pathology 06.06 Flashcards
Which of the following diseases is not considered a risk factor for gastric cancer?
Polya gastrectomy for antral ulcer
Atrophic gastritis
Intestinal metaplasia of columnar type at the gastric cardia
Patient with polyp showing medium grade dysplasia
Long term therapy with sucralfate
Although some acid lowering procedures increase the risk of gastric cancer the use of sucralfate does not, at the present time, seem to increase the risk.
A 55 year old woman complains of nipple discharge. This was blood stained on one occasion. But not subsequently. Clinical examination shows clear fluid but no discrete lump. Imaging with ultrasound and mammography is normal. What is the best course of action?
Mastectomy
Total duct excision
Microdochectomy
Discharge
Mammographic surveillence
Although this is likely to be benign disease, her age coupled with an episode of blood stained discharge would attract a recommendation for microdochectomy. She may have an intraductal papilloma. But the concern would be DCIS.
A 22 year old lady presents with an episode of renal colic and following investigation is suspected of suffering from MEN IIa. Which of the following abnormalities of the parathyroid glands are most often found in this condition?
Hypertrophy
Hyperplasia
Adenoma
Carcinoma
Metaplasia
MEN IIa
Medullary thyroid cancer
Hyperparathyroidism (usually hyperplasia)
Phaeochromocytoma
A 40 year old female is diagnosed as having Dercums disease. Which of the lesions listed below are most likely to be identified on physical examination?
Lipomas
Neuromas
Hamartomas
Arteriovenous malformations
Histiocytomas
Dercums disease is characterized by multiple lipomas. It is also referred to as adiposis dolorosa.
An 83 year old lady presents to the clinic with early satiety. On examination, she is found to have massive splenomegaly. What is the most likely underlying cause?
Acute lymphoblastic leukaemia
Acute myelomonocytic leukaemia
Acute monoblastic leukaemia
Chronic granulocytic leukaemia
Epstein Barr virus infection
Long standing pathology is usually the cause of massive splenomegaly. Of these, its a common finding in chronic leukaemia. Its rare for EBV infections to cause massive splenomegaly.
A 59 year old lady is referred from the NHS breast screening program. A recent mammogram is reported as showing linear, branching microcalcification with coarse granules. Which disease process is the most likely underlying cause of these appearances?
Invasive lobular cancer
Lobular carcinoma in situ
Cribriform type ductal carcinoma in situ
Comedo type ductal carcinoma in situ
Fibroadenosis
Comedo type DCIS is usually associated with microcalcifications. Cribriform lesions are usually multifocal but less likely to form microcalcifications. Lobular cancers and in situ lesions rarely form microcalcifications and are difficult to detect using mammography.
A 59 year old lady is referred from the NHS breast screening program. A recent mammogram is reported as showing linear, branching microcalcification with coarse granules. Which disease process is the most likely underlying cause of these appearances?
Invasive lobular cancer
Lobular carcinoma in situ
Cribriform type ductal carcinoma in situ
Comedo type ductal carcinoma in situ
Fibroadenosis
Comedo type DCIS is usually associated with microcalcifications. Cribriform lesions are usually multifocal but less likely to form microcalcifications. Lobular cancers and in situ lesions rarely form microcalcifications and are difficult to detect using mammography.
A 23 year old man presents to the surgical clinic with an inguinal hernia. On examination he has a small direct hernia. However, you also notice that he has pigmented spots around his mouth, on his palms and soles. In his history he underwent a reduction of an intussusception aged 12 years. Which of the following lesions is most likely to be identified if a colonoscopy were performed?
Hamartomas
Tubulovillous adenoma
Colorectal cancer
Crohns disease
Hyperplastic polyps
He is most likely to have Peutz-Jeghers syndrome which is associated with Hamartomas.
A 56 year old man presents with symptoms of neuropathic facial pain and some weakness of the muscles of facial expression on the right side. On examination he has a hard mass approximately 6cm anterior to the right external auditory meatus. What is the most likely diagnosis?
Pleomorphic adenoma
Adenocarcinoma
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Lymphoma
The patient is most likely to have a malignant lesion within the parotid. Of the malignancies listed; adenoid cystic carcinoma has the greatest tendency to perineural invasion.
A 43 year old lady is admitted with cholestasis secondary to a stone impacted at the level of the ampulla of vater. Which of the following tests is most likely to be predictive of bleeding diathesis at the time of ERCP in this particular case?
Bleeding time
Prothrombin time
APTT
Platelet count
Factor I levels
PT: Vitamin K dependent factors 2, 7, 9, 10
APTT: Factors 8, 9, 11, 12
Jaundice will impair the production of vitamin K dependent clotting factors. This is most accurately tested by measuring the prothrombin time. APTT can be affected by vitamin K deficiency (due to factor 9 deficiency), however this occurs to a lesser extent and is normally associated with severe liver disease. The bleeding time is a measure of platelet function.
Which of the following is not included in Multiple Endocrine Neoplasia Type 2b?
Phaeochromocytoma
Visceral ganglioneuromas
Thyroid medullary carcinoma
Zollinger Ellison syndrome
Marfanoid features
MEN IIB Medullary thyroid cancer Phaeochromocytoma Mucosal neuroma Marfanoid appearance
A 66 year old man is referred via the aneurysm screening programme with an abdominal aortic aneurysm measuring 4.5 cm. Apart from well controlled type 2 DM he has no other co-morbidities. What is the best course of action?
AAA repair during next 48 hours
USS in 3 months
CT aortic angiogram
MRI aortic angiogram
Discharge from the programme
At this point continue with ultrasound surveillance.
USS surveillance of AAA:
3cm- 4.4cm - 1 year
4.5-5.4cm- 3 monthly
This is the data provided by the NHS AAA screening programme (2017) endorsed by NICE 2020.
A 25-year-old female with a history of bilateral vitreous haemorrhage is referred with bilateral lesions in the cerebellar region. What is the likely diagnosis?
Neurofibromatosis type I
Neurofibromatosis type II
Tuberous sclerosis
Von Hippel-Lindau syndrome
Sarcoidosis
Retinal and cerebellar haemangiomas are key features of Von Hippel-Lindau syndrome. Retinal haemangiomas are bilateral in 25% of patients and may lead to vitreous haemorrhage
A 25-year-old female with a history of bilateral vitreous haemorrhage is referred with bilateral lesions in the cerebellar region. What is the likely diagnosis?
Neurofibromatosis type I
Neurofibromatosis type II
Tuberous sclerosis
Von Hippel-Lindau syndrome
Sarcoidosis
Retinal and cerebellar haemangiomas are key features of Von Hippel-Lindau syndrome. Retinal haemangiomas are bilateral in 25% of patients and may lead to vitreous haemorrhage
Which of the following is least likely to cause a prolonged prothrombin time?
Cholestatic jaundice
Disseminated intravascular coagulation
Prolonged antibiotic treatment
Liver disease
Acquired factor 12 deficiency
Vitamin K deficiency results from cholestatic jaundice and prolonged antibiotic therapy. Acquired factor 12 deficiency causes prolonged APTT.
