Current Quiz Score:
Question 1
Q1. Which polyp has got the maximum risk of turning into malignancy?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Tubular villous adenomas (multiple)
Relevant Chapter: 57. Polyps and Colon cancer
Explanation and Thinking Approach:
The risk of a colorectal adenomatous polyp developing into adenocarcinoma is determined by three factors: **size, architectural type, and dysplasia severity.**
The architectural types, in increasing order of malignant risk, are:
- Tubular adenoma (Lowest risk)
- Tubulovillous adenoma
- Villous adenoma (Highest risk)
Adenomatous polyp (d) is a general term; Tubular villous adenoma (c) is a specific subtype with higher risk than the general category.
Question 2
Q2. Most characteristic feature of acute inflammation -
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Vasodilation & increased permeability
Relevant Chapter: 5. Acute inflammation
Explanation and Thinking Approach:
Acute inflammation is characterized by two major changes: **vascular changes** and **cellular events**.
The most crucial vascular changes are:
- Transient initial vasoconstriction (a) (brief, not characteristic).
- **Arteriolar and capillary vasodilation (c)**, causing redness and warmth.
- **Increased vascular permeability (c)**, leading to exudation of plasma fluid and proteins into the extravascular tissue (edema), causing swelling.
Question 3
Q3. A 4-year-old boy with sudden onset of petechial rashes, history of viral illness 2 weeks ago present. Investigations reveal thrombocytopenia and anti-platelet antibodies. What is your diagnosis?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Immune thrombocytopenic purpura
Relevant Chapter: 39. Haemostasis: Part 2
Explanation and Thinking Approach:
The clinical picture is classic for acute **Immune Thrombocytopenic Purpura (ITP)**:
**Age and Onset:** Young child with sudden onset of bleeding symptoms (petechial rashes).
**Antecedent Event:** History of a recent viral illness (often 1-4 weeks prior).
**Lab Findings:** **Thrombocytopenia** (low platelet count) is the hallmark. The presence of **anti-platelet antibodies** (specifically autoantibodies against platelet glycoproteins) confirms the immune-mediated destruction of platelets, which is the definition of ITP.
TTP/HUS (c and d) are microangiopathic hemolytic anemias that present with fever, microangiopathic hemolytic anemia, and renal/neurologic involvement (TTP/HUS pentad/triad). HSP (b) is a vasculitis presenting with rash, arthritis, and renal involvement, but not primary anti-platelet antibodies.
Question 4
Q4. A 16 years old female presents with primary amenorrhea & raised FSH. On examination, her height was 58 inches. What would be the histopathological finding in her ovary?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Absence of oocytes in the ovaries
Relevant Chapter: 18. Genetics - Chromosomal disorders
Explanation and Thinking Approach:
The key features point to **Turner Syndrome (45,XO)**:
**1. Primary Amenorrhea and Infertility:** Due to ovarian failure.
**2. Short Stature (58 inches)**: A classic finding.
**3. Raised FSH (Hypergonadotropic Hypogonadism)**: The ovaries fail to produce estrogen/inhibin, so the pituitary gland responds by oversecreting $\text{FSH}$.
**Histopathology:** The primary ovarian defect in Turner Syndrome is the accelerated degeneration of oocytes, resulting in streak gonads composed of fibrous stroma, with a complete or near-complete **absence of oocytes and follicles (a)**. The ovaries are replaced by inactive, fibrous tissue.
Question 5
Q5. A 45 years old patient presents with fever, night sweats & weight loss. On X-ray, a mass in apical lobe of lung is seen. On histopathology found to have caseous necrosis. What is the underlying process?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) Hypersensitivity reaction with modified macrophages, lymphocytes and giant cells
Relevant Chapter: 6. Chronic inflammation, 51. Granulomas and infections of the lung
Explanation and Thinking Approach:
The combination of clinical symptoms (fever, night sweats, weight loss - constitutional B-symptoms), apical lung mass, and the histopathological finding of **caseous necrosis** is diagnostic of **Tuberculosis (TB)**.
