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Saturday, October 22, 2011

Special Pathology SEQ paper 2009 - Rawalpindi Medical College

Q1.     A 14 years old male presents in the OPD with shortness of breath for one month and swelling of right knee joint for two weeks. He suffers from sore throat off and on. His ASO Titre is 800 IU/ml. The doctor suspects that he is suffering from some sort of heart problem.                               (2+2+1)
    a)    What is the most likely diagnosis? What is the type of joint involvement in this condition?
   b)    What is the pathogenesis of his disease?
    c)    Name two complications which can occur in this boy.

Q2.     Illustrate the pathogenesis of anemia, skeletal deformities and hemochromatosis in beta thalassemia major with the help of a flow chart.                                                             (2+2+1)

Q3.     A 25-year-old female went to a pulmonologist at the peak of spring season having severe dysponea and wheeze. Her pulmonary function tests showed decreased FEV1, serum IgE levels were elevated and blood revealed absolute eosinophilia.                                                         (1+2+2)
 a)   What is the most likely diagnosis?
 b)   Give four histologic findings of this disorder.
 c)    Name four chronic restrictive airway diseases.

Q4.     A 30-year-old villager presents in the gastroenterology ward with a three weeks H/O nausea, vomiting, abdominal pain and bloody stools. On sigmoidoscopy multiple polyps are distributed throughout the colon and a 2x2.5 cm mass is found in the descending colon. His liver is enlarged and nodular. X-ray chest reveals bilateral opacities.                                                                (1+2+2)
a)        What is the likely diagnosis?
b)       Classify neoplasia of large intestine(TNM classification).
c)        Give four dietry factors predisposing to a higher incidence of this cancer.

Q5.     A 26 year old male has recurrent attacks of bloody mucoid diarrhea with abdominal cramps, which are relieved on defecation. Each episode lasts for 5-6 days followed by symptom free periods of 4-5 months. Colonoscopy shows pancolitis extending from rectum to the splenic flexure.         (1+3+1)
a)            What is the diagnosis?
b)           What features will a colonoscopic biopsy show?
c)            What is the role of intestinal flora in the pathogenesis?

Q6.    A 1-month old infant presenting with jaundice is diagnosed with extraheptic biliary atresia.  (3+2)
a)     What are the major histological features on the liver biopsy?
b)     Which two enzymes are likely to be raised in this condition?

Q7.     Clinical pyelonephritis is most commonly caused by ‘ascending infection’. Give the five major steps in its pathogenesis.                                                                                               (5)

Q8.     A male presented in OPD with a right testicular mass.                                                   (2+3)
a)    What three serum markers would you order in a patient with a testicular
b)   What is the value of serum markers in the context of testicular tumors?

Q9.     A 45-year-old female patient develops a peanut sized nodule in an old midline laparotomy scar, which becomes painful during menstrual period. The excised nodule consists of normal-looking endometrial tissue with glands and stroma.                                                                    (1+3+1)
a)       What is the diagnosis?
b)       Give three theories of pathogenesis of such lesions.
c)       List two important sites for this process other than the abdominal wall.

Q10. A 68 year old lady has presented with a painless mass in upper outer quadrant of left breast. A pathologist is grading a breast tumor according to the Scarff-Bloom-Richardson system.           (3+2)
  a)     Which three morphological features will he assess in this system?
  b)     What is the significance of ER/PR and Her 2-neu status in a breast CA?

Q11.     The patient presented with mass in front of neck, throidectomy was done and specimen was sent for histopathology. While examining H & E sections from the thyroidectomy specimen, a pathologist notices a lesion having a follicular pattern of growth.                                                        (3+2)
  a)     What is the differential diagnosis for such lesions?
  b)     List two nuclear features diagnostic for papillary carcinoma of thyroid.

Q12.   A 19 year old male presented in OPD with swelling in left knee for last 6 months which is associated with pain. He complaints of shortness of breath for the last one month. X-Ray of the knee shows ill-defined lesion in metaphyseal region of distal femur with elevated periosteum. X-Ray chest shows multiple coin-shaped opacities.                                                                        (1+2+2)
a)    What is the diagnosis?
b)   Explain the classic radiologic finding associated with this condition.
c)    Give its microscopic features.

Q13.   A 60-year-old man presented to his primary care physician with complaints of headache and weakness in his left arm over the past several weeks. The day before his appointment, he experienced two episodes of uncontrollable shaking in his left arm and leg, accompanied by development of weakness in his left leg. On physical examination, he was found to have mild papilledema, decreased strength in his left arm and leg, and brisk deep tendon reflexes on the left side of his body compared to the right. A CT scan of his head revealed a ring-enhancing mass in the right frontal region.                       (2+2+1)
  a)   What is the most likely diagnosis?
  b)   Give any TWO histological patterns of the lesion.
  c)   What is the most common site of the lesion?

Q14.   List 2 laboratory tests each for the evaluation of hepatocyte integrity, biliary excretory function and hepatocyte function.                                                                                  (2+1½+1½)

This exam is not intended to be especially difficult.  Be prepared for somewhat more challenging exams in the future.
Paper setters: Prof. Dr. Abbas Hayat, Dr. Homera Niazi and Dr. Ali Mujtaba. 


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