Q1.
A 55 year old man presents with left sided facial pain, with palpable left temporal
artery. Biopsy of the artery reveals fragmentation of internal elastic lamina, with
granulomas containing Langerhans and foreign body giant cells.
a. What is the diagnosis?
b. What other condition should be considered in the differential diagnosis if
granulomatous vasculitis involves the aorta?
Q2. A 70 year old male chronic smoker was brought to the emergency department
with a history of acute chest pain with sweating developing into a state of shock. He
expired on arrival in the hospital medical autopsy was carried out where pathologist
observed dark mottling of anterior wall of left ventricle, anterior part of septum and
apex. The cause of death was declared as myocardial infarction.
a. Which coronary artery was critically stenosed in this patient?
b. What must have been the duration of survival after the Mi and what would be the
microscopic picture of this infarcted area?
c. Enumerate complications of MI?
Q3. A 62-year-old man is scheduled for surgery, but the procedure is cancelled
because of abnormal findings in the preoperative blood work. CBC shows increased
WBC count of = 188,000/mL, consisting mainly of maturing neutrophils i.e. a full
range of myeloid maturation. Basophilia and eosinophilia are also observed. The
platelet count is 820,000/ul
a. What is the most likely diagnosis?
b. Name the cell of origin in this disorder
c. Name a molecular finding needed to distinguish it from other myeloproliferative
disorders?
d. What is the mechanism of action of targeted therapy in this case 2
Q4. A 30 year old female has a long standing history of menorrhagia:
a. What etiological type of anemia would you expect in this patient?
b. What would her peripheral smear and bone marrow shows?
c. List three serological tests that you would consider in this patient?
Q5. Following a bone marrow transplantation a patient develop high grade fever with
chills, chest x rays shows pulmonary infiltrates.
a. List three major causes of pulmonary infiltrates in such patients with two examples
for each?
b. What pulmonary infections are likely to occur in an AIDS patient at CD4+ count
greater than 200 cells/mm².
Q6. A 65 years old man presents with anemia and stool for occult blood is positive. A
3.5cm sessile cauliflower like mass is noted in the rectum on Sidmoidoscopy. The
remaining mucosa appears normal
a. List three types of adenomas you will consider in the differential diagnosis?
b. What factors determine the risk of malignancy in similar cases?
Q7. With the help of a flow diagram illustrate the possible outcomes in the following
case scenarios? 2
a. A carrier of HBV with HDV super infection?
b. Draw a chart showing serological markers for hepatitis B virus in acute infection
with resolution? 3
Q8. A 35 year old female was diagnosed with fibrocystic disease of the breast with
atypical ductal hyperplasia. Routine mammography showed an area of increased
density
a. How does the diagnosis affect the patient risk of developing breast cancer?
b. What other factors will modify (increase of decrease) this risk?
Q9. A 24 year old woman presents to clinic complaining of increased pain and
bleeding during menstruation free menstruations have been regular for last months.
After tasity of cramping and larger amount of blood She you her menstrual cycle pas
with intercourse on pelvic examiner taking a complete history, you learn that she ha
having increased pelvic pain with intercourse. On polvic examination you palpate
fixed, bilateral ovarian mase hasad MRI shows chocolate cysts and ovary.
a. What is the diagnosis?
b. Name two other sites/ tissues of body which may get involved
c. Define adenomyosis?
d. How chocolate cysts are formed?
Q10. A An 8 years old boy is brought to the physician because his parents noticed a
mass in his left testis Physical examination revealed a solid mass that could not be
transilluminated. This testicle was removed surgically & H/P revealed
haphazard arrangement of benign differentiated tissues including squamous
epithelium, glandular epithelium, cartilage & neural tissue .The patient is symptom
free 5 years later.
a. What is most likely diagnosis?
b. Is it a germ cell tumor or non germ cell tumor?
c. Classify testicular germ cell tumor
Q11. A 60-year-old woman comes to your office for evaluation of a breast "lump
About 4 months ago she noticed a "hard" but painless area along the lateral aspect
of her left breast She has previously had minor chest trauma and thought the lump
was a scar She states that this hard area is now larger than when she first noticed it.
