Yr 2 Rogo Qs Flashcards
Idiopathic pulmonary fibrosis is a restrictive lung disease.
Which of these pulmonary function tests is a defining feature of idiopathic pulmonary fibrosis?
Increased forced expiratory volume in 1 sec
Increased forced vital capacity
Increased total lung capacity
Reduced forced expiratory volume in 1 sec
Reduced total lung capacity
- Idiopathic pulmonary fibrosis is a restrictive lung disease.
Which of these pulmonary function tests is a defining feature of idiopathic pulmonary fibrosis?
Increased forced expiratory volume in 1 sec
Increased forced vital capacity
Increased total lung capacity
Reduced forced expiratory volume in 1 sec
Reduced total lung capacity
Lindsay, an 80-year-old male, presents to his GP with atrial fibrillation and shortness of breath. He has pulmonary oedema.
Which radiological sign is seen when interlobular septa in the pulmonary interstitium become prominent?
Batwing sign
Blunted costophrenic angle
Bullae
Crescent sign
Kerley B lines
Lindsay, an 80-year-old male, presents to his GP with atrial fibrillation and shortness of breath. He has pulmonary oedema.
Which radiological sign is seen when interlobular septa in the pulmonary interstitium become prominent?
Batwing sign
Blunted costophrenic angle
Bullae
Crescent sign
Kerley B lines
Kerley B lines arise from the thickening of which structure in the lungs? [1]
Interlobular septa
What does the measurement labelled A represent?
Forced expiratory volume in 1 sec
Forced vital capacity
Inspiratory reserve capacity
Tidal volume
Total lung capacity
Forced vital capacity
absence of breath sounds
This is a photomicrograph from a heart of a patient who suffered a fatal myocardial infarction. Normal cardiac muscle is shown on the right hand side of the image.
What does the left half of the photo show?
Early myocardial infarct (day 3-7)
Late myocardial infarct (day 15-21)
Late myocardial infarct with fibrosis (over 21 days)
Reperfusion injury to myocardium
Very early myocardial infarct with eosinophilia (day 0-1)
This is a photomicrograph from a heart of a patient who suffered a fatal myocardial infarction. Normal cardiac muscle is shown on the right hand side of the image.
What does the left half of the photo show?
Early myocardial infarct (day 3-7)
Late myocardial infarct (day 15-21)
Late myocardial infarct with fibrosis (over 21 days)
Reperfusion injury to myocardium
Very early myocardial infarct with eosinophilia (day 0-1)
A 60-year old male has dysphagia following a cerebrovascular accident and has been losing weight.
Which feeding option would be the most appropriate way to meet his nutritional requirements?
Frequent meals and high protein snacks
Jejunostomy feeding
Nasogastric tube feeding
Oral Nutritional Supplements
Parenteral Nutrition
A 60-year old male has dysphagia following a cerebrovascular accident and has been losing weight.
Which feeding option would be the most appropriate way to meet his nutritional requirements?
Frequent meals and high protein snacks
Jejunostomy feeding
Nasogastric tube feeding
Oral Nutritional Supplements
Parenteral Nutrition
.
A 70-year old woman was transferred from a nursing home to hospital due to reported deterioration in her general condition. Staff from the nursing home inform you that she has eaten very little food in the past 2 weeks. On the ward she is given oral nutritional supplements in addition to small meals, but the next day she develops arrythmias.
What is the most likely cause?
Hyperkalemia
Hypermagnesemia
Hyperphosphatemia
Hypokalemia
Hyponatremia
- A 70-year old woman was transferred from a nursing home to hospital due to reported deterioration in her general condition. Staff from the nursing home inform you that she has eaten very little food in the past 2 weeks. On the ward she is given oral nutritional supplements in addition to small meals, but the next day she develops arrythmias.
What is the most likely cause?
Hyperkalemia
Hypermagnesemia
Hyperphosphatemia
Hypokalemia
Hyponatremia
Patients with a history of abusing alcohol should be given vitamin B1 on admission to hospital as part of their treatment.
