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 hence Jones proteins can be nephrotoxic to the tubule epithelium
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
**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
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)
Polyarteritis nodosa MOST likely affects
- Renal arteries
- Pulmonary arteries
- Carotid arteries
- Other
-Renal arteries
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:
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
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
Tricuspid and pulmonary
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
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
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