There is a 5 om firm area in the upper outer quadrant which seems firmly attached to
the chest wall. The overlying skin is dimpled but the mass is painless. There is a firm
2 cm nodule in the left axilla and her left arm is swollen
a. What is the most likely (Specify histological type) diagnosis
b. What are the risk factors for such category of lesions (name 4 factors)
c. Name four retinal lesions/ findings found in of diabetes mellitus
Q12. A 50 yrs old man complains of muscle weakness & dizziness of 3 months in
duration. His B.P is 185/100 mmHg Laboratory studies shows hypernatremia &
hypokalemia Endocrine studies reveal elevated serum aldosterone & low renin &
angiotensin. BUN is 24mg/dl & Creatinine is 1.2mg/dl. Endocrinological studies rule
out cushing Syndrome
a. What is most appropriate diagnosis?
b. Name two commonest causes of this condition?
c.Give two causes of adrenal crisis?
Q13. A 19-year old architectural student is admitted from university halis of residence
with a 24-hour history of headache, nausea, vomiting and listlessness. There is neck
stiffness on physical examination
a. What is the probable diagnosis
b. Which investigations would u perform to confirm the diagnosis
c. What is the most probable causative organism
d. Tabulate 2 differences between purulent and aseptic meningitis
Q14. A 53 year old male presents to his GP with an acutely painful right big toe. On
examination the toe is swollen, erythematous with red and shiny overlying skin and is
exti amely tender to touch.
a. What is the most probable diagnosis
b. Which investigation will be the most helpful for the diagnosis (only one)
c. Name two causes of the underlying abnormality
d. Name four Prognostic Factors for melanoma of skin
Q15. List the four major groups of ovarian tumors. Which ovarian tumors are
associated with BRCA1 & BRCA 2 23 mutations?
Q16. A 28 years female attended endocrine outpatients because of weight loss,
weakness, amenorrhoea, buccal pigmentation and vitiligo. Lab tests were performed
which shows following results Na 118mmol/l (135-145), K 5.8 mmoill (3.5-5), urea
4.5mmol/l (2.5-7.5), creatinine 90µmol/l. 9.00hours cortisol 89nmol/l (180-720)
cortisol 30 min after 250ug intramuscular Synacthen 80nmol/l
a. What is the most likely diagnosis?
b. Enlist atleast six causes of this disease
Q17. A middle aged man presents in gastroenterology clinic with epigastric
discomfort and dyspepsia for the last one year, Investigations reveal diffusely
thickened wall of entire stomach. Histopathology reveals diffuse infiltration of the
mucosa and underlying wall by individual cells. These cells contained mucin. No
mass or glands were seen.
a. What is the most probable diagnosis?
b. What is the usual morphology of cells in such cases?
c. Name an inherited mutation seen in such cases
d. Name four complications of peptic ulcer
Q18. A 32-year-old man has had malaise with a 7 kg weight loss over the past 6
months. Investigations show a 7 cms hard mass in right lobe of liver. Microscopically,
it is composed of well-differentiated cells rich in mitochondria (oncocytes) growing in
nests or cords separated by parallel lamellae of dense collagen bundles.
a. What is the most likely diagnosis?
b. What is the Male to Female ratio in this tumor?
a. Name two types of hepatic adenomas.
c. Name a predisposing condition for this tumor.