What molecule is formed in greater quantities when there is a severe deficiency of vitamin B1?
lactate, lactate acid, lactic acid
In the image below, an area of the tongue, is labelled X. Which cranial nerve provides general sensation to the labelled region?
cn v3, cn v3 lingual nerve, cn5 v3, cnv3, cranial nerve v3, lingual, lingual branch of mandibular, lingual branch of mandibular nerve cn v3, lingual branch of rigeminal nerve, lingual branch of the mandibular, lingual branch of the trigeminal v3, lingual branch of trigeminal, lingual branch of trigeminal nerve, lingual branch of v3, lingual branch of v3 (cnv), lingual nerve, lingual nerve (trigeminal , mandibular)
Left gastric and azygos veins
Left renal vein
Left renal artery
Right renal vein
Right renal artery
Hepatic portal vein
Left renal vein
Left renal artery
Right renal vein
Right renal artery
Hepatic portal vein
Acute proliferative glomerulopathy
Diabetic glomerulopathy
Membranous glomerulopathy
Minimal change glomerulopathy
None; no abnormality is evident
Acute proliferative glomerulopathy
Diabetic glomerulopathy
Membranous glomerulopathy
Minimal change glomerulopathy
None; no abnormality is evident
The following photomicrograph is a cross section through a dorsal root ganglion (DRG). Identify the highlighted structures in green.
Axons
Satellite cells
Neuronal cell bodies
Schwann cells
White matter
The following photomicrograph is a cross section through a dorsal root ganglion (DRG). Identify the highlighted structures in green.
Axons
Satellite cells
Neuronal cell bodies
Schwann cells
White matter
You are examining a patient’s reflexes. When you roll his legs from side to side and you notice that there is spasticity in the ankle, and when you gently roll each ankle then briskly dorsiflex the foot, there are beats of clonus.
What could the cause of this be?
contralateral upper motor neurone lesion, corticospinal injury, corticospinal lesion, corticospinal tract damage, corticospinal tract lesion, pyramidal tract lesion, pyramidal tract syndrome, umn damage, umn injury, umn lesion, umn lesions, uppe moto neuron lesion, upper motar lesion, upper moter lesion, upper motor lesion, upper motor lesions, upper motor nerve lesion, upper motor neuron damage, upper motor neuron disease, upper motor neuron legion, upper motor neuron leison, upper motor neuron lesion, upper motor neuron lesions, upper motor neurone, upper motor neurone damage, upper motor neurone defect, upper motor neurone disease, upper motor neurone injury, upper motor neurone lesion, upper motor neurone neurone lesion, upper motor neurone syndrome, upper nerve lesion)
A 23-year-old female suffers from heavy periods that are often associated with chronic pelvic pain.
Her GP refers her for a transvaginal ultrasound. This shows tissue similar to the lining of the uterus over the patients’ ovary and also in and around the rectum.
What is the most likely diagnosis?
Endometriosis
Polycystic ovary suyndrome
Ectopic pregnancy
Chlamydia infection
Ovarian cancer
A 23-year-old female suffers from heavy periods that are often associated with chronic pelvic pain.
Her GP refers her for a transvaginal ultrasound. This shows tissue similar to the lining of the uterus over the patients’ ovary and also in and around the rectum.
What is the most likely diagnosis?
Endometriosis
Polycystic ovary suyndrome
Ectopic pregnancy
Chlamydia infection
Ovarian cancer
This is a photomicrograph of an ovarian tumour. What type of tumour is it?
Serous adenocarcinoma
Sex cord-stromal tumour
Dysgerminoma
Teratoma
Mucinous adenocarcinoma
This is a photomicrograph of an ovarian tumour. What type of tumour is it?
Serous adenocarcinoma
Sex cord-stromal tumour
Dysgerminoma
Teratoma
Mucinous adenocarcinoma
This cytology preparation is of a breast aspirate obtained from a lump in a woman’s breast.
What do the features suggest?
Fibroadenoma
Leiomyosarcoma
Leiomyoma
Fibrosarcoma
Adenocarcinoma
This cytology preparation is of a breast aspirate obtained from a lump in a woman’s breast.
What do the features suggest?
Fibroadenoma
Leiomyosarcoma
Leiomyoma
Fibrosarcoma
Adenocarcinoma
A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips.
Which muscle and tendon could be transferred to help this individual walk better?
Tibialis posterior
Tibialis anterior
Gastrocnemius
Fibularis longus
Flexor hallucis longus
A 25-year old man has a common peroneal nerve palsy after a road traffic accident. He has problems walking and often stumbles and trips.
