Pathology EMQ template.

Name: Adrienne Seitz

Candidate number:

Theme: Renal Failure- Glomerular Pathology

 

OPTION LIST

 

A	LM: Mesangial proliferation IF: Mesangial deposits of IgA and C3	E	EM:Subepithelial immune complex deposits
B	LM: Segmental sclerosis and hyalinization of various glomeruli	F	LM:Multiple spikes in the glomerular basement membrane
C	LM: Normal histologic appearance of glomeruli EM: Foot process effacement	G	EM: amorphous granular electron dense deposits of beta pleated sheets
D	EM: Glomerular basement disruption IF: smooth and linear pattern of IgG and C3 in the glomerular basement membrane	H	LM: Mesangial proliferation and basement membrane thickening Splitting of basement membrane seen with PAS stain

LM: Light microscopy

EM: Electron microscopy

IF: Immunofluorescence

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 14yr old boy is brought in by his mother because his face looked puffy. He has no complaints, other than a recent upper respiratory infection that has resolved. O/E, the boy is normotensive, has significant periorbital swelling, and pitting oedema of both extremities. Urine dipstick shows 3+ proteinuria and no blood. No casts are seen on microscopic examination. 24hr urine reveals 3.7g/day protein. Serum albumin is 24g/l, and LDL cholesterol is 290mg/dl.

 

 

2. A 3yr old boy is brought to the physician by his mother because of a 2-day history of ‘puffy eyes and smoky urine’. He had a ‘skin infection’ 2 wks before the onset of these symptoms. His temperature is 38.1°C and his blood pressure is 140/90. He has significant periorbital edema. Lab studies show raised antistreptolysin o titers and decreased serum complement.

 

 

3. A 20 year old man has haemoptysis, acute renal failure, and haematuria; he has bilateral pulmonary infiltrates on a chest radiograph.

 

 

4. A 60 yr old woman with longstanding rheumatoid arthritis presents with insidious renal failure, proteinuria, hepatosplenomegaly, restrictive cardiomyopathy and malabsorption with diarrhoea.

 

 

5. A 6yr old boy is brought in by his mother. He has gross haematuria, which started following a recent respiratory infection. Past medical history includes Henoch-Schönlein purpura

 

 

 

ANSWERS

1. C

2. E

3. D

4. G

5. A