Second Professional Examination (Part III) for the Degree of M.B.,B.S.
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1. A 58 year old man presented with a chronic ulcer of the left foot. He has been diabetic for the past 10 years but has defaulted treatment on many occasions.
a) What clinical biochemistry tests should be ordered and what results would you expect from them? (6 marks)
b) Discuss the pathogenesis of the foot ulcer. (7 marks)
c) Describe the process(es) of healing in such an ulcer (7 marks).
2. A 63 year old woman underwent a mastectomy with axillary clearance for carcinoma of the breast. What parameters would you expect to find described in the subsequent pathology report and how would these help you to decide on her prognosis and future treatment. (20 marks)
3. A 45 year woman presents with a central neck swelling that moves on swallowing. (In the questions below, parts b and c are independent of one another).
a) What structure / organ is enlarged? List 3 differential diagnoses that may cause this enlargement. (4 marks)
b) If cervical lymph nodes are also enlarged, what is the most likely diagnosis? (1 mark)
Describe the pathological changes that you would expect to find in a biopsy of the enlarged lymph nodes (7 marks)
c) If the patient also had palpitations and an irregular pulse, what is the most likely diagnosis? (1 mark)
What clinical biochemistry tests should be ordered and what results would you expect from them? (7 mark)
4. A 73 year old lady with a history of systemic hypertension and chronic bronchitis sustained an intertrochanteric fracture of the left femur following a fall at her nursing home. She underwent open reduction and internal fixation of the fracture and appeared to be making a good recovery until she suddenly collapsed and died on the 5th post-operative day.
a) Discuss whether her death should be reported to the Coroner. (5 marks)
b) List the likely causes of death in this case. (5 marks)
c) Outline the gross pathology of one of these caused of death. (10 marks)
a) Describe the histological features you expect to find in the liver biopsy.
b) Explain the pathogenesis of jaundice and abdominal distension in the patient.
c) What other complications may be present in the patient?
2. Discuss the concept of cervical intraepithelial neoplasia (CIN) and its relationship to invasive squamous cell carcinoma of the uterine cervix. What is the role of human papilloma virus (HPV) in this condition?
3. Give an account of primary tuberculosis and its complications in children and adults.
4. Write short notes on:
a) Osteogenic sarcoma.
b) Pathogenesis of renal calculi.
c) Complications of infective endocarditis.
5. A 17-year-old girl was admitted unconscious and was found on arterial sampling to have a pH of 7.02 (reference range 7.35 - 7.45) and a pCO2 of 10 mmHg / 1.3kPa (reference range 32 - 45 mmHg / 4.3 - 6.0 kPa). Discuss the possible causes and the further biochemical investigations of this patient.
6.
How would you
distinguish between:
a) suicidal
and homicidal wounds
b)
strangulation and hanging
c) rape and consensual sex of a young girl
2001 (Supp)
1. A middle-aged man complained of recurrent epigastric pain. A gastric biopsy showed the presence of Helicobacter pylori. Discuss the possible pathological consequences and complications of Helicobacter pylori infection of the stomach.
3.
a)
A 50-year-old man collapsed and died after having been stung by a swarm
of bees. Describe the cellular events that occurred and correlate these with the
clinical presentation.
b)
A 12-year-old boy underwent a Mantoux test. After 72 hours, he developed
reddening and induration at the site of injection. Discuss the cellular events
responsible for the reaction.
4. Write short notes on the following:
a) endometrial hyperplasia
b) bronchiectasis
c) pathogenesis of myocardial infarction
5.
A 62-year-old man was found by his GP to have a serum sodium
concentration of 121 mmol/L (reference 134-145 mmol/L). He is known to be a
chronic heavy smoker but was otherwise well. Discuss the further biochemical
investigations you would consider performing, and how you would interpret these
results.
1.
Describe the pathogenesis and pathological features of the diseases
associated with Helicobacter pylori.
2.
Describe the pathogenesis of myocardial infarction and the subsequent
complications that may ensue.