The underlying process in $\text{TB}$ is a **Type IV (delayed-type) Hypersensitivity reaction** that forms a **granuloma**. This granuloma is composed of:
- **Modified macrophages (Epithelioid cells)**
- **Giant cells** (Langhans type)
- **Lymphocytes** (T-cells)
Question 6
Q6. A 30 years old lady presents to the outpatient department with an erythematous butterfly rash on her cheeks. Which of the following antibodies should be assayed initially for her suspected condition?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Anti-dsDNA
Relevant Chapter: 20. Hypersensitivity reactions
Explanation and Thinking Approach:
The patient's presentation, especially the **"butterfly" (malar) rash** on the cheeks, is the classic, pathognomonic feature of **Systemic Lupus Erythematosus (SLE)**.
While Anti-Nuclear Antibodies ($\text{ANA}$) are used for screening $\text{SLE}$, the most specific and diagnostically important antibodies are:
- **Anti-dsDNA (a)**: Highly specific for $\text{SLE}$ and is a marker of disease activity, particularly $\text{Lupus}$ Nephritis.
- **Anti-Sm (Smith) Antibodies**: Highly specific for $\text{SLE}$.
Question 7
Q7. A 60 years old female is suffering from renal failure and is on hemodialysis since last 8 years. She developed carpal tunnel syndrome. Which of the following finding will be associated?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (d) $\beta$2-microglobulin
Relevant Chapter: 23. Amyloidosis
Explanation and Thinking Approach:
The patient has **long-term chronic kidney failure (CRF)** and has been on **hemodialysis for 8 years**. The symptom, **Carpal Tunnel Syndrome (CTS)**, in this context is highly suggestive of **Dialysis-Associated Amyloidosis (DAA)**.
**DAA** is caused by the deposition of $\beta$2-microglobulin ($\text{B}2\text{M}$), a normal serum protein that is not efficiently cleared by standard dialysis membranes. Over time, this protein accumulates and forms $\text{A}\beta$2M amyloid fibrils. These deposits frequently occur in joints, leading to arthralgia and, classically, $\text{CTS}$ due to median nerve compression in the wrist.
Question 8
Q8. RET proto-oncogene is associated with-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) Medullary Carcinoma of thyroid
Relevant Chapter: 72. Thyroid tumors
Explanation and Thinking Approach:
The **RET** ($\text{Rearranged}$ during $\text{Transfection}$) proto-oncogene, which codes for a receptor tyrosine kinase, is strongly associated with several endocrine tumors.
**MEN 2 (Multiple Endocrine Neoplasia type 2)** is defined by activating germline mutations in the $\text{RET}$ gene. The tumors seen in $\text{MEN }2\text{A}$ and $\text{MEN }2\text{B}$ are:
- **Medullary Thyroid Carcinoma (MTC) (b)** (always present)
- Pheochromocytoma
- Parathyroid hyperplasia (MEN 2A) or Mucosal neuromas (MEN 2B)
Question 9
Q9. HLA is located on
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Short arm of chromosome 6
Relevant Chapter: 21. HLA and Graft rejection
Explanation and Thinking Approach:
The **Human Leukocyte Antigen ($\text{HLA}$)** system, also known as the Major Histocompatibility Complex ($\text{MHC}$) in humans, is a gene complex on Chromosome **6**.
Specifically, the $\text{HLA}$ complex is located on the **short arm** (p arm) of chromosome 6, at position **6p21.3**. This cluster of genes is crucial for the immune system, particularly in distinguishing self from non-self (e.g., in transplantation).
Question 10
Q10. Natural killer cells attack which of the following cells:
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) Cells which are not able to express MHC1
Relevant Chapter: 19. Immunity - Types of immune cells
Explanation and Thinking Approach:
**Natural Killer ($\text{NK}$) cells** function through the "missing self" hypothesis: they kill cells that fail to express self-**MHC Class I ($\text{MHC }1$)** molecules.
