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Pathology > path MCQ 2014 March recalls - formatted > Flashcards

path MCQ 2014 March recalls - formatted Flashcards

1
Q
  1. 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

A

c. pericarditis

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2
Q
  1. 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

A

multiple deep blue cutaneous metastases can regress spontaneously
90% abnormal catecholamine
adrenal medulla involved

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3
Q
  1. 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

A

. toxic megacolon

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4
Q
  1. 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)

A

d. total parental nutrition

a. Ascaris lumbricoides pigment
b. ileal bypass pigment
c. sickle cell disease pigment

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5
Q
  1. 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

A

endodermal sinus (yolk sac) tumour

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6
Q
  1. Pregnancy all of the following are complications except:
  2. Hepatic hematoma
  3. Thrombocytosis
A
  1. Thrombocytosis

Read HELLP syndrome

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7
Q
  1. Associations:
  2. Carcinosarcoma in post menopausal females.
  3. Vulval sarcoma
A
  1. Carcinosarcoma in post menopausal females.
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8
Q

Which of the association is not true:

  1. NSAID’s associated diffuse cortical necrosis.
  2. Contrast agent and acute tubular necrosis
A
  1. NSAID’s associated diffuse cortical necrosis. Renal cortical necrosis cause- hypovolaemia - shock etc- HUS- renal transplant

*AJL - mnemonic for renal cortical necrosis = SHT (like shit without an I…)
Shock, HUS, Transplant.

(Combine with COAG for cortical nephrocalcinosis and you’ll sound like a smart cookie in a viva)

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9
Q
  1. Stromal tumor of uterus least likely to present as metastatis:
  2. Leiomyoma
  3. Leiomyosarcoma.
A
  1. Leiomyoma

**LJS - caution, depends what other answers are. Rare variants of fibroid - benign metastsizing leiomyoma and disseminated peritoneal leiomyomatosis (Rob 9th ed)

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10
Q
  1. Which of the following presents as painless mass:
  2. Perisosteal osteosarcoma
  3. Paraosteal osteosarcoma low grade
  4. High grade surface osteosarcoma
  5. Telangiectatic osteosarcoma
  6. Small cell osteosarcoma
A
  1. Paraosteal osteosarcoma low grade
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11
Q
  1. Radiograph of mandible shows lucent lesion near the root of the tooth with denticle particles. Which is most likely
  2. Odontoma
  3. Kertogenic odondtoid tumor.
  4. Dentigerous cyst
  5. Ameloblastoma
  6. Cementoma rare but also periapical, has density
A
  1. Odontoma
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12
Q
  1. Young patient after trauma undergoes Contrast CT of abdomen. It shows non enhancing upper pole of left kidney. No bleeding or collection.
  2. Dissection at renal hilum.
  3. Avulsion of segmental artery.
  4. Venous thrombosis.
  5. Venous dissection.
A
  1. Dissection at renal hilum.
  2. Young patient after trauma undergoes Contrast CT of abdomen. It shows non enhancing upper pole of left kidney. No bleeding or collection.
  3. Dissection at renal hilum.
  4. Avulsion of segmental artery. No bleeding
  5. Venous thrombosis. ?expect some enhancement. Not commonly assoc with trauma.
  6. Venous dissection. Never heard of this - ? Even possible
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13
Q

Regarding knee trauma: Most likely

  1. Common peroneal nerve is most commonly involved.
  2. Often associated with avulsion fracture
  3. Must do DSA to rule out Popliteal artery injury
A
  1. Common peroneal nerve is most commonly involved.

Regarding knee trauma: Most likely

  1. Common peroneal nerve is most commonly involved.
  2. Often associated with avulsion fracture can be it not often
  3. Must do DSA to rule out Popliteal artery injury
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14
Q
  1. Multiple myeloma: Most likely
  2. x-ray is most sensitive than bone scan for staging of myeloma
  3. More sensitive anyway
A
  1. x-ray is most sensitive than bone scan for staging of myeloma
  2. More sensitive anyway
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15
Q
  1. Young female presenting with back pain and sclerotic lesion in the vertebra
  2. Osteoid osteoma
  3. Metastasis
  4. GCT
  5. Osteoblastoma
  6. ABC
A
  1. Osteoid osteoma
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16
Q
  1. Phthisis Bulbi
  2. Osseous metaplasia
  3. Optic nerve hypertrophy.
A
  1. Osseous metaplasiaphthisis bulbi changes- micropthalmia- thickened sclera- effusion between choroid and sclera- dystrophic calcification- osseous metaplasia

**LJS - optic nerve atrophy

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17
Q
  1. Juvenile Nasopharyngeal angiofibroma
  2. Location: posterolateral wall of nose
  3. Complication is sarcomatous transformation
A
  1. Location: posterolateral wall of nose
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18
Q
  1. Parotid malignancy: ( don’t remember the Q but I think it said least likely)
  2. Acinar cell carcinoma
  3. Mucinous mucoepidermoid
  4. Pleomorphic x adenocarcinoma
  5. SCC
A

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.

