Sunday, 16 January 2011

some link for you guys

ni soalan past year (semua jawapan) dan nota 2. sila downloaddddd!!!!

Past Year Question 2009

A.      Give short account:

a.       Meningioma has the gross appearance of being irregular, bosselated mass that usually single but occasionally might be multiple. Cut section shows whorl, solid appearance. Hyperostosis of the underlying bone might be seen.
b.      Astrocytoma is divided based on their different histologic features and its occurrence into:
a.       GI : Pilocyticastrocytomas:
Well circumscribed cystic spaces with mural solid nodule on the cystic wall. It is the most common in children (Pediatrician tumor) seen infratentorially (cerebellum affection).
b.      GII: Diffuse astrocytoma:
Infiltrative mass of gray white in colour.
c.       GIII: Anaplastic astrocytoma:
Similar gross appearance as GII with abundance mitotic figure but there is no vascular proliferation neither necrosis.
d.      GIV: Glioblastomamultiforme:
Variegated appearance (pleomorphic) with areas of necrotic foci, cysts and hemorrhage.
c.       Mycosis fungoides is a type of NHL that arises from the skin (cutaneous T-cell lymphoma). It has negative response to dermatologic treatment (it is not an infection)
d.      Acute lymphadenitis is divided into:
a.       Localized:
As it drains a focus of infection eg in tonsillitis lead cervical LN enlargement.
b.      Generalized:
Associated with systemic vireamia or bacteremia eg infectious mononucleosis, measles.
Both conditions clinically diagnosed as enlarged tender palpable LN with red overlying skin. Grossly seen as swollen, gray-red engorged LN (cardinal signs?). Microscopically, there is sign of inflammation (cells?, vessels?) and sometimes suppuration may follows leading to abscess. Fate?

B.      Tabulate difference between:

a.       The CSF changes in meningitis are:

Clear and may clot
Leukocytosis (esp lymphocyte & PMNL)
-          GLUCOSE
-          PROTEIN
-          CHLORIDE

Very low
Normal / Low

Slight elevation

Very high
Very low

b.      Differences between HL & NHL are:

Localized to single group of axial LN
Multiple peripheral LN involvement
Not contiguous spread
LN involvement
Mesenteric and Waldeyer’s ring rarely involved
Common involvement of Mesenteric and Waldeyer’s ring
Extranodal presentation
Systemic manifestation
Not present
RS cells against a non-neoplastic inflammatory cells
Absence of RS cell and inflammatory background

C.      Discuss :

A)     Hydrocephalus is the accumulation of excessive CSF within the ventricular system of the brain.
There are two types that occur :      

1)      Hydrocephalus with normal CSF pressure aka compensatory hydrocephalus.

↑Volume of CSF due to ↓ brain volume. It may be either
·         Localized in cases like infarcts.
·         Diffuse such as in Alzheimers’ disease where there is a general enlargement of the cerebral ventricles and widening of the cortical sulci.

2)     Hydrocephalus with raised CSF pressure
It occurs when there is obstruction to CSF flow, or ↑ formation, or ↓ absorption.
·         Non communicatinghydrocephalus :
(neoplasms and cysts obstructing the aqueduct and 3rd ventricle, as well as gliosis and inflammation involving aqueduct)
·         Communicating hydrocephalus :

1)      Post meningitic fibrotic adhesion in subarachnoid space
2)      Arnold Chiari malformation
3)      Deficient absorption of CSF as in dural sinus thrombosis
4)      Choroid plexus papilloma (↑ secretion )
Effects :
Depends on age of patient and cause of hydrocephalus. If obstruction occurs after fusion of skull suture, it causes an ↑ in intracranial pressure. If occurs before fusion (in early life) , the head enlarges and the effects of progressively ↑ intracranial pressure are delayed. However, progressive atrophy of brain occurs.

B)   Classifications of Hodgkin’s lymphoma

1)      Rye classification into 4 subtypes
·         Lymphocyte predominance
·         Mixed cellularity
·         Lymphocyte depletion
·         Nodular sclerosis
2)      WHO classification into 5 subtypes
·         Nodular sclerosis
·         Mixed cellularity
·         Lymphocyte-rich
·         Lymphocyte depletion
·         Lymphocyte predominance.
3)      Ann Arbor classification into 4 stages
·         STAGE 1 : Involvement of single lymph node region or involvement of single extralymphatic organ or site
·         STAGE 2 : Involment of 2 or more lymph node regions on SAME SIDE of diaphragm or with involvement of limited continuousextralymphatic organ or tissue
·         STAGE 3 : Involvement of lymph node regions on BOTH SIDES of diaphragm, which may include the spleen and/or limited contiguous extralymphatic organ or site.
·         STAGE 4 : Multiple or wide spread involvement of bone or more extra lymphatic organs or tissues WITH OR WITHOUT lymphatic involment.
All stages are further subdivided on basis of absence (A) or presence (B) of systemic symptoms : fever, night sweat, and/or weight loss of greater than 10% of body weight.

