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Question 1
Q1. A 5-year-old boy following intramuscular injection develops painful swelling on right gluteal region over 4 days. Aspirate on microscopy shows numerous neutrophils. Pain is experienced by this patient is predominantly due to which of these chemical mediators?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Prostaglandin E₂ and bradykinin.
Relevant Chapter: 7. Mediators of inflammation
Explanation and Thinking Approach:
Pain in acute inflammation is classically mediated by bradykinin (powerful pain stimulant) and prostaglandins (especially PGE}_2 which sensitizes nociceptors). The aspirate with many neutrophils indicates acute suppurative inflammation in which these mediators produce the predominant pain.
Why others are less likely: Complement C3b/C2b (b) are opsonins—they help phagocytosis, not pain. Histamine/serotonin (c) cause vasodilation and increased permeability and contribute to itching/vasodilation rather than the primary painful sensation here. Leukotriene B4/E4 (d) are mainly chemotactic {LTB}_4 and bronchoconstrictive/permeability modulators {LTE}_4, not the main pain mediators.
Question 2
Q2. A 51-year-old male has long standing history of an inflammatory disease, Rheumatoid arthritis. On routine examination his blood investigation showed anaemia. Which of these acute phase reactants may be responsible for his anaemia?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) Hepcidin.
Relevant Chapter: 26. Peripheral smear examination (RBC disorders)
Explanation and Thinking Approach:
Anaemia of chronic disease (in inflammatory conditions like long-standing rheumatoid arthritis) is mediated by hepcidin (an acute phase protein) which decreases iron release from macrophages and decreases intestinal iron absorption causing functional iron deficiency.
Why others are less likely: CRP (a) and Serum amyloid A (d) are acute phase reactants but do not cause iron sequestration directly. Fibrinogen (b) contributes to ESR elevation and clotting but is not the principal mediator of anaemia of chronic disease.
Question 3
Q3. During process of repair, which of these substances is essential for procollagen fibers to transform into collagen fibers?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) Ascorbic acid (vitamin C).
Relevant Chapter: 8. Wound healing and Tissue repair
Explanation and Thinking Approach:
Hydroxylation of proline and lysine residues in procollagen (required for stable triple helix formation and subsequent cross-linking into mature collagen) is vitamin C–dependent. Without vitamin C you get defective collagen to scurvy.
Why others are less likely: Cortisone (a) inhibits collagen synthesis; carotene (b) and prothrombin (d) are unrelated to procollagen hydroxylation.
Question 4
Q4. Process by which inflammatory cells are positively moves towards the focus of tissue injury is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (b) Chemotaxis.
Relevant Chapter: 5. Acute inflammation
Explanation and Thinking Approach:
Directed movement of inflammatory cells towards the site of injury is chemotaxis.
Why others are less likely: Anaphylaxis (a) is a systemic type I hypersensitivity reaction; complement fixation (c) is an immune activation event; phagocytosis (d) is ingestion of microbes/debris, not the directed migration step.
Question 5
Q5. Type of amyloid protein seen in patients with long term hemodialysis is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (b) beta_2-microglobulin.
Relevant Chapter: 23. Amyloidosis
Explanation and Thinking Approach:
Dialysis-associated amyloidosis (seen after long-term hemodialysis) is caused by deposition of beta_2-microglobulin in bone and joints.
Why others are less likely: ATTR (a) = transthyretin amyloid (familial/age-related cardiomyopathy), beta-amyloid (c) is neuronal Alzheimer plaque, AL (d) is light-chain amyloid from plasma-cell dyscrasias.
Question 6
Q6. An autopsy on a 65-year-old male revealed tree bark appearance in intima of aorta. Disease which caused this lesion is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Tertiary syphilis.
Relevant Chapter: 44. Blood vessels - Sclerosis
Explanation and Thinking Approach:
“Tree-bark” appearance of the aortic intima results from chronic endarteritis of vasa vasorum in tertiary syphilis (syphilitic aortitis).
Why others are less likely: Atherosclerosis (b) causes intimal plaques and calcification but not the classic tree-bark pattern; rheumatic fever (c) and infective endocarditis (d) primarily affect valves, not cause the described aortic intimal change.
Question 7
Q7. Which of the following is a labile cell?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (d) Enterocyte.
Relevant Chapter: 1. Cell adaptations
Explanation and Thinking Approach:
Labile cells continuously proliferate throughout life—examples: surface epithelium, bone marrow cells, and intestinal mucosal epithelium (enterocytes).
