Patho sendups-sorted out Seqs 2012

CNS

---Enlist 4 major classes of brain tumors,Enlist tumors derived from glial cells and which 1 has best prognoisis among them?Enlist 4 hstological features of hemangioms and how psammoma bodies r formed(WMC)

young blood transfusion officer presented with headache, photophobia, imitability, fever, clouding of conscious neurological impairment & neck stiffness. CSF is frankly purulent. Ct Sean showed no mass or tumor

a. What is your diagnosis?
b. Describe different types of suspected disease & dynastic approach

(CMC)

 A 15 year old boy presented with painful swelling above left knee joint from lastfew months. On examination swelling is warm and tender. There is no h/o of trauma.Lab report shows raised ESR and leukocytosis. X-rays shows destructive lytic lesion inthe distal diaphysis of femur.

1.   Give two provisional differential diagnoses.  2

2.   Biopsy report shows sheets of uniform small round cells having hyperchromatic nuclei and scanty cytoplasm. Homer-Wright rosettes are present. Areas of tumor necrosis are also seen. What is your definite diagnosis? 1

3.   Enlist four benign chondrogenic neoplasms.  2 (RMC)

A 66 yrs old male patient, hypertensive for the last 20 yrs, reports in the emergency department with severe headache and vomiting. He is confused. His wife tells that he has not taken antihypertensive medication for 3 weeks because it is not possible for them to buy expensive medicines.

1.   What are the effects of hypertension on brain?                                                                                     3           

2.   What are different types of brain aneurysms?                                               (RMC)                                     2

---(a) Give the CSF laboratory findings of Acute Pyogenic Meningitis.

                 (b) Enumerate the Brain Tumors and give the morphology of Astrocytoma.(SZMC)

---A 50 years old male with history of severe headache & seizures presents with SOL (space occupying lesion) in white matter of temporal lobe of left cerebral hemisphere. Histological examination reveals sheets of cells with regular nuclel & clear halo of cytoplasm along with calcification & delicate network of anastomosing capillaries.

a.     What is your diagnosis?                                               (1)

b.     Give molecular genetics of this neoplasm.                                     (2)

a.     Classify other glial tumors.                                                   (2)(SMC)

---A 29 year old female suffering from episodes of headach throughout her pregnancy. Her B.P Was….. but on CT-Scan planed after delivery shows a well circumscribed dural based tumour …. In diameter the left cerebral hemisphere.

          a) Write most likely morphological type of tumour in the above patient. 02

          b) Classify brain tumours               (PMC)

---.         a) classify brain tumors.                                                                  (2.5)

a)    Give Macroscopic and microscopic picture of Astrocytoma.   (2.5)(SIMS)

a. Give the CSF findings in tabulated from in                                (3)

Acute phylogenic meningitis,Viral meningitis and Tuberculous meningitis.

b. Give briefly the histological picture of acute meningitis.         (MMDC)

---A 10 year old architectural student a admitted from university halls of residence with a 24 hours history of headache. Nausea vomiting and tastelessness. There is neck stiffness on physical examination

i.                   What is the probable diagnosis

i.                   Which investigations would u pattern to confirm the diagnosis    1

ii.                What is the most probable causative organism                              1

iii.             Tabulate 2 differences between purulent and aseptic meningitis   2(NSMC)

GIT

Q2) A 23 year old years old female resents with recurrent episodes of blood diarrhea lasting for 3-d times at a time accompanied by severe abdominal pain & cramps. She remains alright for 1-2 min in between. These episodes. Left hemicolectomy revealed pancolitis

a.     What is the diagnosis?

b.    Give the etiology & pathogenesis of this disease

c.     Give histological findings of this condition(CMC)

----Define leukoplakia?4 risk factors for development of squamous cell esophageal carcinoma?enlist gross and microscopic features of diffuse gastric cancer?Classify gastric carcinoma according to their location in stomach and according to gross and microscopic features(WMC)

A 20 year old female presented,  in the OPD with mass in the parotid region. She told that swelling is from last 10 years. Initially it was of almond size and gradually it has acquired the size of walnut. On clinical examination the swelling is painless, mobile, firm and discrete.

1.   Give two most likely differential diagnoses. 2

2.   Name the test you will request for its immediate diagnosis. 1

3.   What is the relationship of salivary gland tumor being malignant with the anatomical size of the salivary gland?1

4.   Name the most common primary malignant tumor of the salivary gland. 1 (RMC)

 Q3) A 35 years old comes to the hospital with pain epigastrium relieved on drinking cup of milk

a.     Give pathogenesis & morphology

b.    Enumerate the gastric tumors with morphology of any one of them(CMC)

---A 30 years male smoker, presents in emergency with hematermesis. He gives history of progressive dysphagia for the last 3 months and anorexia for 1 month. History of marked weight loss is also given. Physical examination revealed non specific findings. ultrasound examination of abdomen shows "leather bottle stomach" with enlarged pyloric lymph node.

a)    What is your diagnosis?                                               (1)

b)    Give the etiological risk factors of this disease?                  (2)

c)    What are the modes of spread?                                    (1)

d)    What is Krukenberg tumour?                                       (2)(SIMS)

---A 50 years female resented in OPD clinic with history of altered bowel habits, abdominal pain and blood stools. Her colonoscopy shows pseudopolyps and hyperemic mucosa.

a)    What is the diagnosis?                                                                                  (1)

b)    Enumerate the difference between ulcerative colitis and Crohns disease? (3)

c)    What are the extra intestinal manifestations of this disease?                               (1)(SIMS)

