Current Score:
Question 1
Q1. Which hepatitis marker can be used to diagnose Acute Hepatitis B?
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Correct Answer: (c) HBs Ag (and often Anti-HBc IgM, though not listed)
Relevant Chapter: 58. Liver Pathology: Part 1
Explanation and Thinking Approach:
**HBsAg** (Hepatitis B surface Antigen) is the first marker to appear after exposure and its presence indicates an active infection (either acute or chronic). For **Acute** Hepatitis B, it is often seen along with **Anti-HBc IgM**, which is highly specific for a recent infection. Since HBsAg is present in both acute and chronic phases, it is the most basic initial diagnostic marker for active disease.
For a detailed breakdown of the serology markers and their phases, visit this
Advanced Hepatitis B Study Guide.
Question 2
Q2. The most common cause of community-acquired pneumonia in an immunocompetent adult is:
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Correct Answer: (c) Streptococcus pneumoniae
Relevant Chapter: 65. Respiratory Infections
Explanation and Thinking Approach:
***Streptococcus pneumoniae* (Pneumococcus)** is responsible for the vast majority (around two-thirds) of bacterial Community-Acquired Pneumonia (CAP) cases. While *Mycoplasma* is a common "atypical" cause, *S. pneumoniae* remains the number one overall cause in this patient population.
Question 3
Q3. Which of the following ECG findings is characteristic of acute pericarditis?
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Correct Answer: (c) PR-segment depression
Relevant Chapter: 42. Pericardial Diseases
Explanation and Thinking Approach:
The two hallmark ECG findings in acute pericarditis are **diffuse concave ST-segment elevation** (in most leads except aVR and V1) and **PR-segment depression**, which is highly specific for the condition due to injury to the atrial myocardium. Localized ST elevation is more typical of myocardial infarction.
Question 4
Q4. Cushing's syndrome is most commonly caused by:
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Correct Answer: (d) Exogenous corticosteroid administration
Relevant Chapter: 22. Adrenal Disorders
Explanation and Thinking Approach:
The single most common cause of Cushing's syndrome (hypercortisolism) overall is **iatrogenic**, meaning it's caused by the medical use of glucocorticoids (like prednisone) for treating inflammatory conditions. When discussing endogenous causes, a **pituitary adenoma** (Cushing's disease) is the most common cause. The question asks for the most common cause overall.
Question 5
Q5. A patient presents with a history of recurrent episodes of abdominal pain, joint pain, and an elevated erythrocyte sedimentation rate (ESR). The most likely diagnosis is:
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Correct Answer: (c) Familial Mediterranean Fever (FMF)
Relevant Chapter: 37. Autoinflammatory Syndromes
Explanation and Thinking Approach:
**Familial Mediterranean Fever (FMF)** is a classic example of an autoinflammatory syndrome characterized by recurrent, self-limiting episodes (attacks) of fever, serositis (inflammation of lining tissue), which manifests as severe abdominal pain (peritonitis), pleuritic chest pain, and arthritis/arthralgia (joint pain). An elevated $\text{ESR}$ or $\text{CRP}$ is typical during attacks.
Question 6
Q6. Which of the following organs have tumors in patients with MEN type 1?
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Correct Answer: (c) Pituitary, parathyroid, and pancreas
Relevant Chapter: 74. Pituitary and Parathyroid gland (Covers two of the three main organs), 73. Adrenal medulla (MEN can affect the adrenal cortex, but it is not one of the main 3 P's)
Explanation and Thinking Approach:
Multiple Endocrine Neoplasia type 1 ($\text{MEN }1$), also called Wermer Syndrome, is an inherited condition that causes tumors in three main endocrine glands. It is classically remembered by the **3 P's**:
- **Parathyroid** (most common, typically adenoma/hyperplasia)
- **Pituitary** (adenoma)
- **Pancreas** (tumors, often gastrinoma, insulinoma, etc.)
Option (a): Includes Thyroid (classic for MEN 2), not MEN 1.
Option (b): Includes Kidneys and Liver, which are not part of the classic syndrome.
Option (d): Includes the Pineal gland, which is not part of the classic syndrome.
**Thinking Approach:**
Identify the Core Topic: Multiple Endocrine Neoplasia Type 1 ($\text{MEN }1$).
Recall the Mnemonic: The classic mnemonic for $\text{MEN }1$ is the 3 P's: Pituitary, Parathyroid, and Pancreas.
Evaluate Options: Scan the options for the combination of the 3 P's.
Option (c) is the only one that includes all three classic organs.
Select the Best Fit: Pituitary, parathyroid, and pancreas.
Question 7
Q7. In lysosomal storage diseases, the following cells are particularly involved:
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Correct Answer: (c) Macrophages
Relevant Chapter: 4. Intracellular accumulations (Lysosomal storage diseases)
Explanation and Thinking Approach:
Lysosomal storage diseases ($\text{LSDs}$) result from a deficiency of lysosomal enzymes, leading to the accumulation of undigested substrate within the lysosomes of various cells.
