Send Up Examination
DEPARTMENT OF PATHOLOGY
RAWALPINDI MEDICAL COLLEGE RAWALPINDI
Time allowed: 65 minutes
Attempt all questions. Mark the appropriate square on the response sheet
- When a guinea pig is injected subcutaneously with virulent tubercle bacilli, the puncture wound heals quickly, but a nodule forms at the site of injection in two weeks. This nodule ulcerates and the ulcer does not heal. The regional lymph node develops tubercles and caseates massively. When the same animal is injected with tubercle bacilli in another part of the body, 6-8 weeks later the following phenomenon is observed.
- If the patient of tuberculosis left untreated, one person with tuberculosis will infect
- 0-5% people per year
- 1-10% people per year
- 10-15 people per year.
- 30-50% people per year
- 60-80% people per year
- The major difference between Mycobacterium tuberculosis and Mycobacterium other than tuberculosis(MOTT) is:
- MOTT is transmitted by humans to humans
- MOTT is transmitted by environment
- MOTT is transmitted by sexual contact
- MOTT is transmitted by vertical transmission
- MOTT is transmitted from animal to human
- The difference between GHON COMPLEX and GHON LESION is :
- Primary lesion + Draining Lymph nodes in Ghon complex.
- Reinfection or without involvement of draining lymph nodes in Ghon complex.
- In Ghon lesions draining lymph nodes are involved.
- In Ghon complex draining lymph nodes are not involved.
- In Ghon lesion draining lymph nodes are involved.
- Mycobacterium Contains complex lipids
- Phospholipids are responsible for Acid fastness
- Phospholipids: cause Caseation necrosis
- Glycolipid cause Caseation necrosis
- Phospholipids acts as Freunds adjuvant
- Phospholipids confers Acid fastness
- A clinician sent a specimen of sputum for Mycobacterium culture to a microbiology laboratory. The specimen was inoculated on a solid medium. After 6 weeks incubation growth was observed on the medium. What are the most likely colony characteristics on LJ Medium?
c. Rough brownish colonies
e.Fried egg like
7. A 25 years milkman comes to emergency department, saying that about 2 hours ago he began to feel feverish and weak; on examination he has a temperature of 40 degree centigrade, and a history of relapsing fever but no other pertinent findings. A blood cultures grows small gram positive rods that cause beta hemolysis on blood agar plate, incubated at room temperature. Which one of the following bacteria is most likely the cause?
a. Clostridium perfringens
c. Bacillus cereus
8. A 13 year old girl who return a few days ago from a school campaign trip is ill from school.she tells her parents that she has a headache and bouts of chills, over next few days she develops rashes which begin from palms and soles and spread to her wrist and ankles and then to her trunk. Her worsening condition leads her parents to take her to emergency department. Her blood tests reveals antibodies that react with proteus antigen, the patient is most likely infected with which of the following:
a. Borella burgdoferri.
c. Coxsasckie virus A
9.LEPROMATOUS LEPROSY: course progressive and malign, with nodular skin lesions, symmetric nerve involvement abundant acid fast bacilli in scrapings continuous Bacteremia, the lepromin test is :
a. negative lepromin skin test
c. in unequivocal
e.is insignificant for differentiation of the two types of leprosy.
10. A neonate after delivery develops fever, neck rigidity and convulsions, CSF findings show markedly decreased glucose levels, high lactact and outnumber of Polymorphonuclear cells: the most likely organism is:
b.Strept. Group B
c. Staph. aureus
e.Strept, Group A
11. Fungal Meningitis: Insidious onset, history of lung infection, yeast cells in CSF, slight changes in CSF chemistry. The most likely fungus involved is :
a. Candida albicans
c. Histoplasma capsulatum
12. The major cause of blindness in Asia and Africa is because of :
a. Chlymadia serovars A-C.
