path recallse sept 2013 NSW - formatted

Question 1

1. Cause of PML

a. HIV
b. Jakob Creutzfeldt virus
c. Measles
d. rabies
e. CMV

Answer 1

*LW:
JC virus:
JC virus activation in immunosuppression such as HIV, post transplant etc.

a. HIV jc virus in HIV. Bilateral, asymmetrical in frontotemporal most common, involve subcortical u-fibres.

Question 2

2. VHL not associated (repeat)

a. renal cell papillary
b. renal cell clear cell
c. casabellar (yes misspelled like that) haemangioblastoma
d. renal haemangioblastoma
d. pheochromocytoma

Answer 2

a. renal cell papillary

Question 3

3. Hyaline membrane disease what is incorrect (slight variation on previous)

a. predisposed in maternal diabetes
b. predisposed in cesarean section
c. type I pneumocytes produce surfactant
d. bronchi lined with necrotic cells and fibrin

Answer 3

c. type I pneumocytes produce surfactant type 1 pneumocyte - gas exchange
type 2 pneumocyte - surfactant
primary hyaline deficiency - rare
secondary hyaline deficiency - maternal diabetes

Question 4

3. What is most likely to be a spiculated mass

a. tubular
b. medullary
c. papillary
d. lobular
e. DCIS

Answer 4

a. tubular almost always spiculated mass.

e. DCIS also most common appearance but may be asymmetries or distortions in up to 50%

Question 5

4. Which is not important in grading breast cancer

a. invasive lobular carcinoma
b. mitosis
c. tubule formation
d. mucin production
e. nuclear pleomorphism

Answer 5

*LW:
Grade of breast carcinoma:
 - tubule formation
 - nuclear grade
 - mitotic rate.

thus invasive lobular carcinoma and mucin production are not features of the normal histological grading of breast cancer.

All are

Question 6

5. Medulloblastoma which is false

a. has rosettes
b. Has round nucleus with abundant cytoplasm
c. Most common paediatric posterior fossa tumour

Answer 6

• LW:
  5. Medulloblastoma which is false

a. has rosettes - TRUE Homer Wright ROssettes.
b. Has round nucleus with abundant cytoplasm - FALSE - Scant cytoplasm
c. Most common paediatric posterior fossa tumour: controversial but likely true out of these options.

Question 7

6. Which is least associated with NF1

a. lisch nodules
b. CN 8 schwannoma
c. kyposcolois
d. café au lait

Answer 7

b. CN 8 schwannoma

Question 8

7. CCAM (similar to prior repeat)

a. supplied by systemic circulation
b. mostly homogenous
c. most contains 1 or more large cysts
d. has a well defined internal bronchial system

Answer 8

c. most contains 1 or more large cysts

Question 9

8. Sequestration most common location (repeat)
9. LLL
10. RLL
11. LUL
12. RML
13. RUL

Answer 9

1. LLL

Question 10

9. CF is caused by a genetic trait that needs to be homozygous to be symptomatic.

a. Two heterozygous parents have a 25% chance of a symptomatic child
b. Two symptomatic homozygous parents have a 50% chance of a symptomatic child
c. A symptomatic homozygous parent and a heterozygous parent etc.

Answer 10

a. Two heterozygous parents have a 25% chance of a symptomatic child
AR inheritence

Question 11

10. Gout which is false (repeat)

a. 10% die of renal failure
b. tophi calcify
c. tophi occur in fingertips and toes
d. erosions occur before marked loss of articular cartilage
e. can be secondary to chronic diuretic use

Answer 11

a. 10% die of renal failure - 20%

10. Gout which is false (repeat)
    a. 10% die of renal failure - 20%
    b. tophi calcify – can do
    c. tophi occur in fingertips and toes depends on what you define as a finger tip – definitely occur around the DIPJ
    d. erosions occur before marked loss of articular cartilage possibly. Both occur in chronic tophaceous. **LJS agree - joint space is preserved until late

Question 12

11. Pancreatitis Which is incorrect (variation of repeat)

a. 10-20% of patients with gallstones get acute pancreatitis
b. SPINK1 gene can cause acute pancreatitis
c. associated with activation of trypsinogen
d. seen pathologically with yellow chalky appearance indicating necrotic fat

Answer 12

a. 10-20% of patients with gallstones get acute pancreatitis 5% in robbins.

