Path Recalls 2017 Flashcards
Which is not consistent with Wegeners?
Upper respiratory tract granulomas Lower respiratory tract granulomas Renal artery vasculitis Pulmonary artery vasculitis Glomerulonephritis
Renal artery vasculitis no
Which is not consistent with Wegeners?
Upper respiratory tract granulomas yes Lower respiratory tract granulomas yes Renal artery vasculitis no Pulmonary artery vasculitis yes Glomerulonephritis yes
Two questions on Churg strauss
Associated:
pANCA
eGPA
Two questions on Churg strauss
Associated pANCA yes
eGPA asthma, eosinophilia, transient pulmonary infiltrates.
Churg struass and Microscopic polyangitis both p-ANCA
Wegners c-ANCA
Which doesn’t cause bowel ischaemia
PAN
Behchets
Atherosclerosis
Which doesn’t cause bowel ischaemia
PAN yes
Behchets yes
Atherosclerosis yes
*LW:
Although Bechet can, It would be least likely out of options listed.
GI symtpoms are mainly due to ulceration and intestinal over growth.
Carotid, pulmonary, aortic, iliac, femoral, and popliteal arteries are most commonly involved; cerebral and renal arteries are uncommonly involved.
Venous disease resulting in venous thrombosis is more common than arterial involvement, and is often an early feature of Behçet syndrome.
Most likely cause of acute bowel ischaemia
SMA atherosclerosis
SMV thrombosis
Aortic dissection
SMA embolus
SMA embolus AF most likely
**LJS - RP says acute arterial occlusion more commonly embolic (50%) and in situ thrombosis due to atherosclerosis only 15-30% (Robbins doesn’t specify)
Most likely cause of acute bowel ischaemia?
SMA atherosclerosis common
SMV thrombosis yes
Aortic dissection yes HTN and dissect into SMA
SMA embolus AF most likely
Aortic dissection
5-10% don’t have an intimal tear
Dissection between media and the intima
Most common to have tear at junction of arch and proximal descending aorta
- *LJS - 5-10% no intimal tear
- LW agrees.
Dissection between media and the intima ?maybe not dissection usually outer third of media and can rupture into adventitia (robbins)
IVM: Intimomedial flap is a misnomer as there is always some component of media in the flap (StatDx)
Aortic dissection
5-10% don’t have an intimal tear - IMH 10%
Dissection between media and the intima - ?maybe not dissection usually outer third of media and can rupture into adventitia (robbins)
Most common to have tear at junction of arch and proximal descending aorta - *AJL - Most common in the ascending aorta, within 10cm of the valve.
What is least associated with BRCA
Pancreas
Prostate
CRC
Ovarian
CRC yes no
What is least associated with BRCA Pancreas yes Prostate yes CRC yes no Ovarian yes
BRCA1: Ovarian, male breast cancer (but lower than BRCA2), prostate, pancreas, fallopian tube
BRCA2: Ovarian, male breast cancer, prostate, pancreas, stomach, melanoma, gallbladder, bile duct, pharynx
Most likely to cause colon cancer
PJ
UC
*AJL - PJ has about 40% lifetime risk. UC has 1% per year. I’m unsure which is higher but maybe PJ?
Most likely to cause colon cancer
PJ less likely but is associated with colon and breast
UC yes
Least likely to cause gastric cancer
Fundic gland polyp Hyperplastic polyp Adenomatous polyp Partial gastrectomy H pylori
**LJS - disagree. Hyperplastic polyp risk of dysplasia correlates with size, removed > 1.5cm
Fundic gland polyp - most common, no malignant potential when they are sporadic (can also be ass/w FAP)
Robbins 9th ed p772.
*LW: theme of agreement continues….
UTD states following:
–> Malignancy develops in hyperplastic polyps through a dysplasia/carcinoma sequence. Between 1 and 20 percent of hyperplastic polyps have been reported to harbor foci of dysplasia. The risk of malignancy in hyperplastic polyps is increased in polyps >1 cm and pedunculated in shape.
–> Somatic APC gene mutations have been detected in over 70 percent of syndromic fundic gland polyps without dysplasia, but in less than 10 percent of sporadic lesions.
Sporadic fundic gland polyps and those associated with PPI use have virtually no malignant potential, but may rarely show dysplasia.
Between 30 to 50 percent of fundic gland polyps in patients with FAP show dysplasia, which is typically low grade. However, fundic gland polyps, in contrast with adenomas in patients with FAP, rarely progress to cancer
—-> Favoured answer is fundic gland polyp is LEAST likely to cause gastric cancer.
Previous answer:
Hyperplastic polyp - virtually no malignant potential.
