
al TTrract
Genital
1. Which of the following are true?
A. Metastases in prostate carcinoma are osteoblastic.
B. Alkaline phosphatase can be increased in late stage in
serum.
C. Seminoma consists of sheets of large pale cells and
lymphocytes.
D. Differentiated teratoma resembles ovarian cystic teratomas but is malignant in males.
E. Sperm count less than 70 10/liter is associated with
infertility.
2. Which of the following are true?
A. XXY pattern is associated with infertility.
B. Small testes with Leydig cell pseudohyperplasia and
loss of tubules is associated with male infertility.
C. Embryonal carcinoma represents an anaplastic variant
of teratoma.
D. Lymphomas are the most common malignant testicular
tumors in adult males.
E. Idiopathic gangrene of scrotum (Fourniers) is caused by
group B streptococci.
3. Which of the following are true?
A. Lymphogranuloma venerum is caused by Chlamydia
trachomatis serotypes L1-L3.
B. LGV causes condylomata acuminata.
C. Yolk sac tumor of testes contain characteristic perivascular tumor cells.
D. Yolk sac tumor of testes expresses alpha feto-protein.
79
ANSWERS
1. A. True
B. True: It is because of bone metastasis. In intitial stages
only acid phosphatase is increased.
C. True
D. True
E. False
2. A. True
B. True
C. True: It has got a bad prognosis.
D. True
E. False: Fecal organisms are the usual causative agents.
3. A. True
B. False: Human papilloma virus causes condylomata
acuminata.
C. True
D. True
CONCEPTS
Genital Pathology, Breast
Q.1. Which of the following are true?
A. Pelvic inflammatory disease is usually hematogenously
acquired.
B. Cervical carcinoma is the most common malignant
tumor of female genital tract.
C. Leiomyomas are the most common tumors of female
genital tract.
D. The most common primary site for secondaries in
ovaries is GIT.
E. Partial mole is usually diploid.
Ans. A. False: PID is an ascending infection usually, often due
to gonorrhea and/or Chlamydia, from cervix to endometrium, fallopian tubes and pelvic cavity. It is an important cause of pelvic and even peritoneal inflammation,
abscess formation and scarring.
B. False: Cervical carcinoma is the third most common
malignancy of FGT. Endometrial adenocarcinoma is the
most common malignancy of FGT and usually presents
with postmenopausal bleeding.
80
C. True.
D. False: Though stomach and colon are the common primary sites for secondaries in ovary, primaries in endometrium and breast spread to ovaries more commonly.
E. False: Partial mole is usually triploid. Complete moles
are diploid.
Q.2. What are the pre-invasive lesions of breast cancer?
Ans. Pre-invasive lesions that may progress to breast cancer
include ductal carcinoma in situ and lobular carcinoma in
situ. Invasive cancer occurs in several histological variants.
They are ductal carcinoma, tubular carcinoma, mucinous
carcinoma, tubular carcinoma, medullary carcinoma and
inflammatory carcinoma.
Q.3. Which of the following are true?
A. Squamous cell carcinoma of penis can occur because
of not doing circumcision before adolescence.
B. Spermatocele contains sperms in its fluid.
C. Testicular tortion can cause painful hemorrhagic infarction.
D. Seminoma occurs in older men.
E. Prostate cancer is commoner than lung cancer in the
men in PSA.
Ans. A. False: Squamous cell carcinoma of penis has nothing
to do with early or late circumcision. It is related to HPV
infection and is uncommon.
B. True: Spermatocele is a dilated efferent duct in epididymus containing sperms.
C. True: Tortion of testis is twisting of spermatic cord.
D. False: Seminoma is a radiotherapy and chemotherapy
sensitive cancer of young men that causes bulky
testicular mass. Spermatocytic seminoma can occur in
older men.
E. True: Prostate cancer is the most common cancer of
men in the USA. It occurs in the peripheral zone of
prostate (posterior part). Serum PSA are raised.
Chapter 14
Kidney and
Urinar
inaryy TTrract
PRETEST
1. Which of the following are true?
A. Younger age-group males are more susceptible to
urinary tract infection.
B. Renal carcinoma generally spread to bones.
C. Urinary calculi are more common in temperate than tropical climates.
D. Diseases of glomerulus cause non-selective proteinuria,
if glomerulus is damaged more severely.
E. Transitional cell carcinoma has a positive association
with bilharziasis.
2. Which of the following are true?
A. Kidneys are shrunken in chronic glomerulonephritis.
B. Amyloidosis usually causes nephritic syndrome.
C. Nephroblastoma (Wilms tumor) commonly metastasizes to lungs.
D. Bilateral renal agenesis usually occurs as a lone entity.
E. Adult polycystic kidney disease causes renal failure in
earlier life.
3. Which of the following are true?
A. Wegeners granulomatosis affects kidneys and lungs.
B. Rapidly progressive glomerulonephritis is characterized
by proliferation of parietal epithelium of Bowmans
capsule and forms crescents filling the capsular space.
C. Diabetic kidney is characterized by crystals in collecting
tubules.
82
ANSWERS
1. A. False: Incidence is more in females from puberty to
middle age.
B. True: Other tumors spreading to bone include breast,
prostate, thyroid and lungs.
C. False: Because of more concentration of urine, these are
commoner in tropical countries.
D. True: This is in contrast to selective proteinuria that is
commoner in minimal change disease.
E. False: Cigarette smoking is related to TCC whilst bilharziasis, if long standing, can cause the rare squamous
cell carcinoma of bladder.
