MCQs in Objective Pathology PDF

MCQs in
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
Director of Blood Bank and Transfusion Services
King Khalid Hospital
Najran, Kingdom of Saudi Arabia
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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
Bade Jatan se Beeni Chadariya

Jyon ki Tyon Rakh Deeni Chadariya
After living with great care, I will give back

this life uncorrupted.
– Sant Kabir
Preface to the Second Edition
Pathology is an oceanvast and without shores. The second edition

of this book (the first edition was entitled MCQs in Objective
Pathology authored by Dr Sumant Sharma), is an attempt to con-
dense this ocean in a drop. As Gautama Buddha described (and
later Immanuel Kant proved it to be correct) man is in the middle of
creation (Madhyam Sthith), i.e. as far is man from the beginning of
creation, so is God from man. Man’s knowledge of Pathology also
has reached this middle point and it just makes the challenge of
knowing it all more daunting.
Buddha also described the characteristics of a good horse
(Shrestha Ashwa). An excellent horse is one that gets up from
slumber with the sight of rider’s cane. A slightly lower standard is
given to a horse which gets up on hearing the stroke of the cane on
his friend. The worst is one that requires the stroke of the rider’s
cane to awaken.
Hurry up, flip the pages. The journey may be longer than ex-
pected. Let’s draw blood!
Sumant Sharma
Yogesh Chhabra
Preface to the First Edition
Most Pathology books are written with one examination or another

in mind. The one in your hands now, is an all encompassing work-
book. You can use it to enhance your skills in the subject or use it
as a workbook to test your learning. The format of true/false is
used in many national and international licensure examinations.
Study the chapter from any comprehensive textbook and then
check your learning using this book. Give 1 mark for any correct
answer and 0 for unanswered one, Give 1 mark for any incorrect
response. In this way, a score of up to 70% should be deemed
appropriate.
For somebody, who has regular responsibilities, it is difficult to
compile such a Question Bank without the outside help from fellow
professionals. I wish to thank everyone who has been directly or
indirectly involved with the project.
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 sub-
ject 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
Introduction tto
Introduction o PPat
athology
athology
Including Cell Pathology

and Immunopathology
(Including Special Diagnostic Techniques)
PRETEST
1. Which of the following are correctly matched? (R-1)
A. Virchow—Invention of microscope.
B. Celsius—Work on naked eye appearance of diseased
organs.
C. Pasteur—Showed the way to active immunization.
D. Jenner—Laid foundation of bacteriology.
E. Mendel—Discovered principles of inheritence.
2. Which of the following are pathology subspecialities!?
A. Histopathology—The diagnosis of disease by examining
altered histology of tissue sections.
B. Exfoliate cytology—Diagnosis of disease by studying
body fluids secretion and excretions.
C. Toxicology—Study of defence processes in the body
D. Hematology—Study of infectious processes.
E. Forensic pathology—Use of pathology for legal purposes.
3. Which of the following definitions are correct?
A. Allophenic mouse—A mouse in which two types of cells
form clones of varying number in different organs.
2 MCQs in Objective Pathology with Explanations
B. In paraffin wax technique, tissue is fixed usually in

10 percent formalin, dehydrated graded alcohols,
cleared in xylol, chloroform or other solvent which is
mixable with both alcohol and wax.
C. Pathogenesis—The cause of disease.
D. Etiology—The mechanism by which disease is caused
E. Recombinant DNA—Artificial joining of DNA of one
species (e.g. humans) to that of others (e.g. bacteria).
4. Which of the following are true about electron micro-
hyplum scopy?
A. Can differentiate between lymphoma and carcinoma as
well as between adenocarcinoma and mesothelioma.
B. Can be used to classify lymphomas.
C. Can employ osmium tetraoxide as a fixative as well as
special stain for lipids.
D. Can differentiate between prostate cancer and gastric
cancer.
E. Can locate the primary site of a squamous cell carci-
noma (SCC).
5. Which of the following are true about cytology?
A. FNAC preserves cellular and tissue architecture.
B. Urinary cytology detects transitional cell carcinoma
C. Diagnosis is not very accurate.
D. Exfoliate cytology is performed on cells aspirated by fine
needle.
6. Which of the following are true?
A. A biopsy should be sent to pathology ideally fresh in
saline, but is sent in 10 percent formalin 10 to 20 times
the volume of specimen.
B. For immunohistochemical (IHC) analysis using immuno-
flouresence of immunoperoxide method, the latter (IP)
method is less advantageous.
C. A biopsy can be sent to laboratory without any infor-
mation.
D. Cloning involves isolation of a particular fragments of
DNA (usually a gene) and obtaining multiple copies.
E. Vectors used for cloning can be plasmid vectors or
artificial yeast chromosomes (YACS).
Introduction to Pathology 3
7. Which of the following prefixes and suffixes are

correctly defined?
A. Hypo—deficient
B. It’is—Inflammation
C. Plasia—Growth abnormality
D. Hetero—Dissimilar in composition
E. Meta—In excess
ANSWERS
1. A. False: Inventor of microscope was Leeuwenhoek.
B. True
C. False: Pasteur laid the foundation of bacteriology.
D. False: Jenner showed the way to active immunization.
E. True
2. A. True
B. True
C. False: Toxicology is study of effect of poisons.
D. False: Hematology is study of blood disorders.
E. True
3. A. True: Alophenic mice are produced by implantation into
a psuedopregnant female a combined embryo developed
in vitro by fusing two developing eggs from two pregnant
mice.
B. True
C. False: Pathogenesis is the mechanism by which
disease is caused.
D. False: Etiology is the cause of disease.
E. True
4. A. True
B. False: Immunohistochemistry (IHC) or gene rearrange-
ment studies are required.
C. True
D. False: Immunohistochemical studies for prostate speci-
fic antigen are required.
E. False
5. A. False: Cellular morphology is preserved but not the
tissue architecture.
B. True
C. False: FNAC can be used to diagnose tumors in some
situations and may eliminate the need for surgery.
D. False: In exfoliate cytology cells shed or scraped from

a epithelium surface are examined.
6. A. True
B. False: The immunoperoxide method provides a perma-
nent slide–a major advantage over immunofluorescene.
C. False: The request form should tell the site of biopsy
and patient’s age and sex besides other operative
details.
D. True
E. True
7. A. True
B. True
C. True
D. True
E. False: Meta denotes a change from one form to another.
Excess is denoted as hyper.
CONCEPTS
Q.1. Which of the following are true about cell-cell inter-
actions?
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 leuko-
cyte—endothelial 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-
cules which bind adjacent cells and prevent invasion of

ECM by cancer cells.
E. True: These act through other adhesion molecules and
cytokines.
F. False: Cytokines can be secreted by nonhemopoietic
cells too. So far about 50 cytokines have been recog-
nized.
G. True: This is an example of enzyme-linked receptors
which are involved in cell growth.
H. True
Q.2. Which of the following are true?
A. Cyclin E controls synthesis of mRNA and proteins
required for DNA synthesis; cyclin A controls DNA repli-
cation, and cyclin B controls correct daughter DNA
synthesis.
B. After mitosis cyclins and cyclin dependent kinases are
degraded in peroxisomes.
Ans. A. True
B. Caretaker proteins—Ubiquitins are responsible for this.
A. Hypoxia and Ischemia result in same type of reversible
injury.
B. Inability to reverse mitochondrial function after removal
of causative agent and membrane damage are two
defining differences between reversible and irreversible
injury.
C. Intracellular accumulation of lactic acidosis is a cause
of chromatin clumping.
D. Intracellular accumulation of potassium causes hydropic
swelling of cell.
E. Myelin figures are found only intracellularly in reversible
injury. .
Ans. A. False: Reversible injury due to ischemia blocks the
nutrient supply to cells too and thus both aerobic and
anaerobic respiration in the cell is compromised, resul-
ting in more severe cell injury. Furthermore, highly
specialized cells like myocardium, proximal tubular cells
of kidney and neurons are specially dependent on
aerobic respiration and are thus more severely and
rapidly affected by ischemia than hypoxia alone.
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 lipo-
proteins between lamellae of membranes.They can be
found both intracellularly and extracellularly.
A. Phospholipid rich amorphous densities are seen in
mitochondria in irreversible cell injury.
B. Ischemia-reperfusion injury is mainly because of oxida-
tive 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 radi-
cals.
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
A. Cloudy swelling and hydropic swelling are the same.
B. Russell’s bodies representing excessive immunoglobin
in plasma cells’ rough endoplasmic reticulum represent
a form of hyalin change.
C. Hyalin degeneration occurs in rectus abdomin’s muscle
in typhoid fever.
D. Mallory’s 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).
B. True
C. True: This is called Zenker’s degeneration.
D. False: It is seen in alcoholic hepatitis.
E. False: It is an example of extracellular hyaline.
A. In hepatic Steatosis, granulomas may be found in the
liver.
B. In hepatic steatosis, neutral fat accumulates both inside
the hepatocytes and outside.
C. Mallory’s hyaline bodies are basically proteins.
D. Albinos are more prone to skin cancers.
E. Ochronosis and alkaptonuria are synonymous.
Ans. A. True: Lipogranulomas may appear consisting of collec-
tions of lymphocytes, macrophages and some multi-
nucleated giant cells.
B. False: There is only intracellular accumulation. Stromal
infiltration by mature adipose cells is sometimes seen
in obesity; most common organs affected being the
heart and pancreas.
C. True: These are intermediate filaments of cytokeratin
D. True: Albinos are deficient in tyrosinase activity in skin
and have generalized hypopigmentation. This makes
them more prone to develop basal cell and squamous
cell cancers on excessive exposure to sun.
E. False: Ochronosis is a rare condition marked by dark
pigmentation of ligaments, cartilage,fibrous tissue skin
and urine. It may be caused by an inborn error of meta-
bolism, alkaptonuria. This allows formation of Homo-
gentisic acid, part of which is excreted in the urine and
part of which is stored in tissues. But ochronosis may
also be caused by chronic phenol poisoning.
Q.7. In which cases are the number of cisterns of rough
endoplasmic reticulum increased and in which condi-
tions are they decreased?
Ans. 1. Increased number of cisterns: In all cells with high protein
production and secretion, e.g. plasma cells.
2. Decreased number of cisterns: Inactive cells with de-
creased protein synthesis, e.g. in liver of undernourished
patients.
Q. 8. What is oncosis?
Ans. Irreversibly impaired metabolism (generally oxidative meta-
bolism) 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”.
SYNONYM OF ONCOSIS IS ACCIDENTAL

