Previous year question on staining based on neet pg, usmle, plab and fmge or mci screening exams

A 30 year old male presents with itchy papulo-vesicular lesions on the extremities, knees, elbows and buttocks since one year. Direct immunofluorescence staining of the lesions showed IgA deposition at dermoepidermal junction. Which of the following represents the most probable diagnosis?

A: Pemphigus vulgarisB: Bullous pemphigoidC: Dermatitis herpetiformisD: Nummular eczema

Correct Ans:CExplanation

Patient is showing features of dermatitis herpetiformis. Dermatitis herpetiformis is a chronic, intensely itchy blistering disease characterized by the presence of papules and vesicles occurring predominantly on the extensor surfaces of the body such as the elbows, knees, buttocks and scapula. It is seen in association with gluten sensitive enteropathy.

Diagnosis is made by the presence of IgA deposits in the dermoepidermal junction by direct immunoflouresence examination of a perilesional or normal appearing skin biopsy sample. Treatment includes dapsone and gluten free diet.

Ref: NORD Guide to Rare Disorders: National Organization for Rare Disorders, Page 103; Atlas of Clinical Dermatology By Anthony Du Vivier, 3rd Edition, Pages 418, 426; Dermatology in Clinical Practice By S. W. Lanigan, Page 170

Sample Previous Year Question on Staining based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

Calcium deposits in tissues when stained with Hemotoxylin and Eosin (H/E) stain shows which of the following staining?

A: BasophilicB: EosinophilicC: Does not stain with H/E ainsD: Both eosinophilic and basophilicCorrect Ans:AExplanationHistologically, with the usual hematoxylin and eosin stain, calcium salts have a basophilic, amorphous granular, sometimes clumped appearance. Ref: Robbins 8th edition Chapter 1.


A 30-year-old man undergoes a lung biopsy, which shows multiple nodular lesions consisting of large epithelioid cells surrounded by lymphocytes and fibroblasts. There is an area of necrosis in the center of some nodules. Numerous acid-fast bacilli are demonstrated by Ziehl-Neelsen staining within the cytoplasm of epithelioid cells. Silver stains for fungi are negative. Which of the following is the MOST likely condition that predisposed the patient to this pulmonary disease?

A: Acquired immunodeficiency syndrome (AIDS)B: Common variable immunodeficiency

C: Cystic fibrosisD: Depressed level of consciousnessCorrect Ans:AExplanation

The lesion shown is a necrotizing granuloma developing as a result of infection by acid-fast bacilli (most likely mycobacteria). Granulomatous inflammation is a specialized form of chronic inflammation, which begins with the uptake of foreign antigens by macrophages. These cells process and present the antigen to helper T lymphocytes, which in turn activate macrophages by interferon-γ secretion. Granulomas may be due to infectious and noninfectious causes. Usually, infectious granulomas are necrotizing and non-infectious granulomas are non-necrotizing, but there are many exceptions to this rule. Among the infectious causes, mycobacterial infections are of the utmost importance, especially in patients with AIDS. Fungi may also cause granulomas, which may be of the necrotizing or non-necrotizing type. By definition, however, caseating necrosis is pathognomonic of mycobacterial infection.

Also know:Common variable immunodeficiency is one of the most common forms of congenital immune deficiency syndrome. It is due to inability of lymphocytes to mature into plasma cells. Consequently, levels of immunoglobulins are depressed, and patients suffer from depressed humoral immunity. Cell-mediated immunity (on which granuloma formation is largely dependent) is intact.

Cystic fibrosis predisposes to recurrent bronchopneumonia and development of bronchiectasis.

Depressed level of consciousness predisposes to aspiration of gastric contents and development of aspiration pneumonia. Sheets of macrophages are often observed, but not necrotizing granulomas (unless there are additional predisposing conditions, such as AIDS).

Ref: Chandrasoma P., Taylor C.R. (1998). Chapter 7. Deficiencies of the Host Response. In P. Chandrasoma, C.R. Taylor (Eds), Concise Pathology, 3e.


Which of the following procedures is used as a routine technique for karyotyping using light microscopy?

