pathology examination 2017, Exams of Pathology

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KABARAK

UNIVERSITY

UNIVERSITY EXAMINATIONS

MAIN CAMPUS

FIRST SEMESTER 2020/2021 ACADEMIC YEAR

EXAMINATION FOR THE DIPLOMA IN CLINICAL MEDICINE

DCMED 213: PATHOLOGY II

STREAM: Y2S1 TIME: 9:00-12:00 NOON

EXAMINATION SESSION: SEPT-DEC DATE: 14/1/

VENUE: UNIVERSITY DOME TENT COPIES:

READ INSTRUCTIONS CAREFULLY

1. The examination paper has THREE (3) sections. [Total 100 Marks]
2. Answer ALL questions in the three sections A, B and C
3. SECTION A has Multiple Choice Questions. [40 Marks]
4. SECTION B has Short Answer Questions. [30 Marks]
5. SECTION C has Long Answer Questions. [30 Marks]
6. Answer all the questions in the BOOKLET provided.

MULTIPLE CHOICE QUESTION 30 MARKS

1. Most common etiologic factor implicated in chronic bronchitis is: a) Atmospheric pollution

b) Lower lobe of left lung c) Upper lobe of either lung d) Middle lobe of right lung

10. The most common causative organism for lobar pneumonia is: a) Staphylococci b) Streptococci c) Pneumococci d) Haemophilus
11. Most common congenital anomaly of the heart is: a) VSD b) ASD c) PDA d) Tetralogy of Fallot
12. Which of the following produces right ventricular hypertrophy: a) Coarctation of aorta b) Aortic stenosis c) Pulmonary insufficiency d) Systemic hypertension
13. All of the following cause left-sided heart failure except: a) Cor pulmonale b) Systemic hypertension c) Mitral stenosis d) Aortic stenosis
14. Major criteria in the modified Jones’ criteria include the following Except: a) Carditis b) Polyarthritis c) Raised C-reactive proteins d) Subcutaneous nodules
15. In rheumatic heart disease, antibodies against the following Streptococcal products are seen in the serum except: a) DNAase B b) Streptokinase c) Streptolysin S d) Streptohyaluronidase
16. In hypertensive heart disease left ventricular hypertrophy is Correlated with: a) Duration of hypertension b) Severity of hypertension c) Cause of hypertension

d) Severity of coronary atherosclerosis

17. The most common anatomic pattern of distribution of coronary blood supply is: a) Left coronary preponderance b) Right coronary preponderance c) Circumflex preponderance d) Balanced circulation
18. Chronic is chaemic heart disease is most often due to: a) Coronary atherosclerosis b) Repetitive coronary vasospasm c) Embolization to coronary branches d) D.Stenosis of coronary Ostia
19. Which of the following group of streptococcal is the commonest cause of rheumatic fever consequently rheumatic heart disease a) Group D or Streptococcus feacalis b) Group B Streptococcus agalactiae c) Group C (Streptococcus equisinmolis) d) Group A -Streptococcus pyogenes.
20. The diagnosis of rheumatic fever in a patient with an elevated antistreptolysin O titer is confirmed by: a) Fever with an elevated erythrocyte sedimentation rate b) Carditis and elevated erythrocyte sedimentation rate c) Arthralgia and previous history of rheumatic fever d) Prolonged P-R interval on ECG and fever.
21. A 34 years old female presents with a history of on and off palpitation, headache and sweating for one month. Her blood pressure at home was found to be 190/120mmHg. Three hours later when she arrived at the hospital, her blood pressure was 130/90 mmHg, no treatment was given at home. The most likely diagnosis is: a) Primary aldosteronism b) Primary hypertension c) Phaechromocytoma d) Anxiety disorder
22. An old lady present with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Her chest x-ray is likely to reveal one of the following conditions a) Pleural effusion b) Pneumothorax c) Consolidation d) Collapse

b) Electrocardiography c) Cardiac MRI d) Cardiac CT-Scan

30. The following type of bronchogenic carcinoma has worst prognosis: a) Squamous cell carcinoma b) Small cell carcinoma c) Large cell carcinoma d) Adenocarcinoma
31. Which one does not conform to effects of Ventricular septal defects a) Hypertrophy and dilatation of the right ventricle b) Hypertrophy and dilatation of the right atrium c) Enlargement and hemodynamic changes in all the heart valves d) Narrowing of the heart valves
32. Composition of Tetralogy of Fallot does not include a) Ventricular Septal Defect (the shunt) b) Displacement of the aorta to the right side (dextraposition of the aorta) so that it overrides the VSD c) Pulmonary enlargement with ventricular outflow obstruction d) Right ventricular hypertrophy
33. In esseinmenger syndrome life will totally depend on the following except. a) Patent Duct Arteriosus, b) Absence of Ventricular Septal Defect, c) Atrial Septal Defect d) Patent foramen ovale
34. In classification of obstructive pulmonary congenital heart disease anomalies which one is odd one out? a) coarctation of the aorta b) overriding of aorta c) aortic stenosis and atresia d) pulmonary stenosis and atresia
35. The following are microscopic effects of pathology of Asthma, which one is not? a) Widespread plugging of airways with thick mucous b) Desquamation of the epithelium c) Hypertrophy of smooth muscle d) Hyperplasia of mucosal glands
36. Systemic effects of COPD does not include a) Excavatum carinatus b) Muscle wasting/ muscle weakness c) Pulmonary HTN d) Corpulmonale From question 37 to 40 match appropriately side A of the table and side B

Side A Side B

37 Blue Bloaters A Mycoplasma pneumoniea 38 Immunocompromised Pneumonia

B Emphysema

39 Pink Panthers C Pneumocystis jirovecii 40 Community acquired pneumonia

D Chronic Bronchitis

SECTION B: SHORT ESSAY QUESTIONS 40MARKS)

1. Enumerate FIVE (5 ) conditions manifesting in the upper respiratory tract (5 Marks)
2. Outline right to left shunt {early cyanotic heart diseases (5 Marks)
3. Elucidate at least FIVE (5) cardinal signs heart failure. (5 Marks)
4. FIVE (5) common causes of marked left ventricular hypertrophy (5 Marks)
5. a) Define congestive cardiac failure (1 Mark) b) Grade cardiac failure according to New York heart association (NYHA) Classification. (4 Marks)
6. Outline types extra pulmonary tuberculosis (5 Marks)
7. Briefly discuss FIVE (5) most reliable investigations in a patient suspected rheumatic fever (5 Marks)
8. Outline five ( 5) complications of rheumatic fever (5 Marks)

SECTION C: LONG ESSAY Q’S (20MARKS).ANSWER ALL QUESTIONS

1. A 32 years old female presents at causality with acute onset of cough, chest tightness and wheezing. She has not taken any medication for two weeks. She is unable to complete a sentence in one breath and she is confused. On physical examination, she is dyspnoeic with respiratory rate of 38bpm, PR is 120bpm and blood pressure is 90/60mmHg. Lung auscultation scattered wheezes all over. a) What is the most likely diagnosis? (2 Marks) b) What are the differentials of this condition (5 Marks) c) Enumerate 6 factors that can trigger the above symptoms (6 Marks) d) Outline three complications (3 Marks) e) Explain four investigations that you will carry out on this patient and their rational. (4 Marks)