Although Radiopaedia says up to 15%
spink 1 gene - Mutations in this gene are associated with hereditary pancreatitis and tropical calcific pancreatitis - cause chronic pancreatitis
macroscopic - swollen pale pancreas.

Question 13

12. Alpha 1 anti-trypsin which is false

a. causes cirrhosis and emphysema
b. AD with variable penetrance
c. classically causes lower zone emphysema
d. is a common cause of jaundice in the neonate

Answer 13

• LW: Favoured answer is B: AD is incorrect, it is AR inheritance.
  a. causes cirrhosis and emphysema: True
  b. AD with variable penetrance: False, Robbins states it as AR.
  c. classically causes lower zone emphysema: True
  d. is a common cause of jaundice in the neonate: Likely true, Robbins states among new borns 10-20% show colestasis.

Question 14

13. Which does not cause AVN (variant of previous)

a. cirrhosis
b. pancreatitis
c. collagen vascular disease
d. dysbarism
e. gauchers

Answer 14

a. cirrhosis although alcoholism can

Question 15

14. Which does not cause AVN (yes question repeated with one different option)

a. AMI
b. pancreatitis
c. collagen vascular disease
d. dysbarism
e. gauchers

Answer 15

a. AMI

Question 16

15. Which does not cause acute small bowel ischemia (repeat)

a. atherosclerotic stenosis SMA
b. Bechets
c. PAN
d. atrial fibrillation
e. aortic dissection

Answer 16

b. Bechets not specifically mentioned in robbins

Behçet disease is a multisystemic and chronic inflammatory vasculitis of unknown etiology.

Question 17

16. What favors acute over sub acute bacterial endocarditis

a. 1 cm large vegetation
b. slow increase in size of vegetation
c. no presence of metastatic infection
d. no perforation of leaflets
e. pre-existing damaged valve leaflet

Answer 17

*LW:
Agree, favoured answer is large vegetation:
Pathoma states, Strep viridins most commons cause over all, as causes Sub acute IE - resulting in small vegetations.
Staph aureus high virulence organism, resulting in large vegetations.

a. 1 cm large vegetation

16. What favors acute over sub acute bacterial endocarditis
    a. 1 cm large vegetation This is what the Auckland intensive course answers had as correct

b. slow increase in size of vegetation: Sub acute
c. no presence of metastatic infection: sub acute.
d. no perforation of leaflets: sub acute.
e. pre-existing damaged valve leaflet - I think best answer if question is “what favours subacute over acute”..

Question 18

18. Fibroadenomas false (similar to prior repeats)

a. common in postmenopausal women
b. most below the age of 45
c. contain foci of invasive carcinoma
d. more than a third in patients on cyclosporine for renal

Answer 18

c. contain foci of invasive carcinoma

18. Fibroadenomas false (similar to prior repeats)
    a. common in postmenopausal women but uncommonly present post menopause
    b. most below the age of 45
    c. contain foci of invasive carcinoma do have a very low rate of conversion.

Question 19

19. Adamantinoma true

a. multicystic lytic lesion
b. single lytic lesion
c. multiple lytic lesions
d. sclerosis and trabecular thickening

Answer 19

a. multicystic lytic lesion

Question 20

20. Leiomyoma which is true (repeat)

a. not even moderate mitotic activity
b. bleeding is associated with malignancy
c. benign tumors are polyclonal
d. size >10cm has an increased risk of malignancy
e. cords of tumour cells in veins indicates malignancy

Answer 20

a. not even moderate mitotic activity

Question 21

21. Not a location of ectopic pancreatic tissue (repeat)

a. duodenum
b. jejunum
c. ileum
d. colon
e. stomach

Answer 21

colon

Question 22

22. Which is most likely bilateral (no serous was not an option)

a. endometriod
b. Brenner
c. mucinous
d. dermoid (mature teratoma)

Answer 22

a. endometriod 30 odd percent

22. Which is most likely bilateral (no serous was not an option)
    a. endometriod 30 odd percent
    b. Brenner 6-7%
    c. mucinous 5%
    d. dermoid (mature teratoma) 20%