3.
What is edema? Describe the pathogenesis of edema in
a)
cardiac failure.
b)
liver cirrhosis.
c)
acute inflammation.
4. Write short notes on the following:
a) primary pulmonary
tuberculosis.
b) small cell carcinoma of the
lung.
c) cor pulmonale.
5. A 58-year old man was reviewed at the medical outpatient clinic with a long history of renal impairment. Review the role of the clinical biochemistry laboratory in the management of this patient.
6. Discuss how you would distinguish the differences in the appearance of homicidal, suicidal and defensive wounds. What are the features that can help you determine if the wound is self-inflicted or otherwise?
2000 (Supp)
1.
Give an account of the pathogenesis, clinical manifestations and possible
sequelae of infective endocarditis.
2.
Discuss the major mechanisms involved in immunologic tissue injury, and
illustrate by describing the pathology of one disease.
3.
A 40-year-old woman presents with a thyroid nodule. Discuss the pathology
of the common conditions with a view to correlating with the clinical
presentation, gross and microscopic appearances and approach to management.
4.
Write short notes on the following:
a)
cervical intraepithelial
neoplasia
b)
secondary
hyperparathyroidism
c)
giant cell tumour of bone
5.
A 44-year-old woman was referred to the outpatient department with a
history of generalized pruritus and was noted to be jaundiced. Discuss the role
of the clinical biochemistry laboratory in the diagnostic evaluation of this
patient.
6.
What are the features that would lead you to suspect that a child has
been abused? How would you proceed to examine and confirm your suspicion? What
would you do when suspicion is confirmed?
1)
Give an account of the aetiology,
pathological features and complications of obstruction of the biliary
tract.
2)
An elderly man has died from
longstanding diabetes mellitus. Describe and explain the pathological findings
that may be found at the post-mortem examination. What do you think are the
possible causes of death?
3)
A young man discovered that he was
bleeding badly from the gums after brushing his teeth. Discuss the possible
causes.
4)
Write short notes on the following:
a)
Complications of mitral
stenosis
b)
The benefits and adverse effects of
inflammation
c)
Tumour progression and
heterogeneity
5)
A 59-year-old man has been told by
his specialist that he has multiple myeloma. Discuss the role of the chemical
pathology laboratory in the diagnosis and management of his
condition.
1999 (Supp)
1) Discuss and describe the
clinicopathological syndromes and potential outcomes that may occur in
the liver as a result of infection by the hepatitis viruses.
2) A 50-year-old man had a non-functioning thyroid nodule. Discuss the
possible pathology of this lesion.
3) A 61-year-old male patient died as a result of longstanding systemic
hypertension. Describe and explain the pathological findings that may be found
at an autopsy examination of this patient.
4) Write short notes on the following:
a) pulmonary embolism
b) granulomatous inflammation
c) p53 suppressor oncogene
5) A 35-year-old woman presents with Cushingoid facies and persistently
elevated blood pressure (150-160/ 90-100 mmHg). How would the chemical pathology
laboratory assist in the investigation of Cushing’s Syndrome?
6) A 72-year-old man was admitted for intestinal obstruction. An operation
was performed. What are the possible causes of the intestinal obstruction in
this case? He died 25 hours after the operation. Should this case be made into a
Coroner’s case and why?
1) A 50-year-old woman had a mastectomy with axillary clearance for carcinoma of the breast. What are the pathological parameters in the specimen that would help determine or influence the management and prognosis?
2) A 6-year-old child is admitted to hospital with clinical manifestations of increased intracranial tension. Discuss the pathological conditions that
may
give rise to this condition.
3) Define thrombosis. Describe the process of thrombosis, the likely
appearance of the intravascular lesions and the sequelae that may
ensue.
4) Write short notes on the following:
a) Causes of thrombocytopaenia
b) Hashimoto’s thyroiditis
c) mesothelioma
5) A 45-year-old Chinese bus driver, attending a medical outpatient clinic,
was noted to have a fasting venous blood glucose of 9.8 mmol/L. He was asymptomatic with a
blood pressure of 160/105 mmHg. Describe how you would best utilize the chemical
pathology laboratory in the investigation and subsequent management of this
patient.