Which muscle and tendon could be transferred to help this individual walk better?
Tibialis posterior
Tibialis anterior
Gastrocnemius
Fibularis longus
Flexor hallucis longus
A patient complains of numbness and weakness in both of their thumbs. They have been asked to make a fist and this is the result shown below
Which nerve has been damaged and in what location?
Median nerve in the carpal tunnel
Median nerve, anterior, supracondylar region of the humerus
Ulnar nerve, posterior to medial epicondyle
Ulnar nerve, Guyon’s canal
Ulnar and median nerve, at the medial cord
A patient complains of numbness and weakness in both of their thumbs. They have been asked to make a fist and this is the result shown below
Which nerve has been damaged and in what location?
Median nerve in the carpal tunnel
Median nerve, anterior, supracondylar region of the humerus
Ulnar nerve, posterior to medial epicondyle
Ulnar nerve, Guyon’s canal
Ulnar and median nerve, at the medial cord
A patient complains of increasing pain and instability in their left knee. Their radiograph is shown below.
Based on this information, what is the most likely cause?
(lack of cartilage, loss of articular cartilage, loss of cartilage, loss of hyaline cartilage, no cartilage, oa, ostearthritis, osteo arthritis, osteoartheitis, osteoartheritis, osteoarthiritis, osteoarthritis, osteophyte due to osteoarthritis, osteroarthritis, wearing of cartilage, wearing out of cartilage)
A 23-year-old male was involved in a motor vehicle accident and was admitted to hospital complaining of right leg paresis and bladder-bowel disorder. They had a computed tomography (CT) scan that is shown below.
(axial burst, axial burst fracture, burst, burst fracture)
2/granulation, 2nd, 2nd stage, 2nd stage: procallous and soft callous formation, callus, cartiladge, cartilage, cartilage calcification,
Epidemiology and statistics aims to show the relationship between different variables.
What would be the most ideal study type to research the effect of smoking on the development of Parkinson’s diease?
Cross-over randomised trial
Case-control study
Cohort study
Cross-sectional study
Parallel group randomised controlled trial
Epidemiology and statistics aims to show the relationship between different variables.
What would be the most ideal study type to research the effect of smoking on the development of Parkinson’s diease?
Cross-over randomised trial
Case-control study
Cohort study
Cross-sectional study
Parallel group randomised controlled trial
Poverty impacts health on many different levels. There are different measures of poverty.
If a person is living off 1.09 USD per day, what is this is an example of?
Relative poverty
Absolute poverty
Extreme poverty
Direct poverty
Permanent poverty
Poverty impacts health on many different levels. There are different measures of poverty.
If a person is living off 1.09 USD per day, what is this is an example of?
Relative poverty
Absolute poverty
Extreme poverty
Direct poverty
Permanent poverty
In statistical analyses, outlying values of a continuous variable can have too much influence, affecting interpretation of results
Which of the following descriptive statistics is not affected by outliers?
Mean
Standard deviation
Range
Interquartile range
Variance
In statistical analyses, outlying values of a continuous variable can have too much influence, affecting interpretation of results
Which of the following descriptive statistics is not affected by outliers?
Mean
Standard deviation
Range
Interquartile range
Variance
During a teleconsultation, a 27-year old patient complains of a blocked nose in addition to her sore throat.
What is the major pharmacological action of decongestants?
Alpha-2 adrenoceptor agonist
Alpha-1 adrenoceptor agonist
Alpha-1 adrenoceptor antagonist
Alpha-2 adrenoceptor antagonist
Beta-2 adrenoceptor agonist
During a teleconsultation, a 27-year old patient complains of a blocked nose in addition to her sore throat.
What is the major pharmacological action of decongestants?
Alpha-2 adrenoceptor agonist
Alpha-1 adrenoceptor agonist
Alpha-1 adrenoceptor antagonist
Alpha-2 adrenoceptor antagonist
Beta-2 adrenoceptor agonist
The GP thinks the biopsychosocial model may be best for analysing a patient’s situation and taking into account their social history as well as history of presenting complaint. The GP knows there are different pathways between the biological (B), psychological (P) and social (S) but is not sure how to incorporate this into the management plan. The biomedical model focuses on one particular pathway.