Question 23

23. What makes serous the most likely diagnosis in a right sided ovarian tumor that is cystic and 5 cm

a. similar lesion on the other side
b. ascites
c. calcifications
d. papillary projections

Answer 23

a. similar lesion on the other side
23. What makes serous the most likely diagnosis in a right sided ovarian tumor that is cystic and 5 cm

a. similar lesion on the other side
b. ascites
c. calcifications
d. papillary projections others, such as mucinous, can have these

Question 24

24. Carcinoid affects which heart valves

a. tricuspid and pulmonary
b. mitral and aortic can if lung origin
c. tricuspid and mitral
d. aortic and pulmonary

Answer 24

a. tricuspid and pulmonary

Question 25

25. Craniopharingomas incorrect a. lobulated and ill defined b. can calcify in a child c. bimodal d. In adults CPs are solid

Answer 25

a. lobulated and ill defined (well defined)

Question 26

26 CF wrong a. affects Na channel b. presents as pancreatitis in children c. most associated with DF508 mutation d. on chromosome 7 e. azospermia f. CF is commonly associated with deficiency of fat soluble vitamins

Answer 26

a. affects Na channel CFTR gene located on chromosome 7q31.2 ∂F508 a. affects Na channel b. presents as pancreatitis in children not initial presentation c. most associated with DF508 mutation d. on chromosome 7 e. azospermia f. CF is commonly associated with deficiency of fat soluble vitamins

Question 27

27. CF most commonly associated a pseudomonas b. TB c. ABPA

Answer 27

a pseudomonas almost all patients

Question 28

28 Ewings true (repeat) a. most commonly 15-20 year olds b. neuroblastoma is in the differential c. occurs in metaphysis d. aggressive chondroblastoma is in the differential e. characterized by early metastases to the liver

Answer 28

a. most commonly 15-20 year olds median 13 years a. most commonly 15-20 year olds - median 13 years b. neuroblastoma is in the differential **LJS - can look like neuroblastoma mets but only in appropriate age group. Mean age of neuroblastoma presentation in 2 yr, so younger than Ewings c. occurs in metaphysis - yes but also diaphysis (30%), flat bones d. aggressive chondroblastoma is in the differential e. characterized by early metastases to the liver

Question 29

29. Neuroblastoma true a. under 1 year old commonly spontaneously regress b. usually amendable to complete surgical resection at diagnosis c. diagnosis and surveillance done with VMA and HMA

Answer 29

c. diagnosis and surveillance done with VMA and HMA a. under 1 year old commonly spontaneously regress can do, not common? b. usually amendable to complete surgical resection at diagnosis 70% stage 3 or 4 c. diagnosis and surveillance done with VMA and HMA

Question 30

30. Wilms tumor true a. WAGR b. when bilateral almost always have nephrogenic rests c. poor prognosis despite treatment

Answer 30

*LW: a. WAGR : The WAGR syndrome stands for: Wilms tumours (greatly increased risk) Aniridia Genital anomalies intellectual Retardation (disability) b. when bilateral almost always have nephrogenic rests: Probably true: Robbins states; important to document presence of neprhogenic rests in resected specimen, as patient at increased risk for developing Wilms in contra lateral kidney. c. poor prognosis despite treatment: False, usually good outcome with treatment.

Question 31

31. Elderly male patient with known heart disease, develops cirrhosis. What is the most likely underlying condition? (repeat) a. restrictive pericarditis b. dilated cardiomyopathy c. aortic stenosis d. mitral valve disease e. ASD

Answer 31

*LW: difficult question, as most common cause of congestive cirrhosis is right sided failure, with most common cause of RHF is left sided failure, with below frequency: The most frequent causes of cardiac cirrhosis are the following: Ischemic heart disease (31%) Cardiomyopathy (23%) Valvular heart disease (23%) Primary lung disease (15%) Pericardial disease (8%) Thus for the listed options, if a true recall, I would favour dilated cardiomyopathy. Previous answers: a. restrictive pericarditis 31. Elderly male patient with known heart disease, develops cirrhosis. What is the most likely underlying condition? (repeat) a. restrictive pericarditis b. dilated cardiomyopathy c. aortic stenosis may also be true – most common cause of right heart failure is left heart failure (ischaemic, HTn, valvular disease most common) d. mitral valve disease e. ASD

Question 32

32. Doesn’t cause hepatic fibrosis (repeat) a. Budd Chiari b. biliary atresia c. hemochromatosis d. Wilsons e. Alpha 1 anti-trypsin

Answer 32

*LW: All do, although only in chronic / slow developing thrombus of Budd Chiari, and not in acute setting, thus if was acute Budd Chiari, this would be my favoured option for not causing hepatic fibrosis. All do?, PSC, PBC, schistosomiasis, NRH and fibropolycystic may not. Would probably choose budd chiari if I had to.

