Download University of Jaffna (University of Sri Lanka) MBBS (Bachelor of Medicine and Bachelor of Surgery) 2016 December Pathology Paper II Previous Question Paper
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (1st) December 2016
Pathology II
Date : 16.01.2017
Time allowed: 3 hours
Answer all Ten (10) questions
Answer each question in separate answer book
1.
1.1 A 62 year old driver was admitted to the hospital with gangrene of the left
fourth toe and a non-healing ulcer over the lateral malleolar region of right leg.
1.1.1 What is gangrene?
1.1.2 Mention the different types of gangrene with one (01) cause and one
(05 marks)
(01) example for each type.
1.1.3 Mention the factors which affect the wound healing.
(15 marks)
(15 marks)
1.2 A 68 year old woman underwent Anterior resection for moderately
differentiated adeno carcinoma of upper rectum and admitted to Intensive Care
Unit for post-operative care. On 4 111 post-operative day she developed
low grade fever with pain and swelling of the left calf. She was suspected to
have Deep Vein Thrombosis in her left lower limb.
1.2.1 List the possible risk factors for deep vein thrombosis in this woman.
1.2.2 Describe the pathogenesis of deep vein thrombosis.
(10 marks)
1.2.3 Enumerate the sequelae of deep vein thrombosis.
(25 marks)
1.2.4 How could you have prevented deep vein thrombosis in this woman?
(15 marks)
(15 marks)
2.
2.1
List three (03) types (chemical composition) of urinary calculi.
(15 marks)
2.2
Give one (01) predisposing factor for each type of calculi mentioned in
2.1
(15 marks)
2.3 Describe briefly the pathological features (microscopy and
microscopy) that may occur in the kidney following obstruction of the
urinary tract by calculi
(70
marks)
3.
A 57 year old known hypertensive man was admitted to the medical ward with an episode of
sudden onset of chest pain associated with sweating. A myocardial infarction was suspected.
3.1
List four (04) investigations you will do to confirm the diagnosis.
(20 Marks)
3.2
Describe the pathogenesis of myocardial infarction in this patient
(30 Marks)
3.3
This patient died on the 3 rd day of admission.
Describe the pathological changes that you would expect to see in his
thoracic contents during a post mortem examination.
(50 Marks)
4.
A 5 months old infant was admitted to paediatrics ward due to failure to
thrive. Clinical examination revealed pallor, mild jaundice and marked
hepatosplenomegaly. His Haemoglobin was 4gIdL
4.1
State the most likely diagnosis.
(05 Marks)
4.2
State the expected red cell findings in this infant's full blood count.
(15 Marks)
4.3
State the red cell morphology you would expect in this infant's blood
picture.
(15 Marks)
4.4
State the confirmatory test and expected findings for the most
(10 marks)
likely disease you mentioned in 4.1
4.5
State the expected findings of the test you mentioned in 4.4 for both
parents.
(15 marks)
4.6
Explain the pathological basis for hepatosplenomegaly in this
(35 marks)
4.7
patient State two (02) tests that are very important in the
(05 marks)
management of this patient.
5.
A 58 year old garage worker developed haematoma many hours after herniotomy
and repair surgery. Re-exploration revealed no bleeding points. Many hours
after re-closure, the haematoma recurred and the surgeon wanted to exclude
non-surgical causes for haematoma formation. Other than regular alcohol
consumption, history was unremarkable. He is not on any medications.
5.1State the most likely underlying disease which caused impaired
haemostasis in this patient
(05 marks)
5.2List five (05) causes for the haemostasis impairment in disease you
mentioned in 5.1
(25 marks)
2
5.3
State two (02) laboratory tests you would request to assess the
defect in haemostasis, giving expected findings and samples to be
collected for the tests mentioned
(15 marks)
5.4
State three (03) biochemical parameters which can be expected to
be abnormal in this patient giving reasons
(15 marks)
5.5
State two (02) therapeutic products available to correct haemostasis
failure in this patient
(10 marks)
5.6
Describe the common red cell changes you would expect in this
patient's peripheral blood smear giving the reasons for the changes
(15 marks)
5.7
State one (01) non-laboratory investigation you would request to
evaluate this patient's disease status and expected findings
(15 marks)
6.
A 47 year old man with a history of heavy smoking over 20 years presented
\Nith a mass in the right lung. A CT guided tru-cut biopy confirmed a
malignant neoplasm.
6.1List the different types of lung carcinoma
(20 marks)
6.2Describe the macroscopic and microscopic features of one (01) type
listed in 6.1
(40 marks)
6.3Name four (04) paraneoplastic syndromes that may he seen in lung
carcinoma.
(20 marks)
6.4Describe four (04) local complications that can occur in lung carcinoma.
(20 marks)
7.
A 27 year old man presented with blood and mucus diarrhoea for the last
one year.
7.1Mention three (03) benign conditions for this presentation
(15 marks)
7.2Briefly describe the macroscopic appearance of the diseased bowel in
each condition mentioned in 7.1
(45 marks)
7.3Discuss briefly the pathological basis of the complications of two (02)
conditions mentioned in 7.1.
(40 marks)
3
8.
A 60 year old man presented to the surgical unit with gradually worsening
right sided abdominal pain for three months. Past history revealed that he
had three episodes of bleeding per rectum six months ago for which he had
sought medical advice. Clinical examination revealed marginally enlarged
liver, mild pallor and no jaundice. The Ultrasound scan of abdomen revealed
an enlarged liver with multiple space occupying lesions in the liver.
8.1
List three (03) possible causes for the lesions in the liver.
(15 marks)
8.2
State two (02) laboratory investigations that can be performed for the
above lesions to obtain a diagnosis.
(20 marks)
83
State two (02) clinical examination procedures that need to be
performed to establish the aetiology of the lesions in the liver.
(15 marks)
8.4
Describe the inacroscopy and microscopy of one (01) of the causes
you have mentioned in 8.1
(50 marks)
9.
A mastectomy specimen from a 42 year old woman shows a two centimeter
diameter tumour which is a well differentiated ductal carcinoma of no
special type with a minor in-situ component. Two of the fourteen axillary
lymph nodes are positive for metastatic tumour. The tumour Oestrogen
and Progesterone receptor studies are negative and Her2-neu is positive.
There is no distant metastasis.
9.1
Identify the prognostic and predictive factors listed above and discuss
the relative importance ?leach factor mentioned.
(50 marks)
9.2
Describe the risk factors for ovarian cancer
(25 marks)
9.3
Briefly describe the pathophysiology of pre-eclampsia
(25 marks)
10.
10.1 A 26 year old girl presented with loss of weight in spite of eating,
sweating and palpitations. On examination she had a thyroid nodule.
Following initial thyroid function test results were noted.
TSH
<0.015
mIU/L
(reference interval 0.47-4.7)
Free T4
11
mmol/L
(reference interval 10-28)
4
10.1.1 Explain the results with a probable diagnosis.
(20 marks)
10.1.2 List one (01) important hormonal investigation required to
arrive at a definitive diagnosis.
(20 marks)
A
10.1.3 List one (01) investigation that has to be done in each of the
following situations in this patient
10.1.3.1
After initial treatment has been started.
(10 marks)
10.1.3.2
On long term follow up.
(10 marks)
10.2 A patient presented with a solitary nodule of thyroid and is clinically
euthyroid. Briefly describe one (01) non-hormonal investigation
with
interpretation to arrive at a pathological diagnosis.
(40 marks)
5
This post was last modified on 19 October 2021