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Path August 2018 Flashcards

1
Q

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

A

Light chain proteinuria contributes to renal failure

Form casts and obstruct tubules, also hence Jones proteins can be nephrotoxic to the tubule epithelium

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2
Q 
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
A

**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’

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3
Q

PXA with meningeal reaction

A

**LJS - true, reactive dural thickening

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4
Q

DNET temporal lobes

A

**LJS - true, typical location

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5
Q

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
A
  • *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
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6
Q

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
A

**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
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7
Q

Regarding Alzheimers, which is false?

  • Early preference for mesial temporal lobe
  • Early preference for occipital lobe
  • Tend to die from extra-CNS infections
A

-Early preference for occipital lobe

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8
Q

Most common pituitary adenoma?

  • Prolactinoma
  • Somatotrophic / GH secreting
  • ACTH secreting
  • TSH secreting
A

Lactotroph - prolactinoma

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9
Q

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
A
  • *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)

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10
Q

Polyarteritis nodosa MOST likely affects

  • Renal arteries
  • Pulmonary arteries
  • Carotid arteries
  • Other
A

-Renal arteries

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11
Q

Regarding aortic dissection:

  • 5-10% don’t have an obvious intimal tear.
  • HTN is an important antecedent in young patients
A

-5-10% don’t have an obvious intimal tear.

Systemic or localised connective tissue disorder most imp in younger pt (Robbins)

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12
Q

AAA which is true

  • Inflammatory in younger patients
  • HTN most important risk factor
  • Mycotic aneurysms present with septic emboli
A

**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

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13
Q

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)
A

**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

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14
Q

Acute v subacute endocarditis

  • 1cm vegetations
  • Slow progression
  • Absence of disseminated sepsis
  • Previous valve damge
A

-1cm vegetations. Acute has large vegetations

  • Slow progression - subacute
  • Absence of disseminated sepsis
  • Previous valve damge - subacute. Acute can affect previously normal valves
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15
Q

Which don’t you get in MI:

  • Aortic regurgitation
  • Mitral regurgitation
  • Tamponade
  • Fibrinous pericarditis
  • Mural thrombus
A

-Aortic regurgitation

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16
Q

Which is true:

Ostium primum most common ASD
VSD can present in adulthood

A

VSD can present in adulthood

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17
Q

Heart tumours, least common:

Myxoma
Haemangioma
Fibroelastoma
Lipoma
Rhabdomyoma.
A

Haemangioma

Overall (incl adults and kids): myxoma > fibroma > lipoma > papillary fibroelastoma > rhabdomyoma > angiosarcoma

Cardiac haemangioma is rare

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18
Q

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

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19
Q

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

A

**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

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20
Q

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

A
  • *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)
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21
Q

Regarding Thyroglossal duct:

Most cyst are <1cm
SCC rarely metastsises
UV important

A

*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

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22
Q

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

A

Anaplastic kills by local spread

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23
Q

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

A

*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

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24
Q

Which is true:

Zenkers is traction
Scleroderma is top third of oesophagus
Barrets – intestinal Metaplasia

A

Barrets – intestinal Metaplasia

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25
Q

Regarding pulmonary hypertension:

Defined as over 40mmHg
Sleep apnoea is a possible aetiology

A

Sleep apnoea is a possible aetiology

MAP > 25mmHg at rest

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26
Q

Which doesn’t show UIP histology:

COP
Chronic HSP
IPF
Asbestos
RA
A

COP - not fibrotic, no interstitial fibrosis

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27
Q

Which of the following statements regarding lung disease is incorrect:

Silicosis fibrosis is primarily in lower zones.

A

Silicosis fibrosis is primarily in lower zones.

