NEET PG High Yield Questions for Pathology

To do well in the NEET PG exam, you need a smart study plan focusing on important topics. This blog provides a list of key questions in Medicine that are likely to be on the exam. By studying these questions and their explanations, you'll improve your understanding of Medicine concepts and feel more prepared and confident for the exam.

1.At 38 weeks of pregnancy, a 32-year-old lady with poorly controlled diabetes delivered a healthy child. Pancreatic islets in the neonate would be expected to demonstrate which of the following morphological responses to injury resulting from maternal hyperglycemia during pregnancy?

A. Atrophy

B. Dysplasia

C. Hyperplasia

D. Metaplasia

Correct Option C- Hyperplasia:

• Infants born to diabetic moms have a 6% to 10% chance of developing serious developmental abnormalities such as heart and great vascular malformations and neural tube problems.
• The islet cells of the pancreas have a proliferative capacity during fetal development, and they respond to increasing demand for insulin by physiologic hyperplasia.
• A fetus may develop pancreatic hyperplasia, which can produce insulin and induce hypoglycemia at birth.

Incorrect Options: 

Option A- Atrophy:

• Atrophy is a decrease in the size of a cell or organ
• This can be due to the disuse of your muscles in neurological conditions.

Option B- Dysplasia:

• Dysplasia is the abnormal growth or development of cells or organs
• Dysplastic cells may exhibit considerable pleomorphism and often contain large hyperchromatic nuclei with a high nuclear-to-cytoplasmic ratio. Dysplastic epithelial surfaces also typically show architectural disarray and a loss of orderly differentiation
• Examples are cervical dysplasia, bronchopulmonary dysplasia, etc.

Option D- Metaplasia:

• Change in phenotype of differentiated cells in response to chronic irritation, that makes cells better able to withstand the stress.
• Usually induced by altered differentiation pathway of tissue stem cells
• May result in reduced functions or increased propensity for malignant transformation
• Types are intestinal metaplasia and squamous metaplasia.

2. What histological finding is most likely in the biopsy of a 62-year-old male with occupational asbestos exposure, presenting with shortness of breath, pleuritic chest pain, and imaging showing pleural thickening with calcified nodules and microscopy showing spindle-shaped cells forming papillary structures with focal areas of calcification?

A. Auer rods

B. Lewy bodies

C. Psammoma bodies

D. Call-Exner bodies

Correct Option C- Psammoma bodies:The patient's history of occupational asbestos exposure and the presentation of pleural thickening and calcified nodules are indicative of mesothelioma, a malignant neoplasm commonly associated with asbestos exposure. Microscopic examination of mesothelioma often reveals spindle-shaped cells forming papillary structures and frequently demonstrates psammoma bodies, which are concentric, lamellated, calcific structures. These structures are commonly observed in serous tumors, such as papillary carcinoma of the thyroid and meningiomas, and can also be found in malignant mesothelioma. Their presence helps in the histological diagnosis of mesothelioma.

Incorrect Options: 

Option A- Auer rods: Auer rods are needle-like, azurophilic inclusions found in the cytoplasm of myeloblasts or immature myeloid cells. They are characteristic of acute myeloid leukemia (AML) and are not typically seen in mesothelioma.

Option B- Lewy bodies: Lewy bodies are abnormal protein aggregates, specifically alpha-synuclein, found in the cytoplasm of neurons. They are a pathological hallmark of Parkinson's disease and other neurodegenerative disorders but are not associated with mesothelioma.

Option D- Call-Exner bodies: Call-Exner bodies are small, eosinophilic, glandular structures found in granulosa cell tumors of the ovary. These structures are not associated with mesothelioma.

3. Which of the following amino acids plays an important role in the process shown below?

A. Leucine

B. Methionine

C. Arginine

D. Valine

Correct Option C - Arginine:

Arginine plays a crucial role in NETosis, which is the process by which neutrophils release web-like structures composed of chromatin (DNA) and antimicrobial proteins to capture and neutralize pathogens.

1. Nitric Oxide (NO) Production: Arginine is a substrate for the enzyme nitric oxide synthase (NOS), which generates nitric oxide (NO). Nitric oxide is involved in various cellular processes, including the regulation of NET formation.
2. Citrullination: During NETosis, arginine residues on histones are converted into citrulline by a specific enzyme called protein-arginine deiminase (PAD). This citrullination of histones reduces the positive charge of histones and their electrostatic interactions with DNA leading to chromatin decondensation.

