RECENT EXAM 2019 PATHOLOGY Dr. Sai Sridevi MD.

, DNB
KONCPT
ENDOGENOUS PYROGENS ?? IL -1
Endogenous pyrogens – IL-1 & TNF
Exogenous pyrogens – Bacterial product - lipopolysaccharides.
Acute phase proteins – C reactive proteins, fibrinogen –stimulated by IL -6.
serum amyloid A protein (SAA) – stimulated by IL -1 or TNF.

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 99. KONCPT
IL 1 ACTIVATED BY ???
A. Caspase 1
B. Caspase 3
C. Caspase 5
D. Caspase 8

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 188. KONCPT
 ANTI APOPTOTIC GENE?? BCL 2
Anti apoptotic genes: BCL2, BCL –XL, MCL 1
Pro apoptotic genes: BAX, BAK
Sensors: BAD, BIM, BID, Puma, Noxa

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 55. KONCPT
VESSEL RELATED NECROSIS?
A. coagulative
B. liquefactive
C. fibrinoid
D. caseous
•Fibrinoid necrosis seen in immune reactions involving blood vessels.
•Deposits of immune complexes and fibrin – bright pink and amorphous appearance.

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 44. KONCPT
Type Characteristics
Coagulative Most common type
Architecture preserved
Protein denaturation – all solid organs except CNS
Liquefactive Transformation of tissue into viscous mass
Enzymatic action - CNS
Gangrenous Not a specific pattern of cell death.
Wet gangrene – liquefactive
Dry gangrene - coagulative

Caseous Granuloma formation with collection of amorphous granular debris enclosed by

inflammatory cells.
Eg. TB, Fungi – Histoplasma, Coccidiodomycosis
Fat Fat destruction – lipases – fatty acids combine with calcium – fat saponification
Eg. Acute pancreatitis, Injury to breast
Fibrinoid Immune reaction in blood vessels
Eg. Malignant hypertension, acute rheumatic fever, PAN, Libman sacks endocarditis
Dr. Sai Sridevi MD., DNB
KONCPT
TRUE ABOUT MHC II MOLECULE ???
A. detects intracellular Properties Class I MHC Class II MHC MHC III
organisms Located at All nucleated cells APC: B cells, dendritic
B. between alpha1 and 2 cells, endothelial cells &
fibroblasts
C. seen in APC
Encoded by HLA –A, HLA –B, HLA –DP, HLA –DQ, HLA Codes for
D. ……….. HLA-C -DR complement
component, C2,C4,
properdin, factor B,
TNF, HSP 70, tyrosine
hydroxylase
Ref : Robbins 9th edition Peptide α1 and α2 α1 and β1
binding cleft
pg 194.
Antigens Viral and tumor Extracellular microbes
antigens
intracellularly.
Major role Graft rejection GVHD No role in immune
Dr. Sai Sridevi MD., DNB system
KONCPT Recognised by CD8+ T cell CD4+ T cell
 AUTOSOMAL DOMINANT?
System Disorder
Nervous Huntington disease
Neurofibromatosis
Myotonic dystrophy
Tuberous sclerosis

Urinary Polycystic kidney disease

Gastrointestinal Familial polyposis coli
Hematopoietic Hereditary spherocytosis
Von Willebrand disease
Skeletal Marfan syndrome
Ehler danlos syndrome
Osteogenesis imperfecta
Achondroplasia
Metabolic Familial hypercholesterolemia
Acute intermittent porphyria Dr. Sai Sridevi MD., DNB
Ref : Robbins 9th edition pg 141. KONCPT
 AUTOSOMAL RECESSIVE?? Ref : Robbins 9th edition pg 141, 143.

System Disorder
Metabolic Cystic fibrosis
Phenylketonuria
Galactosemia
Homocystinuria
Lysosomal storage disorder
Alpha 1 antitrypsin deficiency
Wilson disease
Hemochromatosis
Glycogen storage disorder
Albinism
Hematopoietic Sickle cell anemia
Thalassemia
Endocrine Congenital adrenal hyperplasia
Skeletal Ehler danlos syndrome
Alkaptonuria
Nervous Neurogenic muscular atrophies
Friedreich ataxia
Spinal muscular atrophy Dr. Sai Sridevi MD., DNB
KONCPT
 FRAGILE X SYNDROME – TRUE IS?
A. triple nucleotide CAG sequence mutation
B. 10% carrier females mentally retarded
C. males have IQ 20 to 60
D. gain of function mutation

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 169. KONCPT
 FRAGILE X SYNDROME
•Second most common genetic cause of mental retardation after Down’s syndrome.
•Caused by trinucleotide mutation in familial mental retardation 1 FMR1 gene.
•Trinucleotide repeats CGG.
•Male IQ 20 to 60.
•30 to 50% carrier females mentally retarded.
•Macro orchidism – 90% of post pubertal males
•Loss of function
Fragile X tremor/ataxia
•Gain of function
Dr. Sai Sridevi MD., DNB
•Intention tremors and cerebellar ataxia.
KONCPT
Ref : Robbins 9th edition pg 169.
VITAMIN A STORED IN???
A. Hepatocyte
B. Ito cell
C. Hepatic endothelial cell
D. Kupffer cell
•Kupffer cells – mononuclear macrophage system attached to
the luminal face of endothelial cells.
•Stellate cells or Ito cells – found in Space of Disse.