Q19. A 69-year-old man is scheduled for surgery, but the procedure is canceled
because of abnormal findings in the preoperative blood work. A CBC shows
leukocytosis (WBC 188,000/mL), consisting mainly of maturing neutrophils ie a full
range of myeloid maturation. Basophilia and eosinophilla are also observed. The
platelet count is 820,000/L
a.What is the most likely diagnosis?
b. Name a chromosomal finding in this case
c.Name the molecular abnormality
d. What is the mechanism of action of Imatinib therapy
Q20. A 40 year old man presents to the emergency department with a seizure. When
he has been stabilized, he tells that he had several attacks of headache over past
couple of months. A CT scan of his head reveals a large mass in the frontal lobe of
his brain that demonstrates areas of calcification
a. What is the diagnosis?
b. Enumerate two macroscopic and microscopic features of this tumor? 2 c. Enlist
two types of brain parenchymal edema and how these are caused?
Q21. A-A50-year-old woman complains of weakness, headaches and dizziness. The
patient has a history of recurrent proteinuria and hematuria. The blood pressure is
180/110 mm Hg. Laboratory studies show elevated levels of BUN (78 mg/dL) and
creatinine (5.6 mg/dl). A CT scan of the lower abdomen reveals symmetrically
contracted kidneys with diffusely granular cortical surfaces and the cortex is thinned.
A renal biopsy is performed and a diagnosis of Chronic Glomerulonephritis is made
a. Name three lesions that usually progress to Chronic Glomerulonephritis.
b. Name 3 types of Rapidly Progressive Glomerulonephritides c. Name four toxins
that cause Tubulointerstitial Nephritis
Q22. An 8 years old boy is brought to the physician because his parents noticed a
mass in his left testis. Physical examination revealed a solid mass that could not be
transilluminated. This testicle was removed surgically & H/P revealed a haphazard
arrangement of benign differentiated tissues including squamous epithelium,
glandular epithelium, cartilage & neural tissue. The patient is symptom free 5 years
later
a. What is most likely diagnosis?
b. Is it a germ cell tumor or non germ cell tumor?
c. Classify testicular germ cell tumor.
Q23. A 52-year-old woman feels a lump in her right breast on self-examination and
goes to her physician. On physical examination the 4 cm mass is not freely movable
and feels quite hard. A fine needle aspirate is performed and cytological examination
shows cells consistent with carcinoma
a. Name the most common histological type of breast carcinoma
b. What is the need forfor determining the estrogen and progesterone receptors son
breast carcinoma cells
c. Which three histological characteristics are used for grading of carcinoma breast
d. Name three retinal lesions/ findings found in diabetes mellitus
Q24. A 30 year old male diagnosed as a case of community acquired pneumonia
was admitted in pulmonology ward. Upper lobe consolidation was seen on chest X-
ray
a. Describe the pathogenesis of development of this condition
b.Give the FAB classification of AML
c.Enlist causes of spleenomegaly
Q25.
a.What is infarct modification by reperfusion?
b. Write down the morphological features of acute RF and chronic RHD
Q26. A 44-year-old woman, a non-smoker, has had a fever and cough for the past 4
days. She does not have hemoptysis. She has not experienced weight loss, malaise,
nausea, or vomiting. On physical examination her temperature is 37 6°C. There are
decreased breath sounds over the right upper lung A chest radiograph reveals a 6
cm area of infiltrates in the right upper lobe. She is given a course of antibiotic
therapy, but her cough persists. A month later her chest x-ray now reveals a 3 cm
peripheral mass in the right upper lobe.
a.What is the most likely diagnosis?
b.Name the various genes mutation involved in lung carcinomas.
Q27. A 20-year-old woman has had worsening fatigue for the past year. On
examination her mucus membranes are pale. No hepatosplenomegaly is present.
Her CBC show's a Hb of 7.1 g/dL, Hct 19.9%, MCV 67 IL, platelet count 190,000/ul,
and WBC count 5,400/ul. There is no history of drug ingestion.
a. What is the most likely diagnosis?
b. What morphologic findings are most likely to be present on examination of her
peripheral blood smear?
c. Name four Prognostic Factors for melanoma of skin.