A: C- bandingB: G- bandingC: Q- bandingD: V- stainingCorrect Ans:BExplanation

Giemsa stain is the most commonly used staining method that allow identification of each individual chromosome, on the basis of a distinctive and reliable pattern of alternate light and dark bands along the length of the chromosome. Since giemsa stain is used, the procedure is called G banding.

Ref: Robbins Pathologic Basis of Disease, 6th Edition, Pages 165-6


Which of the following tumours have an increased elevation of placental alkaline phosphatase in the serum as well as a positive immunohistochemical staining for placental alkaline phosphatase ?

A: SeminomaB: HepatoblastomaC: Hepatocellular carcinomaD: Peripheral neuroectodermal tumourCorrect Ans:AExplanation

Seminoma is the most common germ cell tumor. It is associated with elevated levels of beta hCG, LDH and placental alkaline phosphatase. Placental alkaline phosphatase has the highest sensitivity for detecting metastatic disease.

Elevated serum LDH levels correlate with seminoma invasive status, metastatic status and poor outcome.

Serum bhCG levels reflects an increase in tumor volume and thus suggests metastasis.

Seminoma does not result in elevated aFP levels and its presence should suggest a nonseminomatous or mixed tumor.

Ref: Advanced Imaging of the Abdomen By Jovitas Skucas page 847-8.


Congo red staining of abdominal fat has confirmed a diagnosis of Amyloidosis in a 28-year-old man. Which is the most common cause of death in primary AL Amylodosis?

A: Respiratory failureB: Cardiac failureC: Renal failureD: Septicemia

Correct Ans:BExplanation

Cardiac failure is the most common cause of death in primary or AL amyloidosis. Cardiac involvement is seen in 40% of patients with AL amyloidosis. Amyloid involvement of myocardium, intramural coronary arteries and conduction system may cause congestive heart failure, ischemic syndrome and rythm disturbances.

Diagnosis of amyloidosis should be considered in patients with unexplained nephropathy, cardiomyopathy (diastolic dysfunction), neuropathy, enteropathy, or pathognomonic soft tissue findings of macroglossia or periorbital ecchymoses. Pathologic diagnosis of amyloid fibrils can be made by congo red staining of aspirated abdominal fat or of an involved organ biopsy specimen.


Carbon monoxide poisoning shows the following post-mortem staining:

A: Cherry red postmortem stainingB: Pink postmortem staining

C: Chocolate coloured postmortem stainingD: Blue postmortem staining

Correct Ans:AExplanationIn carbon monoxide poisoning, the colour of post mortem staining is cherry-red. In poisoning by nitrites, potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide, bromates, and aniline the colour is chocolate brown. In asphyxia, the colour of the stains is deeply bluish-violet or purple. A bright pink colour is seen in hypothermia and bodies taken from cold water. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 139.


Which of the following poison causes cherry-red -color postmortem staining?

A: Carbon monoxideB: AnilineC: PhosphorusD: Nitrites

Correct Ans:AExplanation

A cherry-red colouration of the skin, mucous membranes, conjunctiva, nail beds, areas of hypostasis, blood, tissues and internal organs is seen in carbon monoxide (CO) poisoning. It is associated with 30-40% COHb.

Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 555.


A physician decides to discontinue or not to use extraordinary life sustaining measures to prolong his patients life. It is known as?

A: Active euthanasiaB: Passive euthanasiaC: Positive euthanasiaD: Assisted Suicide


Active euthanasia or positive euthanasia is a positive merciful act, to end useless suffering or a meaningless existence. It is an act of commission.

Example: By giving large doses of drugs to hasten death.Passive euthanasia means discontinuing or not using extraordinary life sustaining measures to prolong life. This includes acts of omission. Example: Failure to resuscitate a terminally ill or hopelessly incapacitated patient.Assisted suicide: A person providing information to another with information, guidance and means to take his own life with the intention that it will be used for this purpose is assisted suicide. Ref: The Essentials of Forensic Medicine and Toxicology 29th Ed Page 42.


A contusion can be differentiated from postmortem staining by doing:

A: Diaphanous testB: Picard's test

C: Incision testD: Gettler's test

Correct Ans:CExplanationWhile taking an incision on contusion, extravasation of blood into the surrounding tissues which is firmly clotted and cannot be washed by gentle stream of water. Subcutaneous tissues are deep reddish-black. On incision in postmortem staining, blood is seen in blood vessels, which can be easily washed away. Subcutaneous tissues are pale. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 163.