  1. Pleomorphic x adenocarcinoma
  2. Parotid malignancy: ( don’t remember the Q but I think it said least likely)
  3. Acinar cell carcinoma 1-5% of salivary gland tumours.
  4. Mucinous mucoepidermoid?
  5. Pleomorphic x adenocarcinoma I think. 10% over 15 years convert
  6. SCC
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19
Q

Peutz Jegher. Describe

A
  • 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
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20
Q
  1. Pseudohermophroditism: same question was included in the radiology and pathology.
  2. Leydig cell tumor
  3. Serotoli Leydig cell tumor
  4. Granulosa cell tumor
  5. Serous malignancy
  6. Mucinous tumor
A
  1. Serotoli Leydig cell tumor
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21
Q
  1. Which of the following association is LEAST correct:
  2. Nodular fasciitis has irregular margins
  3. Nodular fasciitis presents in forearm
  4. Nodular fasciitis is associated
  5. Myositis ossificans has well defined margins
  6. Myositis ossificans involves proximal extremity.
A

*AJL - Myositis ossificans has a well-defined calcified margin after 4-6 weeks but can be ill-defined early on.
Nodular fasciitis appears to have smooth margins (as LJS describes below)
Preferred answer is probably 1.
(acknowledging that there’s no acuity mentioned or what the association is)

**LJS - agree that margins only calcified later on, but no time frame specified, so could be considered correct. Nodular fasciitis is described as well circumscribed, and all the RP/statdx/google pics look round/oval with relatively smooth margins. Maybe 1. is incorrect?

Previous answer…
4. Myositis ossificans has well defined margins

  1. Which of the following association is LEAST correct:
  2. Nodular fasciitis has irregular margins – Nodular.
  3. Nodular fasciitis presents in forearm. Most common
  4. Nodular fasciitis is associated with trauma usually
  5. Myositis ossificans has well defined margins
  6. 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
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22
Q
  1. Squamous cell skin cancer: Not associated
  2. SLE
  3. CLL
  4. Post renal transplant
  5. HPV
  6. Sun rays
A
  1. SLE ?? is apparently, but not mentioned in Robbins20.

Squamous cell skin cancer: Not associated
1. SLE ?? is apparently, but not mentioned in Robbins
*LW: –> Infrequently, squamous cell carcinoma develops in sites of DLE. Squamous cell carcinoma in DLE is estimated to occur in 2 to 3 percent of DLE patients, is postulated to be related to the presence of chronic inflammation, and is associated with increased risk for a poor prognosis for squamous cell carcinoma.
This is relatively rare assoication.

  1. CLL yes
  2. Post renal transplant yes
  3. HPV definitely
  4. Sun rays obviously
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23
Q
  1. Primary biliary cirrhosis: (F)
  2. Elevated serum transaminase
  3. Associated with antimitochondrial antibodies
  4. Associated with HCC
  5. Middle aged female
  6. Involves both intra and extra hepatic radicals
A

. 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.