CELL DEATH
Q.1. What are oncofetal lesions of rough endoplasmic reti-
culum (RER)?
Ans. Deranged cisterns of RER, which occur in this form only
in fetal and tumor tissue.
Types
1. Ribosome-layer complexes: These are layered aggregates
of RER cisterns with interposed rows of ribosomes.
2. Annulated lamellae complexes: These are layered aggre-
gates 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 aggre-
gation of smooth endoplasmic reticulum (“fingerprint dege-
neration”).
Cytoplasmic nuclei are a sign of blocked enzyme syn-
thesis, such as is occasionally seen in blocked or dege-
nerative 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 post-
translational protein modification. So it is typical in cells that
lose their nuclei, e.g. erythroblasts and undifferentiated

malignant tumors.
Q. 4. Give examples in which various substances accumu-
late in the golgi apparatus.
Ans. Several disorders are attributed to disturbed secretion and
therefore to dysfunctioning of golgi apparatus. Examples
are:
1. Cholestasis: Gall drainage disorders in which gall is blocked
up into cisterns of the golgi apparatus.
2. Fatty liver: Hereditary or acquired disorders of lipoprotein
metabolism, lipoprotein component accumulates in cisterns
of golgi of hepatocytes.
3. Achondroplasia: (Chondrodystrophica fetalis, dwarfism)
Impaired proteoglycan synthesis causes proteoglycan
accumulation in golgi cisterns of chondrocytes.
4. Alveolar proteinosis: Surfactant proteins accumulate in golgi
cisterns of type II alveolar surface cells.
Q.5. What are oncocytes?
Ans. These are swollen cells with grainy eosinophilic cytoplasm.
Pathogenesis: Mitochondrial DNA mutation disturbs ATP
synthesis. This in turn causes compensatory mitochondrial
proliferation. So oncocyte is a descripitive term for a cell
rich in mitochondria. This is not a tumor cell. Carcinomas
of salivary and thyroid glands, though, may exhibit total or
partial oncocytic transformation (Oncocytic thyroid ca.,
Oncocytic salivary gland ca.) These tumors have mahogany
brown color because of high cytochrome content.
Q.6. What are megamitochondria?
Ans. These occur in severe deficiencies (Vitamin B complex defi-
ciency or alcoholism) as a result of defective mitochondrial
division or fusion. They are not caused by toxic swelling.
Q.7. What is “turbid swelling of parenchymal organs”?
Ans. First described by R Virchow in 1852, this implies swelling
of internal organs with enlarged, doughy, turbid cut surface.
Microscopically, cells are swollen with granular light
cytoplasm. Ultrastructurally, swelling begins in response to
the change in osmotic pressure with condensation of matrix
and swelling of space between the cristae (crista type). This
is followed by distribution of mitochondrial matrix and mito-
chondrial cristae (matrix type). There is usually generalized

cytoplasmic degeneration with formation of vacuoles.
Q.8. Which of the following are true about dysplasia?
A. It rarely occurs in epithelial tissue.
B. It can be called atypical hyperplasia.
C. Loss of polarity in dysplasia means disorderly arrange-
ment of cells from basal layer to surface layer.
D. Dysplasia always progresses to carcinoma.
E. Anaplasia is a hallmark of dysplasia.
Ans. A. False: Dysplasia means disordered cellular development
and often is accompanied with metaplasia and hyper-
plasia. It occurs most commonly in epithelial tissue.
B. True: Epithelial dysplasia is a characterized by cellular
proliferation and cytological changes.
C. False: Loss of basal polarity means nuclei lying away
from basement membrane. Of course in dysplasia, dis-
orderly arrangement of cells in different layers is also
seen but it is not termed ‘loss of basal polarity’.
D. False: On removal of inciting stimulus which is usually
chronic irritation or prolonged inflammation, changes
may disappear.
E. False: Anaplasia is loss of cellular differentiation and
functions is a feature of frank cancer.
SUPPLEMENTARY TOPICS—GENERAL PATHOLOGY

Q.1. Which of the following are true/false?
A. General pathology is related to basic reactions of cells
and tissues to abnormal stimuli that underlie all diseases.
B. Specific responses to all stimuli of specialized organs
and tissues are examined under special or systemic
pathology.
C. Etiology and pathogenesis are synonymous.
D. In modern terms, intrinsic or genetic and environmental
are the two groups of etiological agents of diseases.
E. Understanding pathogenesis of cystic fibrosis involves
knowing the gene responsible for its causation.
F. Morphological changes in a diseased organ have nothing
to do with diagnosis of etiological process.
G. Molecular techniques like DNA microassays and immu-

nological approaches for analysis diseases are no more
helpful in studying diseases than traditional morpho-
logical 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 enco-
ded 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 obso-
lete. 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 characteri-
stic of the disease or diagnostic of etiologic process.
Diagnostic pathology is devoted to identify nature and
progression of disease by studying morphological chan-
ges in tissues and chemical alterations in patients.
G. False: Molecular analyses have begun to reveal genetic
differences that bear on behavior of tumors. Examples
are breast cancers and tumors of lymphocytes that look

morphologically identical but may have widely different
courses, therapeutic responses and widely different
courses, therapeutic responses and prognosis. Increasingly,
such techniques extend and even supplant traditional
morphological methods.
H. False: Rudolf Virchow, known as the father of modern
pathology first put forth a concept in nineteenth century
that virtually all forms of organ injury start with molecular
or structural alterations in cells.
I. False: Different cells in tissue constantly interact with
each other and an elaborate system of extracellular-
matrix is necessary for integrity of organs. Cell-cell and
cell-matrix interactions contribute significantly to res-
ponse to injury which are as important as cell injury in
defining the morphologic and clinical patterns of disease.
KEY WORDS
Etiology, pathogenesis, morphological changes, clinical significance,
molecular biology, tissue, cell and organ injury, Father of modern
pathology.
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 cell’s
normal function and structure. For instance in response
to increased hemodynamic loads, heart muscle first

becomes enlarged—an adaptation. If blood supply to
myocardium is insufficient to meet with demand, muscle
becomes reversibly injured and finally cell death occurs.
C. True: Cell death is a normal and essential part of em-
bryogenesis, the development of organs, maintenance
of homeostasis and is aim of cancer therapy.
D. False: Necrosis is a cell death that is always pathologic.
Apoptosis can be pathological too when cells are
damaged beyond repair and especially, if cell’s nuclear
DNA is damaged.
E. False: Metabolic derangements can cause some intra-
cellular accumulations of which calcium is one. However
calcification also occurs normally during skeletal mine-
ralization.
F. False: Damage might not occur in sublethal, chronic
stimuli but cells may show subcellular alterations.
G. True.
Q.3. A. Give an example of cellular adaptation involving altera-
tions in protein synthesis.
B. What are the major molecular mechanisms of cellular
adaptations?
C. Do estrogens have any effect on (1) DNA synthesis of
uterine epithelial cells (2) Structural components of
myometrial cells?
D. In hormonal hyperplasia of physiological type, some
hormones may themselves act as growth factors—True
or false.
E. Compensatory hyperplasia of physiological type in liver
occurs only by proliferation of remaining cells—True or
false.
F. Some bone marrow cells can give rise to liver cells—
True or false.
Ans. A. Example 1: induction of new protein synthesis by target
cells as in response of muscle cells to increased
physical exercise. Example 2: Switch from one type of
protein synthesis to another—Or, markedly overproducing
on type of protein—cells producing various collagen
types and extracellular matrix proteins in chronic
inflammation and fibrosis.
B. 1. Direct: Stimulation of cells by factors produced by res-

ponding cells or other cells in environment.
2. Activation of various cell surface receptors and down-
stream signalling pathways.
C. 1. Yes: Hormone induced growth of uterus involves in-
crease in both number (hyperplasia)(→↑ DNA synth.)
and size (hypertrophy) ( ↑ Str Comp.) of smooth
muscle cells and epithelial cells. Abnormal endo-
metrial hyperplasia is an example of pathological
hyperplasia and the consequence is mainly hyper-
plasia 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 proges-
terone is tripped, there is absolute or relative increase
in estrogen with consequent hyperplasia of endo-
metrial glands.
D. True: Hyperplasia is caused by increased local produc-
tion 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 cellu-
lar 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 trans-
cription 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.
F. True: Recent clinical and experimental data suggests

that some bone marrow stem cells may be able to give
rise to many types of differentiated, specialized cell
types including hepatocytes. Then these bone marrow
stem cells have a potential to repopulate damaged
tissues.
Q.4. A. What is the difference between cell proliferation that
occurs pathological benign hyperplasia and cancer?
B. What role does tissue hyperplasia play in wound
healing?
C. Skin and mucosal tissue can be stimulated by growth
factors. True or false.
Ans. A. Pathological hyperplasia (alone) regresses, if the stimu-
lus for growth is taken off. Whereas growth in number
of cells in cancer is because of loss of normal growth
control mechanisms and goes on occurring after
particular phase of initiation. Most forms of pathological
hyperplasias are caused by excessive hormonal or
growth factor stimulation of target organs. Benign pros-
tatic hyperplasia, e.g. occurs because of stimulation by
androgens.
Pathological hyperplasia however, provides a fertile
soil on which cancer can arise. Thus patients of
endometrial hyperplasia are more prone to endometrial
cancer.
B. Hyperplasia is an important connection tissue response
in wound healing in which proliferation of fibroblasts and
blood vessels and in repair growth factors are res-
ponsible for this hyperplasia.
C. True: Stimulation of skin epithelium can occur by growth
factors in papilloma viral infections leading to skin warts.
Same viruses and other viruses can also cause similar
mucosal lesions.
Q.5. A. In nondividing cells like myocardial cells, both hyper-
plasia and hypertrophy can occur. True or false?
B. Why is nuclear DNA content of hypertrophied cells
higher than the rest of cells?
C. There’s a similarity in mechanisms of production of bul-
ging muscles of men engaged in ‘pumping iron’ and
cardiac hypertrophy in hypertension. True or false.
D. When do uterus and breast physiologically grow in size?

Ans. A. False: Cells capable of division can respond to stress
by both hyperplasia and hypertrophy but in nondividing
cells only hypertrophy occurs. Hypertrophy refers to
increase in individual cell size leading to increase in size
of whole organ.
B. Because of arrest at some stage of cell cycle in these
cells without undergoing metosis.
C. True: Most common stimulus for hypertrophy of muscles
is increased workload. In both the examples given, the
increase workload is shared by greater mass of cellular
components and each muscle false is spared of excess
work and so escapes injury. The enlarged muscle cell
achieves a new equilibrium, permitting it to function at
a higher activity level. The striated skeletal and heart
muscle are able to respond to increased workload (and
thus ! metabolic demands) by tremendous hypertrophy
as there is no mitotic response. In chronic hemodynamic
load like faulty values or HT, an imbalance occurs bet-
ween demand and response of cell’s functional capacity.
Greater number of myofilaments per cell permits an
increase workload with a level of metabolic activity per unit
volume of cell not different from that borne by normal cell.
D. Uterus: During pregnancy, uterus grows massively
because of hypertrophy and hyperplasia both caused by
hormonal influence of estrogens on smooth muscles.
Oestrogens act on hormone receptors on individual myo-
metrial cells leading to hypertrophy—increase in smooth
muscle protein synthesis and increase in cell size.
Breast: During lactation again the stimulus is hormonal.
This time it is estrogen and prolactin.
Q.6. A. Is these a conclusive and substantial evidence that dur-
ing stress, hypertrophy and hyperplasia occur together?
B. For a patient in cardiac failure decompensation because
of previous MI, coronary and peripheral vascular athero-
sclerosis is a common setting. Previous to decom-
pensation, peripheral vascular atherosclerosis might
have caused gene induction of which genes in heart
muscle?
C. When do the genes in heart muscle fibers switch to

similar to fetal or meonatal forms from adult forms
expression.
Ans. A. Hyperplasia and hypertrophy often occur together. The
conclusive evidence comes from the fact that cardiac
and skeletal muscles, under stress, undergo an
increase in their individual fiber size as well as (a recent
discovery) repopulation from some existing and
precursor cells. So neither hyperplasia nor hypertrophy
is ever absolute.
B. Blood pressure (arterial) increase is a common disease
caused by atherosclerosis of peripheral and visceral
vessels leading to increased risk of ischemic heart
disease, if untreated for long. Hypertension causes
hypertrophy (by definition only hypertrophy) of cardiac
muscle fibers. During this increase in individed fiber
mass of cardiac muscles, three types of genes are
induced:
1. Those coding transcription factors (C-fos, C-jun)
2. These coding growths factors (TGF-b, insulin like
GF-1, IGF-1) fibrolast growth factor.
3. These coding vasoactive agents (alfa-adrenergic
agonist, endothelin-1, angiotensin II)
C. During muscle hypertrophy, e.g.
1. In hypertrophied cardiac muscle fibers, b myosin
chain production mostly replaces alpha-myosin heavy
chain production. This leads to decreased myosin
ATP-ase activity. This leads to slow utilization of ATP
by myosin and then slower contraction of individual
fibers. So in a given time lesser ATP’s are used and
heart rate decreases (efficiency of myosin is more).
2. Re-exprasion of early developmental gives like atrial
natriuretic peptide in ventrides occur. (In embryo, ANP
gene is expressed in both atrium and ventricle. After
birth, oly in atrium). ANP is a peptide hormone that
causes increased slat and water loss by kidneys
leading to decreased hemodynamic load on stressed
heart.
QUESTIONS AND ANSWERS

