Final Essay Questions and Answes 2009/2020

A. Give a short account : a. Gross picture of urinary schistosomiasis. Page 24 Chonic specific cystitis. Wall - thicked Cavity reduced leading to contracted calcified bladder. b. Complication of uterine leiomyomas (page 70) Hyalinization Calcification Cystic degeneration Red degeneration (pregnancy) Ischemis necrosisi (dt torsion) Parasitic leiomyoma.

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c. Renal complication of Diabetes Mellitus (refer page 125) Diabetic Nephropathy Renal failure 2nd cause of death in DM a. Glomerular lesion o Diffuse thickening & increase leakage of basement membrane of glomerular capillaries o Diffuse or nodular glomerulosclerosis b. Hyaline arteriosclerosis (benign nephrosclerosis) o Affect afferent & efferent renal arterioles o Renal artery atherosclerosis c. Pyelonephritis o Common in diabetics both acute & chronic o Noticed in cases of necrotizing papillitis

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Tabulate the differences Page 62 & 68 Cervical carcinoma 4th 5th decades of life Endometrial Carcinoma. 55 65 years old Uncommon 40 years Obesity Diabetes mellitus Hypertension Infertility Endometrial hyperplasia Hyperesterinism (therapy or estrogen secr tumour)

Age

1. Most Important: Sexucally transmitted agents; - Human Papilloma Virus (HPV) - Herpis Simplex Virus II (HSV II) - Smegma bacilli: Cervical carcinoma is less common among populations practicing male circumcision e.g. Muslims. 2. Early age at first intercourse 3. Multiple sexual partners - Cervical carcinoma is rare in virgins and nuns 4. A male partner with multiple previous sexual partners 5. Low socioeconomic status 6. Chronic cervicitis and increased parity 7. Others - Genetic factors - Host altered immunity - Smoking Ingat ni STD je, pastu korang goreng yg highlight tu. 90-95% (mainly!!) o squamous cell carcinoma o Large cell (keratinizing-well differentiated)or(non keratinizing-moderately differentiated) o Small cell (poorly undifferentiated carcinoma) 5-10% o Adenocarcinoma o Mixed adenosquamouscarcinoma

Risk Factor

Microscopic Picture

85% - well differentiated adenocarcinoma Some show foci of squamous metaplasia.(adenochanthoma) Also show adenosquamous. 15 %show moderately or poor differentiated adenocarcinoma

Refer page 13 & 17. (utk soalan macam ni korang ingat 2-3 point je k) Minimal Charge Disease (Lipoid Nephrosis) Children (<15) After infection (skin/respiratory tract) Neprotic Syndrome Post-streptocoocal GN (acute Diffuse, post infection GN) children

age

Characteristic/ Clinical Picture

1. Heavy proteinuria (>3.5g per day) 2. Severe hypoproteinemia 3. Generalized edema 4. Hypercholesterolemia and lipiduria (but no hypertension and hematuria) No immune complex ! Pathogenesis o Disorder in T cells o They elaborate cytokines o That inhibit nephrin o Thus loss of foot process Symmetrically enlarge Pale LM :normal +lipid vacuolization at PCT cells FM : no deposits EM : Loss of epithelial fott process Gross Microscopic

Present hematuria Oliguria Azostemia Hypertension Proteinuria Periorbital edema High titre of anti-streptolysin (ASO) in serum Hypocomplementenemia Immune complex deposited in gromeruli. Infalmmation by activastion of complement system.

LM : Proliferation of cells bloodless glomeruli may show cresent FM : Ganular IgG and C3 EM : shows Humps

Good prognosis, respond well to corticosteroid

Fate / Prognosis

Chidren: 90% recover after 1week Chronic GN Rapidly progressive GN Adult: 15-50% develop chronic GN

Enumerate
a.Gross pathologic findings that may be seen as result of urinary tract obstruction in cases of Senile Prostate Hyperplasia. Refer page 52. Gross -mostly affects periurethral glands -prostate is enlarged -CS: multiple well circumscribed nodules,(solid or contain cystic spaces) -urethra is compressed. -the hypertrophied gland bulge in the urinary bladder as pedunculated mass, resulting in a ballvalve type of urethral obstruction.

Major prognosis factors of Breast carcinoma . Refer page 98

3. Predisposing factors for urothelial tumours. (refer to external sources , not present inside the textbook) i) Older age. ii) Being male, unfortunately. iii)Smoking. 4. The major types of thyroid carcinoma.refer to page 113-114 It is classified microscopically into: i) ii) iii) iv) Papillary carcinoma (75% - 85% of cases) Follicular carcinoma (10% - 20% of cases) Medullary carcinoma (5% of cases) Anaplastic carcinoma (Rare)

D. Problem Solving.
1. A female patient with rheumatoid arthritis (not present inside the book) a. What is the name of this material? - Amyloid protein. b. What is the stain-specific for this material? - Congo red, leads to apple green birefringence of amyloid when viewed under polarizing microscope. c. Enumerate other organs in which this material could be deposited? - Brain, Liver, Lung. 2. An 8 year old male child (refer page 47-49) a. What is the most likely diagnosis? - Mature Teratoma. b. State the cell origin of this tumour. - Ectoderm, mesoderm and endoderm. c. According to WHO classification; to which category does this tumour belong to? - Tumours of one histological pattern. d. Outline the expected biological behaviour of this tumour in this patient and in an older age group.

- It is benign/of low malignant potential in children, while in adults, it should be considered malignant; as all teratomas should be regardless of its variance.

3. During a routine breast self examination, a 35 year old woman (see page 89) a. Name the different microscopic findings that might be detected microscopically in such lesions. Cyst formation with apocrine metaplasia. Adenosis. Fibrosis.

b. What are the risks of developing carcinoma in such a case? c. - Fibrocystic changes does not increase the risk of developing carcinoma of the breast. - Proliferative disease without atypia has a mild increase in risk while proliferative disease with atypia has a moderate increase in risk.