Chocolate or copper brown post mortem staining is seen in all of the following causes of death, except:

A: NitratesB: Aniline dyesC: Clostridium perfringenceD: Potassium chlorate

Correct Ans:CExplanation

Nitrates, Potassium chlorate, Potassium bicarbonate, Aniline, all produce chocolate or copper brown post-mortem staining. Clostridium perfingence causes bronze pigmentation in septic abortion.


Gram stain separates most bacteria into gram-positive bacteria and gram-negative bacteria. Which of the following stain is NOT used in gram staining?

A: Methylene blueB: Crystal violet

C: IodineD: SafraninCorrect Ans:AExplanation

The Gram stain involves the following four-step procedure:

The crystal violet dye stains all cells blue/purple. The iodine solution (a mordant) is added to form a crystal

violet–iodine complex; all cells continue to appear blue. The organic solvent, such as acetone or ethanol, extracts the

blue dye complex from the lipid-rich, thin-walled gram-negative bacteria to a greater degree than from the lipid-poor, thick-walled gram-positive bacteria. The gram-negative organisms appear colorless; the gram-positive bacteria remain blue.

The red dye safranin stains the decolorized gram-negative cells red/pink; the gram-positive bacteria remain blue.

Ref: Levinson W. (2012). Chapter 2. Structure of Bacterial Cells. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.


A 36-year-old healthy Punjabi man working in an abattoir presented with pustule on hand which turned into ulcer. Staining with which of the following will best help in diagnosis?

A: Polychrome methylene blue B: Carbol fuschin

C: Acid fast stainD: Calcoflour whiteCorrect Ans:AExplanation

Pustule on the hand of an abattoir worker suggests the diagnosis of cutaneous anthrax.

Anthrax bacillus is gram positive and non acid fast. When blood films containing anthrax bacilli are stained with polychrome methylene blue for a few seconds and examined under microscope an amorphous purplish material is noted around the bacilli. This represents the capsular material and is characteristic of the anthrax bacillus. This is called M’Fadyen’s reaction and is employed for presumptive diagnosis of anthrax in animals. When it is stained with Sudan black B, fat globules may be made out within the bacilli.


The most sensitive investigation for the diagnosis of asymptomatic Chlamydial infection is:

A: Ligase Chain ReactionB: SerodiagnosisC: Iodine StainingD: Culture


Ligase chain reaction (LCR) or polymerase chain reaction (PCR) are the most sensitive NAA methods. Isolation of C trachomatis has been the gold standard for diagnosis, but it is clear that it is less sensitive than specific nucleic acid amplification (NAA) assays.

Culture is usually performed using idoxuridine or cycloheximide treated McCoy cells.

C trachomatis inclusions contain glycogen and are stainable with iodine

Serodiagnosis not helpful for most genital infections. Detection of IgM antibodies against C trachomatis is helpful in cases of infant pneumonitis.

Ref: Ray C.G., Ryan K.J. (2010). Chapter 39. Chlamydia. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.


Which stain is used for staining fungal elements?

A: Acid fast stainB: Methenamine silverC: MucicarmineD: Ziehl–Neelsen stainCorrect Ans:BExplanation

Methenamine silver stains and the periodic acid schiff (PAS) are valuable methods for demonstration of fungal elements in tissue sections. Commonest culture media used in mycology are Sabouraud's glucose agar, Czapek-Dox medium, Cornmeal agar. Tissue sections like skin scrapings, are treated with 10% potassium hydroxide. The alkali digests cells and other tissue materials, enabling the fungal elements to be seen clearly.

Do You Know:Only gram positive fungi is candida albicans. Ref: Ananthanarayanan & Paniker’s textbook of microbiology Ed 8 Pg 601.


A patient presented with cough and evening rise of temperature since one month. Which among the following is the definitive diagnostic test for tuberculosis?

