Download University of Jaffna MBBS 2020 December Patholgy Paper II Question Paper

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Index number: .....................................................................
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXA.MINATION FOR MEDICAL DEGREES (2 nd).-DEC 2020
Pathology Paper II
Date: 16.12.2020
Time: 03 hours
ANSWER ALL THE 10 QUESTIONS
Write the answers in the given space below each question.
1. Anaemia is a common clinical manifestation. Based on underlying pathology, anaemia can
be classified in to anaemia due to marrow under production, anaemia due to excessive red
cell destruction and anaemia due to acute blood loss.
1.1.
Define anaemia.
(10 marks)
1,2.
State key characteristics in each group of anaemia stated above.
(20 Marks)
1
2. ...................................................................................................................
3 . ...........
1.3.
List different categories of disorders falling in to marrow underproduction
group of anaemia.
(15 Marks)
Page 1 of 23

1.4.
Outline pathological basis of anaemia in one
1.3.
)
1.5.
Outline the manifestations you would expect in severe uricompensa:ed
anaemia in an infant.
(20 Marts)
1.6.
Briefly outline red cell characteristics you can observe in anaemia due to
(15 Marks)
excessive red cell destruction.

rt
Index number: .....................................................................
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (2 nd)
DECEMBER 2020 Pathology Paper II
2 A 68- year - old male was admitted to Teaching Hospital Jaffna with a clinical suspicion
. of chronic myeloid leukemia (CML).
2.1.
Outline the pathogenesis of CML.
(20 marks)
2.2.
State the blood picture findings expected in CML.
(15 marks)
2.3.
Patient was treated for one year and CML progressed to acute myeloid
leukemia (AML). State how you would confirm the diagnosis of AML.
(15marks)
Page 3 of 23

2.4.
Outline the pathological basis for the following in AML,
2.4.1 Excessive bleeding tendency in AML.
(10 marks)
2.4.2. Fever in AML.
(10 marks)
2.4.3 Organornegaly in AML.
(15 marks)
2.5.
Outline the investigations useful to manage AML.
(15 marks)
4

Index number: ...........................................................................
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (2") December
2020 Pathology Paper II
3 A 67- year --old male smoker presents with progressive dysphagia. He has lost 10 Kg in
. the last month and the dysphagia is worse for solids compared to liquids.
3.1.
That is the most likely diagnosis?
(10 marks)
3.2,
List 2 different histological type of above condition.
(10 marks)
33.
List four (04) risk factors for each histological type mentioned in 3.2,
(20 marks)
3.4.
List the different macroscopic appearance of condition mention in 3.1.
(10 marks)
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3.5.
Explain the possible local extensions (organs) of condition mentioned in 3.1.
(2 Ozarks)
3.6.
Write one investigation which will confirm your diagnosis.
(10 marks)
3.7.
Write the reasons for progressive dysphagia and more dysphagia to solid than
liquid.
(20 marks)

Index number:
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UNIVERSITY OF JAFFNA, SRI LANKA

SECOND EXAMINATION FOR MEDICAL DEGREES (2nd)--
DECEMBER
20
Pathology Paper II
4 A 47-year-old man, whose father died of metastatic rectal cancer, was referred to the
outpatient surgical clinic by a primary care physician with positive fecal occult blood for
further evaluation.
(05 marks)
4.1.
How would you further evaluate him?
Further evaluation revealed a polyp at the upper rectum. Histopathotogy of the polyp
was reported as adenomatous polyp with high grade dysplasia.
4.2.
What do you understand by the term dysplasia?
(10 marks)
4.3.
Under the microscope how would you differentiate dysplasia from carcinoma?
(05 marks)
Even though follow up plan was informed to the patient, he has defaulted the follow up
and after 3 years of initial review he presented with bleeding per rectum. Further
evaluation revealed a poorly differentiated adenocarcinorna of the rectum with a solitary
metastasis in the left lobe of the liver.
4.4.
Mention five risk factors for carcinoma of the rectum other than the family
history.
(10 marks)
1
. ........................................................................................................................................................................................................................................................................................................................................................................................................................................................
2
. ........................................................................................................... ............................................................................................................................. ................................................................................................................................................................................................................
3
.............................................................................
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4
. ..................................................
5 ................
4.5.
Explain the term poorly differentiated adenocarcinoma.
(15 marks)
4.6_
How did an adenornatous poly turn around an adenocarcinoma in this patient?
(15 marks)
4.7_
Briefly describe the steps of spread of a rectal cancer to the liver. (20 marks)

UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (2nd)--DECEMBER 2020
Pathology Paper II
5
5.1
A 55- year -old man was found to have serum creatinine of 290 !mon (RR
60-115 Amon) on routine check-up at his General Practitioner's office. He
was a known diabetic for the last 10 years and was not controlling his blood
glucose level as expected. He was referred to the hospital nephrology clinic
and serum creatinine was repeated after few days and was found to be 300
ja mon. Chronic kidney disease was confirmed with a renal biopsy later.
5.1.1. His estimated glomerular filtration rate (eGFR) was 20.1
niLimin/1.73 m2. How will you grade chronic kidney disease using
eGFR and in what chronic kidney disease grading is he in? (15 marks)
5.1.2. List five (05) blood investigations you will do in this patient and
indicate the expected changes.
(20 marks)
1
. ..........................................................................................................................................................................................................
2 ..........................................................................................................................
3 ..........................................................................................................................
4 ........................................................................................................................
5
................................................
Page 11 of 23

5. L3 List two (02) investigations that can be done in urine in this scenario,
111
(05 marks)
1 ...................................................................................................
2 ...................................................................
5.2.
Give the macroscopic and microscopic changes of kidneys in the following
conditions.
5.2.1 Diabetes mellitus.
(40 marks)
5.2.2 Calculi in the left renal pelvis.
(20 marks)

Index number: .....................................................................
UNIVERSITY OF JAFFNA, SRI LANKA SECOND EXAMINATION FOR MEDICAL
DEGREES (2 nd)--DECEMBER 2020 Pathology Paper II
6 A 45- year- old woman presented to the outpatient clinic with a solitary small lump in
the thyroid region of 3 months duration.
6.1.
List one (01) laboratory (non-biochemical/ non-endocrine) test you will do in
this patient.
(10 marks)
6.2.
Total thyroidectomy was done and the histopathology report revealed a
papillary carcinoma of thyroid. Describe the microscopic features of papillary
carcinoma of thyroid.
(40 marks)
She developed tetany after few days postoperatively. Briefly describe the
patho g enesis of tetany in this patient.
(20 marks)
Page 13 of 23

6.4.
List one (01) biochemical test (non-endocrine) you will do in this patient and
what change you will expect in that test?
(10 marks)
6.5.
What precautions will you take when doing the test mentioned in 6.4?
(20
marks)
14

Index number.
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.):,
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (2 nd)--DECEMBER
2020
Pathology Paper II
7
7.1
A 50-year-old healthy man presented with sudden onset of fever with chills
and rigor, and productive cough. Physical examination revealed stony dullness
in the right lower zone. Auscultation revealed bronchial breathing in the right
middle zone and, reduced air entry and inspiratory crackles in the right side of
the lung.
7.1.1. Mention the most likely diagnosis?
(05 marks)
7.1.2. Outline the pathophysiology of the following clinical features.
15 marks)
I. Bronchial breathing on auscultation.
2. Stony dullness on percussion.
3. Inspiratory crackles on auscultation.
7.1.3. List three (03) complications of the condition you mentioned in 7.1.1.
(15 marks)
1 ...................................................................................
2 ............................................................................................................................
3 ..................................................................................................
7.1.4. List three (03) basic biochemical or radiological investigations you will
perform in this patient and indicate the expected findings. (15 marks)
1 ............................................................................................................................
3 .............................................................................................................................
Page 15 of 23

7.2.
A 65 -- year-old man who admits to a 60-pack year smoking history,
complains of fatigue and dyspnea with minimal exertion and a cough that is
productive every morning throughout the year for last 2 years.
7.2.1 Mention the most likely diagnosis?
(05 marks)
7.2.2 Outline the pathogenesis of the condition you mentioned in 7.2.1.
(20 marks)
7.23. List four (04) complications of the condition you mentioned in 7.2.1.
(20 marks)
1 ..........................................................................................................................
2 ...........................................................................................................................
3. ..........................................................................................................................
4, ..........................................................................................................................
7.2,4. List two (02) risk factors other than smoking for the condition you
mentioned in 7.2.1.
(05 marks)
1 ..........................................................................................................................
2 ...........................................................................................................................
16.

