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4th Yr: Pathology viva and Practical

Edited By Sadaf Hafeez (class of 2013)

okay so i m gna post all the viva patterns coz the seniors this year were no help... none of them exactly remembered what they did in their vivas the year before.... starting off with pathology....
u have to give 6 vivas in pathology
Viva no. 1 : Dr. afsar. This viva is based on the scenario u are given in the form of printed pages... Its mostly from Endocrne...
though a few were out of the Endocrine as well. On the page u are given there is a scenario given along with the related questions. Its very easy and even if u dont manage to diagnose it right .. not to worry u can ask around and discuss it before Dr afsar starts the viva
Viva no. 2 : this is on the haematology slide u get... this is too taken by an internal... not anyone specifically... the internal changed everyday..
Viva no. 3 : Its with dr. munir... Dr. munir this year tau was asking really superficial questions... like name all the lung diseases.. what is athersclerosis... define stroke.. lab findings in meningitis... do remember to go through his CNS notes though it isnt necessary tht he might only ask from CNS.And do the normal counts for lipids, kidney function tests, na, k , ca levels and other important counts
Viva no. 4 : DR samina.... just do blood really well for her... and dont forget to learn the BASIC COUNTS of everything... TLC,DLC,platelet count, etc these should be at ur fingertips.
Viva no. 5 : this is taken by the external.
Viva no. 6 : the viva too is taken by an external on the pathology slides u get... u get 2 slides ... one a malignant tumour and other some benign condition

The entire ordeal starts at 9:00 am .. begins with spotting ... 20 spots are there ...and not necessarily the ones u saw in revesion classes.... then are given the scenarios ... and 3 slides.. one of haem, one of a malignant condition and one of a benign condition... u have to identify and draw the three slides.U get a whole lot of time to do that ...All in all pathology isnt definitely all tht scary... u get through everything quickly and before u know it its over..



VIVA Questions Compliled by class of 2012



Patho viva questions
mam sameena : hb , anemia def , von wilebrand disease its types mode ov inheritance lab diag y factor 8 is low in it
sir munir :
model ov leiomyoma a scenaria 35 year old female 1 year after mariage presents wd ryt lower quadrant pain n fever tel d/d stagin ov cervical cA
ext 1: renal cel cA model types n mode of spread
lipoma model most comon sites its malignant variant n mode ov spread
ext 2 : tumors ov skin other name of bcc hist features ov bcc gorlins syndrome


Mam Samina:
tlc count, disorders of homeostasis, acquired coagulation disorders, dic lab dx, vit-k deficiency effect, receptors for vWF, von Willebrand disease.
External sitting with sir munir-
renal cell CA model, benign tumors of renal, route of spread, secondaries, how u see them on x-ray? Lipoma model, liposarcoma, types of liposarcoma.
Sir Munir-
Atherosclerosis, vessel wall disease, joints disease, hydrocephalus, and meningitis, causative organisms,
External (2)-
crohns, ulcerative collitis, carcinoid and most common site...
maam samina cause of increase of all wbcs seperately..cml..chromosome involved in cml and its gene...external with maam...names of benign tumors of the body..leiomyoma..pathological changes in leiomyoma..sites of leimyoma ..most common bening tumor of git. invasive mole..tumors of ovary ..markers of tumors of ovary ..in wat other conditions hcg n @feto protien is present..sir munir..wat is arteroseclerosis..its pathogenesis steps ..complicatins n wats aneurysm..external with sir munir..had a lot of specimens...asked me abt the lung one and the kidney one..kidney ws renal cell carcinoma and he asked wat was the old name for renal cell carcinoma..n lung ws pneumoconiasis he didnt ask anythng except definition from that



ma'm samina:
TLC,DLC,causes of rise in basophil count,conditions in which paraproteins r raised?(dey r M proteins) ,types of Igs in MM %age of pts in MM who have lite chains in urine,asked abt dat prof wala pbq " do u think it was misleading?" :P cause of chest infection in MM,somethng abt platelet count in MM
sir munir:
a man falls on d road..wat happens ?he ws asking abt d head injuries dat occur sequence wise 4m scalp upto d brain parenchyma,types of hemorrhages,hydrocephalus def,types,Rx of cong hydrocephalus,a 60 yr old man comes wid bleeding in stool..likely cause?,causes of increased frequency of UTIs in females.
ext 1:
identification of a model it ws a staghorn stone wid ch pyelonephritis n i guessed sum hydronephrosis as well :P another model of lung tb pneumonia n dere ws anthracosis too he pointed dat out!urine findings in UTI,radiologic feature of diffuse interstitial lung disease,causes of CA lung.
ext 2:
names of childhood tumors,names of bone tumors,yolk sac tumors,schiller duval bodies,GCT benign/malignant?