A: Gram's stainingB: Culture

C: Guinea-pig inoculationD: Tuberculin testing

Correct Ans:BExplanationDefinitive diagnosis depends on the isolation and identification of M. tuberculosis from a clinical specimen or the identification of specific sequences of DNA in a nucleic acid amplification test. Specimens may be inoculated onto egg- or agar-based medium (e.g., Löwenstein-Jensen or Middlebrook 7H10) and incubated at 37°C (under 5% CO2 for Middlebrook medium). Because most species of mycobacteria, including M. tuberculosis, grow slowly, 4–8 weeks may be required before growth is detected. Ref: Raviglione M.C., O'Brien R.J. (2012). Chapter 165. Tuberculosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.


All of the following statements regarding melioidosis are true, EXCEPT:

A: It is caused by Burkholderia malleiB: It is caused by a gram negative aerobic bacteriaC: Etiologic agent shows bipolar staining with methylene blue stainD: Pulmonary infection is the most common form of melioidosis


Melioidosis is caused by Burkholderia Pseudomallei. It is a free living small motile aerobic gram negative bacillary saprophyte normally found in soily ponds & rice paddies. Humans and animals are infected by inoculation, inhalation, or ingestion.

It grows at 42 degree C & oxidize glucose, lactose & is oxidase positive. It is a facultative intracellular organism which replicates in neutrophils and macrophages with the help of a polysaccharide capsule. The organism also possesses elements of a type III secretion system that plays a role in its intracellular survival.

Gram’s stain of a specimen shows a small gram negative bacilli. Wright’s stain or methylene blue staining shows a bipolar regularly staining (safety pin appearance). Positive culture is diagnostic. Ref: Harrisson’s Principles of Internal Medicine, 18th Edition, Chapter 152


A young boy had a flea bite while working in a wheat grain godown. After 5 days he developed fever and had auxiliary lymphadenopathy. A smear was sent to the lab to perform a specific staining. Which one of the following staining method would help in the identification of the following staining method would help in the identification of the suspected pathogen?

A: Albert stainingB: Zxhihl –Neelson stainingC: McFadyean’s stainingD: Wayson staining

Correct Ans:DExplanationThe young boy working in a wheat grain godown (habitat for rats) is likely to have been bitten by a rat flea. Fever and axillary lymphadenopathy is consistent with the presentation of Plague. Ref: Harrison’s Principles of Internal Medicine, 16th Edition, Page 924; Medical Microbiology By MIMS, 2nd Edition, Page 372


Autopsy of a 23-year-old male victim of a motor vehicle accident reveals a small cluster of caseating granulomas in the right lung just above the interlobar fissure and similar granulomas in the hilar lymph nodes. Acid-fast staining demonstrates acid-fast bacilli within these lesions. No other lesions were found in

the remaining organs and systems. Which of the following is the MOST accurate interpretation of these findings?

A: Cavitary tuberculosisB: Ghon complexC: Histoplasma infectionD: Miliary tuberculosis


The Ghon complex is the most frequent pathologic form of primary pulmonary tuberculosis. Mycobacterium tuberculosis first localizes in the lung parenchyma and then in the hilar lymph nodes. In both these locations, a granulomatous reaction takes place. These lesions usually heal by fibrosis, leaving only small scars at the sites of remote tuberculous infection. In some cases, owing to immunosuppression (e.g., AIDS, immunosuppressant treatment, and lymphomas), reactivation of dormant bacilli in old lesions or additional re-exposure leads to secondary tuberculosis, with progression of lesions. Sometimes, active lesions of the Ghon complex are discovered by chance at autopsy. More frequently, scars due to remote healed tuberculosis are found postmortem and listed in autopsy reports as incidental findings.

Also know:Cavitary tuberculosis and miliary tuberculosis are expressions of secondary infection, following reactivation of old, usually clinically silent, lesions. The cavitary form is characterized by development of large areas of liquefactive necrosis that empty into the air spaces, leading to cavities within the lung parenchyma. The miliary form is due to lymphohematogenous dissemination and subsequent seeding of tubercle bacilli throughout the body, with myriad small granulomas forming in the lungs, spleen, liver, bone marrow, retina, and adrenals, for example. Acid-fast bacilli suggest tuberculosis, rather than an infection with a fungus such as Histoplasma.

Ref:Raviglione M.C., O'Brien R.J. (2012). Chapter 165. Tuberculosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e


A 26 year male patient presented with a granulomatous penile ulcer. On Wright Giemsa staining, tiny organisms of 2 microns are seen engulfed by macrophages. What is the causative organism?

