Path Recalls 2017 Flashcards

1
Q

Which is not consistent with Wegeners?

Upper respiratory tract granulomas 
Lower respiratory tract granulomas
Renal artery vasculitis 
Pulmonary artery vasculitis 
Glomerulonephritis
A

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
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2
Q

Two questions on Churg strauss
Associated:
pANCA
eGPA

A

Two questions on Churg strauss
Associated pANCA yes
eGPA asthma, eosinophilia

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3
Q

Which doesn’t cause bowel ischaemia
PAN
Behchets
Atherosclerosis

A

Which doesn’t cause bowel ischaemia
PAN yes
Behchets yes
Atherosclerosis yes

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4
Q

Most likely cause of acute bowel ischaemia

SMA atherosclerosis
SMV thrombosis
Aortic dissection
SMA embolus

A

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

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5
Q

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

A
  • *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

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6
Q

What is least associated with BRCA

Pancreas
Prostate
CRC
Ovarian

A
What is least associated with BRCA
Pancreas yes
Prostate yes
CRC yes no
Ovarian yes
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7
Q

Most likely to cause colon cancer
PJ
UC

A

Most likely to cause colon cancer
PJ less likely but is associated with colon and breast
UC yes

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8
Q

Least likely to cause gastric cancer

Fundic gland polyp 
Hyperplastic polyp 
Adenomatous polyp 
Partial gastrectomy 
H pylori
A

Hyperplastic polyp - virtually no malignant potential.

Fundic gland polyp - yes, most common polyp
Adenomatous polyp yes
Partial gastrectomy yes
H pylori yes

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9
Q

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
A

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

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10
Q

Most common location of small bowel adenocarcinoma

Duodenum 
Proximal jejunum 
Distal jejunum
Proximal ileum
Distal ileum
A

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
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11
Q

Young patient with bicornuate uterus and one kidney

Mesonephric duct
Mullerian duct
Wolffian duct
Genital ridge

A

Mullerian duct mullarian anomalies

Young patient with bicornuate uterus and one kidney

Mesonephric duct
Mullerian duct mullarian anomalies
Wolffian duct
Genital ridge

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12
Q

Newborn with dilated colon and unilateral sacral agenesis

Hirschsprungs
Anal atresia
Ileal atresia
Meconium plug

A

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

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13
Q

Which is associated with CF?

Hypertrophic pyloric stenosis

A

Which is associated with CF?

Hypertrophic pyloric stenosis articles say maybe, but I would say no

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14
Q

Which is most suggestive of UC?

Pseudopolyps
Uveitis
Fistulas
Sacroiliitis

A

Pseudopolyps yes.

Which is most suggestive of UC?

Pseudopolyps yes
Uveitis IBD
Fistulas no
Sacroiliitis IBD

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15
Q

Most consistent with reactive arthritis?

Symmetrical sacroiliitis
Shoulder arthropathy
Commonly follows GI infection

A

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

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16
Q

Hydroxyapetite deposition disease associated with?

Dermatomyositis
Sjogrens
Scleroderma
Dialysis

A

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

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17
Q

Least liekly to have changes in CJD?

Dentate nuclei
Caudate
Putamin
Thalami

A

Dentate nuclei no

Least liekly to have changes in CJD?

Dentate nuclei no
Caudate yes BG
Putamin yes BG
Thalami yes hockey stick

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18
Q

Least likely CADASIL manifestation?

External capsule ischaemia 
Basal ganglia ischaemia 
Anterior temporal white matter change
Periventricular white matter changes
Skin changes
A

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

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19
Q

Most true regarding HSV?

HSV1 Most common cause of neonatal encephalitis
HSV2 most common cause of adult encephalitis
Causes haemorrhagic necrosis

A

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

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20
Q

What is the least likely consequence of herniation?

DAI 
Duret haemorrhage 
ACA infarct 
PCA infarct 
Kernohans notch
A

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

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21
Q

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

A

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

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22
Q

Least likely to cause thoracic outlet syndrome?

Levator clavicular muscle 
Anterior scalene hypertrophy 
Cervical rib 
Pectoralis minor tunnel 
Supracalvicular mass
A

**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

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23
Q

Varicose veins most correct?

Vein thickening
Enlarged vein with competent valves
Venous ulcers that are slow to heal
Cause significant numbers of PE

A

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

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24
Q

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

A

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

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25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
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.
33
``` Most common testicular cancer Yolk sack Teratoma Seminoma Choriocarcinoma ```
Seminoma yes ``` Most common testicular cancer Yolk sack Teratoma Seminoma yes Choriocarcinoma ```
34
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.)
35
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
36
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
37
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)
38
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
39
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
40
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
41
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
42
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
43
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
44
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
45
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
46
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 ```
47
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 ```
48
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...
49
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
50
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.
51
``` 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
52
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
53
Least true regarding Wilsons Reduced ceruloplasmin Increased excretion of copper into bile Autosomal recessive
Increased excretion of copper into bile - no has reduced excretion
54
Least likely to cause splenomegaly Biliary acarisis Cirrhosis Schistosomiasis Hepatitis B
Least likely to cause splenomegaly Biliary acarisis no Cirrhosis Schistosomiasis Hepatitis B
55
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
56
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.
57
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
58
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 ```
59
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
60
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.
61
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.
62
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
63
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
64
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
65
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 ```
66
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
67
Most commonly associated with renal papillary necrosis NSAIDS Steroids
Most commonly associated with renal papillary necrosis NSAIDS yes Steroids