RMC patho sendup 2012- Solved MCQs+SEQs

DEPARTMENT OF PATHOLOGY,   RAWALPINDI MEDICAL COLLEGE RAWALPINDI Send Up 17/09/2012

MCQ`S Paper       Time allowed: 65 minutes                                                                       Total Marks: 65

Attempt all questions.   Mark the appropriate square on the response sheet

1. A 29 years old women presents with heat intolerance, nervousness, weight loss, protruded eyes & diffuse enlargement of thyroid. On Lab examination, TSH is decreased. Histologic sections   from thyroid reveal increased cellularity with scalloping of the colloid at the margins of the follicles. Which of the following antibodies are more specific for this individual disease:

            a. Antimicrosomal antibodies
            b. Antithyroglobulin antibodies
            c.  TSH – receptor – stimulating antibodies
            d.   Antithyroid peroxidase antibodies
            e.TSH – receptor – blocking antibodies

1. A 45 year old female diagnosed case of follicular variant of papillary carcinoma of thyroid presented with mass in the abdomen. CT scan shows left adrenal mass. Excision biopsy shows metastatic thyroid carcinoma on the basis of microscopic features which includes colloid follicles, nuclear grooves , optically clear nuclei and the presence of:
2. Russell’s bodies
3. b.       Psammoma bodies
4. Apoptotic bodies
5.        Myelin figures
6. Mallory bodies
   1. Most common form of Cushing’s   Syndrome is :
   2. Due to pituitary tumors
   3. Due to adrenal lesions
   4. Due to Ectopic production of Cortisol
   5. d.       Iatrogenic(drug induced)
   6. Due to renal insufficiency.
      1. A patient of Cushing’ssyndrome was given high doses of Dexamethasone. It can suppress hyper cortisolism is due to:
      2. a.       Pituitary or hypothalamic lesions
      3. Adrenal carcinoma           
      4. Ectopic Cortisol production
      5. Exogenous glucocorticoids intake
      6. Loading effect
         1. An old lady 58 years of age c/o gradual on set of bone pain, anorexia, constipation, polyuria, polydipsia and muscular weakness. Her serum Ca and Alk phosphatase were raisedand PO4 was low. She was probably suffering from:
         2. Hypercalcemia
         3. Hypophosphatemia
         4. Bone tumor
         5. d.       Hyperparathyroidism
         6. Hypoparathyroidism
            1. An old-man living alone was found comatosed inhis home in the suburbs of Newyork city on sunday morning. He was shifted to hospital. His LFT showed SBilirubin 150mg/dl, ALT 400 iu, AST 1600 iu, Alk Phosphatase 300iu. What further test would you like to perform to look for the cause of his unconciousness?
            2. PT & APTT
            3. HBsAG
            4. AntiHCVab
            5. d.       GTT
            6. S Albumin
               1. A 58yrs old man presented to his family doctor with weight loss, generalized weakness, and lethargy of 6 months’ duration. He c/o Polyuria especially at night. He had become impotent. On examination, pt found tobe slightly anemic, BP was 185/115. His urine contained protein but no glucose. His serum Na was 130, K 5.2,HCO3 16 mmol/L, Urea 65mg/dl, creatinine 5.3 mg/dl, Glucose R 135mg/dl, Alk phosphatase 205 U/L, &Hb 9.1 g/dl. Patient was suffering from,
               2. Diabetes mellitus
               3. Diabetes insipidus
               4. Nephrotic syndrome
               5. Renal osteodystrophy
               6. e.       Chronic renal failure