A: LGVB: Calymmatobacterium granulomatisC: NeisseriaD: Staph aureusCorrect Ans:BExplanation

Calymmatobacterium granulomatis is a gram-negative rod that causes granuloma inguinale (also known as donovanosis), a sexually transmitted disease characterized by genital ulceration and soft tissue and bone destruction.

The diagnosis is made by visualizing the stained organisms (Donovan bodies) within large macrophages from the lesion.

Tetracycline is the treatment of choice for this disease, which is rare in the United States but endemic in many developing countries. C. granulomatis is also known as Klebsiella granulomatis.

Ref: Levinson W. (2012). Chapter 27. Minor Bacterial Pathogens. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.


A child had pustular lesion on leg. On gram staining gram positive cocci are seen. To establish the diagnosis of Group A streptococcal erythroderma, the test used is?

A: Bile solubility test

B: Novobiocin sensitivityC: Optochin sensitivityD: Bacitracin sensitivityCorrect Ans:DExplanation

Streptococcal erythroderma is caused by streptococcus pyogenes. Sensitivity to bacitracin is employed as a convenient method for differentiating str.pyogenes from other hemolytic streptococci.

Pustule: A vesicle filled with leukocyte. Most common cause is virus. Most common bacterial cause is str.pyogenes. Str.pyogenes is the etiological agent in most of streptococcal skin infection. Vancomycin is the drug of choice. Ref: Ananthanarayan 7th Ed Page 205


A vitreous aspirate from a case of metastatic endophthalmitis on culture yields Gram-positive round to oval cells, 12-14 mm in size. The aspirate on Gram staining shows the presence of pseudohyphae. Which of the following is the most likely aetiological agent?

A: AspergillusB: Rhizopus

C: CandidaD: FusariumCorrect Ans:CExplanation

In smears of exudates Candida appears as gram positive oval cells and pseudohyphae. Aspergillus, Rhizopus andfusarium are filamentous fungi forming true mycelia (and not pseudohyphae).

Ref: Textbook of Microbiology By Ananthanarayan and Panicker, 7th Edition, Pages 610, 624-25; Jawetz, Melnick and Adelberg's Medical Microbiology, 23rd Edition, Pages 625, 645, 649


The following diagnostic tests are useful for corresponding purposes, EXCEPT:

A: Ziehl -Neelsen staining - Detection of mycobacteriaB: Immunofluorescence - Detection of Influenza virus

C: Specific IgM antibodies - Immunity against RubellaD: Specific IgM antibodies - Detection of acute infectionCorrect Ans:CExplanation

Ziehl Neelsen is used for Mycobacterial detection.

Rapid diagnosis of influenza is made by demonstration of viral antigen on the surface of nasopharyngeal cells by immunofluorescence.

IgM antibodies are antibodies of primary response so it indicates acute/recent infection. Its production signify that immune response of individual is proper but does not mean that person has immunity against infection.

Ref: Harrison's Principles of Internal Medicine, 18th Edition, Chapter 193


A child had pustular lesion on leg. On gram staining gram positive cocci are seen. To establish the diagnosis of Group A beta streptococcal pyoderma, the test used is:

A: Bile solubility testB: Catalase test

C: Optochin sensitivityD: Bacitracin sensitivityCorrect Ans:DExplanation

Group A beta streptococcus produces pyogenic infections with a tendency to spread locally, along lymphatics and through the bloodstream. The growth of Str. pyogenes on agar plates in the laboratory is inhibited by the antibiotic bacitracin, an important diagnostic criterion. Sensitivity to bacitracin is a convenient method for differentiating Group A streptococcus from other hemolytic streptococci.

Laboratory tests for group A beta streptococcus:

Bacitracin sensitive PYR (pyrrolidonyl naphthylamide) test positive Ribose not fermented

Ref: Ananthanarayan and Paniker's Textbook of Microbiology By Ananthanarayan And Paniker, 7th edition, Page 205.


