PRACTICAL ESE PATHOLOGY WITH ANSWERS AND PROJECTION

Pathology practicals and projection with enough answers and explanations that will help you ace your examination.

1. PRACTICAL EXAMINATION MD3 (SEMESTER 5)- 15 TH MARCH 2010 HURBERT KAIRUKI MEMORIAL UNIVERSITY

2. INSRUCTIONS: 1.Each question carries 4 minutes 2.There is no going back to the previous question when the 4 minutes have elapsed 3. Write down or stick to the number of answers you are required two give for each option, otherwise the first answers in chronological order will be marked and the rest will not be considered 4. Be brief and abide to what you are asked 5. Write your responses of each respective question on the answer book provided 6. Remember to write the examination number on the answer book provided

3. Q.1 The gross specimen to the left was surgically removed from a patient with foul smelling, bloody vaginal discharge. Identify the specimen - cervix Give 2 morphological findings seen - tumor -bleeding/discharge What is the most likely diagnosis - malignant tumor

4. Q.2 A biopsy was taken from the lesion seen in the previous question. (Q.1) Describe 3 histological findings seen in this slide - keratin pearls. -inflammatory cells -invasive tumor . b) What is your diagnosis - squamous cell carcinoma . c) what is the histological grade of the lesion - grade I.

5. Q.3 A 34 years old lady had irregular heavy menstrual bleeding. Open surgery was performed where the organ was removed. a) Identify the organ - uterus b) Describe two morphological findings - enlarged uterus -nodular mass on fundal area c) What is the most likely diagnosis - uterine leiyomyoma d. mention 1 most likely complication of this lesion - infertility

6. Q.4 A 45 years old female patient had abdominal swelling, emaciation and constipation. An operation was done and a tumor removed from the left ovary. a) describe 2 gross morphological features. - enlarged ovary - cystic with fluid b) What is your 2 provisional diagnoses - ovarian cyst -tumor of the ovary

7. Q.5 A biopsy material was taken from the gross specimen on previous Question (Q.4). Examine the histological slide on the left. Describe 3 morphologic findings - psamoma body -papillary invasion -papillary growth . b) What is your diagnosis? - carcinoma of the ovary

8. Q.6 A 32 year old female with abdominal swelling underwent surgical operation a) Describe the 2 gross features of the mass - enlarged ovary -hairs and fluid b) What is your most likely diagnosis - ovarian teratoma c) Mention 2 common sites where this lesion can occur - ovary -testis in males -medial sternum.

9. Q.7 This the histology from the previous Q.6 a) Describe the 3. histo-morphological features - fat tissues -cartilage tissue -Glandular tissue b) What is the final diagnosis - Mature teratoma .

10. Q.8 Identify the organ - penis Describe 2 gross pathology - tumor on glans penis -ulceration on the skin Why do you think this organ was surgically removed - part of treatment to prevent spread to other part. What is the name given to the act of surgical removal - amputation of the penis

11. Q.9 A biopsy was taken from the lesion seen in the previous question. (Q.8) a) Describe 3 histological findings seen in this slide - keratin pearls -inflammatory cells -invasive tumor (b) What is your diagnosis - carcinoma of the penis. c) Describe the histological grade of the lesion - grade I d) Mention 1 commonest route of metastasis of the lesion - lymphatic root

12. Q.10 The patient to the left had emotional instability, weight loss in spite of good appetite and fine tremors. 1.Mention 2 gross pathological features - eye protrusion -dropped eyelid 2.What is the most likely diagnosis - graves disease 3.Mention 3 serum biochemical abnormalities which would help to confirm the diagnosis - T3 -T4 raised -decreased TSH

13. Q.11 1.What is the gross pathology seen to the woman on the left - swelling on ant neck 2.What is the name of the anatomical region of the body where the lesion is located If the lesion seen tended to move on swallowing when palpated - thyroid gland 3. Mention 2 differential diagnoses - Goiter -Graves disease.

14. Q.12 The histological picture was taken from a lesion on previous question (Q.11) 1.Describe 2 histomorphological features - follicular with variable size -thin epithelium. 2. What is the diagnosis - simple goiter. 3. Mention 2 aetiological factors of the lesion - iodine deficiency -impaired thyroid hormone synthesis

15. Q.13 The organs to the left was surgically removed from a 2 years old child What are the 2 organs seen? - kidney -adrenal gland 2a.Describe the 2 gross morphological features - enlarged kidney -hemorrhage 2b.If the finding in urine was positive for VMA What would be the 2 most likely differential diagnoses - pheocromocytoma. -neuroblastoma

16. Q.14 If this was the child who underwent surgical removal of the lesion seen in Question 13. Describe the gross pathology-2 - bleeding around the eye -dark brown lesion 2.What would be the most likely diagnosis - neuroblastoma 3. What is the name of the phenomenon given to the lesion seen on the picture to the left - Hutchison's neuroblastoma

17. Q.15 A 32 years old male had malaise, anaemia, anuria and died. At autopsy the kidneys were found to be abnormal. Examine the specimen provided. Identify the organ - distorted kidne y (b) Describe 2 gross morphological findings - enlarged kidney -multiple cysts (c) What is your diagnosis - adult polycystic kidney disease . (d) Mention the genetic anomaly associated with this condition - autosomal dominant

18. Q.16 Identify the organ - kdney Mention 2 gross morphological features - enlarged kidney -double ureter What is the most likely diagnosis - malignant tumor of the kidney .