1. An 8 yrs old girl was admitted to hospitalwith generalized oedema. Her urine became frothy and family doctor had found proteinuria. Results of other investigations showed serum is lipemic with raised total cholesterol and triglyceride levels. Her Na, K, Urea, Creatinine levels were low. Total proteins and serum albumin were also low. Urinary protein excretion in 24 hrs was 12g/L. In your opinion what is the diagnosis?
2. Hyperlipidemia
3. Hypoproteinemia
4. Ac. renal failure
5. Ac. fluid overload
6. e.       Nephrotic syndrome
   1. Bulla is fluid filled raised lesion 5mm or less in diameter. Which skin lesion is associated with bulla formation?
   2. Erythema multiforme
   3. Lichen planus
   4. Psoriasis
   5. d.       Pemphigus
   6. Panniculitis
      1.  In most laboratories a serum PSA level of 4ng/mL is taken as cutoff point between normal and abnormal. Serial measurements of PSA are of great value in;
      2. a.       Assessing response to radiotherapy
      3. Diagnosing prostatic cancer
      4. Chronic prostatitis
      5. Benign prostatic hyperplasia
      6. Prostatic Infarction
         1.  In prostatic adenocarcinoma fatal outcome is associated with;
         2. Gleason score
         3. Gleason grade
         4. Raised PSA levels
         5. Associated chronic prostatitis
         6. e.        Lymph node Metastases
            1. Following serum tumor markers are helpful in supporting testicular neoplasm. In yolk sac tumour of testis which marker is raised?
            2. Beta HCG
            3. b.       Alpha Fetoprotein
            4. LDH
            5. Placental Alkaline phosphate
            6. Placental lactogen
               1. Alzheimer disease is the most common cause of dementia in the elderly. Autopsy of the patient died of this disease shows characteristic histological features in the brain which of the following is not a feature of this disease.
               2. Neuritic plaques
               3. Neurofibrillary tangles
               4. Cerebral amyloid angiopathy
               5. Granulovacuolar degeneration
               6. e.       Lewy body
                  1. A 40 year old male is diagnosed to have gout. The different pathological lesions  associated with gout do not includes.
                  2. Acute arthritis
                  3. Chronic tophaceous arthritis
                  4. Tophi
                  5. Gouty nephropathy
                  6. e.       Gouty retinopathy
                     1.  A 5 year old child presented with a mass in the nasal cavity. A biopsy was taken from the mass. Morphology shows hyperchromatic round tumor cells forming submucosalzone of hypercellularity called cambium layer. This feature is seen in which type of sarcoma?
                     2. Alveolar Rhabdomyosarcoma
                     3. Ewing sarcoma
                     4. c.        Embryonal Rhabdomyosarcoma
                     5. Ostesarcoma
                     6. PNET

1. Malignant melanoma is a very aggressive neoplasm. Its common site is skin. Other primary sites are oral and anogenital mucosal surfaces, esophagus and meninges. Identify one more primary site where this lesion can occur.
2. Breast
3. Brain
4. c.        Eye
5. Liver
6. Testis
   1. X-ray skull of a 60 year old male showed multiple punched out lytic lesions. Identify the neoplasm which produces such lesions.
   2. Ewing sarcoma
   3. Giant cell tumor
   4. Lymphoma
   5. d.       Multiple myeloma
   6. Metastatic prostatic carcinoma
      1. A 50 year old female presented with bilateral breast lumps. Mammography showed densities with irregular borders. FNA of both lumps shows malignant cells. Which histological type of malignancy usually presents with this clinical picture.
      2. Invasive ductal carcinoma
      3. b.       Invasive lobular carcinoma
      4. Medullary carcinoma
      5. Mucinous carcinoma
      6. Tubular carcinoma
         1. In a 30 year old female breast lump of 2cm is excised having irregular borders. Histopathology report shows sclerosing adenosis.  Which lesion is not a part of benign proliferative breast disease?
         2. Complex sclerosing lesion
         3. Duct ectasia
         4. Epithelial hyperplasia
         5. d.       Fibrocystic change
         6. Papilloma
            1. Which one is the most important prognostic factor in the carcinoma of breast?
            2. Age
            3. b.       Axillary lymph node metastases
            4. Involvement of resection margin
            5. Tumor grade
            6. Tumor necrosis
               1. Mammographic report of 40 year old female shows linear branching pattern of calcification. This type of calcification is characteristic of;
               2. a.       Ductal carcinoma in Situ
               3. Fibrocystic change
               4. Fibroadenoma
               5. Invasive ductal carcinoma
               6. Phyllodes tumor
                  1. Liver biopsy of thalassemic patient was submitted to look for Iron pigment load. Which stain can be helpful in the demonstration of iron in liver tissue?
                  2. Crystal violet
                  3. Fontana Masson
                  4. c.        Perl stain
                  5. Reticulin stain
                  6. Von Kossa
                     1. A liver biopsy of a 45year old obese female shows hepatic steatosis .Which condition is not associated with Hepatic steatosis?
                     2. Alcoholic hepatitis
                     3. Aspirin toxicity
                     4. HCV positive Hepatitis
                     5.  NASH
                     6. e.       Rotor’s syndrome