Question 33

33. Which is not a type of Hodkins Lymphoma (repeat) a. lymphocyte predominant b. lymphocyte rich c. lymphocyte depleted d. anaplastic e. mixed cellularity

Answer 33

d. anaplastic

Question 34

34. Most common thyroid cancer (repeat) a. anaplastic b. papillary c. medullary d. follicular e. Hurtle cell

Answer 34

b. papillary

Question 35

35. Which of these conditions are correctly described a. Sturge Weber - cortical malformations, seizures and glioma b. NF2 - plexiform neurofibroma, brain and spinal astrocytoma, and hyper pigmented skin lesions c. VHL - cerebellar haemangioblastoma, adrenal and lung cancer d. HHT - mucosal telangiectasia, cerebral and lung AVMs e. Tuberous sclerosis - subependymomas, mental retardation and RCC

Answer 35

d. HHT - mucosal telangiectasia, cerebral and lung AVMs * LW: a. Sturge Weber - cortical malformations, seizures and glioma: Incorrect - No glioma. VHL has Subcortical Ca++ with volume loss, facial cutaneous haemangioma V1 of the trigeminal nerve, childhood seizures, choroidal or scleral angiomatous involvement, which may be complicated with retinal detachment, buphthalmos or glaucoma. b. NF2 - plexiform neurofibroma, brain and spinal astrocytoma, and hyper pigmented skin lesions: No neurofibromas in NF2 (occurs in NF1). c. VHL - cerebellar haemangioblastoma, adrenal and lung cancer: Associated with adrenal pheochomocytomas, not adrenal carcinoma, no mention of lung cancer. d. HHT - mucosal telangiectasia, cerebral and lung AVMs: Correct. e. Tuberous sclerosis - subependymomas, mental retardation and RCC: RCC doesn't occur with greater frequency, rather at a younger age than normal population.

Question 36

36. Infective endocarditis least correct a. Associated with mycotic aneurysms b. Infection of the aortic valve may spread through the aortic valve ring to the pericardium c. Infection of the aortic valve may cause aortic incompetence d. Left sided valves are involved more commonly than right sided valves e. fungal endocarditis is a rare cause

Answer 36

b. Infection of the aortic valve may spread through the aortic valve ring to the pericardium * LW: ring abscess into adjacent myocardium

Question 37

37. What is most indicative of a complication post pneumonectomy (repeat) a. Rising air fluid level b. mediastinal shift towards the side of pneumonectomy c. mediastinal shift away from the side of pneumonectomy d. no mediastinal shift e. complete obliteration of the pneumonectomy site

Answer 37

c. mediastinal shift away from the side of pneumonectomy

Question 38

38. Thalamic and basal ganglia infarct in a 30 year old female patient. Which vein is most likely thrombosed (repeat) a. ISS b. SSS c. internal cerebral veins d. cavernous sinus e. vein of Labbe

Answer 38

c. internal cerebral veins

Question 39

39. Phaeochromocytoma is not seen in a. VHL b. Von Recklinghausen c. Sturge Weber d. MEN1 e. VHL

Answer 39

d. MEN1

Question 40

40. Anaphylaxis may be associated with contrast and may occur within a wide time frame after administration. Which is most relevant with regards to anaphylaxis? a. Hives and normal BP b. Gastrointestinal symptoms and normal BP c. Respiratory distress and increased BP d. mucosal swelling and decreased BP e. Rash and increased BP

Answer 40

d. mucosal swelling and decreased BP

Question 41

41. Lowest association with gastrointestinal malignancy a. pernicious anemia b. partial gastrectomy c. Cronkite Canada syndrome d. Coeliac disease e. Ulcerative colitis