Why others are less likely: Cardiomyocytes (a) and neurons (b) are permanent cells (do not normally divide). Hepatocytes (c) are stable cells—quiescent but able to proliferate after injury (not continuously dividing).
Question 8
Q8. A 30-year-old male had abdominal pain and frequent diarrhea. He had mild tenderness in right iliac fossa. One week prior he had been to local fair where he had a meal. His stool sent for examination showed red blood cells, Charcot-Leyden crystals and eosinophils. Intestinal biopsy will most likely show:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (d) Flask-shaped ulcers.
Relevant Chapter: 55. Intestinal disorders
Explanation and Thinking Approach:
Flasks-shaped ulcers are characteristic of Entamoeba histolytica intestinal infection; Charcot-Leyden crystals and eosinophils + RBCs in stool fit an invasive protozoal colitis.
Why others are less likely: Ulceration in Peyer’s patches (a) is more typhoid; non-caseating granuloma (b) suggests Crohn disease; ischemic ulcer (c) would be in ischemia and lacks the parasitic features described.
Question 9
Q9. A 12-year-old boy presented with fever and sore throat of two days duration. On examination there was mild cervical lymphadenopathy. Peripheral blood smear of child showed lymphocytes with typical lymphocytosis. Heterophile antibody reaction was positive. What is an acute complication of this disease?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (d) Splenic rupture.
Relevant Chapter: 35. Hodgkin's lymphoma (General Hematology/Spleen)
Explanation and Thinking Approach:
Infectious mononucleosis (EBV; heterophile positive with atypical lymphocytes) can lead to splenic enlargement and rarely spontaneous splenic rupture—a recognized acute complication.
Why others are less likely: Bone-marrow failure (a) and Burkitt lymphoma (b) are not typical acute complications; cerebral abscess (c) is not a classical complication here.
Question 10
Q10. Which of these is an antigen presenting cells:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Dendritic cells.
Relevant Chapter: 19. Immunity - Types of immune cells
Explanation and Thinking Approach:
Classical professional antigen-presenting cells (APCs) that initiate T cell responses are dendritic cells.
Why others are less likely: Neutrophils (b) are phagocytes (not APCs), NK cells (c) are cytotoxic innate effectors, lymphocytes (d) are adaptive effector or regulatory cells but not the primary tissue APC.
Question 11
Q11. The ubiquitin–proteasome pathway is responsible for:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Degradation of cellular proteins.
Relevant Chapter: 1. Cell adaptations (General metabolism)
Explanation and Thinking Approach:
The ubiquitin–proteasome pathway tags proteins with ubiquitin for regulated proteasomal degradation (clearance of misfolded/short-lived regulatory proteins). This is its central role (it also generates peptides used in MHC class I presentation, but the canonical function is proteolysis).
Why others are less likely: Antigen presentation (b) can involve peptides produced by this pathway (secondary effect), protein synthesis (c) is a ribosomal process, apoptosis (d) is a cell death process (the pathway contributes regulatory steps but the primary biochemical role is proteolysis).
Question 12
Q12. Carcinogenesis induced by Ultraviolet light is due to:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (b) Formation of pyrimidine dimers in DNA.
Relevant Chapter: 11. Types of carcinogenesis
Explanation and Thinking Approach:
UV-B causes covalent crosslinking of adjacent pyrimidine bases (thymine dimers) leading to mutagenesis and skin carcinogenesis.
Why others are less likely: Inhibition of apoptosis (a) or inactivation of tumor suppressors (d) can be downstream consequences but the direct DNA lesion is pyrimidine dimer formation; increased pro-growth signaling (c) is not the primary UVB mechanism.
Question 13
Q13. Which of the following is called the 'Wear and tear pigment'?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Lipofuscin.
Relevant Chapter: 4. Intracellular accumulations
Explanation and Thinking Approach:
Lipofuscin is the classic “wear-and-tear” pigment (age-related, peroxidation of membrane lipids).
Why others are less likely: Carbon (b) = anthracotic pigment from inhaled particulate; melanin (c) = skin pigment; hemosiderin (d) = iron pigment from hemorrhage/iron overload.
Question 14
Q14. A 65 year old male recently had an aortic valve replacement, following which his hemoglobin is decreased and blood smear shows presence of schistocytes and polychromatic cells. The likely cause of anemia in this patient is:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (b) Mechanical disruption of red cells.
