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
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.
3
Q
wherethe testes are implanted in Orchidopexy
A
Dartos fascia of scrotum
4
Q
Hormone to check for recurrence after removal of athyroid gland
A
Thyroglobulin
5
Q
Thyroid hormones
1 TPO
2 Ab to TSH receptors
A
- 100% in Hashimotoand 70% in Grave
- Only in Grave
6
Q
Most likely GUT cancercaused by smoking is
A
TransitionalCell carcinoma of bladder
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.
8
Q
Most lillely site for Mesenteric embolism
A
splenic flexure
9
Q
Dominant feature of Acute on chronic mesenteric ischemia
A
Post prandial abdominal discomfort and weight los
10
Q
which disease symptoms mimic Ischemic Colitis in chroonic phase
A
Acute on chronic Mesenteric Ischemia I
11
Q
Os teopetrosis is also called
A
Marble bone disease
12
Q
Microcalcifications occur in which, type of breest cancer
A
Comedo type DCIS
13
Q
Early vs late hemolytic
reaction due to transfusion
A
Early due to 7 ABO incompatibility
Late due to in incompatibility
14
Q
What is Berry sign
A
Enability to palpate carotid due to extensive thyromegaly
15
Q
Which thyroid cancer is of neural crest origin
A
Medullary Carcinoma of thyroid is of neural crest origin.
16
Q
Which thyroid cancer is associated with 2Asyndrome
A
Medullary Carcinoma
17
Q
Lifrau meni syndrome is associated with which gene
A
p53 suppressor gene cdysfunction
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.
19
Q
FAP gene mutation
A
APC gene
20
Q
Immature granulocytes and unleaded rbcs in blood with normal cbc
A
Metastatic carcinoma like myeloma, myelofibrosis not splenectomy
21
Q
First line treatment for hypercalcemic crisis
A
Intravenous fluids which is 0.9 % saline
22
Q
2nd line treatment for hypercalcemia
A
Calcitonin
Mithramycin
23
Q
Which neck mass is common in glassblowers and wind instrument players
A
Laryngocele
24
Q
What is ranula
A
Mucocele in floor of mouth in sublingual gland
25
Which neck swelling is due to failure in obliteration of 2nd brachial cleft
Brachial cyst
26
Bluish cyst in neck
Ranula
27
Neck swelling behind anterior border of sternocleidomastoid muscle
Brachial cyst
28
Brachial cyst aspirated feature
Opalescent fluid with cholesterol crystals
29
Pharyngeal pouch
Due to weakness in inferior constrictor muscle
30
Which is present in hepatitis vaccinated patient
Anti Hbs
31
Histologically Psammoma bodies are
Clusters of calcification
32
Features of hashimoto thyroiditis
In Middle Age females
HLA, DR5
microscopically it has Lymphocytes and plasma cells
33
superior thyroid artery should be ligated at which part
superior thyroid artery should be ligated close to the gland as here it's not very close to external laryngeal nerve
34
Why Strap musclesshould be divided at their upper end
Strap musclesshould be divided at upper end to avoid damage to ansa cervicalis which is at their lower end
35
Commonest thyroid malignancy
Papillary carcinoma
Commonest sub-type
36
haematogenous spread is of which thyroid tumor
Follicular
37
laterally located apparently ectopic thyroid tissue canbe which cancer
Papillary dueto its lymph spread
38
Diagnosis of follicular Carcinoma of Thyroid
all follicular FNA's (THY 3f) will require at least a hemi thyroidectomy as cant be diagnosed on FNAC.
1
39
Worst prognosisof which thyroid carcinoma
Anaplastic
40
Which thyroid carcinoma appears as part of the MEN -2A disease spectrum.
Medullary carcinoma of thyroid
41
Which thyroid carcinoma is not responsive to radioiodine.
Medullary carcinoma are not derived primarily from thyroid cells they are not responsive to radioiodine.
42
which test is used in screening for disease recurrence of medullary Thyroid carcinoma
calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence
43
How follicular adenoma is differentiated from carcinoma
May appear macroscopically encapsulated, microscopically capsular invasion is seen. Without this finding the lesion is a follicular adenoma.
44
Orphan Annie Nuclei histology
Histologically tumour has papillary projections and pale empty nuclei
45
Most common in elderly females thyroid carcinoma
Anaplastic
46
Most common site of metastasis in thyroid Ca
Most common site of metastasis:Bone.
