General Pathology

Inflammation

Traditional essay:

1. Define inflammation. Describe the vascular and cellular events of acute inflammation. Add a note on the outcomes of acute inflammation. (2+8+5=15).
2. Define Acute inflammation. Describe the vascular and cellular events of acute inflammation. Add a note on the morphological patterns of acute inflammation.
   (1+10+4=15)

Modified essay:

1. An 18-year-old female complains of nausea, vomiting and abdominal pain that began around the umbilicus but then shifted to the right lower quadrant. O/E- Patient is febrile, with abdominal tenderness, in the right iliac fossa. Urine analysis is normal. Complete blood count: Total WBC count – 18000 cells/ cumm; N-90%, L-6%, M-4%. CRP: Positive. Beta-hCG: Negative. USG/ CT abdomen: Thickened appendiceal wall. (2+2+6+5=15)
   a) What is the most likely diagnosis?
   b) What is the type of inflammation occurring here?
   c) What are the vascular and cellular events occurring here?
   d) What are the chemical mediators causing pain, fever and leucocytosis?
2. A 12 year old male underwent surgery for an appendicular abscess. On the 5 th post op day he had fever with pus discharge from the surgical site. Debridement was done and he was managed on antibiotics. (2+5+3+5=15)
   a. What is the type of wound healing occurring here?
   b. What are the steps of wound healing?
   c. Components of granulation tissue.
   d. What are the factors affecting wound healing?

Short essay: 8 marks

1. A 38-year-old man has a health screening examination. He has a routine chest x-ray that shows a 2 cm nodule in the right lower lobe. The nodule has focal calcifications. A wedge resection of the nodule is done. On microscopic examination the nodule shows granulomatous lesion.
   • a. What is your diagnosis?
   • b. Describe the gross and microscopic features. (2+6=8)
2. Chemical mediators of inflammation.
3. Vascular and cellular events of acute inflammation.

Short answer: 4 marks

1. Steps in phagocytosis.
2. Chemotaxis.
3. Types of giant cells.
4. Secondary wound healing.
5. Granulomatous inflammation.
6. Factors affecting wound healing.

Name the following: 1 mark

Components of Ghon complex.

Define chemotaxis?

The five cardinal signs of inflammation are ______

Name two opsonins.

Name two vasoactive amines.

A local defect or excavation of the surface of an organ or tissue that is produced by the
sloughing of inflamed tissue is called ___

Process of new blood vessel development from existing vessels is called __

Name four causes for delayed wound healing.

Modified fibroblasts with contractile properties is called __

What is a keloid?

Immunopathology

Traditional essay:

1. SLE – pathogenesis, spectrum of autoantibodies, clinical features, renal findings. (4+4+4+3=15marks).

Modified essay:

1. A 25 year old female presented to OP with butterfly shaped rash on the malar area, multiple joint pains and oral ulcers. She also gave a past history of one episode of seizures 2 years back.O/E- Pallor+; CVS-? Pleural rub+; Investigations-Urine-Proteins+++; Hb-7g/dL

a. What is your diagnosis? (2 marks)
b. What is the etiopathogenesis of this condition? (5 marks)
c. What are the useful investigations here? (4 marks)
d. What are the expected findings in renal biopsy in this patient? (3 marks) (2+5+4+3=15 marks)

2. A 40 year old lady, sneezes continuously every day after cleaning and dusting her house. She also complains of occasional wheezing.

a. What is the type of hypersensitivity occurring in this case?
b. Explain the mechanism of this type of hypersensitivity with a note on the mediators involved. (1+7=8 marks)

3. A 30year old male, a recipient of a donor matched renal transplant, was on an immunosuppressant medication Cyclosporine. He stopped his medication by himself after a month of the transplant. 2 weeks after stopping the medication, he developed fever, anuria, periorbital oedema and pain over the transplanted kidney.

a. What is the type of rejection occurring here?
b. Explain the mechanism?
c. Write briefly about the morphology of the kidney here?
(2+3+2=7 marks)

4. A 50 year old male who is suffering from Myasthenia Gravis, finds it difficult to maintain physical activity for more than 30mins at a stretch.

