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Auckland IC path 2022 Flashcards

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1
Q

Klinefelter syndrome is characterised by all of the following EXCEPT:

Increased risk of germ cell tumours
Sclerosis of seminiferous tubules and Leydig cell nodules
Increased risk of breast cancers
Elevated serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels
A karyotype of 47XXY

A

CCF - Sclerosis of seminiferous tubules and Leydig cell nodules
Klinefelter increased risk mediastinal germ cell tumor, not testicular.

Increased risk of germ cell tumours - yes
Sclerosis of seminiferous tubules and Leydig cell nodules - no
Increased risk of breast cancers - yes
Elevated serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels - yes
A karyotype of 47XXY - yes

Official course answer is Increased risk of germ cell tumours but this is BS

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2
Q

Which of the following is FALSE regarding Graft Versus Host Disease?

Marked luminal narrowing of small bowel results in ‘ribbon like’ appearance on enterography
May occur following allogenic liver transplantation
Major clinical manifestations result from involvement of immune system, epithelia of skin, liver and intestines in the acute stage
Mediated by B lymphocytes of donor graft
Biopsy of intestinal mucosa reveals crypt loss and denudation of gut mucosa on histology

A

CCF -Mediated by B lymphocytes of donor graft - FALSE
-mediated by T lymphocytes

SCS:
Big robbins.
May occur following allogenic liver transplantation. True. GVHD most commonly in HSC transplant. But rarely may occur following transplantation of solid organs, rich in lymphoid cell (ie LIVER, transfusion of unirradiated blood).

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3
Q

Which of the following is least associated with urachal remnants?

Cysts
Abscess
Adenocarcinoma
Squamous cell carcinoma
Sinus tract

A
  • Squamous cell carcinoma
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4
Q

Which of the following is FALSE of Craniopharyngioma?

Is a WHO grade 1 neoplasm
Papillary subtype is found almost exclusively in children
Has a bimodal distribution
Arise from epithelial origins of Rathke pouch
Adamantinomatous and papillary are the two subtypes

A

-Papillary subtype is found almost exclusively in children
**Adamantinomatous - children
Papillary - adults

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5
Q

What is the MOST likely palpable testicular tumour in a 20 year-old male?

Teratoma
Lymphoma
Embryonal carcinoma
Seminoma
Endodermal sinus tumour

A
  • Seminoma

testicular tumours - 2 major categories
germ cell tumour (95%) - seminomas and nonseminomas
sex cord stromal tumours

Seminoma most common in the thrid decade (20s)
Embryonal mostly occur 20-30 year age group but less common than seminoma

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6
Q

Which of the following is NOT a recognized association of Thymoma?

Graves’ disease
Pernicious anaemia
Cushings syndrome
Myesthenia gravis
Hypergammaglobulinaemia

A

-Hypergammaglobulinaemia

** its HYPOgammaglobulinemia

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7
Q

Which of the following is NOT a feature of Rheumatic heart disease?

Bulky friable vegetations along the line of closure of the mitral valve
Fibrous thickening and fusion of chordae tendinae.
Microscopic appearance of Aschoff bodies in any of the three layers of the heart
Subependymal lesions called Mac callum plaques usually in the left atrium
Fibrinous bridging across valvular commissures resulting in ‘button hole ‘ or fish mouth stenoses

A

SCS: bulky friable vegetations- suggestive of infective endocarditis.
-assuming they mean subendocardial - location of MacCallum plaques…

“Bulky”- verrucae in Rh hrt disease is 1-2 mm- SMALL VEGETATIONS Usually along lines of closure which lead to regurgitation.
Subependymal lesions called Mac callum plaques usually in the left atrium.
** subendocardial lesions called MacCallum plaques, usually in the left atrium (Robins 9th edit pg 558).

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8
Q

Which cancer type is most associated with loss of function of the E-cadherin gene?

Invasive ductal carcinoma of the breast
Ewing’s sarcoma
Diffuse brainstem glioma
Diffuse gastric adenocarcinoma
Clear cell renal cell carcinoma

A

-Diffuse gastric adenocarcinoma (significant reduced expression)

Breast - lobular carcinoma (not listed - loss of e-cadherin)
diffuse gastric adenocarcinom has down regulation of e-cadherin

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9
Q

Which of the following favours acute over subacute bacterial endocarditis?

1 cm large vegetation
Absence of metastatic infection
Slow increase in size of vegetation
Pre-existing damaged valve leaflet
No perforation of leaflets

A
  • 1 cm large vegetation
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10
Q

Which of these are statements are NOT true with regards to Wilms tumour?

