Department of Biomedical Sciences

Module: Applied Pathobiology

Module Code: 5BIOM007W
Module Leader: Dr Ray Camilleri
Date: 20th January 2017
Start: 10:00
Time allowed: 90 minutes (1 hour, 30 minutes)

Instructions for Candidates:

You are advised (but not required) to spend the first ten minutes of the
examination reading the questions and planning how you will answer
those you have selected.
This paper is in TWO sections.

Section A consists of two long answer case study-style questions, but only ONE of
these questions should be answered in the booklet provided. You should aim to
spend no longer than 45 minutes on the Section A question of your choice.

Section B consists of 40 multiple choice questions (MCQs) and all should be

attempted in the answer grid provided. Please note that some of these MCQs
may have more than one correct answer to choose from. You should aim to
spend no longer than 45 minutes on Section B.

The long answer question (Section A) carries 25% of the marks for the module.

The MCQs (Section B) carry 25% of the marks for the module.

This paper, in total, carries 50% of the marks for the module.

DO NOT TURN OVER THIS PAGE

UNTIL THE INVIGILATOR INSTRUCTS YOU TO DO SO

© UNIVERSITY OF W ESTMINSTER, 2016

 FACULTY OF SCIENCE & TECHNOLOGY Page 2 of 3
Module: Applied Pathobiology
Module Code: 5BIOM007W
Date: 20th January 2017

SECTION A – long answer case study-style question

Answer just ONE of the two questions provided in this section in the answer booklet provided.
You should aim to spend no longer than 45 minutes on this section.

1. A young female patient (15 months old), whose parents were born in Crete and Cyprus (islands
in the Mediterranean Sea) respectively, presented in hospital with a fever. On clinical
examination, she was also found to have fractured legs and an enlarged liver and spleen.
Microbiological testing revealed the presence of a bacterial infection.

The results of the majority of her full blood count are presented here:

Parameter measured Patient value Reference range for 1 year olds

RBC count (x1012/L) 2.2 3.9-5.1
Hb (g/L) 52 111-141
PCV (L/L) 0.19 0.30-0.38
MCV (fL) 54 72-84
MCH (pg) 18 25-29
MCHC (g/L) 240 320-360
Reticulocyte count (x109/L) 145 30-100
WBC count (x109/L) 18 6-16
Platelets (x109/L) 394 200-550

RBC, red blood cell count; Hb, haemoglobin; PCV, packed cell volume (haematocrit); MCV,
mean corpuscular volume; MCH, mean corpuscular haemoglobin; MCHC, mean corpuscular
haemoglobin concentration; WBC, white blood cell count.

a) From the full blood count results presented above, what can you say about the red blood cell
pathobiology of the patient? (30% of question)

b) What pathophysiological mechanism would explain the reticulocyte count shown above? (30%)

c) Give the most likely diagnosis for the patient’s condition based on the information above, stating
your reasons for this. (30%)

d) What would you expect the blood film of this patient to show? (10%)
 FACULTY OF SCIENCE & TECHNOLOGY Page 3 of 3
Module: Applied Pathobiology
Module Code: 5BIOM007W
Date: 20th January 2017

2. A 55 year old man presented to his GP with visible jaundice. Since recently becoming the owner
of a pub, he would drink alcohol regularly, but believed he did not drink excessively or have an
alcohol drinking problem. He was in fairly good health, but had noticed some weight loss and
the severity of itching had increased over the past year. He had travelled to Africa in the past 6
months, but did not report to be a drug user or have had any blood transfusions. In his previous
job, he worked in the NHS for 30 years. The man had some blood taken for biochemical tests.

Serum: Patient Results Reference range

Total Bilirubin 110 µmol/L (3-21 µmol/L)
Conjugated Bilirubin 100 µmol/L (3-21 µmol/L)
AST 70 U/L (10-50 U/L)
ALT 100 U/L (3-55 U/L)
ALP 350 U/L (80-280 U/L)
gGT 100 U/L (<60 U/L)
Total Protein 58 g/L (62-82 g/L)
Albumin 30 g/L (35-50 g/L)
Urine Bilirubin positive (negative)

% Carbohydrate Deficient Transferrin (CDT) 4% (<2%)

Hepatitis B surface antibody (anti-HBs) +ve (negative)

Hepatitis B Surface antigen (HBsAg) -ve (negative)

a) With reference to the case history, explain the blood results reported. (30%)

b) Using named examples, discuss the pathophysiological mechanisms involved in the

development of hepatitis. (70%)

SECTION B – multiple choice questions (MCQs)

MCQ section withheld in accordance with Faculty policy