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24
Q
  1. Cholangiocarinoma association
  2. PBC
  3. Choldedochal cyst
  4. Bile duct adenoma
A
  1. Choldedochal cyst
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25
23. Miliary nodules in spleen 1. Cardiac failure 2. Myelofibrosis 3. CLL possibly 4. Portal hypertension 5. Polycythemia vera
4. Portal hypertension possibly – gamma gandy bodies
26
24. Polycythemia vera: Not associated | 1. Cyanosis
1. Cyanosis
27
25. Sickle cell anemia. what doesn't happen 1. Acute chest pain 2. Shock with splenic sequestration 3. Aplastic crisis – with B19 4. Staph aureus with autosplenectomy
4. 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
28
26. Chronic meningoencephalitis (F) 1. Borelia burgdorferia (lyme disease) 2. Listeria 3. TB 4. Syphilis 5. ? crypto
2. Listeria (causes rhombencephalitis)
29
27. Association which is true: 1. H influenza in neonates 2. Genitourinary infection 3. Corynebacterium diphtheria and genitourinary
1. H influenza in neonates
30
29. Adenocarcinoma of lung 1. Scar association – lung 2. Cavitating lesion 3. Location is periphery
3. Location is periphery | LW favoured answer, although I think scar carcinoma is of adenocarcinoma histology
31
31. Lobular carcinoma in situ (repeat): Least likely 1. Presents as speculated mass 2. Microcalcification 3. Seen only on one mammographic view.
2. Microcalcification
32
32. Spiculated lesion in breast 1. Sclerosing adenosis 2. Fibroadenoma
1. Sclerosing adenosis
33
34. Picks disease which is true: 1. Anterior parietal lobe atrophy 2. Asymetric frontal and temporal lobe atrophy 3. Substansia niagra atrophy 4. Cerebellar atrophy
2. Asymetric frontal and temporal lobe atrophy * AJL - Picks disease is also called frontotemporal lobar dementia. 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
34
35. HIV infection least associated: 1. JC papovo virus 2. CMV virus 3. Toxoplasmosis 4. Cryptosporidium 5. Nocardia asteroides
* AJL - all are associated. Nocardia is rare so probably the answer in this case. 35. HIV infection least associated: 1. JC papovo virus (presumably this is JC polyomavirus, otherwise this is definitely incorrect) 2. CMV virus 3. Toxoplasmosis 4. Cryptosporidium 5. Nocardia asteroides
35
36. Toxoplasmosis: 1. 75% in the basal ganglia 2. Hemorrhage with treatment
1. 75% in the basal ganglia
36
37. Cereberal venous thrombosis: 1. Spares the cortex with hemorrhagic infarct of the subcortical white matter 2. Empty delta sign in noncontrast CT 3. Dense sinus in non contrast CT 4. Non vascular territory infarcts?
3. Dense sinus in non contrast CT | * AJL - ?also non-vascular territory infarcts. (Though dense sinus is more correct)
37
40. Tunneled catheter(repeat) 1. Femoral catheter can stay in place for long time 2.
1. Femoral catheter can stay in place for long time 2. **LJS - Femoral catheters < 30days use (high risk infection, limited mobility)
38
41. Most common intravascular device used to retrieve the foreign bodies: 1. Goose neck snare 2. Intravascular biopsy forceps 3. Stent
1. Goose neck snare
39
Patient with minimal claudication with 20 cm of SFA occlusion. No critical ischemia 1. Exercise programme. 2. Angioplasty 3. Stent 4. Bypass
1. Exercise programme. Solely chosen using logic. Long segment (not amenable to perc intervention) and minimal sx – why risk it?
40
43. Cervical cancer with smoking not associated with adeno
Cervical cancer with smoking not associated with adenobut a/w SCC
41
44. Endometrial cancer : 1. Endometrial ca with diabetes 2. Endometrial ca with nulliparity
2. Endometrial ca with nulliparity
42
46. Ovarian cyst 4.5cm 35Y presenting with pain, CA 125 was normal, anechoic simple 1. Gynaecological referral 2. 12 months follow up 3. Mention in the report no follow up needed possible 4. Aspiration of the cyst
1. Gynecological referral because of pain? May have torted. From a follow-up perspective <5cm pre-menopausal does not need follow-up
43
47. Testis: 2year old MC germ cell tumor 1. Yolk sac tumor 2. Choriocarnioma 3. Teratoma 4. Seminoma 5. Spermatocytic seminoma
1. Yolk sac tumor
44
48. Cryptorchidism: False 1. Infertility resolves with orchidopexy 2. Complete descent in 1 year most 3. Malignancy of the contralateral testis 4. Majority located in the inguinal canal
**LJS - infertility persists despite orchidopexy. Therefore 1 is false. Malignancy risk is increased for BOTH testes, not just undescended one 2 and 4 also true *AJL agree. 48. Cryptorchidism: False 1. Infertility resolves with orchidopexy 2. Complete descent in 1 year most 3. Malignancy of the contralateral testis 4. Majority located in the inguinal canal
45
50. All of the following will metastasize to brain except 1. Lung 2. RCC 3. Breast 4. Prostate 5. Melanoma
4. Prostate can met to meninges
46
51. Uveal melanoma 1. Ciliary body melanoma has good prognosis than iris melanoma 2. Iris melanoma better prognosis than choroidal melanoma 3. Naevi is a precussor of uveal melanoma. 4. Spreads to cervical lymph nodes 5. Commonest hematogenous spread to liver
2. Iris melanoma better prognosis than choroidal melanoma 5. Commonest hematogenous spread to liver * *LJS - this is correct answer. * LW: agree **LJS - Robbins 9th ed p1331 Prognosis related to: -Size -Cell type - epithelial worse than spindle -Proliferative index. -No mention of different parts of the uvea having different prognosis *AJL - Disagree with the last comment. Both 2 and 5 are correct. Robbins says iris melanoma follows a relatively indolent course while choroidal and ciliary are more aggressive. (Robbins 10th p1318) Almost purely haematogenous spread (first to liver). Previous answer: 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
47
52. 2 Year child with hyperinflated lung on expiratory and inspiratory film with hilar mass overlying the hilum 1. Foreign body
1. Foreign body
48
53. Neonate with hyperdense mass in the hilum which shows the rim calcification and homogenous enhancement 1. Carcinoid 2. Bronchial carcinoma 3. Teratoma should 4. SJ syndrome 5. Bronchopulmonary
not sure53. Neonate with hyperdense mass in the hilum which shows the rim calcification and homogenous enhancement 1. Carcinoid no 2. Bronchial carcinoma seems very unlikely 3. Teratoma should have some hypodense parts and rim calcification unusual 4. SJ syndrome no. Response to infection 5. Bronchopulmonary ???