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 436. KONCPT
 CAUSE OF INTRINSIC HEMOLYSIS??
A. PNH
B. Snake venom
C. Hypersplenism
D. Transfusion

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA

•Acquired mutation in phophatidyl inositol glycan complementation group A gene (PIGA)
•Red cells deficient in these GPI linked factors are abnormally susceptible to lysis or injury by
complement – manifests as intravascular hemolysis caused by C5b – C9 membrane attack
complex. Dr. Sai Sridevi MD., DNB
KONCPT
Ref : Robbins 9th edition pg 642.
CRYPTOCOCCUS STAINED BY????
A. Mucicarmine
B. grams stain
C. Giemsa
D. Ziehl Neelson stain
CRYPTOCOCCUS:
•Has yeast form but not pseudohyphal or hyphal forms.
•5 to 10 µm
•Thick gelatinous polysaccharide capsule – intense red with
periodic acid Schif and mucicarmine.
•Indian ink creates a negative image.
•Detected by antibody coated beads in an agglutination assay.
•Affects lung, CNS – meninges, cortical grey matter and basal nuclei.
Dr. Sai Sridevi MD., DNB
KONCPT
Ref : Robbins 9th edition pg 388.
 SERPIGINOUS ULCERS IN DISTAL ESOPHAGUS??
A. pill
B. corrosive
C. herpes
D. CMV

• Pill induced ulcers – at site of strictures accompanied by superficial necrosis with granulation tissue
and fibrosis.
•Corrosive ulcers – no neutrophils.
•Herpes ulcers – punched out with nuclear viral inclusions within a rim of degenerating epithelial cells at
the margin of ulcer.
•CMV ulcer – shallow ulcers with nuclear and cytoplasmic inclusions within capillary endothelium and
stromal cells.
Dr. Sai Sridevi MD., DNB
KONCPT
Ref : Robbins 9th edition pg 755.
 SOLITARY LYTIC LESION IN SKULL BONE WITHOUT
ORGAN DAMAGE/URINE/BLOOD CHANGES?
A. localised CML
B. localised MM
C. Localised Langerhan’s cell histiocytosis
D. Localised osteoblast proliferation
SOLITARY MYELOMA ( PLASMACYTOMA)
•3 – 5%
•Extraosseous locations : lungs,
Oronasopharynx, nasal sinuses.
•Progress to myeloma in 10 to 20 years. Dr. Sai Sridevi MD., DNB
Ref : Robbins 9th edition pg 601. KONCPT
 CUT SECTION OF UTERUS???
A. Fibroid
B. Endometriosis
C. Adenomyosis
D. ………….

ADENOMYOSIS :
• Presence of endometrial tissue within uterine wall.
(myometrium)
• Seen in 20 % of uteri.
• Gross: grey brown areas in myometrium
• Microscopy: irregular nests of endometrial stroma with
or without glands are arranged within myometrium
separated from the basalis by atleast 2 to 3mm
Dr. Sai Sridevi MD., DNB
• Ref : Robbins 9th edition pg 1012. KONCPT
 TRUE ABOUT ALPHA 1 ANTITRYPSIN ??
A. inhibits elastase in WBC of lung
B. inhibit trypsinogen activation in pancreas
C. inhibits trypsin activating protease

•Alpha 1 antitrypsin normally present in serum, tissue fluids and macrophages.

•Major inhibitor of proteases particularly elastase secreted by neutrophils during
inflammation.
•Alpha 1 antitrypsin encoded by proteinase inhibitor Pi locus on chromosome 14.
Dr. Sai Sridevi MD., DNB
Ref : Robbins 9th edition pg 676. KONCPT
 HYPERTROPHIC CARDIOMYOPATHY TRUE IS???
ASYMMETRICAL SEPTAL ENLARGEMENT
HYPERTROPHIC CARDIOMYOPATHY:
•Massive myocardial hypertrophy usually without ventricular dilation.
•Asymmetric septal hypertrophy
•Systolic anterior motion of anterior leaflet
•Haphazard disarray of bundles of myocytes
•Interstitial and replacement fibrosis

Ref : Robbins 9th edition pg 569.

Dr. Sai Sridevi MD., DNB
KONCPT
 ALCOHOL ABUSE ASSOCIATED WITH ??
A. dilated cardiomyopathy
B. hypertrophic cardiomyopathy
C. restrictive cardiomyopathy

Ref : Robbins 9th edition pg 565.

