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1

CHEMICAL PATHOLOGY

1.Name the enzymatic markers of hepatocyte injury?


AST, ALT, LDH

2.What protein binds bilirubin in plasma?


Albumin

3.What type of hyperbilirubinemia will be produced by obstruction to biliary outflow?


Conjugated hyperbilirubinemia, since hepatocyte function is normal and bilirubin is being
conjugated normally. 887

4.Which enzyme is high in cholestasis? Why?


Alkaline Phosphatase. It is present in bile duct epithelium and hepatocyte canalicular
membrane. In cholestasis retained bile salts have a detergent action on hepatocyte membrane
and the enzyme is released into canaliculi. -

5. What enzyme deficiency can cause hepatic cirrhosis?


Alpha 1 anti trypsin 911

6.What is the metabolic defect of hemochromatosis?


A loss in regulation of iron absorption leading to a net iron accumulation of 0.5 1g/yr

7.What plasma albumin levels will you expect in a patient of nephritic syndrome/ chronic
liver disease?
Low levels

8. In Iron deficiency anemia what is the change in total plasma iron binding capacity?
It is increased, representing an increased transferin concentration, which is a feedback response
to low serum iron levels.

9.How is central diabetes inspidus different from nephrogenic?


In Central Diabetes inspidus there is decreased secretion of ADH,
in Nephrogenic there is resistance of renal tubules to action of ADH. Both result in polyuria.

10.Which ONE test will you order in a suspected hyper/hypothyroid patient? What result
will you expect?
TSH assay, which can pick up hyperthyroidism even in subclinical forms. It is low in
hyperthyroidism and high in hypothyroidism.

11. If a patient has low TSH, what would be the usual outcome of a free T4 assay?
It will be very high, except in few cases of T3 toxicosis in which it is the free T3 levels which
are high and causing the symptoms.

12.What is the serum calcium level in primary hyperparathyroidism?


2

It is elevated.

13.If serum calcium is increased due to malignancy or excess Vit D (toxicity), what
parathyroid hormone levels would you expect?
Low to undetectable

14.In vit D deficiency, what is the status of parathyroid gland?


There is hyperparathyroidism

15.In a patient developing tetany after thyroid surgery with low serum calcium levels,
what is the cause?
Secondary hypoparathyroidism due to accidental removal of parathyroid glands causing
hypocalcemic tetany

16.What are the three main types of glucose measurements performed in the lab/
Fasting, Random and Oral Glucose tolerance test after a loading oral Carbohydrate dose.

17.What is the effect of insulin deficiency on fat and protein metabolism


There is catabolism of both

18.From what are ketone bodies formed in diabetic ketoacidosis?


These are formed by unrestricted fatty acid oxidation in the liver.

19.What is the diagnostic test for hypercortosloism/Cushings syndrome?


24 hour free urinary cortisol

20.What K+ levels would you expect in a patient with an aldosterone producing adenoma
of the adrenal gland?
Hypokalemia, aldosterone spares Na at the cost of K excretion by renal tubules.

21.When Cushing syndrome is caused by an adrenal tumor producing cortisol, what


ACTH levels would you find in serum?
Low levels as excess of serum cortisol causes feedback inhibition of ACTH production by
pituitary gland.

22. In adrenocortical insufficiency, what are the serum K+ levels?


There is hyperkalemia, low levels of mineralocorticoids cause loss of Na and water with K+
reabsorption 1216

23.What metabolite of catecholamine is commonly measured for diagnosis of


pheochromocytoma?
Vanillylmandellic acid (VMA)

24.In a patient suspected of gout what serum measurements would you do?
Serum Uric acid levels, which are raised.
3

25.What is the role of C reative protein in the diagnosis of ischemic heart disease?
CRP measurements predict risk of reinfarct in a patient of MI and risk of first time infarct in a
patient of angina 584

26.In a patient with chest pain and equivocal ECG changes what test will you do to rule
out MI?
CK, CK-MB initial two days and tropinin later on; an absence of change in levels rules out MI
584

27.What is the serum marker for acute pancreatitis?


