path recall April 2015 - formatted Flashcards
- Which of the following cancer is most closely associated with UV ray
a. Sebaceous carcinoma
b. Merkel cell carcinoma
c. Mastocytosis..
b. Merkel cell carcinoma as per dermnet
Sebaceous carcinoma is a rare type of cancer that begins in an oil gland in your skin. Sebaceous carcinoma most often affects the eyelids.
Merkel cell carcinoma is a very rare disease in which malignant (cancer) cells form in the skin.
Sun exposure and having a weak immune system can affect the risk of Merkel cell carcinoma.
Merkel cells are found in the top layer of the skin. These cells are very close to the nerve endings that receive the sensation of touch. Merkel cell carcinoma, also called neuroendocrine carcinoma of the skin or trabecular cancer, is a very rare type of skin cancer that forms when Merkel cells grow out of control. Mastocytosis is characterized by excessive accumulation of mast cells in one or more organs. - diffuse sclerosis
- Not recognized as risk factor for HCC
a. Lysosomal storage disorder
b. Tyrosinaemia
c. Wilson
d. Hemachromatosis
e. Hepatitis B
a. Lysosomal storage disorder not listed on RP2. Not recognized as risk factor for HCC
a. Lysosomal storage disorder not listed on RP
b. Tyrosinaemia listed RP
c. Wilson definitely
d. Hemachromatosis definitely
e. Hepatitis B definitely
- Which of the following is not a complication of autoimmune gastritis
a. Subacute combined degeneration
a. Carcinoid
b. Increased gastrin level
c. Gastric cancer
d. Microcytic anaemia
e. Microcytic anaemia - Usually macrocytic due to pernicious anaemia
- Which of the following is not a complication of autoimmune gastritis
a. Subacute combined degeneration yes – due to B12 deficiency (pernicious anaemia
b. Carcinoid - yes
c. Increased gastrin level - yes. Hypochloridia due to loss of parietal cells means reduced feedback inhibition of gastrin secreting cells.
d. Gastric cancer - yes
e. Microcystic anaemia - Usually macrocytic due to pernicious anaemia
Autoimmune gastritis is a chronic inflammatory disease with destruction of parietal cells of the corpus and fundus of the stomach. The known consequence is vitamin B12 deficiency and, consequently, pernicious anemia.
Complication- subacute combined degeneration- increased gastrin level - carcinoid- gastric cancer- megaloblastic anaemia
- Congenital intra-abdominal hernia, most common
a. Foramen of Winslow
b. Paraduodenal
c. Para-sigmoid
d. Para-cecal
e. Trans mesenteric
b. Paraduodenal according to RP – left foramen of Landzert more common than right foramen of Waldyer
- Which is an associated complication of pre-eclampsia
a. Hypofibrinogenaemia
b. Thrombocytosis
a. Hypofibrinogenaemia
- Highest risk of uterine rupture
a. Placenta previa
b. Placenta increta
c. Placenta acreta
d. Placenta percreta
d. Planceta percreta
- Which disorder affects liver and skin
a. Dermatitis herpetiformis
b. Porphyria cutanea tarda
c. Necrotising erythema migrans
d. Wilson disease
e. Mycosis fungoides
b. Porphyria cutanea tarda due to defective enzyme in the liver involved in the synthesis of haem. Although liver function only affected sometimes. Probably most correct.
- Which disorder affects liver and skin
a. Dermatitis herpetiformis can have fatty liver
b. Porphyria cutanea tarda due to defective enzyme in the liver involved in the synthesis of haem. Although liver function only affected sometimes. Probably most correct.
c. Necrotising erythema migrans can do
d. Wilson disease can have increased pigmentation.
e. Mycosis fungoides no
- Regarding retinoblastoma,choose most accurate
a. Contralateral retinocytoma suggest hereditary process
b. Lung is a common site for hematogenous metastasis
c. Autosomal recessive inheritance.
d. Chondrosarcoma is a secondary primary cancer.
a. Contralateral retinocytoma suggest hereditary process
- Regarding retinoblastoma,choose most accurate
a. Contralateral retinocytoma suggest hereditary process
b. Lung is a common site for hematogenous metastasis bone, bone marrow and liver
c. Autosomal recessive inheritance. AD
d. Chondrosarcoma is a secondary primary cancer.