a. What is the type of hypersensitivity reaction here? (1 mark)
b. Explain the mechanism. (4 marks)
c. Give other examples. (3 marks)

5. A 12 year old girl with sickle cell anaemia needs bone marrow stem cell transplantation. A buccal swab was taken from a distant relative of hers and was a 10 by 10 HLA match.

a. What is MHC and HLA? (4 marks)
b. What is GVHD? (4 marks)

6. A 25-year-old male presents with unintentional weight loss, chronic diarrhoea, generalized lymphadenopathy, and oral candidiasis. He is a long-standing drug abuser. Investigations reveal a decreased CD4 count.

a. What is your diagnosis?
b. Describe the pathogenesis of this condition.
c. Explain the pathology of the organ(s) involved.
d. List the investigations to be performed in this case.

7. A 30-year-old male truck driver presented with a history of fever and cough for 3 weeks, progressive fatigue, and weight loss of about 10 kg over the last 6 months.

On examination:

• He had generalized lymphadenopathy.
• Warts on hands and genitals were noted.
• CNS examination showed neck stiffness and Kernig’s sign positive.
• RS examination revealed crepitations.

He died after 2 days.

a. What is your diagnosis?
b. Explain the etiopathogenesis of the condition.
c. What is the probable cause of death?

Short essay: 8 marks

1. Hypersensitivity reactions.

2. SLE – pathogenesis, clinical findings, renal findings.

3. Amyloidosis – physical and chemical properties, classification, morphology.

4. Transplant rejection.

Short answer: 4 marks

1. Lupus nephritis.

2. Type 1 hypersensitivity reaction.

3. Delayed hypersensitivity reaction.

4. Morphology and special stains in amyloidosis.

5. Central tolerance.

6. MHC.

7. ANAs in SLE.

8. Opportunistic infections in AIDS

9. HIV associated changes in immune function

10. Pathogenesis of CNS lesions in HIV infection

Name the following: 1 mark

1. Sago spleen is seen in which condition.

2. Single, firm, non-tender, raised, red lesion seen in primary syphilis is called _____________

3. Major Histo-compatibility complex in humans is called __________________

4. Type of hypersensitivity seen in Myasthenia Gravis is ­­­­­­­­­­­­­­­­­­­____________

5. Malar rash is seen in ___________

6. Two examples for type II hypersensitivity reaction.

7. Name two ANAs seen in SLE.

Hematology

RBC DISORDERS and BLOOD TRANSFUSION

Traditional essay:

1. Define anemia. Classify anemia. Describe in detail about nutritional anemias. (1+4+10=15marks).

2. Classify anemia. Describe the pathogenesis, clinical features, lab investigations and complications of sickle cell anemia. (2+4+2+4+3=15marks).

3. Classify anemia. Describe the pathogenesis, clinical features and lab investigations of beta thalassemia. (2+5+3+5=15marks).

Modified essay:

1. A 35 year old female, a strict vegetarian, presented with complaints of progressive fatigue with paraesthesia and numbness of hands and feet since 6 months. Physical examination reveals pale conjunctiva and nail bed. Lab results show Hb = 8.2gm%, Total WBC count = 3100/cumm, platelets = 1.4 lakhs/cumm, MCV = 120fl. (1+2+8+4=15marks)

1. What is your probable diagnosis.
2. How do you explain her neurologic findings.
3. Draw a labelled diagram and describe the peripheral blood smear appearance and bone marrow findings in this condition.
4. What are the other tests you would like to do to arrive at the diagnosis.

2. A 34 year old female presented with history of menorrhagia and easy fatigue for many months. She also gives history of eating excessive ice over the last few days. She has no significant family history. Physical examination reveals pale conjunctiva and nail bed. Lab results show Hb = 7.5gm%, Total WBC count = 5000/cumm, platelets = 2.7 lakhs/cumm, MCV = 70fl, RDW = 17%.

a. What is your probable diagnosis.
b. Describe the etiopathogenesis of this condition.
c. Draw a labelled diagram and describe the peripheral blood smear appearance in this condition.
d. What are the other tests you would like to do to arrive at the diagnosis.(1+4+6+4=15marks)