b.Chlymadia serovars D-K
c. Chlymadia serovars LGV1
d.Chlymadia serovar -LGV3
13. Food poisoning caused by Campylobacter species can be severely debilitating but rarely life-threatening. It has been linked with subsequent development of Guillain- Barré syndrome (GBS), which usually develops two to three weeks after the initial illness. The major cause of this condition is :
a. incorrectly prepared meat and poultry
c. unpasteurized milk
14. Peptic ulcer disease: An ulcer is now known to be the result of an imbalance between aggressive and defensive mechanisms in the stomach and duodenum. Part of that imbalance can be attributed to infection by H. pylori. The organism is:
a. Gram negative rod, urease negative,oxidase positive
b.Gram negative rod,urease positive,curved shaped
c. Gram negative rod,urease negative ,curved shaped
d.Gram negative rod,oxidase positive ,curved shaped
e.Gram positive rod,urease positive,curved shaped
15.Infection with the Malassezia furfur organism causes skin hypopigmentation.It is found most frequently in hot and humid regions. It is also responsible for causing one of the cutaneous mycosis. Infectin with malassezia furfur also causes which of the following disorders:
a. tinea capitis
c. tinea nigra
16. A 34 year old woman newly diagnosed with HIV is currently asymptomatic. She is not taking any medication yet and she is skeptical about the impact medication might have on her fatal disease. She is aware that if left untreated her disease will progress and make her susceptible to different infections. She inquires about the natural course her disease may take and the different infections she may acquire. Which of the following infections manifest with the lowest T cell count?
a. Cryptococcus meningitis
b.Dissemenated Mycobacterium avium –intracellulare
c. Herpese simplex
17. A 28 year old male visits his physician complaining of intermittent pain in his right elbow and left knee of two weeks duration.He has also noticed a slight drooping of the left side of his face in last three days.He also gives history of rash on his right arm two months ago.Rash was clear at the centre. On examination the physician notices several circular rashes with central clearing. Which pathogen is responsible for this condition?
a. Borrelia burgdoferri
c. Leptospira interogans
18.After a long camping trip a 29 years old man comes to the physician complaining of fever and general malaise.Examination shows a well demarkated skin lesion with a black base .On further questioning the patient says the lesion developed over a deer fly bite site, which of the following organism is most likely responsible for this lesion:
a. brucella melitensis
c. Nocardia astroides
19.A 12 year old patient presents to pediatric OPD with history of hacking cough for three weeks.He has already taken a course of ampicillin without any improvement of his cough.X-Ray chest reveals interstitial pneumonia with patchy infilteration .The physician labels him as a case of “Walking Pneumonia”.What is the most probable organism responsible for this illness?
a. Hemophillus influenza
c. Klebsiella Pneumoniae
20. A 30 years old man presents to his physician with complaints of dysuria, urgency, and urethral discharge. His uretheral discharge swab is sent for culture to lab, inoculation on free cell medium shows pinpoint colonies with fried egg appearance ,organism is urease positve .What is the most likely organism responsible for his illness?
a. Neisseria ghonorrea
c. Ureaplasma urealyticum
21.A 35 years old man with the history of pain and swelling of his axillary lymph nodes, high grade fever, myalgias and generalized weakness. On examination the affected nodes are extremely tender. Pus from the node is sent for evaluation to microbiology lab.Waysonn’s staining of his specimen’s smear shows safety pin appearance of the organism. What is the most probable organism responsible for his illness?
a. Yerisinea pestis
c. pasturella multocida
22. A 40 years old male presents to his physician with maculopapular rashes on his palm and soles, low grade fever, malaise, anorexia, weight loss, headache and myalgias. Examination reveals generalized lymphadenopathy.On further questioning he gives a history of non tender ulcer in his groin regions 2 months prior to his present symptoms what is the most likely organism responsible:
a. Borellia recurrentis
c. Borellia burgdoferri
23. Spore-forming anaerobic bacteria are usually present as normal flora of colon of animals, which one of them is responsible for causing flaccid paralysis after food poisoning.
a. C. perfringens
c. C. botulinum
24.In association with anaerobic fusiform bacteria gingivo-stomatitis and Vincent’s angina is caused by :
a. Borrelia vincenti
c. Leptospira interogans
25. Nontreponemal Ag tests measure anti-treponemal antibody using a cross reactive cardiolipin lecithin as an antigen rather than the actual bacterial antigens. The advantage of these test is that they have a:
a. Diagnostic index
c. Do not require spirochetes
26.A diagnosis of diphtheria is confirmed by:
a. Microscopic appearance of organisms stained with methylene blue
b.Isolation of a typical colony on Tindal’s agar
c. Isolation of typical organisms from materials such as blood, showing invasiveness
d.Detection of " phage plagues in cultures of suspicious isolates
e.Demonstration of toxin production by a suspicious isolate.
