3

FMGE JAN 2024

November 23rd : Systemic Pathology
P
Ed study
• Vasculitis
• MI
• Lung tumors
• Occupational diseases lung
• Brain tumor buzz words
• Renal spotters
• Impt renal-medicine mcqs
• Stomach impt tumors buzz words
• GI polyps
• Ovarian tumor bodies
• Thyroid tumor- PCT
FMGE JAN 2024 12noo_2pm_
November 24th - General pathology and hematology
• Hematology anemia buzz words
• Leukemia lymphoma buzz words and photos
• Lymphoma RS cells types
• Burkitt lymphoma
• Hemophilia
• Amyloid table and photo
• SLE antibodies and ANA
• Non mendelian disorders
• Karyotyping and FISH
• Inflammation cellular events and diseases
• Giant cell and granuloma photos
• Stains revision with application
Q. A 20-year-old woman complains of double vision, fainting spells,
tingling of the fingers of her left hand, and numbness of the fingers of
I
I
her right hand. Physical examination reveals absence of pulse in her
right arm. Laboratory tests show elevated erythrocyte sedimentation
UK Pileser
rate and thrombocytosis. An aortogram demonstrates narrowing and

4h
occlusion of branching arteries, including the right subclavian artery.
The patient subsequently develops heart failure and dies of massive
pulmonary edema. Which of the following is the most likely diagnosis?

A.Giant cell arteritis

tu
B.Takayasu arteritis
C.HSP
D.Wegener granulomatosis
Q) A 70-year-old woman complains of a throbbing unilateral
headache and vision problems. She reports weight loss and
mandibular pain while eating. The patient also has a history of
recurrent bouts of fever accompanied by malaise and muscle
aches. Physical examination reveals nodular enlargement of the g
temporal artery with pain on palpation. A biopsy is obtained
(shown in the image). What is the appropriate diagnosis?

A.Giant cell arteritis Giants cells

B.Takayasu arteritis Granuloma t
C.HSP
D.Wegener granulomatosis
LARGE VESSEL FEATURES

X
VASCULITIS
TEMPORAL ARTERITIS/ M/C VESSEL?
GIANT CELL ARTERITIS

9
KEEFE L
M/C SYMPTOM?
1504
Claudia
B steroid E Jaw
MOST SPECIFIC SYMPTOM?

MOSTDANSSIS L O U
STAT

80
TAKAYASU ARTERITIS/
PULSELESS DISEASE/
AORTO ARTERITIS
Upy
5094 Aof A
SUBCLAVIAN A
Q. A 45 year old man presents with pain in the legs upon exercise and destruction of the
tips of his fingers. He has an 80 - pack year history of smoking. Laboratory values include
hemoglobin of 16 g/dL, WBC of 8,500, serum cholesterol of 220 mg/dL, fasting blood sugar
of 90 mg/dL, and negative tests for antinuclear antibodies. Biopsy of the affected area
reveals intraluminal thrombi in medium - sized arteries and inflammation extending
from arteries to neighboring veins and nerves. What is the appropriate diagnosis?

A.Buerger disease Bi mea

B.Kawasaki disease
C.HSP
D.Wegener granulomatosis
thfmbo clot
Ft Angititinfi
Ian Obliterate
ocd

R stopsmoking
A 27-year-old male presents to the outpatient department with complaints of
fever,
e
weight loss, abdominal pain and myalgias for 2 weeks. Laboratory
investigations revealed autoimmune inflammatory vasculitis, and a probable
diagnosis of polyarteritis nodosa was made. Which of the following conditions
is associated with this patient's suspected diagnosis?
A. Arsenic
B. Chlamydia pneumonia
C. Hepatitis B virus
Hbs
D. Asthma Ag
MEDIUM VESSEL FEATURES
VASCULITIS PAN KHAATA BACHA
PAN 3 VIRAL MARKER
1
Polyarteritis
nodosa
HBsAgt
MOST COMMON VESSEL
CAustraliaAgtg
GLOMERULONEPHRITIS
FIBRIN

P PAN RHD
Effy

IIIIy
VESSEL SPARED?
palm U
KAWASAKI Trichomona
stervix
DISEASE
sigoungbeney garde
55yd
BUERGER’S Aka T A O
T
DISEASE
Bid
 E I
A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks
and legs and joint pain. The parents report seeing blood in the urine. Physical
examination reveals palpable purpuric skin lesions and markedly swollen knees.
The results of laboratory studies reveal abnormally high erythrocyte

too
sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3
mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is
positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood
o
vessels. Which of the following is the most likely diagnosis?