Which of the following is true for the biomedical model?
B → B
B → S
P → B
S → B
B → P
The GP thinks the biopsychosocial model may be best for analysing a patient’s situation and taking into account their social history as well as history of presenting complaint. The GP knows there are different pathways between the biological (B), psychological (P) and social (S) but is not sure how to incorporate this into the management plan. The biomedical model focuses on one particular pathway.
Which of the following is true for the biomedical model?
B → B
B → S
P → B
S → B
B → Pv
Research on medical student bias showed that there is a significant proportion of medical students who held a bias of preference over body type.
Which of the following statements is true of the greatest proportion of medical students?
Medical students are biased towards believing weight gain is due to laziness
Medical students are biased towards overweight body types
Medical students are biased towards underweight body types
Medical students don’t have a view on body types either under- or overweight
Medical students struggle with their own weight loss
Research on medical student bias showed that there is a significant proportion of medical students who held a bias of preference over body type.
Which of the following statements is true of the greatest proportion of medical students?
Medical students are biased towards believing weight gain is due to laziness
Medical students are biased towards overweight body types
Medical students are biased towards underweight body types
Medical students don’t have a view on body types either under- or overweight
Medical students struggle with their own weight loss
A 25-year-old woman is having a follow up examination of her right knee after recovering from a knee injury.
What knee structure is being tested in this image?
Anterior cruciate ligament
Lateral collateral ligament
Medial collateral ligament
Patella ligament
Posterior cruciate ligament
Anterior cruciate ligament
In the GP surgery you are using the manual BP (blood pressure) cuff to take the blood pressure of a patient who has attended for a diabetic review. You cannot detect the 5th Korotkoff sound.
How do you know what the diastolic blood pressure will be?
4th korotkoff sound, 4th korotkoff sound disappear, 4th korotkoff sound will be taken
Gaussian distributions have useful properties
If a variable follows a Gaussian distribution, which of the following is the 95% range?
Mean±1.96×standard deviation
Mean±1.64×standard deviation
Mean±1.64×standard error
Mean±1.96× standard error
Mean± 2.58×standard deviation
Gaussian distributions have useful properties
If a variable follows a Gaussian distribution, which of the following is the 95% range?
Mean±1.96×standard deviation
Mean±1.64×standard deviation
Mean±1.64×standard error
Mean±1.96× standard error
Mean± 2.58×standard deviation
.
P-values are usually given when reporting the results from clinical trials. The report of a randomised trial showed quicker recovery from an illness in a group treated with a new drug than another group treated with a placebo. The p-value for this result was 0.06
What does this p-value of 0.06 mean?
The probability of the result or one more extreme occurring by chance alone is 6%
The probability that the new drug is better is 6%
The probability that the new drug is better is 94%
The probability that the result is attributable to confounding is 6%
The result is statistically significant
.
P-values are usually given when reporting the results from clinical trials. The report of a randomised trial showed quicker recovery from an illness in a group treated with a new drug than another group treated with a placebo. The p-value for this result was 0.06
What does this p-value of 0.06 mean?
The probability of the result or one more extreme occurring by chance alone is 6%
The probability that the new drug is better is 6%
The probability that the new drug is better is 94%
The probability that the result is attributable to confounding is 6%
The result is statistically significant
Parabiosis, which allows circulatory systems from two animals to commingle and equilibrate, is a powerful experimental procedure for physiological studies.
What was the outcome of the parabiosis experiment between an obese db/bd mouse [lacking the leptin receptor] and a wild type lean mouse?
db/db mouse continued to eat and increase its weight – the lean mouse starved to death
db/db mouse developed hyperphagia and increase its weight – the lean mouse starved to death
db/db mouse lost weight [in response to satiety signal from lean mouse] – lean mouse stayed the same
db/db mouse lost weight [in response to satiety signal from lean mouse] – lean mouse started eating more and increased its weight
db/db mouse starved to death – the lean mouse started eating more and increased its weight
Parabiosis, which allows circulatory systems from two animals to commingle and equilibrate, is a powerful experimental procedure for physiological studies.
