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OSPE 3rd Prof

Microscopic slide of biopsy of an appendix from a patient with right iliac
fossa pain.
Carefully examine the focused slide and answer the following
questions:
 
1. Give your diagnosis (01)
2. Give three features of identification (03)
 

Key
1
• Acute Suppurative Appendicitis
2
a. Ulcerated mucosa.
b. All coats of appendix infiltrated by acute
Inflammatory cells.
c. Congested and dilated serosal vessels.

LDL and reduced HDL. (02) • 3. Give TWO potential controllable risk factors for this disorder in this age group. She had a history of hypertension her Vital signs were: HR 105. Triglycerides. •   • 1.• Carefully read the given clinical Scenario and answer the following questions: • A 40-year-old diabetic woman was evaluated in the emergency room for chest pain. BP 100/50mm of Hg (her usual BP was about 155/95mm of Hg). (01) . Name two main histological patterns of the underlying lesion in the blood vessels. What may be the potential vascular disease responsible for her hypertension? (01) • 2. Her lipid profile indicates elevated serum cholesterol. She was obese and diaphoretic. temp. 100 0F.

No • Key • 1. • Atherosclerosis • 2. • a) Hyperlipidemia • b) Hypertension • c) Diabetes • d) Cigarette smoking • 3. • Fatty streaks • Atheroma .• Sr.

• Carefully examine the given photomicrograph and answer the following questions: •   • Give your diagnosis.Microphotograph of a soft lump in the breast of a fifty years old female. (01) • Give three principal patterns of morphologic change of this disorder. (02) • Is this a proliferative or a Non-Proliferative breast change? (01) •   .

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(i)Cyst formation. Fibrocystic Disease 2.SR. •   3. • (ii) Apocrine metaplasia • (iii) Adenosis.No Key 1. A Non-Proliferative breast change. .

(01) • 2. Give the gross morphological patterns of the lesion. with H/O HEMATURIA and increased micturation •   • Carefully examine the focused slide (or photomicrograph) and answer the following questions: • 1. Microscopic slide (or photomicrograph) of tissue obtained after biopsy of urinary bladder of a fifty years old patient. Give your diagnosis. (01) . (02) • 3. Give the histological grades of the tumor.

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• Sr.urothelial carcinoma of high grade • 3. • a) Papilloma.invasive and non invasive carcinoma . • b) Grade I.papillary and invasive • b) Flat.urothelial carcinoma of low grade • d) Grade III. • a) Papilloma..low malignant potential • c) Grade II.No • Key • 1. • Transitional Cell Carcinoma • 2.

Identify the specimen and give your diagnosis. Describe the gross morphology of the lesion. (01) • 3. What are risk factors for the development of • Endometrial Adenocarcinoma? (02) • . Specimen of Uterus (or photograph of specimen of uterus) from a patient with H/O postmenopausal bleeding • Carefully examine the given specimen (or photograph) and answer the following questions: • 1. (01) • 2.

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diabetes. . The most likely common threat in these conditions is unopposed estrogenic stimulation. • 3. hypertension. • Presents as a localized polypoid tumor or as a diffuse tumor involving the entire endometrial surface.• Sr. • Specimen of uterus with dilated uterine cavity Uterus. and infertility with anovulatory cycles. endometrioid adenocarcinoma • 2. • Obesity.No • Key • 1.

what is the primary mode of therapy for pure classic Seminoma: chemotherapy or radiotherapy? (01) • . In addition to surgery. Name two other Germ cell tumors of the testis. with scrotal swelling. • Carefully examine the given microphotograph and answer the following questions: • 1.Microphotograph of a biopsy from a 45 years old male. (01) • 2. (02) • 3. Give your diagnosis.

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• 3. Spermatocytic seminoma. because Seminoma are very radiosensitive.Testis • 2. . • Embryonal carcinoma. • Radiotherapy. Teratoma.• Sr.No • Key • 1. Yolk sac tumor. Choriocarcinoma. • Classical Seminoma .

How would a radioactive iodine scan look in a • Thyroid gland such as the one pictured here? (01) •   . (02) • 3. Specimen of Thyroid gland removed after surgery in a 30 year old female with H/O thyroid swelling • Carefully examine the given specimen and answer the following questions: •   • 1. (01) • 2. Identify the specimen and give your diagnosis. Describe the gross morphology of the lesion.

