SUMMATIVE M107 ENDO,REPRO,RENAL

OBA
1. Breastfeeding mother developed a painful fissure over her nipple. What is the most likely organism
causing this condition
A: Staphylococcus aureus (mastitis)

2. 25Y F, breast lump, 1cm non tender, mobile. What is true about this lesion?
A: Does not turn into breast ca

3. Woman with dry cough, haemoptysis, wheezing. Oral progesterone was prescribed. What is the site of
action of progesterone?
A: Myometrium

4. When is the embryonic period?

A: Week 3 - 8

5. Which of the following statement is correct about androgens ?

A: Androgen increase libido

6. Picture of cervical smear given.

A: HPV koilocytosis

7. What structures lie behind the retromammary space?

A: pectoralis major and serratus anterior

8. What triggers the suckling reflex?

A: mechanoreceptors around the nipple

9. Which of the following sequence describes development of speech in infants

A: cooing > babbling > one word sentence > telegraphic speech

10. Which of the following cannot be ruled out using pipelle sampling.(Adenomyosis, endometrial Ca,
polyps?)
A: Adenomyosis

11. What is a possible cause of azoospermia

A: decr in FSH levels

12. Patient has a diagnosed ovarian tumour. All the below are true except.
A : FNA is done to rule out ovarian tumour.

13. What is the cause of physiological anaemia during pregnancy?

A: Increase in plasma volume and decrease in relative Hb

14. Ureter opens to an ectopic site e.g. at the prostatic urethra. What is this condition?
A: complete duplication of the ureter

15. Pt with DM has ketoacidosis. What are the acids contributing to this condition?
A: Acetoacetic acid

16. Which of the following is a cause of bilateral hydronephrosis that is reversible?

A: normal pregnancy

17. Pt with Escherichia coli bacteriuria. What is considered a significant bacteria count?
>105 organisms in 1 ml urine

18. 5y/o with proteinuria, periorbital oedema.

A: Minimal change disease

19. What happens when renal perfusion decreases.

A: JG cells secrete rennin

20. Pt with fever, frequent micturition. Urinalysis shows pus cells +, granular casts +. What is the Dx?
A: pyelonephritis

21. Voiding reflex with out voluntary control can be cause by ?

A: Trauma to the head/spinal cord.

22. Urine Analysis of this patient shows nitrate ++, pus cell +. What is the microbe responsible for this ?
A: Escherichia Coli.

23. What is the pathophysiology of Acute proliferative glomerulonephritis?

A: Immune complexes get lodged glomerular basement membrane causing complement pathway to
be activated. This lead to destruction.

24. 50 yr old patient is hypertensive for long years. What diuretic would be given to the patient?
A: furosemide

25. What would happen if there is an increase in Tubular fluid pressure ?

A. GFR would increase >50ml/min

26. What is the alkali reserve ratio?

A: 20:1

27. ? some statement on zygotes ?

28.
29. Cause of squamous cell carcinoma
A: Schistosoma haematobium

30. Pt with decreased Potassium level, hypertension and hypokalemia. what is your diagnosis ?
A. Conn's Syndrome

31. 5 yrs old Pt with testicular enlargement

A: precocious puberty

32. Why is there easy bruising in hypercortisolism.

A: loss of structural proteins

33. What causes lytic lesions in multiple myeloma?

IL-6

34. Tumour in the optic chiasma causes which clinical syndrome?

A: pituitary adenoma
 35. How to diagnose neonatal hypothyroidism?
A: plasma TSH

36. Which of the following is an effect of adrenaline?

A: incr blood flow in the legs (to run away from the lion…) / vasodilator

37. Which is the definition of impaired glucose tolerance?

A: FPG<7.0mmol/L 2hr plasma glucose>7.8mmol/L

38. Which condition shows a marked increase in TSH?

A: Riedel’s thyroiditis

39. What is the Rx for Grave’s disease

A: carbamizole

40. Which of the following inhibits bone resorption by acting as an adsorbent?

Bisphosphonate

41. Which of the following can cause hypersecretion of ADH

A: Trauma

EMQ 1
[Female commercial sex worker with purulent
B – Gonorrhea
discharge from the vagina]
[Ulcerations that spread (painless) and nodules seen,
D – Granuloma Inguinale
no lymphadenopathy]
A – Syphilis [Indurated Painless ulcer after 2 weeks]
[ Patient travelled to Africa, then presents with
E – Lymphogranuloma Venerulum Painless ulcers which later becomes painful and there
is lymph node tenderness. “ulcerationà discharge]
I – Candida Albicans [Vulvo vaginitis with cheesy discharge and itchiness]