An infant had high grade fever and respiratory distress at the time of presentation to the emergency room. The sample collected for blood culture was subsequently positive showing growth of a haemolytic colonies. On Gram staining these were gram positive cocci. In the screening test for identification, the suspected pathogen is likely to be susceptible to the following agent:

A: BacitracinB: NovobiocinC: OptochinD: OxacillinCorrect Ans:CExplanation

Pneumococci are the most common cause of community-acquired pneumonia, meningitis, sepsis in splenectomized individuals, otitis media, and sinusitis. Pneumococci are gram-positive lancet-shaped cocci arranged in pairs (diplococci) or short chains. On blood agar they produce alpha-hemolysis. In contrast to viridans streptococci, they are lysed by bile or deoxycholate, and their growth is inhibited by optochin.

Rapid diagnosis of pneumococcal meningitis can be made by detecting its capsular polysaccharide in spinal fluid using the latex agglutination test. A rapid test that detects urinary antigen (capsular polysaccharide) is also available for the diagnosis of pneumococcal pneumonia and bacteremia. Ref: Levinson W. (2012). Chapter 15. Gram-Positive Cocci. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.


Minimum number of mycobacteria required to be detected by AFB staining is (per ml):

A: 15-20B: 150-200C: 10,000D: I Lac

Correct Ans:CExplanationA presumptive diagnosis is commonly based on the finding of AFB on microscopic examination of a diagnostic specimen. At least 10,000 acid fast bacilli should be present per ml of sputum to be readily demonstrable in direct smears. A negative report should not be considered till at least 300 fields have been examined, taking about 10 minutes. A positive report can be taken only if two or more typical bacilli have been seen. Ref: Textbook of Microbiology By Ananthanarayan And Paniker, 7th edition, Page 357.


Which of the following method is used for early diagnosis of carcinoma stomach?

A: EndoscopyB: Staining with endoscopic biopsyC: Physical examinationD: Ultrasound abdomen


Endoscopy with multiple biopsies and brush cytology is the investigation of choice for gastric cancer.

Ref: Schwartz 9/e, Page 932; Harrison 17/e, Page 572.


A 25 year old woman had premature rupture of membranes and delivered a male child who became lethargic and apnoeic on the 1st day of birth and went into shock. The mother had a previous history of abortion 1 year back. On vaginal swab culture growth of Parahaemolytic colonies on blood agar was found. On staining these were found to be gram positive cocci. Which of the following is the most likely etiological agent?

A: Strptococcus pyogenesB: Strptococcus agalactiaeC: PeptostreptococciD: Enterococcus faecumCorrect Ans:BExplanation

This neonate is presenting with features of systemic infection (lethary apnea & shock) within the first 24 hours of life. Presence of hemolytic colonies on blood agar (p hemolysis) and gram positive cocci in smears is almost diagnostic of Group B hemolytic streptococci infection (streptococcus agalactiae).

Ref: Text Book of Pediatrics By Nelson, 17th Edition, Pages 627, 880


A 25 year old woman had premature rupture of membranes and delivered a male child who became lethargic and apnoeic on the 1st day of birth and went into shock. The mother had a previous history of abortion 1 year back. On vaginal swab culture growth of Parahaemolytic colonies on blood agar was found. On staining these were found to be gram positive cocci. Which of the following is the most likely etiological agent?

A: Strptococcus pyogenesB: Strptococcus agalactiaeC: PeptostreptococciD: Enterococcus faecumCorrect Ans:BExplanation

This neonate is presenting with features of systemic infection (lethary apnea & shock) within the first 24 hours of life. Presence of hemolytic colonies on blood agar (p hemolysis) and gram positive cocci in smears is almost diagnostic of Group B hemolytic streptococci infection (streptococcus agalactiae).

Ref: Text Book of Pediatrics By Nelson, 17th Edition, Pages 627, 880


All are TRUE about Antineutrophil Cytoplasmic Antibodies, EXCEPT:

A: Proteinase-3, in neutrophil azurophilic granules, is the major cANCA antigen

B:The major target for pANCA is the enzyme myeloperoxidase

C:A pANCA pattern of staining has been associated with nonvasculitic entities such as rheumatic and nonrheumatic autoimmune diseases

D: There are three major categories of ANCA

Correct Ans:DExplanation

There are two major categories of ANCA. Other statements are true.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2786


A 30 year old woman undergoes her yearly gynecologic examination and is found to have microscopic hematuria. The hematuria is again documented on several more occasions when she is seen for other reasons. Because no etiology is obvious, renal biopsy is eventually performed; a photomicrograph of a hematoxylin and eosin-stained section is shown above. Immunofluorescent staining of histologic sections similar to the one shown demonstrates IgG, IgM, and complement in the glomerular mesangium. Which of the following is the most likely diagnosis?

