Gen. Pathology MCQz (Sendup paper RMC 2011)

3RD YEAR MBBS SENDUP EXAMINATION 22nd OCTOBER 2011


GENERAL PATHOLOGY AND MICROBIOLOGY MCQ’s (THEORY)

Time allowed: 65 minutes Marks: 65

65 MCQs distributed according to modules, with Topic of Specifications.

Attempt all questions, each question carries one mark
.

CHOOSE ONE BEST ANSWER:

CELL INJURY, DEATH AND CELLULAR ADAPTATIONS.

Q1. A patient with suspicious lesion in the lungs has to undergo multiple chest X-rays. Radiation energy such as X-rays can result in cell injury by causing hydrolysis of water. Which one of the following cellular enzymes protects cells from this type of injury?

a) Phospholipase.

b) Glutathione peroxidase.

c) Endonuclease.

d) Lactic dehydrogenase.

e) Protease.

Q2. A 15-year-old female thallasemic patient with H/O multiple blood transfusions for many years presents with enlarged liver and deranged liver function tests. What would be the histologic findings on liver biopsy?

a) Steatosis in hepatocytes.

b) Bile stains in liver cells.

c) Glycogen deposition in liver cells.

d) Hemosidrin in hepatocytes.

e) Kupfer cell hyperplasia.

Q3. . A 45 –year –old –female is diagnosed to have essential hypertension. If this condition remains untreated for years which of the following cellular alterations will be seen in the heart?

1. Atrophy.
2. Hyperplasia.
3. Metaplasia.
4. Hemosidrosis.
5. e. Hypertrophy.

Q4. A 70-year –old known hypertensive woman is bedridden for three months after a cerebrovascular accident. The diameter of her calf muscles has decreased. What is the possible underlying pathology?

a) Aplasia.

b) Atrophy.

c) Dystrophy.

d) Hypertrophy.

e) Hyaline change in muscles.

INFLAMMATION AND MEDIATORS OF INFLAMMATION.

Q5. The products of complement system have no role in which of the following steps/ or phases of the inflammatory reponse?

a) Chemotaxis

b) Increased vascular permeability.

c) Neutrophil activation.

d) Phagocytosis

e) Killing of bacteria in phagolysosome.

Q6. Which of the following is not a feature of chronic inflammation?

a) Cellular reaction by mononuclear cells.

b) Proliferation of fibroblasts.

c) Scarring and distortion of tissues.

d) Presence of neutrophils.

e) Formation of granulomas.







Q7. Neutrophils have a primary role in acute inflammation. Defect in neutrophil functions predisposing to infections is seen in which of the following disease?

a) Dubin Johnson syndrome.

b) Klinefelter syndrome.

c) Chediak-Higasi syndrome.

d) Down’s syndrome.

e) Turner’s syndrome.

Q8. Which of the following compounds mediates vasodilatation that would be useful to prevent additional ischemic tissue damage?

a) Thromboxane

b) Complement C3b

c) Nitric oxide

d) Tumor necrosis factor

e) Phospholipase

Q9. A 10 year-old child presents with fever and chills of 3 days duration along with a sore throat with purulent exudates on the tonsils. This clinical course is most typical for:

a) Granulomatous inflammation

b) Acute inflammation

c) Abscess formation

d) Resolution of inflammation

e) Chronic inflammation

Q10. Infection with mycobacterium tuberculosis results in formation of granulomas. Granulomatous inflammation is characteristically marked by the presence of Langhans giant cells. The mediator that most aids in the giant cell formation is:

a) Tumor necrosis factor (TNF)

b) Complement C3b.

c) Leukotriene B4.

d) Interferon Gamma.

e) Interleukin 1.

HEALING AND REPAIR.

Q11. Angiogenesis (Neovascularization) is an important component of healing and repair. It is therefore most important in:

a) Granuloma formation with Mycobacterium tuberculosis infection

b) Abscess formation with Staphylococcus aureus infection

c) Chronic active viral hepatitis with Hepatitis B virus

d) Healing of acute myocardial infarction

e) Liquefactive necrosis after brain ischemia

Q12. While playing football a medical student injured his hand. The laceration was sutured. After the sutures were removed a week later, healing continued. However over next two months a raised nodular scar developed at the wound site. What process has occurred during wound healing?

a) Resolution.

b) Keloid formation.

c) Organization.

d) Dehiscence.

e) Secondary union.



