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OSPE

Pathology 1. A lady had a lesion on her left leg and had an amputation done. The picture shows the cut section of the removed limb (Picture of osteosarcoma) a. Describe the gross appearance of the picture i. Large, ill-defined lesion in metaphyseal region of long bone ii. Characteristically destroy the cortex iii. Extends inward into marrow cavity and outward into adjacent soft tissues (sunburst appearance) iv. Tumour elevates the periosteum to Codman triangle (x-ray) b. What is the diagnosis? i. Conventional osteosarcoma osis? c. Give 3 complication of the lesion i. Metastases to the blood stream to lung ii. Pathological fracture, soft tissue destruction iii. Necrosis progress to Osteomyelitis 13. give photo showing cut section of osteosarcoma in distal femur a) describe the lesion - bulky solitary tumour, invasive and ill defined - necrotic and haemorragic - gritty tan white - at metaphysis of long bones - sun burst appearance at new spicules of bone b) diagnosis - ostesarcoma c) biological behavior of this condition - aggressive, invasive malignant tumour - mostly erode into medullary cavity or extend outwards into adjacent soft tissue/elevate periosteum - early pulmonary metastases 2. given a picture showing a cut section of adrenal gland (adrenal adenoma) a. Describe the gross appearance of the picture i. Encapsulated, expansible, yellow tumour b. What is the diagnosis? Adrenocortical adenoma c. Give the condition associated with the lesion Cushing Syndrome d. Give 3 clinical sign of the given condition hypertension, truncal obesity, osteoporosis 3. a lady had her ovary remove because it was enlarged due to a lesion. The slide shows section from the ovary. (benign ovarian teratoma) a. Describe the microscopic appearance i. Unilateral cyst lined by epidermis ii. Filled with sebaceous secretion and hair iii. Nodular projection from which teeth protrude iv. Foci of bone, cartilage, nests of bronchial and GIT v. Epithelium is also present vi. Rarely exceed 10cm in diameter b. What is the diagnosis? benign cystic teratoma c. Give 2 other place in the body that you might find this condition testis, pineal gland, saccrococcygeal

11. given gross specimen of benign teratoma of ovary a) describe the lesion - well circumscribed uniocular cyst with capsule, smooth surface - presence of maltod hair with sebaceous secretion, tooth, bone and cartilage - grey-white lining, rarely more than 10cm b) what is the diagnosis - benign cystic teratoma of ovary c) complications - sterility - prone to undergo torsion acute emergency - may transformation into SCC 4. a man had a progressive chronic headache. He came to university hospital and was found to have an intracranial lesion. The slide shows a section of the lesion (meningioma) a. describe the microscopic appearance i. Whorled clusters of cells with scanty intervening fibro vascular stroma ii. Many histo pattern but low mitotic activity iii. At the central whorls may be area of calcification termed Psammomma bodies b. What is the diagnosis? Meningioma c. Give 3 complication of the lesion i. Increase intracranial pressure, hydrocephalus, cerebral oedema, herniation and structural distortion 12. microscopy : papillary carcinoma of thyroid a) describe what you see - overcrowding of follicular epithelium, forming papillary projections into gland lumen with fibrovascular core - psammoma bodies found in papillary projections - neoplastic cells have ground glass/orphan Annie nuclei - pseudoinclusions can be seen b) diagnosis - papillary carcinoma of thyroid c) outcome it left untreated - mass effect i) compression of recurrent laryngeal nerve voice alternation ii) compression of esophagus dysphagia iii) compression of trachea airway obstructuion - invasion of extra thyroidal tissue - metastase to cervical lymph node/lung 12. papillary CA (slide) a) describe 8M b) diagnosis 2M 14. microscopic : squamous cell carcinoma at the mucosal surface of mouth a) describe what you see - epithelia atypia, keratin pearls, polygonal cells forming nests, island sheets - cells have intensely eosinophilic sytoplasm with pleomorphic looking nuclei, high nuclear : cytoplasmic ratio and atypical mitosis - intercellular bridges and keratin pearls can be seen b) diagnosis - squamous cell carcinoma of mouth