Mam Samina:
lab tests of hemolytic anemia, immunohemolytic anemias causes pathogenesis tests,haptoglobin
Sir Munir:
thyroid diseases,cold nodule d/d,diabetes,seminoma model,morph diff of seminoma leiomyoma
Ext 1:
childhood tumors,burkitt lymphoma morph,aneurysm types,sites of ath aneurysm,subacute bact endocarditis diagnosis,ASO titers
Ext 2:
RCC model,benign tumors of kidney,aangiomyolipoma gross app,emphysema types complications

mam samina:
name of specific and non specific inhibitors of coagulation,acquired and inherited disorders of coagulation,hemophilia A and B,its mode of inheritance,von W disease and its types,causes of extracorpuscular hemolytic anaemia
sir munir:
diabetes def,diagnosis,cold nodule(diagnosis),thyroid function test
ext1:
cholangiocarcinoma,name of tumours in children
ext2:
emphysema types complications,asks u to identify about 3 or 4 models,staghorn calculusetc,lipoma and a bit of viva on them

sir munir....peptic ulcer pathogensis, typhoid n tb involve which part of GI n wot type of lesionz
ma'm samina....dic causes n dx, a person wd nrml screening tests n bleeding...where is d prb, nrml pt value
xtrnlz....pheochromocytoma dx, scc how come in bladder, uterine tumors

sir munir.....gout,which dietry precaution taken in gout and why,how would you identify hypertrophy in heart model (its size would be greater than your fist),size of heart,normal thickness of its walls,diff b/w artereosclerosis and atherosclerosis

ma'am samina......disorders of hemostasis,disorders of platelets,hereditary coagulation defects other than haemophilia a,b n vWBF...(ans:any factor could be deficient),pt presentation in haemophilia a,where do they usualy land (to orthopeads with joint disorders),its screening tests,could there be multiple deficencies

ext 1........normal levels of creatinine,urea,uric acid,thyroid tumors,from where medullary tumor arises

ext 2.......d/d of renal cell ca (angiomyolipoma)




mam sam: Ir0n deficiency anemia ki cause.source? heme iron better absorbed. commonest in female menorhagia. otherwise GIT bleed in males n old females(carcinoma). B thalasemia maj0r. Details. Kis age peh present. Lab diagn0sis.esp Hb f, hb a2. Y anemia.cuz of destructi0n plus n0 hbA synthesis. Fe overl0ad cause? And effect and cause of death in b thalasemia.
occupational diseases name and some detail


sir munnir:name joint diseases. biomechanical theory of osteoarthritis?? (i gues the decrease in proteoglycans n collagen in joints and increase in water.continuous wear and tear by condrocytes. angulation of bones also disturbed.do confirm). we do doppler study for stroke. what is that and why we do at bifurcation of carotids.( common sit of atherosclerosis leading to stroke)dissecting aorta define. atherosclerosis complications? hydrocephalus ki proper definition from sirs notes. y TB causes hydrocephalus? (exudates at base--> organize-->scaring at base---> so block drainage at luschka). DM eye complications. y diabetic foot?(peripheral neuropathy)



ext: endometriosis? its common site(ovary?). adenomyoma? (not adenomyosis). uric acid lvl: 3 to 7 mg/dl ? bilirubin lvl?


sir munir : whats wrong wid your internal assessment? name important diseases of female genital tract? how to differentiate btw leiomyoma nd leiomyosarcoma? microscopic findings of leiomyosarcoma.. cervical cancer staging and risk factors?

mam samina : anemia def , which thalassemia is more difficult to differentiate from iron deficiency? how does beta thalassemia differ from iron deficiency on clinical presentation? are alpha tetramers more troublesome or beta tetramers? hb barts? how does hbH appear in the cells? what stain used?

external 1 : which testicular tumor appears in childhood? its marker? in what other conditions does AFP raise ? the rest was total repitition !