I
47
which thyroid disease is One of the most common reasons for presentation
Multi nodular goitre
48
Toxic Goitre includes
3
Diffuse Goitre (Grave)
Toxic nodule
Toxic multinoduler goitre
49
Which drug causes hypothyroidism and is antipsychotic
Lithium
50
feature of anaplastic carcinoma
Marked local invasion is a feature of anaplastic carcinoma. These tumours are more common in elderly females.
51
IF extremely large goitre and no other issues apart from respiratory distress then it's due to
Tracheo malacia
52
Post thyroidctomy hypocalcemia occurs after
first 2-5 post operative days.
53
Hurthle cell tumor
Type of follicular thyroid Ca
Have Oxyphil cells (eosinophilic granular cytoplasm as a result of accumulation of altered mitochondria.)
54
TSH level in hyperthyroidism
A TSH level of <0.5U/L suggests hyperthyroidism.
55
most sensitive test for diagnosing hyperthyroidism and hypo
Hyper : Free T3
Hypo : TSH
56
How primary hyperparathyroidism is diff from benign Familial hypocalciuric hypercalcemia
concordant biochemistry (urine calcium : creatinine clearance ratio <0.01-distinguished from primary hyperparathyroidism).
In primary hyperparathyroidism it's >0.01
57
How long one should wait to treat tertiary hyperparathyroidism after renal transplant
Allow 12 months to elapse following transplant as many cases will resolve
58
When hyperthyroidism with increased PTH in which physiological condition
Where hyperthyroidism occurs secondary to pregnancy the TSH is typically elevated.
59
Which drug of breast Ca causes venous thromboembolism
Tamoxifen
60
Pneumonic for clinical features of digeorge syndrome
CATCH’:
Congenital heart defects
Abnormal facies
Thymic aplasia
Cleft palate
Hypoparathyroidism.
61
Diagnostic point of osteomalacia
Osteomalacia
low: calcium, phosphate
raised: alkaline phosphatase
62
C/F of rickets
rickets: knock-knee, bow leg, features of hypocalcaemia
63
C/F of osteomalacia
osteomalacia: bone pain, fractures, muscle tenderness, proximal myopathy
64
Xray findings of osteomalacia
x-ray: children - cupped, ragged metaphyseal surfaces;
adults - translucent bands (Looser's zones or pseudofractures)
65
Most common cause of primary hyperparathyroidism
Most cases due to solitary adenoma (80%),
66
Which thyroid carcinoma cause distant metastasis and of what kind
Follicular carcinomas may metastasise haematogenously (often to bone)
67
Whichthyroid marker is only useful for followup of cancer
Thyro globulin
68
which Ab is present in both Hashimoto and Grave disease
Thyroid peroxidase (microsomal) antibodies
69
Which by causes tHypothyroidism
Lithium
Amiodarone
Sulfonylurea
70
Histology of Hashimoto Thyroiditis
Lymphocytic infiltrates and fibrosis are typically seen in Hashimotos thyroiditis.
71
ANA profile Ab
Anti Ro and La
Anti-centromere
Anti-Scl70
Anti-Ro and anti-La (associated with Sjögren syndrome)
•Anti-centromere (associated with CREST syndrome)
• Anti-Scl70 (associated with scleroderma)
72
Subacute(deQuervain)thyroiditis is caused by
Viral infections like EBV, mumps ,measles
73
Tinel sign is?
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.
74
Phalen test
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
75
Rx of hyperthyroid phase in Hashimoto’s thyroiditis
During the hyperthyroid phase of illness beta blockers may manage symptoms
76
Hashimoto thyroiditis is associated with which melegnancy
Thyroid lymphoma (Non Hodgkin's B cell lymphoma
77
Which muscles is innervated by the cervical branch of the facial ner
The cervical branch of the facial nerve innervates platysma
78
Sick euthyroid syndrome
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
79
Extra colonic diseases of Gardners syndrome
skull osteoma, thyroid cancer and epidermoid cysts
80
MOA of methimazole
Methimazole prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin
81
Most common liver tumor
Metastatic
82
Most common primary liver tumours
Hepatocellular carcinoma
83
main risk factor for cholangiocarcinoma
Primary sclerosing cholangitis is the main risk factor.
84
Most common cause of Hepatocellular Carcinoma
Most cases arise in cirrhotic livers or those with chronic hepatitis B infection,
85
Biopsy inHepatocellular carcinoma
Biopsy should be avoided as it seeds tumours cells through a resection plane.