Fundic gland polyp - yes, most common polyp
Adenomatous polyp yes
Partial gastrectomy yes
H pylori yes
With regard to celiac disease (least likely)
Severely affects the distal small bowel Increase in number of small bowel folds Villous atrophy Autoimmune reaction to ingested to gliadin Increased risk of MALToma
Severely affects the distal small bowel
With regard to celiac disease (least likely)
Severely affects the distal small bowel -no. Duodenum and jejunum
Increase in number of small bowel folds -yes distally. (Jejunal-ileal fold reversal. Hide bound appearance on barium, which can also been seen in scleroderma)
Villous atrophy -yes
Autoimmune reaction to ingested to gliadin -yes
Increased risk of MALToma -no MALToma with Hpylori, T lymphoma (and adenocarcinoma) with celiac disease
Most common location of small bowel adenocarcinoma
Duodenum Proximal jejunum Distal jejunum Proximal ileum Distal ileum
Duodenum periampullary tumor
Most common location of small bowel adenocarcinoma
Duodenum -periampullary tumor Proximal jejunum -GIST Distal jejunum Proximal ileum Distal ileum -lymphoma, TB, Yersinia, carcinoid from enterochromaffin cells
Young patient with bicornuate uterus and one kidney
Mesonephric duct
Mullerian duct
Wolffian duct
Genital ridge
Mullerian duct mullarian anomalies
Young patient with bicornuate uterus and one kidney
Mesonephric duct (= Wolffian duct)
Mullerian duct mullarian anomalies
Wolffian duct
Genital ridge
Newborn with dilated colon and unilateral sacral agenesis
Hirschsprungs
Anal atresia
Ileal atresia
Meconium plug
Anal atresia VACTERL or curarino ASP triad anorectal malformation, sacral osseus defect, presacral mass
Newborn with dilated colon and unilateral sacral agenesis
Hirschsprungs not sacrum
Anal atresia VACTERL or curarino ASP triad anorectal malformation, sacral osseus defect, presacral mass
Ileal atresia no
Meconium plug no
Which is associated with CF?
Hypertrophic pyloric stenosis
Which is associated with CF?
CF recap
-Cystic fibrosis is due to a homozygous defect of the CFTR gene located on chromosome 7
-gene encodes for a transmembrane protein known as cystic fibrosis transmembrane regulator (CFTR)
-regulating chloride passage across cell membranes
-difference between skin and other tissue
-in skin, CFTR protein is responsible for the influx of chloride and increases the sodium channel activity, thus controlling the influx of sodium, Defective channel causes sodium to remain in the sweat hence sweaty.
Hypertrophic pyloric stenosis articles say maybe, but I would say no
Which is most suggestive of UC?
Pseudopolyps
Uveitis
Fistulas
Sacroiliitis
Pseudopolyps yes.
Which is most suggestive of UC?
Pseudopolyps yes
Uveitis IBD
Fistulas no
Sacroiliitis IBD
Isolated islands of regenerating mucosa often bulge into the lumen to create pseudopolyps, and the tips of these polyps may fuse to create mucosal bridges.
Most consistent with reactive arthritis?
Symmetrical sacroiliitis
Shoulder arthropathy
Commonly follows GI infection
Commonly follows GI infection yes arthritis follow GI or chlamydia is most consistent
Most consistent with reactive arthritis?
Symmetrical sacroiliitis no asymmetrics
Shoulder arthropathy non specific
Commonly follows GI infection yes arthritis follow GI or chlamydia is most consistent
Hydroxyapetite deposition disease associated with?
Dermatomyositis
Sjogrens
Scleroderma
Dialysis
Dialysis yes amyloid b2 microglobulin, CPPD and HADD, osteodystrophy
Hydroxyapetite deposition disease associated with?
Dermatomyositis no calcinosis universalis
Sjogrens no
Scleroderma no calcinosis circumscripta
Dialysis yes amyloid b2 microglobulin, CPPD and HADD, osteodystrophy
Least liekly to have changes in CJD?
Dentate nuclei
Caudate
Putamin
Thalami
Dentate nuclei no
Least liekly to have changes in CJD?
Dentate nuclei no
Caudate yes BG
Putamin yes BG
Thalami yes hockey stick
Pathognomonic finding is spongiform transformation of the cerebral cortex, and often deep grey matter (caudate, putamen). Robbins
Least likely CADASIL manifestation?
External capsule ischaemia Basal ganglia ischaemia Anterior temporal white matter change Periventricular white matter changes Skin changes
Skin changes no
Least likely CADASIL manifestation?
External capsule ischaemia yes classic location
Basal ganglia ischaemia yes
Anterior temporal white matter change yes classic location
Periventricular white matter changes yes leukoencephalopathy
Skin changes no. **LJS - can perform skin bx to dx if no genetic mutation found. But no clinically recognisable skin change
UpToDate:
In order to firmly establish a diagnosis of CADASIL, one of the following is required:
●Documentation of a typical NOTCH3 pathogenic variant by genetic analysis
●Documentation of characteristic ultrastructural deposits within small blood vessels by skin biopsy
Most true regarding HSV?