---A 26 years old male has recurrent attacks of bloody mucoid diarrhea with abdominal ceramics which are relieved on defecation. Each episode lasts for 5-6 days followed by symptom free periods of 4-5 months Colonoscopy shows pan colitis extending from rectum to the splenic flexure.

          a) What is the diagnosis                                                                  01

          b) What features will a colonoscopy biopsy show                          03

          c) What is the role of intestinal flora in the pathogenesis              01(PMC)

---a) Define the term leukoplakia                                                                 01

          b)  List the possible predisposing factor of leukopiakia                          01

   describe the morphological features of pleomorphic adenoma               02(PMC)

---a. Write a note on pleomorphic adenoma giving its morphology as well. Why is it necessary to take special care in its resection?                                               (2)

          b. Write a note on etiophathogenesis of peptic ulcer with special emphasis on the role of pylori.                                                                                                    (3)(SMC)

---a.     Discuss the morphology of Crohn disease.                                (3)

b.     Enumerate five differences between Crohn disease & ulcerative colitis. (2)(SMC)

--- 4 Microscopic picture of stomach showed an ulcer base containing a superficial thin layer of necrotic fibrinoid debris overlying a zone of inflammatory infiltrate with neutrophils predominating. Under which was a lower thick zone of granulation tissue with dilated blood vessels and lymphocytes.

(a) What is the relationship between chronic gastritis, Helicobacter pylori, and chronic peptic ulcer?                                                                                             (03)

(b) What are the complications of chronic peptic ulcers?                              (02)(SZMC)

---on gross examination the rectum showed a diffusely inflamed mucosal surface. This causes chronic diarrhea with grossly bloody, mucus filled stools. The disease begins in the rectum and proceeds proximally and is usually evident on proctoscopic examination, where pseudo polyps and ulcers and be seen.

(a) What are inflammatory bowel diseases?                                              (01)

(b) Summarize the differences comparisons of inflammatory bowel diseases (04)(SZMC)

---A 30 years old lady presented to her doctor with history of dyspepsia. On gastro copy, she was having gastric uteer. Her gastric biopsy revealed heavy colonization by small curved spiral organisms in the surface mucus.

a)    Name the causative organisms.                                                                      (01)

b)    Describe the role of this micro-orgamnism in producing this gastric pathology                                                                                                                (04)(MMDC)

---A 27 years old female presented with a 9 month history of bloody diarrhea crampy abdominal pain 3 weeks ago she noticed that her left knee was swollen. Red and painful. Her temperature 38 C (10-11) RR is 32/min & B P is 130/90mmHg. Abdominal palpation showed lower quadrant tenderness. Laboratory / studies showed no 9.3 gm/dl Microscopy of stools reveals numerous white and read blood calls. Colonoscopy showed pseodopoype….. mucosa

i)                  What is most likely diagnosis?                                                                 1

ii)               Write 1 extra intestinal manifestation associated with the disease?                 1

iii)            Name 2 complications                                                                               2

iv)             Give 1 differential diagnosis of the disease mentioned (NSMC)                          1

 ---A 25 yr old man presents with low grade fever,wt loss,fatigue,crampy abdominal pain,episodic diarrhoea and post prandial bloating,Rt lower quadrant tenderness is elicited on palpation of abdomen,on capsule endoscopy=thickening of terminal ileum,edema,markd luminal narrowing and cobblestone appearance of mucosa,Write 2 clincal conditions considered in  DD?6 miicroscopic differences b/w them?4 dietry factors associated with colorectal carcinoma(WMC)

---: 

RENAL

---a) Name the various types of giomerulonephnritis                         02

          b) Give the features of membrane proliferative glomerulonephritis 03(PMC)

---A 5 year child comes to the physician with generalized oedema and proteinuria. He is disguised as nephritic syndrome.

          i- What type of nephritic syndrome is found in this age group?         (01)

          ii. What is its pathogenesis?                                                                    (02)

          iii. Write down two other primary and two secondary causes of nephritic syndrome.                                                                                                           (02)(SZMC)

A 38 yrs old female patient of SLE develops progressive renal failure with very high level of BUN and creatinine. Renal biopsy is performed and the lesion comes out to be rapidly progressive glomerulonephritis.

1.   What are the different types of Primary glomerulopathies? 3

2.   What are the features of glomerular syndrome associated with rapidly progressiveglomerulonephritis? 2 (RMC)

---69 years old industrial worker & chian smoker presented with cost vertebral pain, palpable mass & hematuria. MRI showed metastasis to lungs & bones. This man died after 5 years of initial treatment 

a. What is your diagnosis?
b. Describe gross & microscopic findings of this lesion(CMC)

. an old lady presents with generalized body edema. Her laboratory investigations show hypoalhaminemia and macroulbuminuria. Her fasting glucose levels are more than 200 mg/dl on three consecutive day. Her urine analysis reveals few red blood eels.

a) What diagnosis comes in your mind?                                                                      (01)

b) What characteristic features would you expect to find in her …. Biopsy specimen?

---8 year old boy with poor socioeconomic status presented in nephrology OPD with complaints of fever, malaise, nausea, olliguria and coca-coloured urine 1 to 2 weeks after recovery from sore throat.