1. A 45 year old female gives h/o off and on RHC pain from the last 1 year . Her U/S shows multiple gall stones. Patient is not willing for the surgery. The clinician explains the complication of cholelithiasis to the patient. Which one is not associated with it?
2.  Biliary obstruction
3. b.       Hepatic abscess
4.  Intestinal obstruction
5.  Malignancy
6.  Pancreatitis
   1. 25.    A 35 year old married female having multiple gallstones is waiting for the surgery. One day she presented in the emergency with acute abdomen.  Pain is continuous and also referred to the upper back. Lab investigation shows elevated Serum amylase and lipase levels. What is your diagnosis?
   2. a.       Acute pancreatitis
   3. Acute gastritis
   4. Chronic pancreatitis
   5. Ruptured tubal pregnancy
   6. Perforated duodenal ulcer
      1. A healthy medical student has completed the course of HBV vaccination. To check his immunization status which serological test should be positive?
      2. HBsAg
      3. Anti-HBC IgM
      4. Anti-HBC IgG
      5. d.       Anti HBS
      6. Raised serum ALT levels
         1. Liver biopsy of a 35 year old female suffering from jaundice and pruritus showsperiductal onion skin fibrosis a characteristic  feature of;
         2. Chronic hepatitis
         3. Cirrhosis
         4. c.        Primary sclerosing cholangitis
         5. Primary biliary cirrhosis
         6. Secondary biliary cirrhosis
            1. After few months of modified radical mastectomy and axillary lymph node dissection for carcinoma of left breast patient develops swelling and puffiness of left arm. On examination the swelling was generalized painless and non- pitting in nature .What could be the reason of this swelling?
            2. a.       Lymph edema due to lymphatic obstruction
            3. Subclavian artery thrombosis
            4. Thrombophlebitis
            5. Tumour embolization
            6. Vasculitis
               1. Autopsy of a 50 year old male with sudden death showed 80 % narrowing of left coronary artery due to atherosclerosis. Which of the following cells is least involved in the pathogenesis of this type of coronary lesion?
               2. Endothelial cells
               3. Monocytes
               4. c.        Neutrophils
               5. Platelets
               6. Smooth muscle cells
                  1. A 55 year old male with severe attack of acute myocardial infarction dies within half hour. Which complication is the cause of his death?
                  2. Myocardial rupture
                  3. Pericarditis
                  4. Thromboembolism
                  5. Ventricular aneurysm
                  6. e.       Ventricular fibrillation
                     1. A patient of Non Hodgkin lymphoma is receiving cytotoxic antitumour drugs. Which type of cystitis is suspected in these patients?
                     2. Chronic cystitis
                     3. Eosinophilic cystitis
                     4. Follicular cystitis
                     5. d.       Hemorrhagic cystitis
                     6. Suppurative cystitis
                        1. A 40 year old male presented with right testicular enlargement. Orchidectomy was performed and histological diagnosis of Seminoma was given. An identical tumour arises in the ovary is called as;
                        2. Choriocarcinoma
                        3. b.       Dysgerminoma
                        4. Embryonal carcinoma
                        5. Endodermal sinus tumour
                        6. Granulosa cell tumour
                           1. The skin  lesion  which is not associated with disorders of pigmentation is;
                           2. Freckles
                           3. Melasma
                           4. Leucoderma
                           5. d.       Psoriasis
                           6. Vitiligo
                              1. The disease associated with reduced osteoclasts  bone resorption  results in brittle and fragile bone called as;
                              2. Osteomas
                              3. Osteomalacia
                              4. Osteoporosis
                              5. d.      Osteopetrosis
                              6. e.      Osteodystrophy
                                 1. 35.    A 50 yrs old alcoholic male develops bilateral enlargement of breasts resembling adolescent female breast. The lesion is termed
                                 2. Fibroadenoma
                                 3. Fibrocystic disease
                                 4. c.       Gynaecomastia
                                 5. Phyllodes tumor
                                 6. Mastitis
                                    1. A 65 yrs old female reports with recurrence of a mass in her left breast. She gives history of lumpectomy two years back but has lost her medical record. Biopsy of the lesion shows increased stromal cellularity and cytologicatypia giving rise to the typical leaf like architecture. The diagnosis is
                                    2. Fibroadenoma
                                    3. Lactational adenoma
                                    4. Myofibroblastoma
                                    5. d.      Phyllodes tumor
                                    6. Gynaecomastia
                                       1. A 20 yrs old lady with a family history of breast carcinoma is very apprehensive. The hereditary susceptibility to breast cancer is associated most strongly with the following gene/genes mutation
                                       2. APC
                                       3. BRCA 1
                                       4. P53
                                       5. CHEK 2
                                       6. e.      BRCA 1 & BRCA 2
                                          1. The screening test used for the  early detection of breast cancer in elderly is called
                                          2. Ultrasonography
                                          3. Fine needle aspiration
                                          4. c.       Mammography
                                          5. CT scan
                                          6. MRI
                                             