Many viruses (to evade $\text{T}$-cells) and tumor cells downregulate $\text{MHC }1$ expression. $\text{NK}$ cells recognize this absence and activate their killing machinery (perforin/granzyme). The $\text{MHC }1$ molecule normally sends an inhibitory signal to the $\text{NK}$ cell. When it's missing, the cell is targeted.
Question 11
Q11. Most common pathognomonic sign of irreversible cell injury-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Amorphous densities in mitochondria
Relevant Chapter: 2. Cell injury
Explanation and Thinking Approach:
The morphological hallmark that indicates a cell injury has become **irreversible** (i.e., cell death is imminent) is the severe damage to the **mitochondria**.
Electron microscopy reveals the formation of large, puffy, flocculent (fluffy/wooly) **amorphous densities (a)** within the mitochondrial matrix. This represents massive, irreversible damage to oxidative phosphorylation and mitochondrial function, the point of no return.
Swelling (b), detachment of ribosomes (c), and nuclear chromatin clumping (d) are all features of **reversible** cell injury or early necrosis/apoptosis, but they are not the definitive sign of *irreversibility*.
Question 12
Q12. The initiating mechanism in endotoxic shock is:
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Peripheral vasodilation
Relevant Chapter: 9. Hemodynamic disorders
Explanation and Thinking Approach:
Endotoxic (Septic) Shock is initiated by the release of microbial products (e.g., LPS from gram-negative bacteria) which stimulate the release of inflammatory mediators (cytokines like $\text{TNF}$, $\text{IL}-1$) and mediators like nitric oxide ($\text{NO}$).
The initial and most profound physiological consequence is widespread **vasodilation (a)**, leading to a massive decrease in systemic vascular resistance ($\text{SVR}$). This results in a relative hypovolemia (the circulatory system effectively becomes too large for the blood volume) and a drop in blood pressure, which defines the state of shock.
Endothelial injury (b) and increased permeability (c) are important downstream effects, but the massive, inappropriate dilation that causes the hypotensive state is the immediate cause of the shock state itself. Reduced cardiac output (d) usually occurs much later.
Question 13
Q13. Which of the following is the most common fixative used in electron microscopy?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Glutaraldehyde
Relevant Chapter: 1. Cell adaptations (Technique - Histopathology)
Explanation and Thinking Approach:
Fixatives are essential to preserve cell structures. For light microscopy, **Formalin (b)** (10% neutral buffered formalin) is the gold standard.
For **Electron Microscopy (EM)**, much finer detail is required, necessitating a fixative that preserves ultrastructure without causing excessive artifact. **Glutaraldehyde (a)** is the most common primary fixative used for EM. It is a dialdehyde that rapidly forms cross-links between proteins, providing superior preservation of cellular organelles. It is often followed by post-fixation with osmium tetroxide.
Question 14
Q14. Both hyperplasia and hypertrophy are seen in-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) Uterus during pregnancy
Relevant Chapter: 1. Cell adaptations
Explanation and Thinking Approach:
**Hyperplasia** is an increase in the **number** of cells. **Hypertrophy** is an increase in the **size** of cells.
**Uterus during Pregnancy (b):** The massive enlargement of the uterus is a classic example of both:
- **Hyperplasia:** Estrogen stimulates the proliferation of smooth muscle cells.
- **Hypertrophy:** Both estrogen and mechanical stretching stimulate an increase in the size of individual smooth muscle cells.
Question 15
Q15. HMB 45 is a tumor marker for-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Malignant Melanoma
Relevant Chapter: 13. Lab diagnosis of cancer
Explanation and Thinking Approach:
**HMB-45 ($\text{Human Melanoma Black 45}$)** is an antibody used in immunohistochemistry ($\text{IHC}$) to detect melanocytic differentiation in tumors.