The cells most visibly and characteristically affected are those with a high turnover of complex lipids, carbohydrates, or proteins, and those responsible for phagocytosis.
**Macrophages** (and related mononuclear phagocytes, like Kupffer cells in the liver, and histiocytes in the spleen/bone marrow) are constantly internalizing material. When this material cannot be broken down (due to the enzyme defect), the macrophages become engorged with the stored substance (e.g., lipid-laden foam cells, Gaucher cells), making them the prominent cell type in many $\text{LSDs}$.
**Thinking Approach:**
Identify the Core Topic: Lysosomal Storage Diseases ($\text{LSDs}$).
Recall the Pathophysiology: $\text{LSDs}$ involve the build-up of material inside lysosomes.
Determine the Affected Cell Type: Which cell type has the most active phagocytic and digestive function?
Macrophages (Phagocytes) and Neurons (high lipid turnover in some diseases) are heavily involved.
Evaluate Options:
Hepatocytes/Skeletal muscle: Involved, but not the most characteristically and universally involved cell in the pathology.
White pulp: Contains lymphocytes; storage is more prominent in the red pulp/sinusoids (where macrophages reside).
Macrophages: The key phagocytic cell that becomes engorged with storage material, giving the diseases their classic appearance.
Select the Best Fit: Macrophages.
Question 8
Q8. Which of the following serum tumor markers is most commonly elevated in epithelial ovarian tumors?
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Correct Answer: (b) CA-125
Relevant Chapter: 69. Ovarian tumors
Explanation and Thinking Approach:
Tumor markers are specific substances elevated in cancer.
**CA-125**: The single most widely used and tested serum marker for epithelial ovarian carcinoma (the most common type of ovarian cancer). It is used for monitoring response to therapy and detecting recurrence.
$\text{AFP}$ (a): Marker for Yolk Sac Tumors (a germ cell tumor of the ovary) and Hepatocellular Carcinoma.
$\beta-\text{hCG}$ (c): Marker for Choriocarcinoma (a germ cell tumor) and testicular cancers.
$\text{CEA}$ (d): Marker for Colorectal, Pancreatic, and sometimes Mucinous ovarian tumors, but $\text{CA-125}$ is the general marker for epithelial tumors.
**Thinking Approach:**
Identify the Core Topic: Epithelial Ovarian Tumors and their serum markers.
Recall the Specific Marker: The marker most commonly associated with Ovarian Cancer in general.
Evaluate Options:
$\text{AFP}$, $\beta-\text{hCG}$: Germ cell tumors (not the most common epithelial type).
$\text{CEA}$: $\text{GI}$ tumors.
$\text{CA-125}$: The standard, classic marker for epithelial ovarian cancer.
Select the Best Fit: $\text{CA-125}$.
Question 9
Q9. Barrett esophagus predisposes to development of:
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Correct Answer: (d) Adenocarcinoma
Relevant Chapter: 53. Esophagus
Explanation and Thinking Approach:
**Barrett Esophagus** is a condition where the normal stratified squamous epithelium of the distal esophagus is replaced by metaplastic columnar epithelium with goblet cells (intestinal metaplasia) due to chronic gastroesophageal reflux disease ($\text{GERD}$).
This metaplastic columnar epithelium is highly prone to undergoing dysplasia and transformation into Esophageal **Adenocarcinoma**. Barrett Esophagus is the single most important risk factor for this type of cancer.
Reflux esophagitis (a): The cause of Barrett's, not the consequence.
Esophageal varices (b): A complication of portal hypertension/liver disease.
Squamous cell carcinoma (c): Associated with smoking and alcohol; usually occurs in the upper/mid esophagus and is not caused by Barrett's.
**Thinking Approach:**
Identify the Core Topic: Barrett Esophagus (Metaplasia).
Recall the Progression: Metaplasia $\to$ Dysplasia $\to$ Cancer.
Recall the Cell Type Change: Squamous epithelium is replaced by Columnar/Glandular epithelium.
Link Cell Type to Cancer: Cancer arising from glandular epithelium is an **Adenocarcinoma**.
Select the Best Fit: Adenocarcinoma.
Question 10
Q10. Orphan Annie eye nucleus is seen in -
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Correct Answer: (b) Papillary thyroid carcinoma
Relevant Chapter: 72. Thyroid tumors
Explanation and Thinking Approach:
The **Orphan Annie Eye Nucleus ($\text{OAEN}$)** is the single most classic and pathognomonic (uniquely characteristic) microscopic feature of **Papillary Thyroid Carcinoma ($\text{PTC}$)**.
$\text{OAEN}$: These nuclei appear clear, empty, or washed-out because the chromatin is pushed to the nuclear membrane, leaving the center pale. This resemblance to the large, empty eye sockets of the cartoon character "Little Orphan Annie" gives the feature its name.
Follicular (a): Characterized by follicular architecture and capsular/vascular invasion.
