Long Essay. Answer any one.

10x1-10 1. 35 years female complaints of generalised weakness, fatigue, polymenorrhoea and

menorrhagia since 2 years. On examination: Pallor +++ Koilonychia + Other Clinical parameters are
normal.
a) What is the Clinical diagnosis?(2)
b) Describe Laboratory findings.(5)
c) What are the other conditions that mimic this condition.(3)
OR 2.45 years male complaints of weakness, weight loss, anorexia, mass per abdomen since 6
months. On examination: Hepatomegaly ++, Splenomegaly ++++ No lymphadenopathy. Pallor ++
a) What is the diagnosis.? (2)
b) Describe the phases with lab findings. (6)
c) What is genetic abnormality? (2)
SECTIONC
Long Essay. Answer any two.1012-20
3. Define granuloma. Classify granulomatous inflammation. Discuss pulmonarytuberculosis.
A.Define Apoptosis and Necrosis. Enumerate the differences. Describe the types of necrosis.
8. Define Neoplasia. Diseuss the different routes of metastasis with examples. Enumerate tumor
diagnostic methods.
SECTION D
Short Essay. Answer any nine.5x9-45
6. Describe in detail about Phagocytosis.
Discuss Virchows triad of thrombosis.
8. Describe vitamin C deficiency.
9. Write the types of hypersensitivity reactions with example. Discuss type I hypersensitivity reaction,
10. Discuss the steps of fracture healing and complications.
11. Enumerate Causes of thrombocytopenia. Describe the lab investigations in ITP 12. Define and
classify shock. Describe morphology of various organs in shock.
13. Describe various casts, crystals and cells in urine and their significance.
14. What is Bombay blood group. Enumerate transfusion reactions,
15. Enumerate the indications of exfoliative cytology. Describe the various methods used.
16. Describe the etiopathogenesis of disseminated intravascular coagulation.
17. Enumerate indications of Semen analysis. Discuss the normal values in seminal fluid variables.
SECTION E- Short essay and compulsory.
18. Describe the extent of patient autonomy. (AETCOM)1x5-5
SECTION A
1.

Case: 50 years male, CEO, smoker, hypertensive, diabetic, shock, sweating, shallow breathing, BP
100/70 mmHg, rapid thready pulse, ECG: ST elevation, gallop palpable.

✅ a. Clinical Diagnosis (2):​

Acute Myocardial Infarction (AMI) with Cardiogenic Shock

✅ b. Risk Factors (3):

●​ Smoking​

●​ Hypertension​

●​ Diabetes mellitus​

●​ Male gender​

●​ Age > 45 years​

●​ Sedentary lifestyle, stress​

✅ c. Laboratory Diagnosis (5):

●​ ECG: ST elevation (MI), pathological Q waves, T wave inversion​

●​ Cardiac biomarkers:​

○​ Troponin I & T: rise in 3–6 hrs, peak at 24–48 hrs, remains elevated 7–10 days​

○​ CK-MB: rises in 4–6 hrs, peaks at 24 hrs, normalizes in 48–72 hrs​

○​ Myoglobin: early marker, nonspecific​

●​ CBC: leukocytosis​

●​ Serum electrolytes & glucose​

●​ Lipid profile​

●​ Echocardiography: wall motion abnormalities​

2.

Case: 28 years male, high fever, cough with expectoration, dyspnea – 6 days, vocal fremitus &
resonance full, bilateral basal crepitations, diffuse consolidation on X-ray.

✅ a. Clinical Diagnosis (2):​

Lobar Pneumonia

✅ b. Classification of Pneumonias (3):

●​ Community-acquired pneumonia​

○​ Typical (lobar, bronchopneumonia)​

○​ Atypical (viral, mycoplasma)​

●​ Hospital-acquired (nosocomial) pneumonia​

●​ Aspiration pneumonia​

●​ Chronic pneumonias​

●​ Immunocompromised host pneumonias​

SECTION C

3.

