Path recall March 2018 Flashcards
- Wilsons likely
a. Baby jaundice 3-6months
b. Corona radiata T2 early in disease
c. High ceruloplasmin bound copper
d. Autosomal dominant
e. Fatty liver
e. Fatty liver -true, mix with high density copper in liver may be normal on CT
1. Wilsons likely
a. Baby jaundice 3-6months - too young usually teens
b. Corona radiata T2 early in disease - usually basal ganglia causing parkinsonism
c. High ceruloplasmin bound copper - low ceruloplasmin, high hepatic copper content (most sensitive and accurate test), high urinary copper (most specific screening test). Serum copper levels are of no diagnostic value, since they may be low, normal, or elevated, depending on the stage of evolution of the disease.
d. Autosomal dominant - AR
e. Fatty liver -true, mix with high density copper in liver may be normal on CT
- SLE part of diagnostic criteria
a. Pericarditis
b. Peripheral neuropathy
c. Erosive arthropathy
a. Pericarditis true
2. SLE part of diagnostic criteria
a. Pericarditis true
b. Peripheral neuropathy - CNS
c. Erosive arthropathy - non erosive
d. MD SOAP BRAIN = criteria for SLE = malar rash, discoid rash, serositis, oral ulcers, arthritis, photosensitivity, blood dyscrasias, renal failure, ANA, immunologic, neurologic
- Xlinked
a. Adrenoleukodystrophy
b. Alexanders
c. Canavan
d. MLD
a. Adrenoleukodystrophy yes
3. Xlinked
a. Adrenoleukodystrophy yes
b. Alexanders (most are sporadic)
c. Canavan (Autosomal recessive, think Ashkenazi Jews)
d. MLD (Autosomal recessive)
- FMD doesn’t cause
a. Tinnitis
b. PVD
c. Angina
d. Renal
e. Carotid
**LJS - I think PVD least common of those listed. Tinnitus listed on radiopedia, due to carotid/VA involvement. Rest listed in Robbins, PVD is not in either (though some evidence that it occurs - google)
a. Tinnitis yes but rare, I think rarest only in case series
4. FMD doesn’t cause
a. Tinnitis yes but rare, I think rarest only in case series
b. PVD yes but rare
c. Angina yes but rare in case series
d. Renal
e. Carotid
*ESG, agree best answer is probably PVD.
FMD get coronary involvement with spontaneous dissection rather than the beading appearance seen in affected arteries elswhere.
Snippets from UpToDate as follows:
In general, manifestations of renal FMD (eg, hypertension, flank pain) are more likely to occur in men, as are arterial dissections and aneurysms. By contrast, manifestations of cerebrovascular FMD (eg, headache, pulsatile tinnitus, neck pain, carotid bruit) are more likely to occur in women.
Less common manifestations — Patients with lower-extremity FMD may present with intermittent claudication, critical limb ischemia, or microembolism that manifests as painful, cyanotic toes
- PAN does not affect
a. Lungs
b. Kidneys
c. Mesenteric vessels
a. Lungs PAN spares lungs classically, similar to MPA but medium vessels affected
5. PAN does not affect
a. Lungs PAN spares lungs classically, similar to MPA but medium vessels affected
b. Kidneys
c. Mesenteric vessels
- SCC tongue which doesn’t cause
a. Marijuana
b. Cocaine
c. HPV
d. Syphillis
e. Alcohol
b. Cocaine doesn’t because you snort it, HTN, perforation
6. SCC tongue which doesn’t cause
a. Marijuana smoking
b. Cocaine doesn’t because you snort it, HTN, perforation
c. HPV yes oral sex
d. Syphillis rare syphilitic leukoplakia
e. Alcohol yes
- Not risk factor for RCC
a. Smoking
b. Alcohol
c. Obesity
b. Alcohol no! lower risk
7. Not risk factor for RCC
a. Smoking yes
b. Alcohol no! lower risk
c. Obesity yes
- AJL - Risk factors for RCC (ignoring syndromes)
- Smoking
- Obesity
- HTN
- Cyclophosphamide
- Transplant
- Dialysis-related cystic disease
- Precursor to melanoma
a. Blue naevus
b. Dysplastic naevus
c. Congenital naevus
d. Basal naevus
b. Dysplastic naevus yes
8. Precursor to melanoma
a. Blue naevus
b. Dysplastic naevus yes
c. Congenital naevus
d. Basal naevus
- PML
a. CMV
b. EBV
c. JCV
d. HBV
- PML
a. JCV yes
SCS edit: added extra distractors, not actual recalls
- Jaundice in pregnancy, most common cause of liver disease in pregnancy
a. Cholestasis
b. Hepatitis
c. Preeclampsia
d. HELLP
b. Hepatitis yes most common cause of jaundice in pregnancy
* *SCS: specifically viral according to robbins.