Relevant Chapter: 29. Hemolytic anemia: Part 1
Explanation and Thinking Approach:
A patient with a prosthetic aortic valve who develops anemia with schistocytes (fragmented RBCs) has mechanical hemolysis from the prosthesis (microangiopathic/mechanical fragmentation). The presence of polychromasia reflects increased reticulocytes (bone marrow response).
Why others are less likely: Autoimmune hemolytic anemia (a) tends to show spherocytes and positive direct Coombs test. Paroxysmal cold hemoglobinuria (c) has cold-reactive complement hemolysis pattern and is uncommon after valve replacement. Blood loss (d) from surgery would not produce schistocytes as the main peripheral smear feature.
Question 15
Q15. A 15-year-old girl has pallor and jaundice. Her peripheral smear shows presence of spherocytes. Which of the following investigation is most relevant to arrive at a diagnosis?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (b) Osmotic fragility test.
Relevant Chapter: 29. Hemolytic anemia: Part 1
Explanation and Thinking Approach:
Spherocytes on a peripheral smear suggest either hereditary spherocytosis (HS) or autoimmune hemolytic anemia; the osmotic fragility test (or eosin-5′-maleimide binding test in modern practice) is classically used to detect HS (increased fragility).
Why others are less likely: A reticulocyte count (a) would show hemolysis but is not diagnostic; HPLC (c) and Hb electrophoresis (d) are for hemoglobinopathies (sickle cell/thalassemias) and are not diagnostic for spherocytosis. (Note: in modern practice a Direct Antiglobulin (Coombs) test is necessary to separate immune vs hereditary causes — but among listed options, osmotic fragility is the most specific for hereditary spherocytosis.)
Question 16
Q16. A 70-year-old female has splenomegaly and pancytopenia. Peripheral smear shows rouleaux formation, with many plasma cells. Russell bodies, flame cells and occasional plasmablasts. Which interleukin plays a major role in the pathogenesis of this condition?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) IL-6.
Relevant Chapter: 37. Plasma cell disorders
Explanation and Thinking Approach:
Multiple myeloma (plasmacytosis with Russell bodies, flame cells, mott cells) is driven in large part by interleukin-6 (IL-6), which acts as a major growth and survival factor for malignant plasma cells.
Why others are less likely: IL-1 (a) is a proinflammatory cytokine but not the dominant plasma-cell growth factor. IL-5 (b) is important for eosinophil growth/differentiation. IL-12 (d) promotes Th1 responses and NK activation, not plasma-cell proliferation.
Question 17
Q17. 'Rolling' of leukocytes in cellular events of inflammation is mediated by:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Selectins.
Relevant Chapter: 7. Mediators of inflammation
Explanation and Thinking Approach:
Rolling of leukocytes along the endothelium is mediated by selectins (E-selectin, P-selectin, L-selectin) binding carbohydrate ligands.
Why others are less likely: Chemokines (b) activate integrins to effect firm adhesion; prostaglandins (c) are inflammatory mediators but not the molecular basis of rolling; integrins (d) mediate firm adhesion and transmigration (post-rolling).
Question 18
Q18. A 68-year-old male has splenomegaly and pancytopenia. Peripheral smear shows presence of 40% lymphoid cells with 'hairy' cytoplasmic projections. Bone marrow biopsy shows characteristic 'fried egg appearance'. Which marker will be most helpful in this case?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Tartrate-resistant acid phosphatase (TRAP).
Relevant Chapter: 33. Acute myeloid leukemia (Hairy Cell Leukemia)
Explanation and Thinking Approach:
The described picture—splenomegaly, pancytopenia, circulating lymphoid cells with “hairy” cytoplasmic projections and “fried egg” marrow appearance—is Hairy Cell Leukemia (HCL), which classically shows TRAP positivity (tartrate-resistant acid phosphatase).
Why others are less likely: Chloroacetate esterase (b) is a myeloid marker (neutrophil/monocyte granules); isocitrate dehydrogenase (c) is a metabolic enzyme not used diagnostically here; leukocyte alkaline phosphatase (d) is used in differentiating leukemoid reaction from CML (not hairy cell).
Question 19
Q19. A 58-year-old male with chronic renal disease was on long term dialysis. This patient is likely to develop
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (b) Iron deficiency anemia.
Relevant Chapter: 27. Microcytic hypochromic anemias
Explanation and Thinking Approach:
Patients on long-term hemodialysis commonly develop anemia of CKD (low EPO), and iron deficiency is frequent due to repeated blood loss from the dialysis circuit, frequent phlebotomy, and poor iron intake/absorption—so iron deficiency anemia is a likely complication in long-term dialysis patients.