c) complications - local pain, difficulty in chewing, metastases to surrounding structures 11. leiomyoma (specimen) a) describe 5M b) diagnosis 2M c) complications 3M 13. brain abscess (photo of slice of brain) a) describe 5M b) list out 2 causes 3M c) complications 2M 14. cushing woman 40s, weight gain, easy bruising, hirsutism a) diagnosis 1M b) cause 6M c) other tests 3M 6. meningitis (slide) describe macroscopic feature, diagnosis and causes 7. glucose tolerance test Fasting 2 hours postprandial a) comments b) diagnosis 6. benign cystic teratoma of ovary (photo) a) describe 5M b) diagnosis 2M c) complications 3M 7. multinodular colloid goiter (microscope) a) describe microscopically 5M b) diagnosis 2M c) 3 complications 3M 8. meningioma (gross-photo) a) describe 5M b) diagnosis 2M c) complications 3M 9. lab test : biochem ( Na high normal, K low, glucose high weight gain and hirtutism, high serum cotisol ) a) diagnosis (Cushings syndrome) 2M b) 4 causes 4M c) further tests 4M 1. a) b) c) 2. a) b) c) d) Photograph of chronic myeloid leukemia give the likely diagnosis 2M describe about the molecular basis of the disease 5M what are the complications 3M A gross specimen is showing a cirrhotic liver describe what you see 3M what is the diagnosis 1M list 6 causes 3M what are the complications 3M 6.7 mmol/L 12.5mmol/L

3. A patient has a mass is ascending colon. Given a mesenteric lymph node slide. Assume the changes seen in the mesenteric lymph node are same as the mass in ascending colon. a) describe what you see 4M b) give the diagnosis 2M c) what grade is the mass and why do you say so 2M d) what stage is the mass and why do you say so 2M 4. A 16 years old girls urinary test. pH : 4.5 glucose : -protein : ++ ketone : -Hb : ++ Bilirubin : normal Urobilinogen : -a) b) c) 5. a) b) c) what is the possible diagnosis 3M what investigation needs to be done to confirm the diagnosis 4M what are the complications 3M A lung slide is showing squamous cell carcinoma describe what you see 4M what is the diagnosis 2M what are the predisposing factors 4M

Medical Microbiology 6. A child has acute pharyngitis. A plate is showing Streptococcus pyogenes colonies on blood agar with a bacitracin disc. a) describe the plate 4M b) what is the likely organism 2M c) give 2 direct complications 2M d) give 2 indirect complications 2M 7. A womans urine with >105 organisms/ml. a plate is showing Escherichia coli colonies on MacConkey agar a) describe the plate, give the likely organism, how to confirm the organism 4M b) why should we do viable bacteria count 2M c) interpret the patient result 2M d) what is the likely source of the organism 2M 8. a) b) c) d) 9. a) b) c) d) Photograph is showing Rota virus describe what you see 2M what is likely the organism 2M give 2 preventions 2M give 2 other organisms causing gastroenteritis 2M Patient had lung problem. A slide with Ziehl-Neelson stain is shown under light microscope. describe what you see 3M what is the likely organism 1M state 3 common antibiotics 3M state 3 other organs that can be affected 3M

5. A lady underwent a major operation. She develops septicaemia. Give is a MacConkey agar with pink colonies a. describe the specimen and state the most probable organism Blood specimen Specimen E. coli K. pneumoniae IMViC ++---++

i. ii.

b. 1. 2. 3. c. d.

i. ii. i.

