Path August 2018 Flashcards
Regarding multiple myeloma which is true:
Light chain proteinuria contributes to renal failure
Viral infections common
Polyclonal gammopathy
Expansile lesions most commonly in the appendicular skeleton
Light chain proteinuria contributes to renal failure
(Form casts and obstruct tubules, also Bence Jones proteins can be nephrotoxic to the tubule epithelium)
Decreased production of normal Igs sets the stage for recurrent bacterial infections. Cellular immunity is relatively unaffected.
Burkitt lymphoma – which is false: Rapid growth is a feature Related to HSV1 or 2 Endemic form common in jaw Sporadic form common in abdomen In HIV tend to get other B-cell lymphomas
*AJL - agree with LJS.
Endemic Burkitt is related to EBV.
**LJS - Most false: Related to HSV1 or 2.
HHV8 is related to multicentric Castleman disease, which is an uncommon HIV related lymphoma. But no mention of HSV 1 or 2 in Robbins or google
Burkitt lymphoma – which is false:
Rapid growth is a feature - true
Related to HSV1 or 2 - false. HHV8 is related to multicentric Castleman disease, which is an uncommon HIV related lymphoma. But no mention of HSV 1 or 2 in Robbins or google
Endemic form common in jaw - true
Sporadic form common in abdomen - true
In HIV tend to get other B-cell lymphomas - also false (poor recall on wording?). Get DLBCL (most common) and Burkitt (2nd most common). Mechanism is both induction of mutations (MYC and BCL translocations) and unchecked virus reactivation (EBV, KSHV)
**LW:
The most common systemic NHL subtypes seen in people living with HIV are: [31-34,36]
●Burkitt lymphoma (approximately 25 percent)
●Diffuse large B cell lymphoma (DLBCL, approximately 75 percent)
●Plasmablastic lymphoma (less than 5 percent)
●T cell lymphoma (1 to 3 percent)
●Indolent B cell lymphoma (less than 10 percent)
Previous answer:
??
Burkitt is highly related to EBV
Is also commonly found in HIV patients.
Answer for false is either ‘related to HSV’ or ‘in HIV tend to get other B cell lymphomas’
PXA with meningeal reaction
**LJS - true, reactive dural thickening
*SCS : cf Ganglioglioma - cortical remodelling only.
Both: are cortical lesions, and are causes of seizure. Temporal lobe location. Slow growing. Benign.
DNET temporal lobes
**LJS - true, typical location
Brain demyelinating disorders:
- Pontine demyelinosis is most commonly from rapid correction of hypernatremia
- Acute haemorrhageic encephalomyelitis is more common in children
- ADEM follows bacterial infection
- Multiple sclerosis early is characterized by multiple lesions destroying axons
- *LJS
- Acute haemorrhageic encephalomyelitis is more common in children - true, kids and young adults
Brain demyelinating disorders:
- Pontine demyelinosis is most commonly from rapid correction of hypernatremia - no, hyponatraemia
- Acute haemorrhageic encephalomyelitis is more common in children - true, kids and young adults
- ADEM follows bacterial infection - no, viral
- Multiple sclerosis early is characterized by multiple lesions destroying axons - autoimmune destruction of myelin and oligodendrocytes
Cavernomas - Which is false
- AV shunting is not a feature
- Commonly get steal with gliosis
- Haemorrhage is a feature
- No intervening normal brain tissue
- Haemosderin laden macrophage rim
**LJS
Commonly get steal with gliosis - do get a rim of gliosis but not due to vascular steal
Cavernomas - Which is false
- AV shunting is not a feature - true, no shunting
- Commonly get steal with gliosis - do get a rim of gliosis but not due to vascular steal
- Haemorrhage is a feature - grow gradually due to haemorrhage within (but don’t tend to cause catastrophic haemorrhage)
- No intervening normal brain tissue - true
- Haemosderin laden macrophage rim - true
Regarding Alzheimers, which is false?
- Early preference for mesial temporal lobe
- Early preference for occipital lobe
- Tend to die from extra-CNS infections
-Early preference for occipital lobe
Most common pituitary adenoma?
- Prolactinoma
- Somatotrophic / GH secreting
- ACTH secreting
- TSH secreting
Lactotroph - prolactinoma
Which is true regarding meningitis:
- Fungal meningitis less likely to spread into brain by direct extnsion than bacterial
- Hydrocephalus caused by too much CSF production by a choroid plexitis.