Q28. of thyroid with hashimotos thyroiditis. A middle aged woman presents with
diffuse and symmetrical enlargement gradually developing hypothyroidism She was
diagnosed as a case of
a. Give the pathogenesis of this disease?
b. What are the diseases to which she is at risk of developing?
b. What three serum markers would you order in a patient with testicular mass?
c.What is the value of serum markers in the context of testicular tumors?
Q29. A 45 years old female develops a peanut size nodule in an old midline
laparotomy scar which becomes painful during menstrual period. The excised nodule
consists of normal looking endometrial tissue glands and stroma.
a. Give three theories of pathogenesis of such lesions?
b. List four important sites for this process other than the abdominal wall? 2
Q30. A 30 years old woman is brought to emergency room. She is hypotensive and
breathing rapidly. Her breath had a fruity odour. Analysis of her blood shows glucose
500mg/dl, K+ 6.5MG/DL Arterial blood gases analysis shows pH 7.5. HCO3 1.3
mEq/L, poo2 levels of 25mmHg.
a. What is the likely diagnosis?
b. Write down its pathogenesis?
c. Morphology of diabetic nephropathy? 2
Q31. A 60 year old man presents to the clinician with cola colored urine and flank
pain. After taking a careful history the man had a low grade fever and has lost 10
pound weight over the past month. He is a chronic smoker. On physical examination
he has a large mass in left kidney. Lab finding shows secondary polycythemia.
a. Enlist the risk factors for this tumor?
b. Describe the morphology of clear cell carcinoma?
c. Enlist four common locations of metastases of this tumor?
Q32. A 34 years old patient presented with long standing headache malaise mental
confusion and vomiting. The CSF typically shows pleocytosis made up of
mononuclear cells with an elevated protein concentration and a moderately reduced
glucose. MRI shows well circumscribed intraparenchymal masses in CNS. The
patient was on ATT for the last 4 months
a. What is the most likely diagnosis?
b. Enlist three causative agents causing this type of meningitis
c. Name the complications associated with this type of disease
d.Define atypical hyperplasia?
Q33. A 45 years old female develops a peanut size nodule in an old midline
laparotomy scar which becomes painful during menstrual period. The excised nodule
consists of normal looking endometrial tissue glands and stroma. a
a. Give three theories of pathogenesis of such lesions?
b. List four important sites for this process other than the abdominal wall? 2
Q34. A 30 years old woman is brought to emergency room. She is hypotensive and
breathing rapidly. Her breath had a fruity
odour. Analysis of her blood shows glucose 500mg/dl, K+ 6.5MG/DL Arterial blood
gases analysis shows pH 7.5. HCO3 1.3 mEq/L, poo2 levels of 25mmHg.
a. What is the likely diagnosis?
b. Write down its pathogenesis?
c. Morphology of diabetic nephropathy? 2
Q35. A 60 year old man presents to the clinician with cola colored urine and flank
pain. After taking a careful history the man had a low grade fever and has lost 10
pound weight over the past month. He is a chronic smoker. On physical examination
he has a large mass in left kidney. Lab finding shows secondary polycythemia.
a. Enlist the risk factors for this tumor?
b. Describe the morphology of clear cell carcinoma?
c. Enlist four common locations of metastases of this tumor?
Q36. A 34 years old patient presented with long standing headache malaise mental
confusion and vomiting. The CSF typically shows pleocytosis made up of
mononuclear cells with an elevated protein concentration and a moderately reduced
glucose. MRI shows well circumscribed intraparenchymal masses in CNS. The
patient was on ATT for the last 4 months
a. What is the most likely diagnosis?
b. Enlist three causative agents causing this type of meningitis
c. Name the complications associated with this type of disease
Q37. A.Why HDL cholesterol is called "Good Cholestr."?