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• The thyroid gland shows multiple nodules on cut surfaces. and calcification. fibrosis. . • Thyroid gland. patchy warm and cold nodules. Some nodules show cystic degeneration. Multinodular goiter • 2.No • Key • 1. • Heterogeneous uptake. hemorrhage.• Sr. • 3.

Is it a benign or a malignant tumor? (01) . Give your diagnosis. (02) • 3. (01) • 2. • TASK: • Carefully examine the focused slide (or photograph) of biopsy of the bone and answer the following questions: •   • 1.Microscopic slide (or photograph) of a tissue from a twenty years old female with H/O painful swelling of knee joint. Give important feature of identification.

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•   • 3.• Sr. • Bone giant cell tumor (Osteoclastoma) • 2. .No • Key • 1. • Benign but locally aggressive. • sheets of small mononuclear cells admixed with • numerous giant cells.

Give your diagnosis. What is the most common micro organism causing this • Lesion (01) . Give two points in favour of the diagnosis.Microphotograph of a lesion in the lung from a 45 years old male. pleuritic pain and shortness of breath. •   • Carefully examine the given microphotograph of section of the lung and answer the following questions: • 1. with high grade fever. chills. (02) • 3. (01) • 2.

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Lobar Pneumonia • 2.No • Key •   • 1. the normally empty alveolar spaces are filled with leukocytes and pink fibrin. • Lung. • b) fibrinous (gray hepatization) and hemorrhagic • (red hepatization) inflammation • 3.• Sr. . • Streptococcus Pneumoniae. • a) The lung parenchyma.

and brisk deep tendon reflexes on the left side of his body compared to the right. The day before his appointment. he experienced two episodes of uncontrollable shaking in his left arm and leg. A CT scan of his head revealed a ring-enhancing mass in the right frontal region .• A 60-year-old man presented to his primary care physician with complaints of headache and weakness in his left arm over the past several weeks. he was found to have mild papilledema. On physical examination. accompanied by development of weakness in his left leg. decreased strength in his left arm and leg.

What is the most likely diagnosis? (01) • 2.• 1. Give any TWO histological patterns of the lesion (02) • 3. What is the most common site of the lesion? (01) .

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a) Fibrillary Astrocytoma 02 b) Pilocytic Astrocytoma. d) Glioblastoma Multiforme 3. Cerebral Hemispheres 01 . c) Pleomorphic Astrocytoma. Astrocytoma 01 2.Sr. Marks 1.No Key Max.

Give two features of identification. What is Dukes classification based on? (01) .Microscopic slide (or photograph) of biopsy of colon from a patient • Carefully examine the focused slide (or Photograph) and answer the following questions: • 1. (01) • 3. (01) • 2. Give your diagnosis.

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• The Dukes classification. The deeper the tumor extends into the muscularis propria .• Sr. • b)The glands Lumina contain necrotic/apoptotic • Debris. is based on the extent of local invasion and the presence of lymph node and distant metastasis at the time of diagnosis.No • Key • 1. also known as the Astler-Coller classification. The epithelial cells are hyper chromatic • and pleomorphic • 3. • a) The glands formed by the adenocarcinoma are • irregular in size and shape. adenocarcinoma • 2. • Colon.

chills. he is found to have a murmur in the tricuspid valve area. Laboratory evaluation reveals an elevated leukocyte count with polymorphonuclear leukocytosis. Blood cultures grow gram-negative bacteria. On examination. and rigors. • What is the diagnosis? (01) • What are the major complications of the disease? (02) • What are the most common causative agents? (01) . and his blood pressure is 90/60 mm of Hg. He is treated with intravenous antibiotics. His face and extremities look flushed.• A 25-year-old IV drug abuser presents with high fever.

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chordae tendineae. • Infective endocarditis • 2.• Sr. or papillary muscles may rupture. • Infected vegetations on the mitral valve may embolize systemically and cause infarcts. causing ventricular failure • 3. . abscesses. • Haemolytic streptococci and Staphylococcus aureus. the mitral valve. No • Key • 1. In addition. or septicaemia.

Give your diagnosis. •   • Carefully examine the given focused slide or photomicrograph and answer the following questions: • 1.Microscopic slide or Photomicrograph of biopsy of a hard lump. what other organs • are commonly involved by metastatic breast carcinoma? (01) • 3. (01) • 2. in the breast of a forty years old female. Give TWO factors that influence the prognosis of breast cancer? . Besides the axillary lymph nodes.