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28
Q

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.
A

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
  • 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)
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29
Q

Lung cancer (T)

Tyrosine kinase can treat adeno lung
Small cell is not chemosensitive

A

Tyrosine kinase can treat adeno lung

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30
Q

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.
A

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.
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31
Q

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

A

Panacinar emphysema is worse in bases

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32
Q

Which is true?
Intestinal type is associated with linniis plastica.
H pylori is associated with MALToma

A

H pylori is associated with MALToma - true

Intestinal type is associated with linniis plastica - false. Intestinal type causes exophytic mass or ulcerated tumour/ulcer. Diffuse type (less common) - infiltrative growth pattern with desmoplastic reaction and linitis plastica

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33
Q

Liver lesion with least chance of scar – central or peripheral

Adenoma
FNH
Fibrolamellar HCC
Cholangiocarcinoma
Haemangioma
A

Adenoma

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34
Q

Pancreas which syndrome highest chance

BRCA1
Li Fraumini

A

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)

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35
Q

What is the commonest pancreatic congential abnormality

Pancreas divisum
Annular pancreas
Dorsal agenesis

A

Pancreas divisum

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36
Q

Acute pancreatitis which is false ?

  • 10% is caused by alcohol and biliary tract pathology
  • Get foci of fat necrosis
  • Hypocalcaemia common biochecmical finding
A

-10% is caused by alcohol and biliary tract pathology (combined = 80% acute pancreatitis)

37
Q

What is MOST associated with Wilson’s disease?

A) Is autosomal dominant
B) Commonly presents with corona radiata abnormalities early in the course
C) Often has hepatic fatty infiltration

A

C) Often has hepatic fatty infiltration

38
Q

2: What is LEAST associated with Wilson’s disease?

A) Is Autosomal recessive
B) Serum copper is an important marker for diagnosis

A

B) Serum copper is an important marker for diagnosis

39
Q 
Which is false regarding FAP
50% get CRC but 50
FAP gets ampullary tumour
Lynch have right sided masses
Gardner have desmoids
Turcot have medulloblastoma
A

50% get CRC but 50

100% get CRC, often by 30 yr

40
Q

Regarding UC

Rare after colectomy
Thick fibrosed wall
Transmural
Granulomatous

A

Rare after colectomy

41
Q

Cause of bowel obstruction in diverticulosis

Diverticulitis with spasm
Fibrosis and stricture

A

Fibrosis and stricture
Robbins: “Recurrent diverticulitis can cause segmental colitis, fibrotic thickening in and around the colonic wall, or stricture formation.

42
Q

Phaeos which is false:

Commonly present with hypertension
Sometimes present with hypertension and hypokalaemia
Increased malignancy in MEN2

A

Sometimes present with hypertension and hypokalaemia

implies secretion of aldosterone - adrenal cortical hormone. Phaeo is adrenal medullary - neuroendocrine origin

43
Q

Regarding hyperaldosteronism, which is false

Adrenal adenoma a cause in adults
Adrenocortical a cause in children
Rarely idiopathic,

A
  • LW:
  • -> rarely idiopathic which is incorrect, hence correct answer.

Idiopathic hyper adlosteronism is most common cause of elevated aldosterone, resulting from nodular bilateral hyperplasia, present older and with less sevre HTN than adrneal neoplasm.
Second most common cause is an adenoma (approx 35%), which is called COnns syndrome. Middle adult life, < 2cm in size. thus this option true.
Children cause is usually adrenalcortical (broad term), is is usally due to primary idiopathic hyperplasia.

Previous answer
?Adrenocortical a cause in children

44
Q

Which is not associated with bladder cancer:

Radiation cystitis
Interstitial cystitis
Other option seemed correct
Shistosoma
Urachal remnant with cystitis glandularis
A

*LW:
Interstitial cystitis - FALSE; chronic inflammation not associated with bladder cancer, although clinically mimics CIN.

Interstitial cystitis ?least true
Chronic cystitis of uncertain aetiology, controversial dx. Transmural fibrosis late in disease mimics CIS clinically (needs bx to ddx)

Which is not associated with bladder cancer:

Radiation cystitis - true
Shistosoma - true
Urachal remnant with cystitis glandularis - true, metaplastic glandular epithelium ass/w adenocarcinoma
Other option seemed correct

45
Q

Which is false:

Clear cell RCC hypervascular
Papillary RCC hypervascular
Metachronous tumours
Can’t remember other otpions

A

Papillary RCC hypervascular

46
Q

Which kidney disease is not inherited:

Nephropthisis
Cystic dysplasia
Adult medullary cystic disease

A

?Poor recall

Nephropthisis - nephronopthisis. Part of medullary cystic disease complex, most forms AR inheritance

Cystic dysplasia - ?? vague term, could mean lots of things. If they mean MCDK - is sporadic, so this would be the answer

Adult medullary cystic disease - also part of medullary cystic disease complex

20% of medullary cystic disease complex overall is sporadic non-familial

47
Q

Lowest likelihood tumour in kidney:

Small cell carcinoma
Papillary adenoma
Collecting duct carcinoma

A

Small cell carcinoma - not mentioned in big Rob, google says its rare, so this would be the least common of the 3 answers.