- Jaundice in pregnancy, most common cause of liver disease in pregnancy
a. Cholestasis 1 in 1000
b. Hepatitis yes most common cause of jaundice in pregnancy
c. Preeclampsia HTN and proteinuria
d. HELLP rare but bad
- Least true regarding circumvallate
a. Abruption
b. IUGR
c. Painless bleeding
d. Fetal death
e. Abnormal tocography
c. Painless bleeding
**LJS - anything that increases risk of abruption, IUGR and preterm birth surely also increases risk of fetal death if these things not managed appropriately.
Painless bleeding least likely
*AJL agrees
ADB->Circumvallate placenta as a cause of painless bleeding in this cdhb document.
https://edu.cdhb.health.nz/Hospitals-Services/Health-Professionals/maternity-care-guidelines/Documents/GLM0052-Antepartum-Haemorrhage.pdf
- Least true regarding circumvallate
a. Abruption
b. IUGR
c. Painless bleeding
d. Fetal death
e. Abnormal tocography
- Least correct
a. ADEM follow bacterial infection
b. NMO bilateral optic neuritis
c. Relapsing remitting MS on MRI plaque doesn’t have axonal degeneration
a. ADEM follow bacterial infection
12. Least correct
a. ADEM follow bacterial infection
b. NMO bilateral optic neuritis
c. Relapsing remitting MS on MRI plaque doesn’t
have axonal degeneration
Acute disseminated encephalomyelitis is a diffuse, monophasic demyelinating disease that follows either a viral infection or, rarely, a viral immunization.
Neuromyelitis optica (NMO) is a syndrome with synchronous (or near synchronous) bilateral optic neuritis and spinal cord demyelination.
Robbins MS:
Within an active plaque there is relative preservation of axons and depletion of oligodendrocytes.
Within inactive plaques, little to no myelin is found, and there is a reduction in the number of oligodendrocyte nuclei; instead, astrocytic proliferation and gliosis are prominent. Axons in old gliotic plaques show severe demyelination and are also greatly diminished in number.
Radiopaedia:
Multiple sclerosis is believed to result from a cell-mediated autoimmune response against one’s own myelin components, with loss of oligodendrocytes, with little or no axonal degeneration in the acute phase; however, in later stages, loss of oligodendrocytes results in axonal degeneration
- Hirschprungs false
a. More common in females
b. Involves whole colon
c. Bowel obstruction and perforation
a. More common in females - more common male
SCS: this primary relates to short segment disease. Becoming more even in long segment disease.
- Hirschprungs false
a. More common in females more common male
b. Involves whole colon
c. Bowel obstruction and perforation
**LJS - only 4% total aganglionosis
- PXA
a. Involves grey matter and overlying meninges
b. Adults frontal
c. Child brainstem and cerebellum
a. Involves grey matter and overlying meninges this dural reaction
14. PXA
a. Involves grey matter and overlying meninges this dural reaction
b. Adults frontal - temporal
c. Child brainstem and cerebellum - rare
- Which chondroid lesion crosses physes
a. Chondroblastoma
b. Periostial chondroma
c. Enchondroma
d. CMF
e. Osteochondroma
*AJL - regarding CMF, Wheeless also states: typically located in the metaphyseal region of long bones, and in some cases it is possible for it to invade the epiphyseal plate;
I overall agree with LW that the common tumours are the three he listed so would pick one of those as ‘most correct’ (in this case chondroblastoma)
*LW:
Wheeless states: only three tumors may invade physis: chondroblastoma, GCT, and clear cell chondrosarcoma
**LJS - CMF and chrondroblastoma
*AJL (thinks this is a stupid question)
Chondroblastoma starts in epiphysis and crosses physis
CMF starts in metaphysis and crosses physis.
- Which chondroid lesion crosses physes
a. Chondroblastoma rarely may cross physis
b. Periostial chondroma
c. Enchondroma
d. CMF
e. Osteochondroma
- PVNS and GCT false
a. PVNS most common knee
b. GCT most common wrist
c. PVNS and GCT erode bone
d. GCT excision likely to recur
e. PVNS characteristically cause inflammation
*LW: they referring to giant cell tumour of tendon sheath (i.e. same spectrum as PVNS) which is most common in wrist. thus E false
(*AJL. If they were referring to bone GCT then it is most common at the knee)
(as an aside, PVNS is now known as tenosynovial GCT diffuse type. The type in the tendon sheath is tenosynovial GCT localised type. This is in the more recent Robbins 2018 basic and 2020 big robbins)
ADB-> I favour Tenosynovial giant cell tumours location being most common in the fingers making B wrong
- PVNS and GCT false
a. PVNS most common knee
b. GCT most common wrist
c. PVNS and GCT erode bone
d. GCT excision likely to recur - 10-20% recurrence
e. PVNS characteristically cause inflammation probably this characteristically bleed other answers are all more correct
- Post partum diabetes insipidus
a. Lymphocytic hypophysitis
b. Sheehans
a. Lymphocytic hypophysitis yes, loss of posterior pituitary bright spot and DI
17. Post partum diabetes insipidus
a. Lymphocytic hypophysitis yes, loss of posterior pituitary bright spot and DI
b. Sheehans - hypovolaemia (usually massive postpartum bleed) causing pituitary ischaemic necrosis, usually posterior pituitary is spared (see below)
Sheehan syndrome, also known as postpartum necrosis of the anterior pituitary, is the most common form of clinically significant ischemic necrosis of the anterior pituitary. During pregnancy the anterior pituitary enlarges to almost twice its normal size. This physio- logic expansion of the gland is not accompanied by an increase in blood supply from the low-pressure venous system; hence, there is relative hypoxia. Any further reduction in blood supply caused by obstetric hemor- rhage or shock may precipitate infarction of the anterior lobe. Because the posterior pituitary receives its blood directly from arterial branches, it is much less suscep- tible to ischemic injury and is therefore usually not affected. Pituitary necrosis may also be encountered in other conditions, such as disseminated intravascular coagulation and (more rarely) sickle cell anemia, ele- vated intracranial pressure, traumatic injury, and shock of any origin. Whatever the pathogenesis, the ischemic area is resorbed and replaced by a nubbin of fibrous tissue attached to the wall of an empty sella.