HSV1 Most common cause of neonatal encephalitis
HSV2 most common cause of adult encephalitis
Causes haemorrhagic necrosis
Causes haemorrhagic necrosis yes
Most true regarding HSV?
HSV1 Most common cause of neonatal encephalitis no HSV2 birth canal
HSV2 most common cause of adult encephalitis no HSV1
Causes haemorrhagic necrosis yes
What is the least likely consequence of herniation?
DAI Duret haemorrhage ACA infarct PCA infarct Kernohans notch
DAI false, it is associated but not a consequence
What is the least likely consequence of herniation?
DAI false, it is associated but not a consequence
Duret haemorrhage yes stretching pontine perforators
ACA infarct yes subfalcine
PCA infarct yes transtentorial, also affects CN3
Kernohans notch yes cerebral peduncle of contralateral side
One month history of weakness with T2 hyperintensity in supraspinatus, infraspinatus, teres minor. Normal T1
Impingement of the suprascapular nerve in the spinoglenoid notch
Impingement of the suprascapular nerve in the suprascapular notch
Quadralateral space
Brachial neuritis
Brachial neuritis - yes Parsonage-Turner syndrome (idiopathic brachial neuritis)
One month history of weakness with T2 hyperintensity in supraspinatus, infraspinatus, teres minor. Normal T1
Impingement of the suprascapular nerve in the spinoglenoid notch -no, isolated infraspinatus
Impingement of the suprascapular nerve in the suprascapular notch -no, doesn’t a account for involvement of teres minor
Quadralateral space -no teres minor only from axillary nerve
Brachial neuritis - yes Parsonage-Turner syndrome (idiopathic brachial neuritis)
Least likely to cause thoracic outlet syndrome?
Levator clavicular muscle Anterior scalene hypertrophy Cervical rib Pectoralis minor tunnel Supracalvicular mass
**LJS - they all can. ?poor recall
Supraclavicular mass could cause neurogenic TOS (most common type) by compressing supraclavicular brachial plexus. Listed in radiopaedia causes. Google search supports all others as causes too. ?Go by least common cause ?levator claviculae
**LW:
Agree with above, that the least likely is levator clavicular muscle.
Anterior scalene hypertrophy - TRUE; interscalene triangle
Cervical rib - TRUE
Pec minor tunnel - TRUE; below clavicle containing brachial plexus nerves and vessels.
Supraclavicular mass - TRUE; lymphadenopathy, pancoast tumours, osteochondromas.
(https://link.springer.com/article/10.1007/s40122-019-0124-2)
Varicose veins most correct?
Vein thickening
Enlarged vein with competent valves
Venous ulcers that are slow to heal
Cause significant numbers of PE
Venous ulcers that are slow to heal yes, usually chronic ulcers
Varicose veins most correct?
Vein thickening false thin dilated
Enlarged vein with competent valves false incompentent
Venous ulcers that are slow to heal yes, usually chronic ulcers
Cause significant numbers of PE no usually DVT not superficial
Least correct regarding causes of pulmonary hypertension?
Primary is progressive and results in death
Partial filling defects associated with primary
Primary is more common than secondary
Can be caused by emphysema
Primary is more common than secondary no primary rare
Least correct regarding causes of pulmonary hypertension?
Primary is progressive and results in death yes, death from decompensated cor pulmonale, often with superimposed thromboembolism and pneumonia, usually ensues within 2 to 5 years in 80% of patients.
Partial filling defects associated with primary - yes secondary chronic PE
**LJS - ?referring to tufts of plexogenic arteriopathy in primary
Primary is more common than secondary no primary rare
Can be caused by emphysema yes
Least true regarding malignant hypertension
1-5% of essential hypertension
Can arise in people with previously normal blood pressure
Fibrinoid necrosis (or sclerosis) of the arteriole walls
Greater than 110mmHg diastolic
**LJS (Robbins):
Defined as SBP > 200, DBP > 120 mmHg - this is least true
Least true regarding malignant hypertension
1-5% of essential hypertension - yes
Can arise in people with previously normal blood pressure yes
Fibrinoid necrosis (or sclerosis) of the arteriole walls yes - hyperplastic arterosclerosis with fibronoid necrosis.
Greater than 110mmHg diastolic - no (see above)
Least true regarding berry aneurysms
90 percent internal carotid
25% present within the first 24 hours with infarct due to vasospasm
Can present as an enlarging mass
2% of post mortems
*SD:
I’d say 90% ICA false - 40% AcommA branch, 34% MCA bifurcation, 20% terminal ICA
**SCS - I favour “25% present within the first 24 hours with infarct due to vasospasm” as LEAST correct. (Vasospasm occurs 4-14 days). But Sina makes a good point… CCF - boom Sajith “the truth” Senaderra strikes again.