19. Q.17 The organ seen was surgically removed from a patient with obstruction to urinary flow. Identify the organ - distorted kidney 2. Where is the lesion located in the organ - pelvis 3. What specific name is given to the lesion in the organ-specific location - stag horn calculus

20. Q.18 The organ shown was seen at autopsy of a woman who died after delivery. Prior do her death she had chills, fever, dysuria and lumbar pain. Identify the organ - kidney, aorta & renal artery b. Describe 3 gross morphological features - enlarged, pus and hemorrhage.

21. Q.19 This section to the left was prepared from a previous question(Q.18). 1.Describe 2 histomorphological features - neutrophils & congested blood vessels 2. What is the diagnosis - acute pyelonephritis . 3. What is the commonest causative agent of the lesion . E-coli 4. Name 2 most common route of spread of the causative agents - ascending infection -haematogenous

22. Q.20 Describe 3 gross pathology seen to the patient on the left - enlarged breast -hemorrhage -ulceration Is the condition benign or malignant Give 3. reasons for your answer in question 2 above - involved axillary lymph nodes -ulceration -irregular margin

23. Q.21 The histological picture was prepared from the previous lesion in question 20 Describe 3 histomorphological features - abnormal glandular -infiltrating -small acin and glands 2. What is the diagnosis - infiltrating duct carcinoma of the breast .

24. Q.22 A female patient presented with eczematoid lesion as seen on the organ to the left Identify the organ - breast 2. At what location of the organ is the lesion mostly concentrated - nipple 2. Describe 3 gross pathology - edema -enlarged -ulceration

25. Q.23 The photomicrograph to the left was taken from a histological lesion prepared from the previous question Describe 3 histopathological features - paget’s cells -large nuclei -vacuolated cytoplasm What is the most likely diagnosis - pagets disease

26. Q.24 Identify the organ -distorted kidney 2. Mention 3 pathological findings seen - enlarged kidney -kidney stones -hemorrhage 3. What is the diagnosis - urolithiasis 4. Mention one most important complication - renal failure .

27. Q. 25 1. What is the name of the condition seen to the left of a 2 year old child - hydrocephalus. 2.Mention 3 mechanisms by which this condition may be caused - obstruction to CSF flow -increased CSF production -impaired CSF absorption 3. Mention 3 main types of this condition - congenital -acquired -normal pressure hydrocephalus

28. Q. 26 This is the organ affected by a similar condition seen in question 25. Describe 2 pathological features seen - enlarged ventricle - hemorrhage 2. What is the diagnosis - hydrocephalus 3. What type of the lesion is this - obstructive

29. QUESTION 27. A 5 years old child presented to the doctor with history of passing scanty urine which was bloody. Also had puffiness of face. The following were the findings INVESTIGATIONS RESULTS URINE BLOOD Albumin >3g/dl/24hours 2g/dl → RR (3.5-5.5g/dl) Lipids Present Increased cholesterol Antithrombin III Increased Low Fibrinogen Absent Increased QUESTIONS what is the diagnosis- Nephrotic syndrome 2. mention 3 OTHER biochemical change(other than those mentioned in the table above),which may occur in the blood - elevated liver enzymes, increased platelets and raised biomarkers of MI 3. What is the major cause of this disease in this age group ? -lipoid nephrosis.

30. QUESTION 28. A 30 years old patient presented to the doctor with history of fever, headache, confusion, malaise and Vomiting. The following were the results of the CSF investigations SN FEATURE FINDINGS NORMAL 1. Naked eye appearance Turbid Clear 2. CSF pressure 500mm water 60-150water) 3. Cells 100-1000 mononuclear cells (0-4) 4. Proteins 80mg/dl (15-45mg/dl) 5. Glucose 30mg/dl (50-80mg/dl) 6. Organisms Present (++) Absent Qs Mention the abnormalities/disorders which are noted from the above table - turbid, increased csf pressure, increased cells, increased protein 2. Mention ONE most probable causative organism of these CSF findings - mycobacterium tuberculosis 3. What test will you do in order to identify the organisms (-ZN staining) 4. What is the diagnosis - tuberculosis meningitis.

31. QUESTION. 29 . The following biochemical results were recorded in a 29 year old female who attended her General Practitioner complaining of tiredness, weight loss, heat intolerance and increased bowel movements Patient Results Reference Range Total T4 196 nmol/L (5-11.5) TSH <0.01IU/ (0.7-7.0) Questions : 1. What is your diagnosis ?- hyperthyroidism 2. Mention two physical findings that might be present in this patient ? - eyelid dropping, and eye protrusion 3.Mention two other tests that might be abnormal in this patient?- raised T3 and TRH

32. Question 30.. AM is a 15 years boy and a known patient with Diabetes Mellitus (DM). He is brought in the hospital while he is unconscious and has deep rapid breathing Laboratory results show the following: Patient’s Results Reference range HC03 12 mmol/L (22-30) Blood Glucose 40 mmol/L (3.5-6.5) 1.What is your diagnosis ?- diabetes ketoacidosis 2.Mention two substances you are likely to find in the urine of this patient - ketone bodies and glucose 3.Mention two chronic complications associates with DM - retinopathy -neuropathy and nephropathy