Serum amylase rises in first 24 hours

28.What biochemical marker will you use to monitor a patient of Hepatic cirrhosis for
development of Hepatocellular carcinoma?
Serum alpha fetoprotein

29.A raised CA 125 level would lead you to investigate which organ for malignancy?
Ovaries
30.What will you look for in urine specimen of a patient of Multiple Myeloma?
Light chain/Bence Jones proteins >6g/dl 680

31.What are the biochemical markers of GFR?


BUN: Blood urea nitrogen and Creatinine 960

32.What causes jaundice in hemolytic anemia?


Excess production of bilirubin which is more than the conjugating capacity of the liver, causing
unconjugated bilirubin to spill into circulation

33.What causes hypocalcemia in acute pancreatitis?


Fat necrosis with precipitation of calcium as calcium soaps. 944

34.In a patient of MI would you expect to find raised levels of


LDL or HDL?
LDL, as it is LDL that promoted atheroma formation. HDl protects against it. 521

35.What is the first test you will order to confirm a myocardial infarction?
Tropinin T and Tropinin I, these are proteins which regulate Calcium mediated contractility of
the heart. They have complete tissue specificity and high sensitivity.

36.What is the best possible alternative?


CK-MB, the MB fraction of creatinine kinase derived principally from the myocardium but also
in small amounts from skeletal muscles 583

37. In a chemical analysis of gallstones from 100 patients what type of stones are you likely
to find most frequently?
Cholesterol stones
4

38.How will you differentiate between Nephrotic and Nephritic syndrome on the basis of
24-hour urinary proteins?
Nephrotic syndrome - >3.5g/dLNephritic syndrome - <3.5g/dL

39 .What causes a raise PSA other than a prostatic adenocarcinoma?


BPH, Prostatis, Prostatic infarct, Instrumentation, catheterization

40. What is pheochromocytoma.


41.What is Zollinger Allisons syndrome
42. Which single test can be performed for the assessment of thyroid functions? TSH
43. What are the common complications of Diabetes .When random blood sugar is checked.
( only in emergency)
44.Which is the most important test performed for the confirmation of diabetes? ( Glucose
fasting)
45. What is glycosilated Hb
46. What is the fasting blood glucose level (110mg)
47. What is multiple Myloma?
48. What are Plasma cell dyscrasias
49. What is plasma cell ,what is its function?
50. What is Zollinger Allison syndrome?
51. What is lipid profile.
52. Which is the best out of lipid profile whether LDL or HDL? ( HDL)
53. What is the normal range of cholesterol.
54. What happens if cholesterol is increased?
55. What are atheromas?
56. What is enzymatic fat necrosis?
57. What is traumatic fat necrosis?
5

LIVER

58. What are the predisposing factors for hepatocellular carcinoma?


59. What are alpha fetoproteins ? it is raised in which conditions? What is its source(fungus)
60. What is wilsons disease, how changes are seen in the eye ( through slit lamp)
61. What are the tumour markers for hepatocellular carcinoma?
62. What is cirrhosis
63. What is bridging necrosis
64. what are varicose veins and what are its causes?
65. what are oesophageal varices?
66. what are ground glass hepatocytes.found in which conditions.
67. what are the complications of hepatitis virus infections
68. which hepatic marker is raised in alcoholic hepatitis. (Gema glutamyl transferase)
69. What are Kupher cells, what is their functions
70. what are stellate cells
71. What is the common cause of cirrhosis , what tissue is present in it.
72. what is Dubin jonson syndrome
73. Enumerate Liver function tests
74. what are the causes of conjugated and ungonjugated hyperbilirubinemia
75. what is Bud chiari syndrome
76. what are council man bodies
77. what is the cause of liver abscess
78. Portal hypertension will lead to ;? (cirrhosis)
6