Papillary adenoma - common
Collecting duct carcinoma - rare (1% or less of renal epithelial neoplasms)

48
Q

What renal, ureteric and /or bladder stones are most common in leukaemia?

A)	Calcium oxalate
B)	Uric acid
C)	Struvite
D)	Calcium phosphate
E)	Something else
A

B) Uric acid

49
Q

21: What renal lesion is most likely to be 10cm in size, brown with central scarring?

A)	Pappillary carcinoma
B)	Clear cell RCC
C)	Oncocytoma
D)	Chromophobe RCC
E)	AML
A

C) Oncocytoma

50
Q 
Which teste GCT is most aggressive 
Choriocarcinoma
Teratoma
Seminoma
Endodermal sinus
Embyronal cell
A

Choriocarcinoma

51
Q

20yo tumour testis which is most likely

Embryonal 
Seminoma
Lymphoma
Endodermal sinus tumour
Teratoma
A

*AJL - I favour seminoma. Robbins says “Seminomas are most common, accounting for about 50% of testicular germ cell neoplasms.
It also says that testicular neoplasms peak in the 15-34yr age group. AND in post pubertal males 95% of testicular neoplasms are germ cells (and malignant).
Therefore seminomas are most common testicular neoplasm.

**LJS - Embryonal - 20-30 yr peak

Seminoma - 40-50yr, most common testicular malignancy but 20yr would be young for this. *LW: robbins states peaks in 30s.

Lymphoma - older men 60+

Endodermal sinus tumour - young kids, peak 3 yr

Teratoma - any age

Choriocarcinoma is also peak age 20-30 yr, but rare

52
Q

Where does GCT testis metastasize to ?

ipsilateral retroperitoneal
Pelvic
Inguinal

A

ipsilateral retroperitoneal

53
Q

AFP is raised in which testicular tumour?

Teratoma
Seminoma
Choriocarcinoma
Endodermal sinus tumour
Embryonal cell carcinoma
A

Endodermal sinus tumour

54
Q

Endometrial cancer which is false:

Type 1 usually arise in the context of endometrial atrophy

A

Type 1 usually arise in the context of endometrial atrophy

Type 2 is sporadic, arising from atrophic endometrium in elderly pt
Type 1 is due to unopposed oestrogen (more common) in perimenopausal women

55
Q

Adenomyosis which is false:

Nodular serosal surface 
Can have symptoms like endometriosis
Can have malignant foci
Ill defined junctional zone
Thickening of myometrium
A

?Can have malignant foci

Nodular serosal surface - adenomyoma could cause
Can have symptoms like endometriosis - true
Can have malignant foci ??? don’t think so. No mention of this in Robbins.
Ill defined junctional zone - true
Thickening of myometrium - true

56
Q

5: Regarding cervical cancer which is MOST correct?

A) Invasion of the upper 1/3 of vagina has a bad prognosis
B) LSIL has 50% chance of carcinoma transformation over 5 yrs
C) SCC of the cervix has a better prognosis than neuroendocrine carcinoma

A

C) SCC of the cervix has a better prognosis than neuroendocrine carcinoma

57
Q

Which is false:

Partial mole has 2% chance of chorio
Partial mole has more fetal parts than complet
Partial mole triploid
Partial mole 10% chance of invasive mole

A

Partial mole has 2% chance of chorio

*AJL - Partial mole has no risk of choriocarcinoma. It has a reduced risk (c.f complete mole) of invasive mole.

58
Q

What has lowest risk of ectopic?

Twins
Appendicitis
PID
Endometriosis

A

Twins

59
Q

Twins

Dichorionic diamniotic has to be dizygotic
Monochorionic monoamniotic has to be monozygotic

A

Monochorionic monoamniotic has to be monozygotic

60
Q

Question where answer was that squamous had a better prognosis than neuroendocrine cancer of cervix.
Can’t remember what the other options were.