What is the test that can confirm your answer in (a)? Urease +ve: K. pneumoniae Urease ve: E. coli Produce indole from tryptophan decarboxylated lysine Use acetate as its only source of Carbon Give 2 drugs to counter the infection of the organism 3rd generation Cephalosporin e.g. Cefotaxime Aminoglycoside Give 2 sources of this organism Contaminated food and water

6. A 35 years old man with active sexual history came in with painful ulcers on the penile glans area. Serology test was done and the results are as follow: VDRL TPHA HSV Ag LVG Ag +ve -ve +ve -ve a. Comment on the results shown i. VDRL non-treponemal test ii. False positive results because TPHA specific treponemal test negative b. What is the likely infection? i. Painful ulcer due to H. simplex virus c. Describe briefly immunofluorescent test. i. Detection of microbial antigen is done by staining with specific antibody with fluorescent dye d. Give 2 conditions that can produce biological false negative for VDRL test. i. Measles, mumps, viral pneumonia 7. Given a picture of HIV virus a. Name the part labeled A-F (gp120, gp 41, p17, p24, RNA, protease) b.

b. Give 2 parts involved in its pathogenesis (gp120, gp41) - gp120, reverse transcriptase c. Give 2 parts involved in the diagnosis of AIDS (RNA, gp120) - HIV p24 antigen, HIV RNA 8. Given a picture showing Naeglers reaction a. Describe the principal of this test i. Clostridium perfringens produces alpha toxin which is lecithinase b. What organism can be identified with this test? i. I f the organism is grown on an egg yolk agar, enzyme activity can be detected as opacity around the line of growth. ii. If anti-alpha toxin is applied to the surface before inoculation, activity of toxin is inhibited c. Give the pathogenesis of the organism. Traumatic wounds or surgery can result in contamination with clostridial spores

Vascular damage aggrevated by foreign bodies reduced oxygen tension [increases growth of the anaerobe / exotoxin] destruction of capillary membrane and muscle [gangrene] 5. the organism on this nutrient agar plate was isolated the blood culture of a 25 years old female patient with several body burns. She had been admitted to the hospital 10 days ago. a) describe what you see and name likely pathogen - greenish large colonies with irregular margin, mucoid colonies, blue-green pigment, fruity aroma - pathogen = Pseudomonas aeruginosa b) what are the likely sources of this organism - soil, water, saline drip, disinfectant, normal flora of URT and colon c) name other organism that can cause wound infection from burn - Staphylococcus aureus, Sterptococcus pyogenes d) name 2 antimicrobials that appropriate in the treatment of this patient - gentamicin ceftrixone - polymyx 7. the microorganisms as isolated from a skin infection of a patient. The slide has been stained with lactophenol cotton blue. a) describe what you see and name the likely pathogen - long, thin cigar-shaped macroconidia, smooth walled septated hyphae - numerous small, unicellular microconidia - pathogen = Tricophyton b) name the natural habitat of this pathogen - soil, animal, human c) name the best medium for isolation of this pathogen - Sabourauds dextrose agar d) other than the skin, name other side of the body that can be affected by this pathogen - scalp, nails, hair, groin e) name 2 antimicrobial those are useful in the treatment of this infection - miconazole, itraconazole, oral griseofulvia 1. diplococci slide ( Neisseria gonorrhoeae) a) describe 4M - intracellular gram negative diplococci (kidney-shaped) - > 4 PMN/hpf b) name 1M c) 2 tests - oxidase test oxidase positive - sugar utilization test ferment glucose, not maltose - direct fluorescence antibody test d) antimicrobial and its rational 3M - ceftrixone - not penicillin and tetracycline --- plasmid colloid resistance - chromosomal mediated resistance --- penicillin, kanamycin e) complications - direct spread to cause epididymitis, seminal vesiculitis, periurethral abscesses, prostatitis - distant spread --- gonococcal septic arthritis - spread to lymph nodes --- lymphadenitis