GIT
79. what are goblet cells
80. What is the effect of aspirin on stomach (ulcer)
81. What are adenomas
82. what are polyps ,its types?
83. What are Signet ring cells ,where are they found, why they are clear due to?
84. What are the predisposing factors for peptic ulcer, what is its commonest site ,it is a
predisposing factor for what?
85. name the cells found in chronic inflammation and acute inflammation
86. what are the cells found in acute appendicitis
87. What is Barrets esophagus 1
88. What are the commonest site for carcinoids? Appendix
89. what are carcinoids
90. What is TNM ?
91. What is Dukes classification
92. What is Meckhels Diverticulum
93. What are inflammatory Bowel diseases
94. How you differentiate between ulcerative colitis and Crohons disease.
95. What is Gluten enteropathy
96. what is metaplasia
97. How bile is formed
98. What is the carcinoma of gall bladder called .
99. How gall stones are formed, what are their types
100.What is mucocele
100. What is ascites
102. What is Whipple disease,which bacteria is responsible (Trophyrma whippllie)
103. Where is intrinsic factor found
104. What is the role of intrinsic factor
105. What is Hirushsrung disease( leads to megacolon)
106. What is Malabsorption syndrome.
107. predisposing factors for gall stones
108. What are the enzymes of pancreas ( pepsin, trypsin)
109. Which tests are advised for pancreatitis.
110. What is the name of pancreatic carcinoma (Insulinoma)
111. What are malabsorption syndrome
112. what is congenital pyloric stenosis
113. Define aphthous ulcers:
Ans. Painful superficial ulcers of unknown etiology that are often triggered by stress.
114. What is tropical sprue (hypersensitivity to gluten)
115. What are the causes of peritonitis
7

Thyroid and Endocrines


116.What are orphan anae nuclei .(found in papillary CA thryroid)
117. What are hurthle cells ( found in hashmitos thyroiditis)
116. what is hashmitos thyroiditis
117. What is endemic goiter
118. What are the causes of colloid goiter.
119. What is Graves disease
120. What is the etiology of Mysthenia gravis?
121. What are lipomas ,the cells are clear due to?
122. what is addisons disease?
123. Pituatory tumors
124. What is pineal gland, How it is stimulated, what is its secretion.
125. What are effects of prolactin in males
126. What is the normal uric acid level
127. What is gout, how you diagnose it.
128. What is APUD system
129. What are the tumors of Adrenal medulla (pheochromocytoma)
130. What are the features of pheochromocytoma
131. What are the role of ACTH.
132. What are the effect of steroids on healing (decrease healing)
133. ENDOCRINES
134. What blood glucose levels indicate impaired glucose tolerance (IGT) 2 hours after
standard oral
CHO load (OGTT)? Ans; 140-200mg/dL
135. . What is the implication? Ans; The patient may progress to overt diabetes over time
136. What causes insulin lack in type 1 DM ?
Ans; Autoimmune mechanisms, which destroy Beta cells in pancreatic islets

137. What are the two important factors in pathogenesis of type 2 DM ?

i.Insulin resistance (decreased peripheral sensitivity to insulin)

ii.Beta cell dysfunction, both quantitative and qualitative, Beta cells are unable to adapt to long-
term demands of peripheral insulin resistance

142.. What is the pathogenic mechanism of Hashimotos thyroiditis?


Ans; It is an autoimmune disease

143..What is the functional status of a patient with HT?


Ans; Hypothyroid

144.What is the most important class of autoantobodies in Grave's disease?


Ans; Autoantibodies to TSH receptors
- Thyroid stimulating immunoglobulins (TSI)
- Thyroid growth stimulating immunoglobulins (TGI)
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- TSH- binding inhibitor (TBII)

145. What is the functional status of the patient?


Ans; Hyperthyroidism, at the other end of the spectrum from Hashimoto's thyroiditis

146. Of papillary and Follicular carcinoma of thyroid which is likely to be multifocal?


Ans; Papillary carcinoma
147.Which has a better prognosis?
Ans; Papillary carcinoma, 10yr survival >90%
9

Breast

148. What is comedocarcinoma?


149. What are the tumour markers for Breast carcinoma?
150. What are the ER,PR , where they are used ?
151. what are the conditions of nipples
152. what is gynacomastia, found in males or females?
153. What is Schrirrous cell carcinoma?
154. What is Peau de orange?
155. What are the metastatic sites for breast carcinoma?
156. What is fibrocystic disease of breast?
157. What is fibroadenoma ?
158. What does HERTNUE stands for
159. What is sentinel lymph nodes. (first lymph nodes involved in breast CA)
160. What are the prognostic markers in breast CA