Q.1. Why two classes of etiology’s theory is considered
obsolete?
Ans. Some single gene disorders on one hand and infections on
the other gave rise two one disease—once cause concept.
Two types of etiological types suggested were genetic and
acquired; recent data supports role of genetic factors in
acquired diseases like hypertension and DM similarly even
infectious are prove to genetic susceptibility, e.g. lower
repiratory tract infections in cystic fibrosis.
Q.2. Does pathogenesis involve knowing the earliest
molecular event in a disease?
Ans. Yes but not only this. Pathogenesis means the full course
of immmunological, biochemical and morphological processes
besides the initial infectious or molecular cause. It involves
the whole process from the first stimulus to ultimate
manifestation of a disease. Some of the processes in many
diseases like the mechanism of manifestation of alteration
in genes’structure are still a subject of research.
Q.3. Why is morphological diagnosis of tumors not enough
for management?
Ans. Tumor behavior also depends on its genetic profile. So
studies in molecular biology of tumors which may be
morphologically similar but behave differently in therapeutic
response are required, e.g. slymphomas.
Q.4. What was the most pioneering concept put forth by
Rudolph Virchow?
Ans. Virchow, called the father of modern pathology, put forth the
cell theory. All forms of organ injury starts with molecular
or structural cell injury. Though cells interact with each other
and extracellular matrix ECM. ECM also maintains cells in
themselves.
Q.5. What are the two types of pathogenesis identified?
Ans. Casual and formal pathogenesis. Causal pathogenesis tells
why a pathogen causes a disease. This considers the
environmental factors, host’s bodily disposition (suscep-
tibility without regard to adaptability) and the interplay of
nonspecific immune responses in producing resistance to
some diseases. Formal pathogenesis describes the struc-

tural 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 di-
seases 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 struc-
tured damage and functional deficits after the disease and
subsides. The social and functional adaptability is thus res-
tricted. Recurrence is resurgence of what is basically a
chronic disease after a gap. Remission is temporary dis-
appearance of symptoms of a disease. Death (Exitus letalis
= lethal end)
Q.8. Will it be correct to say that homeostasis is a conti-
nuously 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-
nuous change—in one of different metabolites and other

substances in the cell.
Q.9. What are the triggers for muscle hypertrophy and for
changes in gene expression in cardiac muscle fibers
in myocardial hypertrophy?
Ans. Two groups:
1. Mechanical triggers (stretch).
2. Trophic triggers.
The trophic triggers are chiefly growth factors (IGF-α) and
vasoactive amines (angiotension II, DC-adrenergic orga-
nists). The latter are produced by nonmyocyte cells and
myocytes themselves.
Q.10. What ultimately regulates the size of myocardial
cells?
Ans. From the above discussion it is clear that environmental
cues are important. Nutrients (blood supply to heart muscle)
is also a limiting factor.
Q.11. Why don not heart muscles enlarge unlimitedly in
response to increase burden?
Ans. There’s a limit upto which heart muscle fibers can resond
to increase in their size. Any increase in burden after that
leads to cardiac failure. Various factors are implicated but
not confirmed. These are—limited blood supply, limited
oxidative capacity adaptability of mitochondria, changes in
number and type of proteins, degradation of proteins and
changes in myofibril cytoskeleton. Various ultrastructural
manifestations include the myocardial fibers degeneration.
There may also be apoptosis or nucleosis of myocardial
fibers.
Q.12. Give two examples of physiological atrophy.
Ans. Physiologic decrease in cell size that may ultimately culmi-
nate in cell death can lead to decrease in entire tissue or
even organ. Physiologically this is seen in (1) embryonic
growth—thyroglossal of duct atrophy. (2) in uterus after
parturition.
Q.13. When is atrophy accompanied by osteoporosis?
Ans. Atrophy of disuse may be accompanied by osteoporosis of
disuse.
Q.14. In which conditions is cachexia seen?

Ans. Marked muscle wasting or cachexia may be seen in protein
energy malnutrition of (1) marasmus type or (2) chronic
inflammatory states (because of secretion of TNF) or
(3) cancer.
Q.15. What are the causes of widening of sulci and narro-
wing of gyri in above 50 years persons?
Ans. Aging and compromised blood supply because of atheros-
clerosis. Aging typically causes cell loss in tissues containing
permanent cells: particularly in brain and heart.
Q.16. What are the other causes of atrophy?
Ans. Besides disuse, malnutrition and aging, denervation,
ischemia, loss of endocrine stimulation and pressure by
expanding mass can cause atrophy.
Q.17. What are the ultrastructural changes seen in atrophy?
Ans. Ultrastructural changes in atrophy represent a new balance
between compromised conditions and size of cell upto the
limit of its viability. Atrophied muscle fibers have fewer
structural and functional components like myofibrils, mito-
chondria and endoplasmic reticulum.
Q.18. Can atrophy lead to cell death?
Ans. If the conditions are compromised limitlessly, cell death
may result in atrophied tissue. Examples include ischemic
necrosis and apoptosis in developing embryo.
Q.19. What are the mechanisms involved in atrophy?
Ans. 1. Proteolysis by lysosomal hydrolases and ubiquitin pro-
teasome pathway.
2. Autophagy by autophagic vacuoles.
Lysosomes and proteasomes: Cytosomal hydrolases
like cathepsins degrade protein molecules from the inter-
cellular environment, surface of cells, environment. Ubi-
quitin conjugates cytosolic and nuclear proteins and
binds to large proteolytic organelles called protea-
somes–leading to proteolysis. Ubiquitin proteasome
pathway is involved in cancer cachexia and proteolysis
by glucocorticoids and thyroxine. Insulin inhibits this.
TNF also stimulates this.
Autophagy: Small membrane bound vacuoles within cell
with fragments of organelles form and then fuse with
lysosomes the latter throwing their proteolytic enzymes

in the autophagic vacuoles. Some residual bodies—
vascuoles with digested material may remain.
Lipofuscin or aging pigment is a form of these
residual bodies causing brown coloration of organs in
which it accumulates brown atrophy.
Q.20. What are the equivocal signs of death?
Ans. These are cardiac arrest, lack of pulse, cessation of
breathing, areflexia and decreasing body temperature. This
is referred to as clinical death.
Q.21. What are the criteria for brain death?
Ans. A patient is regarded as biologically dead where brain death
has been diagnosed according to following criteria:
1. An isoelectric or flat electroencephalogram for 24 hours.
2. Two angiographic studies performed ½ an hour apart
demonstrating absent cerebral circulation.
3. Irreversible absence of spontaneous respiration.
4. Aflexia (loss of corneal and papillary reflexes).
Q.22. What are the unequivocal signs of death?
Ans. Livores: After cardiac arrest, gravity causes blood in venous
system to collect in lowest part of body. This produces
reddish violet skin spots that can be mobilized by applying
local process.
Regor mortis: Postmortem rigidity begins 3 to 6 hours after
death.
Nystem’s law: Rigor mortis begins at head and spreads
towards feet. Later subsides in the same manner. Occurs
due to lack of ATP and subsequent coagulation of active and
myosin filaments.
Antolysis or decomposition: Because of activiation of
lysosomal intrinsic protease and extrinsic protease from
intestinal bacteria which digest the organic components of
body. Failure of tissue respiration causes lysosomal protease
activation.
Q.23. The above three types of signs of death can be simu-
lated in which condition?
Ans. In any condition causing reduced vital functions like barbi-
turate intoxication.(apparent death).
Q.24. Define average life expectancy, morbidity and morta-

lity 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 popu-
lation who suffer from a disease.
Mortality: Number of persons per year per 100,000 popu-
lation 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 insu-
rance 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 contai-
ning RNA, loosely structured, genetically active euchroma-
tin 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.
Q.28. What is a karyogram?

Ans. Chromosomes of a cell are shown to be arranged in a karyo-
gram. This is a short formula or description of chromosomes
using the following criteria:
– Total number of chromosomes.
– Sex chromosome status.
– Applicable aberrations.
Q.29. Based on a computer model, which part of DNA
corresponds to software and which one to hardware?
Ans. The software is the program and base sequence containing
and instructions for:
1. Copying the program—DNA replication.
2. Repairing program defect—DNA repair.
3. Using subprograms to create protein (Structure and
functional).
The replication process and machinery, transcription pro-
cess and machinery and translation process and machinery
can be compared to hardware—computer itself.
Q.30. What is a nucleosome?
Ans. Nucleosome consists of:
1. A histone molecule with 2, H2A, H2B, H3 and H4 poly-
peptides each.
2. One histolne H1 polypeptide
3. Limker DNA
4. DNA proper.
Diameter of a nucleosome in a solenoid model is 11 cm.
A DNA double helix diameter is 2 mm.
Q.31. What are the dimensions or diameter (average) of a
chromatid?
Ans. Each chromatid is a supercoil of around 700 mm diameter
with each coil of single DNA strand and histone molecules
(polynucleosome) being of around 30 mm diameter.
Q.32. Give an example of congenital DNA repair defect.
Ans. Xeroderma pigmentosum.
It is rare. It is hereditary (because of an endonuclease
defect).
Pathogentic chain reaction: Ultraviolet radiation