2. Pseudonomas a) describe and name 4M - mucoid colonies, fluorescent blue-green colonies, fruity aroma b) what do you see microscopically with gram-staining 2M - gram negative bacilli with polar flagellum, no spores c) transmission 3M - nosocomial infection (direct/indirect contact, saline drips) - water, soil, aqueous solution - normal flora of colon, found on skin, URT - burn --- ulcer --- barrier damage --- contamination by skin flora d) antimicrobial 1M - ceftazidime, gentamicin 3. slide of leaf-like micronidia a) describe the structure 4M - thick wall, spindle shape macroconidia, tapered to knob like ends, rough, spiny surface - micrconidia few but present b) name 2 possible organisms with the disease they cause - M.audouinii --- tinea capitis - M.sypsium --- tinea corporis c) 2 drugs 2M - itraconazole, miconazole 4. measles ( patient with fever, coryza, maculopapular rash ) a) provisional diagnosis 2M b) further test to confirm 2M - measles haemaglutination inhibition test --- 4 fold increase of Ab titre between acute and convalescent sera - immunoflourescence test on nasopharyngeal swab to detect Ag c) treatment - symptomatic, supportive, isolation of patient d) how to prevent - passive immunization (Ig) to exposed cell-mediated immunity deficient patient and babies < 1 year old - active immunization with live attenuaeted vaccine e) complication - laryngitis, secondary bacterial pneumonia 15. Neisseria meningitides (photo) a) describe b) etiological agents c) prevention 16. VDRL 1:2 TPHA negative comments, diagnosis and prevention 17. Microsporodium (slide) describe, identify and 2 treatments 18. hand foot mouth disease (photo) diagnosis, 2 etiological agents, causes, describe rash

Parasitology 10. a) b) c) d) 11. a) b) c) d) 12. a) b) c) d) 13. a) b) c) d) e) 14. a) b) c) d) Photograph is showing Brugia malayi microfilaria give the genus, species, stage 3M give 2 characteristics 4M name a disease caused by this organism 2M treatment 1M Photograph is showing Paragonimus westermani egg give the genus, species, stage 3M mode of transmission 4M 2 other specimens other than sputum 2M treatment 1M Photograph is showing Clonorchis sinensis / Opisthorchis viverrini egg give the genus, species, stage 3M mode of transmission 2M what are the symptoms shown in patient 3M treatment 1M Photograph is showing hookworm egg name the organism and stage 2M mode of transmission 3M give 1 characteristic 2M treatment 1M complications 2M Photograph is showing Enterobius vermicularis egg give the genus, species, stage 3M 3 modes of transmission 3M what technique used to diagnose 2M drugs 2M

10. scabies (photo of adult time) a) genus, species and stage 3M b) 2 characteristics 4M c) mode of transmission 2M d) drug to treat 1M 11. P.falciparum ring form (history of fever and tiredness in a 33 years old female) a) genus, species and stage 3M b) characteristics 4M c) what is vector in Malaysia (give genus and species) 2M d) infective stage 1M 9. given a slide showing a forked tail larvae a. give the genus, species and stage of the parasite i. Strongyloides stercoralis, filariform larva b. Give the reason why this parasite can infect the host for a very long time - It can autoinfect in the host by penetrating perianal skin of host c. Give the drug used for this parasite -Thiabendazole 10. given a slide showing a fertilized egg of ascaris a.give the genus, species and stage of the parasite -Schistosoma mansoni egg (lateral spine) b.Give 2 complication of this parasite -Hepatosplenomegaly

-Cercarial dermatitis -Septicemia/Katayama fever c.Give the drug used for this parasite -Praziquantel 11. a man came back from the Middle East. Given is a picture showing the egg. a.Give the genus, species and stage b.Ascaris lumbricoides unfertilized egg c.Give 2 complications of the infection by the parasite - Pneumonitis Loefflers, acute intestinal obstruction d.Give a drug used for treatment Mebendazole 15. Plasmodium falciparum a) genus, species and stage 3M b) 2 diagnostic characteristics 2M c) 3 complications 3M d) treatment for coma, why 2M 16. Entamoeba histolytica anal infection (slide) a) genus, species and stage 3M b) 2 ways it invade the skin 2M c) complications 3M d) treatment 2M 17. Pneumocystic carinii (AIDS patient/slide) a) genus, species, stage 3M b) diagnostic characteristics 3M c) 2 clinical signs 2M d) treatment 2M 12. brain (photo) of AIDS patients. Toxoplasma gondii a) mode of transmission b) 2 diagnostic methods c) 2 treatments 13. blood film (Plasmodium falciparum) a) 2 characteristics b) 2 complications c) treatment 14. lung specimen (photo) of AIDS patient (Pneumocystic cariniii) a) characteristics b) respiratory clinical features c) treatment Pharmacology 8.Combined oral contraceptive a. One example of oestrogen and one example of progestagen b. Mechanism of action of i. Oestrogen ii. Progestagen c. 3 dosage regimens d. Explain adverse Cardiovascular effect i. Venous thromboembolism ii. Hypertension e. 3 non-contraceptive beneficial effects of COCs f. Drug interaction with broad-spectrum antibiotics