49
54. Elderly patient presenting with hemorrhage in parietal lobe white matter with no enhacment on CT. 1. Amyloidosis 2. Hemorragic metastatis
1. Amyloidosis
50
55. Pediatric tumor involving the cerebellum: LEAST likely 1. Ependymoma 2. Medulloblastoma 3. Hemangioblastoma 4. Juvenile pilocytic astrocytoma 5. 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
51
57. Difference between Lefort 1 and lefort 2. Which least likely favours lefort 2 1. Orbital floor 2. Posterolateral maxillary wall 3. Anterior wall 4. Medial wall 5. Pterygoid plates
4. Medial wall of the maxillary sinus
52
58. Transverse fracture involving pterygoid plates, 1. Lefort 1 2. Lefort 2 3. Lefort 3 4. Maxill
1. Lefort 1- answer
53
59. Juvenile papilomatosis of breast(repeat) 1. Present as palpable mass 2. Nipple discharge 3. Malignant potential no potential to degenerate, but condition is associated with increased risk of malignancy 4. Prepubertal age group
1. 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.
54
60. Mamographic appearance of papilloma 1. Microlobulations 2. Calcification
2. Calcification
55
61. Ultrasound showing intensely hyperechoic lesion
Lipoma, hamartoma, fat necrosis, LN, haematoma. Rarely malignancy
56
62. Pagets disease (repeat) 1. Refer to breast surgeon 2. Dermatological reference for the dermatitis
1. Refer to breast surgeon
57
63. Bilateral ovarian tumor least likely 1. Serous if cystadenocarcinoma 2. Mucinous 3. Metastatic adenocarcinoma 4. Endometroid carcinoma
2. Mucinous 63. Bilateral ovarian tumor least likely 1. Serous if cystadenocarcinoma 2. Mucinous 3. Metastatic adenocarcinoma 4. Endometroid carcinoma second commonest malignancy neoplasm. Bilateral 30%. 30% have endometrial carcinoma
58
64. Which of the following is least likely 1. Vulval sarcoma 2. Fallopian tube serous adenocarcinoma occurs 3. Cervical mucoid
3. Cervical mucoid cant find a mention of this
59
65. Mesothelioma 1. Smoking is associated 2. Mediastinal invasion 3. Commonly associated with pulmonary asbestosis 4. Metastasis is associated at presentation
2. Mediastinal invasion says “usually” in Robbins 65. Mesothelioma 1. Smoking is associated 2. Mediastinal invasion says “usually” in Robbins 3. Commonly associated with pulmonary asbestosis 25% 4. Metastasis is associated at presentation 25%
60
66. Pleural effusion 1. Hemorrhagic effusion in renal causes 2. Transudative effusion in liver causes 3. Empyema is defined as collection of pus with spread of infection from lung 4. Hemothorax is collection of blood associated with trauma 5. Chylothorax is collection of lymph fluid due to obstruction of thoracic duct.
2. Transudative effusion in liver causes
61
68. Which one of the following will not cause systemic hypertension 1. Recurrent pulmonary embolism 2. Coarctation of aorta
1. Recurrent pulmonary embolism 68. Which one of the following will not cause systemic hypertension 1. Recurrent pulmonary embolism 2. Coarctation of aorta although not truly systemic
62
69. All of the following will cause aortic regurgitation except 1. Bicuspid aortic valve 2. Hypertension 3. Marfan’s syndrome 4. Syphilis 5. Infective endocarditis
2. Hypertension
63
70. All of the following cause restrictive cardiomyopathy except 1. Radiation 2. Hemochromatosis 3. Sarcoidodis 4. Amyloidosis
*AJL changed question from dilated to restrictive... Answer - Haemochromatosis does not cause restrictive cardiomyopathy (see below) (Robbins) Restrictive cardiomyopathy can be idiopathic or associated with distinct disorders that affect the myocardium, principally amyloidosis (described later), sarcoidosis, radiation-induced fibrosis, metastatic tumors, or the accumulation of metabolites from inborn errors of metabolism. ``` Dilated cardiomyopathy: Familial (up to to 50%) Myocarditis Peripartum Toxic (eg EtOH, chemo, Iron overload) Idiopathic Supraphysiologic stress (excess catecholamines, persistent tachycardia, hyperthyroidism, fetus of IDDM mother, cocaine, phaeochromocytoma) ```
64
71. CPPD 1. Negatively bireferengent 2. MC ankle 3. Secondary associated with hemochromatosis.
3. Secondary associated with hemochromatosis. CPPD- positive birefringent- rhomboid (gout- negative- needle) CPPD cause - OA- hyperparathyroidism- hypomangnesmia- hypothyroidism- ochronosis
65
72. Slipped capital femoral epiphysis 1. 5-10years 2. Posterolateral 3. Early radiograph in frog leg position 4. Most commonly bilateral
3. Early radiograph in frog leg position
66
73. MRI shows retraction of psoas tendon with hyperintensity in the anterior aspect of the hip 1. Avulsion of the lesser trochanter 2. Intertrochanteric fracture 3. Subtranchanteric fracture
1. Avulsion of the lesser trochanter | * AJL - These are typically pathological in an adult (might be a different way of asking the same question)
67
74. THR ( repeat). Bone scan blood pool high Loosening vs infection
infection
68
75. Bone scan radiation dose compared to CXR 1. 50 2. 200 3. 500 4. 1000 5. 2000
**LJS - 200x that of CXR *AJL (agree) CXR - 0.02msV bone scan - 6mSV Therefore 300x the dose (closest option is 200x)
69
77. Pulmonary edema with normal heart size a. Raised intracranial pressure b. Mediastinal fibrosis c. Massive pulmonary embolism d. Constrictive pericarditis
a. Raised intracranial pressurenoncardiogenic pulmonary edema 77. Pulmonary edema with normal heart size a. Raised intracranial pressure b. Mediastinal fibrosis c. Massive pulmonary embolism NO d. Constrictive pericarditis – potentially but mostly right sided
70
78. Complication of the right coronary artery block 1. AV Conduction block 2. Aneurysm 3. Mural thrombus
1. AV Conduction block
71
Inversion injury. Anterior drawer test positive 1. Anterior talofibular ligament 2. Deltoid ligament
1. Anterior talofibular ligament rupture
72
80. An elite sports player present with shoulder pain and recurrent shoulder dislocation. Which one of the following is the BEST investigation 1. MRI 2. Xray 3. USG
1. MRI
73
82. PET negative lymphoma: 1. Nodular sclerosing HD 2. T cell lymphoma 3. Lymphocyte depleted lymphoma 4. Follicular B1 lymphoma 5.
2. T cell lymphoma
74
85. Pathological FDG uptake is seen in a. Thyroid b. Stomach c. Small intestine d. Colon e. Rectum