Medullary (c): Characterized by C-cell origin and amyloid deposition.
Anaplastic (d): Characterized by highly pleomorphic, giant, and spindle-shaped cells.
**Thinking Approach:**
Identify the Core Topic: Specific nuclear features in thyroid tumors.
Recall the Classic Feature: "Orphan Annie" is a famous histology mnemonic.
Link Feature to Tumor: Orphan Annie Eye Nuclei ($\text{OAEN}$), nuclear grooves, and pseudoinclusions are the triad for **Papillary Thyroid Carcinoma ($\text{PTC}$)**.
Select the Best Fit: Papillary thyroid carcinoma.
Question 11
Q11. Most common histopathological type of renal carcinoma is -
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Correct Answer: (a) Clear cell
Relevant Chapter: 64. Kidney tumors
Explanation and Thinking Approach:
**Clear Cell Renal Cell Carcinoma ($\text{RCC}$)**: This is by far the most common type of $\text{RCC}$, accounting for 60% to 80% of all cases. It is characterized by cells with clear or granular cytoplasm due to high glycogen and lipid content, and it typically arises from the proximal renal tubule. It is strongly associated with loss of the $\text{VHL}$ gene.
Papillary $\text{RCC}$ (c): The second most common type, accounting for 10% to 15%.
Medullary $\text{RCC}$ (b): A rare, aggressive subtype seen almost exclusively in patients with sickle cell trait.
**Thinking Approach:**
Identify the Core Topic: Classification and frequency of Renal Cell Carcinoma ($\text{RCC}$).
Recall the Epidemiology: Which type dominates the statistics?
Recall the Mnemonic/Fact: Clear Cell is the undisputed most common type of $\text{RCC}$.
Select the Best Fit: Clear cell.
Question 12
Q12. Which of the following is a common tumor of SIALP?
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Correct Answer: (b) Squamous cell ca of lung
Relevant Chapter: 52. Lung tumors
Explanation and Thinking Approach:
**SIALP** is a common mnemonic used in medical education to classify lung cancers:
**S**quamous Cell Carcinoma (**Central** location)
**I**nvasive **A**denocarcinoma (**Peripheral** location)
**A**denocarcinoma in situ
**L**arge Cell Carcinoma
**P**rimary lung tumors (Small cell is often excluded from $\text{SIALP}$, or $\text{SIALP}$ is used to denote non-small cell lung cancer).
However, $\text{SIALP}$ in the context of location commonly refers to tumors arising **centrally** in the mainstem, segmental, or lobar Bronchi, which leads to obstruction, and is classic for **Squamous Cell Carcinoma**.
Adenocarcinoma (c): Typically arises in the periphery of the lung.
Small cell ca (a): Also central, but a neuroendocrine tumor, not typically grouped with the Non-Small Cell Lung Cancers ($\text{NSCLC}$) for anatomical location questions like this.
**Thinking Approach:**
Identify the Core Topic: Anatomic location of lung cancer types.
Decipher the Mnemonic ($\text{SIALP}$): While context-dependent, $\text{SIALP}$ often relates to the location of the two major $\text{NSCLCs}$. Think: "S" for Squamous $\to$ Central, and "A" for Adeno $\to$ Peripheral.
Evaluate Options: Squamous cell carcinoma is the classic answer for a tumor arising in the central, large airways (like the bronchus/$\text{SIALP}$ region).
Select the Best Fit: Squamous cell ca of lung.
Question 13
Q13. Gleason score is used for -
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Correct Answer: (c) Prostate carcinoma
Relevant Chapter: 65. Male genital - Penis and Prostate
Explanation and Thinking Approach:
The **Gleason Grading System** is a specific system used exclusively by pathologists to grade the prognosis of **Prostate Adenocarcinoma**.
It is based on the architectural pattern of the tumor glands, with a score given to the primary (most prevalent) pattern and the secondary (next most prevalent) pattern. These two scores are added to yield the final Gleason Score (e.g., 3+4=7).
It is not used for tumors of the kidney, testis ($\text{Choriocarcinoma}$), or nervous system ($\text{Neuroblastoma}$).
**Thinking Approach:**
Identify the Core Topic: Specific cancer grading systems.
Recall the Association: The Gleason Score is famously and uniquely linked to one type of cancer.
Evaluate Options:
Choriocarcinoma: Germ cell tumor, graded by staging and $\beta-\text{hCG}$ levels.
Neuroblastoma: Graded by staging and N-MYC status.
Prostate carcinoma: Classically graded using the Gleason score.
Renal cell carcinoma: Graded using the Fuhrman/ISUP nuclear grading system.
Select the Best Fit: Prostate carcinoma.
Question 14
Q14. Which of the following is the primary mechanism of Hepatitis B virus (HBV) entry into hepatocytes?