(a) What is the most likely diagnosis?
(b) What is the most likely cause?
(c) Write down the laboratory diagnostic tool? (SZMC)

---a.     Write down causes of nephritic syndrome.                                (2)

b.     Describe morphology of crescentic glomerulonephritis            (3)(SMC)

---A 60yr old man comes to clinician with complaint of coco coloured urine n flank pain.man has had low grade fever and lost 10 pounds over the past month.hes chronic smoker.large mass can b palpated in lt.kidney,lab findings=secondary polycythemia.risk factors?2microscopic features of clear cell carcinoma?4 common locations of metastasis?(WMC)

Give in a tabular from the clinical presentation, eight microscopy and election microscopy immured eurescence features of acute past streptococcal and membranous glomerulo nephritis.   (MMDC) 

---….: A 12 years old girls complains of swelling of her eyelids abdomen & ankles she has been a good health until overal months ago, when she gained weight & also noted swelling of her lower logs An x-ray … of the chest shows bilateral postural effusions without evidence of lung disease Un analysis reveals heavy ……………. (8 g per 24 hrs)

Without hematuria a per coetaneous needle biopsy of kidney discloses no morphological abnormalities by light microscopy

i.                   What is most likely diagnosis?                                                       1

ii.                Give two probable causes?                                                              2

iii.             Enlist the differences between nephritic & nephritic syndrome?  2 (NSMC)

---A 6 years old-boy presented in OPD with generalized odema and proteinuria of 8.5g/day. His condition who wed marked improvement with corticosteroid therapy.

a)    What is your diagnosis? Name two other biochemical investigations which could assist in the diagnosis?                                                      (2)

b)    Give the light microscopic and ultra structural changes seen in the glomeruli in a renal biopsy obtained from such a case.                 (3)(SIMS)

MUSCULOSKELETAL

a.     Enumerate the bone forming tumors. Give morphology of giant cell tumor of bone

b.    Compare & contrast the morphology of Osteoarthritis & Rheumatoid arthritis(CMC)

---A 60 years old female presented with deep, achy pain in her legs and back haberden nodes were also present at distal interphalangeal joints. 

(a) What is the most likely diagnosis?                                                   (01)

b) What is hone eburnation?                                                                   (02)

(c) What is joint mice?                                                                             (02)(SZMC)

A year old male presented with increasing pain in the left leg near knee joint, of approximately 3 months duration and a recent onset of low-grade fever. On physical examination, there was some local tenderness and soft tissue swelling over the lower end of left femur. Radiological examination revealed mixed tytic and ectoblastic lesions with peri-osteal elevation in the metaphy seal region.

a.     What is your diagnosis?                                                                        (2)

b.     What will be the histomorphological findings?                                   (3)(MMDC)

--- a. What is Rheumatoid arthritis? Describe its morphological features             (3)

b. What are the X-ray findings of following two tumors…….?                        (2)

          i. Osteosarcoma

          ii. Chondrosarcoma     (SMC)

---12  a) Give histological features of chondrosarcoma                     02

          b) Enlist the complications of Rheumatoid Arthritis                     03(PMC)

---A boy presented in surgical opd,hes 20.and has sweeling(painful) in lower part of thigh just above knee and difficulty in walking,radiogram shows destructive mixed lytic and blastic lesion and codman triangle.Diagnosis?Whats codman triangle and how is it formed?Give histological variants of chondrosarcoma?Describe histological features of dysplasia(fibrous)Name commonest organisms causing pyogenic osteomyelitis,define involucrum(WMC)

---A-

---…: A…..A 53 year old male presents to his CP with an acutely painful right big toe. on examination the toe is swollen erythematous with red and shiny overlying skin and is extremely tender to touch.

i)                  What is the most probable diagnosis

ii)               Which investigation will be the most helpful for the diagnosis (only one)  1

iii)            Name two causes of the underlying abnormality                                        1

8….. Name four Prognostic Factors for melanoma of skin(NSMC)

HEART

A 40 years male presents with chest pain with associated dyspnoea and profuse sweating. Physical examination reveals pulse 130/min and B.P 160/100mm Hg. His ECG shows ST-Segment elevation.

a)    What is the most probable diagnosis?                                             (1)

b)    Enlist them complications associated with it.                                (2)

Which cardiac enzymes will you advise in such a patient to reach a definite diagnosis?            (SIMS)

A 58 year old man with ACUTE MYOCARDIAL INFARCTION after he collapsed on his office. Desk. He is known hypertensive and smokes.  Serum cholesterol level is elevated. His father died of myocardial infarctions and his mother has stable angina.

          a. identify the major risk factors for atherosclerosis in this patient.                 (2)

          b. Microscopic structure of Atheroma.                                                              (3)(MMDC)

A 40 year old male chronic smoker with sudden on set of severe chest pain was brought to cardiac institute. The ECG showed left ventricular infarction and Lab investigation showed raised cardiac enzymes.

1.   What will be the morphologic changes in the myocardium after 2 days of attack? 3

2.   What pathologies are seen in the reperfusion injury after thrombolytic therapy? 2 (RMC)

---A-A 34 year old I/V drug abuser presents to ER with a 24 hrs history of fever & shaking……His murmurs Echocardiography shows vegetations on heart valves The patient develops headache & right arm paralysis. CT scan on bran demonstrates an infarct of right frontal lobe.                                                                 

i)                  What is the most likely diagnosis of heart?                                             1

ii)               What is the most likely causative agent?                                                 1

iii)            What is cause of brain infarct in this case?                                              1

B—What are 4 major Jones criteria for rheumatic heart disease?                    2(NSMC)

A ten-year-old child had history of a mild sore throat. Three weeks later, the child suffered from fever and painful swelling of the knee joints, followed by pain and a murmur suggestive of mitral regurgitation. The antistreptolysin O titer was elevated. In her thirties, the patient began to to have dyspnea on exertion, which slowly increased in severity in her forties and had coughed up some blood-tinged sputum.