Dr. Sai Sridevi MD., DNB
KONCPT
PATIENT DEVELOPS ANEURYSM IN WHICH INFARCTION??
A. anterior transmural
B. subendocardial
C. posterior transmural
D. posteroanterior
Complications following MI:
• Contractile dysfunction
• Arrhythmias
• Myocardial rupture Anterior transmural infarct – free wall
• Ventricular aneurysm rupture, expansion, mural thrombi and
aneurysm.
• Pericarditis
• Infarct expansion Posterior transmural infarct – conduction
• Mural thrombus blocks, right ventricular involvement
• Papillary muscle dysfunction
• Progressive heart failure
Ref : Robbins 9th edition pg 549.
Dr. Sai Sridevi MD., DNB
KONCPT
FISH MOUTH STENOSIS IN RHEUMATIC HEART
DISEASE?? CALCIFICATION AND FIBROSIS
Cardinal anatomic changes in chronic RHD:
1) Leaflet thickening
2) Commissural fusion and shortening
3) Thickening and fusion of tendinous cords
Mitral valve – two thirds, aortic valve – 25%, pulmonary – rare.
Rheumatic mitral stenosis – calcification and fibrous bridging across the valvular commissures
create – “fish mouth” or “button hole”stenosis.

Dr. Sai Sridevi MD., DNB

Ref : Robbins 9th edition pg 559. KONCPT
ZELLWEGER’S SYNDROME?
A. golgi bodies
B. lysosomes
C. ER
D. peroxisomes

Dr. Sai Sridevi MD., DNB

KONCPT
PATTERN OF PARTIAL MOLE??
A. 69 XXY
B. 46XX
C. 46 XY
D. Trisomy 18

PARTIAL MOLE:
•Partial mole result from fertilization of an egg with two sperms.
•69 XXY, 92XXXY
•Fetal tissue present.
•Increased risk of persistent molar disease
Ref : Robbins 9th edition pg 1040. Dr. Sai Sridevi MD., DNB
KONCPT
 ARTHRITIS, HEPATOSPLENOMEGALY, HYPERPIGMENTATION,
SERUM FERRITIN ELEVATED?? PSEUDOGOUT
HEMOCHROMATOSIS:
PSEUDO GOUT/CHONDROCALCINOSIS/CPPD
•Hepatomegaly Secondary form associated with
• Previous joint damage
•Abdominal pain • Hyperparathyroidism
• Hemochromatosis
•Skin pigmentation • Hypomagnesemia
•Diabetes mellitus due to destruction of pancreatic islets • Hypothyroidism
• Ochronosis
•Arrhythmia, cardiomyopathy • Diabetes

•Atypical arthritis
•Screening of family members probands is important.
Ref : Robbins 9th edition pg 849. Dr. Sai Sridevi MD., DNB
KONCPT
 GLANZMANN THROMBASTHENIA???GP IIB/IIIA
DEFICIENCY
Platelet function
defects

Defect in platelet Defect in platelet Defects of platelet Defects of platelet

adhesion aggregation secretion coagulant activity

Glanzmann ‘s
Von Willebrand thrombasthenia(Gp IIb Decreased
disease IIIa) cyclooxygenase Scott’s syndrome
Bernard Soulier syn Afibrinogenemia activity
(Gp Ib-IX) Drug induced NSAID
Granule storage pool
defects Dr. Sai Sridevi MD., DNB
Ref : Robbins 9th edition pg 118. KONCPT
 FOLLICULAR LYMPHOMA RELATED TO WHICH
APOPTOTIC GENE? BCL2
•Most common form of indolent NHL.
•Middle age.
•Male =female
•Arises from germinal centres.
•t(14;18) IGH;BCL2
•Mutations of bcl 2 and MLL2 genes.
Dr. Sai Sridevi MD., DNB
Ref : Robbins 9th edition pg 594. KONCPT
METAL TRANSPORT PROTEIN INVOLVED IN WHICH CONGENITAL JAUNDICE?
MRP 2 (MULTIDRUG RESISTANCE PROTEIN 2)IN DUBIN JOHNSON SYNDROME
MOST FATAL CONGENITAL JAUNDICE?
CRIGGLER NAJAR TYPE 1 Ref : Robbins 9th edition pg 854.

Dr. Sai Sridevi MD., DNB

KONCPT
BLOOD GROUP ??? O POSITIVE

Dr. Sai Sridevi MD., DNB

KONCPT
CPDA ADVANTAGE OVER ACD IN IMPROVING OXYGEN
TRANSPORT BY WHICH OF THE FOLLOWING?
A. fall in 2,3 BPG is less
B. less acidic
C. has low p50 value
D. less temperature

•2,3 BPG levels decline with storage but the levels are maintained by CPD A.

Dr. Sai Sridevi MD., DNB

Ref : Textbook of Blood banking and transfusion medicine pg 269 KONCPT
 DISTINGUISHING FEATURE OF UC FROM CROHN’S DISEASE???
A. crypt abscess
B. diffuse polyps
C. mucosal edema
D.lymphocyte infiltrate
CONTROVERSIAL QUESTION!!!
As per Robbins, Crypt abscess is seen Crohn’s disease but many
books say its seen in ulcerative colitis also.
Only distinctive feature is noncaseating granuloma in Crohn’s disease
which is not given.

Ref : Robbins 9th edition

pg 797.
Dr. Sai Sridevi MD., DNB
KONCPT