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Correct Answer: (d) Sodium taurocholate co-transporting polypeptide mediated transport
Relevant Chapter: 58. Liver Pathology: Part 1
Explanation and Thinking Approach:
This question tests specific virology/pathogenesis knowledge. The entry of $\text{HBV}$ into a hepatocyte is not a simple endocytosis or fusion process.
The $\text{HBV}$ surface protein ($\text{HBsAg}$) binds specifically to the cellular receptor **Sodium Taurocholate Co-transporting Polypeptide ($\text{NTCP}$)**, which is primarily found on hepatocytes. $\text{NTCP}$ is necessary and sufficient for $\text{HBV}$ entry. This specialized binding and transport mechanism is required for the virus to infect the cell.
**Thinking Approach:**
Identify the Core Topic: Mechanism of $\text{HBV}$ entry (a detailed microbiology/pathogenesis question).
Recall the Specific Receptor: In modern pathology/virology, the key to viral entry is the specific cellular receptor.
Recall the $\text{HBV}$ Receptor: $\text{HBV}$ uses the $\text{NTCP}$ receptor.
Evaluate Options: Recognize that option (d) describes the $\text{NTCP}$-mediated process. The other options describe general mechanisms used by many other viruses but not the primary, specific mechanism for $\text{HBV}$.
Select the Best Fit: Sodium taurocholate co-transporting polypeptide mediated transport.
Question 15
Q15. The significant genetic mutations in adenoma-carcinoma sequence are all the following except:
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Correct Answer: (c) Mutated RB gene
Relevant Chapter: 57. Polyps and Colon cancer (Adenoma-Carcinoma Sequence), 11. Types of carcinogenesis (General genetics)
Explanation and Thinking Approach:
The **Adenoma-Carcinoma Sequence** (or Vogelstein model) describes the stepwise accumulation of mutations that lead to colorectal cancer:
**APC Loss (a)**: Leads to hyperproliferative epithelium (early step).
**K-RAS Mutation (d)**: Leads to formation of an adenoma (mid step).
**DCC Deletion (b)** & **p53 loss**: Leads to carcinoma (late step).
**Mutated RB gene (c)**: The Retinoblastoma ($\text{RB}$) gene is a key tumor suppressor involved in many cancers (e.g., Retinoblastoma, Osteosarcoma, Small Cell Lung Cancer), but it is **NOT** a canonical, defining part of the colorectal Adenoma-Carcinoma Sequence. The sequence relies primarily on $\text{APC}$, $\text{K-RAS}$, $\text{DCC}$, and $\text{p53}$.
**Thinking Approach:**
Identify the Core Topic: Genetic basis of Colorectal Cancer ($\text{CRC}$) / Adenoma-Carcinoma sequence.
Recall the Key Genes (The $\text{CRC}$ Gene List): The model is $\text{APC} \to \text{K-RAS} \to \text{p53}/\text{DCC}$.
Evaluate Options (Check the List):
a) $\text{APC}$: Yes, crucial.
b) $\text{DCC}$: Yes, late stage.
d) $\text{K-RAS}$: Yes, mid stage.
c) $\text{RB}$ gene: Not part of the core $\text{CRC}$ sequence.
Select the EXCEPT Answer: Mutated $\text{RB}$ gene.
Question 16
Q16. Liquid based cytology:
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Correct Answer: (a) provides uniform noniscolored cell dispersion
Relevant Chapter: 13. Lab diagnosis of cancer
Explanation and Thinking Approach:
**Liquid-Based Cytology ($\text{LBC}$)**, commonly used for cervical (Pap) smears, is an advanced method designed to improve the quality of cell samples compared to the traditional direct smear:
**LBC Advantage**: In the $\text{LBC}$ method, the cells are suspended in a preservative liquid rather than being directly smeared onto a slide. This process virtually eliminates artifacts like cellular clumping (c) and thick layers of cells, providing a thin, **uniform layer of cells (a)** for the pathologist to review. This enhances sensitivity and specificity.
**Utility**: $\text{LBC}$ is widely used for both gynaecological (cervical) and non-gynaecological (e.g., fine needle aspiration of breast or thyroid) samples, making options (b) and (d) incorrect.
**Thinking Approach:**
Identify the Core Topic: Liquid-Based Cytology ($\text{LBC}$) technique and its purpose.
Recall the Goal of $\text{LBC}$: Why was this method developed? To overcome the limitations of the traditional smear (thick, clumped, obscured cells).
Deduce the Result: If $\text{LBC}$ solves clumping and thick smears, the result must be a thin, dispersed, uniform monolayer of cells.
Evaluate Options:
a) Uniform dispersion: Correct, this is the main benefit.
c) Clumping: Incorrect, $\text{LBC}$ prevents clumping.
b, d) Only non-gynaecological/only gynaecological: Incorrect; $\text{LBC}$ is versatile.
Select the Best Fit: provides uniform noniscolored cell dispersion.