DISORDERS OF CIRCULATION

Q13. A patient of Ischemic heart disease is advised by the cardiologist to take low dose of aspirin to reduce the risk of arterial thrombosis. Which of the following steps in haemostasis is inhibited by aspirin?

a) Adhesion of platelets to collagen.

b) Aggregation of platelets.

c) Synthesis of antithrombin III.

d) Synthesis of von Willebrand factor.

e) Production of tissue factor.

Q14. A 27-year- old navy diver of Pakistan Navy descends to 50m in the Arabian Sea during a training exercise and returns to surface after completing his task. An hour later he develops severe painful arthralgias and myalgias.The symptoms improve over the next day.What is the likely cause of his symptoms?

a) Venous thrombosis.

b) Systemic vasodilation.

c) Disseminated intravascular coagulation.

d) Tissue nitrogen thrombi.

e) Fat embolism.

Q15. Infarcts may be classified on the basis of colour into red(hemorrhagic) and white (anaemic) infarcts.A hemorrhagic infarct is most typically present in which of the following organs by the mechanism given:

a) Lung with pulmonary thromboembolism

b) Heart with coronary thrombosis

c) Liver with hypovolemic shock

d) Kidney with septic embolus

e) Spleen with embolized mural thrombus

Q16. Which of the following does not contribute to the development of different types of oedema?

a) Obstruction of lymphatics

b) Sodium loss

c) Decreased oncotic pressure of plasma

d) Increased vascular permeability

e) Increased intravascular pressure.

PARASITOLOGY

Q17.The most common trematode which can predispose to carcinoma of urinary bladder is?

a) Clonorchis sinensis.

b) Enterobius vermicularis

c) Heterophyes Heterophyes.

d) Schistosoma hematobium

e) Schistoma japonicum.

Q18. Megaloblastic anaemia is most commonly seen in infection with which of the following helminth?

a) Entamoeba histolytica.

b) Leishmania donovani

c) Schistoma hematobium

d) Diphylobothrium latum

e) Fosciola hepatica.

Q19. A 30-year-old male was being operated for suspected liver mass.On opening the mass; the patient went into anaphylactic shock. Which possible worm Infection/ parasite may result in such complication?

a) Cysticercosis.

b) Elephantiasis

c) Schistosoma mansoni

d) Echinococcus granulosis

e) Fasciola hepatica.

Q20. Which of the following does not fit in the blood /tissue protozoa category?


a) Entamoeba.

b) Toxoplasma gondii

c) Trypanosoma

d) Acanthamoeba.

e) Babesia.

Q21. Which of the following parasite preferentially encyst in striated skeletal muscle?

a) Hookworm.

b) Lavae of trichenella spiralis.

c) Egg of round worm

d) Ankylostoma braziliensis

e) Entrobius vermicularis.







VIROLOGY

Q22. The typical clinical syndrome associated with rotavirus infection is:

a) Acute gastroenteritis of young adults.

b) Acute bronchitis of infants.

c) Nausea, vomiting and diarrhoea in infants and very young children

d) Acute viral hepatitis.

e) Urinary tract infection.

Q23. A 40-year-old male is diagnosed to have acute viral hepatitis B. He would be considered to be highly infectious if he is positive for:

a) HBsAg

b) Anti-HBs

c) HBeAg

d) Anti-HBe

e) Anti-HBc

Q24. What is the vector of Dengue fever


a. Aedes aegypti

b. Anopheles mosquito

c. Aedes albopictus

d. Deer fly

e. Flea

Q25.A large number of patients presented to emergency departments of the Allied hospitals during an outbreak of dengue fever. Which of the following is the Most Rapid test for the diagnosis of this disease?

a) Determination of IgG levels in the patient’s blood.

b) Determination of IgM levels in the patient’s blood.

c) Determination of Hemoglobin levels.

d) Determination of Platelet levels.


e) Determination of NS1 antigen in the blood.

Q26. Virus belonging to which of the following groups, are likely to establish latent infections?

a) Herpes viruses.

b) Poxviruses.

c) Filoviruses.

d) Influenza viruses.

e) Caliciviruses.

Q27.A 20-year-old medical student had acute onset of fever, nausea, and pain in right hypochondrium.He had jaundice and observed passing dark urine. On investigations he was positive for HAVIgM, but negative for other markers of viral hepatitis. The physician can inform him that:

a) He acquired the infection from a recent injection for vaccination.

b) He is likely to develop chronic hepatitis.

c) He is at a risk of developing hepatocellular carcinoma.

d) He has developed resistance to infection with hepatitis E virus.


e) He may transmit the infection to other students by person to person spread for upto 2 weeks.



