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Pathology > path recall August 2014 WA - formatted > Flashcards

path recall August 2014 WA - formatted Flashcards

1
Q

Pneumothorax least likely

  1. Alpha 1 antitrypsin
  2. Ehler Danlos
  3. Marfan
  4. Kleinfelters
  5. Homocystinuria
A
  1. Kleinfelters Pneumothorax least likely
  2. Alpha 1 antitrypsin - emphysema
  3. Ehler Danlos - emphysema
  4. Marfan - emphysema
  5. Kleinfelters
  6. Homocystinuria - spontaneous pneumothorax
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2
Q

Small cell lung carcinoma

  1. Typical carcinoid is a precursor
  2. Associated with raised PTH and calcium
A
  1. Associated with raised PTH and calcium
    *LW
    Well PTHrP, although true, paraneoplasic PTHrP and HyperCa++ more common in SCC.

paraneoplastic syndrome- hypoglycaemia- hypercalcaemia- hyperparathyroidism- SIADH- limbic encephalitis

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3
Q

Constrictive pericarditis is most likely caused by: (repeat) A. Radiotherapy

A

Idiopathic most common, surgery second, radiotherapy 3rd, infection, Sarcoid, renal failures rheumatic fever (rare), SLE (rare)

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4
Q

Diastolic dysfunction most likely caused by: (repeat)

  1. Hypertension
  2. Constrictive pericarditis
  3. Diabetes
A
  1. Hypertension
  2. Hypertension
  3. Constrictive pericarditis less common
  4. Diabetes
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5
Q

What is implicated in coronary artery disease?

  1. Lupus anticoagulant
  2. Some gene…
A

What is implicated in coronary artery disease?

  1. Lupus anticoagulant associated with MI, but not atherosclerosis
  2. Some gene… not sure of the answerlupus anticoagulant - antibody against cell membrane phospholipid and glycoprotein- procoagulant state
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6
Q

What isn’t caused by fibromuscular dysplasia?

  1. Pulsatile tinnitus
  2. Angina
  3. TIA
  4. Mesenteric ischaemia
A

All correct

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7
Q

What is associated?

  1. Smoking and RB-ILD
  2. Granulomas and immune complexes in Wegners
A
  1. Smoking and RB-ILD
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8
Q

Cardiac neoplasms are associated with:

  1. Valvular problems
  2. Emboli
  3. Pericardial effusion
A
  1. Valvular problems
  2. Emboli
    both true
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9
Q

H. Pylori is associated with?

  1. Gastric cancer
  2. Mantle cell lymphoma marginal zone (MALToma)
  3. Decrease vitamin B12
  4. Hyperplastic polyp
  5. Duodenal villous atrophy
A
  1. Gastric cancer

**LJS - ass/w intestinal metaplasia which increases risk for adenocarcinoma
Also induces mucosa-associated lymphoid tissue, which has the potential to transform into MALToma (Robbins)

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10
Q

Carcinoid acts most aggressive where:

  1. Oesophagus
  2. Appendix
  3. Stomach
  4. Colon
  5. Terminal ileum
A
  1. Terminal ileum

Small bowel most aggressive. Foregut and hindgut (+appendix incidental/least aggressive)

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11
Q

Cholangiocarcinoma risk factors:

  1. Hepatitis B Chronic
  2. Male or female (?)
  3. Hepatic fibrosis
  4. Primary biliary cirrhosis
A
  1. Hepatitis B Chronic

**LJS - and hepatic fibrosis - fibropolycystic liver disease spectrum, incl Caroli, biliary hamartomas, congenital hepatic fibrosis etc)

Risk for cholangiocarcinoma:
- primary sclerosing cholangitis (PSC)
- recurrent pyogenic cholangitis (hepatolithiasis)
- choledocholithiasis more than cholelithiasis 10,11
- Clonorchis sinensis
- Caroli disease / choledochal cystslifetime risk of 10-15% 2toxins
- thorotrast
- dioxin- polyvinyl chloride
- heavy alcohol use
viral infection(s)- HIV- hepatitis B- hepatitis C- EBV