9. given a line graph showing mean time of onset (reaction of the tested rats on hot plates versus time for morphine, aspirin and saline) a. give the time onset and duration of action of morphine i. onset < 10 minutesb, duration of action > 60 minutes b. give the mean time onset difference between morphine vs saline and aspirin vs saline c. is this experiment suitable to test the analgesics effect of aspirin? Give reasons. Low dose of aspirin, pain does not involve inflammation. d. mechanism of action i. morphine or opiate receptor, aspirin through inhibition of COX ii. morphine more effective 18. pharmaco a) name insulin analogue drugs b) describe graph and explain why it is so c) what is the therapeutic use of analogue insuline d) is it suitable for diabetes maintenance 19. ulcer at the base of leg a) describe 4M b) 2 causes 2M c) other signs of the leg 4M 8.

Drug A Concentration of warfarin

a) describe the changes of warfarin concentration after administration of drug A - plasma concentration of warfarin decreases with administration of drug A b) why does it occur? - drug A might be an enzyme inducer, induces metabolizing enzyme in the liver. So, increase metabolism of warfarin and decrease plasma concentration c) name 1 possible drug A - carbamazepine d) what is the function of warfarin, what will occur of drug A is given? - patients who had myocardial infarction, as an anticoagulant. Attenuation of the anticoagulant effect giving rise to blood clots 9. Migraine a. 2 abortive migraine drugs (2) b. MOA of each (4) c. Adverse effects of each (2) d. Why use it? (2) 10. Antigout a. 2 drugs of different groups (2) b. MOA in lowering serum uric acid (4) c. Drug which can be used for acute attack and prevention (1) d. Mechanism of [c]? (3)

11. Drug interactions a. Explain PK interaction and give example b. Explain PD interaction and give example c. Is this beneficial or adverse? Explain: i. Warfarin and tetracycline ii. Lignocaine and adrenaline (10) 15.

BP

2ug/ml Ach

2ug/ml Ach 200ug/ml Ach time

atropine
a) describe the changes after administration of 2ug/ml Ach i) before atropine 1M ii) after atropine 1M b) explain the differences 2M c) state the effects of 200ug/ml Ach administration 2M d) explain the difference between effects of 2ug/ml and 200ug/ml Ach administration after atropine 4M 16.

BP

isoprenaline Mean BP

NA

time
a) write action of noradrenaline and isoprenaline on systolic, diastolic and mean BP 4M b) explain 6M 17.

Action rate

Diuretic A

Diuretic B

dose

a) b) c) d)

what kind of response does the graph show ( dose-dependent/quantal response ). Explain A or B has higher efficacy Name one example of diuretic A Mechanism of action of drug A

18. Growth chart a) what type of chart is this b) what does 50th percentile mean c) 2 uses of this chart d) can both boy and girl use the same chart?why? . a) what happen before and after administration of drug B? b) what is the effect of drug B and drug C/ c) how does drug B affect activity of drug B? d) one mechanism of drug C

activity B C A A A A A time

5. Rabbit experiment

respiration morphine Drug A

a) comment and explain morphine action on respiration b) what happened when drug A given and explain 4M (reversal of respiratory depression) c) what drug acts like drug A 2M Neuroanatomy 8. brain model a) occulomotor nerve components, function b) trigeminal nerve components, function 9. midbrain (photo) a) identify structure A. (pons) b) arterial supply c) 2 ascending tract functions d) 2 ascending tract functions 10. skull (X-ray) a) identify structure A(internal carotid artery) b) 2 terminal branches c) blood supply of cerebellum

