PATHOLOGY QUESTIONS.
Instructions:
• This section consists of Ten (10) questions
• Encircle the letter of the most correct answer
• One (1) mark will be awarded for each correct answer
1. The major difference between cerebral oedema and hydrocephalus is that in cerebral oedema;
A. There is massive increase in intracranial pressure
B. The choroid plexus are producing more CSF than usual
C. There is increase in CSF volume in the ventricular system
D. THERE IS ACCUMULATION OF FLUID WITHIN THE BRAIN PARENCHYMA
E. The brain becomes large due to increase in intracranial pressure.
2. A common and early event in cardiovascular disease (CVD) happens when damage occurs to the :
A. Myocardium
B. Endometrium
C. ENDOTHELIUM,
D. Endocardium
E. Carotid artery
3. A condition resulting from incomplete closure of urethral folds on the underside of the penis during embryological development is termed as;
A. Epispadias
B. Chordee
C. HYPOSPADIAS
D. Balanoposthitis
E. Balanitis
4. Varicose veins are enlarged veins that are visible through the skin and may appear as:
A. Reddish brown
B. BLUE OR PURPLE
C. Colourless
D. Milky white
E. Dark red
5. Pulmonary embolism is the most common serious clinical complication of;
A. Myocardial infarction
B. Cerebrovascular accident
C. DEEP VEIN THROMBOSIS
D. Hypertension
E. Angina pectoris
6. Vascular Changes During Acute Inflammation includes one of the following;
A. TRANSIENT VASOCONSTRICTION
B. Vasodilatation of venules
C. Decreased Vascular Permeability
D. Increased vascular resistance
E. Increased vascular volume
7. The following is an example of autosomal recessive diseases;
A. Marfan’s syndrome
B. Retinoblastoma
C. Osteogenesis imperfect
D. Neurofibromatosis
E. SICKLE CELL ANEMIA
8. Leucocyte emigration from venules during inflammation is influenced by;
A. Prostaglandins
B. Chemokines
C. Nitric oxides
D. INTEGRINS
E. Bradykinins
9. The following are examples of autoimmune disease, EXCEPT;
A. Type 1 Diabetes Mellitus
B. Rheumatoid arthritis
C. Multiple sclerosis
D. ADRENAL HYPERPLASIA
E. Systemic lupus erythematosus
10. In a family, a father is having a disease and a mother is normal. The disease is inherited to only daughters and not to the sons. What type of disease is this?
A. SEX-LINKED DOMINANT
B. Sex-linked recessive
C. Autosomal dominant
D. Autosomal recessive
E. Multifactorial inheritance
SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS
Instructions:
• This section consists of Four (4) questions with five (5) options each
• Write the word “TRUE” and NOT letter ‘T’ for a correct statement and the word “FALSE” NOT letter ‘F’ for incorrect statement in the space provided before each option
• All responses should be in CAPITAL letters
• Half (1/2) a mark will be awarded for each correct response
• Responses with letters ‘T’ and ‘F’ will not be awarded any mark
• There will be a penalty of half (1/2) of allocated marks for responses with small letters.
1. Regarding apoptosis in physiological situation;
A. FALSE Cell death during mycobacterium infection.
B. FALSE Atrophy of parenchymal organs after duct obstruction
C. FALSE Elimination of damaged cell after exposure to radiation.
D. TRUE Programmed destruction of cells during embryogenesis.
E. TRUE Elimination of potentially harmful self – reactive lymphocytes.
2. Steps of phagocytosis during inflammation include;
A. FALSE Transient vasoconstriction of small arteries.
B. TRUE Killing or degradation of the ingested material.
C. FALSE Migration of leukocytes across the vascular wall
D. TRUE Engulfment and formation of vacuoles by leukocytes
E. TRUE Recognition and attachment of stimulus particles to the leukocytes
3. According to the nature of the pain receptors, abdominal pain can be classified as;
A. TRUE Visceral
B. FALSE Peptic ulcers
C. TRUE Somatoparietal
D. FALSE Splenomegaly
E. TRUE Referred
4. Regarding the gastrointestinal tract immune system.
A. TRUE The gastrointestinal system is a potential portal of entry for pathogenic organisms.
B. TRUE The mucous membrane is protective, secretory, absorptive or a combination of these in different parts of the tract
C. TRUE Secretory immunoglobulin A (sIgA) is an antibody that plays a crucial role in the immune function of mucous membranes
D. TRUE The gut-associated lymphoid system is distributed throughout the tract.
E. FALSE Protective mucus is produced and preserved by paneth cells
SECTION C: MATCHING QUESTIONS 10 MARKS
Instructions:
• This section consists of two (2) questions of matching with five (5) options each
• Match the items from column B with those in column A by writing the letter of correct response in the space provided on each option. USE CAPITAL LETTERS
• Each correct response is awarded one (1) mark
Each item from column B is used only once
I. Match the following descriptions from column A with the corresponding conditions from column B:
S/N ANSWER COLUMN A
(Descriptions) COLUMN B
(Conditions)
1. G Aneurysms that are essentially spherical outpouchings A False Aneurysm
2. D A localized abnormal dilation of a blood vessel or the heart. B Arterial Dissection
3. A A breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space C Varicose veins
4. B Arises when blood enters the wall of the artery, as a hematoma dissecting between its layers. D An aneurysm
5. C Abnormally dilated, tortuous veins E Lyphangitis
F Fusiform aneurysms
G Saccular aneurysms
II. Match the explanations from COLUMN B with their corresponding patterns of necrosis in COLUMN A.
S/N ANSWER COLUMN A
(Patterns of tissue necrosis) COLUMN B
(Explanations)
1. C Coagulative Necrosis A Type of necrosis which refers to the death of tissue due to the lack of blood flow/supply
2. G Liquefactive Necrosis B A special form of necrosis usually seen in immune reactions involving blood vessels
3. A Gangrenous Necrosis C A type of accidental cell death typically caused by ischemia or infarction.
4. D Caseous Necrosis D The dead tissues appears as the soft and white proteinaceous dead cell mass
5. B Fibrinoid Necrosis E The type of necrosis which refers to the death of tissue due to the uncontrolled cell divisions
F The type of necrosis which refers to the death of tissue due to the lack of blood flow/supply
G Type of necrosis which results in transformation of the tissue into a liquid viscous mass
H A specific pattern of reversible, controlled cell death that occurs when antigen-antibody complexes are deposited in the walls of blood vessels along with fibrin
SECTION D SHORT ANSWER QUESTIONS 40 MARKS
Instructions:
• This section consists of Eight (8) questions.
• Write your answers in the space provided on each question.