                                             

1. A 23 yrs old female patient presents in the outpatient department two weeks after delivery with red, swollen, very painful left breast. The nipples of both breasts are cracked and she is running high grade fever. The most likely diagnosis is
2. a.       Acute mastitis
3. Periductal mastitis
4. Mammary duct ectasia
5. Fat necrosis
6. Pagets disease  

1. A 20 yrs old male presents in the surgical OPD with multiple slightly painful slowly growing swellings on his back. Biopsy of one of the swellings reveals fibrousstroma and interspersed short fascicles of spindle cells having wavy nuclei. The lesion is
2. Schwannoma
3. b.       Neurofibroma
4. Meningioma
5. Fibroma
6. Metastatic carcinoma
   1. Transtentorial herniation of the temporal lobe of the brain is most commonly a consequence of which of the following
   2. Intracranial hemorrhage
   3. b.       Increased intracranial pressure
   4. Cerebral edema
   5. Hydrocephalus
   6. Meningitis
      1. A 14 yrs old boy in a village died after being bitten by a stray dog, which was diagnosed to be suffering from Rabies. On autopsy the pathognomic microscopic findings are bullet shaped cytoplasmic inclusion in pyramidal neurons of the hippocampus and Purkinje cells of cerebellum. These inclusions are called
      2. Lofra bodies
      3. b.       Negri bodies
      4. Corpora amylacea
      5. Polyglucason bodies
      6. Lewybodles
         1.  An 8 yrs old boy complains of severe headache and vomiting. On examination his gait is also disturbed. On suspicion of brain tumor, CT scan was ordered which showed a tumor located in the mid line of cerebellum. The tumor is removed by surgery. Grossly it is gray and friable. On microscopic examination extremely cellular neoplasm composed of sheets of small round cells having hyperchromatic nuclei. The tumor is
         2. Astrocytoma
         3. Ependymoma
         4. Meningioma
         5. d.       Medulloblastoma
         6. Lymphoma
            1. Glioblastomamultiforme a variant of infiltrating astrocytoma belongs to which of the following WHO tumor grade
            2. Grade 0/IV
            3. Grade I/IV
            4. Grade II/IV
            5. Grade III/IV
            6. e.       Grade IV/IV
               1. A 50 yrs old diabetic female patient visits the gynecology OPD with complaints of marked vulvoviginalpruritis and curd like vaginal discharge. On PAP smear there are benign squamous cells, endocervical cell groups, neutrophils and filamentous hyphae. The causative agent of this infection is
               2. Trichomonas
               3. Gardenerella
               4. c.        Candida
               5. Chlamydia
               6. Mycoplasma
                  1.  A 40 yrs old female went to her gynaecologist for PAP screening after reading an article about cervical cancer in a magazine. She gave history of having sex with multiple partners. The report of the PAP smear showed severe dysplasia of exfoliated squamous cells. Colposcopy was performed. Cervical biopsy was taken and was reported as carcinoma in situ. This means
                  2. Low grade SIL
                  3. b.       High grade SIL
                  4. Microinvasive carcinoma
                  5. Invasive carcinoma
                  6. Inflammatory lesion
                     1. Endometriosis is the presence of endometrial tissue outside the uterus. The most common site includes;
                     2. a.       Ovaries
                     3. Uterine ligaments
                     4. Retrovaginal septum
                     5. Cul de sac
                     6. Pelvic peritoneum

