Medical Pathology — MCQ ও উত্তর

মেডিকেল ভর্তি · । এই অধ্যায়ে মোট 99টি প্রশ্ন আছে। নিচে প্রথম 10টি প্রশ্ন ও সঠিক উত্তর দেওয়া হলো।

এই অধ্যায়ে সব প্রশ্নে অনুশীলন করুন

1. In contrast-induced nephropathy, the underlying pathogenic mechanism is best described as:

   1. Direct tubular toxicity and renal vasoconstriction
   2. Immune complex deposition
   3. Obstruction of renal tubules
   4. Increased glomerular filtration

   সঠিক উত্তর: Direct tubular toxicity and renal vasoconstriction

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Contrast-induced nephropathy (CIN) primarily results from direct tubular epithelial cell toxicity caused by contrast agents, leading to cellular injury. Additionally, renal vasoconstriction reduces renal blood flow, causing medullary ischemia and exacerbating tubular damage. These combined effects disturb renal function, manifesting as an acute decline in glomerular filtration rate. Immune-mediated or obstructive mechanisms are not the primary causes in CIN. Understanding this pathophysiology is crucial for prevention and management strategies. Reference: Harrison's Principles of Internal Medicine, Kasper et al., 20th Edition.

2. Surgical removal of the parathyroid glands can result in which condition?

   1. Hyperparathyroidism
   2. Hypoparathyroidism
   3. Hyperthyroidism
   4. Addison's disease

   সঠিক উত্তর: Hypoparathyroidism

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B Surgical removal of the parathyroid glands leads to a deficiency in parathyroid hormone (PTH), which is essential for calcium homeostasis. Without PTH, calcium levels drop, causing hypocalcemia and the clinical state known as hypoparathyroidism. This condition manifests with symptoms like muscle cramps and tetany due to low serum calcium. It is a common complication following thyroidectomy or parathyroidectomy if the glands are inadvertently removed or damaged. Therefore, preservation of the parathyroid glands during neck surgery is critical to prevent hypoparathyroidism. Reference: Harrison's Principles of Internal Medicine, J. Larry Jameson et al., 20th Edition.

3. A 45-year-old man with episodic headache, palpitations, and sweating, and elevated plasma metanephrines is most likely to have:

   1. Pheochromocytoma
   2. Addison's disease
   3. Hyperthyroidism
   4. Insulinoma

   সঠিক উত্তর: Pheochromocytoma

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A The patient’s episodes of headache, palpitations, and sweating alongside elevated plasma metanephrines strongly indicate pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla. Plasma metanephrines are the most sensitive diagnostic markers for pheochromocytoma. Key management involves preoperative alpha-adrenergic blockade to control hypertension and prevent intraoperative hypertensive crises, followed by surgical resection of the tumor. Early diagnosis and careful perioperative management are crucial to avoid life-threatening cardiovascular complications.Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.

4. The most common site for endometriosis is the:

   1. Ovaries
   2. Fallopian tubes
   3. Rectum
   4. Bladder

   সঠিক উত্তর: Ovaries

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Endometriosis most commonly affects the ovaries, where ectopic endometrial tissue forms cystic lesions called endometriomas. These lesions often cause inflammation, fibrosis, and adhesions, leading to chronic pelvic pain and infertility. During surgery, careful dissection of ovarian cysts and preservation of healthy ovarian tissue are critical to maintain fertility. The ovary’s rich blood supply and hormone responsiveness make it the predominant site for implantation and growth of endometrial implants. Identifying and excising ovarian endometriomas is a key surgical step to reduce symptoms and prevent recurrence.Reference: Williams Gynecology, Hoffman et al., 3rd Edition.

5. Which of the following is the pathological hallmark of Parkinson's disease?

   1. Lewy bodies
   2. Neurofibrillary tangles
   3. Amyloid plaques
   4. Pick bodies

   সঠিক উত্তর: Lewy bodies

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A The pathological hallmark of Parkinson's disease is the presence of Lewy bodies, which are intracellular inclusions composed primarily of alpha-synuclein protein. These abnormal aggregates disrupt normal neuronal function and are predominantly found in the substantia nigra, leading to the characteristic loss of dopaminergic neurons and the resulting motor symptoms of Parkinson's disease. Lewy bodies are key in distinguishing Parkinson's disease from other neurodegenerative disorders. Reference: Adams and Victor’s Principles of Neurology, Raymond Adams, 11th Edition.