*wji - agree with Saj. ICA option maybe said “ICA territory” or something like that. vasospasm first 24h is wrong.
Least true regarding berry aneurysms
90 percent internal carotid ~maybe. **LJS - branch point in anterior COW most common (90%)
25% present within the first 24 hours with infarct due to vasospasm -no
Can present as an enlarging mass -yes
2% of post mortems -yes
Least correct regarding ADEM?
20-30 percent mortality
Post viral or vaccination
Perivenular
Causes demyelination and axonal degeneration
*AJL- Causes demyelination and axonal degeneration no - axons don’t degenerate
20-30 percent mortality -yes (10-20% (RP))
Post viral or vaccination -yes
Perivenular -yes
Causes demyelination and axonal degeneration -no - axons don’t degenerate
With regard to pleural solitary fibrous tumour?
Associated with asbestos
Hypocalcaemia
other option…
With regard to pleural solitary fibrous tumour?
Associated with asbestos -no
Hypocalcaemia -no, hypoglycaemia
Cant remember the correct answer
SD:
20% associated with HPOA
80% from visceral pleura
2-4% hypoglycemia
Neuroendocrine lung tumour most likely to cause
hypercalcaemia?
- DIPNET
- Typical carcinoid
- Small cell lung cancer
Small cell lung cancer - yes
Neuroendocrine lung tumour most likely to cause hypercalcaemia
DIPNET
Typical carcinoid
Small cell lung cancer - yes
*LW:
Additional note - is the commonest para neoplastic syndrome of SCC lung cancer.
Most likely associated with hypocalcaemia
Primary hyperparathyrodism
Secondary hyperparathyroidism
Tertiary hyperparathyroidism
Most likely associated with hypocalcaemia
Primary hyperparathyrodism no
Secondary hyperparathyroidism yes
Tertiary hyperparathyroidism no
CKD. Not enough active Vit D. High levels of phosphate which directly depress calcium. Chronically low calcium causes compensatory increase in PTH.
Least likely to cause gynaecomastia
Cirrhosis
Adrenal hyperplasia
Leydig cell tumour
Sertoli tumour
Least likely to cause gynaecomastia
Cirrhosis yes
Adrenal hyperplasia no (virilization)
Leydig cell tumour yes - hyperoestrogenism. (though can also cause increased virilisation).
Sertoli tumour yes - produce aromatase which helps to make oestrogen
Congenital adrenal hyperplasia stems from several autosomal-recessive, inherited metabolic errors, each characterized by a deficiency or total lack of a particular enzyme involved in the biosynthesis of cortical steroids, particularly cortisol (Fig. 24-46). Steroid precursors that build behind the defective step in the pathway are channeled into other pathways, resulting in increased production of androgens, which accounts for virilization. Simultaneously, the deficiency of cortisol leads to increased secretion of ACTH, culminating in adrenal hyperplasia.
Most true regarding cryptorchidism
25% are bilateral
Orchidopexy corrects increased risk of malignancy
10% of 1 year old boys
Contralateral testis is almost always normal
AJL - 25% are bilateral yes
(LW - Word for word from Robbins)
Orchidopexy corrects increased risk of malignancy - reduces but doesn’t eliminate
10% of 1 year old boys-no. 1%
Contralateral testis is almost always normal - *LW: robbins states similar histologic changes may also be seen in contralateral descended testis - so not normal, and hence incorrect.
Most common testicular cancer Yolk sack Teratoma Seminoma Choriocarcinoma
Seminoma yes
Most common testicular cancer Yolk sack Teratoma Seminoma yes Choriocarcinoma
Most true regarding placental site tumour?
Associated with markedly elevated BHCG
Mostly associated with normal pregnancy
*AJL- Mostly associated with normal pregnancy - yes 50% (Robbins pg 1042)
Spontaneous abortion, hydatidiform mole make up the remainder.
Excellent prognosis, 10-15% get disseminated disease
**LJS - HCG only moderately elevated. Produces human placental lactogen.
Presents with uterine mass, bleeding amenorrhea.
Makes up less that 2% of GTD.
- LW:
a. Associated with markedly elevated BHCG: FALSE - mild rare form of GGT, with less syncitiotrophblasts hence lower BHCG
b. Mostly associated with normal pregnancy: sometimes may occur after normal pregnancy, molar pregnancy or even after a terminated pregnancy.)
Regarding choriocarcinoma (False)
Better prognosis with non-gestational choriocarcinoma
Frequently metastases at presentation
Can present up to 2 years after pregnancy
Regarding choriocarcinoma (False)
Better prognosis with non-gestational choriocarcinoma false
Frequently metastases at presentation yes
Can present up to 2 years after pregnancy yes up to 15
Choriocarcinoma has high propensity for hematogenous spread, and by the time it is discovered, radiographs of the chest and bones may disclose the presence of meta- static lesions.