d) complications of impaired blood perfusion to cerebellum 11. specimen (spinal cord) arterial supply, congenital anomaly 12. Corticobulbar fibres a. Origin of corticobulbar tract (2) b. Which part of internal capsule does it go through (2) c. 3 Cranical nerve nuclei where corticobulbar tract project to and which muscle group they supply (6) 13. Part of brain and location and function a. Somatosensory cortex, primary auditory area, primary motor, limbic area (8) b. What happen if Brocas area is damaged? (2) 11. Given a. b. c. a brain model Name structure (occulomotor) and B (trigeminal) Give 2 component of A and their function respectively Give 2 component of B and their function respectively Component Motor parasympathetic Function Movement of eyeball (extraocular muscle) Papillary constriction & accommodation Opening & closing of mouth Tension on tympanic membrane General sensation of face

CN Occulomotor

Trigeminal

Motor Sensory

12. Given a brain model a. Name structure A ( cerebellum) b. Name 3 functions parts of A and their functions respectively Part (APN) Archicerebellum Paleocerebellum Neocerebellum Function (BPC) Maintenance of balance Mucle tone & posture Muscular coordination Mnemonic AB PP NC

c. Name structure B (thalamus) d. Name 2 function of it i. Transmit general & special sensory information to corresponding regions of sensory cortices ii. Receive impulses from cerebellum and basal ganglia & interface with motor regions of frontal lobe iii. Connections with associative & limbic areas of cortex iv. 13. Given a picture (from Crossman) showing a cross section of spinal cord ( thoracic level) a. Name structure A Dorsal column b. Give the origin of the tract & where it ends O: dorsal root ganglia T : somatosensory cortex c. Name structure B lateral horn of spinal cord d. What is the function of the structure? i. contains cell bodies of preganglionic sympathetic neurons

14. . Given a picture (from Crossman) showing the main tract of spinal cord a. Name structure A i. ventral spinocerebellar tract b. Give the origin of the tract & where it ends O: base of dorsal horn of spinal cord T : cerebellar cortex within vermis c. Give the function of the tract i. control of posture & coordination of movement d. Name structure B i. corticospinal tract e. Give the origin of the tract & where it ends O: red nucleus T : ventral horn of spinal cord f. Give the function of the tract i. control limb flexor muscles 18. brain model a) point Abducens nerve give its name, its components and functions component motor function innervate LR muscle, movement of the eyeball b) point vagus nerve give name, 3 components and their functions Component Sensory Function General sensation at pharynx, larynx, esophagus, external ear Chemo and baroreceptor Visceral sensation Speech, swallowing Control of CVS, respi and GI tract

Motor parasympathetic

19. cross section of spinal cord (picture) a) label A fasciculus gracilis b) the tract in the area marked A originates at c) the tract in the are marked A terminates at - somatosensory cortex d) blood supply to the area marked A - post spinal artery or either vertebral or post inf cerebellar artery - post branch of radicular artert that arise from cervical post intercostals and lumbar artery e) identify B fasciculus propius g) state the function of the cells in the area marked B - connects asc and desc tracts entering the different segments important for intersegmental spinal reflexes - interconnect adjacent or distant cord segments and permit intersegmental coordination 20. A- trigeminal nerve a) give 2 components and its functions Components Sensory Motor Functions General sensation of face, scalp, nasal and oral cavities, cranial dura matter Mastication Tension on tympanic membrane