86
Tumor markers in Cholangiocarcinoma
CA 19-9, CEA and CA 125 are often elevated
87
Hepatocellular carcinoma marker
a-fetoprotein is elevated in almost all cases
88
Commonest cause of amoebic liver disease
Entamoeba histiolytica
89
Congenital cause of unconjugated prehepatic hyper bili
Gilbert
Grigler_ Najjar
90
Jaundice level
>35 umol /L
91
Most common benign tumours of mesenchymal origi
Haemangioma
92
Haemangioma on US
they are typically hyperechoic
93
Liverlesion caused by oral contraceptive
Liver cell adenoma
94
Mesenchymal hamartomas usually present in
Infants
95
Liver abscess major cause
Biliary sepsis is a major predisposing factor
Structures drained by the portal venous system form the second largest source
96
most common extra intestinal manifestation of amoebiasis
Liver abscess is the most common extra intestinal manifestation of amoebiasis
97
Amoebic abscess mostly occurs in which lobeof liver
Between 75 and 90% lesions occur in the right lobe
98
Aspirate of Amoebic abscess
1Aspiration yield sterile odourless fluid which has an anchovy paste consistency
99
wall of Hydatid cyst
The cyst wall is thick and has an external laminated hilar membrane and an internal enucleated germinal layer
100
Klatskin tumor
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.
101
Black color GB stones
Pigment
102
Mixed stones of GB contains
More cholesterol
Multiple in number
103
Which GB stone is single vs multiple
Single: Cholesterol
Multiple: Mixed and Pigment
104
Gall stone ileus
due to fistula b/w GB and duo, stone get impacted at terminal ileal Level
105
Disease which affect enterohepatic circulation
Damage at terminal ileum suchas Crohn disease,int resection
106
Drugs causing GB stone
Estrogen
Clofibrate
107
The classical symptoms ofAcute cholecystitis
colicky right upper quadrant pain that occurs post prandially
108
sub total cholecystectomy criteria
IF problematic CaloT triangle
109
fistula between the gallbladder and duodenum in Gallstone iLeas in surgery
The fistula between the gallbladder and duodenum should not be interfered with.
110
CBD stone removal criteria
Small stones that measure less than 5mm may be safely left and most will pass spontaneously.
111
When not to surgically explore CBD
When stone is > 8mm
112
Acalculous cholecystitis infective causes
: Due to infection with Ecoli, clostridia or rarely Salmonella
113
Rokitansky-Aschoff sinuses, or Luschka's crypts
Glandular outpouchings formed by lining of mucosa extending into or through muscular coat of GB
114
GB doesn't distend in which cystitis
GB doesn't distend in Chronic Cholecystitis as it causes fibrosis of the wall
115
GB distend several times to its normal size in which disease
GB distend several times to its normal size due to lack of inflammation in Mucocele.
116
Strawberry gallbladder is
CholeSterolosis
117
Hematogenoas spread of Esophageal Ca. to
Lungss and liver
118
Common causes of Esophageal Ca
Diet defi of
1Vit A
2 Riboflavin
3. Zinc
High intaKe of tannic acid
Fungal contamination of food
119
Mostcommon cause of esophageal stasis
Lye strictures
120
most common cause of neck swellings
Reactive lymphadenopathy
121
Rubbery, painless lymphadenopathy in neck
Lymphoma
122
Pharyngeal pouch location
posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
123
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Branchial cyst
124
Branchial cyst Develop due to failure of obliteration of
second branchial cleft in embryonic development
125
Charcot's triad of symptoms
pain, fever, jaundice)
126
Charcot's triad of symptoms in
Cholangitis
127
Acalculus cholecystitis is caused by
Prolonged starvation / TPN
128
Hydatid cyst causes whichkind of ypersensitivity reaction
These cysts are allergens which precipitate a type 1 hypersensitivity reaction.
129
Hydatid cyst causes symptoms when
Size is >5mm
130
Acquired factor 12 deficiency causes prolonged clotting factor which type
Prolonged APTT
131
Apoptosis vS Necrosis of Kidney causes
Nephrotoxic stimuli such as aminoglycosides and radiological contrast media induce apoptosis.
Myoglobinuria and haemolysis result in necrosis
132
Post-operative renal failure is more likely to occur in patients who are
elderly, have peripheral vascular disease, high BMI, have COPD, receive vasopressors, are on nephrotoxic medication or undergo emergency surgery.