Question 17
Q17. The most common artery involved in myocardial infarction is
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Correct Answer: (c) Left anterior descending coronary artery
Relevant Chapter: 47. Cardiovascular system: Part 1
Explanation and Thinking Approach:
The artery most frequently blocked in a Myocardial Infarction ($\text{MI}$) corresponds to the most common site of major coronary atherosclerosis.
The **Left Anterior Descending ($\text{LAD}$) artery** supplies the anterior wall of the left ventricle and the anterior two-thirds of the interventricular septum. It is often referred to as the "**widow-maker**" because blockage here affects a large, critical area of the heart, leading to the most frequent type of $\text{MI}$ (Anterior/Anteroseptal).
The Right Coronary Artery ($\text{RCA}$) is the second most common site of occlusion, leading to inferior wall $\text{MI}$.
The Left Circumflex Artery ($\text{LCX}$) is the third most common.
**Thinking Approach:**
Identify the Core Topic: Location of coronary artery occlusion in Myocardial Infarction.
Recall the Anatomy/Epidemiology: Which artery supplies the largest, most crucial part of the left ventricle? The $\text{LAD}$.
Relate to Frequency: Blockage of the $\text{LAD}$ leads to the most common type of $\text{MI}$.
Select the Best Fit: Left anterior descending coronary artery.
Question 18
Q18. Which of the following is false in neuroblastoma:
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Correct Answer: (d) Surgical treatment is not done
Relevant Chapter: 78. CNS tumors (Though Neuroblastoma is typically a peripheral/adrenal tumor, it is often grouped with CNS/pediatric oncology.)
Explanation and Thinking Approach:
Neuroblastoma is a common, highly malignant tumor of the sympathetic nervous system, typically occurring in **children (c)**, often arising in the adrenal medulla or retroperitoneum.
**Radiosensitivity (a)**: Neuroblastomas are generally highly radiosensitive, and radiation is often a key part of the treatment plan, especially for local control.
**CSF Spread (b)**: Neuroblastoma can metastasize widely, and $\text{CNS}$ involvement, including spread through the Cerebrospinal Fluid ($\text{CSF}$), is a known route of dissemination in advanced disease.
**Surgical Treatment (d) - FALSE**: Surgery is **CRITICAL** for neuroblastoma. Resection is often the primary treatment for localized disease, and even for high-risk or advanced disease, surgery is frequently used to debulk the tumor before or after chemotherapy. To say surgery is not done is definitively **false**.
**Thinking Approach:**
Identify the Core Topic: Key features and treatment of Neuroblastoma.
Evaluate Options for Truth/Falsity:
c) Occur in children: **TRUE**, it's a pediatric tumor.
a) Radiosensitive: **TRUE**, a key feature influencing treatment.
b) Spreads through $\text{CSF}$: **TRUE**, it can spread (metastasize) widely.
d) Surgical treatment is not done: **FALSE**. Surgery is the foundation of local control.
Select the **FALSE** Statement: Surgical treatment is not done.
Question 19
Q19. Bone tumor arising from epiphysis is:
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Correct Answer: (c) Giant cell tumor
Relevant Chapter: 76. Bone and soft tissue lesions
Explanation and Thinking Approach:
This question tests the classic anatomical location of primary bone tumors:
**Epiphysis**: The end of a long bone, near the joint.
**Giant Cell Tumor ($\text{GCT}$) (c)**: Classically arises in the **epiphysis** (or epiphyseal equivalent) of long bones, most commonly the distal femur or proximal tibia, and is characterized by numerous osteoclast-like giant cells.
Osteosarcoma (a): Most commonly arises in the **metaphysis** (the flared end of the shaft next to the growth plate).
Ewing sarcoma (d): Most commonly arises in the **diaphysis** (the shaft) of long bones or in flat bones.
**Thinking Approach:**
Identify the Core Topic: Anatomic location of primary bone tumors.
Recall the Location Mnemonic:
Ewing: Extends down the **Diaphysis**.
Osteosarcoma: **Metaphysis**.
Giant Cell Tumor: **Epiphysis**.
Match the Question (Epiphysis): The epiphysis belongs to the Giant Cell Tumor.
Select the Best Fit: Giant cell tumor.
Question 20
Q20. Rodent ulcer occur due to:
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Correct Answer: (a) Basal cell carcinoma
Relevant Chapter: 75. Dermatopathology
Explanation and Thinking Approach:
A **Rodent Ulcer** is the common clinical term used to describe a subtype of **Basal Cell Carcinoma ($\text{BCC}$)**, particularly the nodular or ulcerative form.
**Clinical Appearance**: It typically presents as a slowly enlarging nodule on sun-exposed skin that eventually develops a central ulceration and rolled, pearly borders, often resembling a gnawed or "rodent-eaten" lesion.
The term is thus synonymous with a presentation of **Basal Cell Carcinoma ($\text{BCC}$)**. Burns, tuberculosis, and syphilis can cause ulcers, but those ulcers are not referred to by the specific term "Rodent Ulcer."
**Thinking Approach:**
Identify the Core Topic: Clinical/Pathology term for a specific ulcer.