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12
Q

Polyarthralgia and skin fat necrosis caused by:

  1. Gastrinoma
  2. Somatostatinoma
  3. Islet cell tumour
  4. Ductal Adenocarcinoma
  5. Glucagonoma
A
  1. Ductal Adenocarcinoma – lipase secretion syndrome

Polyarthralgia and skin fat necrosis caused by:

  1. Gastrinoma ZE
  2. Somatostatinoma DM, diarrhoea, cholelithiasis
  3. Islet cell tumour
  4. Ductal Adenocarcinoma – lipase secretion syndrome
  5. Glucagonoma – 4D’s: dermatitis, DM, DVT, depression
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13
Q

Adrenal Corticocarcinoma:

  1. 11-hydroxylase
  2. 17-hydroxylase
  3. Can resemble adrenal hyperplasia
A
  1. Can resemble adrenal hyperplasia I guess?

**LJS - I’m not sure what this question is asking. But I don’t think CAH (normal adrenals, or bilateral increased thickness with normal shape) resembles adrenal cortical carcinoma (often large at dx, heterogenous, necrosis, haemorrhage, vascular invasion).

60% adrenal cortical carcinomas are functional. 11 beta-hydroxylase and 17 alpha hydroxylase are both enzymes in the adrenocortical hormone synthesis pathway

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14
Q

Anal carcinoma staging with ipsilateral iliac or inguinal lymph nodes:

A. 1
B. 2
C. 3A
D. 3B

A

T?N1Has to be stage 3- but definitely not stage 3b (T4N0 - i.e no nodes)
3a - T12N1
3b - T4n0
3c - T34 N1

**LJS - of answers given, can only be 3A (3B is T4, N0, M0)

Stage 0 - carcinoma in situ, no nodes or mets
Stage 1 - Tumour < 2cm (T1), no LN or mets
Stage 2 - T2 or T3, no LN or mets
Stage 3A - T1 or T2, N1, no mets
Stage 3B - T4 (into adjacent organs), no LN or mets
Stage 3C - T3 or T4, N1, no mets
Stage 4 - Mets

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15
Q

Splenectomy causes what bacterial susceptibility:

  1. H. Influenza
  2. Tuberculosis
  3. Mycosis fungoides
A
  1. H. Influenza
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16
Q

Which affects both the liver and the skin:

  1. Alpha-1 antitrypsin deficiency
  2. Wilson’s disease
A

*LW:
Both technically true per UpToDate:
- Aplha 1 skin manifestations include: necrotising panniculitis, systemic vasculitis, psoriasis, and angio oedema.
- Wilsons skin manifestations include: blue lunulae (lunulae ceruleae), acanthosis nigricans, and pretibial hyperpigmentation. (Dermatologic manifestations may also occur from treatment with penicillamine)

Previous answer:
2. Wilson’s disease

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17
Q

Which of these is not associated?

A. VIPoma with diarrhoea and raised K+

A

A. VIPoma with diarrhoea and raised K+ - hypokalaemia

insulinoma - low glucose
somatostinoma - DM, diarrhoea, gallstone
Gastrinoma - ellison zollinger
VIPoma - WHDA - watery diarrhoea, hypokalaemia, achorydia
glucagonoma - DM, DVT, depression, dermatitis,

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18
Q

Causes of fulminant hepatitis:

A. Autoimmune
B. Hepatitis B
C. Carbon tetrachloride

A

**LJS - Robbins says paracetamol OD most common in USA, and other causes include:
-AI hepatitis
-Other drugs/toxins
-Acute hep A and B - vriral hepatitis accounts for 10% cases of acute hepatic failure
(Hep B and E most common cause in Asia)

So all are true, and according to Robbins Hep B NOT most common (though radiopedia says it’s most common)

*LW:
Just further info, not really helping….
UTD
- Viral and drug-induced hepatitis are the most common causes of acute liver failure in adults.
- Drug-induced liver injury is the most common cause of acute liver failure in Australia, Europe, the United Kingdom, and the United States, whereas in Asia and Africa, viral hepatitis predominates
- In the United States, The most common causes of acute liver failure were acetaminophen overdose (46 percent), indeterminate (14 percent), idiosyncratic drug reactions (12 percent), hepatitis B virus (7 percent), and hepatitis A virus (3 percent).