133
Which syndrome associated with hamartomas
Puetz jegher syndrome
134
Genetics of Peutz-Jeghers syndrome
Autosomal dominant
serine threonine kinase LKB1 or STK11 problem
135
Features of Peutz-Jeghers syndrome
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
136
first line investigation for dysphagia
Endoscopy
137
Which tests to perform before fundoplication surgery for GERD
Ambulatory oesophageal pH and manometry studies
138
For diagnosis of pharyngeal pouch (or any other diverticulum) which test is performed
barium swallow studies can be performed
139
Urgent endoscopy criteria
With dysphagia
Aged ≥55yrs with weight loss plus
Upper abdominal pain
Reflux
Dyspepsia
140
Greenish nipple discharge
Duct ectasia
141
Green nipple discharge with normal USS
Best actions
Discharge and reassure
Duct ectasia
142
Galactorrhoea can be caused by
histamine receptor antagonists
143
What is galactorrh3a in post Parfums females
In postpartum females, this also includes milk production occurring 6-12 months after pregnancy and the cessation of breastfeeding
144
Which viral infection can cause galactorrhea
Varicella zoster
145
What type of hypersensitivity is tuberculosis?
Type IV
Delayed type
146
Levels of prolactin in prolactinoma
>1000
147
Examples of type II hypersensitivity
TIMPAG
Autoimmune haemolytic anaemia
Pemphigus
Goodpasture's
Transfusion reaction
ITP
Myasthenia gravis
148
Example of type 3 hypersensitivity
Serum sickness
SLE
Aspergillosis
Poststreptococcal glomerulonephritis
RA
Polyarteritis nodosa
149
Examples of type IV hypersensitivity
Graft versus host disease
Contact dermatitis
Tuberculin test
Microbial agents like TB
150
Example of type V hypersensitivity
TSH receptor antibody results in prolong hypersecretion of thyroid hormone
151
Tumors defying histogenetic classification are called
Anaplastic
152
Benign vs malignant features I don't know
B: rarely ulcerates or undergo necrosis,
M: opposite
153
Carcinoma versus sarcoma
Carcinoma is a malignant epithelial neoplasm
Sarcoma is a malignant connective tissue neoplasm
154
Histopathologic features of malignancy
Abnormal tissue architecture
Coarse chromatin
Invasion of basement membrane*
Abnormal mitoses
Angiogenesis
De-differentiation
Areas of necrosis
Nuclear pleomorphism
155
Potent vasodilators during acute inflammation
histamine,
prostaglandins,
nitric oxide,
platelet activating factor,
complement C5a (and C3a) and
lysosomal compounds.
156
Serotonin function as a vasodilator versus vasoconstrictor
Intact and healthy tissues and vessels will respond to a serotonin infusion with vasodilation
In damag3d cells it acts as vasoconstrictor
157
What happens during exudative cellular phase of acute inflammmation
Adhesion of neutrophils
Neutrophils migration
Diapedesis
Neutrophils chemotaxis
158
Vascular phase of acute inflammation:
change in vessel calibre
increase vascular permeability
formation of fluid exudates
159
First response of vessel to injury
Vasoconstriction then dilation
160
What is triple response to jnjury
Flush: capillary dilation
Flare: arteriolar dilatation
Weal: zon3 of edema
161
Amount of protein in an exudate of acute inflammation
50g/L
162
Chemicals increasing leukocyte surface adhesion molecule expression versus
Chemicals increasing endothelial expression of adhesion molecules
C9mplement 5a, leukotriene B4, TNF
IL-1, Endotoxins, TNF
163
Chemicals responsible for neutrophil chemotaxis
Leukotriene B4
IL-8
164
Function of C5a
Neutrophils chemotaxis
Increase vascular permeability
Release of histamine from mast cells
165
Opsonization of bacteria and phagocytosis by macrophage is facild by which complements
C4b, 2a and 3b
166
Kindness system is activated by which factor
Factor XII
167
Kinin system
Prekallikrien>kallikrien by factorXII
Kinogen >> Bradykinin by Kallikrien
168
Which factor activate coagulation fibrinolytic and kinin system in acute inflammation
Factorc12
169
How lymphatic system helps in acute inflammation
Buy limiting extent of edema
Carry antigens to lymph nodes for recognition by lymphocytes
170
In TB where reactivation of disease occurs
Reactivation generally occurs in the apex of the lungs and may spread locally or to more distant sites
171
Regions of body affected by tuberculosis apart from lungs
Central nervous system
vertebral bodies
cervical lymph nodes
kidney
gastrointestinal tract
172
Tuberculosis in cervical lymph nodes is called
(scrofuloderma)
173
Risk factors for developing active tuberculosis include
silicosis
chronic renal failure
HIV positive
solid organ transplantation with immunosuppression
intravenous drug use
haematological malignancy
anti-TNF treatment
previous gastrectomy
174
Hadfield procedure
Total duct excision
Usually in periductal mastitis
Uncontrolled duct ectasia
Multiple duct pathology
175
When to perform
total duct excision
Vs
microdochectomy
In breast discharges
Multiple duct pathology
Vs
Single duct pathology
176
Van Gieson and Masson trichrome are histological staining methods for
identification of connective tissues.