a. Thyroid: Normal physiological uptake - brain tissue - skeletal muscle, especially after strenuous activity and laryngeal muscles following speech - myocardium - gastrointestinal tract, e.g. intestinal wall - genitourinary tract: FDG is excreted via the renal system and passes into the collecting systems - brown fat - thymus - bone marrow
75
86. Normal uptake is not seen in a. Thyroid b. Stomach c. Small intestine d. Colon e. Rectum
a. Thyroid
76
87. Amyloidosis least correct 1. Jaundice 2. Diarrhea 3. Protenuria 4. Dilated cardiomyopathy
Dilated cardiomyopathy 87. Amyloidosis least correct 1. Jaundice I think so 2. Diarrhea can do 3. Protenuria definitely 4. Dilated cardiomyopathy restrictive
77
88. Waldenstoms Macroglobulinemia: Least correct 1. Bone lesions can be painful 2. Cold agglutinins 3. Coomb’s test
1. Bone lesions can be painful * AJL - Often incidental diagnosis (as in asymptomatic). If patients are symptomatic they present with fatigue, polyneuropathy or B symptoms.
78
89. Which of the associations is not true 1. Mucormycosis with diabetic ketoacidosis 2. Rhinosporidiosis ? 3. Leprosy involves the nasal septum 4. Immunocompetent male with allergic rhinitis and aspergilus infection
2. Rhinosporidiosis ? Must be this one
79
90. Fetal scan to look for cleft lip 1. Midline Saggital scans are the best. 2. Incidence is 1: 80,000 3. Cleft lip is commonly missed on us scans
2. Incidence is 1: 80,000It is estimated to occur with an incidence of ~1 in 700-to-1000 live births 1 ???ummmm **LJS - all false
80
91. Which of the following association are true | 1. Pneumothorax with paraseptal emphysema
1. Pneumothorax with paraseptal emphysema
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92. A new born with small volume lungs and diffuse ground glass opacity: 1. Transient tachypnea of newborn 2. HMD
2. HMD
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93. New born with HMD treated with surfactant through ET tube, why there is patchy distribution 1. Because of differential aeration of the lung I think 2. ET tube displacement 3. Mucous plugging
1. Because of differential aeration of the lung I think
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94. Least likely to have L-R shunt: a. Transposition of great vessels b. PDA c. VSD d. ASD e. Patent foramen ovale
* *LJS - PFO only allows R to L shunting due to flap in place. Causes paradoxical emboli, but not L to R shunt. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2649639/ TGA (D-loop) needs a shunt to survive. Complex flow dynamics depending on where the shunt is and variable directions during systole and diastole, but significant amount needs to be L-R to supply systemic circulation with oxygenated blood via RV-aorta connection https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.73.1.95 Previous answer: a. Transposition of great vessels
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95. Association which is false: f. Antiendomycial antibodies with diarrhea g. Anticardiolipin and symmetric arthritis h. Antibasement antiobodies and hemoptysis i. Anti neutrophil cytoplasmic antibodies and epistaxis j. Anti mitrochondrial antibodies and jaundice
g. Anticardiolipin and symmetric arthritis antiendomycial - coeliac disease antiBM - goodpasture (pulmonary haemorrhage, glomuerlonephritis and antiGBM antibody) ANCA - wegners AMA - primary biliary cholangitis Anticardiolipin Ab ass/w antiphospholipid syndrome. Which is in turn ass/w SLE, which can have symmetric arthritis, but this is the least direct association of those listed
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96. Rheumatoid arthritis: a. No gender predilection b. Commonly involve the axial skeleton c. Commonly feet joints are spared d. Rhematoid nodules affect the heart valves
b. Commonly involve the axial skeleton ***LJS - 50% involvement of the c-spine. I guess that's commonly. Rheumatoid nodules do affect the heart valves (but uncommon)***
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97. Precocius puberty is associated with all the following except: 1. Craniopharygioma 2. Ovarian cyst 3. Adrenocortical carcinoma
1. Craniopharygioma delayed puberty, decreased libido, diabetes insipidis, visual symptoms, headaches/raised ICP.
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98. Regarding Pituitary macroadenoma a. Shows delayed intense enhancement. b. Has calcification. 1-2%
a. Shows delayed intense enhancement. 98. Regarding Pituitary macroadenoma a. Shows delayed intense enhancement. b. Has calcification. 1-2%um not sure
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99. Rarest form of pituitary adenoma 1. Non functioning PA 2. TSH secreting PA 3. ACTH secreting PA 4. FSH and LH secreting PA 5. Prolactin secreting PA
2. TSH secreting 99. Rarest form of pituitary adenoma 1. Non functioning PA 20-30% 2. TSH secreting PA 1-2% 3. ACTH secreting PA 10% 4. FSH and LH secreting PA 10, 5% 5. Prolactin secreting PA 30% non functioning 30%, prolactin 30% ACTH 10%, FSH LH 10% TSH 1%
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101. Meningioma Least likely 1. Contains haemorrhage and necrosis 2. Can invade the overlying bone 3. Appear en-plaque meningioma 4. Pressure effect on the adjacent brain
1. Contains haemorrhage and necrosis
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102. Fibrinoid necrosis is seen in which of the following 1. Myocardial infarct 2. Vasculitis 3. TB 4. Trauma
2. Vasculitis
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103. Not associated with prion disease(repeat) 1. CJ 2. Kuru 3. SSPE
3. SSPE (subacute sclerosing panenchephalitis - measles)
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104. X lined recessive inheritance 1. Adrenleucodystrophy 2. Metachromatic leukodystrophy 3. Alexander disease 4. Cannavan disease
1. Adrenleucodystrophy 104. X lined recessive inheritance 1. Adrenleucodystrophy 2. Metachromatic leukodystrophy AR 3. Alexander disease Sporadic 4. Cannavan disease AR
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105. Cavitating lung lesions: Least likely 1. TB 2. Mycoplasma 3. Lymphomatoid granulomatosis
2. Mycoplasma 105. Cavitating lung lesions: Least likely 1. TB 2. Mycoplasma 3. Lymphomatoid granulomatosis Similar to Wegeners, type of NHL. Can get multiple cysts.