GENERAL BACTERIOLOGY

Q28. Heat resistance of bacterial spores is due to the presence of:

a) Diaminopimelic acid.

b) D-Glutamic acid.

c) Calcium dipicolinate.

d) Sulphydryl containing proteins.

e) Lipid A.

Q29. Growth rate of bacteria during exponential phase is:

a) Zero.

b) Increasing

c) Constant

d) Decreasing

e) Negative



Q30. Which of the following organism is non-motile?

a) Vibrio cholerae

b) Proteus vulgaris

c) Shigella dysenteriae.

d) Escherichia coli

e) Salmonella typhi

Q31.Thermus aquaticus is an important component of DNA amplification methods such as PCR, because it is a:

a) Mesophiles

b) Psychrophiles

c) Halophiles

d) Thermophiles

e) Chemolithotrophs.



SPECIAL BACTERIOLOGY

Q32. Pus from a non-healing foot ulcer of a diabetic patient yields growth of gram negative rod that forms swarming colonies on blood agar plate and has a fishy odour. The organism most probably belongs to the genus?

a) Serratia

b) Klebsialla

c) Shigella

d) Proteus

e) Salmonella.

Q33.A 40-year-old man comes to the OPD with H/O chancre for last two weeks. What would be the appropriate course of action by the physician in charge?

a) Perform gram staining on chancre fluid.

b) Repeat VDRL in 10 days.

c) Perform dark field microscopy for treponemas.

d) Send the patient home untreated.

e) Swab the chancre and culture on Thayer-martin agar.

Q34.A 23-year-old –male was hospitalized after a road side accident with multiple injuries. His wounds were infected therefore he was treated with Tobramycin, Carbenicillin and clindamycin.Five days later he developed severe diarrhoea and pseudomembranous enterocolitis.These complications are caused by which of the following organisms?

a) Bacillus fragilis.


b) Clostridium difficile.

c) Clostridium perfringens

d) Clostridium sordellii.

e) Staphylococcus aureus.

Q35. A 3 year old child has high grade fever for two days, is irritable and has neck stiffness. Gram stained smear of cerebrospinal fluid obtained after lumber puncture reveals gram negative, small pleomorphic coccobacilli.What is the most appropriate procedure to follow in order to reach an etiological diagnosis?

a) Culture the cerebrospinal fluid on chocolate agar and identify the organism by growth characteristics.

b) Culture the spinal fluid in mannitol salt agar.

c) Perform a catalase test of the isolated organism.

d) Perform coagulase test on the isolate.

e) Perfom latex agglutination tets to detect specific antibody in the spinal fluid.

Q36. Five hours after eating fried rice at a restaurant, a 20-year- old medical student and his friends developed nausea, vomiting and diarrhea.Which one of he following organisms is likely to be involved?

a) Clostridium perfringens.

b) Enterotoxigenic Escheria coli.

c) Salmonella typhi.

d) Bacillus cereus.

e) Clostridium botulinum.

Q37. Patients of Diphtheria should be treated with:

a) Antibiotics immediately.

b) Antibiotics and antitoxin after availability of culture report.


c) Antibiotics and antitoxin immediately

d) Penicillin or erythromycin for one week.

e) Quinolones for one month.

Q38. Which of the following atypical Mycobacterium produces disease in humans which is indistinguishable from tuberculosis?

a) Mycobacterium africanum.

b) Mycobacterium bovis.

c) Mycobacterium kansasii.

d) Mycobacterium avium.

e) Mycobacterium smegmatis.

Q39. A 5-year-old child presents in paediatric emergency with flaccid paralysis. Flaccid paralysis is the result of infection with which of the following organisms:

1. Polio virus and Clostridium tetani.
2. b. Polio virus and Clostridium botulinum.
3. Rhinovirus and Clostridium difficile.
4. Rabies virus and Clostridium perfringens.
5. Rhabdovirus and Corynebacterium diphtheria.

Q40. A hyperaemic edema of the larynx and epiglottis that rapidly leads to respiratory obstruction in young children is most likely to be caused by which of the following organisms?

a) Haemophilis hemolyticus.

b) Haemophilis influenzae

c) Klebsialla pneumoniae.

d) Mycoplasma pneumoniae

e) Staphylococcus aureus.