161. Heriditary/familial breast cancer is associated with which two genes?


Ans; BRCA 1 and BRCA 2

162. What is the association of estrogen exposure with risk of breast cancer?
ANS; It increases the risk, thus early menarche is an important risk factor, and so are exogenous
hormones

163. What is comedocarcinoma?


Ans; A special pattern of intraductal carcinoma (DCIS) of breast characterized by central
necrosis in ducts which show atypical hyperplasia

Bone

164. What is Pagets diseases ? what are its sites?


165. What is codmans triangle , sequestrum, involucrum .In which malignant condition
they are found?
166. What is the commonest site for Osteosarcoma? (Tip of bones)
167. Enumerate bone tumors.
168. What is the most common bone tumor in adults?
10

Genital system
169. What are germ cell tumors?
170. Classify ovarian tumors?
171. What are krukenberg tumors?
172. What is CIN
173. Any vaccine available for prevention of HPV carcinoma.
174. What is polycystic disease of ovaries
175. What is teratoma ,what are its sites and its microscopic features found in it, it is
derived from which line?
176. What are the causes of hirsutism?
177. What is endometriosis, what is its commonest site, how it is produced?
178. What is endometritis ,what is the difference b/w endometritis and endometriosis.
179. What is the most common benign tumor of uterus?
180. What is leiomyoma? What is its source?
181. What is leiomyosarcoma?
182. What is peritonitis ,what is its source?
183. What is HCG ,it is raised in which conditions?
184. What is molar pregnancy ?
185. What is choriocarcinoma?
186. What is hydatiform mole ?it is the complication of which condition(pregnanacy)
187. What are the predisposing factors for cervical carcinoma?
188. How you are going to diagnose cervical carcinoma?
189. What is PAP smear,what does it stands for? How it is prepared, which stain is used.
190. What are Brenners tumors
191. what are the symptoms in polycystic disease of ovary.
192. What is the classification of ovarian tumours
193. What viral infection predisposes to cervical cancer?
Ans; HPV (High risk types)

194. What screening test is used for cervical cancer in at risk populations?
Ans ;Papanecoleau test of cervical cytology

195. .What is caused by low risk HPV infection/


ANs; Condylomata
196. .What is cervical intraepthelial neoplasia (CIN)?
Ans; i.Non invasive,
ii .dysplastic lesion of cervical lining epithelium, of varying
degrees I, II, III, Grade III is carcinoma in situ
197. Where is adenocarcinoma of cervix most likely to arise from?
Ans; From endocervix, which has a columnar epithelium and glandular stroma
198. What is endometriosis?
Ans; Presence of endometrial glands or stroma in myometrium
199. What is the commonest benign tumor of uterus?
Ans; Leiomyoma, tumor of myometrial smooth muscle
200. Is fibrocystic disease a neoplastic/proliferative condition?
11

Ans; No
201. How carcinoids are produced (endocrine tumors due to serotonin)
202. What are the features in carcinoids syndromes,
203. specific markers in carcinoid syndrome
204. What is phenyl ketoneuria
205. What is homocystine uria
206. what is Addisons disease
207. What is the source of catacholamines
208. What are paraneoplastic syndromes.
12

Renal system
209. Enumerate Renal function tests
210. What is the most common kidney tumor in children?
211. Enumerate renal tumors
212. Classify renal cell carcinomas?
213. What are clear cells ,in which carcinoma they are found?
214. Which stain is taken by chromophobe cells(silver stains)
215. Name bladder tumors ?
216. Which dye has been associated with bladder tumors?
217. Which bladder carcinoma is associated with Scistomiasis?
218. What are the causes of hematurea?
219. What is Gleasons grading?
220. Enumerate Prsotatic tumours?
221. What is glomeluronephritis ,what are its causes?
222. What is post streptococcal glomerulonephritis, what is its etiology?
223. Enumerate the renal function tests?
224. what is pylonephritis, what are its causes?
225. Name different renal stones, which stone is associated with proteus infections?
226. What are the shapes of different crystals found in urine?
227. What is transitional cell carcinoma of bladder ?
228. What is polycystic disease of kidneys,what are its complications?
229. what is hydronephrosis ,what are its causes
230. What is PSA velocity
231. What are the causes of painless hematuria
232. what is renal tubular necrosis
233. What is analgesic nephropathy
234. Types of testicular tumors
235. CA bladder has been associated with which predisposing factor( leather dye)

236. Name the glomerular diseases which cause nephrotic syndrome


Ans. Membranous GN, minimal change disease, Focal segmental glomerulosclerosis,
membranoproliferative GN.

