Examination number…………………………………..........

NACTE Registration number………………………

DECCA COLLEGE OF HEALTH AND ALLIED SCIENCES (DECOHAS)

BASIC TECHNICIAN CERTIFICATE IN CLINICAL MEDICINE

(NTA LEVEL 4)
SEMESTER II
CONTINUOUS ASSESSMENT TEST ONE
MODULE CODE: CMT 04210
MODULE NAME: PATHOLOGY

TIME: 2:00 HOURS DATE: ………………

GENERAL INSTRUCTIONS:
1. Read the questions carefully
2. Write your examination number and NACTE registration number on each page of the
answer sheets.
3. Cellular phones and unauthorized materials are NOT allowed in the examination room.
4. This paper consists of five (5) sections with a total of sixteen (16) questions.
5. Attempt ALL questions.
6. The responses should be written in the spaces provided as instructed on each section.
7. Each essay question to be answered on NOT more than two (2) hand written pages.
8. No additional answer sheet will be provided.
9. Failure to follow instructions will lead to loss of marks.

FOR OFFICIAL USE ONLY

SECTIO TYPE OF QUESTIONS ALLOCATE SCORE INITIAL INITIAL
N D MARKS D SIGNATUR SIGNATURE
MARKS E OF OF
MARKER VERIFIER
A MULTIPLE CHOICE 10

B MULTIPLE 10
TRUE/FALSE
C MATCHING 10

D SHORT ANSWER 40

E GUIDED ESSAY 30

TOTAL 100

SECTION A: MULTIPLE CHOICE QUESTIONS 10 MARKS

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Instructions:
 This section consists of Ten (10) items.
 One (1) mark will be awarded for each correct answer.
 Responses with SMALL letter will NOT be awarded any mark.

1. Answer item one (i) to ten (x) by choosing the letter of the most correct answer and write it in
the box provided using CAPITAL letter.

i. When the exact cause of disease is not known, that disease is termed as:
A. Genetic
B. Iatrogenic
C. Idiopathic
D. Neoplastic
E. Congenital

ii. The most characteristic feature of granulation tissues in wound healing is the presence of:
A. Exudates
B. Granulomas
C. Granular scars
D. Monocytes and fibroblasts
E. Fibroblast and new capillaries

iii. Which of the following terms describes an increase in the size of the cell?
A. Atrophy
B. Metaplasia
C. Autophagy
D. Hyperplasia
E. Hypertrophy

iv. Serotonin is one of the chemical mediator of inflammation which cause:

A. Arteriolar constriction
B. Endothelial activation
C. Decreased vascular permeability
D. Endothelial deactivation
E. Moderate vascular permeability

v. One the following is a major cytokine in acute inflammation:

A. Interferon Y
B. Interleukin-1
C. Interleukin-12
D. Prostaglandins A2
E. Thromboxane A2

vi. An abscess is one of the examples of:

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A. Serous inflammation
B. Cattarhal inflammation
C. Fibrinous inflammation
D. Suppurative inflammation
E. Pseudomembranous inflammation

vii. Bronchial asthma, hay fever and parasite involve the increase number of:
A. Basophils
B. Eosinophils
C. Neutrophils
D. Macrophages
E. Lymphocytes

viii. 45 X0 is the karyotype for which of the following genetic diseases?

A. Patau syndrome
B. Down syndrome
C. Turner syndrome
D. Edward syndrome
E. Klinefelter syndrome

ix. One of the following is the benign tumor originated from smooth muscle:
A. Fibroma
B. Argiosarcoma
C. Adenocarcinoma
D. Leiomyosarcoma
E. Rhabdomyosarcoma

x. Which of the following Immunoglobins is involved in Type I hypersensitivity reactions?

A. Immunoglobin A
B. Immunoglobin D
C. Immunoglobin E
D. Immunoglobin G
E. Immunoglobin M

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SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS

Instructions:
 This section consists of Four (4) questions with five (5) options each
 Write the word “TRUE’’ for a correct statement and the word “FALSE’’ for incorrect
statement in the space provided after each option.
 All responses should be in CAPITAL letters.
 Half (½) a mark will be awarded for each correct response.
 Responses with letters ‘T’ and ‘F’ will not be awarded any mark.
 There will be a penalty of half (½) of allocated marks for responses with small letters.

