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MRCS A(My Own) > Pathology > Flashcards

Pathology Flashcards

1
Q

What is Septic Arthritis

A

Kocher criteriaof septic Arthritis
1. Non weight bearing on affected side
2. ESR > 40 mm/hr
3. Fever
4. WBC count of >12,000 mm3

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2
Q

Classic sign of Acute Mesenteric infarction

A

Sudden onset of abdominal pain followed by forceful evacuation are the classical presenting features of acute mesenteric infarction.

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3
Q

wherethe testes are implanted in Orchidopexy

A

Dartos fascia of scrotum

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4
Q

Hormone to check for recurrence after removal of athyroid gland

A

Thyroglobulin

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5
Q

Thyroid hormones
1 TPO
2 Ab to TSH receptors

A
  1. 100% in Hashimotoand 70% in Grave
  2. Only in Grave
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6
Q

Most likely GUT cancercaused by smoking is

A

TransitionalCell carcinoma of bladder

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7
Q

PauI bunneIl Test

A

The Paul Bunnell test is used to screen for Infectious Mononucleosis (IM), which is seen most commonly in adolescents and young adults. IM is caused by the Epstein-Barr virus.

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8
Q

Most lillely site for Mesenteric embolism

A

splenic flexure

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9
Q

Dominant feature of Acute on chronic mesenteric ischemia

A

Post prandial abdominal discomfort and weight los

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10
Q

which disease symptoms mimic Ischemic Colitis in chroonic phase

A

Acute on chronic Mesenteric Ischemia I

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11
Q

Os teopetrosis is also called

A

Marble bone disease

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12
Q

Microcalcifications occur in which, type of breest cancer

A

Comedo type DCIS

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13
Q

Early vs late hemolytic
reaction due to transfusion

A

Early due to 7 ABO incompatibility
Late due to in incompatibility

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14
Q

What is Berry sign

A

Enability to palpate carotid due to extensive thyromegaly

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15
Q

Which thyroid cancer is of neural crest origin

A

Medullary Carcinoma of thyroid is of neural crest origin.

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16
Q

Which thyroid cancer is associated with 2Asyndrome

A

Medullary Carcinoma

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17
Q

Lifrau meni syndrome is associated with which gene

A

p53 suppressor gene cdysfunction

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18
Q

Cowden disease and gene

A

PTEN is a tumour suppressor gene and loss of function mutations result in up regulation of the mTOR pathway.

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19
Q

FAP gene mutation

A

APC gene

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20
Q

Immature granulocytes and unleaded rbcs in blood with normal cbc

A

Metastatic carcinoma like myeloma, myelofibrosis not splenectomy

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21
Q

First line treatment for hypercalcemic crisis

A

Intravenous fluids which is 0.9 % saline

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22
Q

2nd line treatment for hypercalcemia

A

Calcitonin
Mithramycin

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23
Q

Which neck mass is common in glassblowers and wind instrument players

A

Laryngocele

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24
Q

What is ranula

A

Mucocele in floor of mouth in sublingual gland

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25
Q

Which neck swelling is due to failure in obliteration of 2nd brachial cleft

A

Brachial cyst

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26
Q

Bluish cyst in neck

A

Ranula

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27
Q

Neck swelling behind anterior border of sternocleidomastoid muscle

A

Brachial cyst

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28
Q

Brachial cyst aspirated feature

A

Opalescent fluid with cholesterol crystals

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29
Q

Pharyngeal pouch

A

Due to weakness in inferior constrictor muscle

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30
Q

Which is present in hepatitis vaccinated patient

A

Anti Hbs

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31
Q

Histologically Psammoma bodies are

A

Clusters of calcification

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32
Q

Features of hashimoto thyroiditis

A

In Middle Age females
HLA, DR5
microscopically it has Lymphocytes and plasma cells

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33
Q

superior thyroid artery should be ligatedat which part

A

superior thyroid artery should be ligated close to the glandas here it’s not very close to external laryngeal nerve

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34
Q

Why Strap musclesshould be divided at their upper end

A

Strap musclesshould be divided at upper end to avoid damage to ansa cervicalis which is at their lower end

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35
Q

Commonest thyroid malignancy

A

Papillary carcinoma

Commonest sub-type

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36
Q

haematogenous spread is of which thyroid tumor

A

Follicular

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37
Q

laterally located apparently ectopic thyroid tissue canbe which cancer

A

Papillary dueto its lymph spread

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38
Q

Diagnosis of follicular Carcinoma of Thyroid

A

all follicular FNA’s (THY 3f) will require at least a hemi thyroidectomy as cant be diagnosed on FNAC.
1

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39
Q

Worst prognosisof which thyroid carcinoma

A

Anaplastic

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40
Q

Which thyroid carcinoma appears as part of the MEN -2A disease spectrum.

A

Medullary carcinoma of thyroid

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41
Q

Which thyroid carcinoma is not responsive to radioiodine.

A

Medullary carcinoma are not derived primarily from thyroid cells they are not responsive to radioiodine.

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42
Q

which test is used in screening for disease recurrence of medullary Thyroid carcinoma

A

calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence

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43
Q

How follicular adenoma is differentiated from carcinoma

A

May appear macroscopically encapsulated, microscopically capsular invasion is seen. Without this finding the lesion is a follicular adenoma.