It recognizes the glycoprotein $\text{gp}100$, which is found in melanosomes (pigment-producing organelles). Its presence is a highly specific marker for the diagnosis of **Malignant Melanoma (c)** and other tumors of melanocytic origin.
Question 16
Q16. All of the following are example of tumor markers except:
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) $\beta$2-microglobulin
Relevant Chapter: 13. Lab diagnosis of cancer
Explanation and Thinking Approach:
**Tumor Markers** are substances produced by the tumor or by the host in response to the tumor.
Alpha-hCG (a): $\text{hCG}$ (human chorionic gonadotropin) is a marker for germ cell tumors (e.g., choriocarcinoma).
Thyroglobulin (c): Used to monitor recurrence of differentiated thyroid carcinoma.
Alpha fetoprotein (d): Marker for Hepatocellular Carcinoma and germ cell tumors (e.g., yolk sac tumor).
**$\beta$2-microglobulin (b)**: While it can be elevated in some lymphoid malignancies (Multiple Myeloma, Lymphoma) and is used as a prognostic factor, it is fundamentally a low molecular weight protein whose levels primarily reflect the glomerular filtration rate ($\text{GFR}$) and the mass/turnover of lymphocytes (used as a marker for Dialysis-Associated Amyloidosis - Q7). Unlike the others, it is not primarily viewed as a specific tumor-derived marker in the same context. In the context of "classic" tumor markers, this is the exception.
Question 17
Q17. APC gene is located on which chromosome-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Chromosome 5
Relevant Chapter: 57. Polyps and Colon cancer
Explanation and Thinking Approach:
The **Adenomatous Polyposis Coli ($\text{APC}$)** gene is a major tumor suppressor gene involved in the Wnt signaling pathway and the progression of colorectal cancer (Adenoma-Carcinoma Sequence).
The $\text{APC}$ gene is located on the long arm of **Chromosome 5** (specifically $\text{5q}21$). Inherited defects in the $\text{APC}$ gene cause Familial Adenomatous Polyposis ($\text{FAP}$), leading to hundreds of polyps and near 100% risk of colon cancer.
Question 18
Q18. An undifferentiated malignant tumor on immunohistochemical stain shows cytoplasmic positivity in most of the tumor cells for cytokeratin. The most probable diagnosis of the tumor is:
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (d) Carcinoma
Relevant Chapter: 13. Lab diagnosis of cancer
Explanation and Thinking Approach:
**Immunohistochemistry ($\text{IHC}$)** uses antibodies to identify the lineage of an unknown tumor.
**Cytokeratin** is the primary intermediate filament found in **epithelial cells**. Therefore, a tumor that stains positive for cytokeratin is derived from epithelial tissue and is classified as a **Carcinoma (d)**.
Sarcoma (a) (mesenchymal origin) stains positive for Vimentin. Lymphoma (b) (hematopoietic origin) stains positive for leukocyte common antigen ($\text{CD}45$). Malignant Melanoma (c) (melanocytic/neural crest origin) stains positive for $\text{HMB}-45$ and $\text{S}100$.
Question 19
Q19. Common-type of AML in Down's Syndrome is-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) M7 AML
Relevant Chapter: 33. Acute myeloid leukemia
Explanation and Thinking Approach:
Patients with **Down Syndrome (Trisomy 21)** have a significantly increased risk of developing leukemia, particularly Acute Myeloid Leukemia ($\text{AML}$).
The specific subtype that is most strongly associated is **$\text{AML}$ M7 (Acute Megakaryoblastic Leukemia)**, which often occurs in children under the age of 5. It is sometimes preceded by Transient Abnormal Myelopoiesis ($\text{TAM}$).
Question 20
Q20. A patient of 70 years presented with generally lymphadenopathy. Total leucocyte count was 40,000/mm$^{3}$ and blood film showed > 80% mature looking lymphocytes. Next investigation should be done:
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Peripheral blood immunophenotyping
Relevant Chapter: 36. Non hodgkin's lymphoma
Explanation and Thinking Approach:
The patient presents with:
1. **Age:** 70 years (older adult).