Incorrect Options:

Option A. Leucine, B. Methionine, and D. Valine are important amino acids in protein synthesis and other cellular processes, but they are not specifically known to play a central role in NETosis. Arginine, on the other hand, is directly involved in the processes critical for NET formation, making it the most important amino acid in this context.

4. Excisional biopsy of a 4cm breast lump shows malignant cells forming solid nests and gland-like structures surrounded by a dense collagenous stroma are found. A connective tissue stain (trichrome) of the biopsy is shown in the figure below. Which of the following terms best describes the blue areas observed in this specimen?

A. Inflammatory change

B. Anaplastic change

C. Desmoplastic change

D. Dysplastic change

Correct Option C - Desmoplastic change:

• Desmoplasia refers to the growth of benign fibrous tissue secondary to tissue injury in cancer.
• It is the proliferation of non-neoplastic fibrous connective tissue within a tumor.
• Desmoplasia is a process seen in breast cancer, neuroendocrine tumors, lung cancer, and pancreatic ductal adenocarcinoma (PDAC)

The blue areas seen in the specimen are best described by desmoplasia.

• A trichrome stain is a histological staining technique used to stain collagen fibers.
• In desmoplastic tissue, the collagenous stroma appears prominently stained with blue dye, contrasting with the other tissue components. This results in a distinct visualization of the fibrous connective tissue surrounding the tumor cells.
• The image presented above illustrates how the specimens are observed through H&E and trichrome staining..

Incorrect Options:

Option A - Inflammatory change:

• Inflammatory change refers to the presence of inflammation within the tissue.
• This can involve the infiltration of immune cells, such as lymphocytes and macrophages, as part of the body's response to injury or infection.
• Inflammatory changes can occur in tumors, but they are characterized by the presence of inflammatory cells rather than fibrous connective tissue proliferation.

Option B - Anaplastic change:

• Anaplastic change refers to the loss of cellular differentiation and organization, leading to the development of more primitive and undifferentiated cells within a tumor.
• This can result in features such as pleomorphism, increased nuclear size, and abnormal mitotic activity.
• Anaplastic change is characteristic of malignant tumors and signifies dedifferentiation.

Option D - Dysplastic change:

• Dysplastic change refers to the abnormal growth, differentiation, or development of cells within a tissue.
• Dysplasia can range from mild to severe and is often considered a precursor to cancer.

It is characterized by cellular atypia, disordered growth patterns, and alterations in cell morphology.

5. The image below depicts a certain type of major histocompatibility complex. Which of the following components of this complex functions as the antigen binding site?

A. Beta microglobulin

B. Distal domain alpha 1 and 2

C. Alpha and beta domains

D. Alpha 1 and 3 domain

Correct Option B - Distal domain alpha 1 and 2:

• The above-shown Image is of MHC I
• The peptide binding site is formed by the distal domain of alpha 1 and 2.

MHC Class I:

• Class I MHC molecules are expressed on all nucleated cells and platelets.
• They are heterodimers consisting of a polymorphic α, or heavy, chain (44-kD) linked non-covalently to a smaller (12-kD) nonpolymorphic protein called β2-microglobulin.
• The α chains are encoded by three genes, designated HLA-A, HLA-B, and HLA-C, that lie close to one another in the MHC locus.
• Class I MHC molecules display peptides derived from cytoplasmic proteins, including normal proteins and virus- and tumour-specific antigens. These are all recognized and bound to class I MHC molecules by CD8+ T cells.
• Peptide-loaded MHC molecules then associate with β2-microglobulin to form a stable complex transported to the cell surface.

Incorrect Options:

Option A - Beta macroglobulin:

• The beta microglobulin does not act as a primary site for antigen binding.
• Rather, once the antigen is bound to alpha chains, there is an association of this peptide load MHC with B2-microglobulin
• The main function of beta-2-microglobulin is to stabilize the complex.

Option C - Alpha and beta domains:

• The above Image is of MHC class I, not MHC class II.
• The antigen binding between alpha and beta domains occurs in the MHC Class II, not Class I.

Option D - Alpha 1 and 3 domain:

• The antigen binding in the MHC class I is between the alpha 1 and alpha 2 domains.
• The alpha 3 domain attaches the alpha domain to the membranes.

Also Read: NEET PG Previous Year Question Papers of Last 6 Years

6. A 40-year-old male presented to the emergency department with complaints of excessive fatigue, headache, mild abdominal pain, and dark-colored urine for three days. He also gives a history of erectile dysfunction. CBC reveals a WBC count of 2.3 x109/L with hemoglobin at 10.2 grams/dL and a platelet count of 135000 cells/mm3. Flow cytometry is shown below.

