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
2
Q
Crohn’s disease- lifetime risk of parent or sibling being affected
A
10%
3
Q
Not a recognised feature of diverticular disease
A
Crypt abscesses (typical of UC)
4
Q
Peutz Jeger is sporadic hamartomatous polyps- T/F?
A
False: autosomal dominant syndrome characterised by multiple hamartomatous polyps
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.
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
7
Q
Histologically appendicitis characterised by
A
Neutrophils in muscularis propria. If just in mucosa, can be spread from GIT infection elsewhere.
8
Q
Risk of synchronous and meta-synchronous caecal cancer?
A
Rate of synchronous CRC 5%
Rate of meta-synchronous 2%
Both 0.1%
9
Q
PRV and splenomegaly. Least likely: CML, ALL, Budd-Chiari, Cirrhosis
A
Cirrhosis (PRV can transform into ALL)
10
Q
Least likely in Crohn’s
A
PBC (develop PSC instead)
11
Q
H.pylori morphology
A
Spiral shaped gram negative bacterium
12
Q
Most likely feature of benign gastric ulcer
A
Chronic atrophic gastritis- almost universal in PUD. 85% of DU and 65% of GU
13
Q
Mucosa in Coeliac’s disease
A
Flattened villi, elongated glands but overall mucosal thickness remains the SAME
14
Q
Risk of malignancy in coeliacs
A
2-3X risk: intestinal T-cell lymphoma
GIT and breast cancer
15
Q
Most concerning for malignant gastric ulcer
A
Heaped edges
16
Q
Achalasia associated with Chagas- any colonic involvement?
A
Mega-oesophagus and megacolon in 25-30%
17
Q
H. Pylori and chronic gastritis
A
Present in 90% of patients with chronic gastritis of the antrum
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
19
Q
20M with 20 colonic polyps. ? FAP
A
Attenuated FAP can have 100
20
Q
Where does Giardia attach in the GIT?
A
Mucosal surface of duodenum and jejunum
21
Q
Mid-oesophageal stricture in 40F
A
If adenocarcinoma, likely long segment Barrett’s.
22
Q
Giardia on histology?
A
Subtotal villous atrophy in SB. Flagellated protozoan parasite. Dx is usually by stool microscopy for oocysts
23
Q
How often is H.pylori symptomatic?
A
50% of world population affected but majority of individuals are asymptomatic
24
Q
Most common cause of renal papillary necrosis
A
Diabetes (50%)
NSAID: nsaids, sickle cell, amyloidosis, infection (TB), DM
25
Top 3 renal tumours in kids
Wilms tumour
Mesoblastic nephroma
Clear cell sarcoma
26
4 subtypes of RCC
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
27
Where do renal oncocytoma arise from? Should you biopsy them?
Arise from intercalated cells of collecting ducts.
Benign tumour with central fibrous scar.
Core biopsy considered UNRELIABLE to distinguish from RCC. Complete excision needed.
28
Which form on ARPCKD has the best Px (neonatal, infantile or juvenile)?
Juvenile (80% survive > 15 years). Most pronounced hepatic involvement but minimal renal insufficiency
29
Are fatty streaks influenced by geography?
No. Fatty streaks occur in all children> 10 years regardless of geography, race, sex or environment
30
Percentage restenosis post coronary angioplasty
Long term patency limited by proliferative restenosis which occurs in 30-50% in the first 4-6 months
31
Most common type of ASD?
Secundum type. Usually ISOLATED anomaly
32
Different AMI territory infarcts- percentages. How common isolated infarction of RV?
LAD: 45%
RCA: 35%
LCx 15%
Isolated infarction of RV occurs in only 1-3%
33
Which is not associated with coarctation of the aorta? PDA, VSD, dural AVM, Berry aneurysm, bicuspid aortic valve
Dural AVM
34
How often is fat embolism symptomatic and how long does it take for symptoms to manifest?
Symptomatic in 10% and symptoms appear 1-3 days after injury
35
Hypertensive patient- most likely adrenal findings
Bilateral hyperplasia.
Note that aldosteronoma 5 cm
36
Findings in psittacosis
Inflammation: histiocytes/ lymphocytes confined to alveolar walls
37
Heart size in emphysema vs chronic bronchitis
Chronic bronchitis more likely to have cardiomegaly due to cor pulmonale
38
Unusual finding in pleural fibroma
Pleural effusion (only in 20%, esp if malignant).
Usually dense fibrous tissue with occasional cysts
39
Most common cause of lung metastases
Breast> CRC> RCC
40
Atypical for candida bacteraemia
Empyema.
Known to cause OM, TV lesions, splenic/ hepatic abscesses, renal lesions
41
Is long term survival in CF associated with malignancy?