↓
DNA damage in skin cells
↓
Increased DNA defects in skin cells
Sequelae:
1. Skin atrophy (→Thinning of skin)→ an adaptive reaction
of excessive cornification and hyperpigmentation is
induced.
Mitotic dysfunction in skin cells: Skin cancers. Clinically
the→following lesions are seen:
• Dry scaly skin (Xeroderma) with mottled hyper-
pigmentation.
• It is a precusor of skin cancer. Later multiple skin
tumors such as basal cell Ca, squamous cell Ca and
malignant melanoma develop.
Q.33. What are the types of UV radiation?
Ans. Three wavelength ranges exist in UV portion of solar
spectrum:
1. UVA → 280 to 400 mm
2. UVB → 280 to 320 mm→ to cause cutaneous cancers.
3. UVC → 200 to 280 mm filtered by ozone layer.
Q.34. Causation of skin cancers by UV radiation depends
upon which factors?
Ans. 1. Type of UV rays.
2. Intensity of exposure.
3. Quantity of light absorbing protective mantle of melanin
in skin. Fair shinned Europeans who do not tan their
bodies and live near equator, e.g. Queensland Australia,
have the highest incidence of cutaneous cancers.
Q.35. What the subcellular level effects of UV rays?
Ans. 1. Inhibition of cell division.
2. Induction of mutations → carcinogenicity of UV rays is
attributed to formation of dipyrimidine dimmers in DNA.
3. Cell death.
4. Inactivation of enzymes.
Q.36. What is NER and discuss its role in UV radiation caused

cutaneous tumors?
Ans. NER or nucleotide excision repair is the mechanism of
repair of DNA damage such as formation of dispyrimidine
dimmers by UV rays in chin cells. Steps of NER are:
1. Recognition of DNA lesion.
2. Incision of damaged portion on both sides of lesion.
3. Removal of damaged nucleotide.
4. Synthesis of normal nucleotide patch.
5. It is ligation to DNA.
In mammalian cells upto 30 or more proteins are involved.
It is postulated that in excessive sunlight UV ray damage,
NER is overwhelmed leading to large transcriptional errors
and thus cancer.
Q.37. How does UVB radiation cause skin cancers in XP?
Ans. There are basically two mechanisms:
1. Inherited inability to repair UVB damaged DNA.
XP is a heterogenous disease with at least 7 variants
each caused by a defect in one of several genes involved
in NER. There is extreme photosensitivity and 2000 fold
increased risk of skin cancers in sun exposed skin.
2. UVB also causes mutations in oncogenes and tumor
suppressor genes.
Mutant forms of P53 and RAS are +. The mutations
occur mainly at dipyrimidine sequences. In animal
models, P53 mutations occur early than appearance of
tumors.
In XP, there may also be neurological abnormalities.
Q.38. What does the size of nucleus in a cell depend upon?
Ans. 1. Size of cell.
2. DNA content of nucleus.
3. Functional state of nucleus.
Q.39. In what conditions does nuclear polyploidy occur?
Ans. Multiple complement chromosomes in a cells is called
polyploidy. It occurs when:
1. Proliferating cells double their DNA in synthesis phase
and just before mitosis become tetraploid.
2. Where mitosis fails to occur after the synthesis phase
or is followed by several additional synthesis phases.
This occurs in some endocrine gland cells like thyroid.

3. As a morphological sign of stress induced adaptative
reactive as in.
Barbiturate above: Increased liver metabolism results in
liver cells polyploidy.
Cardiac valvular defects: Mycocardium works harder
and produces polyploidy.
Haploid cells are normally seen only while spermio-
genesis and oogenesis.
Q.40. What is nuclear aneuploidy and what is its morpholo-
gical sequela?
Ans. Variation from normal euploid complement (Haploid or
Diploid) of chromosomes in which individual chromosomes
do not exist in their normal quantities. Morphological sequela
of aneuploidy are:
1. Variability in size of nucleus (nuclear polymorphism)
larger cell nucleus indicates cellular activity and smaller
nucleus indicates cellular inactivity.
2. Variability in nuclear chromatin content. (Nuclear poly-
chromasia).
Both polymorphism and ploychromasia are important
criteria characterizing a malignant tumor.
Q.41. What are the nuclear criteria of malignancy?
Ans. 1. Nuclear polymorphism and nuclear polychromasia.
2. Proliferation measured by mitotic count in a field of
vision.
3. Dyskaryosis.
Q.42. What are the chromatin changes seen in nuclear chro-
matin in different disease states?
Ans. 1. Meterochromatin condensation: Checker board type of
chromatin condensation indicates arrested transcription.
2. Dyskaryosis: Irregular pattern of heterochromatin con-
densation and fine aggregates gives cancer cells a salt
and pepper appearance.
3. Perinuclear hyperchromatosis: Chromatin condensation
along inner nuclear membrane. Early sign of cell death
(apoptosis). Later it leads to total chromatin clumping
or nuclear pyknosis.
4. Karyolysis: Fading of nucleus due to chromatin dissolu-

tion. Late sign of induced cell death.
5. Karyorrhexis: Nuclear burst due to chromatin fragmen-
tation. 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 cyto-
plasm in nucleus, associated with dysfunctional cell divi-
sion 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 fixation—Diabetes.
4. Fatty inclusions: Following paraffin fixation, cause lipid
defects in nucleus. Typical of tumors in the form of fatty
tissue—Liposarcoma.
5. Immunoglobulin inclusions: PAS-positive globules (Fahey-
Dutcher 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 squa-
mous 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.
Q.46. Is squamous metaplasia beneficial?

Ans. It is a double edged sword as in case of respiratory epi-
thelium important function of mucous secretion is lost. Also
malignant cancer can arise in metaplasmic tissue and most
common cancer of respiratory epithelium is of squamous
type. All this with standing, stratified squamous epithelium
is more rugged and causes increased resistance to noxious
stimuli.
Q.47. Can metaplasia from squamous to columnar epithe-
lium occur?
Ans. Yes. Barrett’s esophagus is a condition in which lower eso-
phagus after increased exposure to acid reflux from sto-
mach converts from stratified squamous to glandular colum-
nar type of epithelium cancer arising in this setting is most
commonly adenocarcinoma.
Q.48. In connective tissue metaplasia also clearly are adap-
tive response?
Ans. Connective tissue formation of the type which is not indi-
genous to its site is not clearly adoptive. Example is forma-
tion of bone in soft tissue in myositis ossificans in fractures.
Fat and cartilage can form sometimes too.
Q.49. What is the role of stem cells in metaplasia?
Ans. Metaplasia results from reprogramming of stem cells pre-
sent in the tissue or of undifferentiated mesenchymal cells
in connective tissue. Precursor cells develop differently
there is no change in the phenotype of differentiated, mature
cells.
Q.50. What are the mechanisms involved in altered pre-
cursor cells development in metaplasia?
Ans. Many tissue specific and differentiation genes are involved
in coding for growth factors, cytokines and E (M compo-
nents which signal for altered development of precursor
cells, e.g. bone morphogenic proteins, members of TGF-B
superfamily, induce chondrogenic and osteogenic ex-
pression in stem cells. While suppressing differentiating into
muscle or fat these growth factors act as external triggers
induce specific transcription factors that lead the cascade
of phenotype specific genes towards a full-developed (of
different type) cell. Why the normal pathways are disrupted
is not known?
Examples: Vitamin A → Retinoic acid regulates cell growth,

differentiation and tissue pattering.
Certain cytostatic drugs: Cause disruption of DNA methy-
lation patterns and can transform mesenchymal cells from
one cell type (fibroblast) to another (muscle, cartilage).
SUPPLEMENTARY TOPICS—CELL
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.
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.
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 microcircula-
tory vessels a process called pavementing.
D. T-lymphocytes produce antibodies.
E. Transudate is noninflammatory fluid with few cellular
elements.

A. Unidirectional movement of leukocytes towards a stimu-
lus is called diapedesis.
B. Macrophages are found in glomeruli.
C. Hepatocytes have greater regenerative capacity than
myocardial cells.
D. Mast cells have metachromatic granules.
A. Features of acute inflammation are in following chro-
nological order:
a Contraction of arterioles
b. Arteriolar dilatation
c. Active hyperemia
d. Inflammatory exudates
e. Swelling and pain
f. Slowing of blood flow.
B. Cytoplasmic micropinocytotic vesicles are increased for
increasing membrane permeability in acute inflamma-
tion.
C. C3a, C5a, 5-HT, Kallikrein, PGE2 are involved in increa-
sed vascular permeability.
D. In a granuloma, there is polymorphonuclear leuko-
cytosis, cell debris and fibrin.
E. Collagen type found in dermis, tendon, bone, cornea,
and dentin is type IV.
A. Fab fragment consists of light chain and part of heavy
chain.
B. Papain digestion of monomeric immunoglobulin results
in production of an antibody binding fragment.
C. Fc, Fragment consists of C-terminal ends of heavy
chains.
A. IgM class specific antibody production is a primary
antibody response.
B. IgA class antibody has 4 J-chains.
C. Mast cells degranulation is a property of IgE.
D. Lymphocyte surface antigen receptor is a property of
IgD. The deep (or para) cortex is the T-lymphocyte zone
of lymph node and enlarges during antigenic stimulation.
E. The deep (or para) cortex is the T-lymphocyte zone of

lymph node and enlarges during antigenic stimulation.
8. Which of the following are true about T-lymphocytes?
A. Helper T-lymphocytes and T4 positive cells.
B. Cells bearing both T4 and T9 are common thymocytes.
C. Prothymocytes are T10 positive cells.
D. Suppressor T-lymphocytes are T9 positive cells.
E. In the unstimulated lymph node, there are localized
aggregates of lymphocytes in superficial cortex.
A. Following antigenic stimulation, para cortex enlarges
resulting in B-lymphocyte proliferation.
B. Macrophages have a surface receptor for C3b.
C. C5a promotes emigration and accumulation of neutrophil
polymorphs and macrophages.
D. Extrinsic allergic alveolitis is an immune complex,
Arthus (type 3) reaction to bacterial spores on mouldy
hay.
E. Rheumatoid arthritis is an organ specific autoimmune
disease.
10. Which of the following are true about autoimmune
disease?
A. In Di-George syndrome, there is defective B-cell function.
B. In infantile sex-linked agammaglobulinemia there is
selective B-cell defect (Bruton type).
C. In severe combined immuno deficiency, there is defective
B-cell and T-cell function.
D. Wiskott-Aldrich syndrome is characterized by abnormal
platelets and defective T-cell function alone.
ANSWERS
1. A. True
B. False
C. False
D. False
E. True
2. A. True
B. False
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
9. A. False: Following antigenic stimulation of humoral response

type, primary nodules enlarge to become germinal
centers where B-lymphocytes proliferate.
B. True
C. True
D. True
E. False: It is a multisystem connective tissue disease.
10. A. False: There is almost complete failure of development
of thymus and parathyroid with resultant defective T-cell
function.
B. True
C. True
D. False: Alongwith these two abnormalities, IgM and IgA
are also abnormal.
CONCEPTS
IMMUNOPATHOLOGY
A. Heparin mediates type I hypersensitivity (Anaphylactic
reaction).
B. Pernicious anemia and Grave’s 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 glomerulone-
phritis.
D. False: Scleroderma is progressive systemic sclerosis.
CREST syndrome is localized scleroderma charac-
terized by anticentromere antibodies. It is characterized
by calcinosis, Raynaud’s phenomenon, esophageal
dysmotility, sclerodactyly and telangiectasia.
E. False: It is characterized by secondary immune defi-

ciency, other examples being diabetes mellitus and
alcohol abuse.
A. Pneumocystis carinii infection can present with osteo-
myelitis.
B. Acquired Immunodeficiency Syndrome (AIDS) can pre-
sent 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 counts—CMV, 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, auto-
immune disease, lymphoma and gastric cancer.
D. False: Average duration of latent phase in AIDS is
10 years.
INFLAMMATION
A. P-selectin is normally present in Weibel-Palade bodies
in endothelial cells.
B. Defects in cell adhesion is found in diabetes and corti-
costeroid 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 con-
genital deficiencies of adhesion molecules.
C. False: Although incidence of bacterial infection may be
increased, characteristically candidal infections are in-
creased in myeloperoxidase deficiency.
D. False: Along with these two types of cells, platelets also