What was the outcome of the parabiosis experiment between an obese db/bd mouse [lacking the leptin receptor] and a wild type lean mouse?
db/db mouse continued to eat and increase its weight – the lean mouse starved to death
db/db mouse developed hyperphagia and increase its weight – the lean mouse starved to death
db/db mouse lost weight [in response to satiety signal from lean mouse] – lean mouse stayed the same
db/db mouse lost weight [in response to satiety signal from lean mouse] – lean mouse started eating more and increased its weight
db/db mouse starved to death – the lean mouse started eating more and increased its weight
Growth hormone (GH) is released by the pituitary gland.
Which of the following best describes the metabolic effects of GH?
Counteracts all effects of glucagon
Counteracts all effects of insulin on glucose and lipid metabolism, but shares protein catabolic properties with insulin
Counteracts the effects of insulin on glucose and lipid metabolism, but shares protein anabolic properties with insulin
Counteracts the effects of insulin on protein and lipid metabolism, but shares with insulin effects on glucose homeostasis
GH shares all effects of insulin
Growth hormone (GH) is released by the pituitary gland.
Which of the following best describes the metabolic effects of GH?
Counteracts all effects of glucagon
Counteracts all effects of insulin on glucose and lipid metabolism, but shares protein catabolic properties with insulin
Counteracts the effects of insulin on glucose and lipid metabolism, but shares protein anabolic properties with insulin
Counteracts the effects of insulin on protein and lipid metabolism, but shares with insulin effects on glucose homeostasis
GH shares all effects of insulin
.
Metabolic alkalosis is, overall, the most common acid–base disorder in ICU patients.
What will the anion gap calculation show in the case of metabolic alkalosis?
No change
Small reduction
Large increase
Large reduction
Small increment
.
Metabolic alkalosis is, overall, the most common acid–base disorder in ICU patients.
What will the anion gap calculation show in the case of metabolic alkalosis?
No change
Small reduction
Large increase
Large reduction
Small increment
Weight loss surgery can lead to significant weight loss and improve many obesity-related conditions, such as type 2 diabetes or high blood pressure.
A sleeve gastroplasty is classified as which type of surgery?
Banding procedure
Bypass procedure
Malabsorptive procedure
Restrictive AND malabsorptive procedure
Restrictive procedure
Weight loss surgery can lead to significant weight loss and improve many obesity-related conditions, such as type 2 diabetes or high blood pressure.
A sleeve gastroplasty is classified as which type of surgery?
Banding procedure
Bypass procedure
Malabsorptive procedure
Restrictive AND malabsorptive procedure
Restrictive procedure
A 34-year-old man (shown below) was out walking his dog when he experienced severe difficulty walking. It has been established that sensation across his lower limb is normal and he has been asked to point the toes of both feet.
achiles tendon left side
A: Fallopian tube
B: ovarian ligament
C: Rectouterine pouch
3rd ventricle
4th ventricle
Cerebral aqueduct
Interventricular foramen
Lateral ventricle
3rd ventricle
4th ventricle
Cerebral aqueduct
Interventricular foramen
Lateral ventricle
A patient has contrast inserted into their vertebral arteries. Their angiogram is shown below.
Identify the artery indicated by the arrow
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Posterior inferior cerebellar artery
Superior cerebellar artery
A patient has contrast inserted into their vertebral arteries. Their angiogram is shown below.
Identify the artery indicated by the arrow
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Posterior inferior cerebellar artery
Superior cerebellar artery
Label A
Claustrum is a thin, bilateral collection of neurons and supporting glial cells, that connects to cortical (e.g., the pre-frontal cortex) and subcortical regions (e.g., the thalamus) of the brain.
Below is a prosection showing the pleura of the lungs.
What is the nerve supply to the region of pleura indicated by the arrow?
General visceral afferents
Intercostal nerves
Vagus nerve
Phrenic nerve
Long thoracic nerve
Below is a prosection showing the pleura of the lungs.
What is the nerve supply to the region of pleura indicated by the arrow?
General visceral afferents
Intercostal nerves
Vagus nerve
Phrenic nerve
Long thoracic nerve
A patient has a pulmonary embolism.
In which of the labelled structures would the embolus enter the lungs through?
A
B
C
D
E
A patient has a pulmonary embolism.
In which of the labelled structures would the embolus enter the lungs through?
A
B
C
D
E
A 45-year-old man is given a blood transfusion due to a significant GI (gastrointestinal) bleed leading to anaemia. Within a few hours of the transfusion being started he develops fever, shortness of breath and hypotension. His urine also changes.