Maam samina... Normal retic count, retic stainin, scenario of normochromic normocytic anaemia, causes, investigations, haptoglobin, causes n features of intravascular hemolysis, tests of hemolytic anaemia, how do u find hemosiderin in urine, kind of bilirubin raised in hemolytic anemia, does it cum in urine, y not?External with maam samina: he told maam this kid seems 2 know a lot bout blood, how bout i take my viva bout blood 2 :|... Types of lymphomas, nodular sclerosis ka cell, y is it in a lacuna, how 2 prepare tissue 2 prevent the lacuna bein formd (i was blank so dnt ask me :P)... Burkit ki apearence, phosporus n calcium ki normal valuessir munir: ur grades hav dropd, how wud i do a stdy 2 show kay the reasons 4 this drop... Aftr i jst kept quiet for 2 min he was like 'id see othrs grades 2 naah'...def artherosclerosis, common features of hbv hcv n hiv ( ther mot)external with munir: wat is this, i said kidneey, he said no its a bean shaped organ!! :|... So dnt diagnose nythn basicaly... It was renal cell ca ka model n he askd dd, aniomyolipoma, nthng else... I mentiond xanthogrnulomatous pyeloneprhts n he got pissd :P

MY VIVA QUEs;;;;
  Dr.Munir
   name the diseases of female genital tract???what are the sexually transmitted bacteria??
Ma'am Samina
   if a pt comes to u wid her CBC showing anemia,,what else wud u look for???(ans;;odr blood indices ie MCV,MCH etc)..what is hypochromic microcytic anemia???name its most importnat causes???what are Nurse cells and what is their significance??tell me the extracorpuscular causes of hemolytic anemia???
Ext 1(wid Dr.Munir)
  just asked me to identify one specimen which was LIPOMA and then asked to classify soft tissue tumors...
EXT 2(wid Ma'am Samina)
 what are various renal tumors???what are various breast tumors??wts the difference btw lobular CA breast and Intraductal Ca breast???

in short all the patho xaminers (except ma'am samina)were EXXTREEMLYY superficial so just know the basics nd u'll b fyn...b of  lukkk!!!







Patho Practical Questions Class of 2012


1.SPOTTING

(Marks 20.Each spot carries one mark.I heard Prof munir saying later dt spotting ko 20 marks kr dain not 30 so it is 20 marks for 20 spots)
There are 24 spots , you have to do 20 , write the number of the spot you are standing at , DONT START YOUR OWN SEQUENCE
Prepare all the models and slides not just the ones shown in the revision class , there is also stuff from hematology lab eg vacutainers and vials with serumse.g anti-globulin serum,APTT solution, PTsolution and micropipette.  etc 
NOTE: SOME SLIDES HAVE QUESTIONS WITH THEM , DONT FORGET TO LOOK OUT FOR THOSE 
Total Marks 20.

2.MAJOR SLIDES

Next you have are given three slides , One from hematology , 2 from histopathology , of these one is a benign condition n the other is a malignant conditon (they are not from the same organ ) . Identify these slides , draw n label them . Ma'am  Ambreen takes the hematology viva , Another internal will take the histo pathology viva most probably Sir mudassir.He was constantly saying it is ok if u r unable to identify ur slide correctly given u can explain ur reasons for dt . Their main focus was on the viva dy wr taking on slide nd marks wr given on dt.But u should know hw to focus d blood slide and which region(tail region).

Total marks 30(10 marks fr each major slide).

3.BIOCHEMICAL SCENARIO(5 marks)

3.INT. ASSES( 15 marks)

                                TOTAL MARKS OF PATHO PRACTICAL 70

BIOCHEMICAL SCENARIOS:
You'll be handed over a biochemical scenario with some questions , then Dr. Rafeeq will take your viva.For d benefit ov ppl on ds auspicious new yr eve here is ma gift fr everyone.The original biochemical scenarios.

Patho Scenario Topics
1.Diabetes Mellitus
2.Chronic Renal Failure
,
3.Obstructive Jandice,
4. Diarrhoea,
5.Derranged Liver Function Tests
6.Thyrotoxicosis
7.Hypothyroidism,
8.Mi,
9.Angina 
10.anemia, 
11.Asthma ,
12. Nephrotic Syndrome
13. Nephritic Syndrome












 
1.A pt has been ordered ogtt , her fasting glucose level is 98 , after two hours 165.
does she have diabetes ?
what is your diagnosis ?
What will you advise her ? 
What other tests will you order ? Ans  lipid profile 

2.CA cecum..mets in liver..increasd ALP.
Give type ov jaundice?
give ur diagnosis?
other conditions in which alkaline phosphatase is raised other dn liver? Tumour itself releases ALP-sir rafiq said. I said any lytic disease of bonee.g Pagets..but he said since pt has no h/o bone disease so accr to him correct reason ws dt tumour releases it. Nt worry he ws giving 4 marks out ov 5 to every1.

