EMRCS PATHO 6 Flashcards
A 30 year old male presents with gynaecomastia. Clinically, he is noted to have a nodule in the left testis. What is the most likely diagnosis?
Oestrogen abuse Seminoma with syncytiotrophoblast giant cells Teratoma Choriocarcinoma Leydig cell tumour
Leydig cell tumours are rare testicular sex cord stromal tumours (which also include sertoli cell tumours) which are associated with hormonal activity.
Patients with Leydig cell tumours may present with gynaecomastia before they notice testicular enlargement.
Majority are benign
Histology: eosinophilic cells in columns
What is the most common cause of osteolytic bone metastasis in children?
Osteosarcoma Neuroblastoma Leukaemia Rhabdomyosarcoma Nephroblastoma
Neuroblastomas are a relatively common childhood tumour and have a strong tendency to developing widespread lytic metastasis.
Which of the following features are not typical of Crohns disease?
Complex fistula in ano Small bowel strictures Skip lesions 'Rose thorn ulcers' on barium studies Pseudopolyps on colonoscopy
Pseudopolyps are a feature of ulcerative colitis and occur when there is severe mucosal ulceration. The remaining islands of mucosa may then appear to be isolated and almost polypoidal.
At which of the following sites is the development of diverticulosis least likely?
Caecum Ascending colon Transverse colon Sigmoid colon Rectum
Because the rectum has a longitudinal muscle coat (blending of of the tenia marks the recto-sigmoid junction), diverticular disease almost never occurs here. Right sided colonic diverticular disease is well recognised (though less common than left sided).
A 32 year old lady presents with a 1.5cm pigmented lesion on her back. The surgeon is concerned that this may be a melanoma. What is the most appropriate course of action?
2mm punch biopsy from the centre of the lesion 4mm punch biopsy from the centre of the lesion Wide excision of the lesion with 3cm margins Excisional biopsy of the lesion Wide excision of the lesion with 1cm margins
Excisional biopsy of the lesion
Lesions that are suspicious for melanoma should be excised with complete margins. Radical excision is not routinely undertaken for diagnostic purposes and therefore if subsequent histopathological assessment determines that the lesion is a melanoma a re-exicision of margins may be required. Incisional punch biopsies of potential melanomas makes histological interpretation difficult and is best avoided.
A 50 year old male presents with painless frank haematuria. Clinical examination is unremarkable. Routine blood tests reveal a haemoglobin of 18g/dl but are otherwise normal. What is the most likely underlying diagnosis?
Squamous cell carcinoma of the bladder Adenocarcinoma of the prostate Adenocarcinoma of the kidney Wilms tumour Transitional cell carcinoma of the renal pelvis
Polycythaemia is a recognised feature of renal cell carcinoma. Wilms tumours most commonly occur in children.
Which of these lesions is most closely associated with Barretts oesophagus?
Squamous cell carcinoma Gastro intestinal stromal tumours Carcinoid tumours Leiomyosarcoma Adenocarcinoma
Barretts oesophagus is most closely associated with adenocarcinoma, and it confers a 30 fold increased risk of developing the condition.
A 56 year old man presents with epigastric discomfort and episodes of migratory thrombophlebitis. On examination he is mildly jaundiced. A CT scan shows lymphadenopathy at the porta hepatis and a mass in the pancreatic head. Which of the following is the most likely underlying diagnosis?
Squamous cell carcinoma of the pancreas Adenocarcinoma of the pancreas Insulinoma Glucagonoma Gastrinoma
Adenocarcinoma of the pancreas is the most likely diagnosis and migratory thrombophlebitis is associated with the condition. Squamous cells carcinoma is extremely uncommon in the pancreas. Gastrinoma are extremely rare and thus not the most likely diagnosis.
A 45 year old man undergoes a surgical excision of a carotid body tumour. Histological analysis is most likely to demonstrate which of the following?
Paraganglionoma Fibromatosis colli Schwannoma Lipoma Neuroma
Carotid body tumours are the commonest type of head and neck paraganglionoma.
