path MCQ 2014 March recalls - formatted Flashcards
- Which of the following is included in the diagnosis of SLE?
a. erosive arthritis
b. muscle weakness
c. pericarditis
d. peripheral neuropathy
e. pulmonary hypertension
c. pericarditis
- Which is true regarding neuroblastoma:
a. males have a worse prognosis than females
b. most have normal levels of catecholamines
c. multiple deep blue cutaneous metastases can regress spontaneously
d. anterior mediastinum is a common site of origin
e. most common site of organ involvement is the adrenal cortex
multiple deep blue cutaneous metastases can regress spontaneously
90% abnormal catecholamine
adrenal medulla involved
- Which of the following is more common in ulcerative colitis than Crohn’s disease?
a. colovesical fistula
b. fibrosing strictures
c. fissuring ulcers
d. toxic megacolon
e. vitamin B12 malabsorption
. toxic megacolon
- strongest association with forming cholesterol gallstones?
a. Ascaris lumbricoides
b. ileal bypass
c. sickle cell disease
d. total parental nutrition
e. ?(sorry can’t recall - hope it was false)
d. total parental nutrition
a. Ascaris lumbricoides pigment
b. ileal bypass pigment
c. sickle cell disease pigment
- which of the pure forms of testicular germ cell tumours presents in infancy?
a. embyronal carcinoma
b. endodermal sinus (yolk sac) tumour
c. seminomad. spermatocytic seminoma
e. teratoma
endodermal sinus (yolk sac) tumour
- Pregnancy all of the following are complications except: ( Read HELLP syndrome)
- Hepatic hematoma
- Thrombocytosis
- Thrombocytosis
- Associations:
- Carcinosarcoma in post menopausal females.
- Vulval sarcoma
- Carcinosarcoma in post menopausal females.
Which of the association is not true:
- NSAID’s associated diffuse cortical necrosis.
- Contrast agent and acute tubular necrosis
- NSAID’s associated diffuse cortical necrosis. Renal cortical necrosis cause- hypovolaemia - shock etc- HUS- renal transplant
- Stromal tumor of uterus least likely to present as metastatis:
- Leiomyoma
- Leiomyosarcoma.
- Leiomyoma
- Which of the following presents as painless mass:
- Perisosteal osteosarcoma
- Paraosteal osteosarcoma low grade
- High grade surface osteosarcoma
- Telangiectatic osteosarcoma
- Small cell osteosarcoma
- Paraosteal osteosarcoma low grade
- Radiograph of mandible shows lucent lesion near the root of the tooth with denticle particles. Which is most likely
- Odontoma
- Kertogenic odondtoid tumor.
- Dentigerous cyst
- Ameloblastoma
- Cementoma rare but also periapical, has density
- Odontoma
- Young patient after trauma undergoes Contrast CT of abdomen. It shows non enhancing upper pole of left kidney. No bleeding or collection.
- Dissection at renal hilum.
- Avulsion of segmental artery.
- Venous thrombosis.
- Venous dissection.
- Dissection at renal hilum.
- Young patient after trauma undergoes Contrast CT of abdomen. It shows non enhancing upper pole of left kidney. No bleeding or collection.
- Dissection at renal hilum.
- Avulsion of segmental artery. No bleeding
- Venous thrombosis. ?expect some enhancement. Not commonly assoc with trauma.
- Venous dissection. Never heard of this - ? Even possible
Regarding knee trauma: Most likely
- Common peroneal nerve is most commonly involved.
- Often associated with avulsion fracture
- Must do DSA to rule out Popliteal artery injury
- Common peroneal nerve is most commonly involved.
Regarding knee trauma: Most likely
- Common peroneal nerve is most commonly involved.
- Often associated with avulsion fracture can be it not often
- Must do DSA to rule out Popliteal artery injury
- Multiple myeloma: Most likely
- x-ray is most sensitive than bone scan for staging of myeloma
- More sensitive anyway
- x-ray is most sensitive than bone scan for staging of myeloma
- More sensitive anyway
- Young female presenting with back pain and sclerotic lesion in the vertebra
- Osteoid osteoma
- Metastasis
- GCT
- Osteoblastoma
- ABC
- Osteoid osteoma
- Phthisis Bulbi
- Osseous metaplasia
- Optic nerve hypertrophy.
