Final Pat 310

Question 1

Increased intracranial tension (3, last one has 5 subgroup)

Answer 1

An increase in the amount of CSF.

Cerebral edema.

Space occupying lesions:
* Tumors
* Hemorrhage
* Hematoma
* Infarction (with Hemorrhage &edema)
* Infections (localized abscess).

Question 2

Enumerate the thyroid tumors

Answer 2

Follicular adenoma
Follicular carcinoma
Papillary carcinoma
Anaplastic carcinoma
Medullary carcinoma

Question 3

Complications of Plasma cell tumors 7

Answer 3

1. Pathological fracture.
2. Replacement of the marrow by tumor cells, resulting in pancytopenia
3. Hypercalcemia, and metastatic calcification
4. Increased levels of Immunoglobulins (secreted by plasma cells) in the blood and/or in the urine causing renal failure
5. Amyloidosis: Deposition of secreted abnormal protein in the tissues
6. Renal changes : secondary to blockage of tubules and pyelonephritis
7. Spread: direct & early blood producing plasma cell leukemia.

Question 4

Causes of splenomegaly (5)

Answer 4

1. Inflammations & Infections:
   * Bacterial: TB
   * Parasitic: Malaria -Bilharziasis.
   * Viral: Infectious mononucleosis.
2. Circulatory disturbances:
   * Rt. Sided Heart failure & systemic venous congestion (CVC).
   * Portal hypertension.
   * Recent infarction.
3. Blood disorders:
   * Leukemia-polycythemia.
   * Hemolytic anemia-thrombocytopenia.
4. Tumors: Lymphoma & Leukemia.
5. Metabolic disorders:

Question 4

Enumerate vascular tumors and tumor like conditions. 7

Answer 4

VASCULAR ECTASIA
HEMANGIOMAS
LYMPHANGIOMAS
GLOMUS TUMOR
HEMANGIOENDOTHELIOMA
KAPOSI SARCOMA
ANGIOSARCOMA

Question 5

Discuss the pathogenesis (mechanism) of Bronchiectasis

Answer 5

Two processes are involved: obstruction and chronic persistent infection.

In septic bronchopneumonia: Severe persistent suppurative inflammation in bronchi or bronchioles
causes:
- loss of cough reflex and accumulation of secretions,
- inflammation of the wall and weakening of the wall by fibrosis

In case of obstruction: caused by foreign body or lung cancer:
- There is accumulation of secretions which favor infection,
- Infection damages the bronchial walls leading to their weakening
- The obstruction causes collapse of lung parenchyma , and the week bronchial wall are exposed to the negative intrathoracic pressure with each inspiration leading to its dilatation.

Question 6

Microscopic picture of Chronic Viral Hepatitis

Answer 6

Microscopy:
1) Inflammation :
* Portal inflammation: Expansion of the portal tracts by chronic inflammatory cells, Bile duct walls may be inflamed
* Lobular inflammation

2) Piecemeal necrosis: This is inflammation with destruction of the liver cells at the limiting plates of liver lobules. The liver cells become detached.

3) Fibrosis: Portal fibrosis, bridging fibrosis, accompanied by regeneration nodules (cirrhosis).

4) Other Features: Steatosis of hepatocytes
* Hepatocellular dysplasia (precancerous)

Question 7

Discuss the microscopic picture of rapidly progressive GN (crescent GN)

Answer 7

-The glomeruli are enlarged, hypercellular showing proliferation of endothelial, mesangial and epithelial cells as well as leucocytic infiltration. Usually there is glomerular necrosis and may be glomerular capillary thrombosis.

-Crescents are formed in the Bowman space and compressing the tufts. They are formed of proliferating parietal epithelial cells, fibrin and migrating monocytes and leucocytes.

Question 8

Microscopic types of breast carcinoma

Answer 8

A. Noninvasive (In situ carcinoma).
1- Lobular carcinoma in situ (LCIS)
2- Ductal carcinoma in situ (DCIS).

B. Invasive carcinoma.
1- Invasive ductal carcinoma
2- Invasive lobular carcinoma.
3- Special types (Medullary, tubular, mucinous, cribriform….).

Question 9

Benign tumors of the breast. 3

Answer 9

1. Fibroadenoma.
2. Phylloides tumor.
3. Duct papilloma.

Question 10

Two types of ductal carcinoma in situ (DCIS) and their microscopic appearance.

Answer 10

Comedo DICS: The ducts are enlarged and lined by several layers of high grade malignant cells with expanding central necrosis.

Non-Comedo DCIS

Question 11

Quinolones MOA

Answer 11

Quinolones inhibit DNA gyrase and topoisomerase IV—> inhibiting DNA replication

Question 12

Macrolides MOA

Answer 12

irreversibly bind to 50S ribosomal subunits—> decrease translocation—> decrease protein synthesis

Bacteriostatic and Cidal according to drug concentration

Question 13

Co-trimoxazole

Answer 13

They produce sequential block in the synthesis of Folinic acid and DNA—> synergism

Question 14

Glucocorticoid works on

Answer 14

COX II