A.Henoch - schönlein purpura

B.Hypersensitivity vasculitis
C.Kawasaki disease
D.Poststreptococcal glomerulonephritis

Guaiac Test 888in

HE
A 59-year-old male was admitted to the ward with complaints of fever, arthralgia, OBI
weakness, cough, and dyspnea for 2 weeks. During the examination nurse also noticed
blood in the sputum. Chest X-ray shows multiple bilateral infiltrates in the upper lung

E
fields. A transbronchial biopsy was performed, which showed granulomatous
inflammation with multinucleated giant cells. A diagnosis of Wegener granulomatosis
was made based on the biopsy. Which of the following organs are most commonly
involved in this disease?
A. Cutaneous
B. Lung and kidney a
C. Heart and kidney
D. Nervous system
 D
SMALL VESSEL FEATURES

poem
VASCULITIS
HENOCH SCHONLEIN P A A A R pura
o
PURPURA
d d Y RENAL
ARTHRALGIA
Hematuria
41 1 4 YEP
Wegener’s Blood vessel
GORLDSOUP
TIM G
granulomatosis

strawberry EMBEDS
PANCH gums
Microscopic OPPOSITE OF __________
polyangiitis RACAL PIYE
Churg strauss
PSC
INCREASE IN ___________________
syndrome RACAS
Q. Autopsy diagnosis of myocardial infarction can be done by immersion of
tissue slices in a solution of?

LD
a.
b.
Triphenyl tetrazolium chloride
100% alcohol HI
c. Ethanol

i
d. Neutral buffered formalin

2 51 Glutaraldehyde
III
Gross Isis 44HRS of MI death
PRINCIPLE stain LDH
First electron microscopic change
normal MI
First light microscopic change

First gross change

A 24-year-old female presents to the outpatient department due to a
cough and respiratory difficulty for 4 months. The cough occurs mostly
at night or early morning. Physical examination is unremarkable.
Cytological examination of her sputum shows the following findings:
Which of the following is the most likely diagnosis for this patient?
A. Bronchiectasis
B. Emphysema
I Ent
ga
C. Asthma

g p
D.Idiopathic pulmonary fibrosis
 Me
0
I 8g
INI-CET NOV 2023 RECALL
..
mucus
GACACTIN 10 epithelialcells
allergy PATHOLOGY
Eosino
f parasitic in f

µ eASPUTUM
nAIqÉÉstt
67 year old patient presents with chest pain and non productive cough.
Radiological investigations reveal pleural effusion with large pleural
Is
mass. Sputum examination has been shown below. Scattered within
these are neoplastic cells. Which of the following malignancy is
associated with this condition?
A. Lymphoma
B. Melanoma
C. Mesothelioma
00
D.Squamous cell carcinoma
8
I
ASBESTOSBODI
 O
Asbestosis Most common carcinoma

Sufyan Add Ey
industry
Most specific carcinoma
a y 8
otheliome
ye PERSIAN BLUET
a silica Ul
PEYSER coal VC
2
Asbestos
ferruginous
ASBHSEtos.is Body

KILL
Q) A 60-year-old man presents with a 4-month history of increasing J
D
weight loss, wheezing, and shortness of breath. He has smoked two
packs of cigarettes a day for 40 years. His past medical history is
significant for emphysema and chronic bronchitis. A chest X-ray shows
a 10-cm mass in the left lung. Bronchoscopy discloses obstruction of Sm
d
the left main stem bronchus. A biopsy is obtained (shown in the
image). Immunohistochemical studies of this biopsy specimen show Iqa
strong expression of synaptophysin. Which of the following tumor is this
diagnostic of? assopardsma
a) Adenocarcinoma
b) Squamous cell carcinoma g
c) Oat cell carcinoma
d) Large cell carcinoma
X
y
 DO
Features Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Large cell
cancer
Smoking
FIstEGressive
Location
central peripheral central peri
Microscopy

