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
Which doesn’t cause bowel ischaemia
PAN
Behchets
Atherosclerosis
Which doesn’t cause bowel ischaemia
PAN yes
Behchets yes
Atherosclerosis yes
Most likely cause of acute bowel ischaemia
SMA atherosclerosis
SMV thrombosis
Aortic dissection
SMA embolus
SMA embolus AF most likely
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)
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 - yes aortic ischmus
What is least associated with BRCA
Pancreas
Prostate
CRC
Ovarian
What is least associated with BRCA Pancreas yes Prostate yes CRC yes no Ovarian yes
Most likely to cause colon cancer
PJ
UC
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
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
Villous atrophy -yes
Autoimmune reaction to ingested to gliadin -yes
Increased risk of MALToma -no MALToma with Hpylori, T lymphoma 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
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?
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
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
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
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 parsonate turners 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 involve teres minor
Quadralateral space -no teres minor only from axillary nerve
Brachial neuritis -yes parsonate turners 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)
*AJL - Supraclavicular mass (neurovascular bundle is largely infraclavicluar)
Least likely to cause thoracic outlet syndrome?
Levator clavicular muscle ?yes but super rare, above clavicle
Anterior scalene hypertrophy yes interscalene triangle
Cervical rib yes C7
Pectoralis minor tunnel yes subpectoral space
Supracalvicular mass NO
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
Partial filling defects associated with primary yes secondary chronic PE
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 - no
Can arise in people with previously normal blood pressure yes
Fibrinoid necrosis (or sclerosis) of the arteriole walls yes
Greater than 110mmHg diastolic yes
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
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
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
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
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
Least likely to cause gynaecomastia
Cirrhosis
Adrenal hyperplasia
Leydig cell tumour
Sertoli tumour
Least likely to cause gynaecomastia
Cirrhosis yes
Adrenal hyperplasia no
Leydig cell tumour yes
Sertoli tumour yes
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 - yes except for increased cancer risk
*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%
**LJS - HCG only slightly elevated. Produces human placental lactogen
- 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
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
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 ?
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
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
High grade surface osteosarcoma has a similar prognosis to conventional -yes
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
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
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- yes
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
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
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
The correct answer…
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
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.
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
Least frequent with MEN1
Pituitary adenoma
Adrenal cortical adenoma
Pancreatic islet cell tumour
Phaeochromocytoma
Least frequent with MEN1
Pituitary adenoma
Adrenal cortical adenoma
Pancreatic islet cell tumour
Phaeochromocytoma yes
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 acarisis
Cirrhosis
Schistosomiasis
Hepatitis B
Least likely to cause splenomegaly
Biliary acarisis no
Cirrhosis
Schistosomiasis
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
Amyloidosis
Pancreatitis no
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
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
Most likely diagnosis – 2cm cystic mass in the head of the pancreas in a 50 year old male
IPMN yes
Mucinous
Serous
Adenocarcinoma
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.
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
Combination/collision of two different germ cell lines
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
Painful - painless
Difficult to distinguish from tumour clinically
Soft mass
Thought to be autoimmune
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
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
Most commonly associated with renal papillary necrosis
NSAIDS
Steroids
Most commonly associated with renal papillary necrosis
NSAIDS yes
Steroids