(a) What is significance of the history of rheumatic fever as a child? (01)

(b) What are the primary symptoms of acute rheumatic fever?                     (02)

(c) What is the etiology of these inflammatory lesions?                                (02)(SZMC)

A 30 year old man presents to the emergency room with sudden high fever and shaking chills. A new murmur localized to the mitral valve is hear. Patient has bilateral nail-bed hemorrhages, painful nodules on tips of finger and toes. Blood culture and echocardiogram is ordered and broad spectrum antibiotics are immediately started.

A. what is the most likely diagnosis in this case?             

B. Compare the vegetations of infective endocarditis and rheumatic heart disease.

C. Describe characteristic histologic features of myocardium in hypertrophic cardiomyopathy.

D. describe the gross and microscopic appearances of myocardial infarction of 1-3 days duration.(WMC)

---A15 years old girls has sore throat with fever & three weeks later she developed pain in knee & hip joints. Systolic murmur with hypotension

a.     Give the pathogenesis & morphology

a.     Name the lab tests to diagnose the disease(CMC)

A…why HDL cholesterol is called Good cholesterol”?  (NSMC)               1

                             B….describe morphologic features of atherosclerosis    (NSMC)                        4

---a.     Give the evolution of morphological changes in myocardial infarction in relation to interval of time since original injury.                                    (3)

b.     Which form of cardiomyopathy is associated with systolic dysfunction? Give its gross & microscopic appearance.                                               (2)(SMC)

---          A 14 years old boy presented in the OPD with shortness of breath for one month and swelling of were joint’s for 2 weeks. He suffer’s from Sore Throat Off & On. His ASO titer is 800….. Echccardegnactry shows valvular vegetations.

          a) What is most likely diagnosis                                                               01

          b) What is pattern of joint involvement in this condition.                       02

          c) What is pathogenesis of this disease & name two complication which he develops.                                                                                                                    02(PMC)

LIVER

LIVER+Pancreas

Q1) A healthy looking volunteer blood on labeled as Hepatitis B carrier on screening & was not allowed to donate blood.

a.     What is serological diagnosis of Hepatitis B virus carrier?

b.    Define & classify Hepatitis B virus carrier.

c.     Enumerate the routes of transmission of Hepatitis B virus(CMC)

----. 55 years old male presented in OPD department with progressive weight loss & indigestion with yellow discoloration of skin. Physical examination reveals marked scieral itchiness. The lab investigations reversal was diagnosed to have mass on head of pancreas on CT scan.

---Describe the gross and microscopic features of alcoholic cirrhosis        (5)(SMC)

---Define pancreatitis. Give etiology and pathogenesis of chronic pancreatitis. (5)(SMC)

A 45years old female came in the OPD. She gave h/o off and on pruritic, jaundice, dark urine with light stool from last 6 months. MRI showed extra hepatic bile duct obstruction by stone.

1.   What are the important pathological findings in the liver before secondary biliary cirrhosis develops?  3

2.   How you will differentiate histologically this lesion from primary biliary cirrhosis?             (RMC)        2

---a) Tabulate the difference between obstructive and non obstructive jaundice 01

b) Give the salient histological features of Carcinoma Pancreas                      02(PMC)

---. A sixteen year old girl, who has been feeling unwell for a week, presents with nausea and pain in the right upper quadrant of the abdomen. Her liver function tests show:

U/I (<40), ALP 98 u/l (50-120), and Urine is positive for Bilirubin.

a)    What is your diagnosis?                                                                       (1)

b)    What is the reasons or increase in ALT and positive Urinary bilirubin. (2)

c)    Give four causes of conjugated hyperbilirubinaemia.                         (2)(SIMS)

A 60 year old chronic alcoholic male presented in the medical emergency with sudden onset of abdominal pain radiating to back and left shoulder followed by nausea and vomiting. A diagnosis of acute pancreatitis is suspected.                                    

1.   What findings in the plasma of the patient help in diagnosis? 1

2.   Why hypocalcemia occurs in these patients? 1

3.   Enlist three important complications associated with this condition. 3

(RMC)

---A 57 yr old man with H/o blood transfusion presents with jaundica n ascitis,along with mildly elevated transaminases,as well as impaired hepatic synthetic function(coagulopathy,hypoalbuminemia),Give diagnosis?4 etiologies?Enlist central pathogenic processes in cirhosis?describe briefly mechanism of activation and proliferation of stellate cellsin cirhosis(WMC)

---A 55 years old man presented in the emergency with heamatemesis. He was transfused four pints of blood. His LFTs were moderately disturbed. His PT and APTT were prolonged. His abdominal ultrasound revealed coarse hepatic architecture and splenomegaly. Clinical examination showed palamer erythema. He had a past H/O jaundice after blood transfusion.

a)    What is the likely diagnosis? What is the probable cause of heamatemesis?(2)

b)    Give important features you expect to see in the liver biopsy?     (1.5)

Classify this disorder on the basis of etiology. (SIMS)

Q6) A70 years old man is brought to the hospital with h/o cough, chest pain & dyspnea, hoarseness of voice & repeated chest infections

a.     Give Who classification of lungs tumors

b.    What is the role of tobacco smoking in pathogenesis of this condition

c.     What are the three commonest causes of mortality in such conditions(CMC)

---known patient of chronic hepatitis is presented with jaundice blotting from as cites easy bruising from blood clotting abnormalities, loss of appetite, un intentional weight loss and abdominal pain especially in upper right quadrant, also nausea, emesis and fatigue. 

(a) What is the most likely tumor? (01)
(b) Write down is marker? (02)
(c) Write down other investigations. (03)
(SZMC)

---Describe pathogenesis of cholesterol stones (Gull Bladder)   (NSMC)                  5

---. A 50 year-old lady presents with H/O dull right upper quadrant pain and flatulence for the past one year. Plain X-ray revealed no stone in the gall bladder. Ultrasound was advised. Following that cholecystectomy was performed. The lumen of Gall bladder was found to be full of stones.