6) A baby was recovered from water. How would you determine at post-mortem
examination and by laboratory tests that death was due to drowning or otherwise?
Is there a difference between fresh water drowning and sea water
drowning?
1998 (Supp)
1) Discuss the causative factors involved in the formation of urinary
calculi. What pathological changes may occur in the urinary system arising from
urinary calculi?
2) Describe the likely necropsy findings of a patient who has died because
of cirrhosis.
3) Discuss the causation and pathogenesis of infective endocarditis. What
are the possible complications of this condition?
4) Write short notes on the following:
a) carcinoid syndrome
b) osteosarcoma
c) fat embolism
5) Discuss the role of biochemical investigations in the diagnosis and
subsequent management of a 40-year-old male Indian hawker, with suspected acute
myocardial infarction.
6) Describe the early post-mortem changes after death. How would you use
these changes to assist you in the estimation of time since death?
1) What are paraneoplastic syndromes? Illustrate your answer with
examples.
2) A 75-year-old man was found dead in his room. At autopsy, his prostate
was found to be markedly enlarged. Describe and discuss the other findings that
might possibly be found at the autopsy.
3) Define emphysema. Discuss the pathogenesis of the major types of
emphysema and briefly mention the clinical course of this
condition.
4) A 55-year-old Chinese man presents with a swelling at the left side of
his neck. Discuss the differential diagnosis.
5) A 24-year-old female was noted to have a blood pressure of 190/110 mmHg
and found to have a serum potassium level of 2.4 mmol/L (reference: 3.5 - 5.0
mmol/L) during a routine pre-employment health screen. How might the chemical
pathology laboratory assist in the further evaluation and management of this
lady?
6) Name three commonly abused drugs in Singapore. What is Ecstasy? What are
the harmful effects on the human body and how are they
manifested?
1997 (Supp)
1)
Give an account of the pathology of
breast carcinoma, with emphasis on features of prognostic
significance.
2)
What are autoimmune diseases?
Discuss the mechanisms of autoimmune disease, illustrating your answer with
examples.
3)
An autopsy was performed on a
65-year-old man who had been suffering from diabetes mellitus for the past two
decades. Discuss the possible causes of death and describe the findings at
post-mortem.
4)
Write short notes on the
following:
a)
Helicobacter pylori-associated
chronic gastritis
b)
Insulinoma (beta-cell tumour of
pancreas)
c)
Effects of asbestos
exposure
5)
A 58-year-old gentleman was reviewed
at the medical outpatient clinic with a history of progressive weight loss over
the preceding four months. Physical examination revealed a cachectic man who
weighed 42 kg. As malignancy is considered a possibility, discuss the usefulness
and limitations of the tests available in the chemical pathology laboratory in
the further evaluation and management of this patient.
6)
Describe the various types of abrasions
and their significance.
1) A patient aged 19 years presents with a right iliac fossa mass, thought
clinically to be inflammatory. At operation, a carcinoma of the colon is found.
Discuss the findings in the pathology of the resected specimen which could
influence the management of the case.
2) Discuss the possible AIDS related findings at autopsy in an HIV-positive
patient dying after a chronic illness.
3) Write short notes on three of the following:
a) dysplasia
b) hypertensive heart disease
c) cirrhosis
d) IgA nephropathy
4) Define thrombosis. Give an account of thrombo-embolic
disease.
5) A 40-year-old man is seen at the outpatient clinic for an executive
health check-up. He is noted to have an elevated serum calcium of 2.7 mmol/L
(reference range 2.1 – 2.5 mmol/L ). How might the chemical pathology laboratory
assist in the further evaluation of this patient?
6) What are the external and internal injuries that you may find on a child
who is physically abused? What other investigations would you carry
out?
