Path Key Points 1

Question 1

BPH

Answer 1

Lower urinary tract symptoms (frequency, urgency, nocturia, terminal dribbling, poor stream)

Mx

• alpha reductase inhibitor - finasteride
• alpha blocker (with HTN - prazosin; without HTN - tamsulosin)

Question 2

Grading system for RCC

Answer 2

Furhman’s system

Question 3

Clear cell RCC

Answer 3

Most common RCC
Golden colour due to lipid collection
Clear cytoplasm arranged in nests

Question 4

Papillary RCC histo

Answer 4

Friable brown tumours

Question 5

Chromophobe RCC

Answer 5

Variable chromosomal changes

Question 6

Prostate cancer

Answer 6

Genes associated - PTEN, AMACR, P27, E-cadherin
Associated with eating red meats
Prognosis - Gleason score

Question 7

Varicocele

Answer 7

Non-translucent

Dull ache with venous dilation

Question 8

Hydrocele

Answer 8

Translucent

Due to trauma or pathology

Question 9

Zoon’s balanitis

Answer 9

Inflammation of glans –> redness –> biopsy - can be dysplastic

Question 10

Fournier’s gangrene

Answer 10

Necrotising fasciitis of male genitalia

Question 11

High risk HPV

Answer 11

16 & 18

Question 12

Low risk HPV

Answer 12

6 & 11

Question 13

Cervical intra-epithelial neoplasia (CIN)

Answer 13

Figo staging
CIN IA - invasive diagnosis only by microscopy - cone biopsy
CIN IB - visible lesion confined to uterus - radical trachelectomy with lymphadenectomy if tumour <2cm otherwise radical hysterectomy with lymphadenectomy
CIN II - beyond uterus but not past the lower third of vagina or pelvic wall - chemoradiotherapy
CIN III - tumour extends to pelvic wall ± lower third of vagina ± hydronephrosis - chemoradiotherapy
CIN IVA - spread to bladder or rectum - chemoradiotherapy
CIN IVB - distant metastases - combination chemotherapy

Question 14

Endometrial hyperplasia

Answer 14

PCOS, anovulation, perimenopause, granulose cell tumours, unopposed oestrogen therapy, endometrial cancer
Type 1 - K-RAS, BRAF
Type 2 - P53

Question 15

Endometrial hyperplasia prognostic factors

Answer 15

Figo stage
1 - in uterus
2 - spread to cervix
3 - pelvic spread
4 - distant spread

Question 16

Sex cord stromal tumours

Answer 16

Benign - fibromas, thecomas

Variable - granulosa cell tumour, sertoli-leydig cell tumours

Question 17

Lynch syndrome (hereditary non-polyposis colorectal cancer)

Answer 17

Autosomal dominant

Colorectal and endometrial tumours

Question 18

Krukenberg tumour

Answer 18

Ovarian metastases from stomach tumour - signet ring cells

Question 19

Dermatomyositis

Answer 19

Tender inflamed muscles - raised CK

Gottron’s papules

Question 20

Sarcoidosis

Answer 20

Lungs - SOB + dry cough
Skin - lupus pernio, erythema nodosum
Heart - pericarditis, HF, valvular lesions
Non-caseating granulomas, hypergammaglobulinaemia, high serum ACE, hypercalcaemia