Nongestational choriocarcinomas that arise outside of the uterus are much more resistant to therapy.
Not associated with pre-eclampsia
Placental infarcts
HELLP
Neurological symptoms
Retroplacental bleed
Not associated with pre-eclampsia
Placental infarcts yes
HELLP yes
Neurological symptoms no
Retroplacental bleed yes
**LJS - pre-eclampsia get headaches and visual disturbance but eclampsia defined by CNS involvement - seizures/coma
Approximately 10% of women with severe preeclampsia develop microangiopathic hemolytic anemia, elevated liver enzymes, and low platelets, referred to as the HELLP syndrome (Chapter 17).
The placenta reveals various microscopic changes, most of which reflect malperfusion, ischemia, and vascular injury. These include (1) infarcts, which are larger and more numerous that those that may be seen in normal full-term placentas, (2) exaggerated ischemic changes in the chorionic villi and trophoblast, consisting of increased syncytial knots, (3) frequent retroplacental hematomas due to bleeding and instability of uteroplacental vessels, and (4) abnormal decidual vessels, which may show thrombi, lack of normal physiologic conversion (described earlier), fibrinoid necrosis, or intraintimal lipid deposition (acute atherosis)
Not associated with sarcoid?
Membranous glomerulonephritis
Mickulicz
Not associated with sarcoid
Membranous glomerulonephritis no
Mickulicz - IgG4 disease. Associated with sarcoidosis and sjogren and lymphoma. Used to be considered a form of Sjögren (therefore has similar presentation… salivary gland and lacromal ducts)
True regarding pagets disease of the nipple
Eczematous reaction on skin
Occult DCIS involving the nipple
Lactiferous ducts involved in less than 5%
True regarding pagets disease of the nipple
Eczematous reaction on skin yes
Occult DCIS involving the nipple F - not occult, has visible skin change
Lactiferous ducts involved in less than 5% no
Regarding fibrous dysplasia
> 50% polyostotic
Commonly have café-au-lait spots
In the skull, facial bones and mandible more commonly involved than the vault
*AJL- In the skull, facial bones and mandible more commonly involved than the vault yes
20-30% polyostotic
2-3% of polyostotic are McCune-Albright which have coast of maine cafe au lait spots.
Maxilla > mandible > frontal bone > ethmoid and sphenoid bones > T-bone
Regarding osteosarcoma (false):
Periosteal has a cleft between the bone and the tumour
Parosteal has significant cartilage component
High grade surface osteosarcoma has a similar prognosis to conventional
Periosteal has a cleft between the bone and the tumour -false
Regarding osteosarcoma (false):
Periosteal has a cleft between the bone and the tumour -false
Parosteal has significant cartilage component -yes
**LJS - periosteal contains lots of chondroid matrix. Parosteal has osteoid matrix. RP. I think this also false
High grade surface osteosarcoma has a similar prognosis to conventional -yes
*ESG disagree. StatDx parosteal osteosarcoma:
Gross path: Contains nodules of cartilage, some on surface, mimicking incomplete cartilage cap
Histo: 50% show cartilaginous differentiation.
Most common cause of jaundice in pregnancy
Cholestasis
HELLP
Viral hepatitis
Choledocolithiasis
- *LJS - viral hepatitis
- LW agrees
Most common cause of jaundice in pregnancy
Cholestasis yes
HELLP
Viral hepatitis
Choledocolithiasis
Least true with regard to endocarditis:
Acute causes valve destruction
Acute affects previously damage valves
Strep viridans most common cause of subacute
Acute affects previously damage valves -no
Least true with regard to endocarditis:
Acute causes valve destruction -yes
Acute affects previously damage valves -no
Strep viridans most common cause of subacute -yes
Least likely to with regard to congenital heart disease
Truncus arteriosus carries a poor prognosis
Septum primum ASD presents early
**LJS - septum primum ASD is big defect, unlikely to be asx
But overall ASD more likely to present in adulthood vs VSD
*LW: likely incomplete recall with unrecalled correct option.
Primum defects commonly associated with other congential heart defects, so likely present early.
Least likely to with regard to congenital heart disease
Truncus arteriosus carries a poor prognosis yes
Septum primum ASD presents early no
Which is least likely regarding ovarian tumours
Serous carcinoma more common than borderline
Serous carcinoma more likely bilateral
Mucinous more common than serous
Mucinous more commonly malignant
**LJS - serous more commonly malignant than mucinous
Serous more common than mucinous
*AJL agree with LJS.