2. Important biochemical mechanisms of cell injury includes:

i. ATP depletion TRUE

ii. Reactive carbon dioxide species FALSE
iii. Mitochondrial membrane buildup FALSE
iv. Increase calcium entry in to the cell TRUE
v. Misfolded protein and DNA damage TRUE

3. The following diseases show chronic granulomatous inflammatory reactions:

i. Abscess FALSE
ii. Syphilis TRUE
iii. Sarcoidosis TRUE
iv. Tuberculosis TRUE
v. Schistosomiasis TRUE

4. Multifactorial genetic disorders include:

i. Albinism FALSE
ii. Hypertension TRUE
iii. Haemophilia A FALSE
iv. Diabetes mellitus TRUE
v. Sickle cell disease FALSE

5. The following are examples of malignant tumors:

i. Mesothelioma TRUE
ii. Fibroma FALSE
iii. Seminoma TRUE
iv. Chondroma FALSE
v. Hepatoma TRUE

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SECTION C: MATCHING ITEM QUESTIONS 10 MARKS

Instructions:
 This section consists of One (1) question with Two (2) parts of matching each having five (5)
options each.
 Match the items from column B with those in column A by writing the letter of correct response
in the table provided after each question. USE CAPITAL LETTERS.
 Each correct response is awarded one (1) mark.
 Each item from column B is used only once.

6. (A) Match the following benign neoplasm from column B with their respective origins in
Column A
COLUMN A (Tissue of Origin) COLUMN B (Neoplasm)
i. Fibrous tissue A. Hemangioma
ii. Cartilage B. Neuroma
iii. Blood vessels C. Chondroma
iv. Bone D. Lipoma
v. Muscle E. Osteoma
F. Fibroma
G. Myoma
H. Lymphoma

COLUMN A i. ii. iii. iv. v.

COLUMN B F C A E G
6. (B) Match the phases from column B with their respective description in Column A
COLUMN A (Description) COLUMN B (Phases)
i. Stage when messenger RNA and protein required for DNA A. G2 phase
are synthesized
ii. Involve replication of nuclear DNA B. M phase
iii. Short gap phase which there is correctness of DNA C. Meiosis
iv. Process of mitosis to form two daughter cell is completed D. G1 phase
v. Daughter cell remain in the cell cycle and divided further E. S phase
F. G0 to G1 checkpoint
G. G1 to S phase
H. G0 phase

COLUMN A i. ii. iii. iv. v.

COLUMN B D E A B H

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SECTION D: SHORT ANSWER QUESTIONS 40 MARKS

Instructions:
 This section consists of Eight (8) questions.
 Write your answers in the space provided on each question.
 Write a readable handwrite: DIRTY WORK IS NOT ALLOWED.

7. Mention five (5) environmental cause of disease as applied in Pathology (5 Marks)

i. Physical agent
ii. Chemical agent
iii. Chemical agent/poisoning
iv. Infections/infestations (biological agent)
v. Immunological factor
vi. Psychological/psychogenic factor
8. Enumerate five (5) systemic effects of Chronic inflammation (5 Marks)
i. Fever.
ii. Anaemia.
iii. Leukocytosis.
iv. Elevated Erythrocytes Sedimentation Rate (ESR).
v. Amyloidosis.
vi. Weight loss.
9. Mention five (5) causes of cell injury (5 Marks)
i. Oxygen deprivation (hypoxia)
ii. Physical agent
iii. Chemical agent
iv. Infectious agent (Biological agent)
v. Immunological reaction
vi. Nutrition imbalance
vii. Aging
viii. Genetic factors
10. Mention five (5) important factors in which cellular response to injury depend on (5 Marks)
i. Types of injury
ii. Duration of injury
iii. Pattern of injury
iv. Severity of injury
v. Intensity of injury

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vi. Types of cell injury

vii. The cell metabolic rate
viii. The cell ability to adopt
11. Mention four (4) principles of cellular adaptive response (4 Marks)
i. Atrophy
ii. Hypertrophy
iii. Hyperplasia
iv. Metaplasia
12. Mention five (5) causes of pathological atrophy (5 Marks)
i. Lack of inadequate nutrients
ii. Diminished blood supply (ischemia)
iii. Denervation’s of an organ
iv. Disuse of an organ
v. Loss of endocrine stimulation
13. Mention five (5) examples of autosomal dominant disorders (5 Marks)
i. Marfan’s syndrome.
ii. Retinoblastoma.
iii. Osteogenesis imperfecta.
iv. Neurofibromatosis.
v. Achondroplasia.
vi. Huntington disease.
vii. Polycystic kidney disease.
viii. Ehlers – Danlos syndrome.
ix. Tuberous sclerosis.
x. Myotonic dystrophy.
xi. Familial hypercholesterolemia.
xii. Hereditary spherocytosis.
xiii. Familial polyposis coli.
xiv. Von Willebrand disease.
14. Mention five (5) causes of hypersensitivity (5 Marks)
i. Autoimmunity causing autoimmune diseases.
ii. Reactions against microbes e. g. post-streptococcal glomerulonephritis, TB.
iii. Reactions against environmental antigens e. g. pollen, dust giving allergic reactions.