2. **Findings:** Generalized lymphadenopathy, very high $\text{WBC}$ count ($\text{40,000}/\text{mm}^{3}$), and $\gt 80\%$ **mature-looking lymphocytes** in the blood.
This constellation is the classic presentation of **Chronic Lymphocytic Leukemia ($\text{CLL}$)**, which is essentially the leukemic form of Small Lymphocytic Lymphoma ($\text{SLL}$).
The definitive, least invasive, and most rapid test to confirm the B-cell lineage (CD5+, CD23+, faint surface Ig) and clonality in $\text{CLL}$ is **Peripheral Blood Immunophenotyping (c)** (Flow Cytometry). Since the abnormal cells are already circulating in the blood, a lymph node or bone marrow biopsy is not the immediate next step for diagnosis.
Question 21
Q21. High risk of malignancy is seen in-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Complex hyperplasia with atypia
Relevant Chapter: 67. Female genital tract: Part 1
Explanation and Thinking Approach:
This question refers to the classification of **Endometrial Hyperplasia**, which is a risk factor for Endometrial Carcinoma (Type 1, endometrioid).
The risk of progression to cancer is determined by two main factors: **Complexity (Simple vs. Complex)** and **Atypia (with vs. without)**.
The risks of progression are:
- Simple without atypia: 1%
- Complex without atypia (d): 3%
- Simple with atypia (a): 8%
- **Complex with atypia (c):** **20-40% (Highest risk)**
Question 22
Q22. Most important but nonspecific regulator of iron metabolism is:
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Hepcidin
Relevant Chapter: 27. Microcytic hypochromic anemias
Explanation and Thinking Approach:
**Hepcidin (a)** is the central regulatory hormone of systemic iron metabolism. It is produced by the liver.
**Function:** Hepcidin acts by binding to **Ferroportin (b)** (the iron export channel) on the surface of duodenal enterocytes and macrophages, leading to its internalization and degradation. This blocks iron release into the blood, effectively lowering serum iron.
**Nonspecificity:** Hepcidin is a crucial acute phase reactant. Its synthesis is upregulated by iron load **AND** by **inflammation/infection** (cytokines like $\text{IL}-6$). Therefore, it is important but its elevation is non-specific, causing the iron deficiency of chronic disease even when body iron stores are adequate.
$\text{DMT}1$ (c) is an iron transporter. Ferritin (d) is the storage form of iron.
Question 23
Q23. Poor prognostic factor for ALL is
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) $\text{t}(9,11)$
Relevant Chapter: 32. Acute lymphoblastic leukemia
Explanation and Thinking Approach:
In Acute Lymphoblastic Leukemia ($\text{ALL}$), several factors influence prognosis:
**Good Prognosis Factors:** Age 2-8 years (c), low $\text{WBC}$ count ($\lt 50,000$) (d), and Hyperdiploidy (a).
**Poor Prognosis Factors:** Age $\lt 2$ or $\gt 10$ years, very high $\text{WBC}$ count ($\gt 100,000$), presence of specific translocations.
The translocation $\mathbf{t(9;22)}$ ($\text{Philadelphia}$ Chromosome, $\text{BCR-ABL}$) is the most significant poor prognostic factor.
The translocation $\mathbf{t(4;11)}$ (b) ($\text{MLL}$ gene rearrangement) and $\mathbf{t(1;19)}$ are also associated with a poorer prognosis. $\mathbf{t(9;11)}$ is also a poor prognostic marker.
Therefore, $\mathbf{t(9;11)}$ (b) is the only poor prognostic factor listed among the choices, while (a), (c), and (d) are generally considered good or intermediate prognostic features.