B.Describe morphologic features of atherosclerosis
Q38. A-A 34 years old I/V drug abuser presents to ER with a 24 hrs history of fever &
shaking chills. His temperature is 38.7/103F), pulse rate is 110 per min. B.P. is
140/80 mmHg. Physical examination reveals harsh systolic murmurs
Echocardiography shows vegetations on heart valves. The patient develops
headache & right arm paralysis. CT scan of brain demonstrates an infarct of right
frontal lobe
A. what is the most likely diagnosis of heart problem?
B. what is the most likely causative agent?
C.what is the cause of brain infarct in this case?
D. What are 4 major Jones criteria for rheumatic heart disease?
E.
Q39. A 24 years old woman presents to your office for a checkup. She states that her
pregnancy has been proceeding smoothly, although she has been feeling more tired
than she expected. Her physical examination is largely unremarkable except for
marked pallor You order serum studies and find decreased hematocrit, decreased
ferritin and increased iron binding capacity
A.What is the diagnosis?
B.Name two common causes?
C.What are the findings on periphera blood film?
D.What other clinical signs and symptoms you would expect?
E.What is Plummer Vinson syndrome?
Q40. Give WHO Classification of the Lymphoid Neoplasms
Q41. Tabulate differences between Tuberculosis and Sarcoidosis
Q42. A 27 years old female presented with a 9 month history of bloody diarrhea,
crampy abdominal pain. 3 weeks ago she noticed that her left knee was swollen, red
and painful. Her temperature 38 C (1011), R.R is 32/min & B 130/90mmHg
Abdominal palpation showed lower quadrant tenderness. Laboratory studies showed
Hb 9.3gm/dl. Microscopy of stools reveals numerous white and red blood cells
Colonoscopy showed pseudopolyps & friable muco
A.Write extraintestinal manifestation associated with the disease?
B. What is most likely diagnosis?
C. Name 2 complications
D. Give 1 differential diagnosis of the disease mentioned
Q43. Describe Pathogenesis of Cholesterol Stones
Q44. A 12 years old girl complains of swelling of her eyelids, abdomen & ankles. she
has been in good he until several months ago, when she gained weight & also noted
swelling of her lower legs An x-ray film of the chest snows bilateral pleural effusions
without evidence of lung disease. Urinanalysis reveals heavy proteinuria (8 g per 24)
without hematuna. A percutaneous needle biopsy of kidney discloses no
morphological abnromilities by light microsc
A. What is most likely diagnosis?
B. Give two probable causes of renal lesion ?
C. Enlist the differences between nephroic & nephritic syndrome?
Q45. List & give brief account of the three major microscopic abnormalities of
Alzheimers disease
Q46. A 52 years female presented with complains of pain in knees, cervical, proximal
& distal interphalangeal joints of the fingers. Symptoms include deep achy pain that
worsen with use, morning stiffness crepitus & limitation of range of movements along
with muscle spasm
a. Give the diagnosis and pathogenesis of this disease?
b. Name bone forming tumars
Q47. A 35 years old female presents with generalized apathy, mental sluggishness
listlessness, cold intolerance and obesity. She is expected to have myxoedema
a. What laboratory test will you order to confirm the diagnosis?
b. What laboratory findings are going to be present if she is diagnosed with
Hashimotos throiditis? 15
c. Why some palients with Graves disease spontaneously develop episodes of
hypothyroidism
Q48. A77 years old with known type 2 diabetas presented to the causality
department feeling drowsy His home blood glucose monitoring had recently
averaged about20mmoli urine was negative for kelones However his Na was
160mmol/l (135-145) potassium5mmol/l (3.5-5), bicarbonate 21mmol/l(24-32), urea
15mmol/l, glucose 65mmol/l (5.5-11. 1) and pH was 7.38(7.35-7.45)
a. What is the probable diagnosis?