0
I
earls
O
Glands t
001
BIE BV
KERATIN
Markers
NAPS in AEEEEIRDI
40
YE osynapto
63T physin
ochromogranin
 O waara Lang
J my
skavan IFeaumen
CA BELI
GET Max
PNS
 24144184 E
A 68-year-old Caucasian
D
man with a history of smoking of twenty-
five pack-year presented in the outpatient department with GEHT
F
complaints of new-onset dyspnea on exertion and abdominal pain.
Lilith
I
He had a history of prolonged neonatal jaundice. On physical
examination, the patient had a barrel chest, diminished lung
breath sounds, and a swollen abdomen with hepatomegaly. Chest
x-ray shows hyper-inflated lungs widened intercostal spaces and a
low diaphragm. The abdomen ultrasound report showed a nodular
liver surface. Based on the above history and clinical findings,
which of the following is the most likely diagnosis?
A. Alpha-1-antitrypsin deficiency
B. Cystic Fibrosis th Ethosis
C. Bronchiectasis A a AT
def
D. Autoimmune Hepatitis

asisa.at aY 4Is14pdn'kieamrpes
Q) 35 Year old female patient presents with epileptic attacks. Radiological
investigations reveal presence of a frontal lobe mass with foci of
at
calcification. Biopsy shows presence of sheets of cells with fried egg
appearance. Patient is diagnosed with a grade2 brain tumor and advised
genetic analysis. Treatment of the patient shows good response to
chemotherapy. Which of the following tumor best describes this?

oooo
wf.IT
A) Oligodendroglioma
B) Glioblastoma
C) Meningioma
D) JPA

craniopuaryngionia
Raffa F oligodendro
Meningiome
MQ) 55 year old man presents with seizures and muscle weakness
but no other neurological sign. CT scan reveals a mass in the left
cerebral hemisphere. Left frontotemporal craniotomy is performed.
Histological examination of brain biopsy is shown. Diagnosis?
A) Oligodendroglioma

F
B) Glioblastoma

O
C) Meningioma
D) JPA
03
D
Q) A 40 year old female presents with worsening headache since 8
months. A left sub-frontal mass is resected. Microscopy shows whorling of
tumour cells which express progesterone receptors. What is the most
likely diagnosis?
a) Low grade Glioma
JR
b) Craniopharyngioma
c) Meningioma

d) Metastasis
A 12-year-old boy is brought to the clinic by his parents with a complaint of headache,
especially__when he wakes up. He recently got difficulty seeing the board in class. He
also had an episode of unconsciousness at school. The image shows histological
findings in the brain of a patient suffering from the most common primary benign
brain tumour in children. What is your likely diagnosis?
A. Pilocytic astrocytoma

FT
B. Glioblastoma
C. Medulloblastoma
D. Ependymoma
E
A 15-year-old boy is admitted to the oncology department; he has complained of
headache, vomiting and blurry vision. He has one episode of a sudden loss of
consciousness. MRI brain is suggestive of medulloblastoma. Which of the following is
related to medulloblastoma?
of cerebello
f
A. Most commonly seen in adults
x
spinal cord
B. Hematogenous spread is common

X
C. Commonly seen in frontal lobe
D. Homer Wright rosettes are seen
cÉÉÉÉum BE
True
CNS Tumor
Glioblastoma BUTTERFLY GLIOMA

Fi SERPENTINE NECROSIS
52 o
OligOdendrOgliO Fried egg appearance
ma PERINU RHAT
Codeletion 1p/ 19q
8 nets
tocT

f
Meningioma Females
Ret
EATIN On
PR Prog
Psammoma bodies
0
Tumor CHILDREN

0
Pilocytic astrocytoma C

a C i
PILO
C

Rosenthal fibres
fo
Medulloblastoma Cerebellum
Homer wright pseudorosette
a
 ÉEÉÉ
5
B
EMRI done in a 28yrs old male suffering from neurofibromatosis 2 showed an ice
cream cone appearance. On asking, he further revealed that it began with a
ringing sensation in the ears, which progressed to balance problems and hearing
loss. Which of the following microscopic finding is seen in the given disease?
A. Spindle cells
NFL
B. Storiform pattern
BaiggITi
C. Target cells
schannome
D. Antoni A and B pattern
Schwann one

