EMRCS PATHO 5 Flashcards
A patient undergoes excision of a lump and the pathologist then examines a histological section and identifies a clump of Reed Sternberg cells. What is the most likely diagnosis?
Thymoma Papillary carcinoma of the thyroid Hodgkins lymphoma Kaposi sarcoma Carcinoma of the parathyroid gland
Reed Sternberg cells are diagnostic of Hodgkins lymphoma
Which statement relating to phaeochromocytoma is untrue?
They are tumours of chromaffin cells in the adrenal medulla. They are bilateral in 10% of cases. When located in an extra adrenal location have a higher incidence of malignancy. May be associated with an elevated urinary VMA. Up to 40% may have a blood pressure within the normal range.
Normotension is seen in around 10% cases. The remainder show a degree of hypertension.
A 69 year old man presents with a purple lesion on his forearm. It is excised and an a 3 cm Merkel cell tumour is diagnosed. Which of the following statements relating to this diagnosis is false?
He should undergo a sentinel lymph node biopsy. Lymphovascular invasion is typically seen histologically They are more common in immunosupressed patients Histologically they may resemble pyogenic granuloma They are associated with visceral metastasis
Merkel cell tumours are rare cutaneous tumours. Histologically they consist of sheets and nodules of hyperchromatic epithelial cells, with high rates of mitosis and apoptosis. As such they are relatively easy to distinguish from pyogenic granuloma which has no features of malignancy and would not show lymphovascular invasion.
A 58 year old lady undergoes a screening mammogram and appearances are suspicious for ductal carcinoma in situ. A stereotactic core biopsy is performed. If ductal carcinoma in situ is to be diagnosed, which of the following pathological features must not be present?
Nuclear pleomorphism Coarse chromatin Abnormal mitoses Angiogenesis Dysplastic cells infiltrating the suspensory ligaments of the breast
Dysplastic cells infiltrating the suspensory ligaments of the breast
The presence of invasion is a hallmark of invasive disease and thus would not be a feature of DCIS. Angiogenesis may occur in association with high grade DCIS.
Which of the following does not occur as a pathological response to extensive burns?
Plasma leakage into interstitial space Absolute polycythaemia Increased haematocrit Keratinocyte migration during healing Cardiac output reduction by 50% in first 30 minutes
Haemolysis is the main pathological response.
A 67 year old man is investigated for biliary colic and a 4.8 cm abdominal aortic aneurysm is identified. Which of the following statements relating to this condition is untrue?
The wall will be composed of dense fibrous tissue only The majority are located inferior to the renal arteries They occur most often in current or former smokers He should initially be managed by a process of active surveillance Aortoduodenal fistula is a recognised complication following repair.
They are true aneurysms and have all 3 layers of arterial wall.
Which of the following statements in relation to the p53 tumour suppressor protein is false?
It may induce necrosis of cells with non repairable DNA damage It is affected in Li Fraumeni syndrome It can induce DNA repair It can halt the cell cycle It may inhibit angiogenesis
When DNA cannot be repaired it will induce cellular apoptosis (not necrosis)
Which of the following cell types is most likely to be identified in the wall of a fistula in ano?
Squamous cells Goblet cells Columnar cells Ciliated columnar cells None of the above
A fistula is an abnormal connection between two epithelial lined surfaces, in the case of a fistula in ano it will be lined by squamous cells.
A 22 year old man is referred to the surgical clinic. He has been complaining of varicose veins for many years. On examination he has extensive varicosities of the right leg, there are areas of marked port wine staining. The saphenofemoral junction is competent on doppler assessment. The most likely underlying diagnosis is:
Deep vein thrombosis Klippel-Trenaunay syndrome Varicose veins due to sapheno-popliteal junction incompetence Sturge - Weber syndrome Angiosarcoma
Klippel-Trenaunay syndrome
Signs and symptoms
The birth defect is diagnosed by the presence of a combination of these symptoms:
One or more distinctive port-wine stains with sharp borders
Varicose veins
Hypertrophy of bony and soft tissues, that may lead to local gigantism or shrinking.
An improperly developed lymphatic system
A 53 year old woman presents with a bloody nipple discharge. On mammography, there is calcification behind the nipple areolar complex. A core biopsy shows background benign change, but cells that show comedo necrosis which have not breached the basement membrane. Which of the lesions below is most likely?
Fibrocystic disease of the breast Ductal carcinoma in situ Invasive ductal carcinoma Atypical ductal hyperplasia Lobular carcinoma in situ
Comedo necrosis is a feature of high nuclear grade ductal carcinoma in situ. It is has a high risk of being associated with foci of invasion.