store and release histamine.
E. False: IL-I is responsible for pyrexial response. Prosta-
glandin E2 is responsible for pain accompanying acute
inflammation.
A. Apoptosis is generally accompanied by inflammatory
response.
B. bcl-2 and P-53 are both proapoptotic genes.
C. Caspases activate proteases.
D. Councilman bodies are found in alcoholic hepatitis.
E. Fat necrosis is also called saponification.
Ans. A. False: Apoptosis is characterized by the lack of
inflammatory response.
B. False. bcl-2 inhibits apoptosis.
P-53 stimulate apoptosis.
C. True: Caspases activate proteinase as well as
endonucleases.
D. False: Councilman bodies are found in apoptotic liver
cells in viral hepatitis.
E. True.
A. Tissue based basophils are called mast cells.
B. Interstitial infiltration is a common response to viral infec-
tious agents.
C. Syncytia formation is a response seen in cytopathic/
cytoproliferative inflammation.
D. Keloid is characterized by production of collgen of predo-
minantly type IV.
E. Basement membrane has a net positive charge.
Ans. A. True.
B. True: For example in viral hepatitis and viral myocarditis.
C. True: The cells are altered in ultrastructure.
D. False: Type III collagen is found in keloid. Type IV
collagen is found in basement membrane.
E. False: Basement membrane has a net negative charge.
Chapter 2
Genetic and
Envir
Envir onment
vironment al Causes
onmental
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 disease—Autosomal recessive
B. Neurofibromatosis—Autosomal dominant
C. Duchenne muscle dystrophy—Autosomal recessive
D. Ataxia telangiectasia—Autosomal 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 Hashimoto’s disease.
4. Which of the following diseases are caused by bac-
teria?
A. Onchocerciasis
B. Aspergillosis
C. Syphilis
D. Toxopalsmosis
E. Rubella.
5. Which of the following are true about bacterial infec-
tions?
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 broncho-
genic 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
Genetic and Environmental Causes of Diseases 39
2. A. True
B. True
C. False
D. False
3. A. True
B. True
C. False: Location is at chromosome 6.
D. False: DR 5 is associated with Hashimoto’s disease and
DR4 with rheumatoid disease.
4. A. False: It is a round worm disease.
B. False: It is a fungal disease.
C. True
D. False: It is a protozoan.
E. False: It is a togavirus.
5. A. True: Welchi alpha-toxin is a lecithinase that digests cell
membrane.
B. True: The toxin causes pseudomembranous colitis.
C. True: The genus is Staphylococcus.
D. True
6. A. True
B. False: A variety of agents including the carbontetra-
chloride and oral contraceptives damage liver.
C. False: Mesothelioma is caused by asbestos exposure.
D. True
E. True
7. A. False: Though usual time when pregnancy is most
susceptible is 3rd-8th week, teratogens can act before
diagnosis of pregnancy.
B. False: This autosomal recessive disease is usually
associated with multiple liver cysts, congenital hepatic
hibrosis and proliferation of bile ducts.
C. True
D. False: The defect is different.
E. True
GENETIC DISEASES
A. Brushfield spots are seen on skin in Mongols.
B. Tumor’s syndrome patients are usually females and their
somatosomes have Barr bodies.
C. True hermaphroditism is always characterized by ovary

on one side and testis on the other.
D. Sertoli-Leydig cell tumors are never found in females.
E. Cystic fibrosis is characterized by fungal lung infections.
Ans. A. False: Brushfield’s spots are seen in iris of Down’s
syndrome patients.
B. False: They have female phenotype but the somatic
cells do not have Barr bodies.
C. False: True hermaphroditism may also be seen in
patients with ovotestis, a gonad with both testicular and
ovarian tissue.
D. False: In female pseudohermaphroditism, androgen pro-
ducing tumors may be cause.
E. False: Characteristic infections seen are P. aeruginosa
and S. aureus.
A. Zebra bodies are seen in Tay-Sachs disease.
B. Gaucher’s disease and familial hypercholesterolemia
are extremely rare genetic diseases.
C. Ehlers-Danlos syndrome is always autosomal dominant.
D. Von Recklinghausen’s disease and bilateral acoustic
neurofibromatosis are synonymous.
E. Fragile X syndrome is an X-linked disorders.
Ans. A. False: Zebra bodies are electron microscopic feature of
CNS and RE cells in Niemann-Pick disease. Sphingo-
myelin accumulates in distended lysosomes as lamella-
ted figures.
B. False: Both are relatively common. Gaucher’s (Auto-
somal recessive) is the most common lysosomal sto-
rage disease and familial hypercholesterolemia is the
most common inherited disorder (It is an autosomal
Dominant disease with a worldwide incidence of 1 in
500).
C. False: EDS type VI is an AR defect in lysyl hydroxylase
(enzyme responsible for hydroxylation of lysine resi-
dues).
D. False: Von Recklinghausen’s disease is type I neurofibro-
matosis characterized by AD mutation in tumor sup-
pressor gene NF-1. Bilateral acoustic neurofibromatosis
is a type II neurofibromatosis accounting for 10 percent
Genetic and Environmental Causes of Diseases 41
of cases of NF only and is characterized by mutation

in tumor suppressor gene NF-2.
E. True: Fragile X syndrome is characterized by triplet
nucleotide repeat mutations. Nucleotide sequence CUG
repeats typically hundreds to thousands of times.
Mutation is on FMR-1 gene on X chromosome.
Chapter 3
Miscellaneous TTopics
opics in
General Pathology
PRETEST
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: α-granules of platelets contain fibrinogen, fibro-
nectin, factor V and von Willebrand’s 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.
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.
Miscellaneous Topics in General Pathology 43
D. Fibrin Degradation Products (FDP) are increased in DIC.

E. PT is normal and PTT is prolonged in DIC.
Ans. A. True: PT tests extrinsic and common pathways, It tests
adequate level and synthesis of liver synthesized fac-
tors—V, VII, X, prothrombin and fibrinogen.
B. False: PTT tests both intrinsic and common pathways.
Levels of following factors are tested—XII, XI, IX, VIII, X,
V, prothrombin and fibrinogen.
C. False: Thrombin time is a test for adequate fibrinogen
levels.
D. True: FDPs levels test fibrinolytic system. (Protein C and
S, antithrombin III).
E. False: As most of the clotting factors are depleted in
DIC, both PT and PTT are affected (prolonged in DIC).
A. Lines of Zahn are seen in a blood clot.
B. Paradoxical emboli can gain access to systemic circu-
lation through a septal defect.
C. About 50 percent of infarcts result from thrombotic or
embolic occlusion of an artery or vein.
D. Endotoxins are gram-negative bacterial cell wall
lipopolysacharides.
E. Waterhous Fridrichsen syndrome results in acute adrenal
insufficiency.
Ans. A. False: Lines of Zahn are seen in a thrombus.
B. True: This way they gain access from right to left heart.
C. False: Most (99%) of infarcts are results of occlusion
of a vessel.
D. True: Various components like lipoteichoic acid,
pepticoglycan, etc. contribute to a similar shock because
of gram-positive bacteria.
E. True: It is associated with meningococcal septic shock
and results in bilateral hemorrhagic infarction of adrenals.
A. Knudson first gave the 2 hit hypothesis of carcinogenesis.
B. Bax, bad, bct-xS, bid are proapoptotic genes.
C. Tumor grade is clinical marker of degree of malignancy.
D. Renal cell carcinoma spreads most commonly through
lymphatics.
Ans. A. True: Initiator and promoter genes hypothesis was first

given by Knudson.
B. True
C. False: It is a histological marker. Clinically, tumors are
categorized in stages.
D. As kidney is richly supplied by blood, hematogenous
spread is more common.
A. Caplan syndrome involves pneumoconiosis.
B. Carbon tetrachloride (CCL4) poisoning is seen more
commonly in dry-cleaners.
C. Oral contraceptive use increases the risk of breast and
cervical cancers.
D. Lead poisoning can lead to microcytic anemia.
E. Cocaine overuse can cause perforation of nasal septum.
Ans. A. True: Silicosis induced pneumoconiosis with rheumatoid
arthritis is called Caplan’s syndrome.
B. True.
C. True: Both have estrogen receptors.
D. True: Lead interferes with heme synthesis by inhibiting
α-aminolevulinic acid dehydratase and ferrochelase.
Microcytic anemia and basophilic stippling result.
E. True: It is a well known complication in chronic cocaine
abuse.
Chapter 4
Disorder
derss of Gr
Disorder owt
Gro h
wth
and Dif
Diffferentiation
erentiation
PRETEST
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 appen-
dicitis and upper esophagus in esophagitis.
2. Which of the following developmentally abnormal
conditions lead to decrease in physical growth?
A. Down syndrome
B. Turner’s 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, uri-
nary 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. Sheehan’s syndrome can cause thyroid atrophy.
E. Psoriasis is a hyperplastic skin disease characterized

by rapid turnover of epidermis.
4. Which of the following precancerous diseases are
correctly matched with their neoplastic disorders?
A. Down syndrome—Kaposi’s sarcoma.
B. Actinic keratosis and xeroderma pigmentosum—Squa-
mous cells carcinoma of skin.
C. Cirrhosis (alcoholic, hepatitis B, C)—Hepatocellular car-
cinoma.
D. Immunodeficiency states—Malignant lymphomas.
E. Ulcerative colitis—Colonic adenocarcinoma.
5. Which of the following oncogenes are correctly mat-
ched with their caused neoplasm?
A. erb-B2—Breast ovarian and gastric carcinoma.
B. bcl-2—Follicular and undifferentiated lymphomas.
C. N-myc—Burkitt’s lymphoma.
D. Loss or deletion of BRCA-2 gene on chromosome
13 q—Breast cancer.
A. PSA and prostatic acid phosphatase are tumor markers
for prostatic carcinoma.
B. CEA is a marker for colorectal cancers only.
C. HTLV-I is associated with adult T-cell leukemia.
D. EBV is associated with Burkitt’s lymphoma and
nasopharyngeal carcinoma.
A. 70 percent of tumors are above tentorium in adults and
70 percent are below tentorium in childhood.
B. All multiple endocrine neoplasias are autosomal recessive.
C. t(9;22) or philadelphia chromosome is associated with
CML.
D. In males prostatic cancers are leading in worldwide
incidence and lung cancer is highest mortality rate.
E. In females breast cancers are the leaders in worldwide
incidence and lung cancer in highest mortality rate.
Disorders of Growth and Differentiation 47
ANSWERS
1. A. True
B. True
C. False: This will be called a choristoma.
D. False: The typical description is of a hamartoma.
E. False: The typical metaplastic changes are seen in
bronchi of cigarette smokers and in prostate around
areas of infarction.
2. A. True: Decreased skeletal growth.
B. True: Decrease skeletal growth.
C. True: These cause IUGR.
D. False: Average birth weight is greater than normal.
3. A. True
B. False: Lobules do not exist in male breast. Gyncomastia
is male breast hypertrophy.
C. True
D. True: There is panhypopituitarism and TSH is decreased
or absent.
E. True
4. A. True
B. True
C. True
D. True
E. True
5. A. True
B. True
C. True
D. False
6. A. True
B. False: It is also produced by pancreatic cancers and
also by breast and gastric cancers.
C. True
D. True
7. A. True
B. False: All men’s are autosomal dominant.
C. True
D. True
E. True
Chapter 5
Disorder
derss of Me
Disorder 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 myeloma-
tosis.
C. Rectal mucosal biopsy is positive in 80 percent cases
of myelomatosis.
D. Congored and Van Gieson staining methods are impor-
tant in detecting amyloid.
E. Hepatic failure is a common cause of death.
A. Dystrophic calcification occurs in individuals with abnor-
mal calcium metabolism.
B. Psammoma bodies are found in tumors such as papil-
lary carcinoma of thyroid and meningiomas.
C. Dystrophic calcification is associated with hyperparathy-
roidism.
D. Phenylketonuria is due to deficiency of phenylalanine
hydroxylase.
E. Cystathione synthetase is deficient in homocystinuria.
A. Gout is characterized by hypouricemia.
B. First metatarsophalangeal joint is commonly affected in
gout.
C. Cushings syndrome is characterized by hyponatremia
Disorders of Metabolism and Homeostasis 49
D. A deficient diet with excessive alcohol consumption