177
Von Kossa technique is useful for identifying
tissue mineralisation.
178
Markers of carcinoid syndrome in blood
chromogranin A,
neuron-specific enolase (NSE),
substance P,
and
gastrin.
179
Urinary marker of carcinoid tumor
5 HIAA, which is a metabolite of serotonin
180
Common site of carcinoid tumor
mainly in the intestine (midgut-distal ileum/appendix)
Can occur in the rectum, bronchi
181
Site of carcinoid tumor other than gastrointestinal tract
Pancreas and lung
182
What valve issue in carcinoid
Pulmonary valve stenosis and tricuspid regurgitation causing dyspnoea
183
Tests for carcinoid syndrome
5-HIAA in a 24-hour urine collection
Somatostatin receptor scintigraphy
CT scan
Blood testing for chromogranin A
184
When to give Octreotide in patients with carcinoid tumor pre and post op
In the highest risk patients, octreotide can be started 24 hours prior to the operation and continued for 48 hours post-operatively.
185
Lynch syndrome/HNPCC features
locally advanced mucinous carcinoma
scanty polyps in the remaining colo
Right sided colonic Ca at young age
186
What type of gene is HNPCC vs APC
HNPCC: DNA mismatch repair gene
APC: Tumor suppressor gene
187
Lynch syndrome gene mutation
MSH2, MLH1, PMS2 and GTBP
188
Cowden disease diagnostic feature
Multiple intestinal hamartomas
Multiple trichilemmomas
189
Most common site of lynch syndrome
Colorectal>endometrial>gastric
190
Criteria for diagnosis of HNPCC
nemonic 3-2-1 for HNPCC.
3 individuals,
2 generations and
one must be younger than 50 yrs
191
At what cell count of T cells does candidiasis occur in AIDS
<200
192
pathological criteria carries the greatest prognostic weighting for malignant melajoma
Bristow thickness
193
Lesions >4 mm thick on breslow
Rx is
3 cm margin around the malignant melanoma
194
Example of primary chronic inflammation
TB
Suture material
Prosthetic materials like breast
Autoimmune conditions
195
Example of serous inflammation
Conjunctivitis
196
What is catarrhal inflammation
Hypersecretion of mucus in acute inflammation of a mucus membrane
197
How anemia is caused in acute pancreatitis
Loss of blood into exudates
198
A features of chronic inflammation
Usually primary but may follow acute
Granulomatous inflammation is a specific type
May be complicated by amyloidosis
199
Examples of primary chronic inflammation from foreign body endogenous materials
Foreign body reactions
endogenous material: necrotic bone, uric acid crystals
200
Name few diseases which cause primary chronic inflammation
Autoimmune diseases: hashimotos thyroiditis, chronic gastritus of pernicious anaemia, Rheumatoid arthritis
Granulomatus disease: crohn disease sarcoidosis
Ulcerative colitis
Tuberculosis, leprosy
201
Which kind of acute inflammation converts to chronic inflammation mostly
Suppurative inflammation type
202
Example of progression from acute inflammation to chronic
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
Example of recurrent episodes of acute inflammation turning into chronic
Chronic cholecystitis due to gallstones
204
Microscopic appearance of chronic inflammation
Chronic ulceration
Chronic abscess
Caseating granulomatous inflammation
Thickening of hollow viscous
Fibrosis
205
How healing occurs in chronic information
By Fibrosis
206
What is diaphragm disease
When human of small bowl is divided into short compartments by circular membrane of mucosa and sub-mucosor
207
Cause of diaphragm disease
Long use OF NSAIDS
mostly in elderly females
208
Popcorns are present in which sub type of Hodgkin lymphoma
Nodular lymphocyte predominant
209
lymphohistiocytic (L-H) variant of Reed Sternberg cells
Popcorn cells
210
B Symptoms
10% weight loss, fever, night sweats
211
Which virus is associated with hodkin lymphoma
Ebstein bar virus specially to mixed cellularity lymphoma
212
Chronicle features of Hodgkin lymphoma
Cough, Pel Ebstein fever, haemoptysis, dyspnoea
B Symptoms - 10% weight loss, fever, night sweats
213
Which sub type of Hodgkin lymphoma has best prognosis
Nodular sclerosing has the best prognosis
214
Which features of hodgkin lymphoma attribute to worst prognosis
Lymphocyte depleted Hodgkins lymphoma,
advancing age,
male sex and
stage IV disease
215
apple green birefringence with polarised light in which disease
Amyloidosis
216
Which amyloidosis is a long-term complication of several chronic inflammatory disorders
Systemic AA amyloidosis
217
AL amyloidosis
results from extra-cellular deposition of fibril-forming monoclonal immunoglobulin light chains (most commonly of lambda isotype).