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106. All of the following are seen with NF1 except: 1. Acoustic schwanoma 2. Kyphoscoliosis 3. Café au lait spots 4. Optic glioma
1. Acoustic schwanoma
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107. Most common type of urinary bladder injury with blunt abdominal trauma 1. Intra peritoneal rupture 2. Extra peritoneal rupture 3. Both intra and extra peritoneal ruture 4. Mucosal laceration
**LJS opinion - blunt trauma to full bladder causes intraperitoneal rupture. Penetrating trauma/pelvic fractures causes extraperitoneal rupture (much more common)*** *LW: as always I agree with LJS, however i wonder if the wording in this question may be important.... Blunt ABDO trauma, such as car crash dash board, which results in pelvic fractures hence causing penetrating bladder injury and thus extra peritoneal rupture (i.e most common). Vs.. penetrating ABDOMINAL trauma, such as shrapnel etc, would also likely result in extra peritoneal. Vs... blunt BLADDER trauma resulting in intra peritoneal rupture. One would hope there was more to the stem, and I am likely over thinking this...... 2. Extra peritoneal rupture
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108. Proximal fibular fracture with tibiotalar slant 1. Maisonneuve fracture. 2. Weber’s A 3. Weber’s B 4. Weber’s C
1. Maisonneuve fracture.
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109. Cholesteatoma: 1. Most commonly seen in Prussacks space 2. Fistula is most common in superior semicircular canal 3. CT is specific in assessing the size of the cholestetoma 4. Erosion of the scutum is not significant
1. Most commonly seen in Prussacks space
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111. Infraspinatus atrophy. Which nerve is involved(repeat) 1. Suprascapular nerve 2. Nerve to latismi dorsi 3. Long thoracic nerve 4. Axillary nerve
1. Suprascapular nerve
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112. Which of the following commonly causes cholesterol gall stones: 1. Ileal bypass 2. Sickle cell anemia 3. TPN 4. Ascariasis
3. TPN
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113. GIST: 1. Stomach GIST most are malignant 2. Esophageal GIST 3. Association of leiomyoma in MEN syndrome. 4. Recurrence of GIST is related to the initial Size
4. Recurrence of GIST is related to the initial Size. – I think 113. GIST: 1. Stomach GIST most are malignant: FALSE: tend to behave in a more benign fashion 2. Esophageal GIST uncommon compared to leiomyomas. 3. Association of leiomyoma in MEN syndrome. 4. Recurrence of GIST is related to the initial Size. – I think ``` GIST location: stomach: 70% small intestine: 20-25% anorectum: 7%more likely to be high grade colon esophagus: rare. ```
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114. Which of the following is least correct. 1. Allergic bronchopulmonary aspergillosis requires treatment of asthma. 2. Acute eospinophilic pneumonia present with transient opacification which resolves with corticosteroid therapy 3. Chronic esosinophilic pneumonia present with peripheral consolidation not responding to corticosteroid therapy. 4. Tropical eosinophilia responds to antifilarial treatment 5. Loefflers syndrome presents and patchy consolidation and is self limiting.
* **LJS opinion - 3 is false. Chronic eosinophilic pneumonia responds promptly to steroids. Remainder of the answers are true*** * AJL agrees Previous answer - 1 or 5 114. Which of the following is least correct. 1. Allergic bronchopulmonary aspergillosis requires treatment of asthma. 2. Acute eospinophilic pneumonia present with transient opacification which resolves with corticosteroid therapy 3. Chronic esosinophilic pneumonia present with peripheral consolidation not responding to corticosteroid therapy. 4. Tropical eosinophilia responds to antifilarial treatment 5. Loefflers syndrome presents and patchy consolidation and is self limiting.
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115. Hirshprung disease 1. Present with fluid and electrolyte imbalance. 2. Common in female 3. Presents with megacolon and perforation 4. Presents in new born with unable to pass the meconium
4. Presents in new born with unable to pass the meconium
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116. Ulcerative colitis: Most | 1. Toxic megacolon is more common
1. Toxic megacolon is more common
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117. Complication of crohn’s disease: Most likely | 1. Adenocarcinoma
1. Adenocarcinoma
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119. Asian with thickening of the ileum and ceacum with hypodense lymph nodes: 1. TB 2. Carcinoid 3.
1. TB
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121. What is true regarding small bowel malignancy: 1. Carcinoid is common in distal small bowel. 2. Enteropathic T cell lymphoma and Ileum
1. Carcinoid is common in distal small bowel.
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122. Carcinoid (repeat) 1. Appendix is common site. 2. Carcinoid syndrome is common.
*LW: Per previous discussions, most common site varies with edition of Robins: 7th or 8th states appendix 9th onwards states distal small bowel ``` 1. Appendix is common site. SR CASP small bowel rectum colon appendix stomach pancreas ``` Carcinoid syndrome in 10%
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123. HNPCC: Least likely 1. HNPCC with endometrial carcinoma 2. Small bowel adenocarcinoma 3. HNPCC with urothelial cancer
*AJL - urothelial has the lowest rate at 1-7%. (RP) Small bowel - 5% Endometrial - 15-60%. Hopefully there was an answer that isn't normally included in HNPCC. Previous answer: All of the above are true HNPCC= aka lynch- most people develop colorectal cancer by 30 - GBM- gastric- small bowel- colorectal cancer 80% lifetime risk- genitourinary
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125. ADPKD association least likely (repeat) 1. Hepatic fibrosis 2. Liver cyst 3. Pancreatic cysts 4. MVP 5. Berry aneurysm
1. Hepatic fibrosis ARPKD
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126. A patient present with knee swelling which has T2 low signal and shows diffuse calcification on CT. Most likely 1. PVNS 2. Gouty tophi. 3. Desmoid 4. Fibroma 5. GCT