EMQ 2
proximal muscle wasting, obesity, Increase in blood
Cushing’s Syndrome pressure and [mass seen on CT scan of the renal
gland]
mass detected above the kidney, Episodic headache,
Pheochromocytoma
anxiety, increase in hydrocy HMMA
40F, Increase in weight, buffalo hump, striae on
abdomen, moon facies, Facial hair, Increase ACTH
Cushing's disease
secretion and Corticosteroid and High dose
Dexamethasone suppression test
Orthostatic Hypotension, hyperpigmentation,
Addison's disease decreased plasma cortisol, Antibodies against adrenal
gland is present.
Precocious Puberty 21 hydroxylase deficiency 5 years old F with mammary gland development.
EMQ 3
15 yr old M presents with increase BP and ASOT.
Post-streptococcal glomerulopathy
PMH: Sore throat 1 week ago.
27yr old presents with hematuria after honeymoon.
IgA nephropathy PE: normal. Renal biopsy shows depositions of
depositions of Ig.
2 yrs old presents with chronic cough, heamotypsis,
Goodpasture syndrome cachexic, NO fever and Lymphadenopathy. Urinalysis
shows 4 + protein.
25 yrs old got into RTA [Road traffic accidents]
Acute RENAL failure presents with multiple failure and rupture of spleen.
U&E and blood test is done. GFR < 5 ml.
34 yr old presents with ankle swelling with 5gm
Membranous Glomerulopathy protein in urine. Thickened glomerulus is shown on
renal biopsy.

OSPE 1
Gross pictures
- A Endometriosis
- B Adenomyosis
- C Leiomyoma
- D Cervical Carcinoma
Predisposing factors for Cervical Ca. – HPV, multiple sexual partner, early age at first intercourse
Diagnostic tests – Pap smear, endocervical curettage, colposcopy
Picture E – Serous Cystadenoma.
OSPE 2
Patient presents with increase in frequency of urinating. Suprapubic tenderness. Dysuria for 3 days.
Interpret the Data Below
Turbidity - ________________
Pus Cells 15 - _____________
Bacteria 10^5/ml - ______________
Diagnosis – UTI
Treatment – ORAL Trimethoprim-Sulfamethoxazole / Norfloxacin / Ciprofloxacin ( fluoroquinolone )
OSPE 3 *repeat question for EOS 5* [M107]
Anatomy of Thyroid is given with labels on various parts. Match the labels to the affected part according to
the scenario and name the label. [JP question]
Moves with Swallowing - Thyroid Cartilage.
Difficulty in Breathing – Trachea
Difficulty in Swallowing – Esophagus
Carpopedal spasm – Parathyroid Gland
Hoarseness of voice – Recurrent Laryngeal Nerve
MEQ 1
Part 1
Patient presents with a lump in the testes.
1. Four differential diagnoses. Testicular carcinoma, varicocele, epididymal cyst ( spermatocele ),
appendix testes
2. What is the blood supply for the testis and where does it originates from?
Testicular artery from abdominal aorta
3. What are the 2 fascia covering the testis ? external spermatic fascia and internal spermatic fascia
4. What are the 2 spongy masses that makes up the penis ? corpus spongiosum and corpus cavernosum
5. Two tests / investigations – ultrasonography of testes, serum tumour marker
Part 2
Patient is suspected to have testicular cancer.
*endocrine question on Sex steroids* [ can't remember the question ]
Formation of Dihydrotestosterone - Testosterone is converted to DTH by 5 alpha reductase.
How does testicular cancer metastasize and its favoured site of metastases ?
Lymphatic via para aortic lymph node; lung, liver, bone
Part 3
Testes was taken out and the cancer shows cells are large with vesicular nuclei, and pale watery
cytoplasm. Lobules of neoplastic cells have an intervening stroma with characteristic lymphoid infiltrates. The
cells are monotonous in appearance.
1. What is the most probable pathology for this patient ? seminoma of testes
2. What is the significance of tumour markers and their examples? Detect testicular ca, AFP, HCG, LDH
3. Testicular cancer Increase in
Choriocarcinoma Human Chorionic Gonadotrophin
Yolk Sac tumour Alpha Feto Protein