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number of lymph node metastases. proliferative rate and DNA ploidy. • Invasive ductal carcinoma of Breast. bone. • 2. liver. presence or absence of oestrogen receptors. (Any two) .• Sr. • 3. • Size of tumor. histological type and grade of tumor. and over expression of HER2. • Lungs.No • Key • 1.

  •   • Carefully examine the given gross specimen (or photograph) and answer the following questions: • 1. Identify the specimen and give your diagnosis. (01) • 2. Describe the given specimen. (02) • 3. What is the survival rate for Wilms tumor? (01) . presenting with a large abdominal mass. Gross Specimen (or photograph) of kidney of a seven years old male.

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• The survival rate for Wilms tumor is 90% with treatment combining chemotherapy. a well circumscribed and firm mass • With hemorrhage and necrosis.No • Key • 1. • Kidney. • A large. • Cut section shows. tan. and surgery. • 3. . Wilms tumor (nephroblastoma) • 2. radiation.• Sr. well-circumscribed mass greatly distorts the upper pole of the kidney.

Give your diagnosis. (02) • 3. (01) • 2. Give two features of identification. presenting with a lower abdominal mass. • Carefully examine the focused slide and answer the following questions: • 1. What is the most common site of origin for ovarian tumors? (01) .   Microscopic slide of ovarian tissue obtained after biopsy from a forty years old female.

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• a) This ovarian tumor is composed of complex papillary structures. . • 3. • b) Occasional psammoma bodies. • 65-70% of ovarian tumors arise from surface epithelial • cells. • ovary – serous cystadenocarcinoma • 2. lined by hyper chromatic pleomorphic cells. No • Key • 1.• Sr.

Microphotograph of a biopsy of prostate from a 45 years old male. Is nodular hyperplasia of the prostate gland a • risk factor for Prostatic carcinoma? (01) . Give your diagnosis. • Carefully examine the given photomicrograph and answer the following questions: • 1. (01) • 2. How do malignant Prostatic glands differ from benign • Prostatic glands in histological appearance? (02) • 3. with hard Prostatic mass and H/O microscopic haematuria.

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. Benign Prostatic glands tend to be larger. • Malignant Prostatic glands tend to be small. • No.Adenocarcinoma • 2.No • Key • 1. and infiltrating. have a lobular configuration.• Sr. • 3. and are lined by two cell layers. • Prostate. Nodular hyperplasia is not a premalignant lesion. back- to-back. they have a single cell layer and prominent nucleoli.

(01) • 2. What are the diagnostic tools available in this case? (03) •   . and her blood pressure 125/70.5-cm nodule in the middle of the left lobe.• her neck was enlarged. •   • 1. the initial impression was that of moderate thyrotoxicosis with a single. Her thyroid gland was asymmetrically enlarged with a firm 1. she appeared to have a wide-eyed stare with a slight lagging of the upper lid on slow downward gaze. She felt well and active. she formerly suffered from constipation. her pulse was 86 beats per minute.On visual inspection. prominent. goitrous nodule. She had lost a small amount of weight in spite of having a voracious appetite. she now noted that she had bowel movements twice daily. Give your diagnosis. On physical examination.

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TSH. FNA • And excision biopsy . • Thyroid Scan. • Graves Disease • 2.• Sr.T4. • Serum T3.No • Key • 1.

Give TWO sites where rheumatoid nodules typically develop? (02) . What is PANNUS? (01) • 3. Give your diagnosis. Microphotographs of a biopsy and photograph of hands deformity from a 45 years old female. (01) • 2. • Carefully examine the given photomicrographs and answer the following questions: • 1.

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Less commonly. • The pannus consists of the inflamed. (Any two) . • Rheumatoid arthritis • 2. • The nodules typically appear on the extensor surface of the forearm below the elbow. hyperplastic synovium that extends over the articular surface. they form in the lungs. myocardium. and heart valves. or at sites of local pressure. • 3.• Sr.No • Key • 1. spleen. such as the Achilles tendon.

• Microscopic slide of a lesion in the lung from a 45 years old male. Why are heavy smokers at risk for the development • of multiple tumors of the upper aerodigestive tract? (01) . (01) • 2. (02) • 3. Give your diagnosis. Give two features of identification. • Carefully examine the focused slide and answer the following questions: • 1. with pleuritic pain and shortness of breath.