Q41.A patient with suspected brain abscess was admitted in the neurosurgery ward. The abscess was drained and the pus was sent for culture and sensitiviy. The isolate on blood agar is beta haemolytic, Gram positive coccus with positive coagulase and catalase test. The organism is:

a) Streptococcus pyogenes.

b) Enterococcus fecalis.

c) Streptococcus aglactie.


d) Staphylococcus aureus.

e) Listeria monocytogenes.

Q42. Salmonella typhi the causative organism of enteric fever enters the body via the:

a) Parentral route.

b) Respiratory tract.

c) Oral route.

d) Skin.

e) Nasal route.

Q43. A 20-year-old female C/O frequency and burning micturation and is diagnosed to have UTI. The most common cause of urinary tract infection in young women is:

a) Klebsialla

b) Serratia.


c) E.Coli

d) Proteus.

e) Staphylococcus aureus.

Q44. Blood culture from a patient demonstrates Gram positive rods.Klebsialla and Salmonella are two diagnostic possibilities. Which of the following would be most suitable for distinguishing these two organisms?

a) Coagulase test.

b) Dark field examination.

c) Lactose fermentation.

d) Lancefield grouping.

e) Spore formation.





Q45. Staphylococci and streptococci can be differentiated with surety on the basis of which of the following:

a) Coagulase test.

b) Gram’s staining.


c) Catalase test.

d) Oxidase test.

e) Rapid urease test and colony morphology.



MYCOLOGY (FUNGI)

Q46. A 10-year-old boy develops a dry, circular, scaly,pruritic lesion on his leg. Potassium hydroxide –calcofluor white preparation of a scraping from the lesion shows branching, septate, non-pigmented hyphae.What is the diagnostic significance of these findings?

a) Chromomycosis


b) Dermatophytosis

c) Phaeohyphomycosis

d) Sporotrichosis

e) No diagnostic significance.

Q47. A 50-year –old diabetic developed white lesions in the mouth and on the surface of tongue, diagnosed as oral thrush. The causative agent of this disorder is:

a) Aspergillus fumigatus.


b) Candida albicans.

c) Haemophilus influenzae.

d) Streptococcus pneumoniae

e) Staphylococcus aureus.



Q48.Which of the following is an opportunist fungus?

a) Trichosporon species.

b) Trichophyton species.

c) Candida albicans and other Candida species.

d) Histoplasma capsulatum.

e) Coccidioides immitis.

Q49.A 15-year-old boy presents with circular bald patches on the head with short hair stubs and broken hair within hair follicles. Which of the following is responsible for his condition?

a) Tinea corporis

b) Tinea pedis.

c) Tinea capitis.

d) Tinea cruris

e) Tinea unguium.



GENETICS

Q50. A male child in a family suffers from mental retardation. The disorder has affected several generations and has increased in severity with each passing generation. He is diagnosed as a case of Fragile X syndrome. Which of the following mechanisms produces this genetic condition?

a) Point mutation.

b) Missense mutation.

c) Trinucleotide repeat mutation.

d) Frameshift mutation.

e) Mitochondrial DNA mutation.

Q51. A 6 months old child is brought to a paediatrician with C/O slow growth and convulsions (seizures) .On examination liver and kidneys are enlarged, and the patient has severe hypoglycemia. Liver biopsy reveals accumulation of Glycogen in liver cells. Physician suspects glycogen storage disease and labels it as Von Gierke’s disease. Which enzyme deficiency results in this genetic disorder?

a) Muscle phosphorylase

b) Phenyl alanine hydroxylase

c) Glucose 6 phosphatase

d) Hexosaaminidase A

e) Sphingomyelinase



DISORDERS OF GROWTH

Q52. A 65-year-old male with H/O painless haematuria after investigations is diagnosed to have grade IV transitional cell carcinoma of the urinary bladder that has infiltrated through the bladder wall. Regarding these findings which of the following statements are appropriate?

a) This neoplasm is a metastatic tumour.

b) He has a poorly differentiated neoplasm.

c) A paraneoplastic syndrome is likely.

d) The stage of this neoplasm is low.

e) His cancer is probably cured

Q53.Which of the following diagnostic procedures has been found to have greatest impact in reduction of cervical cancer related deaths?

a) Chest radiograph.

b) Stool occult blood.

c) PAP smear.

d) Carcino embryonic antigen (CEA) assay.

e) Urine analysis.

Q54.A 60-year-old man undergoes total laryngectomy for a laryngeal tumor.On histopathological examination it is a moderately differentiated squamous cell carcinoma. This type of neoplasm is strongly related to which of the following risk factors?

a) Nutritional factors.

b) Infection with human papilloma virus.

c) Chronic alcoholism.

d) Smoking.

e) Exposure to radiation.