Why others are less likely: Sideroblastic anemia (a) is classically due to isoniazid/lead or genetic defects—not typical of dialysis. Microangiopathic hemolytic anemia (c) is due to mechanical RBC fragmentation in TTP/HUS or prosthetic valves, not a standard consequence of dialysis. Megaloblastic anemia (d) can occur (folate loss during dialysis) but epidemiologically iron deficiency and EPO deficiency are more common overall in dialysis populations.
Question 20
Q20. Platelet concentrate for blood donation is stored at:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) 22 to 24 °C.
Relevant Chapter: 40. Blood banking and Transfusion medicine
Explanation and Thinking Approach:
Platelet concentrates are stored at room temperature with continuous gentle agitation (generally 20-24•C) to preserve platelet function and circulation time. The listed choice (c) is the intended standard 20-24 storage.
Why others are less likely: 2-6 (a) is for red cells; -70 (d) is used for frozen plasma/long-term frozen components, not platelets.
Question 21
Q21. A 70 year old male of 45 kg weight came for donating blood. He gives history of hypertension, on regular antihypertensive drug. He also gives history of taking lipid lowering drug and low dose aspirin. He was rejected for blood donation. What is reason for his rejection?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Low weight.
Relevant Chapter: 40. Blood banking and Transfusion medicine
Explanation and Thinking Approach:
Most blood donation guidelines set a minimum donor weight (commonly 50 kg in many countries). A 45-kg donor falls below the usual safe threshold and is an exclusion for whole blood donation due to low weight.
Why others are less likely: Antihypertensive drugs (b) and lipid-lowering drugs (c) are not a routine exclusion if BP is controlled. Low-dose aspirin (d) is usually not an exclusion for whole blood donation.
Question 22
Q22. Cell death due to chemotherapy occurs mainly by:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) Apoptosis.
Relevant Chapter: 3. Cell death
Explanation and Thinking Approach:
Many chemotherapeutic agents (DNA-damaging drugs, antimetabolites, etc.) lead to programmed cell death (apoptosis) by damaging DNA and activating intrinsic/extrinsic apoptosis pathways. This is a controlled cell-death program (nuclear condensation, DNA laddering) rather than chaotic necrosis.
Why others are less likely: Coagulative (a) and liquefactive (b) necroses and infarction (d) are forms of necrosis or tissue death seen with ischemia/infection; chemo preferentially triggers apoptosis at the cellular level.
Question 23
Q23. A 30-year-old lady presented with abdominal pain of 1 month duration. She works in a printing press for last 8 years. On general examination, bluish line was noted on the gums. What is the most likely diagnosis?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Lead poisoning.
Relevant Chapter: 4. Intracellular accumulations (Exogenous pigments)
Explanation and Thinking Approach:
A bluish/black line on the gingiva (Burton’s line) with occupational exposure (printing inks historically contained lead) suggests chronic lead poisoning (plumbism). Abdominal pain also fits lead colic.
Why others are less likely: Other heavy metals/conditions do not classically produce a Burton’s line; the occupational history points to lead.
Question 24
Q24. A 5-year-old boy with Down syndrome is prone to develop which of these acute myeloid leukemia subtypes?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (d) Megakaryocytic.
Relevant Chapter: 33. Acute myeloid leukemia
Explanation and Thinking Approach:
Children with Down syndrome are at increased risk of acute megakaryoblastic leukemia (AMKL / M7), particularly in infancy and early childhood (also transient abnormal myelopoiesis in neonates).
Why others are less likely: Promyelocytic (a; M3) is not specifically linked to Down syndrome; monocytic (b; M5) and erythroid (c; M6) subtypes are possible AML subtypes but megakaryocytic is the classic association in young Down children.
Question 25
Q25. A 3-year-old boy was given primaquine for radical cure of plasmodium vivax malaria. He developed pallor, jaundice and complained of abdominal pain and dark coloured urine. On investigation he had Hb 10 gm/dL, TLC 4200/cmm, platelet 2.0 lakh/cmm. Hemoglobinuria and hemoglobinemia positive. Examination of the peripheral blood smear will reveal:
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) Bite cells.
Relevant Chapter: 30. Hemolytic anemia: Part 2
Explanation and Thinking Approach:
Oxidant drugs like primaquine precipitate hemolysis in G6PD-deficient individuals to hemoglobin denatures to form Heinz bodies; splenic macrophages “bite” out these inclusions producing bite (keratocyte) cells and blister cells. Hemoglobinuria/hemoglobinemia and acute dark urine fit intravascular/extravascular hemolysis following oxidant exposure.