Recall the Terminology: In dermatology/pathology, "Rodent Ulcer" is a classic term used for a malignant condition.
Link the Name: Rodent Ulcer = **Basal Cell Carcinoma** (the nodular/ulcerative type).
Select the Best Fit: Basal cell carcinoma.
Question 21
Q21. Caplan syndrome is seen in
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Correct Answer: (b) Pneumoconiosis
Relevant Chapter: 50. Restrictive lung diseases (Pneumoconioses)
Explanation and Thinking Approach:
**Caplan Syndrome** (also known as rheumatoidal pneumoconiosis) is a rare condition defined by the presence of multiple, firm, spherical nodules in the lungs of patients who have rheumatoid arthritis ($\text{RA}$) and concurrent **pneumoconiosis** (lung disease caused by inhalation of mineral dust, especially coal dust—called coal worker's pneumoconiosis or "black lung").
The syndrome represents a hypersensitivity reaction driven by the $\text{RA}$ in response to the inhaled dust.
It is not seen in $\text{COPD}$, edema, or asthma.
**Thinking Approach:**
Identify the Core Topic: The specific medical syndrome: Caplan Syndrome.
Recall the Association: Caplan Syndrome is a famous connection between two separate diseases: Rheumatoid Arthritis + **Pneumoconiosis**.
Evaluate Options: Look for the term that represents lung disease caused by inhaled dust.
Pneumoconiosis: Correct, this is the defining environmental component.
$\text{COPD}$, Edema, Asthma: Incorrect; these are different classes of lung disease.
Select the Best Fit: Pneumoconiosis.
Question 22
Q22. Earliest lesion in asbestosis is:
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Correct Answer: (a) Pleural Plaques
Relevant Chapter: 50. Restrictive lung diseases (Asbestosis/Pneumoconioses)
Explanation and Thinking Approach:
Asbestosis is lung fibrosis caused by inhaling asbestos fibers. The effects of asbestos are divided into benign and malignant.
**Pleural Plaques**: These are localized, non-malignant, white-gray areas of thickened, hyalinized collagen that form on the parietal pleura. Crucially, they are the most common manifestation of asbestos exposure and are usually the **first radiological sign (earliest lesion)** to appear, often decades before more serious conditions like fibrosis (asbestosis) or mesothelioma develop.
Pulmonary carcinoma (c) and Mesothelioma (d): These are malignant long-term complications, not the earliest lesion.
Hilar lymphadenopathy (b): This finding is more characteristic of Silicosis than Asbestosis.
**Thinking Approach:**
Identify the Core Topic: Asbestos exposure and its manifestations.
Recall the Stages/Timeline: What happens first after exposure?
Recall the Most Common Finding: The hallmark of asbestos exposure is the benign, often asymptomatic, **Pleural Plaque**.
Evaluate Options:
Pleural Plaques: Correct, the earliest and most common sign of exposure.
Malignancies: Occur much later.
Lymphadenopathy: More typical of other pneumoconioses.
Select the Best Fit: Pleural Plaques.
Question 23
Q23. Wilm's tumor is associated with all except:
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Correct Answer: (d) Bilateral polycystic kidney
Relevant Chapter: 64. Kidney tumors
Explanation and Thinking Approach:
**Wilms Tumor (Nephroblastoma)** is the most common primary renal tumor of childhood. It is associated with several congenital syndromes and features:
**WAGR Syndrome**: Wilms tumor, Aniridia, Genitourinary anomalies, and mental Retardation. (Includes (b) Aniridia)
**Beckwith-Wiedemann Syndrome ($\text{BWS}$)**: Associated with Wilms tumor and **Hemihypertrophy (a)** (one side of the body grows larger than the other).
**Hypertension (c)**: Often occurs in Wilms tumor due to the tumor secreting renin (or compressing renal vessels), which activates the Renin-Angiotensin-Aldosterone System ($\text{RAAS}$).
**Bilateral polycystic kidney (d)**: This is a separate genetic or developmental disorder of the kidney (e.g., Autosomal Dominant Polycystic Kidney Disease - $\text{ADPKD}$) and is **NOT** associated with the pathogenesis or clinical presentation of Wilms tumor.
**Thinking Approach:**
Identify the Core Topic: Associations with Wilms Tumor (Nephroblastoma).
Recall the Key Syndromes/Features: $\text{WAGR}$ and $\text{BWS}$ (Aniridia, Hemihypertrophy), and the common clinical symptom (Hypertension).
Evaluate Options (Check for associations):
a) Hemihypertrophy: Yes ($\text{BWS}$).
b) Aniridia: Yes ($\text{WAGR}$).
c) Hypertension: Yes (due to renin).
d) Bilateral polycystic kidney: **Not associated** with Wilms tumor.
Select the **EXCEPT** Answer: Bilateral polycystic kidney.