1. A 54 yrs old post menopausal female suffering from irregular vaginal bleeding for last two months undergoes ultrasound examination. A mass 9 cm in diameter, invading the uterine wall is reported. Hysterectomy is performed. On gross examination the mass is bulky and fleshy. Histopathologist reports it as leiomyosarcoma. Which microscopic features distinguish it from leiomyoma?
2. Nuclear atypia
3. Mitotic index
4. Anaplasia
5. Nuclear atypia and mitotic index
6. e.       Nuclear atypia, mitotic index and zonal necrosis.
   1. A 19 yrs old female presents in the OPD with a gradually enlarging mass in the lower abdomen. She is having regular menstrual cycles. Ultrasound shows a cystic mass 10cm in diameter in the right ovary. The mass is removed. On cut opening unilocularcyst  filled with cheesy material,tufts of hair and tooth is seen. Which of the following tumors shows these features?
   2. a.       Benign mature cystic Teratoma
   3. Dysgerminoma
   4. Endodermal sinus tumor
   5. Teratoma
   6. Sertoli-Leydig cell tumor
      1. A 32 yrs old female married for 7 yrs is seeking treatment for primary infertility. She gives history of irregular menstrual cycles, dysmennorhea and pelvic pain. Ultrasound pelvis shows distortion of both ovaries by cystic masses 3-5 cm in diameter, filled with reddish brown thick fluid. The most probable diagnosis in this lady is
      2. Dysfunctional uterine bleeding
      3. b.       Endometriosis
      4. Adenomyosis
      5. Ovarian tumors
      6. Pelvic inflammatory disease
         1. A teenage boy presented with orbital odema and proteinuria. The commonest cause of nephrotic syndrome in children is
         2. Membranous glomerulonephritis
         3. b.       Minimal change disease
         4. Focal segment glomeruloseclerosis
         5. Membranoproliferative glomerulonephritis.
         6. IgA nephropathy
            1. A 6 yrs old child is brought to the paeds department. He is suffering from generalized edema. Serum albumin level is 2g/dl and there is massive proteinuria. Which other feature is required for a diagnosis of nephrotic syndrome.
            2. Hyperbilirubinemia
            3. Azotemia
            4. Glycosuria
            5. d.       Hyperlipidemia &lipiduria
            6. Lipiduria
               1. Acute kidney injury (AKI) is a clinicopathological entity characterize byacute diminution of renal function. The renal tissue shows morphologic evidence of
               2. Glomerular injury
               3. Interstitial inflammation
               4. c.        Tubular injury
               5. Arteritis
               6. Medullary injury
                  1. A 50 yrs old female suffering from fever and painless hematuria. On palpation there is mass in the left flank. Ultrasound confirms a tumor 7 cm in diameter on the upper pole of left kidney. These findings suggest diagnosis of
                  2. Adrenocortical carcinoma
                  3. b.       Renal cell carcinoma
                  4. Renal cyst
                  5. Renal adenoma
                  6. Pheochromocytoma