A 22 year old man is having a blood transfusion after losing blood from a peptic ulcer. He is normally fit and well. Four hours after the transfusion; he complains of sudden onset shortness of breath and chest pain. On examination his temperature is 37.2, saturations are 88% on air, blood pressure 100/55 mmHg and HR 110 bpm. He has crepitations bilaterally up to the midzones. He is given IV furosemide, but deteriorates and is admitted to ITU. Invasive monitoring shows normal right heart pressures. What is the most likely underlying process?
Acute haemolytic transfusion reaction Delayed haemolytic transfusion reaction Fluid overload Transfusion associated lung injury Graft versus host disease
The normal right heart pressures indicate this is not fluid overload. Transfusion associated lung injury is a rare reaction causing neutrophilic mediated allergic pulmonary oedema. Patient’s have antibodies to donor leukocytes. It is important to consider this as a diagnosis when patients don’t respond to treatment for pulmonary oedema. Patients normally respond to supportive therapy including fluids and oxygen.
A 56 year old man with long standing ulcerative colitis and a DALM lesion in the rectum is admitted with jaundice. On CT scanning the liver has 3 nodules in the right lobe and 1 nodule in the left lobe. Carcinoembryonic antigen levels are elevated. What is the most likely diagnosis?
Yolk sac tumour Hepatocellular carcinoma Metastatic lesion Cholangiocarcinoma Rhabdomyosarcoma
This is likely to be due to metastatic lesions from a colonic primary. DALM lesions should be excised by oncological colectomy for this reason. This burden of metastatic disease is unlikely to precipitate jaundice directly and nodal disease at the porta hepatis is the most likely cause in this case.
A 22 year old man presents with symptoms of headache, lethargy and confusion. On examination, he is febrile and has a right sided weakness. A CT scan shows a ring enhancing lesion affecting the left motor cortex. Which of the following is the most likely diagnosis?
Arteriovenous malformation Cerebral abscess Herpes simplex encephalitis Metastatic renal adenocarcinoma Glioblastoma multiforme
The combination of rapidly progressive neurology, fever and headache is highly suggestive of cerebral abscess. CT scanning will show a ring enhancing lesion because the intravenous contrast cannot penetrate the centre of the abscess cavity. HSV encephalitis does not produce ring enhancing lesions.
A 56 year old man from Egypt has suffered from recurrent attacks of haematuria for many years. He presents with suprapubic discomfort and at cystoscopy is found to have a mass lesion within the bladder. What is the most likely diagnosis?
Squamous cell carcinoma Transitional cell papilloma Adenocarcinoma Leiomyosarcoma Rhabdomyosarcoma
In Egypt, Schistosomiasis is more common than in the UK and may cause recurrent episodes of haematuria. In those affected with the condition who develop a bladder neoplasm, an SCC is the most common type.
A newborn infant is noted to have a unilateral cleft lip only. What is the most likely explanation for this process?
Incomplete fusion of the second branchial arch Incomplete fusion of the nasolabial muscle rings Incomplete fusion of the first branchial arch Incomplete fusion of the third branchial arch Incomplete fusion of the secondary palate
Unilateral isolated cleft lip represents a failure of nasolabial ring fusion. It is not related to branchial arch fusion. Arch disorders have a far more profound phenotype and malformation sequences.
A 72 year old woman with back pain and chronic renal failure has the following blood test results:
Reference range
Ca2+ 2.03 2.15-2.55 mmol/l
Parathyroid hormone 10.4 1-6.5 pmol/l
Phosphate 0.80 0.6-1.25 mmol/l
What is the most likely diagnosis?
Hypoparathyroidism Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism Pseudohypoparathyroidism
In relation to secondary hyperparathyroidism; there is a HIGH PTH and the Ca2+ is NORMAL or LOW. In secondary hyperparathyroidism there is hyperplasia of the parathyroid glands in response to chronic hypocalcaemia (or hyperphosphataemia) and is a normal physiological response. Calcium is released from bone, kidneys and the gastrointestinal system.
A 4 year old boy is brought to the clinic by his mother who has noticed a small lesion at the external angle of his eye. On examination there is a small cystic structure which has obviously been recently infected. On removal of the scab, there is hair visible within the lesion. What is the most likely diagnosis?
