1. Compare and contrast the histopathological changes that occur in ulcerative colitis and Crohn’s
disease.
Marking scheme
Outline inflammatory bowel disease
Requires biopsy for confirmation – histopathology – differential diagnosis:
cryptitis and crypt abscesses, transmural inflammation, granulomas, fissuring, neuromuscular
hyperplasia – CD
diffuse mucosal inflammation, crypt abscesses, crypt distortion, paneth cell metaplasia, mucosal
ulceration – UC
2. A 29 year old male intravenous drug abuser is admitted to hospital with a 21 day history of fever,
malaise and fatigue and more recently has developed painless red lesions on his palms. He has
been unable to purchase citric acid and has been using lemon juice to dissolve heroin before
injection. Describe how these clinical symptoms support a diagnosis of infective endocarditis.
Describe with reasoning what other clinical and laboratory tests could be performed to confirm this
diagnosis. Include brief details of the therapy that could be given to this patient.
Marking scheme
Define infective endocarditis and describe prognosis without therapy
Describe the pathogenesis of IE and involvement of valves
List predisposing factors to IE and the relevance of IVDU and use of lemon juice to this case
List and discuss the symptoms of IE in the context of this case
List and discuss the non-microbiology tests useful in diagnosis, especially echocardiography
Discuss the microbiological tests, especially blood cultures
List the most likely causes of infection – in this case Candida or Staph aureus and how they
would be isolated and identified from a blood culture or heart valve
Discuss possible treatment- aggressive, high dose antibiotics or antifungals for several
weeks. If infection is highly developed heart valves may need to be replaced.
3. With the aid of labelled diagrams, describe the sequential processes in healing of a skin wound.
Explain the differences between ‘regeneration’ and ‘repair’.
Marking scheme
Definition of healing by first intention and a diagram
Definition of healing by second intention and a diagram
Outcomes of tissue injury (cell death, inflammation just mentioned here, wound debridement)
Surface fibrin deposition
Closing of the skin wound by epithelial cell proliferation and migration.
In normal skin, basal cells only proliferate (maybe just a line on continuously renewing cell
populations, conditionally renewing cell populations and stable cell populations).
Definition of what granulation tissue is.
Degradation of cells of the inflammatory exudate
Fibroblast infiltration and moderate fibrosis
Erythema
Angiogenesis – endothelial cell proliferation and migration
VEGF
Possible outcomes of healing, resolution, organisation, scarring (severe damage and/or
damage to connective will leave a scar)
Ideal result – restitution of the status quo.
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