1. A 70 yrs old male has developed swelling in the left parotid gland. It is 6cm in diameter and has gradually reached the present size over a period of 4 yrs. FNA of the lesion shows chondromyxoidstroma and groups of epithelial and myoepithelial cells. The tumor is
2. a.       Pleomorphic adenoma
3. Mucoepidermoid carcinoma
4. Warthin tumor
5. Sialadentis
6. Acinar cell tumor
   1. A 53 year old female cardiac patient underwent unremarkable hysterectomy but suddenly collapsed on the second post operative day after becoming breathless. This is a presentation of
   2. Pulmonary hemorrhage
   3. b.       Pulmonary embolism
   4. Pulmonary infarction
   5. Pulmonary hypertension
   6. Pulmonary odema
      1. A lung condition characterized by enlargement of air spaces distal to the terminal bronchiole accompanied by destruction of walls and without obvious fibrosis is labeled as:
      2. Chronic bronchitis
      3. Bronchiectasis
      4. Asthma
      5. d.       Emphysema
      6. Pneumonia
         1. A lung condition characterized by formation of non-caseating granulomas and asteroid bodies is known as
         2. a.       Sarcoidosis
         3. Tuberculosis
         4. Idiopathic pulmonary fibrosis
         5. Pneumoconiosis
         6. Silicosis
            1. A 53 year old male having chronic cough develops hemoptysis. He is a heavy smoker for the last 30 years. X-ray chest shows an opacity 3cm in diameter on the left side. Sputum examination is positive for malignant cells. The most common lung tumor correlated with a history of smoking is
            2. Large cell carcinoma
            3. Small cell carcinoma
            4. c.        Squamous cell carcinoma
            5. Adenocarcinoma
            6. Carcinoid tumour
               1. Persons with heavy exposure to asbestos are at risk of developing
               2. Pleuritis
               3. Hydrothorax
               4. c.        Malignant mesothelioma
               5. Pneumothorax
               6. Pleural effusion
                  1. A 4 years old boy presented with history of fluctuating jaundice .On examination the patient was pale, jaundiced with splenomegaly .Initial laboratory evaluation revealed Hb 6g/dl, MCV 99fl, MCH 27pg, WBC 6x 109/l, platelet count 250x109/l. Reticulocyte count is increased .What is the most probable diagnosis.
                  2. Iron deficiency anaemia
                  3. Aplastic anaemia
                  4. Leukaemia
                  5. d.       Haemolyticanaemia
                  6. Haemophilia
                     1. A 60 years old male presented with complaints of abdominal pain and fever for last 1 month.On examination there is massive splenomegaly. Laboratory evaluation shows leucocytosis 50x109/l. Hb 9g/dl with normal platelet count. Bone marrow examination showed  myeloid hyperplasia  with bimodal peak of neutrophils and myelocytes .What is the most probable diagnosis:
                     2. Infection/sepsis
                     3. Chronic neutrophilic leukemia
                     4. Chronic lymphocytic leukemia
                     5. d.       Chronic myeloid leukemia
                     6. Acute myeloid leukemia