b. Name the hormones and the principal actions involved in glucose hemostasis 1
c.Define Wermer syndrome
Q49. A mastectomy specimen from a 42 years old female shows a 2cm tumor which
is a well differentiated ductal carcinoma of no special type with a minor in situ
component. Two of the 14 auxillary nodes are positive for metastatic tumor. The
tumor is estrogen receptor and progesterone receptor negative and Her2 neu
positive There is no distant metastasis
a. Which of the these tumor characteristics has the highest effect on clinical outcome
in the patient
b. Identify all prognostic and predictive factors listed here and give relative
importance of each
Q50. A 59-year-old female has had vaginal bleeding for the past 2 months. She went
through menopause 7 years ago and has no menstrual periods since then. On
physical examination there were no cervical lesions or adanexal mass and the uterus
was normal in size. The patient was 155cm tall and weighs 74.5 kg a pap smear
shows atypical glandular cells of uncertain significance Heamoglobin concentration
was 9.8 mg/dl 05 Patient is at risk of developing which lesion
a. Enlist surface epithelial ovarian tumors 1.5
b. b. Enumerate 6 conditions associated with endometrial hyperplasia
Q51. A young man presents with nephritic syndrome. He is HCV positive on serelogy
renal biopsy was carned out which revealed out light microscopy an accentuation of
the lobular arrangement of glomaruler tuft and a double contour of GBM.
a. What will be the electron microscopic and detailed light microscopic picture of this
biopsy 73
b. Give the pathogenesis of renal calculi? 2
Q52. a. Enumerate clinical staging of testicular tumors and what is the significance of
the biomarkers in context of testicular tumors
b. Give staging of prostatic adenocarcinoma using the TNM system 25
Q53. A 55 year old male patient is found to have a 3cm polyp in the right colon while
he is being evaluated for anemia
a. List three non neoplastic and three neoplastic types of colorectal polyps
b. Give major histological features of the three types of colorectal adenoma 10
Complete the following lable with N (Normal), 1 (raised) and (decreased) condition
Q54. 53 year old male presents to his GP with an acutely painful right big toe. On
examination the toe is swollen, erythematous with red and shiny overlying skin and is
extremely tender to touch.
a. What is the most probable diagnosis
b. Which investigation will be the most helpful for the diagnosis (only one)
c. Name two causes of the underlying abnormality d. Name four Prognostic Factors
for melanoma of skin
Q55. A77 years old with known type 2 diabetes presented to the causality
department feeling drowsy. His home blood glucose monitoring had recently
averaged about20mmol/l. urine was negative for ketones. However his Na was
160mmol/l (135-145), potassium5mmol/l (3.5-5), bicarbonate 21mmol/l (24-32), urea
15mmol/l, glucose 65mmol/l (5.5-11.1) and pH was 7.38(7.35-7.45).
a.What is the probable diagnosis?
b. List at least four causes of coma in diabetic patient.
c. Name atleast four hormones involved in glucose metabolism.
Q56. A previously healthy 67-year-old man presents to the emergency room with
numbness of his left leg. Temperature and blood pressure are normal. Physical
examination shows pallor and a cool left leg with absence of distal pulse. An ECG
reveals no abnormalities. An arteriogram demonstrates a markedly dilated abdominal
aorta and occlusion of the left popliteal artery. The blockage is removed surgically,
and the patient recovers.
a. What is the most likely pathology in aorta?
b. What is the most likely cause of this pathology in abdominal aorta?
c. What is the most likely reason for occlusion of the left popliteal artery?
d. Name four causes of secondary hypertension
Q57. A 34 years old I/V drug abuser presents to ER with a 24 hrs history of fever &
shaking chills. His temperature is 38.7(103F), pulse rate is 110 per min, B.P. is
140/80 mmHg. Physical examination reveals harsh systolic murmurs.
Echocardiography shows vegetations on heart valves. The patient develops
headache & right arm paralysis. CT scan of brain demonstrates an infarct of right
frontal lobe.
a. What is the most likely diagnosis of heart problem?
b. What is the most likely causative agent?
c. What is the cause of brain infarct in this case?
d. Give the morphological features of aplastic anemia.