- Most common with tumor marker
a. YS tumor
b. Seminoma
c. Granulosa cell
a. YS tumor aFP
18. Most common with tumor marker
a. YS tumor aFP
b. Seminoma
c. Granulosa cell
Marked elevation of serum AFP or HCG levels are produced by yolk sac tumor and choriocarcinoma elements, respectively. Both of these markers are elevated in more than 80% of individuals with NSGCT at the time of diagnosis. As stated earlier, approximately 15% of seminomas have syncytiotrophoblastic giant cells and minimal elevation of HCG levels, which does not affect prognosis.
IVM: Additional info:
YSK most common testicular tumour in infants and children up to 3 years - has a good prognosis.
Rare in pure form in adults.
- Most common elderly testicular tumor
a. Metastatic disease
b. Spermatocytic seminoma
c. Lymphoma
d. Germ cell tumour
(*AJL added some… mwahahahaha)
- Most common elderly testicular tumor
c. Lymphoma
- Most common elderly germ cell testicular tumor
a. Spermatocytic seminoma
b. Mixed GCT
c. Pure Seminoma
d. Lymphoma
e. Sertoli cell
*AJL added some to make it better
- Most common eldertly germ cell testicular tumor
a. Spermatocytic seminoma yes
**SCS from radiopaedia Seminoma divided into 3 subtypes: - classic (85%) - anaplastic (10%) -spermatocytic (5%): age >60, rarely metastasise, well DDx cells resembling spermatocytes.
*IVM: ?mixed more common than spermatocytic (hard to find numbers corresponding to age groups)
- Wilms least correct
a. Bilateral almost always germ line
b. Unilateral is 50% genetic
c. Genetic wilms have nephrogenic rests
b. Unilateral is 50% genetic. No it is 10%
* AJL - sporadic wilms accounts for 90% of all wilms tumours. Bilateral wilms patients are presumed to have a germline gene mutation (on 11p chromosome) - Robbins.
21. Wilms least correct
a. Bilateral almost always germ line
b. Unilateral is 50% genetic 10%
c. Genetic wilms have nephrogenic rests
- Breast least likely in post menopausal
a. IDC
b. LCIS
c. Fibroadenoma
d. Phylloides
e. Papillary
c. Fibroadenoma young
22. Breast least likely in post menopausal
a. IDC
b. LCIS
c. Fibroadenoma young
d. Phylloides
e. Papillary
- Antibodies to GBM
a. Goodpastures
b. PAN
c. Wegners
d. MPA
a. Goodpastures true
28. Antibodies to GBM
a. Goodpastures true
b. PAN
c. Wegners
d. MPA
- Myeloma false
a. IgA
b. IgG
c. Serum light chains
d. BJP
a. IgA less common, maybe this answer or the other not recalled one
29. Myeloma false
a. IgA less common (20%), maybe this answer or the other not recalled one
b. IgG -most common 60%
c. Serum light chains -yes
d. BJP -yes
- Diabetes microangiopathy false
a. Glomerulosclerosis
b. Macula oedema
c. Peripheral neuropathy
d. Autonomic neuropathy
*AJL - all are true.
A previous recall also had papillary necrosis which is not caused by microangiopathy but rather a consequence of recurrent pyelonephritis.
- Diabetes microangiopathy false
a. Glomerulosclerosis -yes
b. Macula oedema -yes
c. Peripheral neuropathy -yes
d. Autonomic neuropathy - *AJL - Affects 20-40% of diabetics (robbins)
- DCIS
a. Prognosis depends on histological microarchitecture
b. High grade worse prognosis
b. High grade worse prognosis - correct grading based on comedonecrosis and pleomorphism
27. DCIS
a. Prognosis depends on histological microarchitecture - wrong but some what true if comedonecrosis is included, but I think they mean appearance of papillary, micropapillary, cribiform etc.
* AJL - Robbins says: The major risk factors for recurrence are (1) high nuclear grade and necrosis, (2) extent of disease, and (3) positive surgical margins. I would take those three factors to be the prognostic factors.
b. High grade worse prognosis - correct grading based on comedonecrosis and pleomorphism