Retinocytoma is considered to be a rare benign phenotypic RB1 gene mutation and carries similar genetic implications as germinal retinoblastoma.[1,2,5] In familial cases, various members of a family may present with either retinocytoma or retinoblastoma or even a combination of both between the two eyes.
- Adenocarcinoma of the cervix
a. Prone to endometrial invasion
b. Pap smear screening is more sensitive for adenocarcinoma than squamous carcinoma
c. The risk factors for adenocarcinoma carcinoma is same as for squamous cell carcinoma
a. Prone to endometrial invasion
- Adenocarcinoma of the cervix
a. Prone to endometrial invasion
b. Pap smear screening is more sensitive for adenocarcinoma than squamous carcinoma less sensitive
c. The risk factors for adenocarcinoma carcinoma is same as for squamous cell carcinoma except for smoking
Cervical cancer - HPVSCC more common
Adenocarcinoma- serous- mucinous- clear cell- emdometriod- metanephric
Met
Lymphoma
- Endometrial carcinoma - the most accurate
a. Endometrial intraepithelial carcinoma is a precursor to type I endometrial carcinoma
b. Type I endometrial carcinoma arises from atrophic endometrium
c. Type II endometrial carcinoma is associated infertility
d. Initial nodal spread to para-aortic nodes
a. Endometrial intraepithelial carcinoma is a precursor to type I endometrial carcinoma
*AJL - Robbins says Endometrial intraepithelial carcinoma is associated with Type 2
Endometrial hyperplasia is associated with type 1.
The most accurate answer is Type 2 associated with infertility as they are usually post-menopausal. Weird way to phrase it/ask it but seems the most correct.
**LJS - agree. The way it’s written, c. is most correct. Though type 1 is perimenopausal, typically 50-60yr, so would class them as infertile too.
- Adenocarcinoma of bladder risk factor
a. Bladder extrophy
b. Urachal remnant
c. Schistosomiasis
d. Smoking
b. Urachal remnant
*LW:
TCC:
- Most common
- Risk factors:
- cyclophosphamide
- aromatic amines in tobacco smoke
- arylamines
- polycyclic aromatic hydrocarbons.
SCC:
- 5%
- RF:
- Schistosomiasis
- chronic irritation, e.g. IDC, calculi, infection
- intravesical BCG (Bacillus Calmette-Guerin)
Adenocarcinoma:
- 1%
- RF:
- persistent urachal remnant (most common)
- cystitis glandularis (itself secondary to bladder outlet obstruction, chronic infection and/or bladder calculi)
- associated with bladder exstrophy
Previous answers:
Schisotosomiasis, smoking - SCC
Types:TCC: 90% begin in urothelial cells- age- male- race : white- previous history of cancer- chemical: smoking, cyclophosphamide- cancer syndrome: LynchSCC: 5%- schistosomiasis,- exostrophy
Adenocarcinoma: 1%- urachal remnant Sarcoma : rare
- Which tumor is not associated with seizures
a. Central neurocytoma
b. Ganglioglioma
c. Pilocytic astrocytoma
d. DNET
e. Oligodendroglioma
pilocytic astrocytoma
LJS agree - pilocytic astrocytoma is circumscribed astrocytoma, posterior fossa, most likely to present with hydrocephalus. All others known to cause seizures
- Which tumor is not associated with seizures
a. Central neurocytoma yes according to RP (common according statdx)
b. Ganglioglioma most common tumoral cause of temporal lobe epilepsy
c. Pilocytic astrocytoma seems to be the cortically based lesions that cause seizures.
d. DNET second behind GG
e. Oligodendroglioma yes.
- Which cancer metastasized to dura without metastasis to brain
a. Prostate
b. Lung
c. Colorectal
d. TCC
e. Breast
a. Prostate
- Which of the following do not have peptidoglycan cell wall.
a. Mycoplasma
b. Poliovirus
c. CMV
d. Chlamydia trichomatis
e. Mycobacterium tuberculosis
- LW:
- LW: likely poor recall as no clear answer:
Quoting Robbins / literature review:
No mention of peptidoglycan cell wall in viruses.
Mycoplasma lacks a cell well.