Answer 41

* LW: c. Cronkite Canada syndrome 41. Lowest association with gastrointestinal malignancy a. pernicious anemia can cause carcinoid, adenocarcinoma. b. partial gastrectomy increased risk c. Cronkite Canada syndrome: non-neoplastic, non-hereditary hamartomatous polyposis syndrome characterised by rash, alopecia, and watery diarrhoea, with no increased risk of malignancy. d. Coeliac disease increased risk adeno, lymphoma e. Ulcerative colitis adeno

Question 42

42 Pseudomembranes are most commonly seen in: (repeat) a. Pseudomembranous colitis and dysentery b. Pseudomembranous colitis and ischemic colitis c. Inflammatory bowel disease and dysentery(sic) d. Pseudomembranous colitis and Chrons

Answer 42

*LW: b. Pseudomembranous colitis and ischemic colitis Most common cause of pseudo membranes is Pseudomembranous colitis secondary to C. Difficile infection. The other mention of pseudomembranes in Robbins is Ischaemic colitis, volvulus, necrotising infections (Staph, shigella, candida, NEC) thus B is favoured answer. Previous answer: Less common non-C. difficile causes of pseudomembranous colitis include Behcet’s disease, collagenous colitis, inflammatory bowel disease, ischemic colitis, other infections organisms (e.g. bacteria, parasites, viruses), and a handful of drugs and toxins.

Question 43

43. Least associated with smoking: (repeat) a. Small cell carcinoma b. Large cell carcinoma c. Invasive adenocarcinoma d. Adenocarcinoma with lepidic spread (BAC) e. Typical carcinoid

Answer 43

e. Typical carcinoid

Question 44

44. Which is not a location of small blue cell tumour in a child (repeat) a. Renal b. Testes c. Eye d. Bone e. Brain

Answer 44

b. Testes

Question 45

45. True regarding Hashimoto’s thyroiditis a. No increased risk of cancer b. Rarely detectable anti thyroid antibody c. Presentation with hyperthyroidism is rare d. Rarely causes hypothyroidism e. Rarely cause a goiter

Answer 45

* LW: c. Presentation with hyperthyroidism is rare 5% 45. True regarding Hashimoto’s thyroiditis a. No increased risk of cancer - FALSE Marginal zone B-cell lymphoma, possibly papillary cancer. b. Rarely detectable anti thyroid antibody: False c. Presentation with hyperthyroidism is rare - TRUE 5% d. Rarely causes hypothyroidism: FALSE e. Rarely cause a goiter - FALSE

Question 46

46. Why is Pagets occult? (repeat) a. It is an ezcematoid reaction and may be associated with other conditions b. DCIS infiltrates the areola and DCIS may be mammographically occult c. DCIS infiltrates the areola and rarely (<3%) extends beyond the lactiferous sinuses d. A paraneoplastic reaction

Answer 46

b. DCIS infiltrates the areola and DCIS may be mammographically occult

Question 47

47. EAA a. Fibrosis occurs in the lower zones b. DDX for UIP c. organic allergens d. honeycombing

Answer 47

c. organic allergens

Question 48

49. Not associated with dilated perivascular spaces (repeat) a. cystercicosis b. TBI c. Cryptococcus d. metachromatic leukoencephalopathy

Answer 48

*LW: favoured answer is D - metachromatic leukoencephalopathy Radiopedia states dilated perivascular space associations: They are usually idiopathic, although they are seen in greater frequency in: - mucopolysaccharidoses, e.g. Hunter disease, Hurler disease - some muscular dystrophies - traumatic brain injury - hypertensive encephalopathy - cerebral amyloid angiopathy Mimics: - Megalencephaly With Leukoencephalopathy and Cysts Therefore: a. cystercicosis: likely a mimic. b. TBI: True c. Cryptococcus: true d. metachromatic leukoencephalopathy: Likely not associated hence favoured answer: Metachromatic leukodystrophy (MLD) is the most common hereditary (autosomal recessive) leukodystrophy, lysosomal storage disorders. It has characteristic imaging features including peri-atrial and to a lesser extent frontal horns leukodystrophy as well as periventricular perivenular sparing. Previous answers: All of these!! probably put metachromatic leukoencephalopathy a. cystercicosis ? Mimic b. TBI definitely c. Cryptococcus definitely d. metachromatic leukoencephalopathy Not mentioned in Stat Dx, but is elsewhere