This sounds like osteochondromatosis 2. Gouty tophi. PVNS calcification very rare
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127. Non-accidental injury: LEAST likely
1. Posterior rib fractures are characteristic.
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128. Diffuse axonal injury 1. Is mostly hemorrhagic 2. Occurs in posterior brain stem 3. Genu of corpus callosum is most commonly involved 4. Involves the cortex. 5. T2 hypointense
2. Occurs in posterior brain stem
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129. Young child with chest wall mass, which shows punctate calcification 1. Hemangioma 2. Teratoma 3. Lymphangioma 4. Venous malformation
4. Venous malformation
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130. Which of the following is least likely associated- 1. Autoimmune hemolytic anemia is associated with TTP microangiopathic 2. HUS can occur in pregnancy. Probably 3. Gall stones is associated with polycythemia vera. 4.
* *LJS polycythaemia has incr rbc production, ?not significant destruction, can't find any evidence of link to gallstones - In TTP get microangiopathic haemolytic anaemia (dmg to rbc passing through narrow bv) *LW: agree with LJS, no evidence of gall stone increase in PCV, and hence is my preferred answer 1. Autoimmune hemolytic anemia is associated with TTP microangiopathic 3. Gall stones is associated with polycythemia vera.
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131. Small bowel ischemia which is least likely cause 1. NSAIDS 2. PAN 3. Aortic aneurysm 4. Combined OCP 5. Atherosclerosis
1. NSAIDS
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132. Which of the renal tumor has central scar 1. Oncocytoma 2. RCC
1. Oncocytoma
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134. Hepatic adenoma : 1. Liver specific agents show early enhancement 2. Anabolic steroids in men assoication 3. Associated with cirrhosis 4. Very low risk of malignancy
* *LW: 2. Anabolic steroids in men assoication: TRUE --> beta catenin-mutated hepatic adenoma: Early arterial enhancement and become nearly isointense about liver on delayed images T1 C+ (hepatocyte-specific): adenomas usually appear hypointense on hepatobiliary phase (20 mins after injection) due to reduced uptake of Gd-EOB-DTPA/Eovist (cf. FNH which appears iso- to hyperintense). Rarely hepatic adenomas can degenerate into hepatocellular carcinomas (HCC), particularly in men, and most commonly in beta catenin-mutated hepatic adenoma: *AJL also 1. Liver specific agents show early enhancement Adenomas and FNH have early enhancement. Adenoma washes out (atypical hepatocystes) FNH retains/becomes iso on delayed ('normal' hepatocytes with atypical bile ducts)
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135. 45 year old female with hepatic specific contrast show early enhancement, iso in the delayed phase, no central scar: Least likely ? 1. Hepatic adenoma 2. FNH 3. Hemangioma 4. Metastasis
4. Metastasis **LJS - agree Adenoma also does not retain heptatobiliary specific contrast but was a bit more variable with older agents, so is less correct answer https://pubs.rsna.org/doi/pdf/10.1148/rg.296095515
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136. 3 month old infant with rapidly enlarging neck mass 1. Congenital hemangima 2. Infantile hemangioma 3. Lymphangioma 4. Venous malformation 5. AVM
2. Infantile hemangioma
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137. Multiple cysts in the left lung. Stomach bubble in normal position 1. CPAM 2. CDH
1. CPAM
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138. Predisposing factor for UB malignancy LEAST likely 1. Cysitis glandularis association with adeno 2. Schistosomiasis and SCC 3. Aniline dye and adeno carcinoma 4. Bladder diverticula
3. Aniline dye and adeno carcinoma SCC
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139. Prostatic Ca: LEAST likely 1. Most commonly in peripheral zone 2. Appears more hypoechoic than hyperechoic on USG 3. PSA levels are proportionate to the prostate size 4. PSA levels can be raised in prostatitis 5. 50% ???????????
everything is rightso probably the weird 50%
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141. Rash with diabetes. Enhancing tumor in arterial and venous phase involving pancreas 1. VIPoma 2. Gastrinoma 3. Somatostatinoma 4. Insulinoma 5. Glucagonoma
5. Glucagonoma 4D’s: depression, DM, dermatitis and DVT
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143. Esophageal narrowing at T11 with distal dilation: 1. barrets esophagus 2. Zenker’s diverticulum 3. Malignancy
1. barrets esophagus most common??
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144. Alcoholic after binge drinking presents with blood tinged vomiting. Barium swallow normal(repeat) 1. Mallory Weiss syndrome 2. Boerhaav’s syndrome 3. Erosive gastritis 4.
1. Mallory Weiss syndrome
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145. Barrets esophagus: | 1. predisposes to adenocarcinoma
1. predisposes to adenocarcinoma risk of oesophageal cancer- smoking - drinking- barret- HPV- radiation- plummer vinson- asbestos
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145. Risk factos or Breast ca(repeat): LEAST likely associated 1. VHL 2. Cowdens 3. Li fraumeni 4. Ataxia telangiectasia 5. BRCA 2
1. VHL li fraumeni- hereditary cancer syndrome- a/w mutation of P53- 50% of patient will develop cancer by 30 types of cancer- brain: glioma, medullo- breast- adrenal cortical carcinoma- leukaemia- sarcoma Cowdens: germ line mutation in PTEN BRCA 1 and BRCA 2 ataxia Telangiectasia.
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146. Abruption placenta is most commonly associated with (repeat) 1. Circumvallate placenta 2. Succinturate lobe 3. Valamentous insertion of cord
1. Circumvallate placenta
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147. Hydatiform mole: LEAST likely(repeat) 1. Partial mole is less associated with choriocarcinoma 2. Complete mole is frequently associated with fetal parts 3. Could be associated with abortion. 4. Metastasis?
2. Complete mole is frequently associated with fetal parts