(a) Enlist various types of gall stones.                                         

(b) What are the expected microscopic features of removed Gall bladder?   (01)

(c) What complication can develop in this Gall bladder (if surgery was not (02)

          Performed)?                                                                                                (02) (SZMC)

MALE

)  A 57 years old man developed frequency of maturation, urgency, overflow, incontinence & nocturia. PR exam showed nodular prostatic enlargement. PSA level is less than 4 ng/dl

a.     What is your diagnosis?

b.    Give gross & microscopic findings of this prostate(CMC)

80 years old man develops urinary symptoms with low backache. His prostatic Specific Antigen (PSA) level was 15ng/ml (Normal cut off value =4ng/ml). Bone scan revealed metastatic deposits in the lumbar spine.

a)    What is the likely diagnosis?                                                          (1)

b)    What would be the gross and microscopic picture of disorder?     (4)(SIMS)

---An 80 yr old man comes with complaint of hesitancy and nocturia for past 1 yr,increasing backpain for 6 months,On digital rectal examination he ahs hard irregular prostate.boe scan shows increaed areas of uptake in thoracic n lubar vertebrae,serum alkaline posphatase=350U/L,serum prostatic acid phosphatase level=8ng/ml,PSA=72ng/ml,BUN=44mg/dl,serum creatinine 3.8 mg/dl,diagnosis?2 microscopic findings?What do u understand by term pin?diagnostic and prognostic significance of PSA?Describe briefly gleason grading system?(WMC)

---A – An 8 years old ….. is brought to the physician because his parents noticed a mass in his left testing physical examination revealed a solid mass that could not be trans illuminated. This testicle was removed ……….. & H/P revealed a haphazard arrangement of benign differentiated tissues including s testicle was removed ……….. & H/P revealed a haphazard arrangement of benign differentiated tissues including squamous epithelium. Glandular epithelium cartilage & neural tissue The patient is symptom free 5 years later                                                                             

          i.       a) What is most likely diagnosis?                                                             1

          ii.      b) is it a germ cell turner or non germ cell tumor?                                  1

B----- Classify testicular germ cell turner  (NSMC)           

                                                                3

--- A male patient presented in the OPD with Right Testicular Mass.                  

          a) Name three testicular germ cell tumors                                                         02

          b) What is the value of serum tumour marker’s in the context of testicular tumours         (PMC)

---a. describe microscopic appearance of carcinoma prostate.           (2.5)

          b. how do you stage the tumor?                                                       (2.5)(SMC)

                                                

. A 70 year old man has increasing difficulty with urination. He also has a feeling of urgency, but each time the urine volume is small. He has difficulty in starting and stopping urination. His problem has progressed over the last few years. His prostatic specifien antigen (PSA) level is slightly increased but has been stable overy this time.

a.     What is the likely diagnosis?                                                                    (2)

b.     Give the microscopic appearance of the prostate in this condition. (MMDC)                 (3)

---A 35-years-old healthy male with a past history of crytorchidism repaired at age 5 presented with painless enlargement of the left testis. Laboratory data included serum HCG of 90 mU/mL (Ref.>5) and AFP of 7 ng/ml (Ref. 0.44).

a) How is Seminoma different from the usual gross appearance of a nonseminomatous germ cell tumor?                                                          (02)                              

(b) Are seminomas associated with increases in serum levels of HCG or a Fetoprotein?                                                                                                (01)

(c) What is the prognosis for classic seminomas confined to the testicle and for metastatic classic seminoma?                                                                  (02)(SZMC)

Left orchidectomy specimen of a 45 years old male was received in pathology lab. On cut section circumscribed grayish white fleshy homogenous mass devoid of hemorrhage and necrosis is seen. Microscopic examination of the representative sections shows sheets of large polygonal cells having clear cytoplasm. Nuclei are large having central 1to2 distinct nucleoli. Sparse lymphocytic infiltration is also present.

1.   What is your diagnosis? 1

2.   Why neoplastic cells have clear cytoplasm? Name special stain for it demonstration.                                             2

3.   Name one immunohistochemistry marker for tumor cell.                                                                                               1

4.   Name the germ cell tumor seen usually above 65 years of age.                      (RMC)                                                               1

Prostatic chips obtained after TURP of 70 years old male with urinary obstruction were submitted for histological examination which shows prostatic adenocarcinoma.

1.   Name the precursor lesion of prostatic cancer.                                                                                               1

2.   How many grades are given in Gleason system?                                                                                              1

3.   Why there is a chance that early malignancy can be missed in TURP specimen.                                       1

4.   What is the importance of serum PSA levels?                                                 (RMC)                                                    2

FEMALE

Classify the ovarian tumors & describe any one benign epithelial lesion(RMC)

---A 65 years old female presented with right adenexal mass. Gross examination showed multiloculated cystic mass filled with mucoid gelatinous material. His pathological examination revealed a tumour composed of papillae and glands lined by pleomorphic stratified mucin secreting epithelium with atypical mitosis and stromal invasion.

a)    What is the likely diagnosis?                                                           (1)

b)    Classify ovarian surface epithelial tumors.                                    (2)

c)    Name nay two serological tumors markers for ovarian tumors.    (2)(SIMS)

---A massively obese, 55 year-old, sexually active woman, nulligravida, presented to her gynecologist because of vaginal spotting for 1 year. An endometrial biopsy yielded abundant tissue. Following the biopsy, the patient was lost to follow up for 8 years. Endometrial biopsy is repeated, followed by a simple hysterectomy with bilateral satpingo-oophorectomy.