Why others are less likely: Target cells (b) occur with hemoglobinopathies/thalassemia or liver disease; crenated cells (c) are due to osmotic shrinkage/artifact; flame cells (d) refer to plasma cell morphology (not RBCs).
Question 26
Q26. Which of the following is involved in the pathogenesis of myeloproliferative disorders?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (a) JAK/STAT signal transduction pathway.
Relevant Chapter: 34. Myeloid disorders
Explanation and Thinking Approach:
Classical myeloproliferative neoplasms (MPNs) (polycythemia vera, essential thrombocythemia, primary myelofibrosis) are frequently associated with activating mutations in JAK2 (e.g., V617F) to constitutive JAK/STAT signaling driving proliferation.
Why others are less likely: RAS (b), Notch (c), and BRAF (d) pathways are important in other neoplasms (e.g., RAS in many cancers, Notch in T-ALL, BRAF in melanoma/colon) but JAK/STAT is the canonical pathway for classical MPNs.
Question 27
Q27. 57-year-old male is diagnosed with lepromatous leprosy. Which of the following changes do you expect in testis?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) Testicular atrophy.
Relevant Chapter: 66. Testis
Explanation and Thinking Approach:
Lepromatous leprosy frequently involves testicular tissue causing atrophy and reduced fertility (the bacilli invade testicular interstitium and destroy Leydig tissue).
Why others are less likely: Testicular tumor (b) is not a feature of leprosy; dysgenetic changes (d) refer to developmental anomalies not caused by infection; “no changes” (a) is incorrect since testicular involvement is common in LL.
Question 28
Q28. Choose the correct association:
(i) Acanthosis nigricans - (v) Small cell carcinoma lung
(ii) Cushing's syndrome - (vi) Squamous cell carcinoma lung
(iii) Myasthenia gravis - (vii) Gastric carcinoma
(iv) Hypercalcemia - (viii) Thymoma
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) i-vii, ii-v, iii-viii, iv-vi (Based on the correct pairings)
Relevant Chapter: 12. Hallmarks of neoplasia (Paraneoplastic Syndromes)
Explanation and Thinking Approach:
The correct associations between paraneoplastic syndromes and their primary tumors are:
(i) Acanthosis nigricans to (vii) Gastric carcinoma (most common underlying malignancy).
(ii) Cushing's syndrome (Ectopic ACTH) to (v) Small cell carcinoma of lung (classic cause of ectopic ACTH).
(iii) Myasthenia gravis to (viii) Thymoma (paraneoplastic condition via autoantibodies against the ACh receptor).
(iv) Hypercalcemia (due to PTHrP) to (vi) Squamous cell carcinoma of lung (most common malignant cause of hypercalcemia).
Option (c) represents these correct pairings.
Question 29
Q29. Breast changes after a lady gives birth child is made possible by which of the following processes?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (d) Lobular hyperplasia.
Relevant Chapter: 70. Breast Pathology
Explanation and Thinking Approach:
Lactation (milk production) after childbirth is made possible by lobulo-alveolar development (hyperplasia and differentiation of alveolar epithelial cells) under influence of prolactin and oxytocin—i.e., lobular hyperplasia and secretory differentiation.
Why others are less likely: Stromal hypertrophy (a) is not the lactational mechanism; epithelial dysplasia (b) is pathologic; ductal metaplasia (c) is not the process that creates secretory alveoli.
Question 30
Q30. A 25-year-old lady presents with gingival hypertrophy. Her peripheral smear shows marked leucocytosis with presence of 40% monocytoid cells and 35% blasts. Which cytochemical stain will be most useful in this condition?
AIIMS DEOGHAR PROF-2 PAPER 2 (2022)
Correct Answer: (c) Non-specific esterase.
Relevant Chapter: 33. Acute myeloid leukemia
Explanation and Thinking Approach:
The patient's presentation (gingival hypertrophy, sim 40\% monocytoid cells, 35\% blasts) is typical for Acute Monocytic Leukemia (AML M5). Monocytic leukemias react strongly with non-specific esterase (NSE) cytochemical stain.
Why others are less likely: Myeloperoxidase (a) and Sudan black B (b) mark myeloblasts/granulocytic lineage (myeloblasts), while PAS (d) highlights other cells (e.g., lymphoblasts/erythroleukemia)—but NSE is the most useful for monocytic differentiation.
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