b) occulomotor nerve c) give 2 components and its functions

Component Motor Parasympathetic

Functions Movement of eyeball Papillary constriction and accomodation

5. cranial nerve (oculomotor nerve) a) name 1M 2 components Function

Trigeminal nerve b) name 1M 2 components Function

6. artery and base of brain 4M a) name A (pons) b) 3 cranial nerve nuclei 3M - abducens nucleus, motor nucleus of facial nerve, superior salivatory nuclei c) arterial supply - arterial supply --- pontine arteries derived from basilar artery d) name B ( vertebral artery) 1M e) origin 1M subclavian artery f) 3 branches - anterior spinal artery - posterior spinal artery - posterior inferior cerebellar artery 7. spinal cord section a) name the tract A ( Dorsal column tract ) 2M b) termination 2M - origin : primary afferent neuron that joins the cord at sacral, lumbar and lower thoracic level - termination : nucleus gracilis c) blood supply 2M - posterior spinal artery - below cervical segment, receive several reinforcements from radicular arteries arising from ascending cervical, intercostals and lumbar arteries d) function 2M - convey propriception, fine touch and vibration sensation e) name the structure B ( dorsal spinal cerebellar tract ) 2M - lateral cortospinal tract - convey fine, delicate, voluntary movements of the contralateral half of the body 8. brain model ( frontal lobe slide ) a) name 2M b) 4 functional areas 4M - primary motor cortex - premotor cortex and supplementary motor complex - Brocas area - prefrontal cortex c) 2 blood supplies - anterior cerebral artery, medial part

- middle cerebral artery, lateral part d) name the structure (olfactory bulb), function 2M - olfactory bulb - function: preliminary processing of olfactory information 1. cranial nerve (Crossman picture) a) name A (oculomotor nerve) 1M b) components and functions 4M c) name B (trigeminal nerve) 1M d) components and functions 4M 2. picture of brain stem and arterial supply (Crossman) a) name A (pons) b) 3 cranial nerve nuclei in A1M c) blood supply of A 3M d) arterial supply 2M e) name B (vertebral artery) 1M f) origin of B 1M g) 2 branches of B 2M 3. spinal cord (Crossman picture) a) name structure A (Fasciculus gracilis) 1M b) function of A 2M c) termination of A 2M d) blood supply of A 3M e) name tract B (dorsal spinocerebellar tract ) 2M 4. brain model a) name A (frontal lobe) 1M b) 4 functional areas of A4M c) 2 artery supplies 2M d) name structure B (olfactory bulb) and its function 3M Neurophysiology 14. Sleep a. Difference between REM and NREM sleep (4) b. Types of EEG waves in human (3) c. Basis of EEG (3) 15. vision a. explain what is 6/18 and 6/24 and what is significance (5) b. What is visual acuity? (2) c. Factors that affect acuity (3) 15. Given an Ishiharas colour chart (no 21) a. What is the name of the cart? i. Ishiharas colour chart b. Give the most famous theory of colour vision i. Young Helmholtz Theory c. Give 2 functional differences between cone and rod receptor i. cone 1. colour vision 2. vision in the light (photopic vision) ii. Rod : 1. vision in the dark condition ( increase sensitivity, decrease acuity) (Scotopic vision) 2. will not give information regarding colour d. Name the most common colour blindness. Give reason why males are more

i. prone to get this disease ii. buta warna dikromat orang tersebut mempunyai 2 jenis kon & boleh beza 2 warna primer sahaja. Buta warna kecatatan warisan berangkai seks. Lelaki mempunyai 1 kromosom X sahaja. Oleh itu mempunyai kebarangkalian yang lebih tinggi untuk mendapat kecatatan tersebut. 18. given the vision tract showing lesion at the right optic nerve, optic chiasm and the right optic radiation. a) Shade the part of visual field affected

Monocular blindness

Lesion at optic chiasma

Lesion at right optic radiation

Bitemporal hemianopia

Homonymous hemianopia

b)With aid of arrows, indicate the direction of movement of the endolymph in the semicircular canal in the diagrams given below, when the person turns (i) to the right To the right Endolymph move left (ii) When he stop turning Stop turning Endolymph move right c) What is the direction of the nystagmus during the rotation? Nystagmus Start rotation