2. A. True
B. True
C. True
D. False: Its associated with pulmonary hypoplasia and
spinal cord defects.
E. False: The renal affections become apparent in adult life.
Childhood polycystic kidney disease is manifested in
younger aged individuals.
3. A. True: It is a necrotizing vasculitis.
B. True
C. False: Crystals are found in metabolic diseases such
as gout. Diabetic kidney is characterized by papillary
necrosis.
D. True
RENAL PATHOLOGY
CONCEPTS
Q.1. Which of the following are true?
A. Glomerular disease, when it causes nephritic syndrome,
is associated with microalbuminuria only.
B. Rapidly progressive GN is another name for crescent
GN.
C. IgA nephropathy is most common cause of gross hematuria in children, young adults and non-smokers.
D. Membranous glomerulonephritis is most common cause
of nephrosis in adults.
E. Renal cell carcinoma may be associated with feminization or masculinization.
Ans. A. False: Nephritic syndrome is characterized by proteinuria
but amount is less than 3.5 gm/24 hrs.
B. True: RPGN is characterized microscopically by hypercellular glomeruli with crescent formation in Bowmans
capsule.
C. True: IgA nephropathy is most common cause of GN
worldwide. It tends to produce recurrent gross hematuria
in children and young adults.
D. True.
E. True. Paraneoplastic syndrome like this may occur from
ectopic hormone production. Other syndromes include
Cushings (corticosteroid), polycythemia (erythropoietin)
and hypertension (Renin).
Chapter 15
Skin, Sof
issue and
Softt TTissue
Sk
ele
Skele
elettal Sy
Syss tem
PRETEST
1. Which of the following are true?
A. Pemphigus is a viral infection.
B. Diverticulitis is associated with dermatitis herpetiformis,
C. Basal cell carcinoma is a highly metastasizing neoplasm.
D. Bowens disease and squamouscellcarcinoma in situ
are closely related.
E. Increased basal layer melanocytes are seen in lentigo.
2. Which of the following are true?
A. Nodular melanoma has a vertical growth phase only.
B. Acute hemolysis can occur in non-immune patients
following quinine treatment in P. falciparum malaria.
C. Lentigo maligna is a misnomer in that it is benign condition.
D. Malignant tertian malarial fever is caused by P. falciparum.
E. Tropical splenomegaly regresses with long-term antimalarial therapy.
3. Which of the following are true?
A. A lack of active vitamin D is seen in osteoporosis.
B. Pagets disease of bone causes raised serum alkaline
phosphatase.
C. Chondrosarcoma can recur locally and may kill the
patient by involvement of a vital structure.
D. Synovial sarcoma arises in joints.
E. Rhabdomyosarcoma mostly arises in skeletal muscles
of extremities.
ANSWERS
1. A. False: The etiology is autoimmune.
B. False: Dermatitis herpetiformis is associated with celiac
disease.
C. False: BCC is a locally aggressive tumor.
D. True
E. True
2. A. True: Malignant melanoma has both horizontal and
vertical growth phases.
B. True
C. False: Lentigo maligna (Hutchinsons melanotic freckle)
is essentially a malignant melanoma-in-situ.
D. True
E. True
3. A. False: Lack of vitamin D in children causes Rickets and
in adults, osteomalacia.
B. True
C. True
D. False: Synovial sarcoma arises mostly in bone or soft
tissue just adjacent to joint especially lower extremity.
E. False
86
Chapter 16
Ner
ervvous Sy
Syss tem
PRETEST AND CONCEPTS
1. Which of the following are true?
A. A frontal lobe tumor will cause interventricular septum
to shift to left of midline.
B. Acute subdural hematoma rarely causes death.
C. Chronic subdural hematoma may present weeks after a
trivial injury.
D. Fracture of skull, particularly in temporal bone may tear
off meningeal vessels.
E. Occipital poles are a common site of hypertensive intracerebral hemorrhage.
2. Which of the following are true?
A. Vertebral artery is a common site of berry aneurysm.
B. Congenital or berry aneurysms are due to a defect in
the medial coat at sites of bifurcation of the intracerebral
arteries.
C. Chronic suppurative otitis media may cause cerebral
venous sinus thrombosis.
D. CMV infection cant be recognized histopathologically.
3. Which of the following are true?
A. Herpes simplex infection of CNS causes acute
necrotizing encephalitis.
B. Type 1 poliomyelitis virus affects motor cells of anterior
horns of spinal cord.
C. Gasserian ganglion is a common site of infection by
herpes simplex.
D. Rabies is characterized by Negri bodies in Purkinje cells
of cerebellum.
88
ANSWERS
1. A. True
B. False: Acute subdural hematoma is usually associated
with cerebral contusions and lacerations and is common
finding if death occurs soon after head injury
C. True
D. True: Extradural hematoma may be caused due to tear
of middle meningeal artery.
E. False: Internal capsule and cerebellum are common
sites.
2. A. False
B. True
C. True: This may occur in improperly treated CSOM.
D. False: CMV infection of CNS is usually acquired in utero
and is characterized by intranuclear inclusion bodies.
3. A. True: Bilateral temporal lobe necrosis can occur.
B. True
C. False: Gasserian ganglion is a common site of infection
by zoster (varicella) virus.
D. True
4 A. True
B. False: It is an anaplastic astrocytoma occurring in
cerebral hemispheres of adults.
C. True: It usually occurs in cerebellum of children.
D. False: It is a tumor of blood vessels occurring mainly
in cerebellum.
E. True