Write a readable handwrite; DIRTY WORK IS NOT ALLOWED
1. List six (6) Broad categories of the causes of cell injury; (6marks)
i. Oxygen deprivation
ii. Physical agents
iii. Chemical agents and drugs
iv. Infectious agents
v. Immunological reaction
vi. Genetic derangements
vii. Nutritional imbalances
2. List four (4) stages in the pathogenesis of pneumococcal pneumonia; (4marks)
i. Congestion
ii. Red hepatization
iii. Gray hepatization
iv. Resolution
3. Mention five (5) principal adaptive responses of a body tissue/organ to stimuli; (5Marks)
i. Hypertrophy,
ii. Hyperplasia,
iii. Atrophy,
iv. Metaplasia.
v. Dysplasia
4. List six (6) causes of pathological atrophy; (6marks)
i. A decreased workload
ii. Loss of innervations
iii. Diminished blood supply
iv. Inadequate nutrition
v. Loss of endocrine stimulation
vi. Aging (senile atrophy)
5. Mention four(4) types of tissues depending on their ability to repair; (4marks)
i. Continuously Dividing Tissues
ii. Stable Tissues
iii. Permanent Tissues
iv. Stem Cells
6. Mention any five (5) presenting features of the gastrointestinal (GI) pathologies; (5 Marks)
i. Abdominal pain
ii. GI bleeding
iii. Diarrhoea
iv. Steatorrhea
v. Constipation
vi. Nausea and vomiting
vii. Dysphagia
viii. Odynophagia
ix. Gastroesophageal reflux
x. Anorexia
xi. Weight loss
7. a) Define Herniation; (2 marks)
Herniation is the displacement of brain tissue past rigid dural folds (the falx and tentorium) or through openings in the skull because of increased intracranial pressure.
b) Outline three (3) types of herniation; (3 marks)
i. Subfalcine (cingulate) herniation
ii. Transtentorial (uncinate) herniation
iii. Tonsillar herniation
8. Mention any five (5) modifiable risk factors for cardiovascular diseases; (5 marks)
i. Smoking
ii. Physical inactivity
iii. Unhealthy diet
iv. Overweight/ Obesity
v. High blood pressure/ Hypertension
vi. Hyperlipidemia
vii. Harmful use of alcohol
viii. Diabetes
SECTION E: GUIDED EESSAY QUESTION 30 MARKS
Instructions
• This section consists of two (2) questions which are supposed to be answered in a narrative way
• Write your answer on the blank pages of this question paper; each question should start on a new page
• There will be a penalty of three (3) marks from score attained in this section if question(s) is/are not answered in essay form
1. Describe five (5) causes of hypersensitivity reactions; (3marks @point)
Answers
i. Autoimmunity causing autoimmune diseases
ii. Reactions against microbes e. g. post-streptococcal glomerulonephritis
iii. Cross-reaction of antibodies and/or T cells reactive with a microbe with a host tissue(s) e. g rheumatic heart disease (RHD)
iv. Injured host tissues during the process of eradicating infection e. g. viral hepatitis
v. Reactions against environmental antigens e. g. allergic reactions
2. Describe Cholelithiasis (Gallstones) using the following guide. Types of gall stones, simultaneous conditions in formation of gall stones, complications of gall stones;
Answer:
Types of gall stones: ( 2 Marks)
i. Cholesterol stones, containing more than 50% of crystalline cholesterol monohydrate,
ii. Pigment stones composed predominantly of bilirubin calcium salts.
Simultaneous conditions in formation of gall stones (8 marks @ 2marks)
i. Super-saturation of the bile with cholesterol.
ii. Establishment of nucleation sites by micro-precipitates of calcium salts.
iii. Hypo mobility of the gallbladder (stasis), which promotes nucleation.
iv. Mucus hyper-secretion to trap the crystals, enhancing their aggregation into stones.
Complications of gall stones. ( 4 marks @ 1 mark)
i. Inflammation of the gallbladder.
ii. Blockage of the common bile duct.
iii. Blockage of the pancreatic duct.
iv. Gallbladder cancer.
SECTION A: MULTIPLE CHOICE QUESTIONS 10 MARKS
INSTRUCTIONS:
• This section consists of ten (10) questions;
• Respond by circling of the most correct answer
• One mark will be awarded for each correct answer.
1. One of the following disease is caused by point mutation:
A SICKLE CELL DISEASE
B Marfan’s syndrome
C Retinoblastoma
D Osteogenesis imperfect
E Neurofibromatosis
2. One of the following is an example of the X-linked recessive diseases:
A Diabetes Mellitus
B Hypertension
C Gout
D HEMOPHILIAS A AND B
E Schizophrenia
3. Mr. X 32 years of age, who has been drinking water from the tap without boiling, came to the hospital complaining of poorly localized periumbilical pain which loosely corresponds to the spinal segment L4 and 5. This pain is classified as:
A Parietal Pain
B Generalized Pain
C VISCERAL PAIN
D Somatoparietal pain
E Referred pain
4. Gastrointestinal bleeding can be classified into three categories upper, middle and Lower GI bleeding: The anatomical demarcation for upper GI bleeding is:
A Distal to the ileocecal valve
B Between the small intestine
C Along the Oesophagus
D From the Mouth to the cardiac sphincter
E PROXIMAL TO THE LIGAMENT OF TREITZ
5. One of the following disorders causes gastrointestinal motility disturbances:
A DISORDERS OF THE EXTRINSIC NERVOUS SYSTEM
B Disorders of the gastric secretion
C Disorders of the mucous lining of the GIT
D Disorders of the Parietal Na+/K+ pump
E Disorders of the endocrine system
6. Non-communicating hydrocephalus is most commonly seen with masses at the:
A Central Gyrus
B Lateral geniculate body
C Brain Sterm
D FORAMEN OF MONRO
E Cisterna Magna
7. One of the following is an example of direct acting human carcinogen:
A Benzopyrene
B Azo Dyes
C Aflatoxin
D UV Rays
E ALKYLATING AGENTS
8. The most important determining modifying variable for a focal cerebral ischemia is:
A The size, location, and shape of the infarct
B The extent of tissue damage
C The volume of blood flow
D THE ADEQUACY OF COLLATERAL FLOW
E Arterial wedge pressure
9. One of the following is NOT an oncogenic virus
A Human T-Lymphocyte Virus-1
B Human Papilloma Virus
C Hepatitic B Virus
D Hepatitis C Virus
E INFLUENZA VIRUS
10. The principal cells responsible for repair and scar formation in the brain is called:
A Glial Cells
B ASTROCYTES
C Fibroblast
D Oligodendrocytes
E Ependymal cells
SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS
INSTRUCTIONS:
• This section consists of four (4) questions with five (5) options
• Write the word “TRUE” and NOT letter ‘T’ for a correct statement and the word “FALSE” NOT letter ‘F’ for incorrect statement
• Half (½) a mark will be awarded for each correct response
QN 1: Malignant neoplasms disseminate by one of the pathwayst :
A ____TRUE_________ Seeding within body cavities
B ____FALSE________ Epithelial layers
C ____TRUE_________ Lymphatic spread
D ____FALSE________ Phagocytic action of WBCs
E ____TRUE_________ Haematogenous spread
QN 2: Acute upper GI bleeding, which may be manifested as:
A ____TRUE_________ Vomiting Blood
B ____TRUE_________ Black Tarry Stool
C ____FALSE________ Fresh Anal Bleeding
D ____FALSE________ Fresh bleeding per vagina
E ____FALSE________ Coughing Fresh Blood
QN 3:The following statements are CORRECT with regards to autosomal recessive diseases:
A ____TRUE_________ The mutated gene is recessive to its allele coding for normal function
B ____TRUE_________ Both males and female may carry the gene ____FALSE________ The recurrence risk is 50% for each birth
C ____TRUE_________ Beta-Thelassemia is an example of autosomal recessive disease
D ____TRUE_________ It follows Mendel’s first law of gene segregation.