Yes, increased risk of GIT, pancreas, biliary malignancies and lymphoma
42
Prognosis in sarcoidosis
60-80% spontaneous resolution
43
2 associations of acanthosis nigricans
Obesity and T2DM
Malignancies- GIT, esp stomach
44
Name 2 syndromal carcinoid disease
MEN-1 and NF-1
45
What is strongyloidosis (helminthic infection) associated with?
Duodenal stenosis
46
Small diverticulum arises from CBD separate from ampulla. What type?
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)
47
What is WDHA syndrome?
Watery diarrhoea, hypokalaemia, achlorhydria syndrome
| Caused by VIPoma
48
What is Bismuth-Corlette classification?
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
49
Increased uptake on red-cell labelled scan- what liver lesion?
Haemangioma (delayed uptake)
50
In cardiac carcinoid, which structures are involved?
TV and PV (right heart valves and endocardium)
51
What group of inherited conditions causes stroke-like symptoms in childhood and early adulthood?
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)
52
Most commonly associated with BRCA-1
Medullary carcinoma
53
Ovarian lesion most commonly bilateral
Serous cystadenoma
54
What is osteogenesis imperfecta and inheritance?
Defect in synthesis of type 1 collagen
Autosomal dominant
55
Types of OI?
Types 1-4
Type 1 most common (80%)
Type 2 is lethal
All have blue sclera except type 4
56
3 stages of paget's disease of bone. Histological landmark?
Lytic, mixed (most common), sclerotic
Jigsaw puzzle on histology
57
Name 3 long-term complications of Paget's?
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
Name 3 polyostotic forms of FD apart from McCune-Albright syndrome?
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
Most common benign bone tumour?
Osteochondroma
60
3 factors that predispose to secondary osteosarcoma
Pagets
Radiotherapy
Bone infarct
61
Name the gene responsible for primary osteosarcoma
Rb tumour suppressor gene (Chr 13): increases risk by 1000X
62
Name 2 features of clear cell chondrosarcoma
Younger patients (10-20 years)
Originates in epiphyses of long tubular bones
63
What does Lesch Nyan predispose to?
Gout (inborn error of purine metabolism)
64
What is carney complex?
Autosomal dominant MEN syndrome:
multiple cardiac myxomas
extra-cardiac myxoma (breast, testis etc)
blue naevi
65
Feature of HOCM. Does it cause obstruction at level of AV?
Reduced compliance and diastolic dysfunction
Note: sub-aortic stenosis
66
Wilson disease: inheritance and blood test?
AR and low serum ceruloplasmin levels
67
Most common anatomical variant of pancreas?
Pancreas divisum
68
Inheritance patterns of hereditary spherocytosis and haemochromatosis
HS: autosomal dominant
HC: autosomal recessive
69
What breast cancer has pushing border?
Medullary
70
In what breast cancer cells line up in indian file?
Invasive lobular carcinoma
71
Biopsy of parotid lesion shows oncocytes, polygonal cells and eosinophils.
Warthin tumour
72
Why is Paget's disease of nipple not seen on mammography?
DCIS infiltrates areola and rarely extends into lactiferous sinuses
73
Leiomyoma of uterus: mitotic figures and presence of cells in venous system. Significance?
Mitotic figures are present but scarce
May have cords of cells in surrounding veins: benign metastasising leiomyoma (note: malignant degeneration is extremely RARE)
74
Not associated with thoracic outlet syndrome?
Subclavian artery dissection
75
LCIS and ILC on MMG?
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
Ranula vs lymphangioma- which space?
Sublingual space. Lymphangioma does NOT involve sublingual space.
77
Infantile haemangioma vs congenital haemangioma
CI has already reached max size at birth and involutes postnatally
IH grows with child and involutes at 5-7 years
78
Most common imaging finding in papillary thyroid ca?
Microcalcs
Note: usually heterogeneous and variable on US
79
Skin necrosis from IV contrast 4-10 hrs after. Repeatable.
Type 3 hypersensitivity: local immune complex disease
80
Where do paragangliomas arise from?
Arise from the non-chromaffin paraganglion cells
These are chemoreceptive cells that form part of the neuroendocrine system
81
Where do phaeochromocytomas arise from?
Catecholamine secreting tumours derived from chromaffin cells
82
Name 4 syndromes associated with phaeo?
MEN 2a and b
NF-1
VHL
SWS
83
What is Carney triad (do NOT confuse with Carney complex)?
Extra-adrenal phaeo
GIST
Pulmonary chondroma (mass containing calcified cartilaginous components)
84
Where do you find Aschoff bodies?
Rheumatic heart disease (focus of fibrinoid necrosis within myocardium)
85
What is a Councilman body?
Apoptotic body within the liver
Associated with toxic or viral hepatitis
86
Name 3 conditions associated with Langhans giant cells
These are transformed macrophages. Found in:
TB (most common)
Sarcoidosis
Fungal infections
87
Name 3 features of Conn syndrome
Primary hyperaldosteronism (HTN and low K levels)
66% hyperplasia, 33% adenoma. Adrenal carcinoma RARE
Adenoma usually small (2 cm)
88
Px for papillary and follicular thyroid cancer?