Q55.A 40-year-old woman presents with a painless soft tissue mass in her left thigh. On excision it is found to be adherent to surrounding tissues. On histological examination it is composed of pleomorphic clear cells with vacuolated cytoplasm. The nucleus of cells is indented by the cytoplasmic vacuoles which are stained with lipid stains. Which of the following is the most likely diagnosis?

a) Chondrosarcoma.

b) Liposarcoma

c) Lipoma

d) Metastatic adenocarcinoma.

e) Rhabdomyosarcoma.

Q56. Changes in sequence, in the morphology of surface epithelium from:

Metaplasia to dysplasia to carcinoma-in-situ would be most characteristic for:

a) Human papilloma virus (HPV) infection of uterine cervix

b) Retroviral infection of T-lymphocytes

c) Hepatitis C infection of liver

d) Epstein-Barr virus infection of B-lymphocytes

e) Influenza virus infection of lung

Q57. Which one of the following histopathology findings is the best indicator of a malignant neoplasm?

a) Pleomorphism

b) Atypia

c) Invasion

d) Increased nuclear/cytoplasmic ratio

e) Necrosis

Q58.Which of the following is the most common site for development of embryonal Rhabdomyosarcoma?

a) Lungs.

b) Kidneys.

c) Head and neck

d) Spleen

e) Liver.







Q59.On exploratory laprotomy the peritoneal mesentery of a 55 –year-old woman with cancer shows innumerable nodules composed of metastatic neoplasm. Which of the following tumours is most likely to give rise to this condition?

a) Carcinoid tumour.

b) Bronchogenic carcinoma

c) Glioma

d) Hepatocellular carcinoma

e) Ovarian carcinoma.

Q60.A male patient presents with a testicular mass, which on orchiectomy and histological examination shows a malignant tumour with yolk sac differentiation. Which of the following tumour markers would be useful in monitoring the patient for recurrent or metastatic disease?

a) Carcinoembryonic antigen (CEA)

b) Prostatic specific antigen (PSA)


c) Alpha-fetoprotein (AFP)

d) S-100

e) CA-125

IMMUNOLOGY

Q61. A five-year-old child has chicken pox. After one year he is again exposed to a case of chicken pox but does not develop the infection because of specific immunity. Immunological memory,a feature of specific immunity can be explained on the basis of:


a) Increased number of antigen-sensitive T and B cells.

b) Increased number of macrophages.

c) Change in amino acid sequence of antibodies formed by individual clones such that the antibodies will fit the antigen more perfectly.

d) Predominant synthesis of IgG antibodies.

e) Predominance of IgG as membrane immunoglobulin of the B-cell population.

Q62.Serum sample of a newborn baby is tested for immunoglobulin levels. The class of immunoglobulin present in highest concentration in the blood of a normal newborn is:

a) IgM.

b) IgG

c) IgA

d) IgD

e) IgE

Q63 In antigen recognition by cytotoxic T lymphocytes, the T cell receptor recognizes antigens in association with:

a) Class II antigens.

b) Class I antigens

c) Class III antigens

d) C3b

e) Fc portion of Ig G.

Q64. A 19-year-old medical student has a pruritic linear, vesicular rash on his leg. The rash developed 16 hours after he returned from a hiking trip with his class. It began as a swollen, erythematous streak that developed into extremely itchy blisters. He has experienced similar episodes in the past when he goes for hiking. The rash is most likely a result of which of the following mechanisms:

a) Antigen-antibody complexes formed in circulation and deposited in the tissue.

b) Cytotoxic antibodies against cell surface antigens.

c) IgE mediated basophil degranulation.

d) Release of histamine from mast cells.

e) Release of lymphokines from sensitized lymphocytes.

Q65. A 30-year-old woman with H/O contact with a patient of Pulmonary TB receives an intradermal tuberculin injection and later develops an indurate, erythematous papule 12 mm in diameter. This reaction is an example of which of the following?

a) Antibody-dependent cell-mediated cytoxicity.

b) Local anaphylaxis.

c) T-cell mediated cytotoxicity

d) Type IV hypersensitivity.

e) Type III hypersensitivity.



Paper Setter: Dr. Abbas Hayat, Dr. Homera, Dr. Fatima




GENERAL PATHOLOGY AND MICROBIOLOGY.