QN 4: The following statements describes the pathogenesis of hydrocephalus
A ____FALSE_________ Refers to the accumulation of excessive CSF within the ventricular system
B ____TRUE_________ Occur as a consequence of impaired flow or impaired resorption of CSF
C ____TRUE _________ Overproduction of CSF can be the cause but occur rarely
D ____FALSE_________ In most of the times is caused by tumours of the choroid plexus
E ____FALSE_________ Hydrocephalus developing after fusion of the sutures results in enlargement of the head
SECTION C: MATCHING QUESTIONS 10 MARKS
Instructions:
• This section consists of two (2) matching questions, each with five (5) options.
• Match the items from column B with those in column A by writing the letter of the correct response in the space provided. USE CAPITAL LETTERS Only.
• Each correct response is awarded one (1) mark.
• Each item from column B is used only once.
QN 1: Match the following signs in Column A with their relevant description in Column B AND put the answer in the ANS column.
SN ANS COLUMN A COLUMN B
1) D Dsyphagia A Burning pain or discomfort that rises up the retrosternum
2) G Odynophagia B Loss of the desire to eat
3) E Achalasia C Vomiting Blood
4) F Melena D The sensation of solids or liquids not passing from the mouth into the stomach
5) B Anorexia E Incomplete relaxation of the lower esophageal sphincter in response to swallowing producing functional obstruction of the esophagus
F Black Tarry Stool
G Pain with swallowing
H Persistent or recurrent epigastric pain
QN 2: Match the tumor markers in Column A with the neoplastic disease they indicate in Column B AND put the answer in the ANS column:
SN ANS COLUMN A COLUMN B
1. H Human Chorionic Gonadotrophin (HCG) A Colo-Rectal Cancer.
2. D Alpha feto-protein (AFP) B Prostatic Cancer
3. A Carcino-embyonic antigen (CEA) C Burkit Lymphoma
4. B Prostatic acid phosphatase D Hepatoma
5. F Paraproteins (monoclonal immunoglobulins) E Hepatocellular Carcinoma
F Myeloma
G Viganal Warts
H Chorionic Carcinoma
SECTION D: SHORT ANSWER QUESTIONS 40 MARKS
INSTRUCTIONS:
• This section consists of eight (8) questions.
• Write your answer in the space provided
• Write a readable handwrite; DIRTY WORK IS NOT ALLOWED.
1 Mention Ten(10) presenting features of the GI pathologies:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer 10 points @ 1 marks
• Abdominal pain
• GI bleeding
• Diarrhoea
• Steatorrhea
• Constipation
• Nausea and vomiting
• Dysphagia
• Odynophagia
• Gastroesophageal reflux
• Anorexia
• Weight loss
2 Outline four(4) major mechanisms that combine to create cirrhosis:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: 4 points @ 1 mark
• Hepatocellular death
• Regeneration
• Progressive fibrosis
• Vascular changes
3 Outline the four(4) major clinical consequences of portal hypertension
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: 4 points @ 1 mark
• Ascites
• The formation of portosystemic venous shunts
• Congestive splenomegaly
• Hepatic encephalopathy
4 Both malignant and benign tumours may cause problems to the adjacent organs or tisuues causing several clinical features such as Anaemia: Mention five(5) mechanism on how the tumours cause observable clinical features:
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ANSWER: Five(5) points @ 1 mark
• Location and impingement on adjacent structures
• Functional activity such as hormone synthesis or the development of paraneoplastic syndromes
• Bleeding and infections when the tumour ulcerates through adjacent surfaces.
• Symptoms that result from rupture or infarction
• Cachexia or wasting
5 Mention five (5) examples of X-Linked recessive diseases:
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ANSWER: Five (5) points @ 1 mark
• Duchenne muscular dystrophy
• Hemophilias A and B
• Chronic granulomatous disease
• Glucose-6-phosphate dehydrogenase deficiency
• Diabetes insipidus
6 Outline four(4) simultaneously occurring conditions causing cholesterol gallstone formation:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: 4 points@ 1 marks
• Super-saturation of the bile with cholesterol.
• Establishment of nucleation sites by micro-precipitates of calcium salts.
• Hypomobility of the gallbladder (stasis), which promotes nucleation.
• Mucus hyper-secretion to trap the crystals, enhancing their aggregation into stones.
7 Outline the basic alterations associated with pancreatitis:
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: 5 points @ 1 mark
• Micro-vascular leakage causing oedema.
• Necrosis of fat by lipases.
• An acute inflammatory reaction.
• Proteolytic destruction of pancreatic parenchyma.
• Destruction of blood vessels with haemorrhage.
8 Outline the three pathological basic processes of Cerebral Vascular Accident (CVA):
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: 3 points @ 1 mark
• Thrombotic occlusion of vessels
• Embolic occlusion of vessels
• Vascular rupture
SECTION E: GUIDED ESSAY QUESTIONS 30 MARKS
INSTRUCTIONS
• This section consists of three (3) questions which are to be answered in a narrative way
• Write your answer in the back of the page; each question should start on a new page.
1 Describe abdominal pain using the following guide( pathogenesis, causes, types of pain with examples)
ANSWER
Pathogenesis: 2 marks
The complaint of abdominal pain depends on a complex interaction of sensory neuroreceptors in the abdominal organs and transmission of these impulses through the autonomic nervous system.
Cause: 5 points @ 1 mark
Pain originates from:
• Tissue injury,
• Distention,
• Contraction,
• Inflammation, and
• Direct chemical injury.