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. the entire upper aerodigestive tract has been damaged by exposure to tobacco-related carcinogens. and is at increased risk for the development of one or more cancers. i. • 3. develops multiple preneoplastic lesions. • b) in the middle is a tumor island consisting of highly • keratinized cell debris. • Well-differentiated Squamous cell carcinoma • 2.• Sr. No • Key • 1.e. • These lesions result from the so-called field effect.. • a) A large epithelial pearl of Squamous cell line. The dividing cells are usually limited to the periphery of the cell mass.

How do neurofibromas differ from schwannomas? (03) . • • TASK: • Carefully examine the given photomicrograph and answer the following questions: • 1. Give your diagnosis.• Microphotographs of a biopsy from a 45 years old female presenting with multiple soft swellings on different parts of the body. (01) • 2.

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• Sr. . Clinically. Neurofibromas arising in larger nerves present as infiltrative masses that tend to expand the nerve of origin. neurofibromas typically lack the Verocay bodies and mixture of Antoni A and Antoni B tissue characteristic of schwannomas. schwannomas present as well-circumscribed lesions located at the periphery of a nerve segment. Histologically. neurofibromas are proliferations of a complex mixture of neoplastic Schwann cells and other cell types. sometimes involving multiple branch points of the parent nerve (plexiform neurofibromas). schwannomas are almost invariably benign. While most neurofibromas (and virtually all cutaneous neurofibromas) are benign. more deeply situated neurofibromas can undergo malignant change. either as a localized mass or as elongated lesions. • Neurofibroma • 2. Grossly.No • Key • 1. while schwannomas are composed exclusively of Schwann cells. • At a cellular level.

It shows many longitudinal ulcers with red hmgic bases.• The photograph shows an opened colon from a 3 year old female who presented with bloody diarheal episodes lasting a week at a time. • Carefully examine photograph and answer the following questions: • What is your diagnosis? • How do pseudo polyps form? • List three features u expect to find in a section from this colon? .

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crypt abcesses. mucosal inflammation.• Ulcerative collitis • Longitudinal ulcers dissected by transverse ulcers with intact mucosa between them appearing to protrude into the lumen • Ulceration. depletion of mucous . cryptitis. gland drop outs. crypt distortion.

• Examine the given photo and answer the following questions: • Describe morphology? • What is this appearance called? • Give pathogenesis of this condition? .• Photograph shows cut surface of liver.

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. Heart failure results in delayed emptying of the great veins and retention of blood primarily in the central veins of the liver.• Altenate areas of dark red color ( due congestion of central veins) surrounded by paler. • Nut meg liver • Rt. This results in dilatation of central veins and pooling of blood in the sinusoids towards centre of liver lobule. yellowish colored periportal areas.

from the autopsy of a 58 year old man who died of cardiac failure. • Describe gross findings • List three possibilities for these changes • Differentiate between pressure overload hypertrophy from volume over loaded hypertrophy of heart on gross examination .• Photograph specimen shows a transverse section of heart.

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Relatively moderate hypertrophy of right ventricle. Foci of congestion in the wall.• Marked thickening of left ventricular hypertrophy to at least twice its normal size. . • Hypertension aortic stenosis and cardiomyopathy • Pressure overload develop hypertrophy of left ventricle with an increased wall thickness • Volume over load leads to dilatation with increased ventricular diameter.

• The photomicrograph shows a section from the heart of a 60 yr old male patient who died after having a heart attack. • what is the nature infiltrate between myocytes? • How would u describe the appearance of myocytes? .

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hence necrotic. .• Acute inflammatory cells • Deeply eiosinophilic lacking nuclei.

• The photomicrograph shows a tumor excised from breast of an 18 yr old girl. • The tumor was 1.5 cm in size. mobile and circumscribed with smooth margins • How will u describe the ducts shown here? • How will u describe the margins of this tumor • What is your diagnosis? • What is the most common benign tumor of breast? .

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cirsumscribed • Fibroadenoma • Fibroadenoma .• Compressed slit like • Smooth.

• The photomicrograph shows a section from a tumor from the kidney of a 50 year old male patient. • Give diagnosis • What hereditary syndrome is the tumor associated with? • Name atleast two ectopic hormones produced by this tumor? .

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• Clear cell/renal cell Carcinoma • Von Hippel Lindau Syndrome • PTH. Renin etc .

• What is the pattern of growth? • What is the commonest malignant tumor of urinary bladder? • List 2 other malignant tumors of bladder.• The photomicrograph shows a section from a transurethral resection of a tumor of urinary bladder. .