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44
Q

Orphan Annie Nuclei histology

A

Histologically tumour has papillary projections and pale empty nuclei

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45
Q

Most common in elderly females thyroid carcinoma

A

Anaplastic

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46
Q

Most common site of metastasis in thyroid Ca

A

Most common site of metastasis:Bone.
I

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47
Q

which thyroid disease is One of the most common reasons for presentation

A

Multi nodular goitre

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48
Q

Toxic Goitre includes

A

3
Diffuse Goitre (Grave)
Toxic nodule
Toxic multinoduler goitre

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49
Q

Which drug causes hypothyroidism and is antipsychotic

A

Lithium

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50
Q

feature of anaplastic carcinoma

A

Marked local invasion is a feature of anaplastic carcinoma. These tumours are more common in elderly females.

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51
Q

IF extremely large goitre and no other issues apart from respiratory distress then it’s due to

A

Tracheo malacia

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52
Q

Post thyroidctomy hypocalcemia occurs after

A

first 2-5 post operative days.

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53
Q

Hurthle cell tumor

A

Type of follicular thyroid Ca
Have Oxyphil cells (eosinophilic granular cytoplasm as a result of accumulation of altered mitochondria.)

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54
Q

TSH level in hyperthyroidism

A

A TSH level of <0.5U/L suggests hyperthyroidism.

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55
Q

most sensitive test for diagnosing hyperthyroidism and hypo

A

Hyper : Free T3
Hypo : TSH

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56
Q

How primary hyperparathyroidism is diff from benign Familial hypocalciuric hypercalcemia

A

concordant biochemistry (urine calcium : creatinine clearance ratio <0.01-distinguished from primary hyperparathyroidism).
In primary hyperparathyroidism it’s >0.01

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57
Q

How long one should wait to treat tertiary hyperparathyroidism after renal transplant

A

Allow 12 months to elapse following transplant as many cases will resolve

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58
Q

When hyperthyroidism with increased PTH in which physiological condition

A

Where hyperthyroidism occurs secondary to pregnancy the TSH is typically elevated.

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59
Q

Which drug of breast Ca causes venous thromboembolism

A

Tamoxifen

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60
Q

Pneumonic for clinical features of digeorge syndrome

A

CATCH’:

Congenital heart defects
Abnormal facies
Thymic aplasia
Cleft palate
Hypoparathyroidism.

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61
Q

Diagnostic point of osteomalacia

A

Osteomalacia
low: calcium, phosphate
raised: alkaline phosphatase

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62
Q

C/F of rickets

A

rickets: knock-knee, bow leg, features of hypocalcaemia

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63
Q

C/F of osteomalacia

A

osteomalacia: bone pain, fractures, muscle tenderness, proximal myopathy

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64
Q

Xray findings of osteomalacia

A

x-ray: children - cupped, ragged metaphyseal surfaces;
adults - translucent bands (Looser’s zones or pseudofractures)

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65
Q

Most common cause of primary hyperparathyroidism

A

Most cases due to solitary adenoma (80%),

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66
Q

Which thyroid carcinoma cause distant metastasis and of what kind

A

Follicular carcinomas may metastasise haematogenously (often to bone)

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67
Q

Whichthyroid marker is only useful for followup of cancer

A

Thyro globulin

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68
Q

which Ab is present in both Hashimoto and Grave disease

A

Thyroid peroxidase (microsomal) antibodies

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69
Q

Which by causes tHypothyroidism

A

Lithium
Amiodarone
Sulfonylurea

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70
Q

Histology of Hashimoto Thyroiditis

A

Lymphocytic infiltrates and fibrosis are typically seen in Hashimotos thyroiditis.

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71
Q

ANA profile Ab
Anti Ro and La
Anti-centromere
Anti-Scl70

A

Anti-Ro and anti-La (associated with Sjögren syndrome)
•Anti-centromere (associated with CREST syndrome)
• Anti-Scl70 (associated with scleroderma)

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72
Q

Subacute(deQuervain)thyroiditis is caused by

A

Viral infections like EBV, mumps ,measles

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73
Q

Tinel sign is?

A

The Tinel sign is the tingling or prickling sensation elicited by the percussion of an injured nerve trunk at or distal to the site of the lesion.

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74
Q

Phalen test

A

The patient is asked to flex at the wrist and hold the position for up to a minute. A positive test elicits pain, paraesthesia, or numbness over median nerve distribution in the affected hand

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75
Q

Rx of hyperthyroid phase in Hashimoto’s thyroiditis

A

During the hyperthyroid phase of illness beta blockers may manage symptoms

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76
Q

Hashimoto thyroiditis is associated with which melegnancy

A

Thyroid lymphoma (Non Hodgkin’s B cell lymphoma

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77
Q

Which muscles is innervated by the cervical branch of the facial ner

A

The cervical branch of the facial nerve innervates platysma

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78
Q

Sick euthyroid syndrome

A

Sick euthyroid syndrome is most commonly seen in chronically ill patients or those with starvation. The thyroid function tests are often low and the patient clinically euthyroid.

Improve

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79
Q

Extra colonic diseases of Gardners syndrome

A

skull osteoma, thyroid cancer and epidermoid cysts

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80
Q

MOA of methimazole

A

Methimazole prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin

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81
Q

Most common liver tumor

A

Metastatic

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82
Q

Most common primary liver tumours

A

Hepatocellular carcinoma

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83
Q

main risk factor for cholangiocarcinoma

A

Primary sclerosing cholangitis is the main risk factor.

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84
Q

Most common cause of Hepatocellular Carcinoma

A

Most cases arise in cirrhotic livers or those with chronic hepatitis B infection,

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85
Q

Biopsy inHepatocellular carcinoma

A

Biopsy should be avoided as it seeds tumours cells through a resection plane.