1996 (Supp)
1) Give an account of the pathogenesis of atherosclerosis. Discuss the
complications that may arise from this condition.
2) Describe the modes of spread of malignant neoplasms, and illustrate them
with examples.
3) Discuss the aetiology and pathology of peptic ulceration. List the
complications that may arise from this condition.
4) Write short notes on the following:
a) membranous nephropathy
b) endometriosis
c) primary tuberculosis
5) A 35-year-old woman complains of tiredness and weight gain. Her doctor
suspects that she may be hypothyroid. How might the chemical pathology
laboratory assist in the diagnosis of this patient? Briefly list other
biochemical abnormalities that may be found in hypothyroid
patients.
6) Describe the coup and contra-coup head injuries. How are they caused and
how would it help in the interpretation of post-mortem
findings?
1) Describe the genetic changes involved in the development of cancer. Give
3 examples of human cancers which are hereditary and describe how they are
inherited.
2) A patient with a long-standing history of benign hypertension developed a
rapid rise of blood pressure and died. Describe the possible post-mortem
findings.
3) Discuss the mechanisms involved in wound healing. Discuss also the
factors which may adversely influence this healing process.
4) Describe the epithelial tumours of the urinary bladder. Discuss their
epidemiology, pathogenesis and prognostic factors.
5) Discuss the role of the laboratory in the assessment of a patient
suspected of having an acute myocardial infarction.
6) Describe the concept of brain death. What are the criteria for its
diagnosis and how are they applied to organ donation?
1995 (Supp)
1)
Write an essay on the classification
of hypersensitivity reactions, and illustrate each type with one disease
example.
2)
Write an essay on tumours arising
from the pancreas.
3)
Write short notes on each of the
following:
a)
crescentic
glomerulonephritis
b) amyloidosis
c)
polyarteritis
nodosa
4)
Write an essay on hepatitis B virus
(HBV) infection, and discuss the well-recognized pathological sequelae
associated with this infection.
5)
Discuss the value of serum
thyrotropin (TSH) in the investigation of a patient with suspected thyroid
dysfunction.
6)
What is DNA? From where and how is
it obtained? What is its role in the investigation of rape and paternity
disputes?
1)
A 45-year-old female presents with a
lump in the left lobe of the thyroid. Give an account of the various disorders
which may cause this and discuss their prognosis.
2)
Discuss the pathology, complications
and chemical laboratory diagnosis of testicular tumours.
3)
Describe the spectrum of diseases
caused by hepatitis B infection and the mechanisms underlying
them.
4)
Write short notes on each of the
following:
a)
differential diagnosis of Crohn’s
disease and ulcerative colitis
b)
the role of human papilloma virus in
the pathogenesis of disease of the cervix uteri
5)
A 42-year-old Chinese man
complaining of weakness is found to have a plasma potassium concentration of 2.4
mmol/L (reference range: 3.4 – 4.8 mmol/L). Discuss the possible causes and
propose additional biochemical tests you would carry out in the further
investigation of this patient.
6)
Describe the various forms of
abrasion and discuss their medico-legal significance.
1994 (Supp)
1) Discuss the causes of enlargement of the prostate gland. Give an account
of the pathological effects of prostatic obstruction.
2) Discuss the pathogenesis and morphological features of peptic ulceration
of the stomach and duodenum. What complications may arise from such
ulceration?
3) Write brief notes on:
a) mucinous tumours of the ovary
b) cervical intraepithelial neoplasia
4) Discuss the pathogenesis, pathological features and prognosis of the
various causative types of meningitis. How may investigations be helpful in
distinguishing the various causes of meningitis?
5) A 33-year-old man elected to have his blood lipids tested at a health
fair. His test results were:
Total cholesterol: 7.8 mmol/l (desirable: < 5.2 mmol/l
)
Triglycerides: 5.2 mmol/l
(desirable: < 2.3 mmol/l )
HDL:
0.9 mmol/l (desirable: >
0.9 mmol/l )
How would you assess his condition further by laboratory tests?