3. A 4 year old girl child presented to OP with sudden onset of hand and foot pain and swelling. Her mother has history of severe anaemia and multiple blood transfusions. O/E- Pallor present, mild icterus seen. Investigations- Hb-7g/dL. (2+4+5+4=15marks)

a. What is your diagnosis? (2 marks)
b. What is the genetics of this condition? (4 marks)
c. What are the useful investigations here? (5 marks)
d. What are the pathophysiology of this acute condition? (4 marks)

4. A 5 year old boy presented with history of severe anemia and retarded growth. Physical examination revealed prominence of frontal bones. His Hb = 6.5gm%, Total WBC count = 9000/ cumm, platelets = 2.5 lakhs/ cumm. (1+8+5+1=15)

a. What is the probable diagnosis?
b. Draw a labelled diagram and describe the peripheral blood smear appearance in this condition.
c. Describe the etiopathogenesis of this condition
d. Mention the confirmatory test for diagnosis

Short essay: 8 marks

1. Blood transfusion reactions.

2. Immune hemolytic anemias.

3. Lab diagnosis of iron defeciency anemia.

4. Lab diagnosis of megaloblastic anemia.

5. Beta thalassemia – pathogenesis and lab investigations.

6. Sickle cell anemia – pathogenesis and lab investigations.

Short answer: 4 marks

1. Bombay blood group.

2. Anti globulin test.

3. Hemolytic disease of newborn.

4. Peripheral smear findings in megaloblastic anemia.

5. Bone marrow findings in megaloblastic anemia.

6. ESR.

7. Blood components.

Name the following: 1 mark

1. Name a condition where Direct Anti-globulin test (Direct Coomb’s Test) is done.

2. One example where autosplenectomy is seen.

3. Two bone marrow findings in megaloblastic anemia.

4. Four blood donor criteria before blood donation.

5. Two causes of microcytic hypochromic anaemia.

6. Mention the mutation seen in Sickle cell anemia.

7. What are Howell-Jolly bodies?

8. Neutrophils having five or more nuclear lobules instead of the normal three to four are called …………

9. Triad of Esophageal webs, microcytic hypochromic anemia and atrophic glossitis is seen in ………..

10.Two causes for aplastic anemia.

Systemic Pathology

Respiratory System

Traditional essay:

1. Define emphysema. Describe its etiopathogenesis. Write a note on the different morphological types of emphysema. (2+6+7=15).

2. Classify lung tumours. Describe the various morphological types of carcinoma lung. Write a note on the paraneoplastic syndromes associated with this condition. (2+8+5=15).

3. Define pneumonia. Write the etiological classification of pneumonia. Describe the four stages of the inflammatory response in lobar pnemonia. Add a note on the complications of pneumonia. (2+4+6+3=15)

Modified essay:
1. 70 year old male, chronic smoker, presented to the ophthalmologist with symptoms of drooping of left eyelid, miosis and dryness of eye on the left side. O/E: Left supraclavicular and axillary lymph nodes were enlarged. CT chest showed a ill-defined hypoechoeic lesion with spiculated margins in the apex of left lung. 
A. What is the most probable diagnosis
B. Classify tumours of the organ involved
C. Describe the gross and microscopy of any two subtypes
D. Write a note on the paraneoplastic conditions associated with this lesion
(2+4+6+3)

2. 46 year old construction worker presents to the medicine OP with complaints of shortness of breath. For the past 2 months, he had exertional dyspnea with dry cough. No history of fever, chills or weight loss. Lung auscultation reveals a diffuse, expiratory wheeze. Chest X ray shows linear densities in bilateral lower lobes. No focal mass lesion. His 69 year old cousin who works with him in construction was recently diagnosed with mesothelioma.
A. What is the most probable diagnosis
B. Describe the gross and microscopy of the lungs in this case
C. Add a note on pathogenesis 
(1+4+3)

3. 68 year old male presented to the emergency department with shortness of breath since 1 week. No history of hemoptysis or fever. He smokes 1-2 packs of cigars/ day for the last 30 years and continues to smoke. O/E: He appears to breathe with pursed lips. Diffuse rhonchi auscultated in bilateral lungs. Chest X ray shows hyperlucent large volume lungs with increased AP diameter and flattened hemidiaphragm.
A. What is the most probable diagnosis
B. Mention the different types of this condition
C. Describe the etiopathogenesis 
(1+2+5)

