1. 1. A 50 yr old man, with a history of pipe smoking, presents with whitish mucosal patches on the vermillion border of the lower lip and buccal mucosa. On biopsy there was marked hyperkeratosis and epithelial dysplasia. (1+3+1)
a) What is the most probable diagnosis?
b) List three possible predisposing factors.
c) What could the lesion itself predispose to?
2. 2. A 40 yr old betel nut chewer for the last 25 yrs presents with difficulty in chewing, and localized pain in tongue. On examination a nodular lesion on left lateral border of tongue was seen. Wedge biopsy was taken which showed dysplasia and keratin pearls. (1+2+2)
a) What is the diagnosis?
b) Write 2 common sites in the oral cavity.
c) List 4 risk factors.
3. 3. A 55yr female presents with a swelling on the angle of the left jaw. It is painless. On examination the swelling is well demarcated, not involving the skin, or deep structures. There are no facial nerve signs. (2+3)
a) List two causes of such a swelling.
b) Give three morphological features of pleomorphic adenoma.
4. 4. A middle aged obese man with a long history of on and off heart burn was evaluated with upper GI endoscopy which showed red velvety mucosa extending from gastroesophageal orifice into esophagus. Diagnosis of Barrett esophagus is made. (2+2+1)
a) Explain the pathogenesis in less than 50 words.
b) What are its complications?
c) What type of cancer does the lesion transform into?
5. 5. A middle aged woman comes to medical OPD with epigastric pain. The pain tends to be worse at night and usually occurs 1-3 hours after meals. She also complains of nausea, vomiting and belching. On physical examination pallor is significant. (2+3)
a) What is your provisional diagnosis and what is the most probable causative organism?
b) Enumerate three significant features in the pathogenesis of this disease causing organism.
6. 6. A young female presents to the medical OPD with complaints of intermittent attacks of relatively mild diarrhea, fever and abdominal pain spaced by asymptomatic periods lasting from weeks to many months. On radiological investigation string sign was positive. Colonic biopsy shows deep mucosal ulceration, transmural inflammation and granulomas. (1+4)
a) What is the diagnosis?
b) Tabulate 2 macroscopic and 2 microscopic distinguishing features each for the two forms of IBD.
7. 7. An 18 yr old boy presented in E.R. with pain in the periumblical region that later shifted to the right iliac fossa (RIF). It was associated with marked nausea and a single episode of vomiting. On examination rebound tenderness in the RIF was elicited and TLC count >10,000 cells/mm3. (1+4)
a) What is the diagnosis?
b) Give the morphology.
8. 8. A 57 yr old man who has a long history of alcohol abuse is diagnosed with liver cirrhosis.
a) Enumerate 3 salient features of cirrhosis.
b) Enlist 4 stimuli for stellate cell activation (collagen synthesis) during cirrhosis.
9. 9. A 40 yr old male, diagnosed case of Hep C, presented to medical OPD with H/O malaise, fatigue, wt. loss, and hematemesis. On examination the liver is found to be enlarged. Lab examination reveals raised levels of α-fetoprotein. Hepatocellular CA is diagnosed. (2+2+1)
a) Give mechanisms implicated in the pathogenesis of HCV and HBV associated hepatocellular CA.
b) Enlist the gross morphological types of hepatocellular CA. How do the tumors metastasize?
c) Name the tumor marker.
1 10. A 55 yr old female presents to the surgical OPD with H/O colicky pain in the right hypochondrium. Ultrasonography reveals stones in the gallbladder. The stones were removed via laproscopic surgery and sent to the lab for analysis. Lab examination showed the stones to be composed of cholesterol and calcium carbonate. (4+1)
a) Enumerate 4 defects in cholesterol metabolism which lead to the formation of such stones.
b) What are Rotikansky- Aschoff sinuses?
1 . 11. A 45 yr old male presents to the surgical OPD with severe constant pain which radiates to the back. Lab investigations reveal glycosuria, hypocalcemia and marked elevation of serum amylase during the first 24 hrs followed within 72 hrs by a rising serum lipase level. Radiography reveals an enlarged pancreas. (1+4)
a) What is the most likely diagnosis?
b) Mention 4 sequelae of this condition.
1 12. A 35yr old house wife has a history of nephrolithiasis for the last 3 years. She now presents with high grade fever, chills, malaise and severe pain in the right costovertebral angle. She complains of dysuria and frequency. The region is tender on palpation. (1+2+2)
a) Give the probable diagnosis.
b) Name 4 common causative agents.
c) Enumerate 4 predisposing factors.
13. mother brings her 8yr old child to the E.R. with complaint of smoky brown urine. The child is mildly pyretic and nauseous. The child has a history of sore throat that resolved 15 days back.
a) What is the diagnosis? Also state the causative agent.
b) List three characteristics of nephritic and nephrotic syndromes each.
14. A 70yr old man presents with complaint of gross hematuria which is intermittent. He has mild flank pain and a palpable mass in the left lumbar region. His baseline investigations show polycythemia. (1+3+1)
a) What is the probable diagnosis?
b) State the 3 types.
c) State the reason for the polycythemia in this case.
(Paper setters: Prof. Dr. Abbas Hayat, Dr. Homera Niazi, Dr. Nabeel M. Syed, Dr. Ali Mujtaba, Dr. Ahmed Salman Qadir, Dr. Misbah Hamid, Dr. Rubab Hameed, Dr. Wajiha Raza, Dr. Rabeea Nazir)