Previous answer:

Hepatitis B - most common
others are true
Also idiopathic, drugs, mushrooms, metabolic disease, HELLP, Bud-chiari, shock, RHF
Acute hepatitis = fulminant hepatitis- acute loss of hepatic function without chronic liver failure
Symptoms- encephalopathy- coagulopathy
Cause- vascular : BC, RHF- infection : hep B (most common)- idiopathic- Toxin: alcohol, paracetamol, muschroom- autoimmune: - metabolic : wilson, pregnancy steatohepatitis,

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19
Q

What does analgesic nephropathy cause?

A. Renal papillary necrosis

A

A. Renal papillary necrosis

20
Q

Deficiency of which of these does not cause neurological issues?

  1. B1 (thiamin)
  2. B2 (riboflavin)
  3. B3 deficiency
  4. B12
  5. Vitamin E
A

*AJL - I think B2 is the correct answer.
Called Ariboflavinosis which causes inflammation of mucosal membranes.
Hypovitaminosis E causes dysfunction of the CNS with ataxia and tremor.

**LJS - agree.

Previous answer…
5. Vitamin E

Deficiency of which of these does not cause neurological issues?

  1. B1 (thiamin) Wernickes
  2. B2 (riboflavin) although assoc with deficiencies in other B vitamins (acts as a cofactors)
  3. B3 deficiency causes pellagra – CNS, skin, GIT = dementia, dermatitis, diarrhoea
  4. B12 subactue combined degeneration
  5. Vitamin E
21
Q

Which does not cause hydrocephalus?

  1. Choroid plexus papilloma
  2. Central neurocytoma
  3. Ependymoma
  4. Medulloblastoma
  5. PXA (maybe ganglioglioblastoma)
A
  1. PXA (maybe ganglioglioblastoma)
22
Q

Which is graded WHO I:

  1. DNET
  2. Ganglioglioma
  3. Ependymoma
  4. Central neurocytoma
  5. Pilomyxoid astrocytoma
A
  1. DNET WHO 1
  2. Ganglioglioma - 80% WHO 1
  3. Ependymoma II
  4. Central neurocytoma II
  5. Pilomyxoid astrocytoma II
23
Q

What is most likely to recur post surgery?

  1. Dentigerous cyst
  2. Ameloblastoma
  3. Odontoma
  4. Periapical cyst
  5. Keratocystodontonic cyst
A
  1. Ameloblastoma 50-90%

5. Keratocystodontonic cyst 50% recur

24
Q

Which is not a feature of NF2?

  1. Ependymoma
  2. Meningioma
  3. Schwannoma
  4. Optic glioma
A
  1. Optic glioma
25
Q

What is caused by HPV in the nasal cavity?

  1. NK/T
  2. Papilloma
  3. Nasopharyngeal carcinoma
  4. Juvenile angiofibroma
A
  1. Nasopharyngeal carcinoma

**LJS - disagree. NPC ass/w EBV. Sinonasal papillomas (e.g. inverted papilloma) ass/w low risk HPV subtypes - big Rob 9th ed

26
Q

Which is diaphyseal in location?