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iv. Cross-reaction of antibodies and/or T cells reactive with a microbe with a host
tissue(s) e. g rheumatic heart disease (RHD).
v. Injured host tissues during the process of eradicating infection e. g. viral hepatitis.

SECTION E: GUIDED ESSAY QUESTIONS 30 MARKS

Instructions:
 This section consists of Two (2) questions which are supposed to be answered in a narrative way
 Bulleting and numbering is NOT ALLOWED.
 Write your answers on the Answer sheets provided.
 Each question should start on a new page.

15. Explain acute inflammation basing on five (5) cardinal signs and three (3) outcomes of acute
inflammation (15 Marks)
Introduction: (1 Mark)
Acute inflammation is a rapid response to injury or microbes or foreign bodies to vascularized
tissue.

Main body (13 Marks)

Cardinal signs of inflammation (10 Marks)
i. Redness (rubor)
 This is due to local increase in blood flow after dilation of small blood vessels within
damaged tissue as it occurs in cellulitis.
ii. Hotness/Heat (calor)
 It results from increased blood flow (hyperemia/ congestion/engorgement) due to
regional vascular dilation
iii. Swelling (tumor)
 This is due to accumulation of fluid in the extravascular space which is due to increased
vascular permeability
iv. Pain (dolor)
 Due to direct nerve injury
 Stretching & destruction of tissues due to inflammatory edema (pressure due to
accumulating exudates compressing nerves)
v. Loss of function (functio laesa)
 The inflamed area is inhibited by pain while severe swelling may also physically
immobilize the tissue
Any three of the of the following outcomes of acute inflammation (3 Marks)
ix. Resolution (Complete healing)
x. Progress to Chronic inflammation
xi. Fibrosis
xii. Spread to other tissues
xiii. Death
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Conclusion (1 Mark)
• Any sounding conclusion relevant to question
16. Briefly explain six (6) patterns of tissue necrosis (15 Marks)
Introduction: (2 Marks)
 Necrosis is defined as series of changes that accompany cell death, largely resulting from
the degradative action of enzymes on lethally injured cells.
 Necrosis is a spectrum of morphologic changes that follow cell death in living tissue due
progressive degradative action of enzymes on lethally injured cell.

Main body (12 Marks)

 Coagulative necrosis
Is a form of necrosis in which the underlying tissue architecture is preserved for at least
several days. The affected tissues take on a firm texture.
 Liquefactive necrosis
Liquefactive necrosis is seen in focal bacterial or, occasionally, fungal infections, because
microbes stimulate the accumulation of inflammatory cells and the enzymes of
leukocytes digest (“liquefy”) the tissue
 Gangrenous necrosis
Although gangrenous necrosis is not a distinctive pattern of cell death, the term is still
commonly used in clinical practice. It usually refers to the condition of a limb, generally
the lower leg,that has lost its blood supply and has undergone Cougulative necrosis
involving multiple tissue layers. (This gives dry gangrene). : Ischemia to lower limb
gives Gangrenous necrosis.
 Caseous necrosis
Caseous necrosis is encountered most often in foci of tuberculous infection. Caseous
means “cheese-like,” referring to the friable yellow-white appearance of the area of
necrosis
 Fat necrosis
Fat necrosis refers to focal areas of fat destruction, typically resulting from release of
activated pancreatic lipases into the substance of the pancreas and the peritoneal cavity.
This occurs in the calamitous abdominal emergency known as acute pancreatitis.
 Fibrinoid necrosis
Fibrinoid necrosis is a special form of necrosis in which complexes of antigens and
antibodies are deposited in the walls of arteries.
The deposited immune complexes, together with fibrin that has leaked out of vessels,
produce a bright pink and amorphous appearance on H&E preparations called fibrinoid
(fibrin-like) by pathologists

Conclusion (1 Mark)
• Any sounding conclusion relevant to question

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