Serous benign - 60%, borderline - 15%, malig - 25%
Mucinous benign - 80%, borderline - 10-15%, malig - 5%
Which is least likely regarding ovarian tumours
Serous carcinoma more common than borderline -yes
Serous carcinoma more likely bilateral -yes
Mucinous more common than serous -no
Mucinous more commonly malignant- no
Most likely cause of partial hepatic fibrosis
Budd Chiari
Alpha-1-antitripsin
Wilsons
Most likely cause of partial hepatic fibrosis
Budd Chiari yes
Alpha-1-antitripsin
Wilsons
The obstruction of two or more major hepatic veins produces liver enlargement, pain, and ascites, a condition known as Budd-Chiari syndrome. Obstruction of a single main hepatic vein by thrombosis is clinically silent.
In the Budd-Chiari syndrome, the liver is swollen and red-purple and has a tense capsule. There may be differential areas of hemorrhagic collapse alternating with areas of preserved or regenerating parenchyma, the patterns are dependent on which small and large hepatic veins are obstructed.
Most true with regard to osteopetrosis
Hepatosplenomegally Axial more affected than appendicular No increased risk of fracture Autosomal recessive form affects the navicular Autosomal dominant form…
Most true with regard to osteopetrosis
Hepatosplenomegally yes Axial more affected than appendicular no No increased risk of fracture no Autosomal recessive form affects the navicular no Autosomal dominant form… no
The primary spongiosa, which is normally removed during growth, persists and fills the medullary cavity, leaving no room for the hematopoietic marrow. Affected individuals who survive into their infancy have repeated—often fatal—infections because of leukopenia, despite extensive extramedullary hematopoiesis that can lead to prominent hepatosplenomegaly.
Least likely to cause expansion of the pituitary fossa
Meningioma Germinoma Craniopharyngioma Lymphocytic hypophysitis Macroadenoma
- *LJS - meningioma
- LW: as always agrees with LJS; meningiomas usually parasellar in location, and if trurly arises in fossa, more commonly shows hyperostosis rather than expansion relative to other lesions.
(https://erc.bioscientifica.com/view/journals/erc/15/4/885.xml)
Least likely to cause expansion of the pituitary fossa
Meningioma Germinoma Craniopharyngioma Lymphocytic hypophysitis yes Macroadenoma
Least correct with regard to macroadenoma:
Commonly non-secretory
PRL production most common
Can invade the cavernous sinus
Least correct with regard to macroadenoma:
Commonly non-secretory yes
PRL production most common yes *AJL - I favour this to be least correct as most common is non secretory…
Can invade the cavernous sinus yes
Cavernous sinus invasion difficult to determine (medial wall is thin, weak). If tumor exists between cavernous carotid artery and lateral dura = invasion
- *SCS: robbins. 9th ed, big version.
- Lactotroph: 30% of adenoma “most common type of HYPERFUNCTIONING pituitary adenoma”
- Non-secretory: 25-30%
- Rarest =‘thyrotroph’ 1%
*ESG - disagree that most common is non secretory. From StatDx pituitary macroadenoma:
75% endocrinologically active (symptoms vary)
Prolactin-secreting adenoma is most common functional adenoma
IVM: RP says Most macroadenomas are non-secretory. ?another least correct option not recalled
Least true with regard to chondrosarcoma
Low grade lesions can cause reactive cortical thickening
15% arise from benign condroid lesions
Majority high grade
Most arise in axial skeleton
Least true with regard to chondrosarcoma
Low grade lesions can cause reactive cortical thickening yes
15% arise from benign condroid lesions yes
Majority high grade no
Most arise in axial skeleton yes
A slow-growing, low-grade tumor causes reactive thickening of the cortex, whereas a more aggressive high-grade neoplasm destroys the cortex and forms a soft tissue mass.
About 15% of conventional chondrosarcomas are secondary, arising from a preexisting enchondroma or osteochondroma.
Fortunately, most conventional chondrosarcomas are grade 1 tumors with 5-year survival rates of 80% to 90% (versus 43% for grade 3 tumors).
Chondrosarcomas commonly arise in the axial skeleton, especially the pelvis, shoulder, and ribs. Unlike benign enchondroma, the distal extremities are rarely involved.
The clear cell variant is unique in that it originates in the epiphyses of long tubular bones.
Woman with history of breast cancer, limp and hip pain 2 weeks, with increased T2 signal surrounding the psoas muscle
Psoas tear
Metastasis of the lesser trochanter
Subtrochanteric fracture
Subcapital fracture
Woman with history of breast cancer, limp and hip pain 2 weeks, with increased T2 signal surrounding the psoas muscle
Psoas tear yes
Metastasis of the lesser trochanter
Subtrochanteric fracture
Subcapital fracture
**LJS - lesser trochanter mets, iliopsoas insertion here
*LW: agree
*AJL - also agree. If it was psoas tear the high signal would be within the muscle not surrounding.