Index number-
UNIVERSITY OF JAFFNA, SRI LANKA
ff
SECOND EXAMINATION FOR MEDICAL DEGREES (2 nd)--
DECEMBER 2020 Pathology Paper II
8 A 45-year --old woman, while recovering in bed several days after having an abdominal
. surgery, develops an acute onset of chest pain and shortness of breath.
On further questioning patient also revealed a 2-day history of a swollen and tender right
leg. On examination the patient appears anxious and tachypneic, but has good air
movement in the lungs bilaterally.
8.1.
Mention the most likely diagnosis?
(05 marks)
8.2.
List two (02) emergencies other than mentioned in 8.1 that may present with
acute chest pain.
(10 marks)
1 ......................................................................................................................
2. ...................................................................................................................
8.3.
State the possible underlying mechanism for the condition you mentioned in
8.1?
(10 marks)
8.4.
Mention the pathogenesis and list three (03) risk factor for the development of
the condition mentioned in 8.1.?
(30marks)
Page 17 of 23

8.5.
Mention one investigation which may confirm / support your diagnosis and
indicate the expected finding.
(10 marks)
8.6.
Briefly mention the reason for swelling of
the right leg of this patient.
(15 marks)
8.7.
List two (02) conditions which
may be associated with bilateral leg swelling
and mention the underlying mechanism for the swelling in each condition.
(20 marks)
S

Index number: .....................................................................
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (2nd)--DECEMBER
2020 Pathology Paper II
9
9.1
A 40-year-old man is being evaluated as a new patient complains of severe
headache and is found to have a blood pressure of 170/95mm Hg
9.1.1. List four (04) causes for high blood pressure in this patient. (20 marks)
1 ............................................................................................................................
2 ...................................................................................................
3 ...............................................................................................................
4
. .............................................................................................................................................................................................................
9.1.2. Mention the effects of hypertension on blood vessels and heart.
(30 marks)
1.B loodves s el s
2.I-leart
Page 19 of 23
r.

9.2.
A 63-year-old man experienced loss of function of his left upper and lower
extremities, One week back he had experienced several episodes of left-sided
weakness lasting a few minutes, but he had recovered function after each of
those episodes. Previously, he had been in good health except for occasional

angina relieved by rest.

9.2.1. Mention the most likely diagnosis?
(10 marks)

9,2.2, Mention the underlying mechanisms associated with the condition you

mentioned in 9.2.1?
(10 marks)

9.2.3. List four (04) risk factors other than Hypertension for developing the

condition mentioned in 9.2.1? (20 marks)

1 .........................................................................................................................

2 ...................

3
. ..........................................................................................................................................

4
. .............................................................................................

9.2.4. Mention one (01) investigation that will help in the diagnosis and the
treatment of this condition you mentioned in 9.2.1.
(10 marks)
20

Index number: ....................................................................
UNIVERSITY OF JAFFNA, SRI LANKA
SECOND EXAMINATION FOR MEDICAL DEGREES (2 nd)--DECEMBER
2020
Pathology Paper II
10
10.1
A 25-year-old man complains of swelling of the right scrotal area, which he
has noted for approximately 1 month. There is no history of trauma to the area
and he has no medical problems. On examination, there is a 5-cm firm,
nontender lump inside the right hemi scrotum.
10.1.1. Mention the most likely diagnosis?
(10 marks)
10.1.2. Briefly mention the histological types of the diagnosis you mentioned
above.
(15 marks)
10.2.
A 21-year-old nulliparous woman has a 9-cm right adnexal mass that on
ultrasound appears cystic and solid.
10.2.1. Mention the most likely diagnosis?
(10 marks)
10.2.2. Mention the morphological appearance of the condition you mentioned
above.
(15 marks)
Page 21 of 23

10.3.
A 7-year-old child presented with oliguria, haematuria, oedema, and impaired
renal function. His past history revealed a sore throat 10 days back.
10.3.1. Mention the most likely diagnosis?
(10 marks)
10.3.2. Mention three (03) investigations you will perform in
patient and
this indicate the expected findings.
(15 marks)
10.4.
A 65-year-old woman complains of soreness and oozing from the nipple of her
left breast. There is no history of trauma. On examination, there is fissuring and
ulceration of the areola and nipple, and a palpable lump below the areola
region.
10.4.1. Mention the most likely diagnosis?
(10 marks)
10.4.2. List three (03) risk factors for the condition you mentioned above.
(15 marks)

This post was last modified on 19 October 2021