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Radiology > Pathology MCQs > Flashcards

Pathology MCQs Flashcards

1
Q

Gastric cancer- Not true

A

Early gastric cancer confined to mucosa/ submucosa with negative perigastric nodes- NOT influenced by presence of perigastric nodes

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2
Q

Crohn’s disease- lifetime risk of parent or sibling being affected

A

10%

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3
Q

Not a recognised feature of diverticular disease

A

Crypt abscesses (typical of UC)

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4
Q

Peutz Jeger is sporadic hamartomatous polyps- T/F?

A

False: autosomal dominant syndrome characterised by multiple hamartomatous polyps

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5
Q

HNPCC (Lynch syndrome)- associated with adenoma?

A

Familial carcinoma of colon (mainly right sided).

Most common inherited CRC susceptibility syndrome- CRC and endometrial ca.

Appear to evolve from adenomas.

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6
Q

60M with colon cancer involving muscularis propria. N0 M0- what is prognosis?

A

67% 5 year survival (Dukes B1)

90% according to TNM

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7
Q

Histologically appendicitis characterised by

A

Neutrophils in muscularis propria. If just in mucosa, can be spread from GIT infection elsewhere.

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8
Q

Risk of synchronous and meta-synchronous caecal cancer?

A

Rate of synchronous CRC 5%

Rate of meta-synchronous 2%

Both 0.1%

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9
Q

PRV and splenomegaly. Least likely: CML, ALL, Budd-Chiari, Cirrhosis

A

Cirrhosis (PRV can transform into ALL)

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10
Q

Least likely in Crohn’s

A

PBC (develop PSC instead)

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11
Q

H.pylori morphology

A

Spiral shaped gram negative bacterium

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12
Q

Most likely feature of benign gastric ulcer

A

Chronic atrophic gastritis- almost universal in PUD. 85% of DU and 65% of GU

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13
Q

Mucosa in Coeliac’s disease

A

Flattened villi, elongated glands but overall mucosal thickness remains the SAME

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14
Q

Risk of malignancy in coeliacs

A

2-3X risk: intestinal T-cell lymphoma

GIT and breast cancer

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15
Q

Most concerning for malignant gastric ulcer

A

Heaped edges

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16
Q

Achalasia associated with Chagas- any colonic involvement?

A

Mega-oesophagus and megacolon in 25-30%

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17
Q

H. Pylori and chronic gastritis

A

Present in 90% of patients with chronic gastritis of the antrum

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18
Q

Previous strongyloides (helminthic parasite) presenting with mucosal oedema of ascending colon. Meaning?

A

Auto-infection in immunocompromised. It can complete ENTIRE life cycle inside human host. In IM suppressed people, the larva matures within GIT and penetrates perianal skin or colonic mucosa to complete cycle of auto-infection

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19
Q

20M with 20 colonic polyps. ? FAP

A

Attenuated FAP can have 100

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20
Q

Where does Giardia attach in the GIT?

A

Mucosal surface of duodenum and jejunum

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21
Q

Mid-oesophageal stricture in 40F

A

If adenocarcinoma, likely long segment Barrett’s.

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22
Q

Giardia on histology?

A

Subtotal villous atrophy in SB. Flagellated protozoan parasite. Dx is usually by stool microscopy for oocysts

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23
Q

How often is H.pylori symptomatic?

A

50% of world population affected but majority of individuals are asymptomatic

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24
Q

Most common cause of renal papillary necrosis

A

Diabetes (50%)

NSAID: nsaids, sickle cell, amyloidosis, infection (TB), DM

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25
Q

Top 3 renal tumours in kids

A

Wilms tumour

Mesoblastic nephroma

Clear cell sarcoma

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26
Q

4 subtypes of RCC

A

Clear cell: 70-80% and proximal tubules

Papillary: 10% and distal tubules. Multifocal/ bilateral with psamomma bodies

Chromophobe: 5% and intercalated cells of collecting ducts

Collecting duct

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27
Q

Where do renal oncocytoma arise from? Should you biopsy them?

A

Arise from intercalated cells of collecting ducts.

Benign tumour with central fibrous scar.

Core biopsy considered UNRELIABLE to distinguish from RCC. Complete excision needed.

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28
Q

Which form on ARPCKD has the best Px (neonatal, infantile or juvenile)?

A

Juvenile (80% survive > 15 years). Most pronounced hepatic involvement but minimal renal insufficiency

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29
Q

Are fatty streaks influenced by geography?

A

No. Fatty streaks occur in all children> 10 years regardless of geography, race, sex or environment

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30
Q

Percentage restenosis post coronary angioplasty

A

Long term patency limited by proliferative restenosis which occurs in 30-50% in the first 4-6 months

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31
Q

Most common type of ASD?