✅ Inflammatory Bowel Disease (IBD):

●​ Definition: Chronic, idiopathic, inflammatory disorders of the GI tract, mainly including
Crohn’s disease and Ulcerative colitis.​

✅ Pathogenesis:
●​ Genetic predisposition​

●​ Dysregulated immune response to gut flora​

●​ Environmental triggers​
 ●​ Barrier defects in mucosa​

●​ Proinflammatory cytokines (TNF-α, IL-12)​

✅ Differences:
Feature Crohn’s disease Ulcerative colitis

Location Any part (mouth–anus) Colon & rectum only

Distribution Skip lesions Continuous

Depth Transmural Mucosa & submucosa

Granulomas Non-caseating Rare

Complications Fistula, stricture Toxic megacolon, carcinoma

✅ Morphology & Complications:

●​ Crohn’s: Thickened wall, cobblestone mucosa, fissures, fistulas, strictures​

●​ Ulcerative colitis: Diffuse ulceration, pseudopolyps​

●​ Complications: Bleeding, perforation, carcinoma, malabsorption​

SECTION D

4. Acute Pyelonephritis

✅ Causes:
●​ Ascending infection (E. coli, Proteus, Klebsiella, Enterococcus)​

●​ Vesicoureteral reflux​

●​ Urinary obstruction, stones, catheterization, diabetes​

✅ Pathogenesis:
●​ Bacterial infection ascending from bladder or hematogenous spread​
 ●​ Inflammatory infiltration of interstitium & tubules​

✅ Morphology:
●​ Gross: Enlarged kidney with surface abscesses, hyperemia​

●​ Microscopy: Neutrophilic infiltration of tubules & interstitium, tubular necrosis​

5. Ovarian Tumors

✅ Classification:
●​ Surface epithelial tumors (serous, mucinous, endometrioid)​

●​ Germ cell tumors (dysgerminoma, teratoma, yolk sac, choriocarcinoma)​

●​ Sex cord–stromal tumors (granulosa, thecoma, Sertoli–Leydig)​

✅ Germ Cell Tumors:

●​ Gross: Solid or cystic masses, areas of hemorrhage & necrosis​

●​ Microscopy:​

○​ Dysgerminoma: sheets of uniform cells with clear cytoplasm & central nuclei​

○​ Yolk sac: Schiller-Duval bodies​

○​ Teratoma: mature (benign) or immature tissues​

SECTION D – Short Essays

6. Lung Carcinoma

✅ Classification:
●​ Small cell carcinoma​
 ●​ Non-small cell carcinoma:​

○​ Adenocarcinoma​

○​ Squamous cell carcinoma​

○​ Large cell carcinoma​

✅ Risk factors:
●​ Smoking​

●​ Asbestos​

●​ Radon​

●​ Air pollution​

7. Acute Pyogenic Osteomyelitis

✅ Etiology:
●​ Staph aureus, Streptococcus, Gram-negative rods​

●​ Trauma, hematogenous spread​

✅ Morphology:
●​ Suppurative necrosis of bone (sequestrum)​

●​ New bone formation (involucrum)​

●​ Edema & inflammatory infiltration​

8. Testicular Tumors

✅ Classification:
●​ Germ cell tumors: seminoma, embryonal, yolk sac, teratoma, choriocarcinoma​
 ●​ Sex cord–stromal: Leydig, Sertoli​

●​ Others​

✅ Seminoma Morphology:
●​ Gross: Homogeneous gray-white, lobulated mass​

●​ Microscopy: Sheets of uniform cells with clear cytoplasm, central nuclei, lymphocytic infiltrate​