218
most commonly affected sites by amyloidosis
kidney and heart
219
If myeloma or any monoclonal gammopathy then amyloidosis
Then amyloidosis can't be from AL
As AL causes just asymptomatic ones
220
Sarcomas in which Lymphatic Metastasis is seen:
'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
Most common site of sarcoma metastasis
Lung
222
Malignant fibrous histiocytoma is now referred to as
undifferentiated pleomorphic sarcoma
223
Some features suspicious of sarcoma
Large >5cm soft tissue mass
Deep tissue location or intra muscular location
Rapid growth
Painful lump
224
Biopsy of a sarcoma
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
Commonest type of Ewings sarcoma
femoral diaphysis
226
4 subtypes of Malignant Fibrous Histiocytoma
storiform-pleomorphic (70% cases), myxoid (less aggressive), giant cell and inflammatory
227
Callus visible on xray after how long from the injury
3 weeks
228
Bone tumors are mostly primary or sec
Secondary
229
Features of primary malignant bone tumor
Rare
Have bad prognosis
Affect patients in a younger age group
230
Genetic abnormality in Ewing sarcoma
genetic translocation of chromosomes 11 and 22
231
Most common bone tumor
Osteochondroma
232
Xray finding of Ewing sarcoma
Lytic lesion with periosteal reactions
Onion rings on x ray
233
Pediatric malignancy of bone
Ewing sarcoma
234
Treatment of Ewing sarcoma
Management is via adjuvant chemotherapy followed by surgical excision.
235
Human herpes virus 8 causes
Kaposi's sarcoma
236
Human T-lymphotropic virus 1
Tropical spastic paraparesis
Adult T cell leukaemia
237
Human papillomavirus 16/18 causes
Cervical cancer
Anal cancer
Penile cancer
Vulval cancer
Oropharyneal cancer
238
Post transplant lymphoma occurs by
EBV
239
Nasopharyngeal carcinoma is caused by
EBV
240
MEN IIB includes
Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Hyperparathyroidism
Marfanoid appearance
241
MEN type IIa includes
Phaeochromocytoma
Medullary thyroid cancer (70%)
Hyperparathyroidism (60%)
242
Genetic of MEN 2
RET Oncogene on chromosome 10
243
Most common presentation of MEN 1
hypercalcaemia
244
Genetic of MEN 1
MENIN gene on chromosome 11
245
MEN 1 syndrome includes
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
Sudden collapse and angioedema following exposure to latex
Which hypersensitivity
Type 1
247
CNS tissue has which kind of necrosis
Colliquative
248
Apoptosis occurs due to
activation of caspases triggered by the bcl-2 family or the binding of the FAS ligand to its receptor
249
Necrosis in arterioles in patients with hypertension
Fibrinoid
250
Black color ingangrene is due to
deposition of iron sulphide
251
Amorphous eosinophilic tissue in which necrosis
Caseous
252
Occurs in tissues with no supporting stroma
Colloiquative
In CNS
253
Nerve damage with no soft tissue injury what will be the rate of neuron growth
1 mm perday
254
Wallerian Degeneration begins
24-36 hours following injury
255
Wallerian Degeneration occurs in
Axonotmesis
Neurotmesis
Not in Neuropraxia
256
Difference between types of nerve injury
1 Neuropraxia
2 Axonotmesis
3 Neurotmesis
1 Only electrical conduction affected.
2 Only axon is affected with intact myelin
3 Both axon and myelin are affected
257
aneurysm screening program age limit
in all men aged 65 years.
258
Commonest cause of Abd aneurysm
Smoking and hypertension
259
Abdominal aortic aneurysm is associated with which type of connective tissue disorder
Marfan syndrome
260
When to perform surgery for aneurysm
Vs
When to perform urgent surgery
When size is >5.5 to 6 cm
If aneurysm is painful
261
Indications for surgery for abdominal aneurysm
Symptomatic aneurysms (80% annual mortality if untreated)
Increasing size above 5.5cm if asymptomatic
Rupture (100% mortality without surgery)
262
Most common rupture site of abdominal aneurysm
retroperitoneal 80%.