D.      Problem solving:
1.       Pilocytic astrocytoma
2.       Most common Primary CNS tumors in adults and children are; Meningioma, Pilocytic astrocytoma, ependymoma, oligodendroglioma and medulloblastoma

Childhood cns tumor
1) pilocytic astrocytoma (benign)
2) ependymoma (not sure benign or malignant cuz in my note tulis malignant, adekwntulis benign)
3) medulloblastoma (malignant)

Middle age n old person
1) anaplastic astrocytoma
2) glioblastoma

1.       Diffuse type of Non-hodgkin’s lymphoma? (page 206) xtaula,info die bgsikitsgt..

Past Year Question 2010

A.      Give short account
a. ischemic encephalopathy (page 158)
Generalized hypoxia occurs with
·         reduced blood oxygen content as in ventilatory disorder
·         reduction of whole cerebral perfusion pressure as with severe hypotension , cardiac arrest and marked increase in intracranial pressure
·         presence of cerebrovascular diseases as atherosclerosis and endarteritis, mild, sudden fall in BP causes generalized hypoxia.
b.Types of hydrocephalus (page 156)
1.       hydrocephalus with normal CSF pressure
a)      localized ; infarct
b)      diffused ; Alzheimer’s disease

2.       hydrocephalus with raised CSF pressure
a)      non communicating
§  congenital
§  acquired
b)      communicating

c. etiologic classification of splenomegaly (page 210)
a)      infection
b)      congestive states related to portal hypertention
c)       lymphohematogenous disorders
d)      immunogenic-inflammatory conditions
e)      storage diseases
f)       miscellaneous
d. Burkitt’s lymphoma (page 207)
Involvement of maxilla or mandible
Intra-abdominal tumor ( retroperitoneal,bowel and ovaries)
Has relation to EBV
No relation to EBV
High grade malignant
Excellent response to chemo
Long remission
B.      Enumerate

a.       Types of chronis non-specific lymphadenitis  (pg 200)
§ Follicular hyperplasia
§ Paracortical lymphoid hyperplasia
§ Sinus histiocytosis

b.      Reed Sternberg giant cell (pg 203)
§ Large cell (15-45micro)
§ Eosinophilic cytoplasm
§ Binucleated, 2 nuclei with overlapping halves with mirror image to each other
§ Prominent eosinophilic nucleolus surrounded by halo ( Owl eye appearance )
§ Non classic type : manonucleated “lacunar cell” ,or multilobed nucleus “popcorn cells”

c.       Causes of Brain infarction (pg 158)
§ Atherosclerosis and thrombosis
§ Emboli
§ Other causes : vasculitis, compression of cerebral arteries, general reduction of cerebral perfusion.

d.      Mode of infection of brain abcess (pg 168)
§ Hematogenous spread
§ Extension from an adjacent infectious focus
§ Direct implantation

C.      Problem Solving

1)      a) Meningioma (pg 175)
§  psammoma bodies
§  wholly masses
§  extra-axial tumor

b)      site
§  hemispheric concavity, falx , lesserwing of sphenoid bone, and olfactory groove.
§  Less common : cerebral ventricles, cerebellopontine angle, foramen magnum and around spinal cord.

2)      a) Hodgkin’s lymphoma Nodular Sclerosis (pg 204)
b)      Hodgkin’s lymphoma  mixed cellularity, lymphocyte predominance, and  lymphocytic depletion.
c)       Presence of Reed-Sternberg cells, non-neoplastic inflammatory background cells ( as lymphocytes,plasma cells,eosinophils ), and systemic manifestations ( fever, night sweats, weight loss greater than 10% )

Friday, 7 January 2011


Prepared  by Section 2


a)      Lymph Node Disorders
-Non Neoplastic Lymphadenopathy Or Reactive Lymphadenitis
-Neoplastic Diseses Of Lymph Nodes

b)      Disorders That Affect The Spleen

-Congestive Spleenomegaly
-Non Specific Acute Splenitis
-Circulatory And Vascular Disorders
-Splenic Neoplasm
-Rupture of The Spleen

1)      Intracranial Pressure
2)      Hydrocephalus
3)      Cerebovascular Diseses
-Ischemic Encephalopathy and boundary zone of infarct
-Haemorrhage (Traumatic and Non Traumatic )
 4)      Infections Of CNS
-Epidural and Subdural Infections
-Leptomeningitis (Meningitis)
5)      Intracranial Tumour

 All intracranial tumours will include in our exam EXCEPT :

5.Malignant peripheral nerve sheath tumour.

Final exam
    i.            20 MCQs and True/False
= 20 marks
(20 Minute)
 ii.            Essay questions containing two
problem = 30 marks
(45 Minute)

 iii.            Oral Written = 15 marks
(25 minute)

Total = 50 marks

Essay Question Include :

1. Enumeration
2. Give Short Account
3. Tabulate Difference

4. Discuss
5. Problem Solving (2 problems) – 10 marks

Oral Written Exam Include:
1. Define
2. Enumerate (Just List Down)

3. Complete
- According to the past year questions, one of the case problem, they will ask about tumours. So try to focus the special characteristic for each tumour.

Overall :
Practical exam = 15 marks
Midterm exam = 20 marks
Oral Written = 15 marks
Final exam = 50 marks
TOTAL = 100

  • All topics above will include in our examination
  • Focus on the note from the lectures, especially for lymphoid disease (Dr.Suzan’s lecture) and diseases of nervous system.

All the best!

Pathology - a study of disease