237.The main feature of minimal change disease


ans. Uniform & diffuse effacement of the foot processes of the podocyte

238. In which type of glomerulonephritides linear deposits are seen on immunofluorescence?


Ans. Crescentic Glomerulonephritis.

239. .Features of nephritic syndrome


Ans. Hematuria, oliguria, proteinuria, hypertension
240.Glomerular diseases that cause nephritic syndrome
ans. Acute post-infectious glomerulonephritis, IgA nephropathy

241. Feature of IgA nephropathy


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Ans. Deposition of IgA in the mesangium

242. Pathogenesis of acute pyelonephritis


Ans. A. Ascending infection bacterial colonization enter bladder vesicoureteral reflux
intrarenal reflux.
B. Hematogenous infection

243. features of chronic pyelonephritis


ans. Scarring involving the pelvis & calyces, papillary blunting, marked calyceal deformities

244. features of malignant nephrosclerosis


ans. Fibrinoid necrosis of arterioles, onion skin lesion, petechial hemorrhages

245. Features of hydronephrosis


ans. Marked dilation of pelvis & calyces & thinning of renal parenchyma

246. Types of renal cell carcinoma


ans. Clear cell carcinoma, papillary renal cell carcinoma, chromophobe renal carcinomas

247. Tumors of urinary bladder and collecting system


ans. Papillomas, transitional cell carcinomas, squamous cell carcinoma occasionally
14

Heart and blood vessels


248. What is Rheumatic heart disease. What is its etiology?
249. what are Aschoffs nodules?
250. what is pericarditis?
251. what is bread and butter pericarditis
252. what is infective endocarditis, what are its causes
253. What is Hemangioma? It is commonest tumor in which age group?
254. What is myocarditis
255. What s giant cell artitis
256. How infarction occur
257. what are heart failure cells
258. what is Kaposi sarcoma ,what are its different variants (asian, europian, African type)

Brain
259. What is the etiology of meningitis, what are the chemical findings in it , how you
diagnose it .
260. what is encephalitis ,what is its etiology
261. Enumerate brain tumors, which is the most common tumor in adults.
262. what is neurofibroma.
263. What is the cause of butter fly rash in a young female, what is its diagnosis, what
antibodies are formed ,what is its etiology.
264. what is Rhematoid arthritis, what is its etiology, which joints are most commonly
involved, what antibodies are formed.
265. what is Sarcoidosis
266. What is wegeners granulomatosis.
267. what is medulloblastoma
15

Respiratory system
268. What are the different types of tuberculosis, what are its route of transmission, which
cells are raised in it,
269. what is a granuloma , how it is formed, what is the central cheesy material ,what it is
called, what is found it ,what is the source of eptheloid cells.
270. what is ghon focus
271. what is ghon complex
272. What is lupus vulgaris
273. Is tuberculosis transmitted through skin and milk and which?
274. what is military tuberculosis
275. what is the site of tuberculosis, what is its diagnosis
276. Name the tumors of lungs
277. What are the chemical carcinogens involved in the bronchogenic carcinoma
278. What are the different types of lung carcinoma, which has worst prognosis, the cells of
small cell CA resemble which cells.
279. what is Emphysema ,what are its types, what happen to alveoli in it .
280. Alpha 1 antitrypsin is increased in which condition.
281. What are pneumocytes, what is the secretion of type two pneumocytes?
282. what is ARDS
283. What is Hyaline membrane disease
284. What is mesothelioma (tumor of pleura due to asbestos found in glass industry)
285. Define Chronic Bronchitis, what happens to bronchi in this condition
286. What is asthma, what are its types, what is atopic asthma, which antibody is raised .
which chemical mediators are released ,by which cells, which type of hypersensitivity is
involved.
287. What is swine flue
288. What are the problems associated with tobacco smoking.
289. Asbestos is the cause of which tumor (mesothelioma)
290. what are the environmental agents causing lung conditions.
291. What is pneumoconiosis,(occupational disease)
292. What are the stages of lobar pneumonia
293. What are the types of pneumonias
294. what is atypical pneumonia, what are its causes
295. inflammation occurs in which part of lung in pneumonia alveoli or interstitium.
296. What are interstitial lung diseases
297. which cells are found in pneumonia, is it acute or chronic type
298. What are the causes of lung abscess
299. what are antioxidants (vit A,E, glutathione)
300. what is gangrene ,what are its types
16