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86
Q

Tumor markers in Cholangiocarcinoma

A

CA 19-9, CEA and CA 125 are often elevated

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87
Q

Hepatocellular carcinoma marker

A

a-fetoprotein is elevated in almost all cases

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88
Q

Commonest cause of amoebic liver disease

A

Entamoeba histiolytica

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89
Q

Congenital cause of unconjugated prehepatic hyper bili

A

Gilbert
Grigler_ Najjar

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90
Q

Jaundice level

A

> 35 umol /L

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91
Q

Most common benign tumours of mesenchymal origi

A

Haemangioma

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92
Q

Haemangioma on US

A

they are typically hyperechoic

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93
Q

Liverlesion caused by oral contraceptive

A

Liver cell adenoma

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94
Q

Mesenchymal hamartomas usually present in

A

Infants

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95
Q

Liver abscess major cause

A

Biliary sepsis is a major predisposing factor
Structures drained by the portal venous system form the second largest source

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96
Q

most common extra intestinal manifestation of amoebiasis

A

Liver abscess is the most common extra intestinal manifestation of amoebiasis

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97
Q

Amoebic abscess mostly occurs in which lobeof liver

A

Between 75 and 90% lesions occur in the right lobe

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98
Q

Aspirate of Amoebic abscess

A

1Aspiration yield sterile odourless fluid which has an anchovy paste consistency

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99
Q

wall of Hydatid cyst

A

The cyst wall is thick and has an external laminated hilar membrane and an internal enucleated germinal layer

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100
Q

Klatskin tumor

A

A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.

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101
Q

Black color GB stones

A

Pigment

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102
Q

Mixed stones of GB contains

A

More cholesterol
Multiple in number

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103
Q

Which GB stone is single vs multiple

A

Single: Cholesterol
Multiple: Mixed and Pigment

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104
Q

Gall stone ileus

A

due to fistula b/w GB and duo, stone get impacted at terminal ileal Level

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105
Q

Disease which affect enterohepatic circulation

A

Damage at terminal ileum suchas Crohn disease,int resection

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106
Q

Drugs causing GB stone

A

Estrogen
Clofibrate

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107
Q

The classical symptoms ofAcute cholecystitis

A

colicky right upper quadrant pain that occurs post prandially

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108
Q

sub total cholecystectomy criteria

A

IF problematic CaloT triangle

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109
Q

fistula between the gallbladder and duodenumin Gallstone iLeas in surgery

A

The fistula between the gallbladder and duodenum should not be interfered with.

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110
Q

CBD stone removal criteria

A

Small stones that measure less than 5mm may be safely left and most will pass spontaneously.

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111
Q

When not to surgically explore CBD

A

When stone is > 8mm

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112
Q

Acalculous cholecystitis infective causes

A

:Dueto infection with Ecoli, clostridia or rarely Salmonella

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113
Q

Rokitansky-Aschoff sinuses, or Luschka’s crypts

A

Glandular outpouchings formed by lining of mucosa extending into or through muscular coat of GB

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114
Q

GB doesn’t distend in which cystitis

A

GB doesn’t distend in Chronic Cholecystitis as it causes fibrosis of the wall

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115
Q

GB distend several times to its normal size in which disease

A

GB distend several times to its normal size due to lack of inflammation in Mucocele.

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116
Q

Strawberry gallbladder is

A

CholeSterolosis

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117
Q

Hematogenoas spread of Esophageal Ca. to

A

Lungss and liver

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118
Q

Common causes of Esophageal Ca

A

Diet defi of
1Vit A
2 Riboflavin
3. Zinc
High intaKe of tannic acid
Fungal contamination of food

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119
Q

Mostcommon cause of esophageal stasis

A

Lye strictures

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120
Q

most common cause of neck swellings

A

Reactive lymphadenopathy

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121
Q

Rubbery, painless lymphadenopathy in neck

A

Lymphoma

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122
Q

Pharyngeal pouch location

A

posteromedial herniation between thyropharyngeus and cricopharyngeus muscles

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123
Q

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx

A

Branchial cyst

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124
Q

Branchial cyst Develop due to failure of obliteration of

A

second branchial cleft in embryonic development

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125
Q

Charcot’s triad of symptoms

A

pain, fever, jaundice)

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126
Q

Charcot’s triad of symptoms in

A

Cholangitis

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127
Q

Acalculus cholecystitis is caused by

A

Prolonged starvation / TPN

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128
Q

Hydatid cyst causes whichkind of ypersensitivity reaction

A

These cysts are allergens which precipitate atype 1 hypersensitivity reaction.

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129
Q

Hydatid cyst causes symptoms when

A

Size is >5mm

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130
Q

Acquired factor 12 deficiency causes prolonged clotting factor which type

A

Prolonged APTT

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131
Q

Apoptosis vS Necrosis of Kidney causes

A

Nephrotoxic stimuli such as aminoglycosides and radiological contrast media induce apoptosis.
Myoglobinuria and haemolysis result in necrosis

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132
Q

Post-operative renal failure is more likely to occur in patients who are

A

elderly, have peripheral vascular disease, high BMI, have COPD, receive vasopressors, are on nephrotoxic medication or undergo emergency surgery.