3.hypothyroid ppt wid atheroseclerosis
management
diagnosis

4.Pt has CA head ov pancreas.
Type ov jaundice?
diagnosis?
other conditions in which CB is raised?

5.chest pain on exertion..no history of heart problem.CK raised..CK MB normal...pain dec in 24 hrs.
MI or angina?
why is CK raised?
diff isoforms ov CK?
which isoform specific fr heart nd why total CK raised nd nt CK MB only?

6.Pt comes wd catarract,thyroidectomy 10 yrs ago,has hypoCa and hyper PO4..normal AL PO4ase.
What is cause? hypoPTH
what is cause ov catarract?
cause ov hypoPTH?

7.a pt of hypoTHYROIDISM wd markedly raised TSH.
causes?
types?
diagnosis?

8.5 yr old diarrhoe nd vomiting fr past few days..pulse increased..Na nd urea increasd..K+ nd creatinine normal.
why Na + raised?
which type ov renal impairment?

9.another case ov primary biliary cirrhosis
type ov jaundice?
which bilirubin fraction raised?
cause ov pruritis in skin?

10.pt of uncontroled diabetes for past 15 years now presents with renal failure and bone pain
diagnosis?
possible serum calcium level?
whats osteodystrophy?

thats all i could think of.Dr Rfiq is d pharma teacher ov last year. 

MAJOR SLIDES:
1.LIPOMA:
its diff from normal adipose tissue
malignant type
sites
all soft tissue tumors
angiosarcoma
kaposi sarcoma
smoth muscle benign malignant tumors

2.FOLLICULAR ADENOMA:
follicular adenoma nd papillary ca differentiation.capsular nd BV invasion by papillary nd nt in follicular.what have you drawn ? explain it .What other lesions can occur in this organ. 
Name some tumors of this organ .


3.OSTEOSARCOMA:
dif from chndroma
dignostc histologic feature
all bone tumors

4.PROSTATIC ADENOCA:
yes it came too.Gleason score,grade.

HAEMATOLOGY:
maam ambreen takes d viva:
1.cml:
diff btwen myelocyte metamyelocyte
meta n promyelocyte
bone marrow pict

2.Microcytic hypochromic anaemia:
def anaemia,leukemia,HB pathies type,% nd chains.Values.Blast series.Myeloid series.Staining.Function of neutrophil,basophil.
How does a patient with CML present to you ?
What are the hematological causes of spleenomegaly ?
What size does the spleen reach ? Ans upto the umblicus 
What are Band cell?
What are the granules in myelocytes called ?
Haemolytic anemias ? causes ? presentation ?



Viva Questions by Class of 2013


Patho Practical :
1-20 spots
-1 minute for each slide
-write just 1 identification point
TODAY'S SPOTS

GROSS: Liopma, cholilithasis,appendicitis,tuberculous pnemonia,hypertrophied heart,tuberculous lymph node,MNG,
Histo: lipoma,MNG,papillary CA, BPH (may be CA prostate,don't know) some CML or CLL (disputed)

2- MAJOR SLIDES:
there are 3
benign,malignant and haematlogy
(they'll tell you which one is benign and which is malignant)
(Mam helps in diagnosing but end pe ghussa ho gayi theen k tum log sub kuch mujh se hi pooch rhe ho , ab nai mene kisi ko btana)

-draw all three
VIVAS: 1-Mam: takes on benign n malignant. mine were pulmonary T.B(questions: which stain you use for acid fast bacilli ?(Z-N stain),Types of granulomas,Name non-caseating one, what stain you use for fungus (silver stain + i guess india ink as well) ) and follicular carcinoma (Q: what's it's characteristic differentiating feature(capsular involvement ), how does it spred? (hematogenous spread,also locally invasive)
2-SIR : takes on hematology slide, asks features of your slide on blood film e.g mine was CLL so lymphoblasts and smudge cells..., asks questions from whole blood,not just your slide
questions he asked ALMOST EVERY student: cuases of aplastic anemia, classification of hodgkin's, lab diagnosis of iron def, anemia