1. Autosomal  Dominant pattern of inheritance is seen in
2. Pyruvate kinase deficiency
3. b.       Hereditary spherocytosis
4. Sickle cell anaemia
5. Gauchers disease
6. G6PD Defeciency
   1. A 34 years old multigravida pregnant lady presented with complaints of shortness of breath on mild exertion and fatigue. Complete blood picture showed Hb 7.8g/dl , MCV 62fl , MCH 17pg ,WBC 5x109/l and platelet count 300x109/l.Peripheral film showed microcytic hypochromic picture with pencil cells .Laboratory investigation will reveal :
   2. a.       Serum Iron ↓ , TIBC ↑ ,Serum ferritin↓. 
   3. Serum Iron ↓ , TIBC ↓ ,Serum Ferritin Normal
   4. Serum Iron ,TIBC ,Serum ferritin all normal
   5. Serum Iron ↑ , TIBC Normal, Serum Ferritin  ↑
   6. Serum Iron ↓, TIBC ↓,Serum Ferritin ↓
      1. A 14 years old boy presented with complaints of high grade fever, fatigue ,anorexia  and gum bleed for last 1 week .Complete blood picture showed pancytopenia with increased WBC count. Peripheral film showed blasts.Bone marrow aspiration showed hyper cellular marrow with 98% blasts.
      2. Chronic lymphocytic leukemia
      3. Lymphoma
      4. c.        Acute leukemia
      5. Multiple myeloma
      6. Chronic myeloid leukemia

Paper setters: Prof. Abbas Hayat . Asst. Prof. Dr Erum Nadeen Rana , Asst. Prof. Dr. Imtiaz Qureshi

DEPARTMENT OF PATHOLOGY

RAWALPINDI MEDICAL COLLEGE RAWALPINDI Send Up

MCQ`S Paper           Time allowed: 65 minutes                                                                                                Total Marks: 65

Attempt all questions. 

Attempt all Questions

Q1. 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.                                                                                     1

Q2. 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?                                                                                                     2

Q3. 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

Q4. 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

Q5.  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

Q6. 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

Q7. 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?

Q8.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?                                                                                                     2

Q9. 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

Q10. 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

Q11.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

Q12. 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?                           2

Q13. 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

Q14. 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.                                                                      1

Paper setters: Prof. Abbas Hayat . Asst. Prof. Dr Erum Nadeen Rana , Asst. Prof. Dr. Imtiaz Qureshi

KEY TO SEQs

1.A     Seminoma                                                                                                              

       B     Glycogen which is PAS positive                                                                                                    

       C     c-KIT and PLAP                                                                                                     

       D   spermatocytic  seminoma

2    A  Prostatic intraepithelial neoplasia PIN                                                                

        B  Graded from I to V                                                                                                                           

        C  Because neoplasm develops in the peripheral region and TURP removes only  

              Para urethral tissue which is involved late by the malignancy                                                           

D)     Increased levels help in diagnosis and decreased levels help in assessing the

management response.

3.    A   Increased plasma amylase in first 24hrs and increased lipase levels followed

Within 72 to 96 hrs.

B)        Precipitate of calcium soaps in the necrotic fat                                              

C)        DIC,ARDS ,Shock and Acute renal tubular necrosis

4.     a Ewing sarcoma and PNET

        b. PNET

        c. Ostechondroma, Chondroma, Chondroblastoma, Chondromyxoid fibroma

5. a. Gross: Mottling with yellow-tan infarct center

        Microscopy:Coagulation necrosis, with loss of nuclei and striations; interstitial infiltrate of

neutrophils

b.Reperfusion-associated pathologies, includes  reperfusion-induced arrhythmias, myocardial

hemorrhage with contraction bands, irreversible cell damage distinct from and additional to

the injury associated with the original ischemic event (reperfusion injury), microvascular

injury, and prolonged ischemic dysfunction.