Question 24
Q24. Malignant hypertension is seen in
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Correct Answer: (b) Malignant nephrosclerosis
Relevant Chapter: 63. Renal involvement in systemic diseases (Covers Hypertension/Sclerosis)
Explanation and Thinking Approach:
**Malignant Hypertension** is a rapid, severe elevation of blood pressure (usually >200/120 $\text{mmHg}$) associated with end-organ damage.
**Malignant Nephrosclerosis (b)**: This term is used to describe the renal pathology that results from malignant hypertension. The kidney shows characteristic changes like **fibrinoid necrosis** of the arterioles and hyperplastic arteriolosclerosis (onion-skinning). Therefore, malignant hypertension causes, and is defined by, malignant nephrosclerosis.
$\text{RPGN}$ (a) and $\text{IgA}$ Nephropathy (c): These are types of primary glomerulonephritis. While they can cause secondary hypertension, they are not the classic name for the pathology associated with malignant hypertension.
Acute pyelonephritis (d): An acute bacterial infection of the kidney, not directly linked to malignant hypertension.
**Thinking Approach:**
Identify the Core Topic: Pathology associated with Malignant Hypertension.
Recall the Terminology: Malignant Hypertension leads to rapid, severe damage to small blood vessels (arterioles) throughout the body, including the kidney.
Recall the Pathology Term: The term for severe kidney damage due to hypertension is **Nephrosclerosis**. The severe form is called **Malignant Nephrosclerosis**.
Select the Best Fit: Malignant nephrosclerosis.
Question 25
Q25. Most common cause of abdominal aortic aneurysm is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2025)
Correct Answer: (a) Atherosclerosis
Relevant Chapter: 44. Blood vessels - Sclerosis (Covers Atherosclerosis)
Explanation and Thinking Approach:
An Aneurysm is a localized abnormal dilation of a blood vessel or the heart.
**Abdominal Aortic Aneurysm ($\text{AAA}$)** is the most frequent type of aneurysm. Its pathogenesis is overwhelmingly linked to severe weakening of the aortic wall, primarily caused by **Atherosclerosis**. The chronic inflammation, enzymatic degradation, and atrophy of the media associated with long-standing atherosclerosis cause the arterial wall to thin and balloon out.
Syphilis (b): Used to be a common cause of Thoracic Aortic Aneurysms (involving the ascending aorta), but it is a rare cause of $\text{AAA}$.
Trauma (c) and Congenital (d): These are rare causes.
**Thinking Approach:**
Identify the Core Topic: Etiology (cause) of Abdominal Aortic Aneurysm ($\text{AAA}$).
Recall the Epidemiology: What is the most common degenerative disease affecting major arteries in the elderly? **Atherosclerosis**.
Link Disease to Aneurysm: Atherosclerosis weakens the wall of the aorta, leading directly to the formation of $\text{AAA}$.
Select the Best Fit: Atherosclerosis.
Question 26
Q26. Commonest histological finding in benign hypertension is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2025)
Correct Answer: (c) Hyaline arteriolosclerosis
Relevant Chapter: 44. Blood vessels - Sclerosis
Explanation and Thinking Approach:
**Benign (Chronic) Hypertension**: This long-standing, gradual elevation in blood pressure leads to structural changes in small arteries and arterioles.
**Hyaline Arteriolosclerosis**: This is the most characteristic and common change. Plasma proteins leak into the arteriolar walls, causing them to thicken and appear pink and homogenous (**hyaline**) on $\text{H\&E}$ stain. This change reduces the vascular lumen, contributing to chronic tissue ischemia (e.g., benign nephrosclerosis in the kidney).
Necrotising arteriolitis (b): This is the hallmark of **Malignant** (accelerated) hypertension.
Proliferating endarteritis (a): Not typically associated with hypertension; seen in other inflammatory conditions.
Cystic medial necrosis (d): Associated with dissecting aneurysms of the aorta (e.g., in Marfan syndrome).
**Thinking Approach:**
Identify the Core Topic: Histology of blood vessels in Benign Hypertension.
Distinguish Benign vs. Malignant:
Malignant $\to$ Necrosis (Necrotizing Arteriolitis).
Benign $\to$ Hyaline (**Hyaline Arteriolosclerosis**).
Recall the Common Finding: The most frequent, non-lethal change from chronic pressure is the hyaline thickening.
Select the Best Fit: Hyaline arteriolosclerosis.
Question 27
Q27. Backwash ileitis is seen in:
AIIMS DEOGHAR PROF-2 PAPER 2 (2025)
Correct Answer: (b) Ulcerative colitis
Relevant Chapter: 56. Inflammatory bowel disease
Explanation and Thinking Approach:
**Backwash Ileitis**: This is a condition where inflammation extends from the colon into the terminal ileum in patients with severe, extensive **Ulcerative Colitis ($\text{UC}$)**, even though $\text{UC}$ classically affects only the colon and rectum. The name suggests the inflammation "washes back" into the ileum.