**SCS: crack the core; MSK “if you see an isolated “avulsion” of the LT in a seemingly mild trauma/injury in an adult - query a pathological fracture”
wji - im in. how many can we fit on this bandwagon.
Vitamin most associated with prostate carcinoma risk D E K A C
*LW:
UptoDate (again our exams are not): states
—> There may be a statistically significant increased risk with vitamin E, as showhn in large prospective trials.
—> Link between vitamin D and prostate is complex, with conflicting studies with regards to vitamin D deficiency as a common pathway.
Vitamin D
- *AJL
**LJS agree but vitamin D is protective! Big Rob 9th ed p984
SCS - I enjoy the D.
Least frequent with MEN1
Pituitary adenoma
Adrenal cortical adenoma
Pancreatic islet cell tumour
Phaeochromocytoma
Phaeochromocytoma yes
Least frequent with MEN1
Pituitary adenoma
Adrenal cortical adenoma
Pancreatic islet cell tumour
Phaeochromocytoma yes
It is now recognized that the spectrum of this disease extends beyond the 3Ps. The duodenum is the most common site of gastrinomas in individuals with MEN-1 (far in excess of the frequency of pancreatic gastrinomas), and synchronous duodenal and pancreatic tumors may be present in the same individual. In addition, carcinoid tumors, thyroid and adrenocortical adenomas, and lipomas are more frequent than in the general population.
Least true regarding Wilsons
Reduced ceruloplasmin
Increased excretion of copper into bile
Autosomal recessive
Increased excretion of copper into bile - no has reduced excretion
Least likely to cause splenomegaly
Biliary acsariasis
Cirrhosis
Schistosomiasis
Hepatitis B
Least likely to cause splenomegaly
Biliary acarisis no (helminthic infection, round worm)
Cirrhosis
Schistosomiasis (causes inflammatory response in the liver leading to fibrosis and cirrhosis)
Hepatitis B
Least likely a result of diabetes
Calcification of the vas deferans
Amyloidosis
Pancreatitis
Least likely a result of diabetes
Calcification of the vas deferans - most common cause
Amyloidosis - islet cell amyloidosis (below)
Pancreatitis no
A form of localised amyloidosis: endocrine amyloid: Microscopic deposits of localized amyloid may be found in certain endocrine tumors, such as medullary carcinoma of the thyroid gland, islet tumors of the pancreas, pheochromocytomas, and undifferentiated carcinomas of the stomach, and in the islets of Langerhans in individuals with type 2 diabetes mellitus.
Least true regarding wilms
Dysplastic kidneys risk factor
Most <2 years old
Least true regarding wilms
Dysplastic kidneys risk factor yes
Most <2 years old no
**LJS - MCDK now not thought to be risk factor for Wilms, several systematic reviews.
True regarding neuroblastoma
Metastases can regress in infants
Frequently lymph node involvement at diagnosis
VMA for screening
True regarding neuroblastoma
Metastases can regress in infants yes
Frequently lymph node involvement at diagnosis yes
VMA for screening yes
Infants with localized primary tumors and widespread metastases to the liver, bone marrow, and skin (stage 4S) represent a special subtype, wherein it is not uncommon for the disease to regress spontaneously. The biologic basis of this welcome behavior is not clear.
Unfortunately, most (60% to 80%) children present with stage 3 or 4 tumors
Because the vast majority of neuroblastomas release catecholamines into the circulation, detection of catecholamine metabolites (VMA and HVA) in urine could, in principle, form the basis for screening for asymptomatic tumors in children. However, two large studies in Europe and North America have failed to demonstrate improved mortality rates with population screening, because most tumors detected had favorable biologic characteristics. Therefore, community-based screening programs for neuroblastomas are not currently advocated.
Least associated with NF2
Meningioma Ependymoma Schwannoma Dural calcification Optic nerve glioma
Least associated with NF2
Meningioma Ependymoma Schwannoma Dural calcification Optic nerve glioma no
Most likely diagnosis – 2cm cystic mass in the head of the pancreas in a 50 year old male
IPMN
Mucinous
Serous
Adenocarcinoma
IPMN yes
**LJS - or serous. IPMN typically elderly males, this guy only 50. 75% serous occur in women.
- *SCS: Robbins.
- SCAs typically in the panc tail. Cysts are typically small, 1-3mm. Macrocystic variants are possible
- IPMN- head is typical location;M>F. Additional things- asscociation w pancreatic duct/ductal dilatation.
- MCM-95% women. Pancreatic tail. Larger cystic spaces filled w mucin. Encapsulated. Neoplastic potential, on a spectrum. 1/3 of surgically resected specimen harbour invasive adenoca.