A: AmyloidosisB: Goodpasture syndromeC: Henoch-Schönlein purpuraD: Systemic lupus erythematosusCorrect Ans:DExplanationSystemic lupus erythematosus can produce a wide range of different glomerular lesions; in some cases, the presenting symptoms may be associated with renal disease. The pattern illustrated in the photomicrograph is mesangial expansion with cellular proliferation and occurs in approximately 25% of lupus patients. Granular mesangial deposits of immunoglobulin and complement are characteristically present and probably reflect the immune complex basis of the problem.Amyloidosis is not usually associated with immune complex deposition.Goodpasture syndrome is characterized by linear IgG deposition along basement membranes.Henoch-Schönlein purpura characteristically shows IgA deposits.

Ref: Hahn B.H. (2012). Chapter 319. Systemic Lupus Erythematosus. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.


A 25 year old male presents to the clinic with a lesion on his penis. On examination he was noted to have a beefy red ulcer on the glans which bled when touched. Smear taken from

the ulcer showed gram-negative intracytoplasmic cysts filled with deeply staining bodies that had a safety-pin appearance. What is he most likely suffering from?

A: SyphilisB: HSV infectionC: ChancroidD: Granuloma inguinaleCorrect Ans:DExplanationHe is suffering from Granuloma inguinale caused by Klebsiella granulomatis comb nov. The lesion starts as a small painless papule which then ulcerates into a beefy red granulomatous ulcer with rolled edges that bleeds easily.

Lesions are most commonly seen on prepuce, coronal sulcus, frenum, and glans in men and on labia minora and fourchette in women. The diagnosis is confirmed by by the presence of Donovan bodies in tissue smears. These are gram-negative intracytoplasmic cysts filled with deeply staining bodies that may have a safety-pin appearance.

Chancroid is characterised by the presence of nonindurated, ragged, undermined, painful ulcer associated with painful adenopathy.

Ref: O'Farrell N. (2012). Chapter 161. Donovanosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.


Gram staining of the sputum of the patients with pneumonia is diagnostic with all these pathogens, EXCEPT:

A: S. pneumoniaeB: S. aureusC: Gram-negative bacteriaD: Coxiella burnetii

Correct Ans:DExplanation

Gram's staining may identify certain pathogens (e.g., S. pneumoniae, S. aureus, and gram-negative bacteria) by their characteristic appearance.

A sputum sample must have 1. >25 neutrophils 2. <10 squamous epithelial cells per low-power field, to be adequate for culture.

Ref: Harrison, E-18, P-2133


The gold standard for the diagnosis of Wilson disease is:

A: Liver biopsy with quantitative copper assayB: Serum ceruloplasmin along with free copper estimationC: 24 hour urine copper quantificationD: Liver biopsy and copper staining


The gold standard for diagnosis is liver biopsy with quantitative copper assays. Affected patients have values > 200 mg/g dry weight of liver tissue. Copper stains are not reliable.

Reference:Harrisons Principles of Internal Medicine, 18th Edition, Page 3188


A 20 year old man complains of difficulty in reading the newspaper with his right eye, three weeks after sustaining a gun shot injury to his left eye. Which of the following is the most likely diagnosis?

A: Macular edemaB: Optic nerve avulsionC: Sympathetic ophthalmiaD: Delayed viterous hemorrhageCorrect Ans:CExplanation

This man in the question has developed a condition called sympathetic ophthalmia in the right eye secondary to the injury in the left eye.

Sympathetic ophthalmia is an inflammation in the second eye after the other has been damaged by penetrating injury. Some portion of the uvea of the injured eye has been exposed to the atmosphere for at least 1 hour. The uninjured eye develops minor signs of anterior uveitis usually within 1 year. Due to the inflammation of ciliary body, patients initially presents with floating spots and loss of the power of accommodation.