A. Osteoblastoma

  1. Chondromyxoid fibroma
  2. Osteochondroma
  3. Chondroblastoma
  4. Non-ossifying fibroma
A

A. Osteoblastoma – maybe more common in spine, metaphysis and distal diaphysis in long bones

Which is diaphyseal in location? 
A. Osteoblastoma – maybe  more common in spine, metaphysis and distal diaphysis in long bones
2.	Chondromyxoid fibroma metaphyseal
3.	Osteochondroma metaphyseal 
4.	Chondroblastoma epiphyseal
5.	Non-ossifying fibroma  metaphyseal
27
Q

Frontal bossing is not seen with:

  1. Thanatophoric dwarfism
  2. Acromegaly
  3. Hurler
  4. Alpha thalassemia
  5. Cliedo cranial dysplasia
A

*LW: Alpha thalassemia - FALSE, listed is Beta thalaemiassia. (although I am likely wrong)

  1. Thanatophoric dwarfism - TRUE
  2. Acromegaly - TRUE
  3. Hurler - TRUE
  4. Alpha thalassemia - FALSE, listed is Beta thalaemiassia.
  5. Cliedo cranial dysplasia - TRUE
    This feature can be seen in many conditions (in alphabetical order):
18q syndrome
acromegaly
achondroplasia
ß-thalassaemia major
cleidocranial dysostosis
Gorlin-Goltz syndrome
Greig cephalopolysyndactyly syndrome
Hurler syndrome
hydrocephalus (typically before the age of two)
pyknodysostosis
Russell-Silver dwarfism
thanatophoric dysplasia

All can I think

28
Q

What is the commonest soft tissue sarcoma in the extremities?

  1. Eosinophilic fibrosis
  2. Myxoid
  3. Pleomorphic
  4. Synovial sarcoma
A
  1. Pleomorphic most common
    *AJL - referring to undifferentiated pleomorphic sarcoma.
    1st = UPS
    2nd = liposarc
29
Q

Which sarcoma is least likely in a peripheral location in deep tissue?

  1. Liposarcoma
  2. Synovial sarcoma
  3. Angiosarcoma
A
  1. Angiosarcoma rare/. Can occur there but probably least likely.

Which sarcoma is least likely in a peripheral location in deep tissue?

  1. Liposarcoma second most common behind PUS
  2. Synovial sarcoma 4th most common
  3. Angiosarcoma rare/. Can occur there but probably least likely.
30
Q

Which is a mitochondrial inherited disorder?

  1. Adrenoleukodystrophy
  2. Alexander disease
  3. Hurler
  4. Leigh
  5. Tay Sachs
A
  1. Leigh - retardation ataxia, opthalmoplegia, dystopia, cranial nerve palsies

Which is a mitochondrial inherited disorder?

  1. Adrenoleukodystrophy storage disease - Xlinked
  2. Alexander disease - sporadic, rapid neurological deterioration, macrocephaly and seizures
  3. Hurler MPS - most AR (except Hunter - X-linked)
  4. Leigh - retardation ataxia, opthalmoplegia, dystopia, cranial nerve palsies
    * **LJS - 75% actually nuclear DNA mutations but 25% mitochondrial, so still best answer
  5. Tay Sachs - lysosomal storage disease, twitching, visual and hearing loss, macrocephaly
31
Q

Which is Wilms tumour not associated with?

A. Denys-Drash
B. WAGR
C. Perlman 
D. Hutchinson 
E. Beckwith–Wiedemann
A

*LW:
D. Hutchinson - neuroblastoma mets cause hutchinson syndrome

Which is Wilms tumour not associated with?
A. Denys-Drash: TRUE - Wilms tumour, male pseudohermaphroditism, progressive glomerulonephritis

B. WAGR: TRUE

C. Perlman: TRUE: (also called renal hamartomas, nephroblastomatosis and fetal gigantism) - wiki
polyhydramnios, fetal overgrowth, neonatal macrosomia, high neonatal mortality, macrocephaly, dysmorphic facial features, visceromegaly, nephroblastomatosis and a predisposition for Wilms tumor at very early age.

D. Hutchinson neuroblastoma mets cause hutchinson syndrome

E. Beckwith–Wiedemann: TRUE

32
Q

Which is not a feature of Tetralogy of Fallot?