- Osseous metaplasiaphthisis bulbi changes- micropthalmia- thickened sclera- effusion between choroid and sclera- dystrophic calcification- osseous metaplasia
- Juvenile Nasopharyngeal angiofibroma
- Location: posterolateral wall of nose
- Complication is sarcomatous transformation
- Location: posterolateral wall of nose
- Parotid malignancy: ( don’t remember the Q but I think it said least likely)
- Acinar cell carcinoma
- Mucinous mucoepidermoid
- Pleomorphic x adenocarcinoma
- SCC
LJS edit - order of parotid malignancy in descending frequency:
mucoepidermoid > adenoid cystic > acinar cell.
Not sure where carcinoma ex pleomorphic adenoma fits in but 5-10% transform and it is the most common benign parotid tumour, so I would think this is not the least common. However, primary SCC of the parotid is very rare (occurs via chronic inflammation = squamous metaplasia), so I think this is the answer (though nodal met of skin SCC to intraparotid nodes is not that rare, so would depend on the wording of the question.
- Pleomorphic x adenocarcinoma
- Parotid malignancy: ( don’t remember the Q but I think it said least likely)
- Acinar cell carcinoma 1-5% of salivary gland tumours.
- Mucinous mucoepidermoid?
- Pleomorphic x adenocarcinoma I think. 10% over 15 years convert
- SCC
Peutz Jegher. Describe
- Harmatomatous polyposis + mucutaneous pigmentation- AD- smooth muscle core polyps -> differentiate from Cowden and Cronkite canada- non-neoplastic polyps- stomach and small intestine, and othersIncreased risk of cancer- GI adenocarcinoma- breast- lung- pancreas- ovary - sex cord tumour- uterus- cervix adenoma malignum (adenocarcinoma subtype of the cervix)- testis
- Pseudohermophroditism: same question was included in the radiology and pathology.
- Leydig cell tumor
- Serotoli Leydig cell tumor
- Granulosa cell tumor
- Serous malignancy
- Mucinous tumor
- Serotoli Leydig cell tumor
- Which of the following association is LEAST correct:
- Nodular fasciitis has irregular margins
- Nodular fasciitis presents in forearm
- Nodular fasciitis is associated
- Myositis ossificans has well defined margins
- Myositis ossificans involves proximal extremity.
- Myositis ossificans has well defined margins
- Which of the following association is LEAST correct: 1. Nodular fasciitis has irregular margins – Nodular.
- Nodular fasciitis presents in forearm. Most common
- Nodular fasciitis is associated with trauma usually
- Myositis ossificans has well defined margins
- Myositis ossificans involves proximal extremity. Yes – “large muscles”Nodular fasciitis is a rapidly growing non-neoplastic soft tissue lesion that is frequently located in the deep subcutaneous region or in the fascia. The most common locations for nodular fasciitis are the volar aspect of the forearm, the lower extremity, and the chest and back. It typically manifests as a rapidly growing mass.Idiopathic causeTx: excise and monitor
- Squamous cell skin cancer: Not associated
- SLE
- CLL
- Post renal transplant
- HPV
- Sun rays
- SLE ?? is apparently, but not mentioned in Robbins20.
Squamous cell skin cancer: Not associated
- SLE ?? is apparently, but not mentioned in Robbins
- CLL yes
- Post renal transplant yes
- HPV definitely
- Sun rays obviously
- Primary biliary cirrhosis: (F)
- Elevated serum transaminase
- Associated with antimitochondrial antibodies
- Associated with HCC
- Middle aged female
- Involves both intra and extra hepatic radicals
. Involves both intra and extra hepatic radicals - FALSE:
Intra only
PBC is characterized by the destruction of small intrahepatic bile ducts, portal inflammation, and progressive scarring. The cause of PBC is unknown, but it is probably due to an inherited abnormality of immunoregulation.