4. Predisposing factor for Testicular cancer - Cryptochidism, Klinefelter Syndrome

MEQ 2
Part 1
50 yr old male patient presents with painless hematuria.
a. Two probable causes of hematuria. Nephritis syndrome, nephrolithiasis, renal cell carcinoma,
transitional cell carcinoma
b. What is the nerve supply for micturition? [4 marks!]
Parasympathetic - S2,S3,S4 ( bladder contraction, relaxation of internal urethral sphincter ); Somatic -
Pudendal Nerve ( external urethral sphincter )
c. Name some further investigations that can be done
Urine analysis, Ultrasound of the kidney, X-ray KUB, IVP
Part2
Patient is suspected to have UTI and renal calculi.
1. What is the 3 common sites of obstruction in the ureter ? ureteropelvic junction, crosses pelvic brim,
pierces urinary bladder
2. Give 4 gram negative organisms that can cause UTI ? *WRITE IN FULL if not marks are not given*
Escherichia Coli, Proteus Vulgaris, Klebsiella penumoniae, Enterobacter cloacae
4. Pathogenesis of Staghorn Calculi ?
Urea splitting bacteria eg proteus break down urea into ammonium. Increased ammonium ions and
alkaline urine cause crystallization of ammonium, phosphate and magnesium, leading to struvite stone
formation. Large, branched struvite stone forms staghorn calculus which fills part of renal pelvis and
calyces.
Part 3
Patient has another 3 bouts of hematuria and lost 8 kg. Further questioning reveals that he works in a dye
factory.
a. What is most probable diagnosis in this case ? Transitional cell carcinoma
b. State one infective and one drug risk factor for this condition - Schistosoma haematobium; phenacetin,
cyclophosphamide
c. What is the 3 most favoured site of metastases ? Bone, lung, liver
MEQ3
Part 1 Patient presents with polyuria, polydipsia, and polyphagia.
1. What is the importance of impaired glucose tolerance ?
Pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk of
cardiovascular diseases. May progress into type 2 diabetes mellitus.
2. What is the WHO 2000 diagnostic criteria for type 2 diabetes based on Fasting Plasma Glucose and 2 hours
plasma Glucose?
Fasting - ≥ 7.0 mmol/L ( 126 mg/dL ); two hour plasma glucose ≥ 11.1 mmol/L ( 200 mg/dL )
3. Four strategies WHO to combat Type 2 Diabetes mellitus ?
Promote ( health education ), Prevent ( screening ), Treat, Care ( prevent complication )
4. What are the differences between Type 1 and Type 2 Diabetes Mellitus?
Type 1 DM – destruction of beta cells, associated with HLA, weight loss is common, diabetic
ketoacidosis is common ; type 2 DM – insulin resistance, not associated with HLA, weight loss is rare,
hyperosmotic non ketotic coma is common
Part 2
1. Underline the management for type 2 diabetes mellitus. Lifestyle changes - diet and weight control
( exercise ) → Anti diabetic drugs / oral hypoglycemic agents → Insulin if poor glycemic control.
2. Name 2 groups of drugs used for Type2 diabetes and their Mechanism of Action.
Sulfonylurea ( glyburide ) – increased insulin secretion, biguanide ( metformin ) – increased glucose
uptake by peripheral cells and reduces hepatic gluconeogenesis
3. Why does patient need to change to insulin after a long period of using oral hypoglycaemics ? to prevent
downregulation of the pancreas to secrete insulin in response to the oral hypoglycemic agent
Part 3
1. Pathophysiology of HONK? Dehydration and hyperglycemia ( > 600 mg/dL ) leads to increased serum
osmolality ( > 350 mOsm ) in the absence of ketone bodies. Ketosis is absent because the presence of
some insulin inhibits lipolysis. Severe hyperosmolality develops that causes mental confusion and finally
coma. Common in elderly or patients precipitated by MI, stroke and post surgery.
2. What is the significance of Microalbuminuria and how do you test for it? Diabetic nephropathy,
microalbuminuria ( 30 – 300 mg/day ) , urine dipstick test using 24 hour urine collection
3. What is the importance of HbA 1c? for monitoring glycemic control, recommended < 6.5 %, check
every 3 to 6 months