- E coli most common pathogen for meningitis
- Haemorrhagic infarct is caused by thromphlebitis
- *LJS - ??probably most correct is:
- Haemorrhagic infarct is caused by thromphlebitis
Robbins p 1279.
Most fungi reach brain by haematogenous dissemination. But direct extension can occur in setting of DM, esp with mucomyocosis (?presumably from sinuses)
Fungal meningoencephalitis causes vascular thrombosis that produces haemorrhagic infarction
Venous sinus thrombosis also known complication of brain abscess (and can cause haemorrhagic infarct)
SCS* (Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis) account for the majority of cases
Polyarteritis nodosa MOST likely affects
- Renal arteries
- Pulmonary arteries
- Carotid arteries
- Other
-Renal arteries
Vessels of the kidneys, heart, liver, and gastrointestinal tract are involved in descending order of frequency.
Regarding aortic dissection:
- 5-10% don’t have an obvious intimal tear.
- HTN is an important antecedent in young patients
-5-10% don’t have an obvious intimal tear.
Systemic or localised connective tissue disorder most imp in younger pt (Robbins)
AAA which is true
- Inflammatory in younger patients
- HTN most important risk factor
- Mycotic aneurysms present with septic emboli
**LJS
-Inflammatory in younger patients - true
(10 yr younger)
AAA which is true?
-HTN most important risk factor - true (HTN and atherosclerosis). But - Robbins:
HTN most imp risk factor for thoracic aneurysms; atherosclerosis most imp risk factor for AAA
-Mycotic aneurysms present with septic emboli. ?
Most common cause of mycotic aneurysm is septic emboli, usually as a complication of infective endocarditits. I guess would also be at risk of causing further septic emboli. And also likely to have emboli elsewhere e.g. brain, lungs. So also true
Which is false?
- Takayasu Pulseless could present as 20yo with aortic occlusion
- Kawasaki can present as MI in children
- Burger can present as absent pulses in the ulnar artery and TIBAL artery in a Non-smoker
- Giant cell arteritis needs urgent treatment
- Aortic dissection of the arch and descending aorta makes up over 80% of dissection. (I think this was the wording- essentially excluded Ascending and root, and abdo I guess)
- *LJS:
- Burger can present as absent pulses in the ulnar artery and TIBAL artery in a Non-smoker - false. Young adult male smokers “almost exclusively in smokers” - Robbins
Which is false?
- Takayasu Pulseless could present as 20yo with aortic occlusion - true
- Kawasaki can present as MI in children - true
- Burger can present as absent pulses in the ulnar artery and TIBAL artery in a Non-smoker - false. Young adult male smokers “almost exclusively in smokers” - Robbins
- Giant cell arteritis needs urgent treatment - true, risk blindness
-Aortic dissection of the arch and descending aorta makes up over 80% of dissection. (I think this was the wording- essentially excluded Ascending and root, and abdo I guess).
?? depends on wording. 60% involve ascending aorta (i.e. Type A) Robbins - vast majority in ascending aorta, usually within 10cm of aortic valve
Acute v subacute endocarditis
- 1cm vegetations
- Slow progression
- Absence of disseminated sepsis
- Previous valve damge
-1cm vegetations. Acute has large vegetations
- Slow progression - subacute
- Absence of disseminated sepsis
- Previous valve damge - subacute. Acute can affect previously normal valves
Which don’t you get in MI:
- Aortic regurgitation
- Mitral regurgitation
- Tamponade
- Fibrinous pericarditis
- Mural thrombus
-Aortic regurgitation
Which is true:
Ostium primum most common ASD
VSD can present in adulthood
VSD can present in adulthood
**LJS - VSD typically presents in infancy, ASD can present in adulthood. Ostium secundum most common ASD
Heart tumours, least common:
Myxoma Haemangioma Fibroelastoma Lipoma Rhabdomyoma.
Haemangioma
Overall (incl adults and kids): myxoma > fibroma > lipoma > papillary fibroelastoma > rhabdomyoma > angiosarcoma
Cardiac haemangioma is rare
Carcinoid – which valve combination most common?:
Tricuspid and pulmonary Aortic and mitral Aortic and pulmonary Tricuspid and mitral Pulmonary and mitral
A: Tricuspid and pulmonary
**SCS edit from radiopaedia:
Ordinarily vasoactive neuroendocrine substances produced by carcinoids get inactivated by liver.
Presence of liver metastases , allows these substances to bypass portal circulation and affect the RIGHT heart.