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 Hypo cellular
cytoplasm

Antony Be
Why

jff.LI
a
gggjXgIiqgg
NFL B A S I

cells
Hyper cellular
A known case of neurodegenerative disease, which is the most
HEEP
common cause of dementia in humans, showed the following findings
on brain biopsy staining with H&E. Which of the following is the
nucleus involved in the given disease?
A. Nucleus Basalis of Meynert
B. Superior salivary nucleus
C. Ventromedial nucleus of the thalamus
D. Midline raphe nucleus
ALZHEIMER's FLAME cells protein
Foyvs Tayy
Dementia
Fauji Werth ch
 CHAPTER -CNS PATHOLOGY
DEGENRATIVE DISEASE M/E

ALZHEIMER DISEASE Flame cells

Tan Hirano bodies
Actin
Tayy
a
PARKINSON DISEASE Lewy bodies
a synuclein

O
ZARLETIBODIES
5 year old child was admitted in the hospital with history of prolapsing rectal
mass and painless rectal bleeding. Which of the following would you
consider as your primary diagnosis?
a. Peutz jegher polyp
b. FAP
c. Cowden syndrome
d. Juvenile rectal polyp
Vr
styrs
genetics ssh
17 year old child was admitted in the hospital with a diagnosis of intussusception.
I
Surgery was performed and histopatholgy revealed the image shown below. Which of the

EARBORISING
following are likely associated with the disease? (multiple correct)
a. STK 11 gene mutation,

E
b. Mucocutaneous pigmentation Eg

My
c. Clubbing
d. Retinal pigment epithelium hypertrophy

PEUTZ JEAHER's Sx
t
Ifyrs
Agm Eje Ek's't'gene
hip's t p
 All are true for GIST except? Imatinib
1) Most common mesenchymal tumour of GIT
2) C-KIT mutation

mesenchymal
3) Originates from cells of Cajal

F
4) Majority seen in duodenum
B
TIETJE
GASTRO INTESTINAL STROMAL TUMOR

CELL OF ORIGIN

e_mutation Itygosine
MUTATION
SENSITIVE
MARKER
R TKI
CD
SPECIFIC
MARKER DOG 1 IMATINIB
MOST COMMON
SITE D int
Q. A 30 year old woman is found to have a germline CDH1 mutation and
undergoes a prophylactic gastrectomy. Which other malignancy is she at a
higher risk of developing?
Iatigasmic
T D H E
a.
b.
c.
d.
Melanoma
Osteosarcoma
EFFY
Lobular carcinoma of breast
Clear cell renal cell carcinoma Lu
EMILIE
Ebulary
ca

HIsstical SKIT 8
DIFFUSE GASTRIC I
KRUKENBERG TX
 S

LOBULIR CARCIOMA BREAST

INDIAN FILE PATTERN

00 00000000
Q) What is the most common molecular alteration of this thyroid
tumor?

A) BRAFV600E mutation
B) EGFR mutation
C) HRAS mutation
D) TP53 mutation

ORPHAN ANNIE eye PL

TUMOR
PAPILLARY
diotie
8 y
880
CARCINOMA
TBrae
FOLLICULAR

I
CARCINOMA

FT Ortman
MEDULLARY ftp.t uaeusygygnPsa Body
CARCINOMA

Tret gene
Chr
ANAPLASTIC
CARCINOMA TEN
Medullary ca
MEN 29,26
CALCITONIN T ACal
Q) The following thyroid tumor cannot be diagnosed on
FNAC? P
O
A) PTC
B) o
FTC
C) MTC
D) ANAPLASTIC CARCINOMA
A fifty-six-year-old male presents to your clinic with complaints of frequent urination and
swelling of his legs. The patient is diabetic and hypertensive and has been prescribed

I
medications for these diseases. He is non-compliant with his treatment and says that he
feels like it's a burden to take these pills. Investigations reveal proteinuria, increased serum
creatinine, and a decreased GFR. What are the pathological changes seen in diabetic

In
nephropathy?
08
A. Kimmelstiel-Wilson nodules _mtbA1c
B. Immune complex deposition
C. Normal basement membrane
0
D. Focal glomerular sclerosis

0 0
DM 88 Yon
aka

Yomi PASI
sclerosis
Middle aged male patient has proteinuria. Based on immunofluorescence below what is
WIRE LOOP LESION
LM
the likely diagnosis?
A. PSGN
B. FSGS