9. Breast Cancer

✅ Types:
●​ Invasive ductal carcinoma​

●​ Invasive lobular carcinoma​

●​ Medullary, mucinous, tubular​

✅ Prognostic factors:
●​ Tumor size​

●​ Lymph node status​

●​ Histologic grade​

●​ Hormone receptor status​

●​ HER2/neu expression​

10. Hashimoto Thyroiditis

✅ Pathogenesis:
●​ Autoimmune destruction of thyroid gland​

✅ Morphology:
 ●​ Gross: Diffusely enlarged, pale, firm thyroid​

●​ Microscopy: Hurthle cell change, lymphoid follicles, fibrosis​

11. Basal Cell Carcinoma

✅ Risk factors:
●​ UV exposure​

●​ Fair skin​

●​ Genetic syndromes (Gorlin)​

●​ Immunosuppression​

✅ Pathology:
●​ Nodular, ulcerative lesions​

●​ Tumor islands with peripheral palisading​

12. Meningitis

✅ Causes:
●​ Bacterial: Neisseria, Streptococcus, H. influenzae​

●​ Viral: Enteroviruses, HSV​

●​ Fungal: Cryptococcus​

✅ CSF findings:
Type Cells Glucose Protein

Bacterial Neutrophils ↑ ↓ ↑↑

Viral Lymphocytes ↑ Normal Mild ↑

 Fungal Lymphocytes ↑ ↓/Normal ↑

13. Viral Hepatitis

✅ Hepatotropic Viruses:
●​ HAV, HBV, HCV, HDV, HEV​

✅ Morphology:
●​ Liver enlargement, mottling​

●​ Ballooning degeneration of hepatocytes​

●​ Councilman bodies​

●​ Portal & lobular inflammation​

14. Peptic Ulcer

✅ Gross: Round, punched-out ulcer​

✅ Microscopy: Necrotic base, fibrinoid necrosis, granulation tissue, fibrosis​
✅ Complications: Bleeding, perforation, obstruction

15. Aneurysm

✅ Definition: Localized abnormal dilation of blood vessel​

✅ Causes: Atherosclerosis, hypertension, trauma, infection​
✅ Types: True, false, dissecting; saccular, fusiform

16. Diabetic Nephropathy

✅ Morphological Changes:
●​ Glomerular basement membrane thickening​

●​ Mesangial expansion​
 ●​ Nodular glomerulosclerosis (Kimmelstiel-Wilson)​

●​ Arteriolar hyalinosis​

●​ Interstitial fibrosis​

17. Cervical Cancer

✅ Etiological factors:
●​ HPV (16, 18, 31, 33)​

●​ Early sexual activity, multiple partners​

●​ Smoking, immunosuppression​

✅ Morphology:
✅
●​ Dysplasia to carcinoma in situ to invasive carcinoma​
Screening:​

●​ Pap smear, HPV DNA testing​

SECTION E

18. Informed Consent & Refusal

✅ Informed Consent:
●​ Voluntary agreement by a patient after being informed about:​

○​ Nature of procedure​

○​ Risks & benefits​

○​ Alternatives​

○​ Right to refuse​
✅ Informed Refusal:
●​ Patient has the right to refuse treatment after being informed about consequences.​

✅ Importance:
●​ Respects autonomy​

●​ Legal & ethical obligation​

●​ Builds trust​

PATHOLOGY ESSAY ANSWERS

SECTION B – LONG ESSAY

1.​ 35 year old female with polymenorrhoea & menorrhagia

a) Clinical diagnosis (2)​

• Iron deficiency anaemia secondary to chronic menstrual blood loss.
b) Key laboratory findings (5)​
• Haemoglobin ↓ (<12 g/dL; often 4 8 g/dL in severe cases)​
• RBC indices: microcytic (MCV <80 fL), hypochromic (MCHC <32 g/dL).​
• Peripheral smear: anisopoikilocytosis, pencil cells, target cells.​
• Reticulocyte count normal/low; RBC distribution width ↑ early.​
• Serum ferritin ↓ (<15 µg/L), serum iron ↓, TIBC ↑, transferrin saturation <15 %.​
• Bone marrow: absence of iron stores on Prussian blue stain.