Question 49

51. Regarding GTD which is true (similar to previous years) a. Gestational and non-gestational choriocarcinoma have the same prognosis b. 10-15% of partial moles lead to choriocarcinoma c. Complete mole is usually due to 1-2 sperm fertilizing an egg devoid of chromosomes d. 25% arise from aborted pregnancies

Answer 49

c. Complete mole is usually due to 1-2 sperm fertilizing an egg devoid of chromosomes a. Gestational and non-gestational choriocarcinoma have the same prognosis b. 10-15% of partial moles lead to choriocarcinoma c. Complete mole is usually due to 1-2 sperm fertilizing an egg devoid of chromosomes d. 25% arise from aborted pregnancies - true for choriocarcinoma

Question 50

52. Which is the most common cause of osteomalacia a. renal failure b. vitamin D deficiency c. hypophosphatemia d. hyperparathyroidism

Answer 50

a. renal failure

Question 51

53. Regarding Conns which is true a. single adrenal (yes that’s all they put) b. hyperkalemia c. hypercalcemia d. hypotension

Answer 51

a. single adrenal (yes that’s all they put) usually solitary adrenal adenoma.

Question 52

54. Regarding HSV encephalitis which is true? a. involves limbic system b. hemorrhagic c. spares basal ganglia d. unilateral e. has mass effect

Answer 52

*LW: likely poor recall and likely which is false: a. involves limbic system - TRUE b. hemorrhagic - TRUE (can be haemorrgic) c. spares basal ganglia - TRUE d. unilateral - FLASE usually bilaterall but asymmetric e. has mass effect: TRUE Previous answer c. spares basal ganglia

Question 53

55. Regarding spinal tumours a. Ependymomas and haemangioblastomas are the most common spinal tumours in adults b. Medulloblastoma is the most common childhood brain tumour under 4 years c. The most common intradural extramedullary tumour in the lumbar spine is meningioma d. The most common intradural intramedullary tumour in the lumbar spine is lymphoma

Answer 53

* LW: difficult question all technically wrong..... so would then roll the dice with medulloblastoma 55. Regarding spinal tumours a. Ependymomas and haemangioblastomas are the most common spinal tumours in adults: FALSE epndymomas most common, astrocytoma second most common. b. Medulloblastoma is the most common childhood brain tumour under 4 years: most common posterior fossa mass, although controversal as DOnnely states astrocytoma most common posterior fossa mass also. c. The most common intradural extramedullary tumour in the lumbar spine is meningioma: FALSE, meningioma is most common in thoracic spine, with only 5% of meningiomas occuring in the lumbar spine. d. The most common intradural intramedullary tumour in the lumbar spine is lymphoma: False - intra medullary lymphoma most commony effects cervical > thoracic > lumbar. **LJS - agree. JPA most common paediatric brain tumour, but peak incidence 5-20yr, and medulloblastoma 2nd most common posterior fossa tumour and is typically younger (0-4yr). All others are false, this is best answer Previous answer: b. Medulloblastoma is the most common childhood brain tumour under 4 years most common posterior fossa.

Question 54

56. Which is not a WHO grade 1 tumor a. subependymal giant cell tumour b. pilocytic astrocytoma c. pleomorphic xanthoastrocytoma d. optic nerve glioma

Answer 54

c. pleomorphic xanthoastrocytoma

Question 55

57. Demyelination which is false (repeat). a. Central pontine myelinosis is associated with alcoholism b. ADEM follows a bacterial infection reasonably well documented c. In MS, “Dawson’s fingers” are related to the medullary veins d. In MS, demyelination occurs in a perivenous distribution e. Diffuse axonal injury results in demyelination

Answer 55

Difficult ADEM can follow bacterial infection. DAI can result in demyelination. **LJS agree, diffc. Robbins says after viral infection or viral immunisation, but googling suggests many think it can happen after bacterial infection. Robbins doesn't mention demylination in DAI section, but papers mention this as a long term consequence, along with Wallerian degeneration of the axons *LW: UpToDate (which our exam is not): states the following non viral pathogens have been implicated in ADEM: ---> Borrelia burgdorferi, chlamydia, Leptospira, Mycoplasma pneumoniae, rickettsia, and beta hemolytic Streptococcus