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133
Q

Which syndrome associated with hamartomas

A

Puetz jegher syndrome

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134
Q

Genetics of Peutz-Jeghers syndrome

A

Autosomal dominant
serine threonine kinase LKB1 or STK11 problem

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135
Q

Features of Peutz-Jeghers syndrome

A

Hamartomatous polyps in GI tract (mainly small bowel)
Pigmented lesions on lips, oral mucosa, face, palms and soles
Intestinal obstruction e.g. intussusception (which may lead to diagnosis)
Gastrointestinal bleeding

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136
Q

first line investigation for dysphagia

A

Endoscopy

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137
Q

Which tests to perform before fundoplication surgery for GERD

A

Ambulatory oesophageal pH and manometry studies

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138
Q

For diagnosis of pharyngeal pouch (or any other diverticulum) which test is performed

A

barium swallow studies can be performed

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139
Q

Urgent endoscopy criteria

A

With dysphagia
Aged ≥55yrs with weight loss plus
Upper abdominal pain
Reflux
Dyspepsia

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140
Q

Greenish nipple discharge

A

Duct ectasia

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141
Q

Green nipple discharge with normal USS
Best actions

A

Discharge and reassure
Duct ectasia

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142
Q

Galactorrhoea can be caused by

A

histamine receptor antagonists

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143
Q

What is galactorrh3a in post Parfums females

A

In postpartum females, this also includes milk production occurring 6-12 months after pregnancy and the cessation of breastfeeding

144
Q

Which viral infection can cause galactorrhea

A

Varicella zoster

145
Q

What type of hypersensitivity is tuberculosis?

A

Type IV
Delayed type

146
Q

Levels of prolactin in prolactinoma

A

> 1000

147
Q

Examples of type II hypersensitivity

A

TIMPAG
Autoimmune haemolytic anaemia
Pemphigus
Goodpasture’s
Transfusion reaction
ITP
Myasthenia gravis

148
Q

Example of type 3 hypersensitivity

A

Serum sickness
SLE
Aspergillosis
Poststreptococcal glomerulonephritis
RA
Polyarteritis nodosa

149
Q

Examples of type IV hypersensitivity

A

Graft versus host disease
Contact dermatitis
Tuberculin test
Microbial agents like TB

150
Q

Example of type V hypersensitivity

A

TSH receptor antibody results in prolong hypersecretion of thyroid hormone

151
Q

Tumors defying histogenetic classification are called

A

Anaplastic

152
Q

Benign vs malignant features I don’t know

A

B: rarely ulcerates or undergo necrosis,
M: opposite

153
Q

Carcinoma versus sarcoma

A

Carcinoma is a malignant epithelial neoplasm
Sarcoma is a malignant connective tissue neoplasm

154
Q

Histopathologic features of malignancy

A

Abnormal tissue architecture

Coarse chromatin

Invasion of basement membrane*

Abnormal mitoses

Angiogenesis

De-differentiation

Areas of necrosis

Nuclear pleomorphism

155
Q

Potent vasodilators during acute inflammation

A

histamine,
prostaglandins,
nitric oxide,
platelet activating factor,
complement C5a (and C3a) and
lysosomal compounds.

156
Q

Serotonin function as a vasodilator versus vasoconstrictor

A

Intact and healthy tissues and vessels will respond to a serotonin infusion with vasodilation
In damag3d cells it acts as vasoconstrictor

157
Q

What happens during exudative cellular phase of acute inflammmation

A

Adhesion of neutrophils
Neutrophils migration
Diapedesis
Neutrophils chemotaxis

158
Q

Vascular phase of acute inflammation:

A

change in vessel calibre

increase vascular permeability

formation of fluid exudates

159
Q

First response of vessel to injury

A

Vasoconstriction then dilation

160
Q

What is triple response to jnjury

A

Flush: capillary dilation
Flare: arteriolar dilatation
Weal: zon3 of edema

161
Q

Amount of protein in an exudate of acute inflammation

A

50g/L

162
Q

Chemicals increasing leukocyte surface adhesion molecule expression versus
Chemicals increasing endothelial expression of adhesion molecules

A

C9mplement 5a, leukotriene B4, TNF
IL-1, Endotoxins, TNF

163
Q

Chemicals responsible for neutrophil chemotaxis

A

Leukotriene B4
IL-8

164
Q

Function of C5a

A

Neutrophils chemotaxis
Increase vascular permeability
Release of histamine from mast cells

165
Q

Opsonization of bacteria and phagocytosis by macrophage is facild by which complements

A

C4b, 2a and 3b

166
Q

Kindness system is activated by which factor

A

Factor XII

167
Q

Kinin system

A

Prekallikrien>kallikrien by factorXII
Kinogen&raquo_space; Bradykinin by Kallikrien

168
Q

Which factor activate coagulation fibrinolytic and kinin system in acute inflammation

A

Factorc12

169
Q

How lymphatic system helps in acute inflammation

A

Buy limiting extent of edema
Carry antigens to lymph nodes for recognition by lymphocytes

170
Q

In TB where reactivation of disease occurs

A

Reactivation generally occurs in the apex of the lungs and may spread locally or to more distant sites

171
Q

Regions of body affected by tuberculosis apart from lungs

A

Central nervous system
vertebral bodies
cervical lymph nodes
kidney
gastrointestinal tract

172
Q

Tuberculosis in cervical lymph nodes is called

A

(scrofuloderma)

173
Q

Risk factors for developing active tuberculosis include

A

silicosis
chronic renal failure
HIV positive
solid organ transplantation with immunosuppression
intravenous drug use
haematological malignancy
anti-TNF treatment
previous gastrectomy

174
Q

Hadfield procedure

A

Total duct excision
Usually in periductal mastitis
Uncontrolled duct ectasia
Multiple duct pathology

175
Q

When to perform
total duct excision
Vs
microdochectomy
In breast discharges

A

Multiple duct pathology
Vs
Single duct pathology

176
Q

Van Gieson and Masson trichrome are histological staining methods for

A

identification of connective tissues.

177
Q

Von Kossa technique is useful for identifying

A

tissue mineralisation.