27. Listeria monocytogenes shows which of the following characteristics?
a. It can grow at refrigerator temperatures (4 degree calcius)
b.It is an extracellular pathogen
c. It is catalase-negative
d.It is a gram-negative coccus
e.It is strictly a human pathogen
28. Which of the following is true of Haemophilus influenzae?
a. Invasive infections are most commonly associated with encapsulated strains
b.Most invasive infections occur in infants during the neonatal period
c. Most human infections are acquired from domestic pets
d.The organism can be readily cultured on sheep blood agar in an environment of elevated CO2
e.Older adults are rarely at risk for infection with this organism because they typically have a high level of immunity
29.A distinguishing feature of human Mycoplasma species is that they:
a. Stain well with Giemsa, but not by Gram stain
b.Contain no bacterial pepidoglycan
c. Are not immunogenic because they mimic host cell membrane components
d.Cannot be cultivated in vitro
e.Are dependent on host sources of ATP
30.Which one of the following is most characteristic of Mycoplasma pneumonia infection?
a. Infection results in a fever of sudden onset accompanied by a productive cough
b.Infection most commonly occurs in the upper respiratory tract
c. Infection is definitively diagnosed by direct microscopic examination of sputum
d.Re-infection is rare and less severe than primary infection
e.Infection causes extensive scarring and calcification of affected lung tissue
31.Selective media needed for isolation of shigella species can be:
a. ss agar
c. chocolate agar
32. The mycobacterium tuberculosis Contains complex lipids including Mycolic acids, which property is conferred to the mycobacterium by them?
a. Acid fastness
c. Caseation necrosis.
e.Ability to grow on LJ medium
33. Swimming pool granuloma``in which treatment by tetracycline effective is caused by:
a. M. kansasii
c. M. scorfulaceum.
d. M. avium- intracellulara
e.M. fortuitum-chelonei complex
34An AIDS patient with a persistent cough has shown progressive behavioral changes in the past few weeks after visiting a zoo. A CSF sample is collected and encapsulated yeast like organism is observed. What is the most likely organism?
35. A woman who pricked her finger while pruning some rose bushes develops a local pustule that progresses to an ulcer. Several nodules then develop along the lymphatic drainage. The most likely agent is:
a. cryptococcus neoformans
c. sporothrix schenkii
36. Which of the following media is used to culture fungi?
a. mac conkey medium
c. sabouraud`s agar
d.eosin-methylene blue agar
e.lowenstein jensen mediu
37. A sample sent to microbiological lab for fungal culture yields growth on sabourods medium .which stain would you use for further fungal identification?
a. Calcoflour white stain
b.Zeihl Nelson stain
c. Gram stain
e.Sudan black stain
38. Dermetophyts are responsible for the following infection:
a. Fungal diseases that are confined to the outer layers of the skin, nail, or hair
b.Deep, ulcerated skin lesions
c. Fungating masses, most commonly involving the lower extremities
d.May involve deep viscera
e.May become widely disseminate
39.Aspergillosis is recognized in tissues by the presence of:
a. Budding cells
c. Metachromatic granules
40. A 35 years old man is HIV antibody positive and has a CD4 count of 50 /mm3.He has had a fever of 1000 degree F.for a few weeks and feels tired all the time. He has no other symptoms .Findings on physical examination are normal. Blood counts, urine analysis and X-ray chest are normal.A bone marrow biopsy reveals granuloma and culture grows an organism that is a budding yeast at 37 degree centigrade but produces hyphae at 25 C.Which of the following is the most likely cause?