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• Papillary • Papillary urothelial carcinoma/ transitional cell carcinoma • Adenocarcinoma. . squamous cell carcinoma.

• The photomicrograph shows a tumor resected from the testis of a 35 yr old man. • Give the diagnosis • What are the 2 prognostically significant diagnostic categories of testicular germ cells . • The surgical specimen has a homogenous pale cut surface with no areas of haemorrhage and necrosis.

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• Seminoma • Seminomatous germ cell tumors. • Non seminomatous germ cell tumors .

The varian tumor measured 4cm in maximum diameter.• Photomicrograph shows one of the sections taken from the wall of a cystic tumor from a 25 yr old woman during C- Section. • Name the epithelium and underlying structures • What is your diagnosis? • What other tissues types maybe seen in such tumors? .

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• Dermoid cyst/ mature cystic teratoma • Teeth. neural tissue. Sebaceous glands. squamous epithelium. bone and cartilage.• Keratinized st. .

• The photomicrograph shows a 2cm tumor excised from thyroid gland of a 35 yr old female. • Name the architectural pattern • Give 2 nuclear features you observe in this picture • Give your diagnosis .

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• Papillary • Optically clear nuclei with marked overlapping • Papillary carcinoma .

• Whats your diagnosis? • What is the commonest causative organism? • Name four stages of evolution of this pulmonary infection? . Chest X ray showed consolidation in the lower lobe of right lung.• The photograph shows a right pnueonectomy specimen from a patient who presented with fever with chills and rigors and productive cough.

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. red hepatization.• Lobar pneumonia • Streptococcus pneumonia • Congestion. gray hepatization. resolution.

• The photomicrograph shows a section from a 4cm tumor resected from the lung of 60 yr old male with history of smoking 40 cigarettes a day for the past 30 years. • What is diagnosis • What is the test you order in a patient you suspect of having this tumor? • Name 2 other malignant tumors of the lung? .

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broncho-alveolar carcinoma. large cell carcinoma .• Squamous cell carcinoma • Sputum exam • Small cell carcinoma. adenocarcinoma.

Haematolo gy .

Serum LDH: increased. PLATELETS: 100x10*9/L. • MCH: 32pg. weakness.1 mg/dl •   • What is the diagnosis? (01) • 2. He has mild hepato- splenomegaly. Serum billirubin: 2. What is the morphology of red cell precursors? (01) • 3. What are Howell-Jolly bodies? . pain epigastrium and painful tongue. MCV: 125fl. TASK: • Carefully read the clinical scenario and examine the Giemsa stained slide of peripheral blood film and answer the given questions: • HISTORY: • A 25 yr old male presented with fever. WBC: 3x 10*9/L. • LABS: • Hb: 5g/dl. Give two aetiological factors of this disorder? (01) • 4.

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• Folic acid deficiency. Open chromatin. Nuclear maturation lags behind cytoplasmic maturation. •   . Vitamin B12 deficiency • Nuclear remnants.• Sr.No • Key • Megaloblastic anaemia • Large in size.Dyserythropoeisis.

Lymphocytes: 20%. What is the diagnosis? (01) • 2. Neutrophils: 20%. Name one stain which will help in diagnosis. Eosinophils: 2%. WBC: 18x 10*9/L. • LABS: • Hb: 7 gm/dl. MCH: 28 pg. What is FAB classification of this leukaemia? (02) • 3. There is no lymphadenopathy. Blast cells: 50% Auer rods are seen in few blast cells. • HISTORY: • A 55 yr old male presented with fever and chest infection. (01) . Monocytes: 8%. • Answer the following questions: • 1. PLATELETS: 30 x10*9/L. MCV: 90fl.• TASK: • Carefully read the clinical scenario and examine the focused Giemsa stained Bone marrow slide.

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• M1-M7 • Sudan black .• Acute myeloid leukaemia.

• PLATELETS: 475x10*9/L • Lymph node biopsy showed effacement of architecture as seen in the slide ( or photomicrograph of the slide). • LABS: • Hb: 12g/dl. She also had axillary lymph node enlargement. •   • Answer the following questions: • What is the diagnosis? (01) • What are these large characteristic cells known as? (01) • Which is the neoplastic component? ( 01) • What is the nature of the lymphocytes? ( 01) .• HISTORY: • A 60 yr old female admitted with fever. WBC: 15 x 10*9/L with 8% eosinophils. weight loss. She had massive matted cervical lymph nodes (6cm in diameter).