Question 24
Q24. Fibrinoid necrosis is seen in all of the following except -
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (d) Diabetic glomerulosclerosis
Relevant Chapter: 3. Cell death, 44. Blood vessels - Sclerosis, 20. Hypersensitivity reactions
Explanation and Thinking Approach:
**Fibrinoid Necrosis** is a special type of necrosis seen in immune-mediated vascular damage, where immune complexes and plasma proteins leak into the vessel wall, creating a brightly eosinophilic, amorphous deposit resembling fibrin (hence "fibrinoid").
**It is seen in:**
- **Malignant Hypertension (a):** Fibrinoid necrosis of arterioles.
- **Vasculitis (Polyarteritis nodosa (c)):** Necrotizing inflammation/necrosis of small-to-medium vessels.
- **Rheumatic Fever/Aschoff Bodies (b):** Fibrinoid necrosis is present in the connective tissue within Aschoff nodules (though the nodules themselves are granulomatous).
Question 25
Q25. A patient died of Alzheimer's disease. At autopsy, heart contains yellow brown finely granular pigment which is due to-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) Lipochrome- Wear and tear
Relevant Chapter: 4. Intracellular accumulations
Explanation and Thinking Approach:
The pigment described is **Lipofuscin**, which has a characteristic yellow-brown, finely granular appearance and accumulates around the nucleus.
**Lipofuscin** is also known as "wear-and-tear" or "aging" pigment. It represents the indigestible residue of lipid peroxidation that accumulates in lysosomes. It is most prominent in non-dividing, long-lived cells (like neurons, cardiac myocytes, and hepatocytes) of older patients (the 60-year-old patient who died of Alzheimer's).
Therefore, the correct association is **Lipochrome** ($\text{Lipofuscin}$) and **Wear and Tear (b)**. Hemosiderin (a) is a brownish iron storage complex.
Question 26
Q26. Both arterial and venous thrombosis occur in-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (a) Antiphospholipid antibody syndrome
Relevant Chapter: 39. Haemostasis: Part 2
Explanation and Thinking Approach:
The procoagulant disorders (thrombophilias) are classified into those that predominantly cause venous thrombosis and those that cause both.
**Antiphospholipid Antibody Syndrome ($\text{APS}$) (a)**: This autoimmune disorder, characterized by the presence of antiphospholipid antibodies ($\text{aPL}$), is the key acquired thrombophilia that causes both **arterial and venous thromboses** (e.g., stroke, myocardial infarction, deep vein thrombosis, pulmonary embolism).
Protein C deficiency (b), Antithrombin III deficiency (c), and Factor V Leiden (d) (Mutation in factor V gene) are all genetic disorders that primarily cause **venous thrombosis** ($\text{DVT}$/$\text{PE}$).
Question 27
Q27. A 35 year old lady on treatment for rheumatoid arthritis has following lab findings:- $\text{Hb}-9 \text{gm}/\text{dl}$, $\text{MCV}-55 \text{fl}$, serum $\text{iron}-\text{30} \text{ug}/\text{dl}$, $\text{Ferritin}-\text{200} \text{ng}/\text{ml}$, $\text{TIBC}-\text{298} \text{ug}/\text{dl}$. What is the most probable diagnosis?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Anemia of chronic disease
Relevant Chapter: 27. Microcytic hypochromic anemias
Explanation and Thinking Approach:
The patient has **Rheumatoid Arthritis ($\text{RA}$)**, a chronic inflammatory condition, which is the underlying cause.
**Lab Profile Analysis:**
1. $\text{Hb}$ low, $\text{MCV}$ low (Microcytic anemia $\to$ Rule out $\text{IDA}$, Thalassemia, $\text{ACD}$).
2. $\text{Serum Iron}$ low ($\text{30} \text{ug}/\text{dl}$) $\to$ Seen in $\text{IDA}$ and $\text{ACD}$.
3. $\mathbf{Ferritin}$ **high** ($\mathbf{200} \text{ng}/\text{ml}$) $\to$ **Rules out $\text{IDA}$** (where $\text{Ferritin}$ is low). $\text{Ferritin}$ is high in $\text{ACD}$ because it is an acute phase reactant.