Types of pain: 3 points @ 1 mark
• Visceral pain is often poorly localized and loosely corresponds to the spinal segment that innervates the involved viscus. (0.5 marks)
Examples include peptic ulcer disease in which pain is localized to the epigastrium, and early appendicitis, in which pain is localized around the periumbilical region. (0.5 marks)
• Somatoparietal pain arises from noxious stimulation of the parietal peritoneum.
This type of pain is more localized and intense and corresponds to the dermatomal distribution that innervates the injured portion of the peritoneum.(0.5 marks)
Examples of somatoparietal pain include appendicitis, with localized right lower quadrant pain attributable to localized peritonitis, and an abscess, with localized pain over the perforated viscus and inflammatory collection .(0.5 marks)
• Referred pain is perceived by the patient in areas that are remote from the diseased organ.
They occur as a result of visceral and afferent neurons from different anatomic regions converging at the same spinal cord segment(0.5 marks)
Example diseased gallbladder causing right subscapular pain or Non-abdominal diseases, including myocardial infarction and pneumonia, can cause pain that is centered in or radiates to the abdominal area(0.5 marks)
2 Describe liver(hepatic) failure using the following guide(Meaning(definition), mechanism, and alteration causing failure)
ANSWER
Meaning(Definition): 1 mark
• This is the loss of 80% to 90% of hepatic function
Mechanism: 3 marks
• It generally develops as the end point of progressive damage to the liver, either by insidious destruction of hepatocytes OR
• By repetitive discrete waves of parenchymal damage OR
• Less commonly, hepatic failure is the result of sudden and massive destruction of hepatic tissue.
ALTERATION CAUSING FAILURE: 6 marks @ 2 marks
The alterations that cause liver failure fall into three categories:
• Acute liver failure with massive hepatic necrosis
o This is most often caused by drugs or fulminant viral hepatitis.
o Acute liver failure denotes clinical hepatic insufficiency that progresses from onset of symptoms to hepatic encephalopathy within 2 to 3 weeks.
• A course extending as long as 3 months is called subacute liver failure.
o The histologic correlate of acute liver failure is massive hepatic necrosis.
o It is an uncommon but life-threatening condition that often requires liver transplantation.
• Chronic liver disease
o This is the most common route to hepatic failure and is the end point of relentless chronic liver damage ending in cirrhosis.
• Hepatic dysfunction without overt necrosis
o Hepatocytes may be viable but unable to perform normal metabolic function, as in acute fatty liver of pregnancy (which can lead to acute liver failure a few days after onset), tetracycline toxicity, and Reye syndrome
3 Describe malignant neoplasm using the following subheadings ( definition of neoplasm, Nomenclature of malignant tumors, distinctive characteristics from benign tumors, Metastasis pathways and effects on host)
ANSWER
DEFINITION OF NEOPLASIA 0.5 marks
• Neoplasia literally means new growth
OR
• A neoplasm is an abnormal mass of tissue of which the growth exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after the cessation of the stimuli which evoked the change.
NOMENCLATURE OF MALIGNANT TUMORS Four(4) points @ 1 marks
• Malignant neoplasms arising from mesenchymal tissue or its derivatives are called sarcomas.
• A cancer of fibrous tissue origin is a fibrosarcoma, and a malignant neoplasm composed of chondrocytes is a chondrosarcoma.
• Malignant neoplasms of epithelial cell origin are called carcinomas.
• Carcinomas that grow in a glandular pattern are called adenocarcinomas, and those that produce squamous cells are called squamous cell carcinomas.
• Sometimes the tissue or organ of origin can be identified, as in the designation of renal cell adenocarcinoma or cholangiocarcinoma, which implies an origin from bile ducts.
• Sometimes the tumour shows little or no differentiation and must be called poorly differentiated or undifferentiated carcinoma
DISTINCTIVE CHARACTERISTICS FROM BENIGN TUMORS 4 points @ 1 marks
• Benign and malignant tumours can be distinguished on the basis of Degree of differentiation, Rate of growth, Local invasiveness and Distant spread
• Degree of Differentiation
o Benign tumours resemble the tissue of origin and are well differentiated
o Malignant tumours are poorly or completely undifferentiated (anaplastic)
• Rate of Growth
o Most benign tumours grow slowly, and most malignant tumours grow much faster eventually spreading locally and to distant sites (metastasizing) and causing death.
• Local Invasion
o A benign neoplasm remains localized at its site of origin.
o It does not have the capacity to infiltrate, invade, or metastasize to distant sites, as do malignant neoplasms.
o Malignant tumours do not develop well-defined capsules
• Metastasis(Distant spread)
o Malignant neoplasms disseminate in remote tissues forming secondary implants (metastases) discontinuous from the primary tumour.
o Benign tumors have no capacity to Metastize
EFFECTS ON HOST 3points @ 0.5 marks
Location is crucial in both benign and malignant tumours
• A small (1-cm) pituitary adenoma can compress and destroy the surrounding normal gland and give rise to hypopituitarism
• A 0.5-cm leiomyoma in the wall of the renal artery may lead to renal ischemia and serious hypertension
• A small carcinoma within the common bile duct may induce fatal biliary tract obstruction
Cancer cachexia
• Many cancer patients suffer progressive loss of body fat and lean body mass, accompanied by profound weakness, anorexia, and anaemia, referred to as cachexia
Paraneoplastic syndromes
• Symptom complexes that occur in patients with cancer and that cannot be readily explained by local or distant spread of the tumour or by the elaboration of hormones indigenous to the tissue of origin of the tumour are referred to as paraneoplastic syndromes
**** ALL THE BEST****
1. List four(4) aspects of a disease process;
Answers
i. Its cause or aetiology
ii. The mechanisms of its development, pathogenesis
iii. The structural alterations induced in the cells and organs of the body, morphologic changes
iv. The functional consequences of the morphologic changes, clinical significance
2. List four(4) patterns of chromosomal rearrangement after breakage;
Answers
i. Translocation
ii. Isochromosomes
iii. Deletion
iv. Inversions
3. List five (5) Cardinal signs of inflammation;
Answers
i. Heat (calor)
ii. Redness (rubor)
iii. Pain (dolor)
iv. Swelling(tumor)
v. Loss of function
4. Highlight five(5) risk factors for tumor/cancer development;
Answers
i. Alcohol and tabacco.
ii. Diet.
iii. Hormones.
iv. Immunosuppression.
v. Infectious agents.
vi. Obesity.
vii. Radiations.
viii. Sunlight.
ix. Age.