c) Conditions that mimic iron deficiency microcytosis (3)​

• Thalassaemia trait (α or β)​
• Anaemia of chronic inflammation (late)​
• Sideroblastic anaemia / lead poisoning

2.​ 45 year old male with massive splenomegaly a) Most likely diagnosis (2)​
• Chronic myeloid leukaemia (CML).

b) Phases with laboratory profile (6)

1.​ Chronic phase – WBC 50–300 x10⁹/L with full spectrum of myeloid cells;
basophilia/eosinophilia; Hb mildly ↓; platelets normal/↑.
2.​ Accelerated phase – WBC difficult to control, peripheral & marrow blasts 10–19 %; basophils
≥20 %; thrombocytopenia/ cytosis, anaemia ↑; new cytogenetic clones.
3.​ Blast crisis – Blasts ≥20 % in blood or marrow or extramedullary blast proliferation; behaves
like acute leukaemia (75 % myeloid, 25 % lymphoid). Hb very low; platelets ↓; organ
infiltration.

c) Genetic abnormality (2)​

• Philadelphia chromosome t(9;22)(q34;q11) producing BCR ABL1 fusion tyrosine kinase.

SECTION C – LONG ESSAY 3. Granuloma, classification & pulmonary tuberculosis • Granuloma:

Focal, organised collection of activated epithelioid macrophages usually surrounded by lymphocytes
± giant cells and fibrosis.​
• Classification: Immune (e.g., TB, sarcoidosis, Crohn disease), foreign body, necrotising vs
non necrotising, infectious vs non infectious.​
• Pulmonary tuberculosis:​
– Etiology & pathogenesis: Inhalation of Mycobacterium tuberculosis → alveolar macrophages →
TH1 response, IFN γ mediated containment.​
– Primary TB: Ghon focus (lower upper lobe/upper lower lobe) + hilar nodes = Ghon complex →
Ranke complex (fibro calcified).​
– Secondary (post primary): Apex cavitary lesions, caseating granulomas; may progress to miliary
TB, tuberculous bronchopneumonia, pleuritis.​
– Morphology: Caseous necrosis at centre, Langhans giant cells, epithelioid cells rimmed by
lymphocytes, fibroblastic healing.​
– Complications: Cavitation, haemoptysis, aspergilloma, miliary spread, bronchiectasis, amyloidosis.

4.​ Apoptosis & necrosis • Definitions: Apoptosis – programmed, energy dependent cell death
without inflammation; Necrosis – unregulated cell death with membrane rupture &
 inflammation.​
• Key differences: cause (physiologic vs pathologic), cell size (shrink vs swell), membrane
integrity (intact vs disrupted), DNA fragmentation (ladder vs random), inflammation (absent
vs present).​
• Types of necrosis: Coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous (dry, wet).
5.​ Neoplasia & metastasis • Neoplasia: Abnormal mass of tissue, growth exceeds and is
unco ordinated with that of normal tissues and persists after cessation of stimuli.​
• Routes of spread:​
– Direct seeding of body cavities (e.g., ovarian carcinoma in peritoneum)​
– Lymphatic spread (most carcinomas → axillary nodes in breast CA)​
– Haematogenous spread (sarcomas; renal cell carcinoma → renal vein → IVC)​
– Transcoelomic, CSF pathways, along epithelium-lined ducts, iatrogenic needle track.​
• Tumour diagnostic methods: Histopathology (biopsy, frozen section), cytology (FNAC,
exfoliative, liquid based), immunohistochemistry, flow cytometry, molecular diagnostics (PCR,
FISH, NGS), serum tumour markers, imaging guided sampling.

SECTION D – SHORT ESSAYS 6. Phagocytosis: Stages – recognition & attachment (opsonins: IgG,
C3b), engulfment (pseudopods → phagosome), killing & degradation (O₂ dependent via NADPH
oxidase → ROS, MPO halide; O₂ independent via lysozyme, defensins). Clinical relevance: chronic
granulomatous disease.