178
Q

Markers of carcinoid syndrome in blood

A

chromogranin A,
neuron-specific enolase (NSE),
substance P,
and
gastrin.

179
Q

Urinary marker of carcinoid tumor

A

5 HIAA, which is a metabolite of serotonin

180
Q

Common site of carcinoid tumor

A

mainly in the intestine (midgut-distal ileum/appendix)
Can occur in the rectum, bronchi

181
Q

Site of carcinoid tumor other than gastrointestinal tract

A

Pancreas and lung

182
Q

What valve issue in carcinoid

A

Pulmonary valve stenosis and tricuspid regurgitation causing dyspnoea

183
Q

Tests for carcinoid syndrome

A

5-HIAA in a 24-hour urine collection
Somatostatin receptor scintigraphy
CT scan
Blood testing for chromogranin A

184
Q

When to give Octreotide in patients with carcinoid tumor pre and post op

A

In the highest risk patients, octreotide can be started 24 hours prior to the operation and continued for 48 hours post-operatively.

185
Q

Lynch syndrome/HNPCC features

A

locally advanced mucinous carcinoma
scanty polyps in the remaining colo
Right sided colonic Ca at young age

186
Q

What type of gene is HNPCC vs APC

A

HNPCC: DNA mismatch repair gene
APC: Tumor suppressor gene

187
Q

Lynch syndrome gene mutation

A

MSH2, MLH1, PMS2 and GTBP

188
Q

Cowden disease diagnostic feature

A

Multiple intestinal hamartomas
Multiple trichilemmomas

189
Q

Most common site of lynch syndrome

A

Colorectal>endometrial>gastric

190
Q

Criteria for diagnosis of HNPCC

A

nemonic 3-2-1 for HNPCC.
3 individuals,
2 generations and
one must be younger than 50 yrs

191
Q

At what cell count of T cells does candidiasis occur in AIDS

A

<200

192
Q

pathological criteria carries the greatest prognostic weighting for malignant melajoma

A

Bristow thickness

193
Q

Lesions >4 mm thick on breslow
Rx is

A

3 cm margin around the malignant melanoma

194
Q

Example of primary chronic inflammation

A

TB
Suture material
Prosthetic materials like breast
Autoimmune conditions

195
Q

Example of serous inflammation

A

Conjunctivitis

196
Q

What is catarrhal inflammation

A

Hypersecretion of mucus in acute inflammation of a mucus membrane

197
Q

How anemia is caused in acute pancreatitis

A

Loss of blood into exudates

198
Q

A features of chronic inflammation

A

Usually primary but may follow acute
Granulomatous inflammation is a specific type
May be complicated by amyloidosis

199
Q

Examples of primary chronic inflammation from foreign body endogenous materials

A

Foreign body reactions
endogenous material: necrotic bone, uric acid crystals

200
Q

Name few diseases which cause primary chronic inflammation

A

Autoimmune diseases: hashimotos thyroiditis, chronic gastritus of pernicious anaemia, Rheumatoid arthritis
Granulomatus disease: crohn disease sarcoidosis
Ulcerative colitis
Tuberculosis, leprosy

201
Q

Which kind of acute inflammation converts to chronic inflammation mostly

A

Suppurative inflammation type

202
Q

Example of progression from acute inflammation to chronic

A

Inadequate drainage of pus like in chronic abscess of osteomyelitis or chronic Empyema thoracis
Foreign body reactions made develop into granuloma like suture material, wood, metal, glass, implanted prosthesis

203
Q

Example of recurrent episodes of acute inflammation turning into chronic

A

Chronic cholecystitis due to gallstones

204
Q

Microscopic appearance of chronic inflammation

A

Chronic ulceration
Chronic abscess
Caseating granulomatous inflammation
Thickening of hollow viscous
Fibrosis

205
Q

How healing occurs in chronic information

A

By Fibrosis

206
Q

What is diaphragm disease

A

When human of small bowl is divided into short compartments by circular membrane of mucosa and sub-mucosor

207
Q

Cause of diaphragm disease

A

Long use OF NSAIDS
mostly in elderly females

208
Q

Popcorns are present in which sub type of Hodgkin lymphoma

A

Nodular lymphocyte predominant

209
Q

lymphohistiocytic (L-H) variant of Reed Sternberg cells

A

Popcorn cells

210
Q

B Symptoms

A

10% weight loss, fever, night sweats

211
Q

Which virus is associated with hodkin lymphoma

A

Ebstein bar virus specially to mixed cellularity lymphoma

212
Q

Chronicle features of Hodgkin lymphoma

A

Cough, Pel Ebstein fever, haemoptysis, dyspnoea

B Symptoms - 10% weight loss, fever, night sweats

213
Q

Which sub type of Hodgkin lymphoma has best prognosis

A

Nodular sclerosing has the best prognosis

214
Q

Which features of hodgkin lymphoma attribute to worst prognosis

A

Lymphocyte depleted Hodgkins lymphoma,
advancing age,
male sex and
stage IV disease

215
Q

apple green birefringence with polarised light in which disease

A

Amyloidosis

216
Q

Which amyloidosis is a long-term complication of several chronic inflammatory disorders

A

Systemic AA amyloidosis

217
Q

AL amyloidosis

A

results from extra-cellular deposition of fibril-forming monoclonal immunoglobulin light chains (most commonly of lambda isotype).