5. List four (4) causes of hypersensitivity reactions;
Answers
i. Autoimmunity causing autoimmune diseases
ii. Reactions against microbes e. g. post-streptococcal glomerulonephritis
iii. Cross-reaction of antibodies and/or T cells reactive with a microbe with a host tissue(s) e. g rheumatic heart disease (RHD)
iv. Injured host tissues during the process of eradicating infection e. g. viral hepatitis
v. Reactions against environmental antigens e. g. allergic reactions
6. Mention four (4) types of hypersensitivity reactions;
Answers
i. Immediate (Type I) Hypersensitivity,
ii. Antibody-Mediated (Type II) Hypersensitivity,
iii. Immune Complex-Mediated (Type III) Hypersensitivity,
iv. T-Cell-Mediated (Type IV) Hypersensitivity,
7. List two(2) types of immunity;
Answers
i. Innate Immunity
ii. Adaptive immunity
8. List two(2) types of adaptive immune responses;
Answers
i. Humoral immunity,
ii. Cell-mediated (or cellular) immunity,
9. Mention the causes of immune deficiency diseases;
Answers
i. Inherited defects affecting immune system development, (primary)
ii. They may result from secondary effects, other diseases, drugs or chemicals examples are;
- Infection
- Malnutrition
- Aging
- Immunosuppression
- Autoimmunity
- Chemotherapy
- Steroids
10. Mention two(2) types of autoimmune diseases;
Answers
i. Organ specific diseases
ii. Non organ specific diseases
11. Distinguish between primary and secondary immune deficiency diseases;
Answers
Primary immune deficiency diseases are rare and mostly are genetically determined, they are inherited from parents to off-springs.
While
Secondary immune deficiency diseases involves Immune deficiencies secondary to other diseases or therapies are much more common than the primary (inherited) disorders.
12. Mention four (4) factors used for differentiating benign and malignant tumors;
Answers
i. Degree of differentiation
ii. Rate of growth
iii. Local invasiveness
iv. Distant spread
13. List three (3) pathways used for dissemination of malignant neoplasms;
Answers
i. Seeding within body cavities
ii. Lymphatic spread
iii. Haematogenous spread
14. List three (3) classes of carcinogenic agents;
Answers
i. Chemicals
ii. Radiant energy
iii. Microbial agents
15. List five (5) Broad categories of causes of cell injury;
Answers
i. Oxygen deprivation
ii. Physical agents
iii. Chemical agents and drugs
iv. Infectious agents
v. Immunological reaction
vi. Genetic derangements
vii. Nutritional imbalances
16. Mention five (5) growth factors and cytokines involved in regeneration and wound healing;
Answers
i. Epidermal growth factor
ii. Transforming growth factor α
iii. Hepatocyte growth factor (scatter factor)
iv. Vascular endothelial cell growth factor (isoforms A, B, C, D)
v. Platelet-derived growth factor (isoforms A, B, C, D)
vi. Fibroblast growth factor 1 (acidic), -2 (basic), and family
vii. Transforming growth factor β(isoforms 1, 2, 3)
viii. Keratinocyte growth factor (FGF-7)
17. Mention four(4) systemic effects of chronic inflammation;
Answers
i. Fever;
ii. Anaemia;
iii. Leucocytosis;
iv. Elevated Erythrocytes Sedmentation Rate (ESR);
v. Amyloidosis;
18. Mention four (4) morphological patterns of inflammation;
Answers
i. Serious inflammation
ii. Fibrinous inflammation
iii. Suppurative or purulent inflammation
iv. Ulcers
19. List three (3) classification of genetic diseases;
Answers
i. Disorders with multifactorial inheritance(polygenic)
ii. Monogenic(mendelian disorders)
iii. Chromosome aberrations
20. Describe the three(3) patterns of mendelian or monogenic inheritance;
Answers
i. Autosomal dominant- both the homozygous and heterozygous are affected. both males and females are affected, they are inherited from one parent.
ii. Autosomal recessive- only homozygotes are affected. Heterozygotes are only carriers
iii. X-linked- transmitted by heterozygous mother to sons. The genes are carried in the X-chromosome.
21. Mention four(4) Vascular Changes During Acute Inflammation;
Answers
i. Transient Vasoconstriction
ii. Arteriolar Vasodilatation
iii. Increased Vascular Permeability
iv. Exudation
22. List four(4) outcomes of acute inflammation;
Answers
i. Resolution
ii. Fibrosis
iii. Progression to Chronic inflammation
iv. Spread
v. Death
23. Mention any five (5) inflammatory mediators;
Answers
i. Histamine
ii. Serotonin
iii. Lysosomal enzymes
iv. Prostaglandins
v. Leukotrienes
vi. Platelet activating factors
vii. Activated oxygen species
viii. Nitric oxides
ix. Cytokines
x. Kinin system (bradykinins)
xi. Coagulation or fibrinolysis system
xii. Anaphylatoxins
24. List four (4) stages in the pathogenesis of pneumococcal pneumonia;
Answers
i. Congestion
ii. Red hepatization
iii. Gray hepatization
iv. Resolution
25. Describe four (4) phases of the cell cycle;
Answers
i. G1 phase. Metabolic changes prepare cell for cell division
ii. S-(Synthesis) phase. DNA synthesis replicates the genetic material. Each chromosomes now consists of two sister chromatids.
iii. G2 phase. Metabolic changes assemble the cytoplasmic materials necessary for mitosis and cytokinesis.
iv. M-(mitosis) phase. A nuclear division(mitosis) followed by cell division(cytokinesis)
26. Mention five (5) complications of atherosclerosis;
Answers
i. Occlusion of a coronary artery, causing myocardial infarction (a heart attack).
ii. Occlusion of carotid artery to cause stroke.
iii. Angina
iv. Pulmonary embolism (blockage in the pulmonary artery)
v. Thromboembolism (rupture of the soft plaque to form a thrombus that can move to different parts of the body and cause blockage of blood vessels).
vi. Aneurysm
vii. Hypertension
27. Mention two types of aneurysms as classified by macroscopic shape and size;
Answers
i. Saccular and
ii. fusiform aneuryms
28. List the four basic clinical syndromes of Ischemic Heart Disease(IHD);
Answers
i. Angina pectoris
ii. Acute myocardial infarction (MI)
iii. Chronic IHD
iv. Sudden Cardiac Death (SCD)
29. Explain the two types of hypertension;
Answers
i. Essential/idiopathic/primary HTN -Hypertension with unknown underlying cause.
ii. Secondary HTN - hypertension secondary or due to a known underlying cause such as renal disease.