RESPIRATORY SYSTEM

301. What are the major diffuse obstructive disorders of the lung?
Ans. Emphysema, chronic bronchitis, bronchiectasis & asthma

302. What are the major morphological features of chronic bronchitis?


Ans. Mucus gland hyperplasia, hypersecretion

303. What are the major morphological features of Bronchiectasis?


Ans. Airway dilation & scarring

304. What are the major morphological features of Emphysema?


Ans. Airspace enlargement, wall destruction

305. What are the types of Emphysema according to anatomic distribution?


Ans. Centriacinar, panacinar, distal acinar, irregular.

306. Pathogenesis of emphysema?


Ans. tobacco reactive oxygen species inactivation of antiproteases (1AT deficiency)
neutrophil elastase tissue damage (emphysema).

307. Major chronic interstitial lung diseases?


Ans. Fibrosing, Granulomatous, Eosinophilic, smoking related

308. Morphological features of sarcoidosis?


Ans. Noncaseating epithelioid granuloma, schaumann bodies, asteroid bodies, stellate
inclusions.

309. According to the anatomical distribution acute pneumonia is divided into:


Ans. Bronchopneumonia, Lobar pneumonia

310. Morphological features of lobar pneumonia:


Ans. Congestion, red hepatization, gray hepatization, resolution.

311. Etiology /Pathogenesis of lung abscess;


Ans. Aspiration of infective material, aspiration of gastric content, bronchial obstruction,
septic embolism, hematogenous spread of bacteria,

312. Classification of malignant epithelial lung tumors


Ans. Squamous cell carcinoma, adenocarcinoma, large cell carcinoma, small cell carcinoma,
adenosquamous carcinoma, carcinoid tumor.
17

SKIN
313. What are the malignant conditions of skin
314. What are squamous pearls
315. Where Basal cell carcinoma metastasize, what is its site.
316. What is mole,which change can occur in a mole.
317. What is nevus
318. What is malignant melanoma
319. What is the site of malanocarcinoma
320. What are Kangri ulcers ,where they are found .
321. what is leukoplakia
322. What is genetic engineering
323. what is cloning
324. What is Dollie, Why it die in early age

BLOOD

325. what are the types of anemias


326. What is macrocytosis
327. What are microcytes
328. What are reticulcytes, In which conditions they are raised
329. What is the etiology of iron defeincy anemia, what is the microscopic picture in it,
which parasite is responsible for it.
330. What are the causes of megaloblastic anemia, which parasite is responcible
331. What is leukemia, What are its types
332. What is leukemoid reaction
333. What are AUER Rods
334. What are lymphomas, what are its types,
335. what is the cause of non hodgkins lymphoma
336. What are Reiid Stern Berg cells, in which lymphoma they are found
337. What is stary sky pattern
338. EB virus causes which type of lymphoma
339. What is infectious monucleosis
340. What is BT,CT
341. What is thrombocytopenia
342. what is purpura
343. what is coombs test
344. what is osmotic fragility test
345. what is hereditary spherocytosis
346. what is sickle cell anemia
347. what is sickling
348. what is G6PD defiency
349. what is thalasemia,what is its cause
350. what is hemophilia, what is its cause
351. What is the normal range of Hb in males/females
352. What is hemolytic anemia ,what is its etiology, which parasite is responsible
18

353. what is pernicious anema


354. What is the FAB classification of leukemia
355. What is hairy cell leukemia
356. B -12 deficiency leads to which anemia.
357. what is FDP
358. How to confirm DIC
359. Increased red cells are known as
360. what is electrophoresis