A

SCC of the cervix has a better prognosis than neuroendocrine carcinoma

61
Q

Cervix:

Cause of a polypoid mass seen in the upper vagina – 
Endocervical polyp
Endometrial polyp
HPV
Cervical cancer
Rhabdomyo
A

Endocervical polyp - can be large and polypoid and extend through cervical os

62
Q

Most common bilateral ovarian tumour:

Endometroid carcinoma
Brenner
Teratoma
Mucinous adenocarcinoma
Thecoma
A

*LW:

Endometroid carcinoma (40% are bilateral).
Although only make up 10-15% of all ovarian cancers.
Overall spectrum (based on Robbins numbers)
*Serous carcinomas are bilateral 66%, 20% in benign serous cystadenoma, 30% serous borderline.
Most common malignant ovarian neoplasm (40% of over all tumours), with 70% reflecting benign or borderline based on frequency, 30% malignant frequency.

Thus as an overall total frequency; Serous cystadenocarcimoma most frequently bilateral at 8%, serous benign & borderline at 7%, and endometriod 6%, mucinous 1%.
(this doesn’t change the above answer out of options listed tho)

Mucinous, although make up 20-25% of all ovarian neoplasms, only 5% primary mucinous cystadenoma and carcinoma are bilateral.

63
Q

Regarding leiomyomas which is false:

> 10cm high likelihood of malignancy
Invading veins is considered benign
Peritoneal deposits are considered benign
Lung deposits are considered benign
Mitoses in pregnancy are not a reliable indicator of malignancy

A

> 10cm high likelihood of malignancy

64
Q

Regarding Proliferative and non-proliferative lesions

Radial scar is non-proliferative.
Proliferative without atypia increases risk 5x
Non-proliferative increases risk?
Can’t remember what exactly the options were

A

**LJS
Radial scar is proliferative without atypia (1.5-2x incr risk)
Proliferative breast disease with atypia is x5 incr risk
Non-proliferative breast changes have no increased risk

65
Q

Calc on biopsy of LCIS is incidental

A

Calc on biopsy of LCIS is incidental

*AJL
LCIS is usually an incidental finding on biopsy of calc.
Some LCIS (pleomorphic type (RP)) is associated with calc.

66
Q

Least likely to be a spiculate mass:

PASH
Lobular cancer
Ductal cancer
Tubular cancer
Sclerosing adenosis
A

PASH - rounded mass

67
Q

Radial scar which is true:

Diagnosis needs further work up
Short spicules
Fat entirely replaced
Aetiology unrelated to ischaemia

A

Diagnosis needs further work up

68
Q

Medullary cancer which is true:

Get in BRCA1
Poor outcome

A

Get in BRCA1

69
Q

Regarding DCIS

Nuclear grade most important for prognosis.

A

Nuclear grade most important for prognosis.

Low grade - noncomedo
High grade - necrosis, poorer prognosis

70
Q

17: What is MOST correct regarding LCIS?

A) Calcification is due to secretion of debris into the ducts
B) This is an incidental finding on biopsy
C) Calcification is due to dystrophic necrotic components
D) No further work up is required if found on biopsy

A

B) This is an incidental finding on biopsy

71
Q

DCIS:
Questions about comedo and non-comedo and what that means

  • One option described a cribriform pattern as surrounding holes without necrosis.
  • One said papillary (or micropapillary) would go well beyond macroscopic disease.
A

All of cribriform, papillary and micropapillary are non-comedo
Cribriform can have rounded cookie cutter like spaces within ducts. Can also be solid
Micropapillary - can extend beyond MG abn

72
Q

Sarcomatous changes has increased risk in Maffucis

A

Sarcomatous changes has increased risk in Maffucis

73
Q

RA which is true:

Rarely have ankylosis late in disease
50% get systemic amyloid
Bakers cyst

A

-Bakers cyst - common in RA

  • *LJS
  • 3% RA pt get secondary amyloid (AA type). RA is most common cause of secondary reactive amyloidosis
  • Bakers cyst common in RA
  • Get ankylosis late in RA - pannus bridges bone and causes fibrous ankylosis. Can progress to bony ankylosis
74
Q