30. Mention any five (5) presenting features of the GI pathologies;
Answer
i. Abdominal pain
ii. GI bleeding
iii. Diarrhoea
iv. Steatorrhea
v. Constipation
vi. Nausea and vomiting
vii. Dysphagia
viii. Odynophagia
ix. Gastroesophageal reflux
x. Anorexia
xi. Weight loss
31. List three(3) classes of abnormal pain;
Answer
i. Visceral pain
ii. Somatoparietal pain
iii. Referred pain
32. Highlight three(3) manifestations of Acute upper GI bleeding;
Answer
i. Hematemesis (vomiting blood)
ii. Melena (Black Tarry Stool)
iii. Hematochezia (Fresh or bright red blood in stool)
33. Mention any three (3)components of gastrointestinal tract immune system;
Answer
i. Mucous membrane
ii. Secretory IgA
iii. GALT – peyer’s patches, MLN
iv. Luminal and epithelial barrier defences
v. Cellular components such as T and B cells
vi. Non-cellular inflammatory mediators
vii. Goblet cells - mucus
viii. Paneth cells
34. Outline six (6) Morphological Responses to Hepatic Injury;
Answer
i. Degeneration and intracellular accumulation
ii. Necrosis and apoptosis
iii. Regeneration
iv. Fibrosis
v. Cirrhosis
vi. Ductular reaction
35. Mention atleast four(4) possible causes of liver cirrhosis;
Answer
i. Chronic alcohol use,
ii. Non alcoholic fatty liver disease,
iii. Viral hepatitis,
iv. Metabolic conditions (eg. Hemochromatosis),
v. Autoimmune disorders,
vi. Alpha-1 antitrypsin deficiency,
vii. Medication toxicity
36. Mention the four(4) major mechanisms that combine to form liver cirrhosis;
Answer
i. Hepatocellular death (Apoptosis & necrosis),
ii. Regeneration,
iii. Progressive fibrosis,
iv. Vascular changes
37. Mention five(5) complications of liver cirrhosis;
Answer
i. Portal hypertension
ii. Ascites
iii. Eosophageal variceal bleeding
iv. Splenomegaly
v. Hepatic encephalopathy
vi. Coagulopathy
vii. Anemia
viii. Pancytopenia
ix. Hepatorenal syndrome
x. Hemorrhoids
38. Define insulinomas;
Answer
An insulinoma is a benign tumour of the pancreas that is derived from beta cells resulting into hyper secretion of insulin.
39. Define gastrinomas;
Answer
A gastrinoma is a tumor in the pancreas that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine.
40. Outline three basic processes that may contribute to the Pathogenesis of Cerebral Vascular Accident (CVA);
Answer
i. Thrombotic occlusion of vessels
ii. Embolic occlusion of vessels
iii. Vascular rupture
41. Define ischemic stroke and hemorrhagic stroke;
Answer
i. Ischemic stroke – stroke resulting from thrombotic/embolic occlusions
ii. Hemorrhagic stroke – stroke resulting from rupture of blood vessels supplying to the brain– bleeding
42. Mention the three(3) types of brain herniation;
Answer
i. Subfalcine (cingulate) herniation
ii. Transtentorial (uncinate) herniation
iii. Tonsillar herniation
43. Mention two (2) types of cholelithiasis (gall stones);
Answer
i. Cholesterol stones
ii. Pigment stones
44. Mention any three(3) complications of Cholelithiasis (Gallstones);
Answer
i. Inflammation of the gallbladder.
ii. Blockage of the common bile duct.
iii. Blockage of the pancreatic duct.
iv. Gallbladder cancer.
45. Differentiate between endometritis and endometriosis;
Answer
Endometritis is an inflammatory condition of the lining of the uterus.
while
Endometriosis is a condition where by endometrial glands and stroma are located outside the endometrium.
46. Differentiate between balanitis and balanoposthitis;
Answer
Balanitis refers to local inflammation of the glans/head of the penis
while
Balanoposthitis refers to local inflammation of the glans penis and the overlying prepuce.
47. List five (5) outdoor air pollutants;
Answer
i. Ozone
ii. Nitric oxide
iii. Sulfuric dioxide
iv. Acid aerosols
v. Carbon monoxide
vi. Particulates
48. List four (4) types of tinea that can cause significant diseases to human;
Answer
i. Tinea capitis
ii. Tinea pedis
iii. Tinea cruris
iv. Tinea corporis
v. Tinea barbae
vi. Tinea unguium
vii. Tinea faciei
49. Mention four (4) possible Causes of Cervical polyps;
Answer
i. Cervical infections
ii. Chronic inflammation
iii. An abnormal response to the hormone estrogen
iv. Clogged blood vessels near the cervix
50. Differentiate between hypospadias and epispadias;
Answer
Hypospadias is an abnormal opening of the urethra along the ventral (below) aspect of the penis.
while
Epispadias indicates the presence of the urethral orifice on the dorsal (Above) aspect of the penis.
SECTION A: MULTIPLE CHOICE QUESTIONS 10 MARKS
INSTRUCTIONS:
• This section consists of ten (10) questions;
• Respond by circling the most correct answer
• One mark will be awarded for each correct answer.
1 The condition where by endometrial glands and stroma are located outside the endometrium is termed as:
A. Cervicitis
B. Endometritis
C. Adenomyosis
D. ENDOMETRIOSIS
E. Adenocarcinoma
2 Progressive inflammation and fibrosis of liver parenchyma is most likely to result in:
A. Hepatitis
B. CIRRHOSIS
C. Fatty liver
D. Liver abscess
E. Heamochromatosis
3 The type of aneurysms that are essentially spherical out pouchings involving only a portion of the vessel wall are called:
A. Fusiform aneurysms
B. Aortic aneurysms
C. Dissecting aneurysms
D. SACCULAR ANEURYSMS
E. Pseudoaneurysms
4 Complications of advanced atherosclerosis are chronic, slowly progressive and cumulative. A complication that result from occlusion of pulmonary artery is termed as:
A. Pulmonary hyperplasia
B. Cerebral Vascular Accident (CVA)
C. PULMONARY EMBOLISM
D. Angina pectoris
E. Myocardial infarction (MI)
5 Mr. John 45 years of age, who has a history of hypertension and hyperlipidemia came to hospital complaining of chest pain radiating to the left arm and jaw. ECG and cardiac enzymes profile suggest Acute Myocardial Infarction. This pain is classified as:
A Parietal Pain
B Generalized Pain
C Visceral Pain
D Somatoparietal pain
E REFERRED PAIN
6 Gastrointestinal bleeding can be classified into three categories upper, middle and Lower GI bleeding: The anatomical demarcation for upper GI bleeding is:
A Distal to the ileocecal valve
B Between the small intestine
C Along the Oesophagus
D From the Mouth to the cardiac sphincter
E PROXIMAL TO THE LIGAMENT OF TREITZ
7 The major difference between cerebral oedema and hydrocephalus is that in cerebral oedema:
A. There is massive increase in intracranial pressure
B. The choroid plexus are producing more CSF than usual
C. There is increase in CSF volume in the ventricular system
D. THERE IS ACCUMULATION OF FLUID WITHIN THE BRAIN PARENCHYMA
E. The brain becomes large due to increase in intracranial pressure.
8 Emboli blocking the cerebral blood vessels often originate from the:
A. Lung
B. HEART
C. Pelvis
D. Brain stem
E. Lower limb
9 The principal cells responsible for repair and scar formation in the brain is called:
A Glial Cells
B Fibroblast
C ASTROCYTES
D Oligodendrocytes
E Ependymal cells
10 A condition resulting from incomplete closure of urethral folds on the underside of the penis during embryological development is termed as:
A. Epispadias
B. Chordee
C. HYPOSPADIAS
D. Balanoposthitis
E. Balanitis
1. The mucous membrane of the gastrointestinal system performs the following tasks:
A PROTECTIVE, SECRETORY AND ABSORPTIVE
B Protective, cellular proliferation and absorptive
C Cellular proliferation, secretory and absorptive
D Protective, cellular proliferation and secretory
E Protective and cellular proliferation only
2. The reason behind GIT being the port of entry for microorganism is:
A Has a thin membrane which is easier to penetrate
B Hydrochloric acid is a favorable culture medium for most of the organisms
C IT FORMS A CONTINUITY OF THE EXTERNAL ENVIRONMENT
D Its length makes it vulnerable for microorganism
E It is always affected by the anal organism
3. Mr. X 32 years of age, who has been drinking water from the tap without boiling, came to the hospital complaining of poorly localized periumbilical pain which loosely corresponds to the spinal segment L4 and 5. This pain is classified as:
F Parietal Pain
G Generalized Pain
H VISCERAL PAIN
I Somatoparietal pain
J Referred pain
4. Gastrointestinal bleeding can be classified into three categories upper, middle and Lower GI bleeding: The anatomical demarcation for upper GI bleeding is:
F Distal to the ileocecal valve
G Between the small intestine
H Along the Oesophagus
I From the Mouth to the cardiac sphincter
J PROXIMAL TO THE LIGAMENT OF TREITZ
5. One of the following disorders causes gastrointestinal motility disturbances:
A DISORDERS OF THE EXTRINSIC NERVOUS SYSTEM
B Disorders of the gastric secretion
C Disorders of the mucous lining of the GIT
D Disorders of the Parietal Na+/K+ pump
E Disorders of the endocrine system
6. Non-communicating hydrocephalus is most commonly seen with masses at the:
A Central Gyrus
B Lateral geniculate body
C Brain Sterm
D FORAMEN OF MONRO
E Cisterna Magna
7. Brain Herniation which may be associated with compression of branches of the anterior cerebral artery is called:
A Subfalcine
B Transtentoria
C Uncinate
D Tonsillar
E Subfalcine and Tonsillar
8. The most important determining modifying variable for a focal cerebral ischemia is:
A The size, location, and shape of the infarct
B The extent of tissue damage
C The volume of blood flow
D THE ADEQUACY OF COLLATERAL FLOW
E Arterial wedge pressure
9. One of the following is NOT a source of cardiac mural thrombi:
A Myocardial infarct
B Valvular disease
C Atrial fibrillations
D ATHEROMATOUS PLAQUES
E Valvular disease and Myocardial infarct
10. The principal cells responsible for repair and scar formation in the brain is called:
F Glial Cells
G ASTROCYTES
H Fibroblast
I Oligodendrocytes
J Ependymal cells
SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS
INSTRUCTIONS:
• This section consists of four (4) questions with five (5) options
• Write the word “TRUE” and NOT letter ‘T’ for a correct statement and the word “FALSE” NOT letter ‘F’ for incorrect statement
• Half (½) a mark will be awarded for each correct response
QN 1: Regarding the gastrointestinal tract immune system.
A. ________ TRUE The gastrointestinal system is a potential portal of entry for pathogenic organisms.
B. ________ TRUE The mucous membrane is protective, secretory, absorptive or a combination of these in different parts of the tract.
C. ________ TRUE Secretory immunoglobulin A (sIgA) is an antibody that plays a crucial role in the immune function of mucous membranes.
D. ________ TRUE The gut-associated lymphoid system (GALT) is distributed throughout the tract.
E. ________ FALSE Protective mucus is produced and preserved by paneth cells
QN 2: Acute upper GI bleeding, which may be manifested as:
A. ________ TRUE Vomiting Blood
B. ________ TRUE Black Tarry Stool
C. ________ FALSE Fresh Anal Bleeding
D. ________ FALSE Fresh bleeding per vagina
E. ________ FALSE Coughing Fresh Blood
QN 3: The major clinical consequences of portal hypertension include:
A. ________ TRUE Ascites
B. ________ TRUE Eosophageal variceal bleeding
C. ________ FALSE Hemorrhagic stroke
D. ________ FALSE Myocardial infarction
E. ________ TRUE Splenomegaly
QN 4: Regarding Lichen sclerosus
A. ________ FALSE The disease rarely occurs in postmenopausal women.
B. ________ FALSE It cannot develop to squamous cell carcinoma of the vulva
C. ________ TRUE Its pathogenesis involves the presence of activated T cells.
D. ________ TRUE It may also be encountered elsewhere on the skin.
E. ________ TRUE When the entire vulva is affected, the labia become atrophic.
SECTION C: MATCHING QUESTIONS 10 MARKS
Instructions:
• This section consists of two (2) matching items questions, each with five (5) options.
• Match the items from column B with those in column A by writing the letter of the correct response in the space provided. USE CAPITAL LETTERS Only.
• Each correct response is awarded one (1) mark.
• Each item from column B is used only once.
QN 1: Match the disease condition from COLUMN B with their corresponding affected Organ in COLUMN A.
S/N ANSWER COLUMN A (Affected organs) COLUMN B (Disease conditions)
1 C Testes A Endometritis
2 G Fallopian tube B Balanitis
3 A Uterus C Cryptorchidism
4 D Ovary D Luteal cyst
5 B Penis E Prostatitis
F Pyelonephritis
G Salpingitis
QN 2: Match the following descriptions from column A with the corresponding conditions from column B:
SN ANSWER COLUMN A COLUMN B
1 G Aneurysms that are essentially spherical outpouchings A. False Aneurysm
2 D A localized abnormal dilation of a blood vessel or the heart. B. Arterial Dissection
3 A A breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space C. Varicose veins
4 B Arises when blood enters the wall of the artery, as a hematoma dissecting between its layers. D. An aneurysm
5 C Abnormally dilated, tortuous veins E. Lyphangitis
F. Fusiform aneurysms
G. Saccular aneurysms
SECTION D: SHORT ANSWER QUESTIONS 40 MARKS
INSTRUCTIONS:
• This section consists of eight (8) questions.