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148. Fibromatosis: Least likely 1. Intrabdominal fibromatosis is associated with gardner’s syndrome 2. Palmar fibromatosis is commonly seen in 4th/5th metacarpal region. 3. Penile fibromatosis is commonly associated with constriction of urethra 4. Plantar fibromatosis is commonly seen in female 5. Abdominal fibromatosis is common in post partum women.
**LJS 4 (Plantar fibromatosis is commonly seen in female ) is false. Superficial fibromatoses are M > F. Aide memoire: picture all the men with Dupuytrens and bent knobs Peyronie does cause urethral stricture 9th ed Rob p 1221 148. Fibromatosis: Least likely 1. Intrabdominal fibromatosis is associated with gardner’s syndrome 2. Palmar fibromatosis is commonly seen in 4th/5th metacarpal region. 3. Penile fibromatosis is commonly associated with constriction of urethra 4. Plantar fibromatosis is commonly seen in female 5. Abdominal fibromatosis is common in post partum women.
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149. Thyroid disorders: LEAST likely 1. Antibodies in hashimoto’s thyroiditis are directed against TSH. 2. Subacute Dequervain thyroiditis has seasonal variation due to viral infection 3. Grave’s disease has low TSH levels. 4. Simple goiter is associated with cassava consuming population 5. Plummer syndrome is due to toxic nodule in multinodular goiter.
1. Antibodies in hashimoto’s thyroiditis are directed against TSH. FALSE - --> antithyroglobulin antibodies: found in ~70% of cases 2 - --> thyroid peroxidase antibodies (TPO): found in 90-95% of cases Plummer disease, also called toxic multinodular goitre Cassava can cause simple goitre- it is a type of plant root
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151. All of the following is associated with short limbs except: 1. Cleidocranial dysplasia 2. Achondrogenesis 3. Thanatotrophic dysplasia. 4. Hypochondrogenesis 5. Hypochondroplasia
1. Cleidocranial dysplasia
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152. Viable pregnancy least likely associated with: 1. Transabdominal 28 mm. No yolk sac or embryo 2. 6 weeks USG with no heart beat. 3. CRL 3 mm no heart beat. 4. Transabdominal CRL 8mm. No heart beat 5. No fetus with bHCG 700IU.
**LJS - both MSD and CRL criteria are supposed to be called on TV scan. - Absent HB more likely to be missed on TA scanning than absent fetal pole? I think MSD 28mm is least incorrect answer *LW: agree with LJS. RP states: TA scanning: --> when the MSD measures ≥25 mm a fetal pole should be visible, hence option one is least likely to be associated with viable pregnancy. --> when the MSD measures 20 mm a yolk sac should be visible However, lack of a yolk sac is not a definite indication of pregnancy failure With regards to TA CRL 8mm with no heart beat; --> Cardiac activity should be present in an embryo with a CRL ≥7 mm. If it not detected at this size on transvaginal scanning performed by an experienced operator, it is an indicator of failed early pregnancy, so although technically unlikely to be associated with viable pregnancy, require TV to confirm! Previous answer: 4. Transabdominal CRL 8mm. No heart beat crown-rump length (CRL) of ≥7 mm and no heartbeat on a transvaginal scan mean sac diameter (MSD) of ≥25 mm and no embryo on a transvaginal scan absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac pregnancy with an embryo with no heart activity on initial scan and repeat scan ≥7 days later 2
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153. Which of the following is least likely 1. Bone changes of ? primary hyperparathyroidism is due to osteomalacia. 2. Vit D deficiency can exacerbate the bone changes due to secondary hyperparathyroidism.
* LW: 1. Bone changes of ? primary hyperparathyroidism is due to osteomalacia - agree this is LEAST likey. . Vit D deficiency can exacerbate the bone changes due to secondary hyperparathyroidism. correct. Also occurs in primary, hence why is recommend as part of clinical work up and testing.
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154. Patient with CT scan which shows hyperdense nodules | 1. Alveolar microlithiasis.
1. Alveolar microlithiasis.
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155. Microangiopathic changes in diabetes mellitus:Least likely 1. Papillary necrosis 2. Glomerulosclerosis 3. Autonomic neuropathy 4. Sensory motor neuropathy 5. Macular edema
1. Papillary necrosis *AJL: All these things can happen in diabetes however agree with LJS below. **LJS - I think they want to know specifically which is not a microvascular complication. Although they are pathologically foci of ischaemic coagulative necrosis, I would say papillary necrosis is predominantly a manifestation of pyelonephritis that occurs commonly in diabetics, rather than a direct result of microangiopathy. This seems to be least clearly a microvascular complication Robbins 9th ed endocrine and renal chapters
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156. Intertitial lung changes with nodular thickening with hilar lymphadenopathy and bilateral pleural effusion 1. Lymphangitis carcinomatosis
1. Lymphangitis carcinomatosis
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157. Which of the following tumor crosses the open epiphyseal plate 1. Chondroblastoma 2. Osteochrondroma 3. Enchondroma 4. Chondro myxoid Fibroma 5. Periosteal true if osteosarcoma
1. Chondroblastoma can do
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158. PAN spares(Repeat) 1. Pulmonary circulartion 2. Renal circulation
1. Pulmonary circulation The pulmonary circulation is typically spared, although bronchial arteries may occasionally be involved.
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159. Regarding contrast reactions: false Steroid prep not useful in major contrast reactions
um
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160. Regarding extrinsic allergic alveolitis 1. silica 2.beryllium 3.cedar wood dust 4coal dust. 5.Thermophyllic actinomyces.
5.Thermophyllic actinomyces.
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162. Least common type of pituitary adenoma a. Non secreting b. Lactotroph c. Thyrotroph d. Gonadotroph e. Corticotroph
c. Thyrotroph ``` non secreting 30% PLH 30% GNH 10 ACTH 10% thyrotroph 1% ```

Pathology (24 decks)

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