218
Q

most commonly affected sites by amyloidosis

A

kidney and heart

219
Q

If myeloma or any monoclonal gammopathy then amyloidosis

A

Then amyloidosis can’t be from AL
As AL causes just asymptomatic ones

220
Q

Sarcomas in which Lymphatic Metastasis is seen:

A

‘RACE For MS’
R: Rhabdomyosarcoma
A: Angiosarcoma
C: Clear cell sarcoma
E: Epithelial cell sarcoma

For: Fibrosarcoma

M: Malignant fibrous histiocytoma
S: Synovial cell sarcoma

Or

‘SCARE’

Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma

221
Q

Most common site of sarcoma metastasis

A

Lung

222
Q

Malignant fibrous histiocytoma is now referred to as

A

undifferentiated pleomorphic sarcoma

223
Q

Some features suspicious of sarcoma

A

Large >5cm soft tissue mass
Deep tissue location or intra muscular location
Rapid growth
Painful lump

224
Q

Biopsy of a sarcoma

A

Never attempt blind biopsy always perform image guided by biopsy in such a way that the tract can be included in any resection in the future

225
Q

Commonest type of Ewings sarcoma

A

femoral diaphysis

226
Q

4 subtypes of Malignant Fibrous Histiocytoma

A

storiform-pleomorphic (70% cases), myxoid (less aggressive), giant cell and inflammatory

227
Q

Callus visible on xray after how long from the injury

A

3 weeks

228
Q

Bone tumors are mostly primary or sec

A

Secondary

229
Q

Features of primary malignant bone tumor

A

Rare
Have bad prognosis
Affect patients in a younger age group

230
Q

Genetic abnormality in Ewing sarcoma

A

genetic translocation of chromosomes 11 and 22

231
Q

Most common bone tumor

A

Osteochondroma

232
Q

Xray finding of Ewing sarcoma

A

Lytic lesion with periosteal reactions
Onion rings on x ray

233
Q

Pediatric malignancy of bone

A

Ewing sarcoma

234
Q

Treatment of Ewing sarcoma

A

Management is via adjuvant chemotherapy followed by surgical excision.

235
Q

Human herpes virus 8 causes

A

Kaposi’s sarcoma

236
Q

Human T-lymphotropic virus 1

A

Tropical spastic paraparesis
Adult T cell leukaemia

237
Q

Human papillomavirus 16/18 causes

A

Cervical cancer
Anal cancer
Penile cancer
Vulval cancer
Oropharyneal cancer

238
Q

Post transplant lymphoma occurs by

A

EBV

239
Q

Nasopharyngeal carcinoma is caused by

A

EBV

240
Q

MEN IIB includes

A

Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Hyperparathyroidism
Marfanoid appearance

241
Q

MEN type IIa includes

A

Phaeochromocytoma
Medullary thyroid cancer (70%)
Hyperparathyroidism (60%)

242
Q

Genetic of MEN 2

A

RET Oncogene on chromosome 10

243
Q

Most common presentation of MEN 1

A

hypercalcaemia

244
Q

Genetic of MEN 1

A

MENIN gene on chromosome 11

245
Q

MEN 1 syndrome includes

A

Mnemonic ‘three P’s’:

Parathyroid (95%): Parathyroid adenoma
Pituitary (70%): Prolactinoma/ACTH/Growth Hormone secreting adenoma
Pancreas (50%): Islet cell tumours/Zollinger Ellison syndrome

also: Adrenal (adenoma) and thyroid (adenoma)

246
Q

Sudden collapse and angioedema following exposure to latex
Which hypersensitivity

A

Type 1

247
Q

CNS tissue has which kind of necrosis

A

Colliquative

248
Q

Apoptosis occurs due to

A

activation of caspases triggered by the bcl-2 family or the binding of the FAS ligand to its receptor

249
Q

Necrosis in arterioles in patients with hypertension

A

Fibrinoid

250
Q

Black color ingangrene is due to

A

deposition of iron sulphide

251
Q

Amorphous eosinophilic tissue in which necrosis

A

Caseous

252
Q

Occurs in tissues with no supporting stroma

A

Colloiquative
In CNS

253
Q

Nerve damage with no soft tissue injury what will be the rate of neuron growth

A

1 mm perday

254
Q

Wallerian Degeneration begins

A

24-36 hours following injury

255
Q

Wallerian Degeneration occurs in

A

Axonotmesis
Neurotmesis

Not in Neuropraxia

256
Q

Difference between types of nerve injury
1 Neuropraxia
2 Axonotmesis
3 Neurotmesis

A

1 Only electrical conduction affected.
2 Only axon is affected with intact myelin
3 Both axon and myelin are affected

257
Q

aneurysm screening programage limit

A

in all men aged 65 years.

258
Q

Commonest cause of Abd aneurysm

A

Smoking and hypertension

259
Q

Abdominal aortic aneurysm is associated with which type of connective tissue disorder

A

Marfan syndrome

260
Q

When to perform surgery for aneurysm
Vs
When to perform urgent surgery

A

When size is >5.5 to 6 cm
If aneurysm is painful

261
Q

Indications for surgery for abdominal aneurysm

A

Symptomatic aneurysms (80% annual mortality if untreated)
Increasing size above 5.5cm if asymptomatic
Rupture (100% mortality without surgery)

262
Q

Most common rupture site of abdominal aneurysm

A

retroperitoneal 80%.

263
Q

BP aim for abdominal aneurysm hematoma

A

100 mm

264
Q

weeping, crusty lesion,areolar region is spared

A

Paget disease

265
Q

Lab findings of antiphospholipid syndrome

A

Lupus anticoagulant may be present and the APTT is prolonged.

266
Q

Features of antiphospholipid syndrome

A

thromboembolism and coagulation issues in a young woman
fetal loss, venous and arterial thrombosis and thrombocytopenia.