Dermoid cyst Desmoid cyst Sebaceous cyst Epidermoid cyst Keratoacanthoma
Dermoid cysts occur at sites of embryonic fusion and may contain multiple cell types. They occur most often in children.
The lesion is unlikely to be a desmoid cyst as these are seldom located either at this site or in this age group. In addition they do not contain hair. Sebaceous cysts will usually have a punctum and contain a cheesy material. Epidermoid cysts contain keratin plugs.
Which of the following tumours are most likely to give rise to para-aortic nodal metastasis early?
Ovarian Bladder Rectal Caecal Cervical
Ovarian tumours are supplied by the ovarian vessels, these branch directly from the aorta. The cervix drains to the internal and external iliac nodes.
Which of the following statements relating to malignant mesothelioma is false?
It may be treated by extrapleural pneumonectomy. It is linked to asbestos exposure. It is linked to cigarette smoking independent of asbestos exposure. It may occur intra abdominally. It is relatively resistant to radiotherapy
It is not linked to cigarette smoking. When identified at an early stage a radical resection is the favored option. Radiotherapy is often given perioperatively. However, it is not a particularly radiosensitive tumour. Combination chemotherapy gives some of the best results and most regimes are cisplatin based.
Which of the following conditions is least likely to exhibit the Koebner phenomenon?
Vitiligo Molluscum contagiosum Lichen planus Psoriasis Lupus vulgaris
Lupus vulgaris
Koebner phenomenon The Koebner phenomenon describes skin lesions which appear at the site of injury. It is seen in: Psoriasis Vitiligo Warts Lichen planus Lichen sclerosus Molluscum contagiosum
Which of the tumour types listed below is found most frequently in a person with aggressive fibromatosis?
Medullary thyroid cancer Basal cell carcinoma of the skin Desmoid tumours Dermoid tumours Malignant melanoma
Aggressive fibromatosis is a disorder consisting of desmoid tumours, which behave in a locally aggressive manner. Desmoid tumours may be identified in both abdominal and extra-abdominal locations. Metastatic disease is rare. The main risk factor (for abdominal desmoids) is having APC variant of familial adenomatous polyposis coli. Most cases are sporadic.
Treatment is by surgical excision.
A 69 year old male presents with haematuria. He worked in the textile industry. He has a left flank mass. A CT IVU shows a lesion of the left renal pelvis. What is the most likely lesion?
Adenocarcinoma Transitional cell carcinoma Nephroblastoma Neuroblastoma Angiomyolipoma
TCC is a rare form of renal cancer, accounting for approximately 7% of all renal tumours. Risk factors include exposure to chemicals in the textile, plastic and rubber industry.
A 20 year old man is suspected of having an inflamed Meckels diverticulum. At which of the following locations is it most likely to be found?
Approximately 60 cm distal to the ileo-caecal valve Approximately 60 cm proximal to the ileocaecal valve Approximately 200cm distal to the ileocaecal valve Approximately 200cm proximal to the ileocaecal valve 50cm distal to the DJ flexure
They are typically found 2 feet proximal to the ileocaecal valve (or approximately 60cm).
A 43 year old lady presents with severe chest pain. Investigations demonstrate a dissecting aneurysm of the ascending aorta which originates at the aortic valve. What is the optimal long term treatment?
Endovascular stent Medical therapy with beta blockers Medical therapy with ACE inhibitors Sutured aortic repair Aortic root replacement
Proximal aortic dissections are generally managed with surgical aortic root replacement. The proximal origin of the dissection together with chest pain (which may occur in all types of aortic dissection) raises concerns about the possibility of coronary ostial involvement (which precludes stenting). There is no role for attempted suture repair in this situation.
A 56 year old man is investigated for anaemia and a large exophytic growth is identified in the distal stomach. What pathological finding is most likely?
Squamous cell carcinoma Adenocarcinoma Lymphoma Leiomyosarcoma Rhadomyosarcoma
Most gastric malignancies are adenocarcinomas