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• Hodgkin’s lymphoma
• Reed sternberg cells
• Reed sternberg cells
• T-cells.

• Carefully read the clinical scenario and examine the
Giemsa stained slide of peripheral blood film.
•  
• A 35-years old female gave history of induced abortion by a
‘Dai’. She presented with massive bleeding per vaginum and
gangrene of left toe. Her labs are PT: Prolonged, APTT:
Prolonged, Fibrinogen: Reduced, Platelet: Reduced.
•  
•  
• 1) What is the morphology of red blood cells? (01)
•  
• 2) Give the most likely clinical diagnosis (01)
• 3) Name the type of anaemia associated with this condition?
(01)
•  
• 3) What tests will confirm the diagnosis? (01)

Key  • Fragmented red cells. • Disseminated intravascular coagulation (DIC).   . • D-Dimers and fibrinogen degradation products ( FDPs). • Microangiopathic haemolytic anaemia.

AB.• Provided are four test labelled A.B.Examine carefully and answer the given questions: •   • What is the ABO blood group? (01) • What is Rh blood group?(01) • Give the class of antibody formed against ABO blood group antigens? (01) • Give the class of antibody formed against Rh blood group antigens? (01) •   .and D.

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• Rh blood group is positive (Rh+).• Key • ABO Blood group is A. • IgM • IgG •   •   .

X-ray shows lytic lesions in the bones. and bone pains.• A 55-year old male presents with fever. weight loss. ESR 100 mmHg. (01) •   • 2) What is the diagnosis? (01) •   • 3) What are Bence jones proteins? (01) •   • 4) What are different types of immunoglobulins? (01) •   . His labs are Hb: 8gm/dl. Platelet 90x109/ L. TLC 3x109/ L. • Answer the following questions: •   • 1) Describe the electrophoresis pattern.

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• IgM. • Multiple myeloma.IgA.• Key • Monoclonal spike in gamma region. IgD. IgG. IgE. • Kappa light chains in urine. •   •   .

•   • HISTORY: • A 55 yr old male presented with fever. weakness and massive splenomegaly. Meta Myelocytes: 13 % • Stabs: 7%. • LABS: • Hb: 9g/dl. Blast cells: 3%.• Carefully read the clinical scenario and examine the focused slide. Neutrophils: 37%. PLATELETS: 765x10*9/L • Pro Myelocytes: 08%. Eosinophils: 2% •   • Answer the following questions: • What is the diagnosis? (01) • Which chromosomal abnormality is consistently seen in this disorder? (01) • • What type of blast crisis is seen in this type of leukaemia? (01) . WBC: 165x 10*9/L. Myelocytes: 30%.

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• Key • .Chronic Myeloid Leukemia (CML) • Philadelphia chromosome t (9:22) • Acute myeloid leukemia .

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Chemicals. Decreased haematopoietic tissue •   . Radiation) • Fat spaces.• Key • Aplastic anaemia • Primary and Secondary (due to Drugs.

Lymphocytes: 92%. MCH: 28 pg. (01) .6. MCHC: 33gm/dl • RDW: 13.• Carefully read the clinical scenario and examine the Giemsa stained slide of bone marrow. No immature cells seen •   • Answer the following questions:- • 1) What is the diagnosis? (01) • 3) How is this anaemia classified? (02) • 4) Describe the findings in the given slide of bone marrow. RBC: 2. PLATELETS: 19 x10*9/L • Hct: 0.8x 10*9/L. Neutrophils: 08%.33L/L.0x10*9/L. • HISTORY: • A 25 yr old male presented in emergency department with marked ulceration of mouth and multiple tiny tonsillar abscesses. He had no hepato- •   • Present investigations show: • WBC: 1. MCV: 88fl.

Chemical pathology .

• A patient presented in emergency with complaint of chest pain. • CPK = 1280 U/L • AST = 69 U/L • LDH = 578 U/L • CK-MB = 208 U/L •   •   • 1) What is the diagnosis? (01) • 2) In a patient of MI would you expect to find raised levels of LDL or HDL? (01) • 3) What is the first test you will order to confirm a myocardial infarction? (01) • 4) What is the best possible alternative? (01) •   . His investigations were carried out with following results.

as it is LDL that promoted atheroma formation. the MB fraction of creatinine kinase derived principally from the myocardium but also in small amounts from skeletal muscles. • CK-MB.• Key • Acute myocardial infarction • LDL. •   . • Tropinin T and Tropinin I. They have complete tissue specificity and high sensitivity. these are proteins which regulate Calcium mediated contractility of the heart. HDl protects against it.