Most likely to have pseudomembranes
Infectious colitis and pseudomembranous colitis
Dysentry and ischaemic colitis
Pseudomebranous colitis and ischaemic colitis
*AJL - Pseudomebranous colitis and ischaemic colitis
Infectious colitis and pseudomembranous colitis - No.
Robbins says pseudomembranes with c.diff, ischaemia and necrotising infections. I think this mean ‘infectious colitis’ doesn’t count.
True regarding mucinous ovarian carcinoma
70% 5 year survival with peritoneal disease
*AJL - Mean survival is 14 months with advanced stage (vs serous with 42 months) - Radiopaedia.
I suspect the wrong answer was remembered but hopefully we all still learned something.
StatDx:
Overall much better prognosis than other subtypes of epithelial ovarian cancer - 5-year overall survival in patients with localized disease exceeds 90%
Patients with advanced-stage primary mucinous carcinomas (stage III or IV) have significantly shorter overall survival compared to patients with advanced-stage serous carcinoma - Estimated median survival between 12 and 33 months compared to 42 months
WJI disagree. FIGO stage 2 is pelvic peritoneal disease and 5yr survival is 70% (statdx) so if peritoneal disease is limited to the pelvis answer is correct
**SCS
Stage 1: 90%, 2: 70%, 3: 39%, 4: 17% (stat dx gives numbers for malignant epithelial tumours in general)
Most likely regarding mixed mullerian tumours
Homologous with endometrial, mesenchymal elements
Heterologous with epidermal and neural elements
Combination/collision of two different germ cell lines
Most likely regarding mixed mullerian tumours
Homologous with endometrial, mesenchymal elements yes
Heterologous with epidermal and neural elements - F?
Combination/collision of two different germ cell lines - F
Majority of ovarian carcinosarcomas are monoclonal, suggesting they are metaplastic carcinomas
High-grade malignant epithelial (carcinoma) and malignant mesenchymal (sarcoma) elements
Either carcinomatous or sarcomatous component may predominate
Epithelial element is most commonly serous carcinoma
Homologous OCS contains malignant stromal elements native to ovary, whereas heterologous OCS contains sarcomatous tissue not normally found in ovary, e.g., cartilage, osteoid, and rhabdomyoblasts
Diabetic mastopathy least likely
Painful
Difficult to distinguish from tumour clinically
Soft mass
Thought to be autoimmune
- *LJS - painless hard mass (fibrotic), diffc ddx from ca clinically
- AJL agree. ?bad recall (maybe was most likely?)
Diabetic mastopathy least likely
WJI: Painful -false Difficult to distinguish from tumour clinically-true Soft mass-false Thought to be autoimmune-true
**SCS:Also ass/w autoimmune thyroid disease and Type 1 DM.
ADB-RP
Diabetic mastopathy manifests clinically as a large, painless, hard breast mass that is usually clinically indistinguishable from breast cancer.ts exact pathogenesis is poorly understood and likely multifactorial, possibly relating to an immunologic reaction,
Least likely regarding male breast cancer
Lobular comparatively more common than ductal when compared to females
Papillary comparatively more common than in females
50% have lymph nodes at presentation
Lobular comparatively more common than ductal when compared to females - no
Least likely regarding male breast cancer
Lobular comparatively more common than ductal when compared to females no
Papillary comparatively more common than in females
50% have lymph nodes at presentation - T
SCS: robbins.
-Dissemination follows the same pattern as in women, and axillary lymph node involvement is present in about HALF of cases at the time of diagnosis.
-Kleinfelters ass/w male BC (3-8% of cases)
-Incidence in men is only 1% of that in women.
4-14% attributed to BRCA2
ER positivity is more common in males
Least likely post acute MI
Pericarditis Mitral valve prolapse Aortic valve prolapse Mural thrombus Myocardial rupture
Aortic valve prolapse no
Least likely post acute MI
Pericarditis yes Mitral valve prolapse yes Aortic valve prolapse no Mural thrombus yes Myocardial rupture yes
Most true regarding haemophilia
Autosomal recessive
Most commonly affects the shoulder
Most common cause of death is HIV/AIDS
Ballooning of the epiphyses
Ballooning of the epiphyses yes
Most true regarding haemophilia
Autosomal recessive no
Most commonly affects the shoulder no
Most common cause of death is HIV/AIDS no
Ballooning of the epiphyses yes
**SCS Overgrowth of both epiphyses and metaphyses (Erlenmeir flask appearance) due to hyperaemia. Gracile diaphyses.
Most commonly associated with renal papillary necrosis
NSAIDS
Steroids
Most commonly associated with renal papillary necrosis
NSAIDS yes
Steroids
Mnemonic: AD SPORT C (see radiopaedia, lists causes in deacending order of frequency). First two are analgesics and diabetes…
Note a prior recall was similar, but in reverse asking which IS NOT a cause (renal arterial occlusion) where as renal vein thrombosis is….