1) What is emphysema of the lung? Discuss the pathogenesis and complications
of this condition.
2)
Describe the pathological changes which may occur in the
kidneys in diabetes mellitus. What complications may arise from these
changes?
3)
Give an account of the various types of polyps which may
occur in the large intestine. In your answer, comment on the biological
behaviour of these various types.
4)
Write short notes on:
a)
causes of left ventricular
hypertrophy
b)
pathological changes in the liver in chronic
alcoholism
c)
causes of Cushing’s Syndrome
5)
Give a critical evaluation of the usefulness of
diagnostic enzyme assays (including isoenzyme analyses) in clinical
medicine.
6)
A partially burnt body was recovered from the site of a
fire. Describe the post-mortem findings that will help you in determining
whether the person was dead before the fire or died in the
fire.
1993 (Supp)
1) Discuss the causes of extrahepatic biliary obstruction, and the
pathological effects of such obstruction on the liver.
2) Discuss the aneuryms of the cerebral arteries. What are the complications
of these aneurysms?
3) Give an account of the pathology of bronchogenic carcinoma under the
following headings:
(a) Aetiology
(b) Histological types
(c) Complications
4) Write brief notes on each of the following:
(a) Chronic gastritis
(b)
Analgesic nephropathy
(c) Osteoporosis
(d)
Medulloblastoma
5) A 3-year-old infant was admitted to hospital for management of moderate
to severe dehydration due to gastroenteritis. Biochemical tests performed on an
unanticoagulated blood specimen showed the following results.
Plasma:
[
Na+ ]
138 mmol/L ( 132 -
148 )
[
K+ ]
3.0 mmol/L (
3.2 - 4.8 )
[
Cl- ]
110 mmol/L
( 96 - 108 )
[
HCO3- ]
12 mmol/L ( 23
- 33 )
[
Urea ]
2.5 mmol/L ( 3.0 -
6.5 )
[
Creatinine ] 0.06 mmol/L ( 0.03 - 0.06
)
[ Glucose ] 3.0
mmol/L
( 3.2 - 5.5 )
Discuss and explain the underlying mechanisms giving rise to these biochemical findings and suggest how you would utilize the chemical pathology laboratory in the further investigation and management of this sick child.
6) Describe the various means of identification of an unknown body. What are
the advantages and disadvantages of these means?
1) Give an account of the pathology of carcinoma of the stomach. Discuss the
possible aetiological factors and the changes which have occurred in the
incidence of this condition.
2) Describe the macroscopic and microscopic changes that may be seen in the
kidney after obstruction of the ureter. Give an account of how these changes are
produced.
3) Describe the pathological changes that may be found in a patient
suffering from hypertension.
4) Explain briefly the mechanisms responsible for the
following:
(a) ascites in cirrhosis of the liver
(b) cardiac failure in pulmonary emphysema
(c) acute renal failure following extensive burns
5) Discuss how the laboratory can aid in the evaluation of patients with
suspected paraproteinaemias.
6) Describe the procedures you will take to examine a person brought in for
drunken driving. What are the effects of alcohol on driving
skill?
1992 (Supp)
1)
Discuss the causes of cerebral
infarction. Describe the gross and microscopic appearances of a cerebral infarct
and mention briefly the functional effects of such a lesion.
2) Discuss the histological classification of carcinoma of the thyroid gland, relating it to prognosis. Describe the pathological features and
modes of spread of any ONE of the histological types.
3)
Write brief notes
on:
a)
complications of cirrhosis of
liver
b)
pathological changes in the bones in
hyperparathyroidism
c)
anatomical sites of peptic
ulceration
4)
Describe and explain the
pathological changes in the heart, lungs and liver that may be associated with
long-standing mitral stenosis of rheumatic origin.
5)
A 65-year-old man presents with
nausea and weakness. His serum sodium is found to be 125 mmol/L ( reference: 135 – 150 mmol/L
). Discuss the laboratory tests that can be of help in elucidating further the
nature of his abnormality.