• A 10 years old boy had following glucose levels; what could be the
diagnosis.
•  
• Fasting Blood Glucose =145 mg/dl
• 2 hrs. PP Blood Glucose =218 mg/dl
• HbA1c =11.5 %
• Urinary glucose = +++
• Ketone Bodies =Present
•  

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• 1) What is the diagnosis? (01)

• 2) What are the three main types of glucose measurements
performed in the laboratory? (01)
• 3) What is the effect of insulin deficiency on fat and protein
metabolism?
(01)
• 4) From what are ketone bodies formed in diabetic ketoacidosis?
(01)

• Key
• Uncontrolled Juvenile Diabetes
• Fasting, Random and Oral Glucose
tolerance test after a loading oral
Carbohydrate dose.
• There is catabolism of both.
• These are formed by unrestricted
fatty acid oxidation in the liver.

• A 24-year-old woman c/o excessive moistness of palms. She also noticed
that her eyes have become more prominent and she has lost weight. On
examination her pulse was 92/min at rest and she had a slightly
enlarged thyroid gland.
• Investigations:
• Serum: TSH <0.1mU/l
• fT3 12pmol/l
• Isotope scan of thyroid showed an enlarged gland with uniformly
increased uptake.
• Autoantibodies to thyroid microsome and thyroglobulin present.
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•  
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• 1. What is the diagnosis? (01)
• 2. Which ONE test will you order in a suspected hyper/hypothyroid
patient? What result will you expect? (02)
• 3. In a patient developing tetany after thyroid surgery with low serum
calcium levels, what is the cause? (01)
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•  

• Key • Thyrotoxicosis-Graves Disease. which can pick up hyperthyroidism even in subclinical forms. It is low in hyperthyroidism and high in hypothyroidism. • TSH assay. which can pick up hyperthyroidism even in subclinical forms. • • TSH assay. It is low in hyperthyroidism and high in hypothyroidism. •   •   .

Two days later. the liver was palpable and tender.0 g/dl 3. • Liver function tests: On Presentation One week Later • Serum: • Bilirubin : 3. he developed jaundice.• A 19 year old medical student developed a flu-like illness with loss of appetite. nausea and pain in the Right hypochondrium. his urine became darker in colour and his stool became pale.8 g/dl • Urine: • Bilirubin Positive Positive • Urobilinogen Positive Negative •   • 1) What is the diagnosis? (01) • 2) What is the cause of raised ALT activity? (01) • 3)Which type of plasma Bilirubin is present in such a case? (01) • 3) Why are bilirubin present in urine? (01) .0 mg/dl12 mg/dl • ALT : 650 u/L 500 u /L • Alkaline phosphatase: 60 u/L 135 u/L • Albumin : 4.On examination.

• Acute viral hepatitis • Raised ALT reflects cell damage. • Impairment of hepatic secretion of conjugated bilirubin causes it to be preset in urine. . • Both conjugated and unconjugated with the former predominating.

4-1.4 mg/dl) • Protein : 3.Her Lab.5) .4 mg/dl(0.6 mmol/L (3.• A 7 year old boy was admitted in the paediatric Nephrology Unit with generalized oedema.His urine was frothy and her family physician found proteinuria.5) • 3) Give the cause of oedema in this case.5 G/dl • Triglycerides : 600mg/dl (↑) • Cholesterol : 300 mg/dl (↑) • 24 hour urinary protein: 8 G/dl • Answer the following Questions: • 1) What is the diagnosis? (01) • 2) Which features constitute this disorder? (1.5 G/dl • Albumin : 1.4-5. (1. Workup shoed the following findings: • Serum Sodium : 130 mmol/L (134-154 mmol/L) • Serum Potassium : 3.2 mmol/L) • HCO3 : 32mmol/L • Urea : 10 mg/dl (10-50mg/dl) • Creatinine : 0.

• The oedema is in part. . hypoproteinemia and oedema constitute the Nephrotic Syndrome. a result of redistribution of ECF between the vascular and interstitial compartment.• Nephrotic Syndrome. • Presence of proteinuria.