7.​ Virchow’s triad of thrombosis: Endothelial injury (atherosclerosis, trauma), abnormal blood
flow (stasis in AF, turbulence over plaques), hypercoagulability (factor V Leiden, malignancy).
8.​ Vitamin C deficiency (scurvy): Impaired collagen hydroxylation → swollen gums, perifollicular
haemorrhages, impaired wound healing, skeletal growth defects; lab – ascorbic acid
<0.2 mg/dL.
9.​ Hypersensitivity reactions:​
I – IgE mediated anaphylaxis (bronchial asthma)​
II – Antibody mediated cytotoxic (AIHA)​
III – Immune complex (SLE, serum sickness)​
IV – T cell mediated (contact dermatitis, TB skin test).​
• Type I steps: Allergen cross links IgE on mast cells → degranulation (histamine) →
late phase cytokines → bronchospasm, oedema.
10.​Fracture healing: Haematoma, inflammatory granulation (soft callus) days 0–7, hard callus
(woven bone) weeks 2–3, remodelling to lamellar bone months. Complications: non union,
mal union, osteomyelitis, fat embolism.
11.​ Thrombocytopenia causes: ↓ production (aplastic, drugs), ↑ destruction (ITP, TTP, DIC),
sequestration (splenomegaly), dilution.​
• ITP labs: Platelets <100 x10⁹/L, large platelets, marrow megakaryocytosis, normal
PT/APTT, anti GpIIb/IIIa antibodies.
12.​Shock: Definition – systemic hypoperfusion. Classes: cardiogenic, hypovolaemic, distributive
(septic, anaphylactic), obstructive, neurogenic.​
• Morphology:​
– Brain: ischaemic encephalopathy.​
– Heart: subendocardial necrosis.​
– Kidneys: acute tubular necrosis.​
– Lungs: diffuse alveolar damage (shock lung).​
 – GI: haemorrhagic enteropathy.​
– Liver: centrilobular necrosis.
13.​Urine casts/crystals/cells:​
– Casts: hyaline (normal), RBC (GN), WBC (pyelonephritis), granular (tubular injury), waxy
(CRF), fatty (nephrotic).​
– Crystals: oxalate, uric acid, cystine, triple phosphate; significance in stones or metabolic
disease.​
– Cells: RBC, WBC, epithelial, malignant.
14.​Bombay blood group (Oh): Lack of H antigen; sera contains anti H, anti A, anti B → can
receive only Oh blood.​
• Transfusion reactions: Febrile non haemolytic, allergic, acute haemolytic (ABO), delayed
haemolytic (Rh), TRALI, TACO, septic, anaphylactic (IgA deficient).
15.​Exfoliative cytology indications & methods: Screening (cervical Pap), respiratory lesions
(sputum, BAL), effusions, urine, brushings. Methods: conventional smear, liquid based
cytology, cell block, automated image analysis.
16.​DIC (etiopathogenesis): Trigger (sepsis, trauma, malignancy, obstetric) → tissue factor
release, widespread thrombin → consumption of platelets & factors, fibrinolysis ↑ →
microvascular fibrin thrombi + bleeding diathesis.
17.​Semen analysis indications & normal values: Infertility work up, post vasectomy, after
varicocele surgery, occupational exposure, donor screening.​
• Volume 1.5–6 ml, pH ≥7.2, sperm concentration ≥15 million/ml, total motility ≥40 %,
progressive motility ≥32 %, morphology ≥4 % normal forms, vitality ≥58 %, WBC
<1 million/ml.

SECTION E – COMPULSORY 18. Extent of patient autonomy (AETCOM): Patients have the right to
receive information, make voluntary decisions about their care, give or withhold informed consent,
and designate surrogates. Autonomy is balanced against beneficence, non maleficence, justice,
cultural context, and legal constraints; may be limited in incompetence, public health emergencies,
or when refusing life saving care endangers dependents. Practitioners must respect choices, ensure
comprehension, and document shared decision making.