6)
Under what circumstances would a
person suffer from carbon monoxide poisoning? Describe the post-mortem findings
in a case of death from carbon monoxide poisoning.
1) Discuss the pathogenesis and complications of
cholelithiasis.
2) What is bronchiectasis? Discuss the aetiology, pathogenesis and
complications of this condition.
3) Discuss the predisposing factors in the development of carcinoma of the
breast. Give an account of the histological types and the factors which may
affect prognosis.
4) Write brief notes on:
a) chronic gastritis
b) idiopathic thrombocytopenic purpura
c) diabetic nephropathy
5) A 28-year-old patient is four months pregnant and is suspected of having
thyrotoxicosis. Her plasma thyroxine concentration is found to be 180 nmol/L (
reference range: 60-155 mmol/L ). Discuss how you would, using the chemical
pathology laboratory, further investigate this patient, briefly explaining the
underlying basis of the tests you intend to use.
6) A charred body was recovered from a fire. Describe the steps you would
take to identify the person, establish the cause of death and determine if the
person had died in or before the fire.
1991 (Supp)
1)
A man of 40 years of age dies of chronic rheumatic heart
disease. Give an account of the pathological changes that may be found at
autopsy.
2)
What are the possible causes of ascites in a woman 50
years of age? Discuss briefly the mechanisms involved in each
case.
3)
Discuss the pathogenesis of thyrotoxicosis. What are the
morphological changes which may be seen in the thyroid gland in
thyrotoxicosis?
4)
Write brief notes on:
a)
hepatic changes in chronic alcoholism
b)
sites of occurrence and functional effects of carcinoid
tumours
c)
gross and microscopic features in the uterus with
endometrial hyperplasia
5)
A 60-year-old woman is found to have a serum calcium
level of 3.8 mmol/L ( reference range: 2.1 – 2.5 mmol/L ). How would you use the
chemical pathology laboratory to aid in the diagnosis and management of this
patient?
6)
Describe the “Battered Baby Syndrome”. What are the
injuries on the child that would lead you to suspect this syndrome? What are the
steps that you would take to investigate this condition?
1) Briefly differentiate between the terms arteriosclerosis and
atherosclerosis and then describe in detail the genesis of an
atherosclerotic plaque. Conclude your answer by listing the complications of
atherosclerosis in the abdominal aorta.
2) A patient is referred to you because of a discrete lump in the neck which
his medical officer suspects may be Hodgkin’s disease. What clinical features
would you look for, and what investigatory processes would you undertake to
confirm or exclude this diagnosis?
3) Discuss the possible causes of biliary obstruction and the effects of
such obstruction on the liver.
4) Write brief notes on:
(a) centrilobular emphysema
(b) diverticular disease of the large bowel
(c) membranous nephropathy
5) Discuss the role of the laboratory in the biochemical evaluation of
patients with cancer.
6) Describe the presentations and pathological changes in a case of paraquat
poisoning. What is the usual outcome of these cases?
1990 (Supp)
1) What is an aneurysm? Discuss the various types of aneurysms of the aorta
in terms of their pathogenesis and pathological effects.
2) Discuss the pathogenesis and complications of tuberculous meningitis. How
would examination of the cerebrospinal fluid help in the differential diagnosis
of this condition?
3) Give an account of the pathology of acute haemorrhagic pancreatitis, and
explain the possible laboratory findings in the blood and urine in this
condition.
4) Write brief notes on:
(a) mucinous cystadenoma of the ovary
(b) papillary
carcinoma of the thyroid
(c) Paget’s disease of the nipple
5) A 40-year-old man was found to have a blood pressure of about 170 / 110
mmHg on several occasions by his doctor. Discuss how biochemical investigations
would help in the management of this patient.
6) When a body is recovered from water, how would you determine if the
person was dead before or after entering water? Discuss the mechanisms of death
from drowning in fresh water and in sea water.
Copyright © Joseph Ong 2003