263
BP aim for abdominal aneurysm hematoma
100 mm
264
weeping, crusty lesion, areolar region is spared
Paget disease
265
Lab findings of antiphospholipid syndrome
Lupus anticoagulant may be present and the APTT is prolonged.
266
Features of antiphospholipid syndrome
thromboembolism and coagulation issues in a young woman
fetal loss, venous and arterial thrombosis and thrombocytopenia.
267
Rx of lead poisoning
Dimercaptosuccinic acid (DMSA)
D-penicillamine
EDTA
Dimercaprol
268
Clinical features of lead poisoning
abdominal pain
peripheral neuropathy (mainly motor)
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)
269
How to differentiate between intermittent porphyria vs lead poisoning
Blue line on gum margin in LP
Heme products in urine in AIP
270
Cbc of lead poisoning
red cell abnormalities including basophilic stippling and clover-leaf morphology
271
What may be seen making it sometimes difficult to differentiate lead poisoning from acute intermittent porphyria
Raised serum and urine levels of delta aminolaevulinic acid
272
Tumor arising from 4th ventricle and can grow through the foramina of Luschka and Magendie
Ependymoma
273
Adult vs pediatrics CNS tumor location
Most paediatric CNS tumours are infratentorial
Most adult CNS tumours are supratentorial
274
Which brain tumor can be treated with surgery and get cured
Meningioma
275
MC cell making giant cells
Macrophages
276
Most malignant CNS tumor
Glioblastoma multiforme
277
Most common CNS tumor in childhood
Medulloblastoma
278
Which sense is lost early in Acoustic neuroma
Corneal reflex
279
Recklinghausen's disease has which neural tumor
Acoustic neuroma
280
Astrocytoma in children
In cerebellum
Benign
Can be excised completely
281
Most frequent sites affected by meningioma
Parasagittal region
Olfactory groove
Sphenoiid wing
Foramen magnum
282
Which tumor compress cerebral cortex at early stage and cause fits
Meningioma
283
Which brain tumors are radio resistant
Astrocytoma
Glioblastoma
284
Which bone type has better healing after fracture
Cancellous bone has better healing than compact
285
steroids, non steroidal anti inflammatory agents affect on bone healing
Decrease it
286
Location of dermoid tumor
midline of the neck, external angle of the eye and posterior to the pinna of the ear.
287
Desmoid cyst are associated with which
familial adenomatous polyposis coli syndrome
288
Graft vs host disease is caused due to which cell line
Lymphocytes
289
Transfusion related lung injury is due 5to which cell
Neutrophils
290
Mnemonic for transfusion reactions:
Mnemonic for transfusion reactions:
Got a bad unit
G raft vs. Host disease
O verload
T hrombocytopaenia
A lloimmunization
B lood pressure unstable
A cute haemolytic reaction
D elayed haemolytic reaction
U rticaria
N eutrophilia
I nfection
T ransfusion associated lung injury
291
Blood pressure compromise during transfusion is die to
IgA antibodies
292
most likely to arise from musculoaponeurotic structures?
Desmoid tumor
293
Beta-naphthalamine causes which Ca
Bladder Ca
294
If jaundice 2° stone then which test will show bleeding diathesis
PT
As cholestasis decreases production of vit l dependent factors 2,7,9 and 10
295
Macroscopic features of chronic inflammation
Ulcers
Fibrosis
Granulomatous process
296
Chronic inflammation usually occurs
Primar
297
Which type of diarrhoea in carcinoid syndrome
Secretary diarrhoea despite fasting
298
Pseudomyxoma peritoneii treatment
peritonectomy (Sugarbaker procedure) and heated intra peritoneal chemotherapy.
299
Pseudomyxoma Peritonei most commonly originates from which organ
Appendix
300
intra peritoneal chemotherapy in Pseudomyxoma Peritonei is dome by
Mitomycin C
301
Most common adverse event with Packed cell vs FFP
Packed cell: Pyrexia
FFP : Urticaria
302
Atrophy in muscle vs other organs
In muscle only the size is changes
In other organs size and cellularity both are changed
303
Neutrophil features
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
Neutrophils produce what as a micocidal agent
Hydrogen peroxide not nitrogen
305
Nasopharyngeal Ca caused by which virus
EBV
306
Nasopharyngeal carcinoma
SCC
Mcommon in China
307
Symptoms of Nasopharyngeal carcinoma
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI
308
Which cranial nerve is affected in Nasopharyngeal carcinoma
III to VI
309
Rx of Nasopharyngeal Ca
1st line therapy is Radiotherapy
310
Organisms causing post splenectomy sepsis:
Streptococcus pneumoniae
Haemophilus influenzae
Meningococc
311
Postsplenectomy meds
Penicillin V 500mg BD or amoxicillin 250mg BD
312
Which age group has highest rate of post splenectomy sepsis
less than 16 years or greater than 50 years.
