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