6.  a. Endometrioid carcinoma or type I

      b. It is defined as an increased proliferation of endometrial glands relative to stroma     resulting in an increased gland to stroma ratio when compared with normal proliferative endometrium Its types are simple hyperplasia without atypia, simple hyperplasia with atypia, complex hyperplasia without atypia, compex hyperplasia with atypia.

c. Inactivation of  PTEN Tumour suppressor gene

7. a. DCIS, LCIS, Invasive ductal ca, Invasive lobular ca , Tubular ca, Medullary ca,

        Papillary and Metaplasticca

    b. Invasive ca or In-Situ disease, Distant metastases, lymph node metastases, Tumour

size, locally advanced disease and inflammatory ca.

    c. The lymph node where breast carcinoma drain first identified with radiotracer or

        Colored dyes injected into the tumour followed by its drainage to the lymph node

which take up the dye first. This lymph node is biopsied to look for the metastases if

lymph node is negative for metastasis patient can be spared the morbidity of a

complete axillary dissection

8.   a. Effects are; Lacunar infarcts, Slit haemorrhages, Hypertensive encephalopathy,

       Massive hypertensive intracerebralhaemorrhage

     b. Different types of brain ANEURYSMS are;

Saccular, atherosclerotic, mycotic, dissecting traumatic

9. A. definition ;Chronic bronchitis is defined as persistent cough with sputum production  for at least 3 mont6hs in at least 2 consecutive years in the absence of any identifiable cause.

B. Complications of chronic bronchitis

1-       progress to COPD

2-       leads to Corpulmonale and heart failure

3 -Atypical metaplasia + dysplasia .respiratory epithelium provides rich soil for cancerous

transformation.

 C. Bronchiectasis, Asthma, Emphysema, Bronchiolitis

10. a.

Primary Glomerulopathies

Acute diffuse proliferative glomerulonephritis

  Poststreptococcal

  Non-poststreptococcal

Rapidly progressive (crescentic) glomerulonephritis

Membranous glomerulopathy

Minimal change disease

Focal segmental glomerulosclerosis

Membranoproliferative glomerulonephritis

IgA nephropathy

Chronic glomerulonephritis

1. Acute nephritis, proteinuria, and acute renal failure

11.     a. Benign salivary gland tumour (pleomorphic adenoma)  2. Lymphadenopathy

1. FNA
2. Larger the size of gland less likely to be malignant and vice versa
3. Mucoepidermoid carcinoma

12.    a. Prominent bile stasis in the bile ducts                                                          

               Bile ductular perforation with surrounding neutrophils                                

               Portal tract oedema

               Parenchyma shows cholestasis, feathery degeneration and bile lakes                   

1. Dense lymphocytic infiltrate in portal tract and granulomatous destruction of 

Bile ducts

.

13.         a.    Grave’s disease, toxic MN goiter, solitary toxic adenoma, thyroiditis, etc

              b. fT3, fT4, TSH, TSH receptor Ab

c. Abrupt on set of severe hyperthyroidism seen in  Graves disease due to increase levels

ofcatecholamines under stress like infection surgery cessation of antithyroid

medication. Considered as medical emergency because significant number of patient

die of cardiac arrythemias  if not treated.

14. a.  The peripheral blood smear shows severe red cell morphologic abnormalities, including marked anisocytosis and poikilocytosis (variation in size and shape, respectively), microcytosis (small size), and hypochromia (poor hemoglobinization). Target cells (so called because hemoglobin collects in the center of the cells), basophilic stippling, and fragmented red cells are also common. The reticulocyte count is elevated, but because of ineffective erythropoiesis is lower than expected for the severity of anemia. Variable numbers of poorly hemoglobinizednormoblasts are seen in the peripheral blood due to "stress" erythropoiesis

b. The major morphologic alterations seen in the bone marrow and spleen. In the untransfused patient, there is striking expansion of hematopoietically active marrow, particularly in facial bones. This erodes existing cortical bone and induces new bone formation, giving rise to a "crew-cut" appearance on X-rays Both mononuclear phagocytic cell hyperplasia and extramedullary hematopoiesis contribute to enlargement of the spleen, which can weigh up to 1500 gm.

c. Bone marrow transplantation from an HLA-identical sibling is currently the only therapy offering a cure

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