313
Which type of pneumococcal vaccine is offered to young children
Pconjugated vaccine (PCV
314
What is Hypersplenism
Splenomegaly associated with
•Any combination of anaemia, leucopenia or thrombocytopenia •Compensatory bone marrow hyperplasia
•Improvement after splenectomy
315
Primary splenism affects
Women
316
Massive splenomegaly is likely to be due to
Chronic myloid leukemia
Myelofibrosis
Lymphoma
317
Which storage disease causes splenomegaly
Gaucher's Disease
318
If platelets above 1000 after splenectomy then what to do
No need to give anticoagulants
Antiplatelets such as aspirin can be given
319
What occurs absmoat immediately post splenectomy
Granulocytosis
320
When splenectomy is ofgreat risk
•In young especially < 2 years.
•When it happens 2' to reticu lo endothelial than trauma.
321
Most common infection after splenectomy
Pneumococcal> H. influenza type B >N.meningitis
322
Which infection occurs after splenectomy due to dog bite
Capnocytophaga canimorsus
323
Other uncommon infections due to splenectomy
E.coli, Malaria, Babesiosis, capnocytophaga canimorsus
324
Why fatal sepsis is less after splenectomy from trauma
Due to splenosis means small multiple implants of splenic tissue auto transplantation
325
Vaccination after splenectomy
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
Which vaccine is recommended annually after splenectomy
Influenza vaccine
327
Vaccination criteria due to planned versus emergency splenectomy
Planned: 2 weeks before or after surgery.
Emergency:Best after 14 days post surgery.
328
Glucaganoma is associated with
diarrhoea, weight loss and necrolytic migratory erythema.
329
Diagnosis of glucaganoma at which level
serum level of glucagon >1000pg/ml
330
Carcinoid tumor arise from
Enterochromaffin cells
331
How carcinoid syndrome is diagnos
5-Hydroxyindolaedcetic acid 5-HIAAmin urine
332
ARDS definition
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
DALM lesion in ulcerative colitis
Rx?
Panproctocolectomy
334
If achalasia turns to malignancy it is
Squamous cell carcinoma
335
Post splenectomy causative organisms
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
Massive transfusion affects which coagulation factors
5 and 8
337
Classification of oncogenes
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
Schilling test used for
A Schilling test is also known as a Vitamin B12 absorption test
339
Vitamin required for collagen
Vit C
340
If increased flexibility then which collagen
III
341
Collagen loss in
Ehlers Danlos vs Osteogenesis imperfecta
E: 1 and 3
O: 1
342
Ehler Danlos patients are prone to
joint dislocations and pelvic organ prolapse.
343
Which symptoms during blood transfusion is the most common event of complication
Mild pyrexia during blood transfusion is the most common event and commonly occurs during transfusion.
344
GIST's are derived from which cells
the interstitial pacemaker cells of Cajal
345
Genetics of GIST
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
Drug to give in GIST which is unresectable
Imatinib
347
pharyngeal pouch, what is the most appropriate investigation?
Upper GI endoscopy is contra indicated in pharyngeal pouch.
348
Organ sites that may metastasise (early) to the para-aortic lymph nodes:
Testis
Ovary
Uterine fundus
349
Infection with which of the following micro-organisms may result in a clinical picture resembling achalasia of the oesphagus?
Trypanosoma Cruzi may result in destruction of the ganglion cells of the myenteric plexus,
350
Which nerve can be damaged after temporal biopsy
Facial
Auriculotemporal
351
Histology of thyroid in hyper thyroidism
hyperplasia of acini, which are lined by high columnar epithelium
Vacuolated or empty acini
Scalloped appearance adjacent to thyrocytes
352
Which hyperthyroid disease will not react to meds
Toxic nodule as it's autonomous
353
From where thyroid is produced in Toxic multinodualr goitre
In between the nodules
Not fromt the nodules themselves
354
Retinal and cerebellar haemangiomas are key features of
Von Hippel
355
Which type of HL is associated the most with EBV
Mixed cellularity
356
Non neoplastic polyps which don't have cancer prognosis
Hamartamatous
Juvenile
Inflammatory
Lymphoid
Hyperplastic