causes vitamin B1 deficiency.
E. Vitamin B deficiency may cause CCF.
A. Wilson’s disease is characterized by low serum copper.
B. Distruction of superior mesenteric artery may cause
gangrene.
C. Adrenocortical adenoma is a cause of secondary
hyperaldosteronism.
D. Burns involving 15 percent of skin’s surface will cause
cardiogenic shock.
A. Hay fever causes generalized edema.
B. Distruction of superior mesenteric artery may cause
gangrene.
C. Adrenocortical adenoma is a cause of secondary
hyperaldosteronism.
D. Burns involving 15 percent of skin’s surface will cause
cardiogenic shock.
A. Postmortem chot has lines of Zahn and is adherent to
vessel wall.
B. Pulmonary embolism causing strain on left heart usually
produces infarction.
C. Streptokinase and thrombin produce thrombolysis.
D. A prosthetic pulmonary valve may give rise to arterial
thrombus.
E. Fat embolism is fatal in 90 percent of cases and is
associated with thrombocytosis.
A. Amniotic fluid embolism is associated with prolonged
labor but is a relatively mild condition.
B. Shock may cause subendocardial MI.
C. Corneal reflex and vestibule ocular reflexes are absent
in brainstem death.
D. Subarachnoid hemorrhage causes sudden death.
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 amy-
loid.
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 hyperparathy-
roidism.
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 ante-
mortem thrombus.
Disorders of Metabolism and Homeostasis 51
B. False: Pulmonary embolism is usually a postoperative

complication causing strain on right side of heart but
rarely causes pulmonary infarction because of dual
pulmonary blood supply.
C. True
D. False: Such emboli will be filtered in lungs and will not
enter arterial side.
E. False: Fat embolism is fatal in about 10 percent of cases
and is associated with thrombocytopenia.
7. A. False: Amniotic fluid embolism is associated with abrupt
precipitous labor and is fatal in 80 to 85 percent of cases.
B. True
C. True: Bile ducts express class II HLA antigens and so
many be destroyed in graft-versus-host disease.
D. True
Chapter 6
Cardio
diovvascular Sy
Cardio Syss tem
PRETEST AND CONCEPTS

A. Atrial septal defect usually causes death before puberty
if untreated.
B. ASD is commoner in females.
C. Infective endocarditis is commoner in drug addicts on
right side of heart.
D. Hypocholesterolemia is a risk factor for atherosclerosis.
E. There is increased risk of deep vein thrombosis in CCF.
A. Fibrinoid necrosis is a hallmark of malignant hyperten-
sion as a hyaline atherosclesoris in benign form.
B. Anistschkow cells are seen in aschoff bodies.
C. Buerger’s disease is a disease of medium sized vessels,
e.g. tibial and radial.
D. Buerger’s disease does not affect surrounding structures.
A. Atherosclerotic aortic aneurysms are commoner in aor-
tic arch.
B. Atherosclerotic aortic aneurysms never contain mural
thrombi.
C. Hypothyroidism and Addison’s disease may lead to
hypertension.
D. There is fibrinoid necrosis of all vessel wall layer in
polyarteritis nodosa.
E. Fatty streaks in aorta contain predominantly intracellular
lipid.
Cardiovascular System 53

A. PDA usually occurs singly.
B. Arterial spasm may acutely exacerbate ischemic heart
disease.
C. Total coagulative necrosis with loss of nuclei is apparent
in MI after 72 hours.
D. Libman-Sacks endocarditis is associated with SLE.
E. Familial hypercholesterolemia is associated with raised
triglycerides levels.
A. Dissecting aortic aneurysm occurs in Marfans
syndrome, the cause of cystic medial necrosis.
B. Cranial (gaint-cell) arteritis affect only head and neck
vessels.
C. Pericarditis is a complication of MI.
D. Mitral incompetence is associated with ankylosing
spondylitis.
E. Trypanosoma cruzi may cause myocarditis.
A. Arteriosclerosis causes systemic hypertension.
B. Lesions similar to those seen in heart in rheumatic fever
can be seen in walls of larger vessels.
C. Buerger’s disease involves thrombotic occlusion of both
arteries and veins of limbs.
D. Chronic pyelonephritis may result in systemic hyper-
tension.
E. Large crumbling vegetation in mitral valve are least likely
to occur in a child during rheumatic fever.
A. Coarctation of aorta is an example of early cyanosis.
B. Right coronary artery predominantly supplies blood to
posterior portion of IV septum.
C. “Cor Livium” is used to describe syphilitic carditis.
D. Morphologic examination of heart, diseased by pericar-
ditis may reveal hemochromatosis.
E. Renin angiotensin system prostaglandins and kallikrein
kinin system contribute to kidney’s regulation of syste-
mic blood pressure.
ANSWERS
1. A. False: Survival to middle age is usual.
B. True
C. True
D. False: Hypercholesterolemia is a risk factor.
E. True
2. A. True
B. True: These are also called caterpillar cells.
C. True
D. False: Extension of inflammation from arteries into
surrounding veins and nerves leads to their fibrous
encasement.
3. A. False: Atherosclerotic aneurysms are commonest in
abdominal aorta. Syphilitic aneurysms more commo-
nest in abdominal aorta. Syphilitic aneurysms more
commonly affect aortic arch.
B. False: Mural thrombus is commonly present and may
fill the saccular aneurysms.
C. False: These usually cause hypotension.
D. True
E. True: Lipid is predominantly within the cytoplasm of
foamy macrophages.
4. A. False. It is usually seen in association with other anoma-
lies such as TGA where shunt may improve hemo-
dynamic situation.
B. True: Prinzmetal angina.
C. True
D. True
E. False: Tg level is usually normal.
5. A. True
B. False: Any artery in the body may be affected.
C. True
D. False: Aortic incompetence has association with
ankylosing spondylitis.
E. True: Seen in South America.
6. A. False: It is the result of hypertension.
B. True
C. True
D. True
E. True
Cardiovascular System 55
7. A. False: This is predominantly late cyanosis or acyanotic

heart disease.
B. True
C. True
D. False: Hemochromatosis may cause dilated or restric-
tive cardiomyopathy but not pericarditis.
E. True
Chapter 7
Blood and
Bone Mar
Marrrow
PRETEST
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.
A. Plasmin derived from plasminogen degrades both fibrino-
gen and fibrin.
B. Hemophilia A and von Willebrand’s diseases are charac-
terized by deficiency of factor VIII.
C. A short history of symptoms and signs of anemia, infec-
tion 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.
A. All slow developing anemia’s are asymptomatic.
B. Myelophthisis is a reduction in productive capacity of
bone marrow.
C. Polycythemia vera is characterized by high erythro-
poietin levels.
Blood and Bone Marrow 57
D. Certain antibiotics and benzene compounds, which

share chemical configurations have been associated
with leukemia development.
E. Thrombocytopenia and acute leukemias, both can
present with petechiae.
A. Characteristic changes seen in some viral infections is
formation of numerous immunoblasts involved in lymph
nodes.
B. Hemolytic anemia is associated with unconjugated
hyperbilirubinemia.
C. Acute hemorrhage is characterized by reticulocytosis
and chronic small blood loss by iron deficiency.
D. Resection of ascending colon will cause vit B12 deficiency.
A. The lack of B- or T-cell membranes in AML indicates poor
response to treatment.
B. Sodium fluoride sensitive non-specific esterase distin-
guishes monoblasts from myeloblasts.
C. Precursors in M2 AML cannot be distinguished histoche-
mically.
D. Acute leukemias cause massive splenomegaly.
E. Secondary carcinoma is the commonest cause of lymph
node enlargement.
6. Which of the following are true about plasma cell
tumors?
A. Heavy chain disease is a rare condition involving neo-
plastic proliferation of lymphoid cells in small intestine
mucosa.
B. Bence Jones protein consists of light chains of immuno-
globulins.
C. 75 percent of myelomas produce only light chains.
D. Blood viscosity is increased in Waldenstrom’s macrog-
lobulinemia.
E. Solitary plasmacytoma typically produces a solitary
tumor in a long bone.
A. In celiac disease, splenic atrophy occurs.
B. Letterer-Siwe disease is a form of histiocytosis.
C. In lymphocyte predominant Hodgkin’s disease, R-S cells

are plenty.
D. Thymic or mediastinal lymphoblastic symptoms of T-cell
type commonly occurs in children.
E. Patients being treated for Hodgkin’s may have fungal
infections.
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 microangio-
pathic hemolysis.
5. A. False: It indicates good response.
B. True
C. False
D. False
E. True
6. A. True
B. True
Blood and Bone Marrow 59
C. False: Only 15 percent of myelomas produce only light

chains.
D. True: Neoplastic cells produce IgM.
E. True
7. A. True
B. True: Macrophages proliferate in this disease.
C. False: RS. cells are scant in this form and the main cell
type is lymphocyte.
D. True
E. True: The chemotheraphy may cause immune supp-
ression with opportunistic fungal infections.
BLOOD AND BONE MARROW

CONCEPTS
A. Iron deficiency anemia is seen most commonly in youn-
ger age group population in developed countries.
B. Anemia of chronic disease is characterized by increased
TIBC and decreased serum iron.
C. All cases of sideroblastic anemia are forms of myelo-
dysplastic syndrome.
D. Anemia of blood loss is always accompanied and lasts
till hypovolemia.
E. Mitosis of RBC precursors is delayed in megaloblastic
anemia.
Ans. A. False: Although Iron deficiency is common in under-
developed world in children, the worldwide incidence is
higher in older population.
B. False: Anemia of chronic disease is characterized by
decreased serum iron, decreased TIBC, decreased per-
centage saturation, and increased serum ferritin.
Second type of microcytic anemia-iron deficiency ane-
mia, has increased TIBC and similar other lab findings.
C. False: Sideroblastic anemia cases have ring side-
roblasts in bone marrow and only some cases are a form
of myelodysplastic.
D. False: Anemia of blood loss (acute) develops if patient
survives acute blood loss and undergoes hemodilution.
In chronic cases, iron deficiency anemia can result.
E. True: There is impaired DNA synthesis and impaired

mitosis.
A. Lymph nodes are tender in acute and chronic non-
specific lymphadenopathies.
B. Acute leukemias are characterized by more than
20 percent blasts in bone marrow.
C. In non-Hodgkin’s lymphomas, most of the malignant
show T-cell phenotype.
D. Burkitt’s lymphoma is common in Africa and America.
E. Waldenstrom macroglobinemia is characterized by lytic
bone lesions.
Ans. A. False: They are tender in acute but not in chronic non-
specific lymphadenitis.
B. True.
C. False: B-cell non-Hodgkin’s lymphomas are most
common. In fact follicular lymphoma is the most commom
NHL. They tend to present with diffuse disease and have
a better prognosis than other diffuse lymphoma.
D. True: Small non-cleaved lymphoma (Burkitt’s lymphoma)
occurs in African type with jaw involvement. Microscopic
appearance is typically starry-sky with 8;14 translocation.
E. False: Waldenstrom’s is also called lymphoplasmacytic
lymphoma and is a cross between multiple myeloma
and small lymphocytic lymphoma ………… No lytic
bone lesions are seen.
Chapter 8
Respirat
espirat or
oryy Sy
ator Syss tem