SEQ’s.Total marks 70



TOS: Acute and Chronic Inflammation



Q1. Acute inflammation is a rapid response to an injurious agent.

a) Enumerate different stimuli for acute inflammation. 2

b) List vascular and cellular events that constitute acute inflammation. 3



TOS: Cellular adaptations, Cell injury and Cell death

Q2. A primigravida delivers a baby girl. The neonatologist advises her to breast feed the baby.

a) What changes occurred in the breast during pregnancy that will enable the mother to nurse her baby? 1

b) Massive enlargement of the uterus during pregnancy is an example of which type of cellular adaptation? 1

c) What is COMPENSATORY HYPERPLASIA? Give TWO examples. 3





Q3.

TOS : Inflammation and Repair



A 10-year-old boy injured his leg while playing football in school. 3 days after injury, pink, soft friable tissue appeared on the surface of the wound.

a) What is this tissue called? 1



b) Give its histologic features. 2

c) Enumerate THREE processes in the formation of a scar. 2







TOS: DISORDERS OF CIRCULATION



Q4. A 60-year-old male has worsening congestive heart failure with increasing pulmonary congestion and oedema. He also has peripheral oedema.

a) Give any four pathophysiologic categories of oedema. 2

b) What is the major cause of oedema in this patient? 1

c) Give two microscopic morphological features of Chronic pulmonary congestion. 2





TOS: GENETIC DISORDERS

Q5. A 8-year-old child is prought to you with history of poor performance in studies. He has epicanthic folds, simian crease on palms of hands and a flat facial profile. Maternal age was 44 years when he was born.

a) What is the most likely diagnosis? 1

b) What cytogenetic abnormality is expected in this child? How is maternal age responsible for this abnormality? 2

c) Approximately 1% of such patients are MOSAICS. What do you understand by this term? 2



TOS: NEOPLASIA

Q6. Anaplasia is considered as a hall mark of malignant transformation.

a) Give three morphologic changes characteristic of anaplasia. 1.5

b) Enumerate three pathways for dissemination of cancers. 1.5

c) Give the basis of grading and staging of cancers. 2





TOS: IMMUNOLOGY

Q7. A one-year-old male boy remained alright for the first 6-9 months of life. He then started having recurrent bacterial infections causing otitis media and pneumonia.

a) Which immune cells are likely to be deficient in him? 1

b) Why was he protected against bacterial infections during first six months of life? 1

c) Give the pattern of antibody production following initial antigen administration and a booster injection.



TOS: BACTERIOLOGY

Q8.A 6-year-old child develops high grade fever and headache for last 4-5 days.. He is brought to the emergency room where he is noted to have neck stiffness indicating meningeal irritation. A lumber puncture is done and the cerebrospinal fluid is sent to the microbiology laboratory.

a) What is the most probable diagnosis? 1

b) Name the possible organism responsible for the disease in the child and give its portal of entry. 2

c) How will you diagnose this infection in the laboratory? 2



TOS: BACTERIOLOGY

Q9 . Give the mechanisms involved in the pathogenesis of H. Pylori infection in the human being. 5





TOS: BACTERIOLOGY (MYCOBACTERIA)

Q10. A 60-year-old-man has a 5-month history of progressive weakness and weight loss. There is H/O intermittent fever, chills and productive cough. A sputum specimen is obtained and numerous acid-fast bacteria are seen.

a) The patient is most likely infected with which organism? 1

b) What is PRIMARY TUBERCULOSIS? Give its complications. 2

c) Name any four atypical forms of this organism. 2





TOS: BACTERIOLOGY

Q11. A grand mother in a remote village applies cow dung to the umbilical stump of a newborn. The child develops strong muscular spasms, pronounced arching of the back, and dies of respiratory failure after a week.

1. What is the likely diagnosis Name the most likely ETIOLOGICAL AGENT. 2
2. Name three other BACTERIAL SPECIES of the genus and the DISEASES caused by them. 3



TOS: PARASITOLOGY



Q12. A child living in a village is in the habit of walking bare foot. He is brought to the basic health Unit by his mother with C/O marked pallor. On investigations he is found to be suffering from severe microcytic hypochromic anaemia.

a) Give the cause of his anaemia and name the helminth that causes such anaemia. (1)

b) Name the infective form of this worm. (1)

c) Give an outline of life cycle of this worm. (3)



TOS: VIROLOGY



Q13. A 23 year old man presents to the medical OPD of Holy Family Hospital in early Autumn with an acute febrile illness of 2-7 days duration.