a. Aspergillus fumigates
c. Mucour spp
41. A 60 years old woman had an adenocarcinoma of colon that was surgically removed. Several blood transfusions were given and she did well 3 weeks after surgery,when fever ,vomiting and diarrhea began. Blood and stool cultures were negative for bacteria.Test for clostridium difficile and HbsAg were negative.A liver biopsy revealed intra-nuclear inclusion bodies.Which of the following is the most likely cause?
c. Hepatitis A virus
e.Yellow fever virus
42. A 12 year old girl had a seizure this morning and was rushed to the hospital. On examination her temperature was 400 C and she had no nuchal rigidity.CT scan revealed no abnormality. A spinal tap was done and the protein and glucose were normal.Gram stain of CSF shows no organism or polymorphs.Routine blood culture and CSF cultures grew no organisms.She was treated with various antibiotics but became comatose and died 2 days later.Autopsy of brain showed eosinophilic inclusion bodies in the cytoplasm of the neurons.Which of the following is the most likely cause?
c. Rabies virus
d.Parvovirus B-19 virus
e.Herpese simplex virus type I
43.A 35 year old man who is HIV antibody positive and has a CD 4 count of 30 says “I can not remember the simplest things”.You are concerned about dementia. An MRI indicates several widely scattered lesions in the brain.Over the next 4 months he develops visual field defects,becomes paralysed and dies.Autopsy reveals that many neurons of the brain has lost myeline and contained intra-nuclear inclusions.Electrone microscopy reveals the inclusions contain non-enveloped viruses.Which of the following is the most likely cause?
c. Herpese simplex virus
44. A 66 years old woman is being treated with chemotherapy for lymphoma.She develops fever of 380 C and a non productive cough.Chest X-ray reveals an infiltrate.She is treated with an appropriate antibiotics.The following day several vesicles appear on her chest.Which of the following is the most likely cause?
a. Measle virus
b.Respiratory syncytial virus
c. Varicella zoster virus
45.A 35 years old man who is HIV antibodies positive and has a CD 4 count of 85 cells. He recently had a seizure and an MRI scan indicates a lesion in the temporal lobe.A brain biopsy specimen reveals multinucleated giant cells with intra-nuclear inclusions.Which of the following is the most likely cause?
a. Herpes Simplex virus
c. Coxsackie virus
d.western Equine encephalitis virus
46.Which of the following statement is correct about viruses?
a. obligate intracellular parasites and have only RNA or DNA
b.obligate intracellular parasites and have both RNA or DNA
c. Nuclic acid is surrounded by a lipid coat
d.Icosahedral helical form cannot exist without an envelope
e.they replicate by binary fission
47.Which of the following is a DNA virus?
a. Herpes virus
48.Some patients who are being infected with certain viruses continue to produce significant amount of the virus for long period. Which of the following viruses can cause this carrier state?
a. Neonatal Rubella virus
b.Yellow fever virus
c. Rabies virus
49.A tumour has to grow larger than 1-2mm. What supportive mechanism will be required? Identify the correct statement.
b. Application of promotors
c. Application of initiators
d. Growth factors
e. Secondary mutations
50.Genes that promote autonomous cell growth in cancer cells are called as;
a. Anti-apoptotic genes
b.DNA repair genes
d.Tumour suppressor genes
e.RNA repair genes
51.A patient of adenomacarcinoma of prostate is treated by the oncologist and is under regular follow-up. Which serum tumour marker will help in determining tumour recurrence
52.Individuals who have hereditary predisposition to cancer, the detection of mutated alleles may allow the patient and physician to devise an aggressive screening program and consider the option of prophylactic surgery and counseling of relatives at risk. This is not seen in germ line mutation of:
53.The incidence of carcinoma of cervix has fallen down in West because of the effective screening program for early detection of premalignant lesions. Select one diagnostic modality for screening of cervical cancer in your population.
- Cervical biopsy
- CT scan
- Serum CA-125 levels
- Pap smear
- IL-1 & TNF
- Thromboxane A2
- An area of chronic inflammation with granulomas in it.