A. Cystic fibrosis and pulmonary edema predispose the
patient to respiratory infections.
B. Carcinoma of larynx is usally of squamous cell type and
is complicate by lung infections.
C. Malignant mesothelioma of pleura usually contain
asbestos bodies.
D. Lobar pneumonia is caused by organisms of high viru-
lence.
E. Pneumocystis carinii pneumonia is associated with
other respiratory infections.
A. Clara cells and pneumocytes are present in terminal
bronchioles.
B. Adult respiratory distress syndrome causes proliferation
of type I pneumocytes.
C. PFFR FEVI/VC and FEVI are reduced in asthma.
D. Bronchiectasis is associated with cystic fibrosis and
Kartageners syndrome.
E. Exposure to uranium and radon cause positive asso-
ciation with carcinoma of lung.
A. Carcinoid tumors are dumb bell shaped tumors nodules
protruding through bronchial walls.
B. Centibular emphysema is commonly present in lower
lobes of lungs.
C. Sarcoidosis consists of noncaseating granulomas away

from site of inflammations.
D. Small cell carcinomas are associated with cigarette
smoking.
E. Silicosis is caused by particles less that 5 mm in diame-
ters.
A. Chronic bronchitis can be associated with coagulase
positive staphylococci.
B. Right to left shunts produce pulmonary hypertension.
C. Progressive pulmonary tuberculosis can occur in the
form of cavitary fibrocaseous tuberculosis, military tuber-
culosis and tubercular bronchopneumonia.
D. Hamman Rich syndrome is synonymous with acute
interstitial pneumonitis.
E. Lipoid pneumonia is always associated with intrinsic
cause of pulmonary lipidosis.
A. Silicosis may result from exposure to gold in gold mines
and also occurs in stonemasons and pottery workers.
B. Respiratory epithelium is normal in chronic bronchitis.
C. Adenocarcinomas of lung contain intracytoplasmic
mucin.
D. Tuberculin test tests humoral immunity.
E. Hyaline membrane disease and ARDS are characterized
by formation of hyaline membrane in alveoli because of
entirely different etiologies.
A. Status asthmaticus is characterized by continuous attack
of asthma, with severe respiratory distress.
B. Left to right shunts are associated with a sustained rise
in pulmonary artery pressure.
C. Aspiration pneumonia is characterized by suppurative
bronchopneumonia with foreign body gaint cell.
D. No allergen can be implicated in intrinsic asthma.
E. Whooping cough in childhood can result in bron-
chiectasis later.
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 cont-
rast to panlobular emphysema that occurs in lower lobes.
C. True: This feature differentiates it from other granulo-
matous inflammations.
D. True
E. True: Larger particles cannot reach alveoli.
4. A. True
B. False: Hypotension can be caused by them.
C. True
D. True
E. False: Lipoid pneumonia can be caused by extrinsic as
well as intrinsic cases.
5. A. True
B. False: Chronic bronchitis causes hyperplasia of mucin
secreting cells.
C. True
D. False: Tuberculin test is index of cell mediated immunity.
E. True
6. A. True
B. False: Only lober pneumonia is characterized by sus-
tained 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 bron-
chiectasis.
Chapter 9
Liver
er,, Biliar
Liver Biliaryy TTrract and
Ex ocr
Exocr ine PPancr
ocrine ancr
ancreaseas
PRETEST
A. Acute viral hepatitis can cause fatty liver.
B. Mallory bodies are found in infective hepatitis.
C. Predominant HBsAg expression in serum and hepato-
cytes 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.
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.
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.
ANSWERS
1. A. False: Fatty liver is caused by protein, energy, malnu-
trition, 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 cerulo-
plasmin 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
aryy TTrract
Alimentar
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.
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. Crohn’s disease gives a cobblestone appearance to
colon.
D. Ulcerative colitis causes colonic mucosal pseudo-
polyps.
E. Pseudomembranous colitis is caused by Vibrio cholerae.
A. Primary malabsorption syndromes are celiac disease,
tropical sprue and Whipple’s 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. Crohn’s disease is associated with increased risk of
small bowel cancer.
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.
GIT AND LIVER/BILIARY TRACT/PANCREAS

CONCEPTS
Gastrointestinal Tract Pathology
A. Schatzki rings are seen in Plummer-Vinson syndrome.
B. Bird-beak sign can be seen in barium swallow in Chagas’
disease.
C. Mallory-Weiss tears and esophageal varices have
similar presentations.
D. Barrett’s esophagus is associated with increased risk
of squamous cell carcinoma.
E. Pyloric stenosis can present with projectile vomiting.
Ans. A. False: Schatzki rings are weblike narrowing at
gastroesophageal junction. Plummer-Vinson syndrome
is a separate entity occurring in middle aged women;
accompanying iron deficiency anemia and increased
Alimentary Tract 69
risk of carcinoma, these are esophageal webs which can

occur anywhere in the esophagus.
B. True: Chagas’ disease is associated with achalasia of
esophagus in which this sign is seen.
C. False: Although both are associated with alcohol abuse,
Mallory-Weiss tears typically occur acutely as a result
of retching/vomiting. Varices result from portal hypertension
and usually present with more significant bleeding.
D. False: Barrett’s esophagus is columnar metaplasia of
lower esophagus because of gastroesophageal reflux. It
is associated with adenocarcinoma of esophagus.
E. True: Pyloric stenosis is congenital hypertrophy of
pylorus and presents with projectile vomiting and
abdominal “Olive”.
A. Enlarged gastric rugae are seen in both Menetrier
disease and Zollinger-Ellison syndrome.
B. Gastric stress ulcers occur with higher incidence in ICU
patients.
C. Fundic type chronic gastritis (type A) is associated with
H. pylori infection.
D. Cirrhosis and COPD are associated with duodenal type
of peptic ulcer.
E. Malignant ulcer of the gastrum is more common in
people with blood group O.
Ans. A. True: Both are examples of hypertrophic gastropathy.
B. True. These are multiple, small, round, superficial ulcers
of stomach and duodenum.
C. False: Fundic type of chronic gastritis is associated with
auto-antibodies to parietal cells or/and intrinsic factor.
Antral type (Type 2) is associated with H. pylori infection.
D. True: Other associations are MEN type I and 2 syndromes.
E. False: People with blood broup A have higher incidence
of gastric carcinoma. Those with blood group O have
higher incidence of duodenal peptic ulcer.
A. Pseudomembranous colitis is easily treatable.
B. Low fiber diet leads to increased intraluminal pressure
in intestines.
C. Turcot syndrome involves familial adenomatosus polypi,

CNS tumors (gliomas).
D. Right sided colonic cancer is associated with iron deficiency
anemia and left sided with reduced caliber stools.
E. Excretion of 5-HIAA is increased in urine in intestinal
carcinoid.
Ans. A. False: Although vancomycin and/with metronidazole can
be given, surgery is usually required.
B. True: This in turn causes increased incidence of
diverticulosis.
C. True.
D. True: Right sided colonic cancer is associated with
bleeding and occult blood in stools and left sided with
change in bowel habits (constipation or diarrhea,
obstruction, etc.)
E. True: It is a metabolite of serotonin.
A. Both volvulus and intussusception are associated with
infarction of involved intestinal segment.
B. Hirschsprung’s disease can present with vomiting.
C. Whipple’s disease is of infectious etiology.
D. Incidence of extraintestinal manifestations is more in
ulcerative colitis than Chrohn’s disease.
E. Ischemic colitis can present with bloody diarrhea.
Ans. A. True.
B. True: Constipation and abdominal distension are more
common though.
C. Organism is Trophermya whippelii.
D. True: These include arthritis, spondylitis, primary sclero-
sing cholangitis, erythema nodosum, pyoderma gangre-
nosum, etc.
E. True.
Pancreatic Pathology
A. Scorpion stings can cause acute hemorrhagic pancrea-
titis.
B. Type I D M patients are absolutely dependent on insulin
to prevent ketoacidosis and coma.
Alimentary Tract 71
C. Kimmelstiel-Wilson disease occurs in diabetic nephro-

pathy.
D. Both C-peptide and insulin are increased in insulinoma.
E. 60 percent of pancreatic carcinomas occur in smokers
and in pancreatic head.
Ans. A. True
B. True
C. True: It is also called Nodular glomerulosclerosis. It is
characterized by nephritic syndrome, nodular (PAS
positive) deposits in mesangial matrix and thickened
basement membranes.
D. True
E. True
Gallbladder and Biliary Tract

A. Clonorchis (Opisthorchis) sinensis or ascaris infections
can lead to increased incidence of gall-stones.
B. Ascending cholangitis can cause conjugated hyperbiliru-
binemia.
C. An enlarged palpable gallbladder is more likely to be
caused by obstruction due to malignancy than by sto-
nes.
D. Calcification of gallbladder due to chronic inflammation
has high association with carcinoma.
E. Klatskin tumor is carcinoma of bifurcation or right and
left hepatic bile ducts.
Ans. A. True: Chronic infections can cause calcium and uncon-
jugated bilirubin deposition.
B. True: It is caused usually by gram-negative bacterial
infection extended up to liver.
C. True: Courvoisier law.
D. True: It is called porcelain gallbladder.
E. True: Bile duct cancer at this site is associated with poor
prognosis.
Liver Pathology
A. Clinical jaundice occurs with bilirubin levels >2-3 mg/ml.
B. Hemolytic disease of newborn presents at or just after

birth.
C. In macronodular cirrhosis, nodules are greater than 3 cm.
D. HBe antigen is an antigenic determinant of HBV core
and is an important indicator of transmissibility.
E. Alcoholic cirrhosis develops in 50 percent of alcoholics.
Ans. A. True.
B. True: Hemolysis starts in utero.
C. False: The size is 3 mm or more, not cm.
D. True: Anti-HBeAb is an indicator of low infectivity and
appears several days later than acute infection onset.
E. False: It occurs in upto 15 percent of alcoholics.
Q.2. Which of the following is true?
A. In Wilson’s disease, there is decreased biliary excretion
of copper.
B. Hemachromatosis can lead to micronodular cirrhosis
and 200 times increased risk of hepatocellular car-
cinoma.
C. Emphysema of lungs is usually seen with liver cirrhosis
in alpha-T antitrypsin deficiency.
D. Reye syndrome is associated with steatosis.
E. Nutmeg liver is seen in acute venous obstruction of
hepatic vein by a thrombus.
Ans. A. True
B. True
C. True
D. True
E. False: Nutmeg liver is usually associated with chronic
passive congestion of liver. Acute hepatic vein throm-
bosis is Budd-Chiari syndrome. There is hepatomegaly
and ascites with abdominal pain and usually death.
Chapter 11
Male and FFemale
emale Genit
Genitalal TTrract
and Endocr ine Sy
Endocrine Syss tem
PRETEST
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.
A. Estrogen stimulation is increased in endometrial carci-
noma.
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 chro-
mosome analysis.
E. Hydatidiform mole can cause hyperthyroidism.
A. Multiple peptic ulcers may be seen in islet cell tumor
of pancreas.
B. Parathyroid adenoma may cause nephrocalcinosis.
C. Adrenocorticoid tumor may cause feminization.