(a) What is a major risk factor for endometrial hyperplasia?               (02)

(b) What are risk factors for the development of endometrial adenocarcinoma? (03)(SZMC)

A 60 yrs old obese, diabetic, post menopausal woman develops irregular vaginal spotting for the last three months. Her Pap smear report is within normal limits. Ultrasound of the uterus shows marked endometrial thickening. The endometrial biopsy diagnosis is complex atypical hyperplasia. Hysterectomy with bilateral salpingo-oophorectomy was done. The histopathology report shows endometrial carcinoma.

1.   Name the type of endometrial carcinoma in this case.    1

2.   What is endometrial hyperplasia and what are its types? 3

3.   Which gene mutation is associated with endometrial hyperplasia andendometrial carcinoma? 1 (RMC)

---Write short notes on.

a.     Molar pregnancy                                                                         (1.5)

b.     CIN                                                                                              (1.5)

c.     Teratoma                                                                                     (2)(SMC)

---A 45 years old woman has raised CA-125 level in her blood and USG shows mass abdomen.

          a. The mass belongs to which organ?                                                                 (2)

          b. describe microscopic features of Granulose cell tumor.                                (3)(MMDC)

----          a) Name six tumours of female genital tract                                            03

          b) Describe briefly the microscopic picture of CIN-111                          02(PMC)

---A 39 year old women reported to gynecologist with irregular spotting / vaginal bleeding for the last 3 months. She gave history of abortion 4 months back. Vaginal examination revealed hemorrhagic necrotic module in vagina. B HCG level was markedly elevated in excess of 50000 m IU/ml, and X-Ray chest revealed metastatic deposits.

A. What is the most likely diagnosis in this case?                               

B. Describe characteristic histological features of complex endometrial hyperplasia without atypia.   (WMC)

---….: a 24 year old woman presents to clinic complaining of increased pain and bleeding during menstruation her last three menstruations have been accompanied by increasing intensity of cramping and large amount of blood. She talls you her menstrual cycle has been regular for last 6 months. After taking a complete history you earn that she has been having increased pelvic pain with intercourse. On pelvic examination you palpate fixed bioteral overrun masses and an MRI shows cohobate cysts and overy

i.                   What is the diagnosis?                                                                     1

ii.                Name two other sites/tissues of body which may get involved      1

iii.             Define adenomyosis?                                                                       1.5

iv.              How chocolate cysts are formed?                                                    1.5 (NSMC)

BREAST

A 62 years old female presented with 5 cm breast lump attached to skin & underlying tissues with enlargement of axillary lymph nodes. Microscopy showed pleomorphic epithelial calls with hyperchromatic nuclei & prominent nucleoli arranged in glandular pattern with invasion to stroma

a.     What is your diagnosis?

b.    Name breast tumors

c.     Enumerate risk  factor of above lesion(CMC)

---An 18 years old female complained of a nodule in the right breast. Clinical examination revealed a non-tender mobile, well eircummseribed tumor with positive slipping test.

a.     What is your probable diagnosis?                                                        (2)

b.     What will be the gross and microscopic findings after excision of this lesion?                                                                                                         (3)(MMDC)

--A 50yr old lady presented to dr with history of lump in rt.breast since 6 months.lump was firm,with irregular margins,4cm and immmobile,uon histology it was foud that lump was ER and PR postive and HER2/NEU negative.Give 2 histological features?Whats the significace of ER+PR positive and HER2NEU negative in treatment?Enumerate architectural subtypes of DCIS?enlist 3 principal morphological features occuring in fibrocystic changes of breat?(WMC)

---          A 50 year old female presented with lump in her right breast. She was diagnosed as a case of carcinoma breast on histological examination of incised limp present in her beast.

(a) Classify carcinoma beast.                                                         (02)

(b) Give histological features of Medullar Carcinoma.               (03)(SZMC)

A 45 yrs old female develops a painless lump in the upper outer quadrant of right breast. The mass is 5 cm in diameter and the right axillary lymph nodes are palpable. FNA reveals malignant cells. Modified radical mastectomy with axillary clearance is performed.

1.   What are the different histological types of breast cancer? 2                   

2.   What are the major prognostic factors of breast carcinoma? 2  

3.   What is Sentinel node? How it is detected and what is its importance? (RMC)

---A 50 years old female presented OPD with lump in the upper outer quadrant of left breast. On physical examination, the lump is firm and poorly circumscribed. FNAC showed malignant cells.

a)    What is the likely diagnosis? Classify carcinoma female breast             (2)

b)    Give microscopic features of Invasive Ductal Carcinoma.                      (2)

c)    Enumerate the major prognostic factors of carcinoma breast                           (1)(SIMS)

---a) Classify tumours of breast.                                                                   03

          b) Describe role of tumour marker in the prognosis of Carcinoma Breast 02(PMC)

---A 60 year old women comes to your office for evaluation of a breast “lump” About 4 months age she noticed a “hard” but painless area along the lateral aspect of her left breast She has previously had minor chest tragus cm firm area in the upper outer quadrant which seems firmly attached to the chest wall. The overlying skin is dampest but the mass is painless There is a firm 2 cm nodule in the left…. And her left arms is swollen

i.                   1        What is the most likely (Specify histological type) diagnosis       1

2        What are the risk factors (name 4 factors)                 (NSMC) 

ENDO

) A 29 years old female presented with solitary nodule in front of need moving with swallowing. Cut surface of specimen showed papillary cocci.MRI showed metastasis to cervical lymph nodes. Later on she developed hoarseness, dysphagla, cough & dyspnea with metastasis to lungs also    

 a.     What is your diagnosis?