- A localized collection of transudate.
- A localized collection of granulation tissue
- A localized collection of pus
- An area of collagen deposition
- MPO-halide system
- H2O2-MPO-halide system
- Lysosomal enzymes
- Increased transcytosis
- Direct endothelial cell damage
- Leucocyte mediated endothelial injury
- Cytoskeletal reorganization
- Endothelial cell contraction
e) Hepatitis B
60. Type III hypersensitivity reaction develops when:
a) Antigens are trapped in macrophages and cannot be cleared
b) Antibody binds to either self antigen or foreign antigen on cells
c) An IgE antibody response is directed against harmless environmental antigens
d) Immune complexes are formed in large quantities and cannot be cleared
e) IgM is produced as a part of primary humoral response
61. Harmful aspect of complement activation is:
a) Opsonization to enhance phagocytosis
b) Lysis of bacteria, tumor and infected cells
c) Enhancement of antibody production
d) Inflammation & anaphylaxis
e) Clearance of immune complexes
62. A 55-year-old woman has been treated in the hospital for pancreatitis for the past three weeks. She is examined one morning on rounds and found to have a swollen right leg. It is tender to palpation posteriorly but is not warm. This condition is most likely to be the result of which of the following vascular complications?
a. Venous thrombosis
c. Congestive heart failure
63. Causes of localized Oedema include:
- Obstruction of lymphatics
- Loss of proteins through kidneys
- Loss of proteins through gut
- Loss of proteins through gut
- Congestive cardiac failure.
a) All cases are familial
b) Trisomy 21 is an X linked disease
c) Meiotic non disjunction occurs in the ovum
d) The extra chromosome is of paternal derivation
e) Only females are carriers
65.Genetic sex is determined by:
a) The number of X chromosomes
c) Type of gonads
d) Secondary sexual characters
e) The presence or absence of Y chromosome
DEPARTMENT OF PATHOLOGY
RAWALPINDI MEDICAL COLLEGE RAWALPINDI send up
SEQ`S Paper Time allowed: 70 minutes Total Marks: 70
Where there is love of medicine, there is love of humankind.-- Hippocrates]
1. Name three species of CHLAMYDIA which cause HUMAN DISEASE. 3
b. Name the DISEASES caused by different species of CHLAMYDIA and its SEROTYPES. 2
KEY 1: Medical Microbiology and Immunology ; Earnest Jawetz 7th ed chapter 25.
a. Chlamydia three species 1. Chlamydia trachomitis. 2. C. pscittaci. 3. C. pneumonia. 4. TWAR 1 mark for each name = 3
. Diseases caused by different serotypes
1. Ocular Infections:
2. Trachoma and inclusion conjunctivitis. Serotype A-C
3. Serotype D-K STI`S
3. Genital Infections or STI`s: non gonococcal uretheritis, salpingitis, cervicitis PID, etc.
4. LGV-1 serotype. Lymphogranuloma venereum
5. C. pneumoniae. Respiratory Infections:
6. (TWAR organism) causes atypical pneumonitis in humans
0.5 mark for name of disease and serotype
2. KEY : Medical Microbiology and Immunology ; Earnest Jawetz 7th ed Chapter 21.
2. Outline LABORATORY DIAGNOSIS of TUBERCULOSIS. 3
b. Tabulate difference between PRIMARY AND REACTIVATION TUBERCULOSIS 2
1 Specimens: sputum. Bronchial washings, biopsy material etc. 2 Staining ZN, Fluorescence. 3. Culture LJ medium, Dubo`s medium, synthetic medium etc. Bactec. Chemilumesence, DNA probes, Luciferase assays.
0.5 marks each for mentioning any of the methods
b PRIMARY & REACTIVATION DISEASE
Tissue destruction results from presence of Organism & Host response (cell-mediated hypersensitivity)
Two types of lesions:
- Exudative Lesions: Acute inflammatory response mainly polymorphonuclear.