Question 56

58. Which is false regarding lung cancer (repeat) a. squamous cell is central b. small cell is peripheral c. carcinoid arises from neuroendocrine cells d. smoking is responsible for 80% of lung cancers

Answer 56

b. small cell is peripheral can be both

Question 57

59. What does LCH not involve (repeat) a. skull b. orbit c. adenohypophyseal axis d. trachea and major bronchi e. pulmonary interstitium and alveoli

Answer 57

d. trachea and major bronchi

Question 58

60. Wegners false (repeat) a. renal artery vasculitis b. upper respiratory granulomatosis c. lower respiratory granulomas d. glomulonephritis e. pulmonary artery vasculitis

Answer 58

probably renal artery vasculitis- the glomeruli vessels are affected not renal artery pulmonary artery definitely affected

Question 59

61. Which causes hypersensitivity pneumonitis (EAA) a. silica dust b. asbestos dust c. thermophilic bacteria

Answer 59

c. thermophilic bacteria

Question 60

62. Doesn’t cause lung fibrosis (repeat) a. aspirin b. bleomycin c. methotrexate d. busulphan e. nitrofurantoin

Answer 60

a. aspirin **LJS - aspirin causes ILD but is ARDS like reaction, ?not fibrotic

Question 61

63. Which is true a. if a patient has an AVM and an aneurysm if there is a bleed there is a greater than 50% chance that the aneurysm is what bled b. a 25mm aneurysm is more likely to rupture than a 10mm aneurysm

Answer 61

b. a 25mm aneurysm is more likely to rupture than a 10mm aneurysm

Question 62

64. In regards to sellar masses: (may be melding several questions here) a. Pituitary adenomas are associated with VHL b. The papillary type of craniopharyngioma is typically cystic c. Pituitary microadenomas can present with lactation, amenorrhoea and loss of libido d. Pituitary macroadenomas can cause bitemporal hemianopia e. Pituitary microadenomas are found incidentally in 2% of autopsies

Answer 62

c. Pituitary microadenomas can present with lactation, amenorrhoea and loss of libido d. Pituitary macroadenomas can cause bitemporal hemianopia

Question 63

65. Lung cancer which is false: a. Bronchial adenoma central b. Bronchial adenoma always benign and never metastasises c. Carcinoid derived from neuroendocrine cells d. Adenocarcinoma equal in men and women e. bronchial carcinomas are rarely secondary

Answer 63

*LW: bronchial adenoma was the historical and incorrect term for bronchila carcinoid - classic question.... b. Bronchial adenoma always benign and never metastasises

Question 64

66. Ependymoma a. Involves foramen magnum in majority of paediatric presentations b. Cause hydrocephalus by overproduction of CSF c. Affects lateral ventricle in adults

Answer 64

*LW: Would favour option A: a. Involves foramen magnum in majority of paediatric presentations: - Soft plastic tumour that squeezes through foramen of Magendie into cisterna MAgna. b. Cause hydrocephalus by overproduction of CSF: doesnt produce CSF, hydrocephlus secondary to obstruction. c. Affects lateral ventricle in adults: - Adults still commonly occurs in posterior fossa - Supra tentorial is more commonly intra parenchymal Previous answer: c. Affects lateral ventricle in adults?

Question 65

67. Regarding Hodgkin’s disease (repeat) a. Reed Sternberg cells are abnormal B cells b. Hodgkin’s disease can co-exist with NHL c. can not diagnose Hodgkin’s on FNA

Answer 65

a. Reed Sternberg cells are abnormal B cells Reed-Sternberg cells are a classical finding diagnostic of Hodgkin lymphoma. They are giant, multinucleated cells with abundant pale cytoplasm.