b.    Give the morphology & pathogenesis of suspected lesion(CMC)

---A 28 yr old woman has difficulty in concentrating at her job at work for past 1 yr,She is constantly getting up and walking to  visiting co-workers.She complains work area is too hot,she seems nervous and spills her coffee alot,hasbeen eating more but lost 5kg in past month.temperature=37.5C,pulse 101/min,respiratry rate=18/min,BP=145/85,diffuse thyroid enlargement.diagnosis?4 lab findings for confirmation,2 characteristic microscopic features of this lesion.(WMC)

----briefly the metabolic complications of diabetes?    (CMC)

---A 25 years old male radiographer presents with cervical lymphadenopthy, selling in front to neck and hoarseness of voice. FNAC of thyroid nodule proves it to be malignant.

(a) What type of thyroid cancer is common in this group?                  (01)

(b) What cellular morphology is diagnostic for it?                               (01)

(c) What are other types of thyroid cancer?                                           (03)(SZMC)

A 20 year old female presented with exophthalmoses, tremors, menstrual irregularities and heat intolerance.

1.   Give 4 causes of hyperthyroidism. 1

2.   What tests you would perform to diagnose Grave’s disease. 2

3.   What is thyroid storm? Why it is considered as a medical emergency? 2 (RMC)

---A 40 year old school teacher went to her general practitioner with complaints tiredness, weight gain and a feeling of discomfort tin neck. On clinical examination she had goiter and her laboratory tests revealed a raised serum TSH and low free T4 levels. Thyroid peroxides (TPO) antibodies were present in high concentrations.

a)    What is the most likely diagnosis                                                        (1)

b)    Give the mechanism of injury in this case                                           (3)

c)    Name two autoimmune endocrine diseases that this patient is at increased risk to develop.                                                                             (1)(SIMS)

---A 40 years old lady c/o perfuse swatting and loss of weight. On examination Tachycardia and are noted.

          a) Name the lab investigations which are indicated for diagnosis of this disease                                                                                                                03

          b) Describe the microscopic features of papillary carcinoma thyroid     02

                    (PMC)

---….: A—A 50 years old man complains of muscle weakness & dizziness of 3 months in duration. His BP is 185/100 mmHg. Laboratory studies shows hypernatemia endocrine studies reveal elevated 50/um aldesterone & low rennin & angiotensin. BUN is 24mg/dl Creatinine is 1.2mg/dl. Entomological studies rule out Cushing syndrome

i)                  What is most appropnate diagnosis?                                     1

ii)               Name two commonest causes of this condition?                            2

B---Give two causes of adrenal crisis?                                                     2(NSMC)

A 15 years old female presented with a swelling on left side of neek, which moves on swallowing. Her thyroid scan reveals a solitary cold module in left lobe of thyroid.

a)    Considering the scenario, write down the differential diagnosis.                    (04)

b)    Which further rest would help the best in finding the provisional diagnosis   (01)(MMDC)

-------Name four retinal lesions/finding found in of diabetes mellitus                           2(NSMC)

---A biopsy from a soft tissue mass in the illac fossa revealed metastatic carcinoma most consistent with a diagnosis of metastatic follicular carcinoma of thyroid gland. A cold thyroid nodulectomy for a 2 cm cold thyroid nodule 8 years back. The lesion was reported follicular adenoma.

a.     If you were to re-examine the slides form the thyroid nodule which part of the lesion would you examine most carefully and why?                       (2)

b.     What is the common mode of metastasis for follicular thyroid cancer and what are the commonest sites for metastasis.                                                (3)(SMC)

A 28 years old male show shrinkage of liver on ultrasound.                  

          a. what is the most likely diagnosis.                                                         (2)

          b. Name three morphologic features of cirrhosis liver.      (MMDC)                                        (3)

     

BLOOD/HEMATOPEITIC

a.     A 22 years lady belonging from minorities of Pakistan and strict vegetarian presented in medical OPD with generalized weakness, pailor and numbness of hand. On CBC his H6 g/dl and MCV is 115 fl. Patient had which type of anemia? What peripheral film findings are expected from a hematologist?

b.    Enumerate the causes of decreased survival of Platelets?

c.     How the morphological features of lymphoblast are different in comparison with the meloblast?

How the histochemical stains are helpful distinguishing ALL from AML?

 (CMC)

A one year old male baby presented with complaints of progressive pallor and abdominal distention for the last three months. There is also H/O of blood transfusion once. On clinical examination hepatosplenomegaly was found. He was diagnosed as a case of Thalassaemia major on Hb Electrophoresis.

1.   Describe peripheral film morphology in β thalassaemia major?                                                                          2

2.   Describe the major morphological alterations seen in the bone marrow and spleen in thalassaemia major.           2

3.   Mention the curative treatment available for thalassaemia major.                       (RMC)                                           1

---a.     Enumerate the causes of hypochromic microcytic anemia.        (2)

b.     Explain the pathogenesis of beta thaiassemia major.                 (3)(SMC)

---A patient living in tropical area is diagnosed as case of Kala-zar. Aabdominal examination reveals massive splenomegaly.

          a) Enlist six other infectious causes of splenomegaly.                (03)

          b) Describe pathogenesis of congestive splenomegaly.              (02)(SZMC)

---. A 13 years old male presented with serve anaemia, and frontal bossing. X-ray skull showed crew cut appearance labs showed: MCV-65 fl, MCH: 18gm/dl, MCHC: 28%, HB: 6gm/dl

a)    What is the most likely diagnosis?                                                 (1)

b)    What is Hb H disease?                                                                     (2)

c)    How would you confirm a case of B Thalassaemia in the Laboratory, both homozygous and heterozygous                                                        (2)(SIMS)