(02) • 3) What is the immunological basis of this disease? (01) • 2) What other investigations you would like to perform. (01) • . obesity. His thyroid functions are as follows: • T4 Total = Decreased • T4 Free = Decreased • T3 Direct = Decreased • T3 Uptake = Decreased • Thyroid binding globulin (TBG) = Normal •   •   • 1) What is your diagnosis? Give reason for your diagnosis.• A 13 years old child manifests with failure to gain height. lethargy and some impairment of school performance.

• Hashimoto’s Thyroiditis. Clinical and
laboratory features of
Hypothyroidism.
• Autoimmunity, Formation of
autoanitbodies.
• Thyroid stimulating hormone (TSH);
• Anti-thyroid antibodies.

• An eighteen year old known diabetic girl presented in the
emergency room with H/O vomiting and drowsiness. On
examination her BP was 95/60 mm of Hg with pulse rate of
112/ min and cold extremities. She had deep, sighing
respiration (Kussmaul’s respiration) and her breath smell of
acetone.
• Investigations:
• Serum:
• sodium : 130 mmol/l
• Pottasium : 5.8 mmol/l
• Bicarbonate : 5mmol/l
• Urea : 18 mmol/l
• Creatinine : 140umol/l
• Glucose : 32mmol/l
• Arterial blood hydrogen ion : 89nmol/l (pH7.05)
• PCO2 :2.0kPa (15 mm Hg)

• Answer the following questions:
• What is the diagnosis?
(01)
• Which type of ACIDOSIS is
present in this condition? (01)
• Give TWO clinical and TWO
metabolic features of Diabetic
ketoacidosis. (02)

(Any two) • Metabolic: Hyperglycemia. hypotension. drowsiness and coma. uraemia. hyperkalaemia. peripheral circulatory failure. Ketosis.• Key • Diabetic ketoacidosis. • Non-respiratory metabolic acidosis.(Any two) . Non-respiratory acidosis.Polyuria. tachycardia. Ketonaemia. • Clinical:Thirst. abdominal pain. Glycosuria. vomiting. dehydration. hyperventilation.

and answer the questions: • Clinical scenario: •   • A patient presented in emergency with complaint of chest pain. • Random Blood sugar = 200 mg/dl • Urea = 50 mg/dl • CPK = 1280 U/L • AST = 69 U/L • LDH = 578 U/L • CK-MB = 208 U/L • Answer the Following questions: •   • 1) Give your diagnosis? (01) • 2) Which of the above biochemical investigations support your diagnosis? (02) • 2) Name ONE other biochemical investigations which you would like to perform to support your diagnosis at this .• Carefully read the given clinical scenario. His investigations were carried out with following results.

Increased Random blood sugar • Troponin-T •   •   . • Raised CPK.• Key • Acute myocardial infarction in a Diabetic patient.CK-MB. LDH.

After detailed investigations he was diagnosed as a case of Nephrotic Syndrome. •   • •   • 1) How will you differentiate between Nephrotic and Nephritic syndrome on the basis of 24-hour urinary proteins? (01) •   • 2) Which Three features constitute the Nephrotic syndrome? (02) • 3) What plasma albumin levels will you expect in a patient of nephritic syndrome? • (01) •   •   . On initial investigations his urine examination revealed proteinuria.• A 10 year old boy was admitted in the Nephrology ward with generalized edema.

hypoproteiemia and edema.5g/dL • Proteiuria.5g/dLNephritic syndrome - <3.• Key • Nephrotic syndrome - >3. • . • Low levels.

•   • A forty-year-old woman presented with jaundice.She was not an alcoholic. • On investigations: •   • Bilirubin : 340umol/l • AST : 98iu/l u/L • ALT : 1200 u /L • Alkaline phosphatase:522iu/l u/L • Total Protein : 85g /l • Albumin : 28 g/l • Gamma-glutamyl transpeptidase: 242iu/l •   • 1) What is the diagnosis? (01) • 2) Which biochemical finding suggests the diagnosis? (01) • 3) Name the enzymatic markers of hepatocyte injury? (01) • 4) What protein binds bilirubin in plasma? (01) •   .• Carefully read the given clinical scenario and answer the questions: • Clinical Scenario. She had been well in the past but had suffered from increasingly intense pruritis during the last one year.There was no H/O contact with hepatitis. injections or transfusions. foreign travel.

ALT.• Key • Cholestatic jaundice. • AST. LDH • Albumin. • The very high alkaline phosphatase. •   •   •   .