GILUPUS
C. SLE
D. MPGN
NEPHRITIS
ftp.I IYyIHOUSEIgFEm
O O O

O O O
SLE - Kidney

h
E
FULLHOUSE
i
 mais

Putty kidney 98
caseous
I
Leather grain
go
É

Flea bitten
kidney kidney
Ho FERIE Pyuria Bengt
Waxy
Amyloid
kidney
 Cysteine URINE Crystals

Tyrosine

EITTEEDLE

E Laxative Abuse
Ammonium
En biurate

Apple Thorn
 8
O B
ISHI
Calcium oxalate Cholesterol BROKEN CHIPS
monohydrate Calcium oxalate
dihydrate
STAGHORN calculus
Proteus
40
Dotti'd y
UNIVERSAL Triple
Uric acid phosphate
STRUYTE
Tamm Horsfall protein is a major component of the following? P
A. Mural thrombi
B. Curshmann spiral asthma 3C
C. Renal casts
tact
slaightetat g
D. Bence jones protein
Hyaline Cast URINE CASTS RBC Cast WBC Cast

TE
of
YY o
00g
9775918.91 910174,4 1 pyelonephritis

pacuteTybethrsis
Muddy Brown Cast Broad Waxy Cast
CRF

so I
I
Match the following appearances with their
respective diseases?
A. Putty kidney 1. Amyloidosis
B. Flea bitten 2. TB
kidney 3. Malignant
C. Leather grain
HTN It
kidney
D. Waxy kidney 4. Benign HTN
A 10 year old boy is brought to your clinic by his mother with complaints of blood in his

t.I
urine. The mother also tells you that the child suffered a throat infection a few days ago.
Physical examination reveals mild edema and hypertension. Based on which of the
following findings below is the diagnosis of PSGN made?
A. Spike and dome appearance
B. Tram track appearance

IYIsGNFEHRiticTpf Post strepto 9N

C. Starry sky sppearance
D. Effacement of foot processes

egnes Ped
NEPHROTIC
t
IIE
DISEASE
 NephrOtic syndrome

IACOLDE
MEMBRANOUS GLOMER. (MGN) MEMBRANO- PROLIFERATIVE GLOMER. (MPGN)

NI
FINI MIG

n
a

SPIKE DOME ● MPGN II K

A A A 1 am
TRACK
APP
88
An adult female recently got unilateral salpingo-

EE
oophorectomy performed which reveals the presence of
nests of cells similar to urinary bladder. Which of the
following tumors best correspond to the same?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Fibrothecoma
d. Brenner tumor
9A 29 year old female is detected with an ovarian cyst on usg
examination and is surgically removed. The cyst on cut is
uniloculated and shows presence of clear watery fluid. Blood
investigations reveal elevated CA125. Histopathological
assessment shows psammoma bodies.?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Fibrothecoma
d. Brenner tumor
Reinke’s crystalloids are seen in?
a.Serous ovarian tumors
b.Mucinous ovarian tumors
c.Teratoma
d.Leydig cell tumors
 Bodies Tumor marker
SEROUS OVARIAN PSAMMOMA BODIES CA125
a
TUMORS
BRENNER TUMOR COFFEE BEAN NUCLEUS
BLADDER EPI Transitional epi
DYSGERMINOMA LDH
SEMIN A
CHORIOCARCINOMA
PLAP
BETA HCG
YOLK SAC TUMOR/ Schiller duval body/ AFP
ENDODERMAL SINUS glomeruloid body ALPHA1 AET
TUMOR 3yrs ANTITRYPSIN
TERATOMA Hair, skin ,etc

Tram I 0
GRANULOSA CELL CALL EXNER BODIES INHIBIN
TUMOR COFFEE BEAN NUCLEUS
LEYDIG CELL TUMOR REINKE’S CRYSTALLOIDES Hyperestrot
 T T

Space T
T
T
T
T T T
B
T
T T
T
T T

SCHILLER DUVAL BODY

GLOMERULI BODY
YOLK SA Tx
 yatncerofy

TERATOMA
 coffee bean

Grains
Granulosa
YBrenner
BREW

Cell Tx Tx

GRANULOSA CELL TUMOR