2. Granulomatous Lesions: Central area of Giant cells containing tubercle bacilli, surrounded by epitheloid cells.
Reactivation lesions: In apices, also Kidney Brain & Bones. 0.5 marks each
3. Robbins and Cotran Pathologic Basis of Disease 7th Ed 324-27
3. A patient of chronic Hepatitis develops a space occupying lesion in right lobe of the liver. If the hepatitis is of viral etiology:
a. Which two virus types may be associated with the development of this tumor?
b. List three other viruses oncogenic in man along with the one principle type of cancer associated with each. (2+3)
2. KEY : Medical Microbiology and Immunology ; Earnest Jawetz 7th ed Chapter 21.
Virus types associated with HCC
- Hepatitis B virus
- Hepatitis C virus
- Human papilloma virus – cancer of cervix
- Epstein Barr virus – Burkitt lymphoma, head and neck cancers
- Human T cell leukemia virus type I – T cell leukemia/lymphoma
4. A medical student who has been suffering from cough fever, fatigue, weight loss and night sweats, for the last many months develops, neck rigidity and meningeal irritation, insidiously (noted by elicitation of Brudzinski's and/or Kerning’s sign) and convulsions. He has received routine antibiotics occasionally from his doctor. Lumber puncture is done and CSF is sent to the hospital laboratory for investigations. No bacteria are isolated on routine laboratory media in 24-48 hours.
4. a. Name the causative organism? 1
b. Tabulate 4 differences in Normal, Bacterial, Viral and Tuberculous meningitis. 4
5. Name 2 ETIOLOGICAL AGENT of Menigitis in Neonates (0-2 weeks Infants (2 weeks to 3 months) Children (3 months - 6years) Normal adults (6 years to 21) each in tabulated form. 5
6. a. Tabulate four differences between bacteria and fungi. 4
b. Name 2 opportunist fungi 1
7. a. Name three genera of Spirochetes with one example each. 1.5+1.5
b. Mention two nonspecific and two specific Serological tests for diagnosis of Syphilis 1+1
8. a. Name 2 Bacterial 2 NGU`s and 2 Viral STI`s. 3
b. Briefly describe in less than fifty words the recent increase in the incidence of S.T.I`s in our community, and what measures will you advise for their prevention. 2
9. a. Define Zoonosis. 1
b. Name four infections and the animal involved in their transmission 4
10 a. Describe in less than 70 words the salient features for eradication of Dengue fever from your community. 2.5
b. Which tests are used to diagnose Dengue fever in the lab? 2.5
11. a. Give an equation showing the relationship between the killing g of bacteria & the concentration of the agent used.
1b. Name three groups of disinfectants that work by causing disruption of the cell membrane.
3c. Which is the preferred method of sterilization for solutions containing heat sensitive components?
112. A six month old infant is brought to the Pediatric OPD with complaints of vomiting, fever, and failure to thrive, on examination he is found to have a protuberant
abdomen with enlarged liver and spleen, and generalized lymphadenopathy. Biochemical assays of bone marrow biopsy established the diagnosis Nieimann - Pick disease.
a. What inherited deficiency causes this diseases, and how many variants of this disease can be seen.
2b. Give the Salient morphological features of this diseases.
14. The following proto-oncogenes; SIS, RET, CMYC, NMYC, Cyclin-D are associated with human tumors
like Astrocytoma, Leukemia, Burkitt lymphoma, Breast carcinoma and Neuroblastoma.
- Enlist four modes of activation of Protooncogenes. 2
- Summarize why P53 is called as guardian of genome. 3.
Now I lay me down to study
I pray the Lord I won't go nutty;
And if I fail to learn this junk
I pray the Lord that I won't flunk.
But if I do, don't pity me at all
Just lay my bones in the study hall;
Tell my teacher I did my best
Then pile my books upon my chest.
Now I lay me down to rest,
I pray I'll pass tomorrow's test.
If I should die before I wake
That's one less test I'll have to take.
-- Author unknown!]
Paper setter:Prof. Dr. Abbas Hayat , Dr .Humaira Niazi, Dr.Fatima