3-SCENARIO: given with 2-3 questions on it. You're not supposed to write anything at all about it. Just prepare mentally for the viva. Viva would be related to your slide only
Mine was some patient who had chest pain after physical activity but his ECG was normal and there was no rise in CK-MB. Total CK was very high however.
written questions were: 1-was it MI or angina?
2-Why was total CK raised?
sir asked what's the diagnosis, i said angina but actually its neither angina nor MI. That total CK rise is due to CK-MM coming from skeletal muscle due to vigerous activity.(I said sir chest pain kese explain ho gi phir to he said wo to wese bhi ho sakti hai )

TIPS:
-do read blood and endo
-spotting includes gross,histo and a 3rd category as well >bottles

Bottle with purple cap is for CBC
Bottle with Light Blue Cap is for coagulation studies
Bottle with Dark Blue cap has Anti sera A
Bottle with Yellow cap has anti sera B
Bottle with grey cap has anti sera D
ESR tube can also come in spotting

-Time khulla hai, no tension
-you can easily discuss your slides and questions with each other.

Major Vivas


Ma'am Samina She askes all questions from Blood. Do Blood Notes really really well.
(Questions with answers are written in bold.)



she presents a scenario usually.. PT normal, APTT prolonged, BT prolonged n platelet count normal.. diagnosis?? its von willibrand disease.. funtions of von willi brand factor, types , dominant, recessive, which is dangerous, test for disease (ristocetin) its details...

TIPS: just relax urself, think properly before answering... take time.. do mam NOTES and also TABLES of robins... values... whatever u speak u must know something about it.. like she asked WHO classification of myelodysplastic syndromes.. if you say 5q syndrome.. she asks about syndrome...

Mylodysplastic leukemia- blood picture, morphology, classification. Reticulocytes and their staining. Sideroblastic
anemia and staining for sideroblasts.
Which anemia has golf-ball inclusions( Formed in Alpha Thallasemia ,found in Hb H varient due to Hb made of 4 Beta chains
) and Heinz bodies.



cml,its blood picture,dnt forget to mention increased basophils nmbr,total tlc count,dlc counts

pancytopenia,kis anemia mein hota hai?,classification of hemolytic anemia on warm n cold agglutinin bases


cbc counter (cysmax something) which counts r included in cbc ,stain used, blood picture of megaloblastic anemaia, causes of follic acid def. its mechanism of causing megaloblasts..

causes of iron def anemia,in what conditions increasd demand? what type of blood loss, acute or chronic?? causes of chronic blood loss?? which parasite cause chronic loss n how?/ in which condition of lower end of git,,ch loss occur (heorrhoids),how anemia occurs in b.thalAssemia major?? why or how in effective erythropoises occur?? what is HB bart? golf ball bodies?? HBH?? staining for golf ball?? staining of reticulocytes??

Normal eiosinophil count? (tell the range)Conditions causing eiosiniphilia?L3 variant of ALL features? It resembles what? (Burkitt cell leukemia).Which gene translocation occurs in Burkitt? (t8;21).Which gene is involved(i think MYC).What would be the charateristic clinical feature(s) of CML?

Parameters in cbc?
How cbc is measured 
Mcv mch normal what type of anemia Causes anemia of ch blood loss what type of anemia cause?
Diff bw iron def anemia and thalassemia how wil u differentiate?

TLC DLC nrml ranges
acquired platlet dysfunction causes

DIC vw disease
define reticulocte, its staing(first do geimsa stain, then to confrm do brilliant prusile green), tlc value (4000 to 11000), units must b right........... extra corpusular cause of hemolytic anemia, dlc values, cml,methods of cbc in lab, megaloblastic anemia pic of blood,

What are myloproliferative disorders ( diseases in which excess cells are produced e.g, cml , polycythemia vera etc)

WHO classification of mylodysplastic disorders? ( blood-notes.Do blood notes a to z complete !)

Will there be a blast crisis in cml ? yes


myeloproliferative diseases k name...dif btw leukemia n lymphoma..acute n chronic leukemia ka dif...CML,ALL,philadelphia chromosome, wch gene z involved
Causes of DIC..itz screening tests..SPECIAL TEST FOR DIC?? increased level of fibrin degradation products..acquired causes of coagulation defects..wt is haemorrhagic disease of new born..

Platelet count? Thromobocytopenia? Causes? Pancytopenia causes? Folic acid deficiency causes?

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