She also has Headache, Retro-orbital pain, Myalgia Arthralgias Rash , Petechiae. Blood CP revealed Leucopoenia & Thrombocytopenia.

1. Give the most probable diagnosis. (1)
2. Name the vector that transmits this disease to humans (I)
3. Enlist Six preventive measures for the control of spread of this disease.(3)







TOS: MYCOLOGY



Q14. A 10-year-old boy develops a dry, circular, scaly,pruritic lesion on his leg. The lesion is red in the centre.Potassium hydroxide –calcofluor white preparation of a scraping from the lesion shows branching, septate, non-pigmented hyphae.

c) What is the diagnostic significance of these findings?

d) Name four skin diseases caused by dermatophyte infection, with location of lesions.


 GENERAL PATHOLOGY AND MICROBIOLOGY.

KEY SEQ’s.Total marks 70



Q1 KEY:

a) Infection-Bacterial, Viral, Parasitic, microbial toxins.

Trauma-Blunt/penetrating.

Physical and chemical agents.

Tissue necrosis (Any cause)

Foreign bodies (Splinters, dirt, sutures)

Immune reactions (Hypersensitivity) 2 marks



b) Vascular changes: 1.5 marks

Change in vascular flow and caliber

Increased vascular permeability (Vascular Leakage)

* Formation of endothelial gaps
* Endothelial cell necrosis (direct injury) and detachment
* Delayed prolonged leakage
* Leukocyte mediated endothelial injury
* Increased transocytosis
* Leakage from new blood vessels.

Cellular events: 1.5 marks

Leukocyte Margination, rolling and adhesion

Transmigration across endothelium (diapedesis)

Migration in interstitial tissue towards a chemotactic stimulus (Chemotaxis)

Leukocyte activation

Phagocytosis

Leukocyte product release and leukocyte induced tissue injury.

REFERENCE:Robbins Pathologic Basis of Disease, Seventh Edition. Pages 50-60

Q2 KEY:

a) Hormonal Hyperplasia: leading to proliferation of glandular epithelium of the female breast during pregnancy.

0.5+0.5 =1mark

b) Hormone induced physiological hyperplasia and Hypertrophy.

0.5+0.5=1mark



c) Hyperplasia is increase in the number of cells in an organ or tissues resulting in increased volume of the organ or tissue. Compensatory hyperplasia increases tissue mass after damage or partial resection.

Examples:

i) Liver after partial hepatectomy.

ii) After unilateral nephrectomy the remaining kidney undergoes compensatory hyperplasia.

1+1+1=3 marks.

REFERENCE:Robbins Pathologic Basis of Disease, Seventh Edition. Pages 6-7


Q3. KEY:

a) Granulation tissue. 1 mark.

b) Formation of new small blood vessels (angiogenesis) and proliferation of fibroblasts. 1+1=2

c) Formation of Scar:

i. Emigration and proliferation of fibroblasts in the site of injury.

ii. Deposition of extracellular matrix (ECM)

iii) Tissue remodelling. 1+0.5+0.5=2

REFERENCE:Robbins Pathologic Basis of Disease, Seventh Edition. Pages 107 &110


Q4 KEY:

a) Pathophysiologic categories of oedema.

i. Increased hydrostatic pressure.

ii. Deceased plasma oncotic pressure (Hypoproteinemia)

iii. Lymphatic obstruction.

iv. Sodium retention.

v. Inflammation.

b) Increased hydrostatic pressure-Generalized increase in venous pressure resulting in systemic oedema.

c) Microscopic features of chronic pulmonary congestion.

i) Septa thickened and fibrotic.

ii) Alveolar spaces contain numerous hemosidrin laden macrophages (heart failure cells).

REFERENCE:Robbins Pathologic Basis of Disease, Seventh Edition. Pages 120-122

Q5. KEY:

a) Down’s Syndrome. 1mark

b) Trisomy 21.

Maternal age has a strong influence. Correlation with maternal age suggests that in most cases the meiotic nondisjunction of chromosome 21 occurs in the ovum. 1+1=2 marks.

c) Mosaics usually have a mixture of cells with 46 and 47 chromosomes.

Mosaicism results from mitotic nondisjunction of chromosome21 during an early stage of embryogenesis .Symptoms in such cases are variable and milder, depending on proportion of abnormal cells. In cases of mosaic Down’s Syndrome maternal age is of no importance. 1=1=2marks.