Therefore for carcinoid heart disease liver Mets are required.
Cardiac lesions are present approx 50% of those with carcinoid syndrome.
Exceptions: Primary bronchial carcinoid and primary ovarian (gonadal veins directly drain into IVC/renal V).
Hashimotos thyroiditis, what is true (can’t remember exactly if this was a true or false question and therefor whether the options were positive or negative ones)
A common cause of hypothyroidism
No increased risk of cancer
No increased risk of lymphoma
**LJS:
A common cause of hypothyroidism - true
No increased risk of cancer - false, increased risk of papillary carcinoma and Hurthle cell tumour.
No increased risk of lymphoma - false. Increased risk of marginal zone B cell lymphoma
Robbins:
The relationship between Hashimoto disease and thyroid epithelial cancers remains controversial, with some morphologic and molecular studies suggesting a predisposition to papillary carcinomas.
Regarding the larynx:
Hyperplasia increases risk of cancer by 10%
Epithelial changes induced by smoking can reverse after cessation
Most cancers are adenocarcinomas
Cancers rarely involve the vocal cords
- *LJS
- Epithelial changes induced by smoking can reverse after cessation
- Hyperplasia increases risk of cancer by 10% - false. Orderly hyperplasia - almost no risk of malignant transformation
- Most cancers are adenocarcinomas - SCC
- Cancers rarely involve the vocal cords - 65% are glottic (anterior true cord most common)
Regarding Thyroglossal duct:
Most cyst are <1cm
SCC rarely metastsises
UV important
*LW:
Cysts 1 - 4cm in size
Lined by stratified squamous at tounge base, or pseudostratified columnar epithelum in lower location.
CT wall may harbour thryoid aggregates.
Malignant transoformation within lining epithelium is reported but rare.
???
I think most are larger than 1cm
Thyroid carcinoma complicates, not SCC
Thyroid disease:
Poor prognosis if lymph node mets in papillary cancer
Anaplastic kills by local spread
Follicular metastasizes first to lymph nodes
Papillary often metastasizes haematogenously
Anaplastic kills by local spread
Papillary carcinomas are indolent lesions, with 10-year survival rates in excess of 95%. Of interest, the presence of isolated cervical node metastases does not have a significant influence on prognosis. In a minority of patients, hematogenous metastases are present at the time of diagnosis, most commonly to the lung.
Follicular carcinomas manifest most frequently as solitary cold thyroid nodules. In rare cases, they may be hyperfunctional. These neoplasms tend to metastasize through the bloodstream (hematogenous dissemination) to the lungs, bone, and liver. In contrast with papillary carcinomas, regional nodal metastases are uncommon.
Anaplastic carcinomas grow with wild abandon despite therapy. Metastases to distant sites are common, but in most cases death occurs in less than 1 year as a result of aggressive local growth and compromise of vital structures in the neck.
Oesophagus
TOF is a Risk factor for squamous cell carcinoma
H pylori is a risk factor for cancer
No gender prediliction
Can’t remember other options
*LW:
RObbins states H pylori infection may be a contributing factor to Barretts and thus adenocarcinoma, but there is no general agreement on this.
UpToDate states no hard evidence for H pylori in oesphageal cancer, seems to be mainly for stomach cardia cancer, that can extend into oesophagus.
Tracheo - oesphageal fistula is a complication, not a risk factor (SCC).
Adenocarcinoma tends to be Male caucasian (USA Northen Euope), while SCC is also Male predominant and is most common world wide.
so…hopefully more correct option was not recalled.
- *LJS ??
- **AJL - thought TOF = tetralogy of Fallot for a long time (now realises its not) and agrees with LJS.
Oesophagus
-TOF is a Risk factor for squamous cell carcinoma - can’t find evidence for this. Can get acquired TOF due to oesophageal SCC
-H pylori is a risk factor for cancer - don’t think it does. Gastritis related to H.pyloris is at the gastric antrum
-No gender prediliction
Generally M > F. Adeno 7:1
SCC 4:1
Which is true:
Zenkers is traction
Scleroderma is top third of oesophagus
Barrets – intestinal Metaplasia
Barrets – intestinal Metaplasia
Regarding pulmonary hypertension:
Defined as over 40mmHg
Sleep apnoea is a possible aetiology
Sleep apnoea is a possible aetiology
MAP > 25mmHg at rest
Which doesn’t show UIP histology:
COP Chronic HSP IPF Asbestos RA
COP - not fibrotic, no interstitial fibrosis
Which of the following statements regarding lung disease is incorrect:
Silicosis fibrosis is primarily in lower zones.