---

Q.No. 12     Give features of FAB classification for AML (MMDC)                                         (5)

Q.No. 13     List the investigations for bleeding diathesis (MMDC)

Draw a diagram to illustrate the DIAGNOSTIC usefulness of PROTHROMBIN TIME [PTT] and ACTIVATED PARTIAL THROBOPLASTIN TIME [APTT] in the diagnosis of coagulation disorders.                                         (5)   (MMDC)                                       

---a) Classify Hemolytic Anemias                                                                02

          b) How will you screen a case of bleeding diathesis                                03(PMC)

 ----A 24 years old woman presents to your office for a checkup. She states that her pregnancy has been proceeding smoothly. Although she has been feeling more tired than she expected she expected. Her physical examination is target unremarkable except for marked pallor. You order serum studies and find decreased hematocnt decreased fern tin and increased iron binding capacity

i.                   What is the diagnosis?                                                                     1         

ii.                Name two common causes?                                                            1

iii.             What are the findings on peripheral blood than?                                     1

iv.              What other clinical signs  and symptoms you would expect?        1

v.                 What is Plummer Vinson syndrome?        NSMC)                                      

2…..4…..: Give WHO classification of the Lymphoid Nepotisms(NSMC)

---Define anemia?classify anemia according to etiology and morphology?how will u manage a suspected case of megaloblastic anemia in the laboratory(WMC) 

---A child 6 years old is suffering from fever for last one month. On examination there is anemia and pattern haemorrage. There is cervical and auxiliary hymphadenopathy. Peripheral film shows blast cells.

          a) What is your diagnosis and enlist good prognostic features of ALL   03

          b) Name the various phases of CML       (PMC)

LUNG

Tabulate differences between Tuberculosis and saracidosis(NSMC) 

A 65 yrs old male smoker is suffering from persistent cough with sputum production throughout the winter with intermittent low grade fever. He gave history of a similar attack last year, treated by antibiotics, bronchodilators and expectorant therapy. He develops dyspnea on exertion and sometimes becomes blue.

1.   Define chronic bronchitis.   1

2.   What are the complications of chronic bronchitis? 2

3.   What other conditions come under the heading of COPD? 2 (RMC)

---A 25 years old man went to pulmonologist at the peak of spring season. Having severe disperse ….. wheez. His pulmonary function tests showed decrease FEV-I, Serum IGE level was elevated and ….. reveals absolute eosinophilla.

          a) What is most likely diagnosis                                                     01

          b) Give four histological finding of this disorder and name three interleukin secreted in this diseases.                                                                      02

          c) Name four chronic restrictive air way diseases.                         02(PMC)

---A 44 yr old male presents to ur office complaining of persistent cough,which produces copious sputum,,hes a heavy smoker and has suffered such coughs for several years,his physical examination reveals diffuse wheexing and crackles,u suspect he will hav decreased fev1?fvc ratio,and strongly recommend that he stops smoking,diagnosis?define obstructive an ddestructive lung diseases and give 4 examples of each,name major etiological factors for malignant mesotheliomas.(WMC)

---A 30 years old man presented to his doctor of episodes of wheezing and normally in the period between the episodes. His physical examination and …… X ray are unremarkable. Scrum IgE level and complete blood count are normal. There is no family history of asthma or other allergies.

a. What is the most likely diagnosis in this case? (1)
b. What are the main abnormalities in this case? (2)
c. List the etiological factors of the condition?
(MMDC)

---. A 64 years old man, how has been smoker since the age of 18 presents with two months history of cough, SOB, hemoptysis and weighe loss. His serum sodium level was low. A 3cm mass was detected in the right lung MCT. Histopathologist reports this mass to be small cell lung cancer.

a.     Give morphology of small call lung cancer.                                   (2)

b.     Explain hyponatremia in this patient.                                             (2)

c.     What would be most suitable treatment option for this patient?   (1)(SMC)

---. X-Ray of a patient showed the hyperlucent lung fields and depressed diaphragm. On gross the external surfaces of the upper lobes of both the right and left lungs have large bullae.

          a) What is the definition of emphysema?                                     (1.5)

          b) is this a clinical or an anatomic term?                                      (0.5)

          c) What are the major forms of emphysema? Can they always be distinguished from each other?                                                                   (03)(SZMC)

---A 35 year-old lady c/o morning stiffness of small joints of hand. The joints are swollen and painful for last two weeks. Complete blood examination reveals leukocytosis. She has raised CRP level and is seroreactive for RA (Rheumatoid arthritis) factor.                                                     

a)    What is the likely diagnosis? Give the pathogenesis of this disease.      (3)

b)    Give the clinical findings and pathogenesis of REITER’S syndrome.    (2)

c)    How can you do differentiate between Chronic Bronchitis and Emphysema.

(1.5)(SIMS)

---a)    Enumerate the chronic obstructive diseases (COPD).                    (2)

b)    What are the different anatomical types of EMPHYSEMA?                   (1.5)

c)    How can you do differentiate between chronic Bronchitis and Emphysema. (1.5)(SIMS)

BLOOD VESSELS

a.     Write down the composition of atherosclerotic plaque and briefly describe the clinically significant pathological changes which can occur in the plaques.                                                                                           (2)

b.     What is the difference between rule & false aneurysm. Give pathogenesis of abdominal aortic aneurysm.                                                       (3)(SMC)

Enlist three principal components of atherosclerotic plaque.    (wmC) 

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