- Cholangiocarinoma association
- PBC
- Choldedochal cyst
- Bile duct adenoma
- Choldedochal cyst
- Miliary nodules in spleen
- Cardiac failure
- Myelofibrosis
- CLL possibly
- Portal hypertension possibly – gamma gandy bodies
- Polycythemiavera
- Portal hypertension possibly – gamma gandy bodies
- Polycythemia vera: Not associated
1. Cyanosis
- Cyanosis
- Sickle cell anemia. what doesn’t happen
- Acute chest pain
- Shock with splenic sequestration
- Aplastic crisis – with B19
- Staph aureus with autosplenectomy
- Staph aureus with autosplenectomy Faplastic cris- parvovirus B1 infects RBC progenitors in bone marrow, resulting in impaired cell division for a few days.- In people with SCD, however, the RBC lifespan is greatly shortened (usually 10-20 days), and a very rapid drop in Hb occurs. The condition is self-limited, with bone marrow recovery occurring in 7-10 days, followed by brisk reticulocytosis.Splenic sequestration- blood pools in spleen causing venous infarct and anaemia + splenomegaly
- Chronic meningoencephalitis (F)
- Borelia burgdorferia
- Listeria
- TB
- Syphilis
- ? crypto
- Listeria
- Association which is true:
- H influenza in neonates
- Genitourinary infection
- Corynebacterium diphtheria and genitourinary
- H influenza in neonates
- Adenocarcinoma of lung
- Scar association – lung
- Cavitating lesion
- Location is periphery
- Location is periphery
LW favoured answer, although I think scar carcinoma is of adenocarcinoma histology
- Lobular carcinoma in situ (repeat): Least likely
- Presents as speculated mass
- Microcalcification
- Seen only on one mammographic view.
- Microcalcification
- Spiculated lesion in breast
- Sclerosing adenosis
- Fibroadenoma
- Sclerosing adenosis
- Picks disease which is true:
- Anterior parietal lobe atrophy
- Asymetric frontal and temporal lobe atrophy
- Substansia niagra atrophy
- Cerebellar atrophy
- Asymetric frontal and temporal lobe atrophy Pick disease is a neurodegenerative disease, and one of the tauopathies characterised by the accumulation of Pick bodies.- sometimes used synonymously with frontotemporal lobar degeneration- cortical atrophy of the frontal and temporal lobes. These changes can be markedly asymmetric and affect one region much more than another. Tauopathies are a heterogeneous group of neurodegenerative diseases characterised by abnormal metabolism of tau proteins leading to intracellular accumulation and formation of neurofibrillary tangles (NFT). These neurofibrillary tangles are deposited in the cytosol of neurons and glial cells. Examples of tauopathies include 3:
- Alzheimer disease- progressive supranuclear palsy (PSP)
- frontotemporal lobar degeneration (FTLD-TAU)
- corticobasal degeneration
- HIV infection least associated:
- JC papovo virus
- CMV virus
- Toxoplasmosis
- Cryptosporidium
- Nocardia asteroides
- Nocardia asteroides
- Toxoplasmosis:
- 75% in the basal ganglia
- Hemorrhage with treatment
- 75% in the basal ganglia
- Cereberal venous thrombosis:
- Spares the cortex with hemorrhagic infarct of the subcortical white matter
- Empty delta sign in noncontrast CT
- Dense sinus in non contrast CT
- Non vascular territory infarcts?
- Dense sinus in non contrast CT
- Tunneled catheter(repeat)
- Femoral catheter can stay in place for long time
2.
- Femoral catheter can stay in place for long time 2.
- Most common intravascular device used to retrieve the foreign bodies:
- Goose neck snare
- Intravascular biopsy forceps
- Stent
- Goose neck snare
Patient with minimal claudication with 20 cm of SFA occlusion. No critical ischemia
- Exercise programme.
- Angioplasty
- Stent
- Bypass
- Exercise programme. Solely chosen using logic. Long segment (not amenable to perc intervention) and minimal sx – why risk it?