• Write your answer in the space provided
• Write a readable handwrite; DIRTY WORK IS NOT ALLOWED.
QN. 1: Outline five Morphological Responses to Hepatic Injury. (5 marks)
Answer: 5 points @ 1 mark
• Necrosis and apoptosis
• Regeneration
• Fibrosis
• Cirrhosis
• Ductular reaction
QN 2: a) Outline four (4) simultaneously occurring conditions causing cholesterol gallstone formation: (4 marks)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: 4 points@ 1 marks
• Super-saturation of the bile with cholesterol.
• Establishment of nucleation sites by micro-precipitates of calcium salts.
• Hypomobility of the gallbladder (stasis), which promotes nucleation.
• Mucus hyper-secretion to trap the crystals, enhancing their aggregation into stones.
b) Mention any three complications of Cholelithiasis (Gallstones) (3 marks)
Answer:
Inflammation of the gallbladder.
Blockage of the common bile duct.
Blockage of the pancreatic duct.
Gallbladder cancer.
QN 3: List the four basic clinical syndromes of Ischemic Heart Disease (IHD) (4 marks)
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ANSWER Four (4) points @ 1mark
• Angina pectoris
• Acute myocardial infarction (MI)
• Chronic IHD
• Sudden Cardiac Death (SCD)
QN 4: a) Define Herniation (2 marks)
Herniation is the displacement of brain tissue past rigid dural folds (the falx and tentorium) or through openings in the skull because of increased intracranial pressure.
b) Outline three (3) types of herniation; (3 marks)
Answer:
• Subfalcine (cingulate) herniation
• Transtentorial (uncinate) herniation
• Tonsillar herniation
QN 5: Mention any five (5) presenting features of the GI pathologies: (5 marks)
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer:
• Abdominal pain
• GI bleeding
• Diarrhoea
• Steatorrhea
• Constipation
• Nausea and vomiting
• Dysphagia
• Odynophagia
• Gastroesophageal reflux
• Anorexia
• Weight loss
QN 6: a) Outline three basic processes that may contribute to the Pathogenesis of Cerebral Vascular Accident (CVA). (3 marks)
Answer:
- Thrombotic occlusion of vessels
- Embolic occlusion of vessels
- Vascular rupture
b) Briefly explain the difference between ischemic stroke and hemorrhagic stroke. (2 marks)
Answer:
Ischemic stroke – thrombotic/embolic occlusions
Hemorrhagic stroke – rupture of blood vessels – bleeding- subarachnoid/intracerebral
QN 7: Mention five most important infectious agents causing vulva infection related to sexually transmitted infections. (5 Marks)
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer( 5 MARKS)
• Human papillomavirus (HPV), producing condylomata acuminata and vulvar intraepithelial neoplasi.
• Herpes genitalis (herpes simplex virus [HSV 1 or 2), causing a vesicular eruption.
• Gonococcal suppurative infection of the vulvovaginal glands. / Neisseria gonorrhea
• Syphilis, with its primary chancre at the site of inoculation. / Treponema pallidum
• Candidal vulvitis.
QN 8: a) Briefly explain insulinomas (2 marks)
Answer:
β-cell tumours (insulinomas) are the most common of pancreatic endocrine neoplasms and may be responsible for the elaboration of sufficient insulin to induce clinically significant hypoglycemia.
An insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin and are generally benign
b) Briefly explain gastrinomas
Answer:
These are gastrin-producing tumours
A gastrinoma is a tumor in the pancreas that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine.
SECTION E: GUIDED ESSAY QUESTIONS 30 MARKS
INSTRUCTIONS
• This section consists of two (2) questions which are to be answered in a narrative way
• Write your answer in the back of the page; each question should start on a new page.
1 Describe atherosclerosis using the following guide ( Definition, risk factors, pathophysiology, complications) (15 marks)
Definition: 1 mark
Atherosclerosis is a hardening of an artery specifically due to an atheromatous plaque.
Risk factors (Any five points @1 mark)
• Physical inactivity, smoking, unhealthy diet, overweight and obesity, high blood pressure, hyperlipidemia, harmful use of alcohol, Diabetes, advancing age, family history, ethnicity
Pathophysiology (5 marks)
Atherosclerosis develops from low-density lipoprotein molecules (LDL) becoming oxidized by free radicals, particularly reactive oxygen species.
Elevated serum levels of LDL cholesterol overwhelm the antioxidant properties of the healthy endothelium and result in abnormal endothelial metabolism of this lipid moiety.
When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL.
The body's immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL forming specialized foam cells.
The white blood cells are not able to process the oxidized-LDL, they ultimately grow then rupture, depositing a greater amount of oxidized cholesterol into the artery wall.
These activated macrophages produce numerous factors that are injurious to the endothelium.
Eventually, the artery becomes inflamed. The cholesterol plaque causes the muscle cells to enlarge and form a hard cover over the affected area. This hard cover is what causes a narrowing of the artery, reduces the blood flow and increases blood pressure.
A plaque rupture may result in thrombus formation, partial or complete occlusion of the blood vessel, and progression of the atherosclerotic lesion due to organization of the thrombus and incorporation within the plaque
Complications ( Any four points @ 1 mark)
Complications of advanced atherosclerosis are chronic, slowly progressive and cumulative. Most commonly are
o Occlusion of a coronary artery, causing myocardial infarction (a heart attack).
o Occlusion of carotid artery to cause stroke.
o Angina
o Pulmonary embolism (blockage in the pulmonary artery)
o Thromboembolism (rupture of the soft plaque to form a thrombus that can move to different parts of the body and cause blockage of blood vessels).
2 Describe liver cirrhosis using the following guide (Meaning(definition), causes, major mechanisms, and complications of liver cirrhosis) (15 marks)
Definition: ( 1 mark)
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions. It is an irreversible condition and is considered to be an end stage liver disease.
Causes: ( Any five points @ 1 mark)
Chronic alcohol use, Non alcoholic fatty liver disease, Viral hepatitis, Metabolic conditions (eg. Hemochromatosis), Autoimmune disorders, Alpha-1 antitrypsin deficiency, Medication toxicity
The major mechanisms that combine to create cirrhosis are ( 4 points @ 1mark)
Hepatocellular death ( Apoptosis & necrosis)
Regeneration
Progressive fibrosis
Vascular changes
Complications of liver cirrhosis ( Any five¬ @ 1 mark)
Portal hypertension
Ascites
Eosophageal variceal bleeding
Splenomegaly
Hepatic encephalopathy
Coagulopathy
Anemia
Pancytopenia
Hepatorenal syndrome
**** ALL THE BEST****