Which is epiphyseal:

Clear cell chondrosarcoma
Chondromyxoid fibroma
ABC

A

Clear cell chondrosarcoma

75
Q

TB discitis is less aggressive than Staph

Infants are more prone to septic arthritis from their osteomyelitis
?question or other options

A
  • TB is more destructive and diffc control than pyogenic OM

- Neonates are prone to septic arthritis from spread of epiphyseal OM

76
Q

Which osteosarcoma subtype is most likely a painless mass

Parosteal
Periosteal
Telangiectatic
Conventional

A

Parosteal - low grade tumour, may present as painless mass

77
Q

Osteoporosis.

Hyperphosphataemia in osteoporosis
Senile osteoporosis more severe than post menopausal
Senile osteoporosis no gender predilicion
Bisphosphonates promote osteoblaststic reaction

A

Senile osteoporosis no gender predilicion

78
Q

OA which is false

Type 2 collagen destruction
Heberden nodes more common in men
Obesity is a risk factor
Ankylosis

A

No ankylosis in OA

Heberdens nodes more common in women

79
Q

Chondrosarc mostly epiphyses
In exostoses malignancy starts in the bony stalk
Enchondromas are epiphyseal
Olliers is defined as multiple osteochondroma

A
  • *LJS ?none are correct
  • AJL - agree none are correct

Chondrosarc mostly epiphyses - only clear cell subtype
In exostoses malignancy starts in the bony stalk - cartilage cap
Enchondromas are epiphyseal - medulla of metaphyses/diaphyses
Olliers is defined as multiple osteochondroma - multiple enchondroma

80
Q

Regarding skin lesions:

A) Melanomas with a familial association account for 1% of melanoma’s
B) Immunocompromised patients have predilection for BCC
C) Melanoma’s are most common on areas of skin that don’t receive sunlight
D) SCC is related to number of blistering UV sunburns below 20yrs

A

B) Immunocompromised patients have predilection for BCC

Incidence of BCC incr in immunosuppression (as with SCC)

81
Q

Meckels 2-8 most common complication:
Haemorrhage
Intussuception
Diverticulitis

A

Haemorrhage

82
Q

Intralobar Sequestration location

left lower lobe
right lower lobe
Right upper lobe
Left upper lobe
Right middle lobe
A

left lower lobe

83
Q

12: What is MOST correct regarding retinoblastoma

A) Autosomal recessive
B) Bilateral suggests a germline mutation
C) Trilateral has associated intracranial germ cell tumour

A

B) Bilateral suggests a germline mutation

84
Q

Ewing sarcoma

Peak 15-20
Neuroblastoma is a differential

A

Peak 15-20

85
Q

TS (false)

Leptomeningeal angioma
Skin lesions
AML
Hepatic cysts

A

Leptomeningeal angioma

86
Q

Whats uncommon in VHL

Pancreatic adenocarcinoma cancer
Hepatic cysts
Haemangioblastoma in spine 
Clear cell renal cancer
Phaeochromocytoma
A

Pancreatic adenocarcinoma cancer

87
Q

Which is not associated:

Fibroepithelial ureteric polyp and desmoids
Renal cortical (or maybe papillary) necrosis and abruptio placenta
Smoking and RCC

A

??Fibroepithelial ureteric polyp and desmoids

Renal cortical (or maybe papillary) necrosis and abruptio placenta - yes. Obstetric catastrophies such as abruption ass/w diffuse renal cortical necrosis - Robbins
Smoking and RCC - yes
88
Q

What is most associated with clinical or biochemical hyperparathyroidism

Parathyroid adenoma
Renal failure
Small cell lung cancer
Parathyroid hyperplasia
MEN1
A

Parathyroid adenoma is most common cause of primary HPT

CRF is most common cause of secondary HPT

Robbins says primary HPT is the most common cause of hypercalcaemia overall.

89
Q

Which is most likely to cause hypopituitary and diabetes insipidus in 30yo female:

Empty sella
Macroadenoma
Rathkes cleft cyst
Craniopharyngioma
Lymphocytic hypophysitis
A

Lymphocytic hypophysitis

Z Back up Path (21 decks)

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