Silicosis fibrosis is primarily in lower zones.
Which is false regarding aspergillosis:
- Target sign in invasive from gelatinous exudates
- Can have haemoptyis from chronic non invasive aspergillis
- ABPA is from colonization of mucosa and treatment includes asthma control
- Invasive aspergillis can look like mucormycosis in the immunocompromised.
Which is false regarding aspergillosis:
-Target sign in invasive from gelatinous exudates - ?false. Target lesions (seen as CT halo sign) - the halo is haemorrhage. Maybe referring to cryptococcus in CNS, causes gelatinous pseudocysts in BG
-Can have haemoptyis from chronic non invasive aspergillis - true. Wall of aspergilloma is lined by vascular granulation tissue, can cause haemoptysis
Aspergilloma (“fungus ball”) formation occurs by fungal colonization of preexisting pulmonary cavities (e.g., dilated bronchi or lung cysts, posttuberculosis cavitary lesions).
These masses may act as ball valves to occlude the cavity, thereby predisposing the patient to infection and hemoptysis.
- ABPA is from colonization of mucosa and treatment includes asthma control - true, superficial colonisation of bronchial mucosa causing hypersensitivity reaction.
- Invasive aspergillis can look like mucormycosis in the immunocompromised. - True. Rhinocerebral aspergillus infection in immunocompromised resembles disease caused by mucormycosis (Robbins)
Lung cancer (T)
Tyrosine kinase can treat adeno lung
Small cell is not chemosensitive
Tyrosine kinase can treat adeno lung
Regarding lung infections:
Staph is the most common CAP Viral have higher CRP than bacterial Most URTIs are bacterial Most abscesses contain oral commensal anaerobes. Mycoplasma common in elderly.
Most abscesses contain oral commensal anaerobes - true, oral cavity anaerobes are the only isolated microorganism in 60%. e..g. Bacteroides, Fusobacterium, Peptococcus (Robbins p 708)
Regarding lung infections:
- Staph is the most common CAP - strep pneumoniae
- Viral have higher CRP than bacterial - false, there are some studies showing higher in bacterial (google)
- Most URTIs are bacterial - viral
- Mycoplasma common in elderly - children/young adults.
Which is true:
Emphysema causes more cor pulmonale compared to bronchitis
Panacinar emphysema is worse in bases
Centrilobular emphysema is caused by fibrosis of the airway and ?enlargement
Panacinar emphysema is worse in bases
Which is true regarding gastric neoplasms?
Intestinal type adenocarcinoma is associated with linitis plastica.
H pylori is associated with MALToma
H pylori is associated with MALToma - true
Intestinal type is associated with linitis plastica - false. Intestinal type causes exophytic mass or ulcerated tumour/ulcer. Diffuse type (less common **previously) - infiltrative growth pattern with desmoplastic reaction and linitis plastica
**In the United States, gastric cancer rates dropped by more
than 85% during the twentieth century. Adenocarcinoma of
the stomach was the most common cause of cancer death
in the United States in 1930 and remains a leading cause of
cancer death worldwide, but now accounts for fewer than
2.5% of cancer deaths in the United States. The cause of the overall reduction in gastric cancer is most
closely linked to decreases in H. pylori prevalence. Notably, the remarkable decrease in gastric cancer incidence applies only to the intestinal type, which is most closely associated with atrophic gastritis and intestinal metaplasia. As a result, the incidence of diffuse type gastric cancer, which was previously low, is now similar to intestinal type gastric cancer.
Liver lesion with least chance of scar – central or peripheral
Adenoma FNH Fibrolamellar HCC Cholangiocarcinoma Haemangioma
Adenoma
Pancreas which syndrome highest chance
BRCA1
Li Fraumini
BRCA
Peutz-Jeghers highest risk 130 x incr risk
Others: BRCA, (4-10 x incr), HNPCC, hereditary pancreatitis, familial melanoma syndrome, strong family hx with unknown genes. Robbins p 894.
TP53 does increase risk, but not one of the core cancers ass/w Li Fraumeni (breast, sarcoma, brain tumours, adrenocortical carincoma, leukaemia)
What is the commonest pancreatic congential abnormality
Pancreas divisum
Annular pancreas
Dorsal agenesis
Pancreas divisum
