path MCQ 2013 August recalls - WA - formatted

Question 1

Pituitary adenoma FALSE -

• 25% at autopsy
• Large invades cavernous sinus
• If encases the vessels more likely meningioma
• If small presents with galactorrhoea and infertility

Answer 1

25% at autopsy - 15%

Question 2

In severe small bowel ischaemia, which is the most frequent association?:

a. Tight atherosclerotic narrowing of the SMA origin
b. Hypotension
c. Aortic dissection
d. Narrowing of the celiac trunk origin
e. PAN

Answer 2

a. Tight atherosclerotic narrowing of the SMA origin

Question 3

Cholangiocarcinoma

• M >F
• Moderate – Well differentiated sclerosing adenocarcinoma
• Peripheral > central
• Associated with choledocholithiasis commonly

Answer 3

Moderate – Well differentiated sclerosing adenocarcinoma

Question 4

Acute pancreatitis not associated

• SPINK1 gene
• Fat necrosis and chalky
• Tripsinogen activation required
• Coxsackie virus infection
• 15% of patients with gallstones have pancreatitis

Answer 4

*AJL - All are associated annoyingly

**LJS - Gallstones are the cause in 35-60% of acute pancreatitis BUT only 5% pt with GS get pancreatitis

Question 5

Ectopic pancreas least likely site

a. Duodenum
b. Gastric antrum
c. Ileum
d. Colon
e. Meckel diverticulum

*AJL added some to make it better

Answer 5

Colon

Question 6

Prostate hyperplasia

Hyperplasia

• can be purely stroma
• Hyperplasia occurs in the periphery first
• Corpora amylasea can be calcified

Answer 6

Corpora amylasea can be calcified
corpora amylase- from degenerative cells or thickened secretion
- increase with age
- in prostate normally occurs in glandular element
-> normally benign

Question 7

Bladder cancer

• Strongyloides and transmittal cell carcinoma
• Alanine dyes and SCC
• Urachal remnant and adenocarcinoma

Answer 7

• Urachal remnant and adenocarcinoma

Bladder cancer

• Strongyloides and transmittal cell carcinoma (SCC)
• Alanine dyes and SCC (TCC)
• Urachal remnant and adenocarcinoma

Question 8

Gout what is MOST LIKELY

Tophi occur in the tips of the fingers and toes
Tophi commonly calcified
Tophi associated with calcium oxalate renal stones
10% die from renal failure
Juxtaarticular erosions before cartilage loss

Answer 8

Juxtaarticular erosions before cartilage loss

Question 9

Leiomyomas (true)

• Polyclonal
• Moderate mitotic activity
• Increased risk of leiomyosarcoma if invades veins
• Increased risk of leiomyosarcoma if >10cm size
• Unrecalled option

Answer 9

• AJL - all are incorrect
• Monoclonal given it is an -oma (confirmed on RP)
• mitotic figures are rare, though leimyomas can be mitotically active in young or pregnant people (robbins)
• If invades vein it is a rare variant ‘intravenous leiomyomatosis’ (robbins)
• leiomyomas can be big and they do not have malignant transformation (leiomyosarcomas arise de-novo)

previous answer:
No sureit is monoclonalThe diag- nostic features of overt leiomyosarcoma include - tumor necrosis- cytologic atypia, - mitotic activity. Since increased mitotic activity is sometimes seen in benign smooth muscle tumors, particularly in young women, an assessment of all three features is necessary to make a diagnosis of malignancy.

Question 10

Radial scar not a histological features

Dilated ducts with inflammation and obstruction
Dilated ducts with calcified debris
Duct ectasia
Associated with dilated lymphatics

Answer 10

*AJL - Radial scar is: A central nidus of entrapped glands in a hyalinized stroma surrounded by long radiating projections into stroma (robbins).
I’m not sure which is the least correct answer in this question.

Previous answer:
Radial scar- fibroelastic co

Question 11

Alpha 1 antitrypsin

Common cause of neonatal hepatitis
Autosomal codominant

Answer 11

Common cause of neonatal hepatitis

Question 12

Wilms tumour FALSE

Bilateral Wilms tumours is associated with nephroblastomatosis
Commonly associated with a condition with 11p mutation

Answer 12

*AJL - WT1 gene mutation which is associated with familial wilms (Beckwith, WAGR and Deny-drash) is on the 11p chromosome so I think both answers are actually correct…

(*LW - love your work, but would have some caution with the word “commonly” in option 2 as only approximately 10 percent of cases, Wilms tumor occurs as a part of a multiple malformation syndrome, including WAGR, Denys-Drash, and Beckwith-Wiedemann syndromes, and Less than 10 percent of patients with sporadic Wilms tumor have a WT1 gene mutation, suggesting that other mechanisms are involved).
Preferred option of nephroblastomatosis.
*AJL - Good call. Now we need a definition of common… But agree with what is said. (question says false so least accurate is 11p mutation is common)

Previous answer:
Commonly associated with a condition with 11p mutation

Question 13

Wegeners - false

Upper tract granulomas
Lower tract granulomas 
Pulmonary artery vasculitis occurs 
Renal artery vasculitis 
Glomerulonephritis

Answer 13

Renal artery vasculitis

Question 14

Toxins and cancer

Lead and soft tissue sarcoma
Mercury and renal disease

Answer 14

Mercury and renal disease - acute tubular necrosis