EMRCS PATHO 7 Flashcards
A splenectomy increases the risk of infection from all the following organisms except?
Pneumococcus Klebsiella Haemophilus influenzae Staphylococcus aureus Neisseria meningitidis
Staphylococcus aureus infection following splenectomy is no more common than in non splenectomised individuals. The other organisms are encapsulated, which is why they are more likely to cause overwhelming post splenectomy sepsis.
Which of the following is not an extraintestinal feature of Crohns disease?
Iritis Clubbing Aphthous ulcers Erythema multiforme Pyoderma gangrenosum
Extraintestinal manifestation of inflammatory bowel disease: A PIE SAC
Aphthous ulcers Pyoderma gangrenosum Iritis Erythema nodosum Sclerosing cholangitis Arthritis Clubbing
Which of the following is not considered a risk factor for the development of oesophageal malignancy?
Oesophageal metaplasia Smoking Excessive intake of alcoholic spirits Achalasia Blood group O
Blood group O is not a risk factor for oesophageal cancer. Achalasia is associated with the risk of developing squamous cell carcinoma of the oesophagus.
A 24 year old man from Sub Saharan Africa presents with a lymphadenopathy and weight loss. A diagnosis of tuberculosis is suspected and a lymph node biopsy is performed. Staining with which of the agents below is most likely to facilitate identification of the causative organism?
Gram stain Ziehl-Neelsen stain Von Kossa stain Van Gieson stain Masson Trichrome stain
Ziehl-Neelsen stain is typically used to identify mycobacteria. They are not stained in the Gram staining process. Van Gieson and Masson trichrome are histological staining methods for identification of connective tissues. The Von Kossa technique is useful for identifying tissue mineralisation
Which of the following is not a pathological feature of breast cancer?
Resemblance to ductal epithelial cells Angiogenesis Nuclear pleomorphism Metastatic calcification Vascular invasion
Dystrophic calcification may be present in breast malignancy and is the basis for the breast screening programme. Metastatic calcification is calcification which occurs in otherwise normal tissues, usually as a result of hypercalcaemia. Invasive ductal carcinoma is the most common type of breast cancer, unless the tumour is very poorly differentiated there is usually some resemblance to ductal epithelial cells.
An 18 month old boy presents with recurrent urinary tract infections. As part of the diagnostic work-up he is noted to have abnormal renal function. An ultrasound scan is performed and shows bilateral hydronephrosis and hydroureter. What is the most likely underlying diagnosis?
Posterior urethral valves Meatal stenosis Hydronephrosis Pelvico-ureteric junction obstruction Benign prostatic hyperplasia
A posterior urethral valve is an obstructive, developmental uropathy that usually affects male infants (incidence 1 in 8000). Diagnostic features include bladder wall hypertrophy, hydronephrosis and bladder diverticula.
An 85 year old man presents with a cough and haemoptysis. He has a modest smoking history of 15 pack years. He is found to have a tumour located in the right main bronchus, with no evidence of metastatic disease. He decides not undergo any treatment and he remains well for a further 12 months before developing symptomatic metastasis. What is the most likely diagnosis?
Adenocarcinoma Small cell carcinoma Squamous cell carcinoma Metastatic renal cancer Lymphoma
Squamous cell carcinomas are reported to be more slow growing and are typically centrally located. Small cell carcinomas are usually centrally located. However, small cell carcinomas would seldom be associated with a survival of a year without treatment.
At which of the following anatomical sites does dormant tuberculosis most frequently reactivate?
Apex of the lung Base of the lung Brain Terminal ileum Lumbar spine
TB reactivation most commonly occurs at the lung apex. This site is better oxygenated than elsewhere allowing the mycobacteria to multiply more rapidly and then spread both locally and distantly.
What is the commonest tumour type encountered in the colon?
Squamous cell carcinoma Adenocarcinoma Lymphoma Anaplastic carcinoma Sarcoma
Adenocarcinoma are the most common and typically arise as a result of the adenoma - carcinoma sequence.
What is the process that is most likely to account for a 73 year old lady presenting with a cold pulseless hand 3 days following a myocardial infarct?
Foreign body embolus Rupture of existing atheromatous plaque Steal syndrome Vasospasm Clot embolus
The development of mural or atrial appendage thrombi may occur following a myocardial infarct and co-existing atrial fibrillation may contribute to the formation. They tend to present with classical features of an embolic event.
Which of the following changes are most likely to be identified in the aortic wall of a 38 year old lady with a Marfans syndrome and a dissecting aortic aneurysm?