- Cervical cancer with smoking not associated with adeno
Cervical cancer with smoking not associated with adenobut a/w SCC
- Endometrial cancer :
- Endometrial ca with diabetes
- Endometrial ca with nulliparity
- Endometrial ca with nulliparity
- Ovarian cyst 4.5cm 35Y presenting with pain, CA 125 was normal, anechoic simple
- Gynecological referral because of pain? May have torted. From a follow-up perspective <5cm pre-menopausal does not need follow-up
- 12 months follow up
- Mention in the report no follow up needed possible 4. Aspiration of the cyst
- Gynecological referral because of pain? May have torted. From a follow-up perspective <5cm pre-menopausal does not need follow-up or maybe no follow up
- Testis: 2year old MC germ cell tumor
- Yolk sac tumor
- Choriocarnioma
- Teratoma
- Seminoma
- Spermatocytic seminoma
- Yolk sac tumor
- Cryptorchidism: False
- Infertifilty resolves with orchidopexy
- Complete descent in 1 year most
- Malignancy of the contralateral testis
- Majority located in the inguinal canal true
- Malignancy of the contralateral testis
- Cryptorchidism: False
- Infertifilty resolves with orchidopexy
- Complete descent in 1 year most
- Malignancy of the contralateral testis
- Majority located in the inguinal canal true
LJS edit - infertility persists despite orchidopexy. Therefore 1 is false. Malignancy risk is increased for BOTH testes, not just undescended one, 3 is true
- All of the following will metastasize to brain except
- Lung
- RCC
- Breast
- Prostate
- Melanoma
- Prostate can met to meninges
- Uveal melanoma
- Ciliary body melanoma has good prognosis than iris melanoma
- Iris melanoma better prognosis than choroidal melanoma
- Naevi is a precussor of uveal melanoma.
- Spreads to cervical lymph nodes
- Commonest hematogenous spread to liver
- Iris melanoma better prognosis than choroidal melanoma
- Commonest hematogenous spread to liver
Malignant uveal melanomas, also referred as choroidal melanomas, are the most common primary tumour of the adult eye
Malignant melanoma of the uvea is the most common primary intraocular malignancy and is predominantly seen in Caucasians .
The incidence of these tumours increases with age, with only 2% of tumours found in patients younger than 20 years of age
- 2 Year child with hyperinflated lung on expiratory and inspiratory film with hilar mass overlying the hilum
- Foreign body
- Foreign body
- Neonate with hyperdense mass in the hilum which shows the rim calcification and homogenous enhancement
- Carcinoid
- Bronchial carcinoma
- Teratoma should
- SJ syndrome
- Bronchopulmonary
not sure53. Neonate with hyperdense mass in the hilum which shows the rim calcification and homogenous enhancement
- Carcinoid no
- Bronchial carcinoma seems very unlikely
- Teratoma should have some hypodense parts and rim calcification unusual
- SJ syndrome no. Response to infection
- Bronchopulmonary ???
- Elderly patient presenting with hemorrhage in parietal lobe white matter with no enhacment on CT.
- Amyloidosis
- Hemorragic metastatis
- Amyloidosis
- Pediatric tumor involving the cerebellum: LEAST likely
- Ependymoma
- Medulloblastoma
- Hemangioblastoma
- Juvenile pilocytic astrocytoma
- Pleomorhic xanthoastrocytoma
PXA
- LJS edit - Haemangioblastoma typically middle age but can occur earlier in VHL. PXA is paed tumour but almost invariably supratentorial (>98%). I think PXA is less likely in the cerebellum of a kid than haemangioblastoma. I would say 5. is answer*
- AJL agrees
- Difference between Lefort 1 and lefort 2. Which least likely favours lefort 2
- Orbital floor
- Posterolateral maxillary wall
- Anterior wall
- Medial wall
- Pterygoid plates
- Medial wall of the maxillary sinus
- Transverse fracture involving pterygoid plates,
- Lefort 1
- Lefort 2
- Lefort 3
- Maxill
- Lefort 1- answer
- Juvenile papilomatosis of breast(repeat)
- Present as palpable mass
- Nipple discharge
- Malignant potential no potential to degenerate, but condition is associated with increased risk of malignancy
- Prepubertal age group
- Present as palpable mass- papillary proliferation of ductal epithelium- present like a peripheral mass- no nipple discharge- young patient group 19-24
Patients present with a firm, well-defined, mobile mass often in the periphery of the breast.
There is usually no nipple discharge.
Despite being a benign entity, it is considered by some to be a marker for familial breast cancer. Approximately 10% of those with papillomatosis are thought to develop breast cancer later in life 10.
- Mamographic appearance of papilloma
- Microlobulations
- Calcification
- Calcification
- Ultrasound showing intensely hyperechoic lesion
Lipoma, hamartoma, fat necrosis, LN, haematoma. Rarely malignancy
- Pagets disease (repeat)
- Refer to breast surgeon
- Dermatological reference for the dermatitis
- Refer to breast surgeon