267
Q

Rx of lead poisoning

A

Dimercaptosuccinic acid (DMSA)
D-penicillamine
EDTA
Dimercaprol

268
Q

Clinical features of lead poisoning

A

abdominal pain

peripheral neuropathy (mainly motor)

fatigue

constipation

blue lines on gum margin (only 20% of adult patients, very rare in children)

269
Q

How to differentiate between intermittent porphyria vs lead poisoning

A

Blue line on gum margin in LP
Heme products in urine in AIP

270
Q

Cbc of lead poisoning

A

red cell abnormalities including basophilic stippling and clover-leaf morphology

271
Q

What may be seen making it sometimes difficult to differentiate lead poisoning from acute intermittent porphyria

A

Raised serum and urine levels of delta aminolaevulinic acid

272
Q

Tumor arising from 4th ventricle and can grow through the foramina of Luschka and Magendie

A

Ependymoma

273
Q

Adult vs pediatrics CNS tumor location

A

Most paediatric CNS tumours are infratentorial
Most adult CNS tumours are supratentorial

274
Q

Which brain tumor can be treated with surgery and get cured

A

Meningioma

275
Q

MC cell making giant cells

A

Macrophages

276
Q

Most malignant CNS tumor

A

Glioblastoma multiforme

277
Q

Most common CNS tumor in childhood

A

Medulloblastoma

278
Q

Which sense is lost early in Acoustic neuroma

A

Corneal reflex

279
Q

Recklinghausen’s disease has which neural tumor

A

Acoustic neuroma

280
Q

Astrocytoma in children

A

In cerebellum
Benign
Can be excised completely

281
Q

Most frequent sites affected by meningioma

A

Parasagittal region
Olfactory groove
Sphenoiid wing
Foramen magnum

282
Q

Which tumor compress cerebral cortex at early stage and cause fits

A

Meningioma

283
Q

Which brain tumors are radio resistant

A

Astrocytoma
Glioblastoma

284
Q

Which bone type has better healing after fracture

A

Cancellous bone has better healing than compact

285
Q

steroids, non steroidal anti inflammatory agents affect on bone healing

A

Decrease it

286
Q

Location of dermoid tumor

A

midline of the neck, external angle of the eye and posterior to the pinna of the ear.

287
Q

Desmoid cyst are associated with which

A

familial adenomatous polyposis coli syndrome

288
Q

Graft vs host disease is caused due to which cell line

A

Lymphocytes

289
Q

Transfusion related lung injury is due 5to which cell

A

Neutrophils

290
Q

Mnemonic for transfusion reactions:

A

Mnemonic for transfusion reactions:

Got a bad unit

Graft vs. Host disease
Overload
Thrombocytopaenia

Alloimmunization

Blood pressure unstable
Acute haemolytic reaction
Delayed haemolytic reaction

Urticaria
Neutrophilia
Infection
Transfusion associated lung injury

291
Q

Blood pressure compromise during transfusion is die to

A

IgA antibodies

292
Q

most likely to arise from musculoaponeurotic structures?

A

Desmoid tumor

293
Q

Beta-naphthalamine causes which Ca

A

Bladder Ca

294
Q

If jaundice 2° stone then which test will show bleeding diathesis

A

PT
As cholestasis decreases production of vit l dependent factors 2,7,9 and 10

295
Q

Macroscopic features of chronic inflammation

A

Ulcers
Fibrosis
Granulomatous process

296
Q

Chronic inflammation usually occurs

A

Primar

297
Q

Which type of diarrhoea in carcinoid syndrome

A

Secretary diarrhoea despite fasting

298
Q

Pseudomyxoma peritoneii treatment

A

peritonectomy (Sugarbaker procedure) and heated intra peritoneal chemotherapy.

299
Q

Pseudomyxoma Peritonei most commonly originates from which organ

A

Appendix

300
Q

intra peritoneal chemotherapyin Pseudomyxoma Peritonei is dome by

A

Mitomycin C

301
Q

Most common adverse event with Packed cell vs FFP

A

Packed cell: Pyrexia
FFP : Urticaria

302
Q

Atrophy in muscle vs other organs

A

In muscle only the size is changes
In other organs size and cellularity both are changed

303
Q

Neutrophil features

A

Lifespan of 1 to 3 days
ACTIONS: movement, opsonise microorganisms, phagocytosis & intracellular killing of microorganisms via aerobic (produce HYDROGEN PEROXIDE) & anaerobic mechanisms.
Neutrophil disorders include chronic granulomatous diseases: rare

304
Q

Neutrophils produce what as a micocidal agent

A

Hydrogen peroxide not nitrogen

305
Q

Nasopharyngeal Ca caused by which virus

A

EBV

306
Q

Nasopharyngeal carcinoma

A

SCC
Mcommon in China

307
Q

Symptoms of Nasopharyngeal carcinoma

A

Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI

308
Q

Which cranial nerve is affected in Nasopharyngeal carcinoma

A

III to VI

309
Q

Rx of Nasopharyngeal Ca

A

1st line therapy is Radiotherapy

310
Q

Organisms causing post splenectomy sepsis:

A

Streptococcus pneumoniae
Haemophilus influenzae
Meningococc

311
Q

Postsplenectomy meds

A

Penicillin V 500mg BD or amoxicillin 250mg BD

312
Q

Which age group has highest rate of post splenectomy sepsis

A

less than 16 years or greater than 50 years.

