Surgical pathology

Question 1

A 24 year old lady presents with a history of severe epigastric pain that is worse post prandially. On examination, the abdomen is soft and non tender with no palpable masses, there is a bruit in the epigastrium. Imaging with USS shows no gallstones and an OGD is normal. What is the most likely diagnosis?

Answer 1

Median Arcuate Ligament Syndrome

Question 2

An 83 year old lady presents to the clinic with early satiety. On examination, she is found to have massive splenomegaly. What is the most likely underlying cause?

Answer 2

Chronic granulocytic Leukemia (Any chronic)

Question 3

Metastatic Calcification

Answer 3

Normal tissue - Hypercalcemia

Question 4

Carcinoid tumors cut off = <2cm

Answer 4

Conservative

Question 5

AAA surveillance

Answer 5

USS surveillance of AAA:
3cm- 4.4cm - 1 year
4.5-5.4cm- 3 monthly

Risks of abdominal aortic aneurysm rupture (over 5 years):
5-5.9cm = 25%
6-6.9cm= 35%
7cm and over = 75%

Question 6

Tumor marker for HCC

Answer 6

AFP

Question 7

A 35 year old type 1 diabetic presents with difficulty mobilising and back pain radiating to the thigh. He has a temperature of 39 oC and has pain on extension of the hip. He is diagnosed with an iliopsoas abscess. Which of the following statements is false in relation to his diagnosis?

Answer 7

Staphylococcus aureusis the most likely primary cause
11%

A= Recurrence occurs in 60% cases
33%

More common in males
9%

Crohn’s is the most likely secondary cause in patients within the UK
29%

CT guided drainage is preferable first line management

Question 8

Marfan’s syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in?

Answer 8

fibrillin-1 gene on chromosome 15 and affects around 1 in 3,000 people.

Question 9

A 45-year-old man presents to surgical outpatients with a long history of recurrent abdominal pain and vomiting. He is noted to have a peripheral motor neuropathy on examination. What is the most likely diagnosis?

Answer 9

AIP

Neurological signs combined with abdominal pain is acute intermittent porphyria or lead poisoning until proven otherwise

Question 10

A pregnant woman suddenly develops bilateral leg swelling. Her mother and aunt were troubled by the same problem. What is the most likely underlying abnormality?

Answer 10

APLA

• Anti cardiolipin
• Anti B2 glycoprotein
• Lupus Anticoagulant (2+ = 3 months apart)
• 1 clinical event = pregnancy/ Thrombosis

Question 11

A 78 year old man presents with unilateral deafness which has been present for the past 3 months. On examination, Webers test localises to the contralateral side and a CT scan of his head shows a thickened calvarium with areas of sclerosis and radiolucency. His blood tests show an elevated alkaline phosphatase, normal serum calcium and normal PTH levels. Which of the following is the most likely underlying diagnosis?

Answer 11

Pagets disease

Question 12

A 56 year old man presents with symptoms of neuropathic facial pain and some weakness of the muscles of facial expression on the right side. On examination he has a hard mass approximately 6cm anterior to the right external auditory meatus. What is the most likely diagnosis?

Answer 12

Adenoid cystic carcinoma

Question 13

A 25 year old man from the far east presents with a fever and right upper quadrant pain. As part of his investigations a CT scan shows an ill defined lesion in the right lobe of the liver. What is the most probable cause?

Answer 13

Amoebic liver absces s