4. $\text{TIBC}$ (Total Iron-Binding Capacity) low/normal ($\text{298} \text{ug}/\text{dl}$) $\to$ Also seen in $\text{ACD}$ (low/normal) and rules out $\text{IDA}$ (where $\text{TIBC}$ is high).
The key findings of **low serum iron** and **high ferritin** in a patient with a chronic inflammatory disease ($\text{RA}$) confirm the diagnosis of **Anemia of Chronic Disease ($\text{ACD}$)**. This iron-restricted erythropoiesis is mediated by the chronic elevation of the iron regulator, Hepcidin.
Question 28
Q28. Proliferation and survival of myeloma cells are dependent on which of the following cytokines?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (b) IL-6
Relevant Chapter: 37. Plasma cell disorders
Explanation and Thinking Approach:
**Multiple Myeloma ($\text{MM}$)** is a malignant plasma cell disorder. The proliferation and survival of the malignant plasma cells are largely dependent on signals received from the surrounding bone marrow microenvironment.
**Interleukin-6 ($\mathbf{IL-6}$) (b)** is the most important cytokine mediator in $\text{MM}$. $\text{IL}-6$ is secreted by bone marrow stromal cells and macrophages, and it acts in an autocrine and paracrine fashion to promote plasma cell growth, prevent apoptosis, and stimulate $\text{VEGF}$ release, which leads to angiogenesis.
Question 29
Q29. Which of the following is not a characteristic feature of Myelodysplastic syndrome?
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (c) Leucoerythroblastic blood picture
Relevant Chapter: 34. Myeloid disorders
Explanation and Thinking Approach:
**Myelodysplastic Syndromes ($\text{MDS}$)** are clonal stem cell disorders characterized by ineffective hematopoiesis, leading to cytopenias and dysplasia in one or more hematopoietic lineages.
**Characteristics of $\text{MDS}$:**
**Dysplasia (Abnormal Maturation):**
- Erythroid lineage: Ring sideroblasts (not listed), megaloblastoid changes.
- Myeloid lineage: Pseudo Pelger-Huët cells (hyposegmented neutrophils) (b).
- Megakaryocytes: Small or large with multiple separate nuclei ("Pawn Ball" or "Putter" megakaryocytes) (a).
**High Risk:** Transformation to $\text{AML}$ (d) is a major risk and part of the $\text{MDS}$ natural history.
**Leucoerythroblastic blood picture (c)**: This is characterized by the presence of immature $\text{WBC}$ and nucleated $\text{RBC}$ in the peripheral blood. It is a feature of bone marrow *infiltration* (e.g., in advanced Myelofibrosis, secondary to malignancy, or massive stress), not a typical dysplastic finding of $\text{MDS}$.
Question 30
Q30. A 48 year old lady presented with hepatosplenomegaly with pancytopenia. On bone marrow examination, a tissue paper crumpled appearance is seen. Which is the most likely product to have accumulated-
AIIMS DEOGHAR 2nd MBBS PROF EXAM (2025)
Correct Answer: (d) Glucocerebroside
Relevant Chapter: 4. Intracellular accumulations
Explanation and Thinking Approach:
The key findings—**hepatosplenomegaly, pancytopenia**, and the characteristic **"tissue paper crumpled"** or "wrinkled tissue" appearance of the storage cells ($\text{Gaucher}$ cells) on bone marrow examination—are pathognomonic for **Gaucher Disease**.
**Gaucher Disease** is a lysosomal storage disorder caused by a deficiency of the enzyme glucocerebrosidase. This deficiency leads to the accumulation of its substrate, **Glucocerebroside (d)**, within macrophages throughout the body, most notably in the liver, spleen, and bone marrow.
Sphingomyelin (b) accumulates in Niemann-Pick disease. Gangliosides (a) accumulate in Tay-Sachs disease.
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