Which type of acquired hemolytic anemia best describes the above scenario?

A. Paroxysmal nocturnal hemoglobinuria

B. Paroxysmal cold hemoglobinuria

C. Autoimmune hemolytic anemia

D. Microangiopathic hemolytic anemia

Correct Option A - Paroxysmal nocturnal hemoglobinuria:

• This is a case of paroxysmal nocturnal hemoglobinuria
• The flow cytometry results showing the absence of CD55 and CD59 are crucial for diagnosing Paroxysmal Nocturnal Hemoglobinuria (PNH).
• PNH is the only acquired cause of intra-corpuscular hemolysis caused by a defect in the PIGA gene leading to dysfunctional red cell membrane protein.

CD55 and CD59

• CD55 (DAF):
  • Function: CD55 regulates the activation of the complement system by accelerating the decay of C3 and C5 convertases, thus preventing the formation of the membrane attack complex (MAC).
  • Role in PNH: In PNH, mutations in the PIG-A gene result in deficient or absent expression of CD55 on the surface of affected red blood cells (RBCs). Without CD55, RBCs are unable to regulate complement activation effectively, making them more susceptible to complement-mediated lysis.
• CD59 (MACIF):
  • Function: CD59 inhibits the formation of the membrane attack complex (MAC) by binding to the C5b-8 complex and preventing the incorporation of C9, thereby blocking the formation of the pore-forming complex that leads to cell lysis.
  • Role in PNH: Similar to CD55, mutations in the PIG-A gene lead to deficient or absent expression of CD59 on the surface of PNH RBCs. This deficiency allows unregulated assembly of the MAC on RBC membranes, resulting in increased susceptibility to complement-mediated hemolysis, a hallmark feature of PNH.

Incorrect Options:

Option B - Paroxysmal cold hemoglobinuria:

• The absence of cold exposure-related symptoms and the flow cytometry findings of CD55 and CD59 deficiency do not support a diagnosis of PCH.

Option C - Autoimmune hemolytic anemia:

• While AIHA can also present with hemolysis and anemia, the absence of autoantibodies and the presence of CD55 and CD59 deficiency on flow cytometry make AIHA less likely.

Option D - Microangiopathic hemolytic anemia:

• Microangiopathic hemolytic anemia (MAHA) typically presents with schistocytes on peripheral blood smear, indicative of mechanical destruction of RBCs within small blood vessels. Since no mention of schistocytes is made in the scenario, and given the flow cytometry findings, MAHA is not the most appropriate diagnosis.

7. Which of the following statements is incorrect regarding the diagnosis of a 10-day-old infant with forceful vomiting, failure to thrive, a non-tender, mobile olive-shaped epigastric mass, and signs of dehydration?

A. It is often associated with Edwards syndrome

B. This can be caused due to exposure to Azithromycin

C. Pyloromyotomy is the definitive treatment

D. None of the above

Correct Option D - None of the above:

Congenital pyloric stenosis:

• This patient with forceful vomiting after feedings, failure to thrive, weight loss, dehydration, lethargy, and a firm, non-tender, mobile, "olive-shaped" epigastric mass most likely has Congenital pyloric stenosis.
• It is caused by hypertrophy of the circular muscle layer of the pylorus.
• Hypertrophy of pyloric musculature → Obstruction, non-bilious projectile vomiting.
• It typically presents in male infants within the first several days to weeks of life and is generally not seen at the time of birth.
• It is often associated with Edwards syndrome and Down syndrome.
• This can be caused due to exposure to Azithromycin or Erythromycin
• Pyloromyotomy is the definitive treatment

8. In a 58-year-old chronic smoker with a persistent cough, unintentional weight loss, muscle weakness improving with activity, and a central lung mass positive for chromogranin on biopsy, which statement regarding the underlying condition is false?

A. The tumor shows positive staining for Neuron-specific enolase and Synaptophysin.

B. The tumor displays an amplification of L Myc

C. The tumor marker p40 is considered to be confirmatory

D. None of the above

Correct Option C - The tumor marker p40 is considered to be confirmatory:

• The patient is probably suffering from squamous cell and small cell carcinoma of the lung.
• Smoking history is a significant risk factor for small cell carcinoma of the lung.
• Clinical features: persistent cough, unintentional loss of weight, paraneoplastic syndrome: Lambert-Eaton Myasthenic Syndrome
  • Lambert-Eaton Myasthenic Syndrome:
  • Small cell lung carcinoma (SCLC) cells often express voltage-gated calcium channels (VGCCs) on their surface. The expression of VGCC by tumor cells triggers the immune system to produce autoantibodies directed against these channels. The autoantibodies produced against VGCCs in the tumor tissue can cross-react with presynaptic VGCC antigens at the neuromuscular junction, leading to impaired neurotransmitter release and muscle weakness characteristic of Lambert-Eaton Myasthenic Syndrome (LEMS).
• Pathogenesis: SCLC carcinogenesis can arise from pathways disrupting DNA repair mechanisms, with prevalent mutations including loss of the RB1 tumor suppressor gene and TP53 mutations reducing cancer cell apoptosis. Additionally, nearly all SCLC tumors exhibit a deletion in chromosome 3p's short arm, encompassing the tumor suppressor gene FHIT.
• Biopsy of the lung mass revealing poorly differentiated nests of cells that stain positive for chromogranin is characteristic of small cell lung cancer (SCLC).
• Small cell lung cancer being a neuroendocrine tumor, shows a Zellballen pattern (nesting) of cells that stain positive for chromogranin, Synaptophysin, and Neuron-specific enolase (NSE).

( Zellballen pattern (nesting) of cells).

• On arriving at a diagnosis of Small cell lung carcinoma,
  • Option A: The tumor showing positive staining for Neuron-specific enolase and Synaptophysin is true. These markers are commonly used in the diagnosis of neuroendocrine tumors, including SCLC.
  • Option B: The tumor displaying an amplification of L Myc is also true. L-Myc amplification is a common genetic alteration seen in SCLC.
  • Option C: The tumor marker p40 is not considered to be confirmatory for SCLC. While p40 staining is useful in distinguishing squamous cell carcinoma from other lung cancers.

Incorrect Options:

All options have been explained under the correct option.

9. Which of the following is an important risk factor for this condition depicted in the image given below of gross examination during autopsy?

A. Silica exposure

B. Tobacco smoking.

C. Asbestos exposure

D. Marble dust exposure

Correct Option C - Asbestos exposure:

• The image shows a thick, firm, white pleural tumor tissue that ensheathes the lung. This is indicative of malignant mesothelioma.
• The most important risk factor for mesothelioma is asbestos exposure.
• Asbestos fibers are mineral fibers that, when inhaled, irritate the pleura. The long and thin structure of asbestos fiber is particularly hazardous as it facilitates penetration of the lung tissue, causing repeated injury to the mesothelial cells lining the pleura. Asbestos fibers disrupt mitosis by severing the mitotic spindles resulting in aneuploidy.

Incorrect Options:

Options A, B and D are incorrect.

10. What's the likely diagnosis for a 55-year-old female with chest pain lasting 5-6 minutes during physical exertion, relieved by rest, radiating to the left jaw, intensity of 8/10, with a history of hypertension and is on amlodipine, and normal ECG and cardiac enzymes?

A. Arrhythmia

B. Myocardial infarction

C. Prinzmetal angina

D. Stable angina pectoris

Correct Option D - Stable angina pectoris:

• The patient presents with the clinical features of stable angina pectoris.
• Angina pectoris refers to intermittent chest pain caused by transient and reversible myocardial ischemia.
• The release of adenosine, bradykinin, and other molecules during ischemia stimulates autonomic nerves, resulting in pain.
• There are three variants of angina pectoris:
  • Typical/Stable angina
  • Prinzmetal/Variant angina
  • Unstable/Crescendo angina
• Stable angina is characterized by episodic chest pain associated with exertion or conditions with increased oxygen demand (tachycardia).
• The pain is substernal with radiation to the left arm or jaw.
• The pain relieves with rest or vasodilators such as nitroglycerin (increases coronary perfusion).
• Risk factors for stable angina include:
  • Hypertension
  • Diabetes mellitus
  • Hyperlipidemia
  • Cigarette smoking
  • Sedentary lifestyle
  • Family history of ischemic heart disease
  • Lack of exercise

Incorrect Options:

Option A - Arrhythmia:

• The primary symptom in arrhythmias is palpitation rather than chest pain.
• Patients report racing of heart and skipped beats.
• ECG shows changes in rate and rhythm in arrhythmias.

Option B - Myocardial infarction:

• Myocardial infarction presents with similar pain to angina pectoris.
• However, the pain is not relieved by rest or nitroglycerin.
• ECG shows ST-segment elevation or depression.

Option C - Prinzmetal angina:

• Coronary artery spasms characterize prinzmetal angina. The anginal attacks are unrelated to physical activity, heart rate, or blood pressure, and can occur at rest.
• It presents with chest pain at rest and usually at night time.
• The pain is relieved by calcium-channel blockers and nitrates.

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