Transmural aortitis Cystic medial necrosis Foamy macrophages Dense dystrophic calcification None of the above
Cystic medial necrosis ( or cystic medial degeneration) occurs when basophils and mucoid material lie in between the intimal elastic fibres of the aorta. It is typically found in the aortic degeneration of Marfans syndrome, but may also be seen in aortic degeneration in older adults.
A 58 year old man undergoes an upper GI endoscopy for the investigation of odynophagia. At endoscopy a reddish area is seen to extend into the oesophagus from the gastro-oesophageal junction. Which of the following pathological events is most likely to explain this process?
Metaplasia Anaplasia Dysplasia Hypoplasia Hyperplasia
This is most likely to represent Barretts oesphagus and is thus metaplasia. Dysplasia is less likely in this setting although biopsies are mandatory.
A male infant is born by emergency cesarean section at 39 weeks gestation for foetal distress. Soon after the birth the baby becomes progressively hypoxic and on examination is found to have a scaphoid abdomen. What is the most likely underlying diagnosis?
Intestinal malrotation Hiatus hernia Foramen of Bochdalek hernia Foramen of Morgagni hernia Tracheo-oesphageal fistula
The finding of a scaphoid abdomen and respiratory distress suggests extensive intra thoracic herniation of the abdominal contents. This is seen most frequently with Bochdalek hernias. Morgagni hernias seldom present in such a dramatic fashion. The other options do not typically present with the symptoms and signs described.
A 72 year old lady falls and lands on her left hip. She attends the emergency department and is given some paracetamol by the junior doctor and discharged. Several months later she presents with ongoing pain and discomfort of the hip. Avascular necrosis of the femoral head is suspected. Which of the following features is least likely to be present?
Union of the fracture Angiogenesis at the fracture site Increased numbers of fibroblasts at the fracture site Osteochondritis dissecans Apoptosis of osteoblasts
Apoptosis is not a feature of necrotic cell death. By this stage there would usually be attempted repair so angiogenesis and proliferation of fibroblasts would be expected. These cells may differentiate further to become osteoblasts which in turn will lay down new matrix.
What is the urinary diagnostic marker for carcinoid syndrome?
B-HCG Histamine Chromogranin A 5-Hydroxyindoleacetic acid 5-Hydroxytryptamine
Urinary measurement of 5- HIAA is an important part of clinical follow up.
Which one of the following is least associated with the development of colorectal cancer in patients with ulcerative colitis?
Unremitting disease Disease duration > 10 years Onset before 15 years old Poor compliance to treatment Disease confined to the rectum
Disease confined to the rectum
A 78 year old lady presents with a tender swelling in her right groin. On examination there is a tender swelling that lies below and lateral to the pubic tubercle. It has a cough impulse. What is the most likely underlying diagnosis?
Thrombophlebitis of the great saphenous vein Femoral hernia Thrombophlebitis of saphena varix Inguinal hernia Obturator hernia
Whilst a thrombophlebitis of a saphena varix may cause a tender swelling at this site, it would not usually be associated with a cough impulse.
Which of the conditions listed below is an example of heterotopia?
Barretts oesophagus Squamous cell carcinoma of the lung Meckels diverticulum containing gastric mucosa Colonic diverticulum Ectopic testis
In heterotopia, the tissue type that is found in the abnormal location is present there from birth and does not migrate to that site subsequently or arise as a result of metaplasia. The tissue that lines a Meckels diverticulum is determined early in development.
A 73 year old man presents with pain in the right leg. It is most uncomfortable on walking. On examination, he has a deformity of his right femur, which on x-ray is thickened and sclerotic. His serum alkaline phosphatase is elevated, but calcium is within normal limits. What is the most probable underlying diagnosis?
Rickets Pagets disease Metastatic lung cancer Osteoclastoma Chondrosarcoma
Pagets is typically associated with thickened, sclerotic, long bones. Lung carcinoma typically causes lytic bony lesions and hypercalcaemia.
An 18 year old female presents with 3 nodules in the right lobe of the thyroid. Clinically she is euthyroid and there is associated cervical lymphadenopathy. She has no family history of thyroid disease. What is the most likely cause?
Follicular thyroid cancer Follicular thyroid adenoma Papillary thyroid cancer Hashimotos thyroiditis Toxic nodular goitre
Papillary thyroid cancers are the most common type of thyroid cancer and are the more common in females (M:F=1:3). Papillary tumours are more likely to develop lymphatic spread than follicular tumours.