Basic understanding is that Chlamydia doesn’t have standard peptidoglycan cell wall, at least by standard methods of detection, and likely use different assembly / elements of peptidoglycan cell wall (I would favour in this question the simple answer would be they do not have the standard cell wall).
TB: The cell wall is complex and does contain peptidoglycan, but otherwise it is composed of complex lipids. Over 60% of the mycobacterial cell wall is lipid. The lipid fraction of MTB’s cell wall consists of three major components, mycolic acids, cord factor, and wax-D.
- *LJS - I spent way too much time on this.
- Bacteria are prokaryotes which have a cell wall (but no membrane bound organelles/nucleus) This cell wall generally contains peptidoglycan. Differences in the peptidoglycan wall determines whether they stain with gram stain. This can be thick (gram +ve) or thin (gram -ve)
- Mycoplasma is the only bacteria lacking a cell wall (bound only by a cell membrane). Can’t be rx by abx that target cell wall synthesis (many abx types)
- Chlamydia has a cell wall but doesn’t contain peptidoglycan
- Viruses do not have cell walls (they are genetic material surrounded by a protein coat). They are not cells or even considered living
- Mycobacterium tuberculosis has a cell wall containing peptidoglycans but is unique because it otherwise is composed mainly of lipids. Is Gram unclassifiable (can be +ve or -ve, not helpful in dx)
Therefore: this must be a poor recall, as the only option that has a peptidoglycan cell wall is myobacterium tuberculosis.
Old answer:
a. Mycoplasma - the only bacteria that lacks peptidoglycan cell wall
- Which of the following do not have peptidoglycan cell wall.
a. Mycoplasma
b. Poliovirus yes
c. CMV yes
d. Chlamydia trichomatis
e. Mycobacterium tuberculosis Does. Could this be a which of the following does have a peptidoglycan cell wall.apparently virus also have peptidoglycan cell wallgram positive- thick peptidoglycan cell wallgram negative bacteria- outer and inner membrane- thin peptidoglycan cell wall
- Harlequin eyes in craniosynostosis
a. Coronal
b. Sagittal
c. Metopic
d. Lambdoid
a. Coronal
- Most common retroperitoneal cancer
a. Liposarcoma
b. Leiomyosarcoma
c. Malignant nerve sheath tumor
liposarcoma in adults anyway
- Leiomyosarcoma of the uterus, which is true
a. Haemtogenous spread is a common form of metastasis
b. Leiomyoma is a precursor to leiomyosarcoma
a. Haemtogenous spread is a common form of metastasis - yes
b. Leiomyoma is a precursor to leiomyosarcoma ( this is very rarely true)
LJS - Robbins and Pathoma say does not arise in leiomyoma, always de novo
- Most common paratesticular malignancy
a. Angiosarcoma
b. Leiomyosarcoma
c. Fibrosarcoma
d. Lymphoma
e. Liposarcoma
*AJL (from Robbins 10e)
Most common benign paratesticular tumour is adenomatoid tumour.
Most common malignant is rhabdomyosarcoma (children), liposarcoma (adults)
I have added liposarcoma to the question.
Previous answer:
b. Leiomyosarcoma I think
No rhadomyosarcoma in the options - if present most common.
Lipoma is most common paratesticular mass, adenomatoid tumour (benign) is the most common epididymal mass.
adult - benign : lipoma, leomyoma, fibroma, epidermoid inclusion cyst
Spermatic cord lesions:
- malignant : -> rhabdo, -> spermatic PUS-> spermatic leiomyosarcoma-> spermatic liposarcoma
- children
- > malignant: embryonal rhabdomyosarcoma
Epididymal lesion:
- adenomatous tumour
- spermatocele, epididymal cyst
- met, leukaemia, leomyosarcoma
- Regarding chondrosarcoma, what is least likely
a. Clear cell is most commonly seen in the pelvis
b. Myxoid subtype is found in soft tissue of the lower limb
c. Hyaline variant is seen in the ribs
d. Mesenchymal chondrosarcoma is commonly found around the mandible
a. Clear cell is most commonly seen in the pelvis - long bones
- Regarding chondrosarcoma, what is least likely
a. Clear cell is most commonly seen in the pelvis - long bones
* *LJS - epiphyses of long bones (mimics chrondroblastoma)
b. Myxoid subtype is found in soft tissue of the lower limb - true
c. Hyaline variant is seen in the ribs - never heard of this as a variant. **LJS - probably just means conventional (hyaline producing) - true, occurs in ribs
d. Mesenchymal chondrosarcoma is commonly found around the mandible - spine, ribs and jaw.