The disease may progress to severe iridocyclitis with pain and photophobia. The retina is usually uninvolved except for perivascular cuffing of the retinal vessels with inflammatory cells. Optic nerve swelling and secondary glaucoma may occur. The best prophylaxis is early excision of the injured eye, when there is no chance of saving useful vision.

Ref: Comprehensive Ophthalmology By AK Khurana, 4th Edition, Page 273; Vaughan and Asbury's General Ophthalmology, 18th Edition, Chapter 16.


A patients presents to the clinic with photophobia, redness and watering from both eyes after sustaining a trauma to his left eye 1 month back. Examination of both his eyes shows features of uveitis. A diagnosis of sympathetic ophthalmitis is made.

Assertion: It is a serious bilateral granulomatous panuveitis which occur following penetrating ocular trauma.

Reason: Uveal pigment act as allergen which inturn induce plastic uveitis in the sound eye.

A: Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

B:Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

C: Assertion is true, but Reason is falseD: Assertion is false, but Reason is trueCorrect Ans:AExplanation

Sympathetic ophthalmitis is a serious bilateral granulomatous panuveitis which occur following penetrating ocular trauma. This condition is thought to be due to uveal pigment that act as allergen which inturn induce plastic uveitis in the sound eye. The injured eye is called exciting eye and the fellow eye which also develops uveitis is called sympathizing eye. It almost always follows a penetrating wound. Wounds in the ciliary region are more prone for it.

Ref:Comprehensive Ophthalmology By A K Khurana, 4th Edition, Page 413


A 20 year old man complains of difficulty in reading the newspaper with his right eye, three weeks after sustaining a gun shot injury to his left eye. Which of the following is the most likely diagnosis?

A: Macular edemaB: Optic nerve avulsionC: Sympathetic ophthalmiaD: Delayed viterous hemorrhageCorrect Ans:CExplanation

This man in the question has developed a condition called sympathetic ophthalmia in the right eye secondary to the injury in the left eye.

Sympathetic ophthalmia is an inflammation in the second eye after the other has been damaged by penetrating injury. Some portion of the uvea of the injured eye has been exposed to the atmosphere for at least 1 hour. The uninjured eye develops minor signs of anterior uveitis usually within 1 year. Due to the inflammation of ciliary body, patients initially presents with floating spots and loss of the power of accommodation.

The disease may progress to severe iridocyclitis with pain and photophobia. The retina is usually uninvolved except for perivascular cuffing of the retinal vessels with inflammatory cells. Optic nerve swelling and secondary glaucoma may occur. The best prophylaxis is early excision of the injured eye, when there is no chance of saving useful vision.

Ref: Comprehensive Ophthalmology By AK Khurana, 4th Edition, Page 273; Vaughan and Asbury's General Ophthalmology, 18th Edition, Chapter 16.


Histologic examination of normal skin demonstrates small numbers of perivascular cells, with darkly stained ovoid nuclei and granular cytoplasm on hematoxylin and eosin staining. The cells demonstrate metachromasia of the cytoplasm when stained with Giemsa stain. Which of the following products would these cells be most likely to secrete?

A: BradykininB: Complement factor 3aC: Histamine

D: Interleukin 2Correct Ans:CExplanation

The cells in question are mast cells, which play an important role in IgE-mediated allergic responses. They are a normal (minor) constituent of dermal skin and are most definitely identified with stains, such as the Giemsa stain, that highlight the granularity of their cytoplasm (mast cells are closely related to blood basophils). Mast cells secrete histamine, serotonin, many leukotrienes, and platelet aggregating factor (PAF). Their histamine secretion after IgE stimulation helps to trigger the acute inflammatory part of the allergic response.

Bradykinin is a nonapeptide found in the plasma. It is a potent vasodilator and stimulates pain receptors.

Complement factor 3a is a plasma protein that induces vascular leakage as part of the acute inflammatory response.

Interleukin 2 is secreted by lymphocytes and augments the immune response.

Ref: Mescher A.L. (2013). Chapter 5. Connective Tissue. In A.L. Mescher (Ed),Junqueira’s Basic Histology, 13e.


Health & Medicine

Previous year question on staining based on neet pg, usmle, plab and fmge or mci screening exams