A

Secundum type. Usually ISOLATED anomaly

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32
Q

Different AMI territory infarcts- percentages. How common isolated infarction of RV?

A

LAD: 45%

RCA: 35%

LCx 15%

Isolated infarction of RV occurs in only 1-3%

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33
Q

Which is not associated with coarctation of the aorta? PDA, VSD, dural AVM, Berry aneurysm, bicuspid aortic valve

A

Dural AVM

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34
Q

How often is fat embolism symptomatic and how long does it take for symptoms to manifest?

A

Symptomatic in 10% and symptoms appear 1-3 days after injury

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35
Q

Hypertensive patient- most likely adrenal findings

A

Bilateral hyperplasia.

Note that aldosteronoma 5 cm

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36
Q

Findings in psittacosis

A

Inflammation: histiocytes/ lymphocytes confined to alveolar walls

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37
Q

Heart size in emphysema vs chronic bronchitis

A

Chronic bronchitis more likely to have cardiomegaly due to cor pulmonale

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38
Q

Unusual finding in pleural fibroma

A

Pleural effusion (only in 20%, esp if malignant).

Usually dense fibrous tissue with occasional cysts

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39
Q

Most common cause of lung metastases

A

Breast> CRC> RCC

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40
Q

Atypical for candida bacteraemia

A

Empyema.

Known to cause OM, TV lesions, splenic/ hepatic abscesses, renal lesions

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41
Q

Is long term survival in CF associated with malignancy?

A

Yes, increased risk of GIT, pancreas, biliary malignancies and lymphoma

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42
Q

Prognosis in sarcoidosis

A

60-80% spontaneous resolution

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43
Q

2 associations of acanthosis nigricans

A

Obesity and T2DM

Malignancies- GIT, esp stomach

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44
Q

Name 2 syndromal carcinoid disease

A

MEN-1 and NF-1

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45
Q

What is strongyloidosis (helminthic infection) associated with?

A

Duodenal stenosis

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46
Q

Small diverticulum arises from CBD separate from ampulla. What type?

A

Type 2

Type 1: cystic dilatation of CBD

Type 2: true diverticulum arising from CBD

Type 3: choledochocele into duodenum

Type 4: multiple intra and extra-hepatic cysts

Type 5: single/ multiple cystic dilatation of intrahepatic ducts (Caroli disease)

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47
Q

What is WDHA syndrome?

A

Watery diarrhoea, hypokalaemia, achlorhydria syndrome

Caused by VIPoma

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48
Q

What is Bismuth-Corlette classification?

A

Classification of perihilar cholangiocarcinoma (60-70% of all CC also known as Klatskin tumour)

Type 1: below confluence of left and right HD
Type 2: reaching confluence
Type 3: occluding RHD or LHD
Type 4: multicentric or extend beyond right and left HD

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49
Q

Increased uptake on red-cell labelled scan- what liver lesion?

A

Haemangioma (delayed uptake)

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50
Q

In cardiac carcinoid, which structures are involved?

A

TV and PV (right heart valves and endocardium)

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51
Q

What group of inherited conditions causes stroke-like symptoms in childhood and early adulthood?

A

Mitochondrial disorders (inherited only from mother)

MELAS (mitochondrial encephalopathy with lactic acidosis and stroke like episodes)

Leigh syndrome

Kearns-Sayre syndrome

MERRF (myoclonic epilepsy with red ragged fibres)

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52
Q

Most commonly associated with BRCA-1

A

Medullary carcinoma

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53
Q

Ovarian lesion most commonly bilateral

A

Serous cystadenoma

54
Q

What is osteogenesis imperfecta and inheritance?

A

Defect in synthesis of type 1 collagen

Autosomal dominant

55
Q

Types of OI?

A

Types 1-4

Type 1 most common (80%)

Type 2 is lethal

All have blue sclera except type 4

56
Q

3 stages of paget’s disease of bone. Histological landmark?

A

Lytic, mixed (most common), sclerotic

Jigsaw puzzle on histology

57
Q

Name 3 long-term complications of Paget’s?

A
  1. Platybasia, CN palsy (deafness) and compression of posterior fossa structures
  2. Malignant transformation (50% osteosarcoma, 40% fibrosarcoma)
  3. High output cardiac failure: hypervascular bone causes AV shunting
58
Q

Name 3 polyostotic forms of FD apart from McCune-Albright syndrome?

A
  1. Cherubism: enlargement of mandible and maxilla
  2. Mazabraud syndrome: multiple intra-muscular myxomas (fibrous soft tissue tumours-very high T2)
  3. Leontiasis ossea: craniofacial FD
59
Q

Most common benign bone tumour?