If young and no lymph nodes, Px is excellent:
PTC: 98% 10 year survival
FTC: 92% 10 year survival
89
Top 3 causes of primary hyperparathyroidism?
Adenoma (most common)
Hyperplasia
Carcinoma
90
Name 3 features of galactosaemia
Inability of newborns to metabolism galactose: affects liver, eyes and brain
Hepatomegaly and cirrhosis
Cataracts
Gliosis and mental retardation
91
What mutation associated with neuroblastoma?
Anaplastic lymphoma kinase (ALK) gene
92
Homer-Wright pseudorosettes found in which tumour?
Neuroblastoma
93
What is schwannian stroma in neuroblastoma associated with?
It's probably a ganglioneuroblastoma or ganglioneuroma
Better prognosis
94
What liver condition associated with Mallory bodies?
Alcoholic hepatitis
95
What condition associated with Aschoff bodies?
Rheumatic fever
96
What's neuron specific enolase a marker for?
SCLC
Neuroblastoma
97
Chagas disease.
Infection with trypanosoma cruzi
Myocarditis
Mega-oesophgus and mega-colon
98
Where do you get CMV ulcers in AIDS patients?
Colon
99
Which small vessel vasculitis is associated with asthma and oesinophilia?
Churg-Strauss
100
Which virus is associated with PAN?
30% have HBV in serum
101
Name 3 histological features of sarcoidosis
Non-caseating epithelioid granulomas
Schaumann bodies (calcium containing concretions)
Asteroid bodies
102
What do rheumatoid nodules mean?
Rapidly progressive disease
Note 3:1 female to male ratio
103
Which are NOT neuroglial tumour?
L'hermitte-Duclos: dysplastic gangliocytoma (no glial component)
Central neurocytoma
104
Name 3 types of gallstones
Cholesterol (10%): supersaturated bile (obesity, OCP, TPN)
Mixed (80%)
Pigment (10%): unconjugated bilirubin (haemolysis, malabsorption, infection)
105
What percentage of gallstones radio-opaque?
Only 15-20%
106
What CD4 count for PML and CNS lymphoma
Less than 50
107
What virus causes mumps?
Paramyxovirus
108
Bacteria within bubbly macrophages on Ag stain?
Legionella pneumoniae
109
What is bronchopneumonia and name 4 common organisms
Suppurative peribronchiolar inflammation
Patchy consolidation
Staph, klebsiella, haemophilus and pseudomonas
110
Pathological hallmark of syphilis?
Obliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells
111
Name 3 stages of syphilis
Primary (weeks): chancre
Secondary (months): rash, LN, condylomata lata
Tertiary (affects 1/3): aortitis, meningovascular, gummas
112
What CNS infection shows positive CSF staining with india ink?
Cryptococcus
113
Name 5 infections associated with AIDS (CD4 less than 200)
PJP
Systemic candidiasis
Toxoplasmosis (most common brain lesion in AIDS)
Cryptococcal infection
CMV retinitis (most common cause of blindness in AIDS)
114
Name 2 malignancies associated with AIDS (CD 4 less than 200)
Kaposi sarcoma (most common malignancy- HHV 8)
NHL (EBV): Burkitt's and CNS lymphoma
115
Charcot- Leyden crystals in sputum
ABPA
116
Anchovy paste liver abscess
Amoebiasis
117
Helminth infecting IMV and causing portal HTN
Schistosoma Mansoni
118
Parasite causing bladder wall calcification and SCC?
Schistosoma haematobium
119
Most common CNS parasitic infection and acquired epilepsy worldwide?
Cysticercosis
120
Most common NHL in kids?
Burkitt lymphoma (median age 8 years)
1/3 extranodal
Only endemic type related to EBV
121
Not inherited renal condition?
Medullary sponge kidney (sporadic)
122
Familial polyposis and genetic mutation?
Gardner and FAP both share APC mutation
HNPCC and Turcot share DNA mismatch mutation
123
Is lead associated with cancer?
No association between lead and sarcoma
124
Not a feature of Wegener's granulomatosis in kidneys?
Renal artery vasculitis
Causes necrotizing GN instead
125
What is the recurrence rate of GCT post curettage?
40%
126
What is a bronchial adenoma? Can it metastasize?
YES it can!
Bronchial adenoma includes carcinoid, adenoid cystic and mucoepidermoid tumours
127
ADPCKD and RCC?
NO increased risk compared to general population
128
SPEN vs insulinoma in terms of malignancy?
15% SPEN malignant
10% insulinoma malignant
129
Grade of myxopapillary ependymoma?
Grade 1
130
Receptor profile of ILC?
ER and PR positive
HER2 very rare