15. FM: rajah 83.13, 84.14 of visual pathway label the lesion for a) bitemporal hemoanopia (draw line at the site of lesion and label A) b) left homonymous hemianopia (B) c) lost light reflex in both eyes (C1& C2) d) light flashed into left eye, only right eye shows consensual reflex (D) 16. FM : rajah 85.6 label the direction of the flow of endolymph when head starts and stops rotation. Label the direction of nystagmus when head starts and stops rotation Besides vestibular, name 3 other sensory input equilibrium i) visual system ii) pressure receptor in the feet iii) proprioceptors in muscle, tendons, joints and ligament 1. a) picture showing cochlear and semicircular duct. Label it b) when head turn left to right Start rotation Endolymph Eye nystagmus 2. picture showing cerebellum. Label it. a) how does cerebellum control voluntary movement? b) 4 clinical features c) differences between cerebellum and resting tremor 17. A- cerebellum a) name the structure b) 3 functional classification and their respective functions Functional subdivision Archicerebellum Paleocerebellum Function Maintenance of equilibrium Maintenance of posture and muscle tone Stop rotation

neocerebellum

Coordination of movement

c) identify structure B - Thalamus d) state 2 functions of structure B - rely centre for transmission of all general sensations (except for smell) to the body to the brain - responsible for emotions and behavior via its association with limbic system 9. sensory homunculus ( given a picture ) a) location 1M - postcentral gyrus ( primary somatosensory cortex ) b) which part of body has large area presented? Why? 3M - palmar surface c) 3 specialized functions of somatosensory 3M - for pain, tenmperature, proprioception, touch receptors - 2 points discrimination - stereognosis - tactile localization d) 2 points discrimination test. Discuss its basis with example of body parts 3M - ability to distinguish contact by 2 points at varying distances from one another, varies from place to place - smaller where touch receptor is most abundant (smaller receptive field) - finger tip 3mm - skin of back 65mm 10. pain a) list types of pain and the fibers associated b) explain gate theory 4M c) name 2 endogenous opioid and their mode of action 4M Clinical 19. Given a picture showing a ladys hand with Rhematoid Arthritis. a) Give 4 salient signs in the picture - Z deformity, swan neck, Boutonniere deformity, ulna deviation b) Give 4 complication in other systems related to this condition - Scleritis, Caplans syndrome (rheumatoid lung nodes + pneumoconiosis), Sjogrens syndrome (enlargement of parotid gland, dry mouth, dry eyes), Pericardial rub c) What is the diagnosis - Rheumatoid arthritis 20. Given a picture showing a lesion on the abdominal wall of a 35 year old man which has grown from a minute lesion to a lesion measuring 8 cm in diameter within a few months time a) Give 4 salient gross features of the lesion -Nodule, ulcer with everted edge, occasional bleeding, necrotic base b) What is the diagnosis -SCC c) Which other part of the body would you examine to determinie the spread of the lesion? -Common on exposed skin (head & neck, hands, forearms, upper trunk) d) Give 1 test that can confirm your diagnosis

-Histopathology . clinical : given a picture showing tongue protruding to one side a) describe clinical condition - deviation of the tongue b) what is the cranial nerve involved - hypoglossal nerve c) name 3 possible causes of the cranial nerve palsy - pseudobulbar palsy degeneration of corticobulbar tract projecting to nucleus ambiguous and hypoglossal nucleus - bulbar palsy degeneration of hypoglossal nucleus - compression as it exits the cranium by tumours 10. given a picture showing swelling/nodule at the pre-external auditory meatus region a) describe the lesion - large, irregular deposits of chalky white sodium urate b) what is the organ involved - helix of ear c) give possible causes - increase purine tumour due to myeloproliferative disease - lymphoma - leukemia - renal disease - hypothyroidism - Lesen-Nyhan disease - low dose aspirin 19. ascites (photo) pathophysiology of chronic liver diseases, 2 other complications 20. thyroid gland enlargement (photo) a) boundaries of anterior and posterior triangle of neck b) 5 causes and 2 maneuvers to diagnose 19. The patient has jaundice, confusion and abdominal distention. Given a picture showing a hand with palmar erythema. a) describe what you see 2M b) diagnosis 2M c) 3 other symptoms 3M why abdomen is distended 3M 20. A 50 years old lady with a lesion on temporal region a) describe the lesion 3M b) what is the differential diagnosis 3M c) give 4 complications 4M