A

Osteochondroma

60
Q

3 factors that predispose to secondary osteosarcoma

A

Pagets

Radiotherapy

Bone infarct

61
Q

Name the gene responsible for primary osteosarcoma

A

Rb tumour suppressor gene (Chr 13): increases risk by 1000X

62
Q

Name 2 features of clear cell chondrosarcoma

A

Younger patients (10-20 years)

Originates in epiphyses of long tubular bones

63
Q

What does Lesch Nyan predispose to?

A

Gout (inborn error of purine metabolism)

64
Q

What is carney complex?

A

Autosomal dominant MEN syndrome:

multiple cardiac myxomas

extra-cardiac myxoma (breast, testis etc)

blue naevi

65
Q

Feature of HOCM. Does it cause obstruction at level of AV?

A

Reduced compliance and diastolic dysfunction

Note: sub-aortic stenosis

66
Q

Wilson disease: inheritance and blood test?

A

AR and low serum ceruloplasmin levels

67
Q

Most common anatomical variant of pancreas?

A

Pancreas divisum

68
Q

Inheritance patterns of hereditary spherocytosis and haemochromatosis

A

HS: autosomal dominant

HC: autosomal recessive

69
Q

What breast cancer has pushing border?

A

Medullary

70
Q

In what breast cancer cells line up in indian file?

A

Invasive lobular carcinoma

71
Q

Biopsy of parotid lesion shows oncocytes, polygonal cells and eosinophils.

A

Warthin tumour

72
Q

Why is Paget’s disease of nipple not seen on mammography?

A

DCIS infiltrates areola and rarely extends into lactiferous sinuses

73
Q

Leiomyoma of uterus: mitotic figures and presence of cells in venous system. Significance?

A

Mitotic figures are present but scarce

May have cords of cells in surrounding veins: benign metastasising leiomyoma (note: malignant degeneration is extremely RARE)

74
Q

Not associated with thoracic outlet syndrome?

A

Subclavian artery dissection

75
Q

LCIS and ILC on MMG?

A

LCIS commonly not seen on mammography- found incidentally when biopsing for other things

ILC most commonly spiculated mass (arc dist 2nd most common) seen on only 1 view (CC)

76
Q

Ranula vs lymphangioma- which space?

A

Sublingual space. Lymphangioma does NOT involve sublingual space.

77
Q

Infantile haemangioma vs congenital haemangioma

A

CI has already reached max size at birth and involutes postnatally

IH grows with child and involutes at 5-7 years

78
Q

Most common imaging finding in papillary thyroid ca?

A

Microcalcs

Note: usually heterogeneous and variable on US

79
Q

Skin necrosis from IV contrast 4-10 hrs after. Repeatable.

A

Type 3 hypersensitivity: local immune complex disease

80
Q

Where do paragangliomas arise from?

A

Arise from the non-chromaffin paraganglion cells

These are chemoreceptive cells that form part of the neuroendocrine system

81
Q

Where do phaeochromocytomas arise from?

A

Catecholamine secreting tumours derived from chromaffin cells

82
Q

Name 4 syndromes associated with phaeo?

A

MEN 2a and b

NF-1

VHL

SWS

83
Q

What is Carney triad (do NOT confuse with Carney complex)?

A

Extra-adrenal phaeo

GIST

Pulmonary chondroma (mass containing calcified cartilaginous components)

84
Q

Where do you find Aschoff bodies?

A

Rheumatic heart disease (focus of fibrinoid necrosis within myocardium)

85
Q

What is a Councilman body?

A

Apoptotic body within the liver

Associated with toxic or viral hepatitis

86
Q

Name 3 conditions associated with Langhans giant cells

A

These are transformed macrophages. Found in:

TB (most common)

Sarcoidosis

Fungal infections

87
Q

Name 3 features of Conn syndrome

A

Primary hyperaldosteronism (HTN and low K levels)

66% hyperplasia, 33% adenoma. Adrenal carcinoma RARE

Adenoma usually small (2 cm)

88
Q

Px for papillary and follicular thyroid cancer?

A

If young and no lymph nodes, Px is excellent:

PTC: 98% 10 year survival

FTC: 92% 10 year survival

89
Q

Top 3 causes of primary hyperparathyroidism?

A

Adenoma (most common)

Hyperplasia

Carcinoma

90
Q

Name 3 features of galactosaemia

A

Inability of newborns to metabolism galactose: affects liver, eyes and brain

Hepatomegaly and cirrhosis

Cataracts

Gliosis and mental retardation

91
Q

What mutation associated with neuroblastoma?