Short essay:

1. Emphysema lung

2. Lung tumours – classification and morphology

3. Pneumoconiosis

4. Lobar pneumonia –  stages and complications.

Short answer:

1. Asbestosis

2. Stages of lobar pneumonia

3. Bronchiectasis

4. Lung abscess

5. Small cell lung carcinoma.

6. Paraneoplastic syndromes in carcinoma lung.

7. Malignant mesothelioma

Name the following:

1. What are Ferruginous bodies?

2. Name two microscopic features of small cell lung carcinoma.

3. Name the most common type of emphysema.

4. Panacinar emphysema is associated with ………….. deficiency.

4. The extrusion of mucus plugs from subepithelial mucus gland ducts or bronchioles seen in the sputum of patients with atopic asthma are called ………….

5. Define bronchiectasis?

6. Define chronic bronchitis?

7. What is Reid index?

8. The most common cause for community acquired acute pneumonia is _________________

9. The most frequent cause for gram negative bacterial pneumonia is ………..

10. Name the four stages of the inflammatory response in lobar pnemonia.

11. Common mutation seen in adenocarcinoma lung involves gain-of-function mutation of …………

12. Common mutations seen in small cell carcinoma lung involves  ………… and …………. tumour suppressor genes.

13. ‘Collar-button lesions’ in the lung are classically described for ………..

14. Name the microscopic types of malignant mesothelioma.

Renal system

Traditional essay:

1. Classify renal tumors. Mention the histological types of renal cell carcinoma. Describe the morphology of Clear cell renal cell carcinoma. Add a note on the paraneoplastic syndromes associated with renal cell carcinoma. (3+2+6+4=15marks).

2. Describe the clinical features, etiopathogenesis and morphology of the kidney in Post Streptococcal Glomerulonephritis. (3+5+7= 15marks)

Modified essay:

1. An 8 year old boy was admitted with malaise, fever, oliguria, cocoa-coloured urine 2 weeks after recovery from sore throat. On examination, he was found to have periorbital oedema and moderate hypertension. (2+4+6+3=15)

a) What is the probable diagnosis?
b) Describe the etiopathogenesis of the condition?
c) Describe the morphology of the organ involved.  
d) List the urinary findings of the condition.

2. A 58 year old male having fever and weight loss presented with painless hematuria, flank pain and palpable mass in the left renal angle. CT scan confirmed a specific organ mass lesion, regional lymph nodes and renal vein involvement. Chest radiography showed pulmonary “cannonball” secondaries and his PCV is of 60%. (2+4+6+3=15)

a) What is the provisional diagnosis?
b) Discuss the etiopathogenesis of the lesion.
c) Describe its morphology.
d) Mention various paraneoplastic syndromes produced by this lesion.

3. A 4 year old female child was brought to the paediatric OP with features of generalised edema. Urine analysis revealed proteinuria of 3.5gm/day and oval fat bodies. No RBCs were seen in urine microcopy. (2+4+6+3=15)

a) What is the provisional diagnosis?
b) Describe the etiopathogenesis of the condition?
c) Describe the morphology of the organ involved.
d) List the urinary findings of the condition.

4. A 10 year old female presented with sudden onset hematuria with oliguria. Urine examination- RBC++, RBC casts+, Protein+.

a) Probable diagnosis?
b) Discuss the etiopathogenesis and classification of the disease
c) Mention the morphological features of the target organ
d) Laboratory diagnosis of the disease

Click here for the answer

Short essay: 8 marks

1. Polycystic kidney disease.

2. Morphological subtypes of renal cell carcinoma.

3. Obstructive nephropathy.

4. Post streptococcal glomerulonephritis – etiopathogenesis and morphology.

5. Lupus nephritis.

6. Describe the histology of the kidney in diabetic nephropathy.

Short answer: 4 marks

1. Renal calculi.

2. Minimal change disease.

3. IgA nephropathy.

4. Chronic pyelonephritis.

5. Nephroblastoma.

6. RPGN.

Name the following: 1 mark

1. Most common gene mutated in sporadic clear cell renal carcinoma.

2. Components of staghorn calculi.

3. Dilation of renal pelvis and calyces with progressive atrophy of the kidney due to obstruction to the outflow of urine is called ……………….