REFERENCE:Robbins Pathologic Basis of Disease, Seventh Edition

Q6. Anaplasia is considered as a hall mark of malignant transformation.

a) Give three morphologic changes characteristic of anaplasia. 1.5

b) Enumerate three pathways for dissemination of cancers. 1.5

c) Give the basis of grading and staging of cancers.

KEY:

a) Morphologic changes characteristic of anaplasia:

b) Pleomorphism: Both cells and nuclei display pleomorphism-variation in size and shape.

i) Abnormal nuclear morphology: Nuclei contain abundance of DNA and are extremely dark staining (Hyperchromatic). Nuclei disproportionately large for cells, nucleus-to-cytoplasm ratio may approach 1:1 instead of normal 1:4 or 1:6. Nuclear shape variable, chromatin coarsely clumped and distributed along nuclear membrane. Large nucleoli in nuclei.

ii) Mitosis: Large number of mitosis

Loss of polarity: Sheets or large masses of tumour

1. d. TNM classification/..........................



REFERENCE:Robbins Pathologic Basis of Disease, Seventh Edition. Pages




Q7. KEY:



a) B lymphocytes (Cells) 1mark

b) He was protected against bacterial infections by the maternal IgG transmitted via the placenta. 1mark

c) Primary Response:Antibody detectable in the serum within days or weeks.

Serum antibody rises concentration concentration continues to rise and then declines.First antibody formed are IgM followed by IgG, IgA or both.IgM declines sooner than IgG.

Secondary Response: Antibody response rapid

Rises to higher levels than during primary response.Response attributed to antigen sensitivite memory cells.Much more IgG produced.IgG persists much longer Such antibody has higher affinity.

REFERENCE:

Medical Microbiology Jawetz 23rd edition Page 135

Q8. KEY:

1. a. Acute bacterial meningitis. 1mark
2. b. Neisseria meningitides. Portal of entry is nasopharynx.

1+1 mark

1. c. DIAGNOSTIC LABORATORY TESTS: 2marks

i)SPECIMENS:

Blood for culture sensitivity.

CSF for smear, culture and chemical/cytological determinations.

Material from petechiae.



iii) SMEARS:Gram stained smears of CSF sediment or of petechial aspirate show neisseriae.

iv) CULTURE:

-on heated blood agar (chocolate agar) or

-on Thayer-Martin medium with antibiotics

-Colonies identified by gram staining and oxidase test

iv) SEROLOGY:Antibodies tomeningococcal polysaccharides measured by latex agglutination or haemagglutination.

Medical Microbiology Jawetz 23rd edition Page 301

Q9 . KEY

Q10. KEY:

a) Mycobacterium Tuberculosis. 1 mark

b)

c) Mycobacterium avium Complex (M avium –intrcellulare complex).

Mycobacterium kansasi

Mycobacterium scrofulaceum

Mycobacterium marinum

Mycobacterium ulcerans. 0.5+0.5+0.5+0.5=2 marks.

Q11 KEY

Microbiology and Immunology, Ernest Jawetz,. 9th edition. Chapter 17 page 126-129



1. Tetanus. C. Tetani 1+1=2 marks
2. 1) C. botulinum…botulism…

2.) C perfringens….gas gangrene and food poisoning. .

3.) C. difficile….pseudo membranous colitis

0.5 each for species and disease caused. = 3


Q12. a) Iron deficiency. Hookworm (Ankylostoma duodenale ).

b)

c) Outline of life-cycle of Hook worm.









Q13. A 23 year old man presents to the medical OPD of Holy Family Hospital in early Autumn with an acute febrile illness of 2-7 days duration.

She also has Headache, Retro-orbital pain, Myalgia Arthralgias Rash , Petechiae. Blood CP revealed Leucopoenia & Thrombocytopenia.

1. Give the most probable diagnosis. (1)
2. Name the vector that transmits this disease to humans (I)
3. Enlist Six preventive measures for the control of spread of this disease.(3)



Q13 KEY






Q14. KEY:

a) The clinical features and laboratory findings suggest Dermatophytosis (Ring worm infection). (01 mark).

b) i) Taenia corporis (ring worm)-Nonhairy smooth skin.

ii) Tinea pedis (athlete’s foot)-Interdigital spaces on feet of persons wearing shoes.

iii) Tinea cruris(jock itch) Groin.

iv) Tinea capitis-Scalp hair;,fungus inside hair shaft or on surface of hair.

v) Tinea barbae-Beard hair.



(Any four: 01 marks each).



Reference:Medical Microbiology:Jawetz Pg 537.

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