What type of transfusion related complication is this most likely to be?
Acute haemolytic transfusion reaction
Anaphylactic reaction
Febrile non-haemolytic transfusion reaction
Transfusion associated circulatory overload (TACO)
Transfusion associated lung injury (TRALI)
A 45-year-old man is given a blood transfusion due to a significant GI (gastrointestinal) bleed leading to anaemia. Within a few hours of the transfusion being started he develops fever, shortness of breath and hypotension. His urine also changes.
What type of transfusion related complication is this most likely to be?
Acute haemolytic transfusion reaction
Anaphylactic reaction
Febrile non-haemolytic transfusion reaction
Transfusion associated circulatory overload (TACO)
Transfusion associated lung injury (TRALI)
This image depicts
Elliptocytosis
Presence of schistocytes
Presence of sickle cells
Pyropoikilocytosis
Spherocytosis
Pyropoikilocytosis:
Hereditary pyropoikilocytosis (HPP) is an autosomal recessive disorder of the red blood cell (RBC) membrane that is clinically related to, and is considered a subtype of, hereditary elliptocytosis (HE). HPP involves a functional defect in spectrin, which is the major cytoskeletal protein of the RBC cell membrane. It manifests as a severe hemolytic anemia with thermal instability of the red blood cells
This image depicts
Elliptocytosis
Presence of schistocytes
Presence of sickle cells
Pyropoikilocytosis
Spherocytosis
This image depicts
Elliptocytosis
Presence of schistocytes
suggests red blood cell injury from damaged endothelium and is a characteristic feature of microangiopathic hemolytic anemia.
Presence of sickle cells
Pyropoikilocytosis
Spherocytosis
.
A 35-year-old woman is admitted to the intensive care unit with sepsis complicated by disseminated intravascular coagulation. Peripheral blood smear analysis reveals microangiopathic haemolytic anaemia.
What finding on peripheral blood smear analysis is diagnostic of microangiopathic haemolytic anaemia?
Elliptocytosis
Presence of schistocytes
Presence of sickle cells
Pyropoikilocytosis
Spherocytosis
.
A 35-year-old woman is admitted to the intensive care unit with sepsis complicated by disseminated intravascular coagulation. Peripheral blood smear analysis reveals microangiopathic haemolytic anaemia.
What finding on peripheral blood smear analysis is diagnostic of microangiopathic haemolytic anaemia?
Elliptocytosis
Presence of schistocytes
Presence of sickle cells
Pyropoikilocytosis
Spherocytosis
A 50-year old patient arrived at hospital after a road traffic accident. A CT scan revealed haemorrhage in the superficial cerebral sulci of both cerebral hemispheres.
What is the most likely diagnosis for this patient?
Epidural haemorrhage
Intracranial haemorrhage
Ischemic stroke
Subarachnoid haemorrhage
Subdural haemorrhage
A 50-year old patient arrived at hospital after a road traffic accident. A CT scan revealed haemorrhage in the superficial cerebral sulci of both cerebral hemispheres.
What is the most likely diagnosis for this patient?
Epidural haemorrhage
Intracranial haemorrhage
Ischemic stroke
Subarachnoid haemorrhage
Subdural haemorrhage
Rumination is associated with an imbalance between the activity of key neuronal structures.
Which brain area is hypoactive in the rumination aspect of depression?
Amygdala
Hippocampus
Insula
Lateral prefrontal cortex
Subgenual cingulate cortex
Rumination is associated with an imbalance between the activity of key neuronal structures.
Which brain area is hypoactive in the rumination aspect of depression?
Amygdala
Hippocampus
Insula
Lateral prefrontal cortex
Subgenual cingulate cortex
Diagnostic tests like biopsies and imaging are used to determine a cancer’s grade and its stage.
Which of the following is considered a staging criterion?
Cytological atypia
Mitotic activity
Necrosis
Resemblance/lack of resemblance to tissue of origin
Spread to distant organs
Diagnostic tests like biopsies and imaging are used to determine a cancer’s grade and its stage.
Which of the following is considered a staging criterion?
Cytological atypia
Mitotic activity
Necrosis
Resemblance/lack of resemblance to tissue of origin
Spread to distant organs