A 68 year old man presents with an ulcerated lesion on his right cheek. It is excised and on histological assessment a squamous cell carcinoma is diagnosed. It measures 25mm in diameter and is 4mm deep. Which of the following statements relating to this condition is false?
In this particular case margins of at least 6mm are required Use of cryosurgery to treat this patients lesion would have been unsafe Use of radiotherapy to treat this lesion would have been unsafe This patients local recurrence rate may approach 15% The disease usually spreads via lymphatics
This man has an SCC with significant risk of metastasis. Although cryotherapy may be used to treat SCC it would be most unsafe in this setting as the lesion extends deeply. However, radiotherapy is a safe treatment modality for SCC and may be used in selected cases. It is unwise to use radiotherapy in areas prone to radionecrosis e.g. the nose.
A 23 year old man presents with weight loss fatigue and lymphadenopathy. He is diagnosed with tuberculosis. Which of the following processes most closely matches the underlying pathological process?
Type 1 hypersensitivity reaction Type 2 hypersensitivity reaction Type 3 hypersensitivity reaction Type 4 hypersensitivity reaction None of the above
Granulomas (which occur in tuberculosis) are a feature of Type 4 hypersensitivity reactions
A 73 year old man undergoes an emergency amputation for severe lower limb sepsis and gangrene. Post operatively he develops disseminated intravascular coagulation. Which of the following clotting factors will be most rapidly consumed in this process?
Factor V and VIII Factor I Factor I and III Factor III and VII Factor VI and VIII
DIC Will tend to consume factors five and eight intially (and platelets).
A pregnant women suddenly develops bilateral leg swelling. Her mother and aunt were troubled by the same problem. What is the most likely underlying abnormality?
Anti endomysial antibodies Anti nuclear antibodies Anti cardiolipin antibodies Anti thyroid antibodies Anti mitochondrial antibodies
Anti phospholipid syndrome= following antibodies
Lupus anticoagulant
Anti-cardiolipin
Anti-β2-glycoprotein
A 63 year old Japanese man presents with epigastric discomfort and iron deficiency anaemia. He undergoes an upper GI endoscopy, where the following appearances are found:
The most likely diagnosis is:
Squamous cell carcinoma Linitis plastica Leiomyosarcoma Gastric varices None of the above
Linitis plastica produces a diffuse infiltrating lesion, the stomach is fibrotic and rigid and will not typically distend. This may be described as a ‘leather bottle stomach’. Diagnosis is made with a combination of pathology examination with endoscopy, radiological or surgical assessment. Pathologically signet-ring cell proliferation occurs.
A 52 year old lady is referred to the breast clinic with symptoms of nipple discharge. The discharge is usually thick and green. Which of the following statements relating to the most likely underlying diagnosis is untrue?
The majority of patients will be smokers Typically produces blood stained nipple discharge It is not associated with increased risk of breast cancer May result in development of mammary duct fistula May require total duct excision (Hadfields operation) if it fails to resolve
Discharge of this type of material is most likely to be due to duct ectasia. Green or brown discharge is most common. Blood stained discharge should raise concern of intraductal papilloma or cancer.
Which of the following statements relating to gas gangrene is untrue?
There is necrosis with putrefaction The causative pathogens may be detected on normal perineal skin Treatment with low dose penicillin is indicated Hyperbaric oxygen may be beneficial Clostridium perfringens is a recognised cause
Rapid surgery and high dose antibiotics are indicated in the treatment of gas gangrene.
A 30 year old man presents with abdominal distension, a laparotomy is performed, at operation the abdomen is filled with a large amount of gelatinous fluid. What is the most likely underlying diagnosis?
Infection with entamoeba histolytica Pseudomxyoma peritonei Metastatic colonic cancer Chylous ascites None of the above
Pseudomyxoma is associated with the deposition of large amounts of gelatinous material. The appendix is the commonest organ or origin.
A 30 year old man is suspected of having appendicitis. At operation an inflamed Meckels diverticulum is found. Which of the following vessels is responsible for the blood supply to a Meckels diverticulum?
Right colic artery Vitelline artery Appendicular artery Internal iliac artery External iliac artery
The vitelline arteries supply a Meckels these are usually derived from the ileal arcades.
A 45 year woman presents with haematuria. She has a temperature of 38 oC and is found to have a Hb 17g/dl. Her urine dipstick shows nitrites and 3+ blood. Blood and urine cultures are negative. What is the most likely cause?
Urinary tract infection Renal vein thrombosis Adult polycystic kidney disease Hypertensive nephropathy Membranous glomerulonephritis
Renal vein thrombosis is a common feature of renal cell carcinoma as it invades the renal vein. Other features include PUO, left varicocele and paraneoplastic endocrine effects due to erythropoietin factor, renin, ACTH and PTH like substance.