313
Q

Which type of pneumococcal vaccine is offered to young children

A

Pconjugated vaccine (PCV

314
Q

What is Hypersplenism

A

Splenomegaly associated with
•Any combination of anaemia, leucopenia or thrombocytopenia •Compensatory bone marrow hyperplasia
•Improvement after splenectomy

315
Q

Primary splenism affects

A

Women

316
Q

Massive splenomegaly is likely to be due to

A

Chronic myloid leukemia
Myelofibrosis
Lymphoma

317
Q

Which storage disease causes splenomegaly

A

Gaucher’s Disease

318
Q

If platelets above 1000 after splenectomy then what to do

A

No need to give anticoagulants
Antiplatelets such as aspirin can be given

319
Q

What occurs absmoat immediately post splenectomy

A

Granulocytosis

320
Q

When splenectomy is ofgreat risk

A

•In young especially < 2 years.
•When it happens 2’ to reticu lo endothelial than trauma.

321
Q

Most common infection after splenectomy

A

Pneumococcal> H. influenza type B >N.meningitis

322
Q

Which infection occurs after splenectomy due to dog bite

A

Capnocytophaga canimorsus

323
Q

Other uncommon infections due to splenectomy

A

E.coli, Malaria, Babesiosis, capnocytophaga canimorsus

324
Q

Why fatal sepsis is less after splenectomy from trauma

A

Due to splenosis means small multiple implants of splenic tissue auto transplantation

325
Q

Vaccination after splenectomy

A
  1. Polyvalent pneumococcal vaccine PPV in adults while New Conjugate 7 valent vaccine for children undr 2.
  2. Hib vaccine.
    Men C and Men ACWY( Latter for children under 2 years mostly).
326
Q

Which vaccine is recommended annually after splenectomy

A

Influenza vaccine

327
Q

Vaccination criteria due to planned versus emergency splenectomy

A

Planned: 2 weeks before or after surgery.
Emergency:Best after 14 days post surgery.

328
Q

Glucaganoma is associated with

A

diarrhoea, weight loss and necrolytic migratory erythema.

329
Q

Diagnosis of glucaganoma at which level

A

serum level of glucagon >1000pg/ml

330
Q

Carcinoid tumor arise from

A

Enterochromaffin cells

331
Q

How carcinoid syndrome is diagnos

A

5-Hydroxyindolaedcetic acid 5-HIAAmin urine

332
Q

ARDS definition

A

The most up-to-date definition of acute respiratory distress syndrome is the Berlin Definition, which broadly consists of 4 key points:

Acute onset within 7 days
PaO2:FiO2 ratio <300 (with PEEP or CPAP >5cmH2O)
Bilateral infiltrates on CXR
Alveolar oedema not explained by fluid overload or cardiogenic causes

333
Q

DALM lesion in ulcerative colitis
Rx?

A

Panproctocolectomy

334
Q

If achalasia turns to malignancy it is

A

Squamous cell carcinoma

335
Q

Post splenectomy causative organisms

A

Mnemonic used to remember some encapsulated pathogens is: ‘Even Some Super Killers Have Pretty Nice Big Capsules’
Escherichia coli, Streptococcus pneumoniae, Salmonella, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Neisseria meningitidis, Bacteroides fragilis, and the yeast Cryptococcus neoformans

336
Q

Massive transfusion affects which coagulation factors

A

5 and 8

337
Q

Classification of oncogenes

A

Growth factors e.g. Sis
Transcription factors e.g. Myc
Receptor tyrosine kinase e.g. RET
Cytoplasmic tyrosine kinase e.g. Src
Regulatory GTPases e.g. Ras

338
Q

Schilling test used for

A

A Schilling test is also known as a Vitamin B12 absorption test

339
Q

Vitamin required for collagen

A

Vit C

340
Q

If increased flexibility then which collagen

A

III

341
Q

Collagen loss in
Ehlers Danlos vs Osteogenesis imperfecta

A

E: 1 and 3
O: 1

342
Q

Ehler Danlos patients are prone to

A

joint dislocations and pelvic organ prolapse.

343
Q

Which symptoms during blood transfusion is the most common event of complication

A

Mild pyrexia during blood transfusion is the most common event and commonly occurs during transfusion.

344
Q

GIST’s are derived from which cells

A

the interstitial pacemaker cells of Cajal

345
Q

Genetics of GIST

A

The vast majority express CD117 which is a transmembrane tyrosine kinase receptor and in these there is a mutation of the c-KIT gene

346
Q

Drug to give in GIST which is unresectable

A

Imatinib

347
Q

pharyngeal pouch, what is the most appropriate investigation?

A

Upper GI endoscopy is contra indicated in pharyngeal pouch.

348
Q

Organ sites that may metastasise (early) to the para-aortic lymph nodes:

A

Testis
Ovary
Uterine fundus

349
Q

Infection with which of the following micro-organisms may result in a clinical picture resembling achalasia of the oesphagus?

A

Trypanosoma Cruzi may result in destruction of the ganglion cells of the myenteric plexus,

350
Q

Which nerve can be damaged after temporal biopsy

A

Facial
Auriculotemporal

351
Q

Histology of thyroid in hyper thyroidism

A

hyperplasia of acini, which are lined by high columnar epithelium
Vacuolated or empty acini
Scalloped appearance adjacent to thyrocytes

352
Q

Which hyperthyroid disease will not react to meds

A

Toxic nodule as it’s autonomous

353
Q

From where thyroid is produced in Toxic multinodualr goitre

A

In between the nodules
Not fromt the nodules themselves

354
Q

Retinal and cerebellar haemangiomas are key features of

A

Von Hippel

355
Q

Which type of HL is associated the most with EBV

A

Mixed cellularity

356
Q

Non neoplastic polyps which don’t have cancer prognosis

A

Hamartamatous
Juvenile
Inflammatory
Lymphoid
Hyperplastic

MRCS A(My Own) (28 decks)

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