Question 66

68. Septic arthritis of the knee least commonly spreads from a. An abscess b. Osteomyelitis c. Adjacent cellulitis d. Iatrogenic (eg. from a joint replacement)

Answer 66

c. Adjacent cellulitis Haematogenous spread is more common than contiguous

Question 67

69. VHL – which is least likely a. pheochomocytona (yes it was spelt that way) b. camebellar haemangioblastoma (yes it was spelt that way) - Assume thye mean cerebellar haemangioblastoma c. pancreatic cancer d. renal cell carcinoma e. renal haemangioblastoma

Answer 67

*LW: - Renal heamangioma VHL Associations: a. pheochromocytona - TRUE 20-30% b. Cerebellar haemangioblastoma - TRUE approx 60% c. pancreatic cancer - Less True - Pancreatic cysts, neuroendocrine tumours, serous cystadenoma, adenocarcinoma rare. d. renal cell carcinoma: TRUE e. renal haemangioblastoma - FALSE (Renal lesions of RCC, cysts, angiomyolipomas)

Question 68

70. Regarding BPH which is false. a. Nodules start initially in the peripheral zone b. Is a pre-malignant condition c. Can be associated with a raised PSA

Answer 68

*LW: a. Nodules start initially in the peripheral zone - False (i think, as affects the transition / central zone) b. Is a pre-malignant condition` - FALSE

Question 69

71. Which is the commonest cause of jaundice in pregnancy? (repeat) a) Intrahepatic cholestasis b) Viral hepatitis c) HELLP d) Acute fatty liver of pregnancy e) Preeclampsia

Answer 69

b) Viral hepatitis in robbins

Question 70

72. Most common solid hypothalamic lesion in a 15 year old male a. Ependymoma b. Ganglioglioma c. GBM d. Pilocytic astrocytoma

Answer 70

d. Pilocytic astrocytoma

Question 71

73. Thickened gastric folds but preserved rugae which is most likely? a. GIST b. Ectopic pancreas c. Lymphoma d. Linitis plastic e. Carcinoid.

Answer 71

c. Lymphoma

Question 72

74. In regards to adenomyosis which is true? a. more uniform enlargement compared to fibroids b. early loss of cyclical hormonal influence c. found in ?% of autopsy specimens d. each nest of cells is monoclonal

Answer 72

a. more uniform enlargement compared to fibroids

Question 73

75. Regarding hydrocephalus which is true (repeat) a. Normal pressure hydrocephalus is a non-communicating hydrocephalus with normal pressure on LP. b. 40% of young adults with hydrocephalus have increased head size c. Normal pressure hydrocephalus is caused by an obstructing mass d. Ependymomas cause hydrocephalus by overproduction of CSF e. Severe obstructive hydrocephalus can cause rupture of the suprapineal recess

Answer 73

e. Severe obstructive hydrocephalus can cause rupture of the suprapineal recess

Question 74

76. Regarding muscle denervation which is true? a. muscle injury results in lipofuscin accumulation b. denervation injury results in fatty atrophy c. muscle displays myoglobulin accumulation d. muscle displays fibrosis

Answer 74

b. denervation injury results in fatty atrophy a. muscle injury results in lipofuscin accumulation Kaplan notes say this occurs with atrophy. Elsewhere says age related

Question 75

77. Regarding undescended testicles which is true a. more likely to undergo torsion b. most that are detected on initial screening have descended by 1 year c. most are intra-abdominal

Answer 75

b. most that are detected on initial screening have descended by 1 year

Question 76

78. With regard to ILD, which of the following statements is false? (repeat) a. Collagen vascular disease associated with NSIP b. Connective tissue disease associated with UIP c. Heavy smoking associated with DIP d. DIP has a better prognosis than UIP e. UIP has a better prognosis than NSIP

Answer 76

e. UIP has a better prognosis than NSIP

Question 77

79. A 60 year old woman is on hormonal replacement therapy. Which is most likely (repeat) a. cholestasis b. cholelithiasis c. acute fatty liver d. cirhossis e. hepatic necrosis

Answer 77

b. cholelithiasis | a. cholestasis this is also in robbins

Question 78

80. Which of these conditions is not associated with breast cancer a. BRCA2 b. VHL c. Cowden d. ataxia telengectasia

Answer 78

b. VHL ``` Genetic conditions associated with breast cancer: BRCA 1 / 2 Li Fraumeni syndrome Cowden disease Ataxia telangiectasia. ```

Question 79

81. Which exposure is not assoc? (repeat) a. asbestos and lung Ca b. analgesia and TCC c. lead and sarcoma d. mercury and RCC e. smoking and bladder ca

Answer 79

c. lead and sarcoma