D. Hashimoto’s thyroiditis is associated with hypothyroi-
dism.
E. Iodine deficiency is the commonest cause of nontoxic
goiter
A. Dyshormogenesis results from genetically programmed
lack of an essential hormone.
B. Cushings syndrome is characterized by decreased
ACTH secretion.
C. Craniopharyngioma and rathke’s cyst are benign lesions.
D. Medullary carcinoma thyroid may be associated with
multiple endocrine adenomas in other organs.
E. Follicular carcinoma of thyroid is least likely to spread
by blood.
A. Type I diabetes mellitus is the juvenile onset type.
B. Addison’s disease is characterized by low ACTH levels.
C. Pheochromocytomas are derived from adrenal cortical
cells.
D. Graves thyroiditis is caused by excess of TSH.
A. Kimmelstiel Wilson lesions in kids are seen in diabetes
mellitus.
B. DM can cause pre-eclamptic toxanemia of pregnancy.
C. Insulin is produced by alpha cells of islets of Langer-
hans.
D. Di George syndrome is an acquire disease.
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
Male and Female Genital Tract and Endocrine System 75
2. A. True
B. True: Released keratin leads to granulomatous inflam-
mation.
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
Breas
eastt
Breas

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.
A. Gynecomastic occurs in III decade of life.
B. Intralobar carcinoma has a comedo variant.
C. Paget’s disease of nipple may effect skeletal system.
D. Phyllodes tumor occurs in younger age group.
A. Paget’s disease is a feature of cystic mastopathy.
B. Formation of new breast lobules and apocrine meta-
plasia 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
D. False: They are mostly solitary.

E. True: Careful examination is required to differentiate the
two.
2. A. False: It occurs mostly in puberty and old-age.
B. False: Comedo variant occurs in intraductal carcinoma
C. False: Skeletal Paget’s disease is an entirely different
entity.
D. False: Median age is 45, can occur at any age.
3. A. False
B. True
C. True
D. True: It is associated with better prognosis.
Chapter 13
Male Genit al TTrract
Genital

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 terato-
mas but is malignant in males.
E. Sperm count less than 70 × 10/liter is associated with
infertility.
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 (Fournier’s) is caused by
group B streptococci.
A. Lymphogranuloma venerum is caused by Chlamydia
trachomatis serotypes L1-L3.
B. LGV causes condylomata acuminata.
C. Yolk sac tumor of testes contain characteristic perivas-
cular tumor cells.
D. Yolk sac tumor of testes expresses alpha feto-protein.
Male Genital Tract 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
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 endo-
metrium, fallopian tubes and pelvic cavity. It is an impor-
tant 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.
C. True.
D. False: Though stomach and colon are the common pri-
mary sites for secondaries in ovary, primaries in endo-
metrium 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.
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 infarc-
tion.
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 epididy-
mus 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
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 tro-
pical 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.
A. Kidneys are shrunken in chronic glomerulonephritis.
B. Amyloidosis usually causes nephritic syndrome.
C. Nephroblastoma (Wilm’s tumor) commonly metasta-
sizes to lungs.
D. Bilateral renal agenesis usually occurs as a lone entity.
E. Adult polycystic kidney disease causes renal failure in
earlier life.
A. Wegener’s granulomatosis affects kidneys and lungs.
B. Rapidly progressive glomerulonephritis is characterized
by proliferation of parietal epithelium of Bowman’s
capsule and forms crescents filling the capsular space.
C. Diabetic kidney is characterized by crystals in collecting
tubules.
D. Irregular cortical scars may be seen in chronic pyelone-

phritis.
E. Clear cell carcinoma is a childhood tumor.
A. Bilateral hydronephrosis is never caused by urethral
obstruction.
B. Pyonephrosis can be caused by a staghorn calculus in
pelvis.
C. Infective endocarditis can cause multiple small abs-
cesses in kidney.
D. Bony metastasis never occurs in clear cell.
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 bilhar-
ziasis, 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
Kidney and Urinary Tract 83
E. False: Urethral obstruction causes bilateral hydro-

nephrosis.
4. A. False: Urethral obstruction causes bilateral hydrone-
phrosis.
B. True
C. True: Septic emboli may detach in infective endocarditis.
D. False
RENAL PATHOLOGY
CONCEPTS
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 hema-
turia 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 femini-
zation 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 hyper-
cellular glomeruli with crescent formation in Bowman’s
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
Cushing’s (corticosteroid), polycythemia (erythropoietin)
and hypertension (Renin).
Chapter 15
Skin, Sof
Softt TTissue
issue and
Sk ele
elettal Sy
Skele Syss tem
PRETEST
A. Pemphigus is a viral infection.
B. Diverticulitis is associated with dermatitis herpetiformis,
C. Basal cell carcinoma is a highly metastasizing neo-
plasm.
D. Bowen’s disease and squamouscellcarcinoma in situ
are closely related.
E. Increased basal layer melanocytes are seen in lentigo.
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 condi-
tion.
D. Malignant tertian malarial fever is caused by P. falci-
parum.
E. Tropical splenomegaly regresses with long-term antima-
larial therapy.
A. A lack of active vitamin D is seen in osteoporosis.
B. Paget’s 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.
Skin, Soft Tissue and Skeletal System 85
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 (Hutchinson’s 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
SKIN AND SKELETAL SYSTEM PATHOLOGY

CONCEPTS
A. Osteophytes are also called Heberden’s nodes and
Bouchard’s nodes.
B. Morning stiffness in rheumatoid arthritis is worsened by
activity.
C. Some patients of psoriasis develop rheumatoid arthritis
like condition.
D. Pseudogout usually involves great toe.
E. Bone remodeling occurs up till adolescence.
Ans. A. True: Osteophytes or reactive bony spurs occur in osteo-
arthritis and are called Heberden’s nodes, if they involve
DIP joints and Bouchard’s nodes, if they involve PIP
joints.
B. False: Morning stiffness is allayed by activity.
C. True: Psoriatic arthritis is a seronegative spondylarthro-
pathy (HLA B-27 associated).
D. False: Pseudogout (Chondrocalcinosis) is deposition of

calcium pyrophosphate crystals (positively birefringent,
rhomboid shape) and commonly involves knees of older
adults.
E. False: Bone remodeling occurs throughout life.
Q.2. What abnormalities are associated with Osteogenesis
imperfecta?
Ans. OI has variable genetics and is characterized by little bones,
blue sclera, deafness, teeth abnormalities and hypermobile
joints.
Q.3. What is the ‘brown tumor of bone’?
Ans. Osteitis fibrosa cystica is a disease with generalized bone
resorption with changes as in hyperparathyroidism. In the
bones, there may be hemorrhage and reactive fibrosis
leading to brown tumors.
Q.4. What is the most common tumor of bones?
Ans. Metastases to bone are the commonest bone malignancies.
Primary sites include prostate, heart, lung, thyroid and
kidneys.
Ans. A. Type 2 (white) skeletal muscle uses aerobic metabolism
of fatty acids.
B. Inflammatory myopathies usually have lymphocytic
infiltrate on microscopy.
C. Eaton-Lambert syndrome is a type of myasthenic synd-
romes.
D. Guillain-Barre syndrome can sometimes lead to death
of the patient.
Ans. A. False: Type 1 (red) skeletal muscle is used in postural
weight bearing and uses fat metabolism. Type 2 (white)
skeletal muscle is used for purposeful movement and
uses anaerobic glycolysis of glycogen.
B. True: Inflammatory myopathies include polymyositis,
dermatomyositis.
C. True: Eaton-Lambert syndrome is a paraneoplastic
syndrome of small cell carcinoma of lungs with proximal
muscle weakness.
D. True: Death because of respiratory muscle paralysis
may occur.
Chapter 16
Ner
ervvous Sy
Syss tem

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 intra-
cerebral hemorrhage.
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 can’t be recognized histopathologically.
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.

A. Cerebellar astrocytomas in children are usually cystic.
B. Glioblastoma multiforme occurs in cerebellum.
C. Medulloblastoma is derived from nerve cells.
D. Hemangioblastoma occurs in medulla usually.
E. The commonest intracerebral neoplasms are secon-
daries.
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

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MCQs in Objective Pathology with Explanations

First Edition: 2000

Bade Jatan se Beeni Chadariya

After living with great care, I will give back

Pathology is an oceanvast and without shores. The second edition

Most Pathology books are written with one examination or another

I am extremely thankful to Shri Jitendar P Vij (Chairman and

1. Introduction to Pathology ............................................. 1

Including Cell Pathology

B. In paraffin wax technique, tissue is fixed usually in

7. Which of the following prefixes and suffixes are

D. False: In exfoliate cytology cells shed or scraped from

cules which bind adjacent cells and prevent invasion of

SYNONYM OF ONCOSIS IS ACCIDENTAL

lose their nuclei, e.g. erythroblasts and undifferentiated

chondrial cristae (matrix type). There is usually generalized

SUPPLEMENTARY TOPICS—GENERAL PATHOLOGY

G. Molecular techniques like DNA microassays and immu-

are breast cancers and tumors of lymphocytes that look

to increased hemodynamic loads, heart muscle first

B. 1. Direct: Stimulation of cells by factors produced by res-

F. True: Recent clinical and experimental data suggests

D. When do uterus and breast physiologically grow in size?

C. When do the genes in heart muscle fibers switch to

QUESTIONS AND ANSWERS

some diseases. Formal pathogenesis describes the struc-

nuous change—in one of different metabolites and other

Q.14. In which conditions is cachexia seen?

lysosomes the latter throwing their proteolytic enzymes

Q.24. Define average life expectancy, morbidity and morta-

Q.28. What is a karyogram?

Pathogentic chain reaction: Ultraviolet radiation

Q.36. What is NER and discuss its role in UV radiation caused

This occurs in some endocrine gland cells like thyroid.

4. Karyolysis: Fading of nucleus due to chromatin dissolu-

Q.46. Is squamous metaplasia beneficial?

Examples: Vitamin A → Retinoic acid regulates cell growth,

4. Which of the following are true?

E. The deep (or para) cortex is the T-lymphocyte zone of

9. A. False: Following antigenic stimulation of humoral response

E. False: It is characterized by secondary immune defi-

D. False: Along with these two types of cells, platelets also

A. Splicing involves editing out of superfluous information

C. True hermaphroditism is always characterized by ovary

of cases of NF only and is characterized by mutation

D. Fibrin Degradation Products (FDP) are increased in DIC.

Ans. A. True: Initiator and promoter genes hypothesis was first

E. Psoriasis is a hyperplastic skin disease characterized

D. A deficient diet with excessive alcohol consumption

B. False: Pulmonary embolism is usually a postoperative

PRETEST AND CONCEPTS

4. Which of the following are true?

7. A. False: This is predominantly late cyanosis or acyanotic

D. Certain antibiotics and benzene compounds, which

C. In lymphocyte predominant Hodgkin’s disease, R-S cells

C. False: Only 15 percent of myelomas produce only light

BLOOD AND BONE MARROW

E. True: There is impaired DNA synthesis and impaired