4. Most common cause for nephrotic syndrome in children is ………………

5. What is the IF finding in Post streptococcal glomerulonephritis?

6. Rapidly progressive glomerulonephritis is characterized by formation of …………………… in the glomeruli.

Male Genital System

Short essay: 8 marks

1. Classify testicular tumours. Write a note on Germ cell tumours of testis. (3+5=8)

Short answer: 4 marks

1. Seminoma – gross and microscopy.

2. Cryptorchidism.

3. Gleason grading.

4. BPH.

5. Bowen’s disease.

Name the following: 1 mark

1. AFP levels are elevated in which type of testicular tumour?

2. Schiller-Duval bodies are seen in …………….

3. Complete or partial failure of the intra-abdominal testes to descend into the scrotal sac is known as  ………….

4. Name one positive immunohistochemical stain for seminoma testes.

5. Rod shaped crystalloid structures seen in Leydig cell tumours are called …………

Female Genital Tract

Traditional essay:

1. Classify ovarian tumours (WHO classification). Describe the germ cell tumours in detail. (5+10=15).

Modified essay:

1. A 52 year old female presented with postmenopausal bleeding per vagina, foul smelling discharge and pain during intercourse. P/s examination showed a friable mass arising from the cervix which bleeds on touch. (2+3+5+5=15)

a. What is the most likely diagnosis?
b. Mention the risk factors for this condition.
c. Describe the different morphological patterns of the lesion?
d. Write a note on the precursor lesions of this lesion.

Short essay: 8 marks

1. Surface epithelial tumours of ovary.

2. Germ cell tumours of ovary.

3. Gestational trophoblastic neoplasms.

4. Endometrial carcinoma – etiopathogenesis, morphology.

5. Carcinoma cervix – risk factors, pathogenesis and morphology.

Short answer: 4 marks

1. CIN.

2. Molar pregnancy.

3. Endometrial hyperplasia.

5. Adenomyosis.

6. Teratoma ovary.

7. Krukenberg tumour.

8. Leiomyoma.

Name the following: 1 mark

1. Call exner bodies are seen in …………….

2. What is adenomyosis?

3. Name two microscopic findings in endometrisos.

4. Benign genital warts caused by low-risk HPV 6 and 11 are called ………….

5. Inactivation of ……………. tumour suppressor gene is a common genetic alteration in both endometrial hyperplasia and endometrioid endometrial carcinoma.

6. Name two germ cell tumours of the ovary.

7. Mature teratoma of ovary composed entirely of mature thyroid tissue is called ……………

8. Karyotype in ninety percent of complete mole is …………..

Breast

Traditional essay:

1. Carcinoma breast – risk factors, molecular classification, histologic types, staging. (3+4+6+2=15).

Modified essay:

1. A 55 year old female presented with a hard lump in the upper outer quadrant of left breast. Mammography showed an irregular radiodense mass with calcifications. Axillary lymph nodes are palpable. (2+8+3+2=15)

a. What is the most likely diagnosis?
b. Describe the different morphological patterns of the lesion?
c. Write the molecular classification of this condition.
d. List the prognostic and predictive factors here.

Short essay: 8 marks

1. Write a note on fibroepithelial lesions of breast.

2. Carcinoma breast – risk factors, morphology, molecular classification.

3. Prognostic and predictive factors in carcinoma breast.

Short answer: 4 marks

1. Paget’s disease of breast.

2. DCIS.

3. Lobular breast carcinoma.

5. Risk factors for breast carcinoma.

6. Phyllodes tumour.

7. Gynecomastia.

Name the following: 1 mark

1. Most common benign tumour of the female breast is ……………

2. “Leaf-like” bulbous protrusions is seen in …………… tumour of breast.

3. Most common gene mutated in familial breast carcinoma is ………………….

4. Name the grading system used for histologic grading of breast carcinomas.

5. Two causes for gynecomastia.

6. Two types of DCIS.

7. Loss of expression of E cadherin is seen in ………………. breast carcinoma.

8. Two histological patterns seen in fibroadenoma of breast.