Crohn's Disease (a): Crohn's disease commonly affects the terminal ileum (called ileitis), but this is due to its primary, often segmental, transmural inflammation, not the "backwash" phenomenon.
**Thinking Approach:**
Identify the Core Topic: Specific pathological patterns in Inflammatory Bowel Disease ($\text{IBD}$).
Recall the Location Rules for $\text{IBD}$:
$\text{UC}$: Colon-only (continuous), but exception is **Backwash Ileitis**.
Crohn's: Any part of the $\text{GI}$ tract (patchy/skip lesions), most common in terminal ileum.
Link the Term: "Backwash Ileitis" is the key term linked to the exception in Ulcerative Colitis.
Select the Best Fit: Ulcerative colitis.
Question 28
Q28. All are true about carcinoid syndrome except:
AIIMS DEOGHAR PROF-2 PAPER 2 (2025)
Correct Answer: (d) Splenomegaly
Relevant Chapter: 55. Intestinal disorders (Carcinoid/Neuroendocrine tumors)
Explanation and Thinking Approach:
**Carcinoid Syndrome** is a paraneoplastic syndrome caused by the release of vasoactive substances (e.g., serotonin, bradykinin) by functional Carcinoid Tumors (Neuroendocrine tumors), usually after metastasis to the liver.
The classic clinical triad is:
**Flushing (c)**: Episodic deep reddening of the skin.
**Diarrhea**: Due to increased motility.
**Bronchospasm/Wheezing (a)**: Due to bronchoconstriction.
In advanced, long-standing cases, the circulating mediators can cause fibrous thickening of the endocardium, leading to heart valve damage, most commonly **Pulmonary Valve Stenosis and tricuspid regurgitation (b)**.
**Splenomegaly (d)**: Enlargement of the spleen is **NOT** a typical or defining feature of Carcinoid Syndrome.
**Thinking Approach:**
Identify the Core Topic: Clinical features of Carcinoid Syndrome.
Recall the Triad/Cardiac Complication: Flushing, Diarrhea, Wheezing, and Right-sided heart failure/Pulmonary Stenosis.
Evaluate Options:
a, b, c: All are true features of the syndrome.
d) Splenomegaly: **False**. This is characteristic of other conditions (e.g., portal hypertension, hematologic disorders), but not carcinoid syndrome.
Select the **EXCEPT** Answer: Splenomegaly.
Question 29
Q29. Bone tumor arising from epiphysis is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2025)
Correct Answer: (d) Giant cell tumor
Relevant Chapter: 76. Bone and soft tissue lesions
Explanation and Thinking Approach:
This is a repeat of Question 19, confirming the importance of anatomic location for bone tumors.
**Epiphysis**: The end of a long bone, near the joint.
**Giant Cell Tumor (d)**: Classically arises in the **epiphysis** of long bones (e.g., distal femur, proximal tibia).
Osteogenic Sarcoma (a) (Osteosarcoma): Most commonly arises in the **metaphysis**.
Ewing Sarcoma (b): Most commonly arises in the **diaphysis** (shaft).
Chondrosarcoma (c): Highly variable, but often occurs in the medullary cavity of the pelvis, shoulder, or ribs, or the metaphysis of long bones—not the classic epiphyseal tumor.
**Thinking Approach:**
Identify the Core Topic: Anatomic location of primary bone tumors (Epiphysis).
Recall the Mnemonic: Giant Cell Tumor $\to$ **Epiphysis**.
Select the Best Fit: Giant cell tumor.
Question 30
Q30. Primary biliary cirrhosis is positive for:
AIIMS DEOGHAR PROF-2 PAPER 2 (2025)
Correct Answer: (d) Anti-mitochondrial antibody
Relevant Chapter: 58. Liver Pathology: Part 1
Explanation and Thinking Approach:
**Primary Biliary Cholangitis ($\text{PBC}$)** (formerly Primary Biliary Cirrhosis) is a chronic, progressive autoimmune liver disease characterized by the destruction of small intrahepatic bile ducts.
**Anti-Mitochondrial Antibodies ($\text{AMA}$)**: This is the single most important and characteristic serological marker for $\text{PBC}$. $\text{AMA}$ is highly sensitive and specific, typically present in over 90% of patients.
$\text{p-ANCA}$ (a): Associated with Primary Sclerosing Cholangitis ($\text{PSC}$) and some forms of vasculitis.
Anti-nuclear antibody ($\text{ANA}$) (b): Associated with Autoimmune Hepatitis.
Anti-microsomal antibody (c) ($\text{Anti-TPO}$): Associated with Hashimoto thyroiditis.
**Thinking Approach:**
Identify the Core Topic: Serological markers for Autoimmune Liver Disease ($\text{PBC}$).
Recall the Specific Marker: $\text{PBC}$ has one of the strongest, most specific antibody associations in pathology.
Link Disease to Antibody: Primary Biliary $\to$ **Mitochondrial ($\text{AMA}$)**.
Select the Best Fit: Anti-mitochondrial antibody.
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