Chondrosarcoma types: conventional - low, medium, high grade juxtacortical extra skeletal clear cell - slow growing, better prognosis myxoid - soft tissue > bone mesenchymal - soft tissue or bone dedifferentiated
**LJS - according to big Robbins (9th ed p 1202), subtypes as follows:
-Conventional, divided into central/intramedullary (most common 90% of all chondrosarcomas) and juxtacortical
-Mesenchymal - rare, can occur in young adults
-Clear cell - rare, can occur in young adults
Originates in the epiphyses of long tubular bones and can mimic chondroblastoma
-Dedifferentiated - second high grade non-cartilaginous sarcoma arising within lower grade chondrosarcoma.
- PUJ - least common
a. Occurs more commonly in the inferior moeity in the duplex kidneys as oppose to upper moeity.
b. Occurs more commonly in male than female
c. Occurs more commonly on the right than left
d. Associated with contralateral renal agensis
c. Occurs more commonly on the right than left - left side in 2/3rds.
- Regarding vulval pathology, most accurate
a. Lichen simplex chronicus is a precursor to squamous cell carcinoma
b. Vulval melanoma frequently invasive on presentation
c. Lichen sclerosis……
b. Vulval melanoma frequently invasive on presentation
- Regarding vulval pathology, most accurate
a. Lichen simplex chronicus is a precursor to squamous cell carcinoma nope. Lichen sclerosis is. (think of oral lichen planus)
b. Vulval melanoma frequently invasive on presentation
c. Lichen sclerosis……
- Regarding anal cancer
a. Anal melanoma often familial
b. Vulval carcinoma is a risk factor
b. Vulval carcinoma is a risk factor
anal cancer risk factor
- HPV / HIV infection
- immunosuppression
- number of lifetime sexual partners, and receptive anal intercourse
- smoking
- Regarding carcinoid, which is associated with lowest risk for metastasis
a. Oesophagus
b. Stomach
c. Ileal
d. Colon
e. Appendix
e. Appendix
Carcinoid location- SR CASP- small intestine- rectum- colon- appendix- stomach- pancreas
- Phthisis bulbi, least likely
a. Ciliochoroidal effusion
b. Metaplastic bone
c. Retinal detachment
Features include all of these as well as cyclitic membrane, optic nerve atrophy, thickening sclera and micropthia.
- Regarding pulmonary alveolar proteinosis, least correct
a. Congential PAP is fatal without transplant
b. Adult PAP is associated with recurrent infection
c. Adult PAP is associated with smoking
d. Adult PAP is associated with immunodeficiency
e. Adult PAP is associated with silicosis
- Regarding pulmonary alveolar proteinosis, least correct
a. Congential PAP is fatal without transplant - yes
b. Adult PAP is associated with recurrent infection - yes susceptible to recurrent infection eg nocardia
c. Adult PAP is associated with smoking - strong association
d. Adult PAP is associated with immunodeficiency - yes
e. Adult PAP is associated with silicosis - yes
Alveolar proteinosis- autoimmune : IgG antibodies to GM-CSF- secondary : silica dust, haematological malignancy, infection ( nocardia)- congenital
Smoking related lung disease
- copd, bronchitis, emphysema- alveolar proteinosis- CEP- UIP, DIP, RBILD- PLHC- cancer
- What is the most common profile for lobular carcinoma
a. ER + PR + HER2 –ve
b. ER –ve PR-ve HER2 –ve
c. Different combinations of ER, PR, HER 2
a. ER + PR + HER2 –ve
**LJS agree: Oestrogen and progesterone expression more common in ILC than IDC: 95% ER+ve 65% PR+ve 5% HER2+ve (rare cf IDC) Robbins says no HER2 overexpression
- Which is not a prion associated with spongiform encephalopathy
a. CJD
b. Variant CJD
c. Kuru
d. Familial fatal insomnia
e. Some syndrome……
e. Some syndrome……spongiform encephalopathy = prion disease