6. Microglial nodules in the brain are most characteristic of:

   1. Viral encephalitis
   2. Bacterial meningitis
   3. Multiple sclerosis
   4. Alzheimer's disease

   সঠিক উত্তর: Viral encephalitis

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Microglial nodules are clusters of activated microglia found in the brain, primarily seen in response to viral infections. They represent the brain's innate immune response to infected and damaged neurons. These nodules are especially characteristic of viral encephalitis, where they form around sites of neuronal injury and viral replication. In contrast, bacterial infections typically cause neutrophilic inflammation in meningitis, and the pathology of multiple sclerosis or Alzheimer's disease does not prominently feature microglial nodules. Thus, the presence of microglial nodules is a key histopathological hallmark aiding in the diagnosis of viral encephalitis.Reference: Robbins Basic Pathology, Kumar, Abbas, Aster, 10th Edition.

7. The black discoloration seen in dry gangrene is primarily due to:

   1. Bacterial pigment production
   2. Breakdown of hemoglobin
   3. Melanin accumulation
   4. Iron deficiency

   সঠিক উত্তর: Breakdown of hemoglobin

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B The black discoloration in dry gangrene results from ischemic necrosis leading to the breakdown of hemoglobin within the affected tissues. As the tissue dies, red blood cells rupture and hemoglobin breaks down into dark pigments like hemosiderin and other iron-containing compounds, causing the characteristic black color. This is a hallmark of dry gangrene where there is no bacterial involvement or infection, differentiating it from wet gangrene. Recognizing this pigment change is important for surgical decision-making, especially in determining the viability of tissue and planning debridement or amputation. Reference: Robbins Basic Pathology, Kumar, Abbas, Aster, 10th Edition.

8. A hallmark feature of caseous necrosis is:

   1. Fibrinoid deposits
   2. Cheese-like gross appearance
   3. Liquefactive changes
   4. Fatty infiltration

   সঠিক উত্তর: Cheese-like gross appearance

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B Caseous necrosis is characterized by a distinctive cheese-like gross appearance due to the combination of dead cell debris and lipid material. This hallmark feature is commonly seen in granulomatous inflammation associated with tuberculosis. The affected tissue appears soft, white, and friable, resembling clumpy, cottage cheese. Unlike liquefactive necrosis, where the tissue is completely digested, caseous necrosis maintains a firm, amorphous structure. Recognizing this appearance is crucial during surgical biopsy and pathological examination for accurate diagnosis.Reference: Robbins Basic Pathology, Kumar, Abbas, Aster, 10th Edition.

9. The ideal thickness of a peripheral blood film is:

   1. Multiple layers of overlapping cells
   2. Very thick with clumps
   3. No cells visible
   4. A single layer of cells with minimal overlap

   সঠিক উত্তর: A single layer of cells with minimal overlap

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option D The ideal thickness of a peripheral blood film is a single layer of cells with minimal overlap because this allows for clear visualization and accurate morphological assessment of individual blood cells. Overlapping cells or thick areas cause misinterpretation of cell size, shape, and staining characteristics, leading to diagnostic errors. A well-prepared film ensures that each cell is distinct, enabling precise identification of abnormalities. This optimal thickness is crucial for reliable hematological evaluation and clinical decision-making. Reference: Clinical Hematology: Theory and Procedures, Mary Louise Turgeon, 6th Edition.

10. A high hemoglobin level (polycythemia) is most commonly associated with:

    1. Iron deficiency anemia
    2. Chronic kidney disease
    3. Tuberculosis of the spine (Pott's disease)
    4. Leukemia

    সঠিক উত্তর: Tuberculosis of the spine (Pott's disease)

    ব্যাখ্যা: সমাধান সঠিক উত্তর: Option C A high hemoglobin level (polycythemia) in tuberculosis of the spine (Pott's disease) is primarily due to chronic hypoxia caused by vertebral destruction and impaired respiratory mechanics. The body's compensatory response to prolonged low oxygen levels is to increase erythropoietin production, stimulating red blood cell production and raising hemoglobin. This adaptive mechanism distinguishes Pott's disease from other options where anemia or low hemoglobin is expected. Therefore, polycythemia in this condition reflects the body's effort to improve oxygen delivery despite compromised pulmonary function from spinal deformity.Reference: Harrison's Principles of Internal Medicine, Kasper et al., 20th Edition.