A

Anaplastic lymphoma kinase (ALK) gene

92
Q

Homer-Wright pseudorosettes found in which tumour?

A

Neuroblastoma

93
Q

What is schwannian stroma in neuroblastoma associated with?

A

It’s probably a ganglioneuroblastoma or ganglioneuroma

Better prognosis

94
Q

What liver condition associated with Mallory bodies?

A

Alcoholic hepatitis

95
Q

What condition associated with Aschoff bodies?

A

Rheumatic fever

96
Q

What’s neuron specific enolase a marker for?

A

SCLC

Neuroblastoma

97
Q

Chagas disease.

A

Infection with trypanosoma cruzi

Myocarditis

Mega-oesophgus and mega-colon

98
Q

Where do you get CMV ulcers in AIDS patients?

A

Colon

99
Q

Which small vessel vasculitis is associated with asthma and oesinophilia?

A

Churg-Strauss

100
Q

Which virus is associated with PAN?

A

30% have HBV in serum

101
Q

Name 3 histological features of sarcoidosis

A

Non-caseating epithelioid granulomas

Schaumann bodies (calcium containing concretions)

Asteroid bodies

102
Q

What do rheumatoid nodules mean?

A

Rapidly progressive disease

Note 3:1 female to male ratio

103
Q

Which are NOT neuroglial tumour?

A

L’hermitte-Duclos: dysplastic gangliocytoma (no glial component)

Central neurocytoma

104
Q

Name 3 types of gallstones

A

Cholesterol (10%): supersaturated bile (obesity, OCP, TPN)

Mixed (80%)

Pigment (10%): unconjugated bilirubin (haemolysis, malabsorption, infection)

105
Q

What percentage of gallstones radio-opaque?

A

Only 15-20%

106
Q

What CD4 count for PML and CNS lymphoma

A

Less than 50

107
Q

What virus causes mumps?

A

Paramyxovirus

108
Q

Bacteria within bubbly macrophages on Ag stain?

A

Legionella pneumoniae

109
Q

What is bronchopneumonia and name 4 common organisms

A

Suppurative peribronchiolar inflammation

Patchy consolidation

Staph, klebsiella, haemophilus and pseudomonas

110
Q

Pathological hallmark of syphilis?

A

Obliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells

111
Q

Name 3 stages of syphilis

A

Primary (weeks): chancre

Secondary (months): rash, LN, condylomata lata

Tertiary (affects 1/3): aortitis, meningovascular, gummas

112
Q

What CNS infection shows positive CSF staining with india ink?

A

Cryptococcus

113
Q

Name 5 infections associated with AIDS (CD4 less than 200)

A

PJP

Systemic candidiasis

Toxoplasmosis (most common brain lesion in AIDS)

Cryptococcal infection

CMV retinitis (most common cause of blindness in AIDS)

114
Q

Name 2 malignancies associated with AIDS (CD 4 less than 200)

A

Kaposi sarcoma (most common malignancy- HHV 8)

NHL (EBV): Burkitt’s and CNS lymphoma

115
Q

Charcot- Leyden crystals in sputum

A

ABPA

116
Q

Anchovy paste liver abscess

A

Amoebiasis

117
Q

Helminth infecting IMV and causing portal HTN

A

Schistosoma Mansoni

118
Q

Parasite causing bladder wall calcification and SCC?

A

Schistosoma haematobium

119
Q

Most common CNS parasitic infection and acquired epilepsy worldwide?

A

Cysticercosis

120
Q

Most common NHL in kids?

A

Burkitt lymphoma (median age 8 years)

1/3 extranodal

Only endemic type related to EBV

121
Q

Not inherited renal condition?

A

Medullary sponge kidney (sporadic)

122
Q

Familial polyposis and genetic mutation?

A

Gardner and FAP both share APC mutation

HNPCC and Turcot share DNA mismatch mutation

123
Q

Is lead associated with cancer?

A

No association between lead and sarcoma

124
Q

Not a feature of Wegener’s granulomatosis in kidneys?

A

Renal artery vasculitis

Causes necrotizing GN instead

125
Q

What is the recurrence rate of GCT post curettage?

A

40%

126
Q

What is a bronchial adenoma? Can it metastasize?

A

YES it can!

Bronchial adenoma includes carcinoid, adenoid cystic and mucoepidermoid tumours

127
Q

ADPCKD and RCC?

A

NO increased risk compared to general population

128
Q

SPEN vs insulinoma in terms of malignancy?

A

15% SPEN malignant

10% insulinoma malignant

129
Q

Grade of myxopapillary ependymoma?

A

Grade 1

130
Q

Receptor profile of ILC?

A

ER and PR positive

HER2 very rare

Radiology (16 decks)

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