  1. Overriding aorta
  2. VSD
  3. Pulmonary stenosis
  4. Mitral stenosis
  5. RV hypertrophy
A
  1. Mitral stenosis
33
Q

Most common childhood orbital tumour:

  1. Haemangioblastoma
  2. Lymphoma
  3. Retinoblastoma
  4. Optic sheath meningioma
A
  1. Retinoblastoma
34
Q

Juvenile Idiopathic Arthritis:

  1. RF negative, Anti-CCP+
  2. RF negative…
A
  1. RF negative…
35
Q

Pre-eclampsias vs acute fatty liver of pregnancy. Which makes pre-eclampsia more likely?

  1. Coagulopathy
  2. Neurological impairment
  3. Proteinuria
  4. Fetal distress
  5. Abnormal LFT
A
  1. Proteinuria

Pre-eclampsias vs acute fatty liver of pregnancy. Which makes pre-eclampsia more likely?

  1. Coagulopathy both
  2. Neurological impairment both
  3. Proteinuria not mentioned in RP
  4. Fetal distress
  5. Abnormal LFT both
36
Q

Which is not risk factor for pre-eclampsia?

  1. Anti-phospholipid syndrome
  2. Hypertension
  3. Renal problems
  4. Liver problems
  5. Diabetes mellitus
A
  1. Liver problems
    Risk factors of Pre-eclampsia- diabetes mellitus - chronic hypertension - family history - nulliparity - advanced maternal age (>40 years) - obesity - Twins- autoimmune conditions
37
Q

Choriocarcinoma

  1. Unlikely to recur
  2. Associated with ectopic
A
  1. Associated with ectopic 25%. 25% normal pregnancies, 50% from complete moles

Choriocarcinoma

  1. Unlikely to recur very high cure rate
  2. Associated with ectopic 25%. 25% normal pregnancies, 50% from complete moles
38
Q

Which doesn’t cause Meig’s syndrome?

A. Brenner
B. Dysgerminoma
C. Granulosa
D. Fibroma
E. Thecoma
A

B. Dysgerminoma

39
Q

Which are associated?

  1. Adenocarcinoma of the cervix and HPV
  2. SCC of the cervix and HIV
A
  1. Adenocarcinoma of the cervix and HPV
40
Q

Which is not a risk factor for gynaecomastia?

  1. Germ cell tumour
  2. Chronic renal failure
  3. Liver failure
  4. Spironolactone
  5. other un recalled option
A

All are according to RP
Renal failure and germ cell tumours not mentioned in robbins

**LJS - agree. All listed in stat dx as well. Quick google suggests GCT and renal CRF both also known to cause gynaecomastia, but not listed in big Rob (p1050)
?poor recall

*AJL - GCT cause gynaecomastia from b-HCG effect.
CRF causes it from uraemic hypogonadism.

41
Q

Breast lesion triple negative (HER, ER and PR) most likely lesion:

  1. Invasive tubular
  2. Lobular invasive
    C. Mucinous
    D. Medullary
A

D. Medullary

Breast lesion triple negative (HER, ER and PR) most likely lesion:

  1. Invasive tubular - ER/PR +ve, HER2-ve
  2. Lobular invasive er +ve, HER-2 -ve
    C. Mucinous er +ve, HER-2 -ve
    D. Medullary
42
Q

Lyme disease is not associated with?

  1. Locomotor ataxia
  2. VII palsy
  3. Radiculoneuritis
  4. Aseptic meningitis
  5. Encephalomyelitis
A
  1. Locomotor ataxia

infection by Borrelia Borgdorferi- bacteria- fever, systemic symptoms- skin- Neurological- cardiac- MSK: arthritis

43
Q

Which is most likely to affect the kidneys and lungs:

  1. Diabetes
  2. PAN
  3. Tuberous sclerosis
A
  1. Tuberous sclerosis
44
Q

What is caused by the Philadelphia chromosome thing?

  1. CLL
  2. ALL
  3. CML
A

**LJS - disagree. CML caused by Philadelphia chrm (t(9;22) causing BCR-ABL fusion gene

  1. CLL
45
Q

What is associated?

A. Condylomata and SCC

A

A. Condylomata and SCC condylomata = genital warts

Pathology (24 decks)

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