Nephrogenic rests are identified in 100% of bilateral Wilms tumour
Children with WAGR syndrome have a 33% chance of developing Wilms tumour
Pulmonary metastases are uncommon at the time of diagnosis
In 10% of cases, there are bilateral or multicentric tumours at the time of diagnosis
The peak age for diagnosis of Wilms tumour is 2-5 years of age

A

Answer: Pulmonary metastases are uncommon at the time of diagnosis (FALSE)

FROM ROBBINS
- Most children with Wilms tumors present with a large abdominal mass. Hematuria, pain in the abdomen after some traumatic incident, intestinal obstruction, and appearance of hypertension are other patterns of presentation. in a considerable number of these patients, pulmonary metastases are present at the time of primary diagnosis.

  • Nephrogenic rests are putative precursor lesions of Wills tumors, and are seen in the renal parenchyma adjacent to approximately 25-40% of unilateral tumors; this frequency rises to nearly 100% in cases of bilateral Wilms tutors.
  • The risk of Wilms tumor is increased with a least three recognisable groups of congenital malformations associated with distinct chromosomal loci; WAGR syndrome, Denys-Drash syndrome, and Beckwith-Wiedemann syndrome
  • WAGR syndrome is characterised by Wilms tumor, aniridia, genital anomalies, and mental retardation. The lifetime risk of developing Wilms tumor is approximately 33%.
  • Grossly, Wilms tumor tends to present as a large, solitary, well-circumscribed mass, although 10% are either bilateral or multi centric at the time of diagnosis.
  • IN approximately 5-10% of Wilms tumors involve both kidneys, either simultaneously (synchronous) or one after the other (metachronous).
  • The peak incidence for Wilms tumor is between 2 and 5 years of age, and 95% occur before the age of 10 years old.
  • Approximately 5% of tumors reveal anaplasia. The presecence of anaplasia correlates with the presence of TP53 mutations, and the emergence of resistance to chemotherapy.
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11
Q

Which of the following is MOST likely to be associated with Rheumatoid arthritis?

HLA B27 antigen
IgM anti IgG antibodies
Anti - DNase B
Urate crystals and neutrophils in synovial fluid
Antibodies to double stranded DNA

A

Answer: IgM anti IgG antibodies.

FROM ROBBINS
- 80% of patient has serum IgM or IgA autoantibodies that bind to the Fc portions of their own IgG. These autoantibodies are call Rheumatoid Factor.

  • 50% of the risk developing RA is related to inherited genetic susceptibility. Specific HLA-DRB1 alleles are linked to RA. (HLA-DRB1 is the most common allele of HLA-DR4).
  • The synovial of RA contains germinal centres with secondary follicles and plasma cells which produce antibodies. Many of the autoantibodies produced are specific for citrullinated peptides (CCPs).

FROM RADIOPAEDIA
- RF is a traditional marker but is non-specific, associated with several autoimmune and chronic infectious diseases
- Anti-CCP/anti-citrullinated plasma antibody (ACPA) is more than 80% sensitive and more than 95% specific.

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12
Q

What is the MOST common location of an intralobar sequestration?

Right upper lobe
Left upper lobe
Right middle lobe
Left lower lobe
Right lower lobe

A

CCF - Left lower

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13
Q

All of the following conditions affect the terminal duct lobular unit except:

Carcinoma
Breast cyst
Sclerosing adenosis
Atypical hyperplasia
Fibroadenoma

A

-Fibroadenoma

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14
Q

Which lesion is MOST likely to be epiphyseal?

Unicameral bone cyst
Clear cell chondrosarcoma
Chondromyxoid Fibroma
Conventional osteosarcoma
Aneurysmal bone cyst

A

Answer: Clear cell chondrosarcoma

FROM RADIOPEDIA

DDX for epiphyseal lesions
- Chrondroblastoma
- GCT
- Geode
- Intraosseous ganglion
- Osteomyelitis
- Clear cell chondrosarcoma

  • Others that occur rarely: ABC, osteosarcoma and osteoblastoma, brown tumour, enchondroma, osteoid osteoma.
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15
Q

Hypoparathyroidism can be caused by all of the following except:

Congenital parathyroid absence
Autoimmune mediated
Parathyroid removal
Chronic hypocalcaemia
End organ resistance to parathyroid hormone (PTH)

A

Official answer: chronic hypocalcaemia. Round one goes to Saj.

CCF - End organ resistance to parathyroid hormone (PTH)
as this is describes pseudohypothyroidism and is ass w HyperPTH.
Chronic hypocalcaemia - is also wrong (Hyper PTH like in secodary hyperpara)).
^SCS agree; two technically incorrect answers. The body is essentially running as hypoparathyroid in pseudoHPT so i would go with chronic hypocalcaemia if i had a gun to my head….
Also hypomagnesaemia can do it.
Good discussions all around. Pity about the ambiguity in the question.

Disagree - Chronic hypocalcaemia will give your HYPERparathyroidism.
End organ resistance to parathyroid hormone (PTH) - yes this is pseudo but still results in hypoparathyroidism which is what the question is asking]
^ Disagree - Psudo is end organ resistance to PTH, therefore to try and compensate the PTH is HIGH (feedback loops).

*** see robins pg 1105 (9th edition) PTH levels can be normal in pseudospeudphypo

**WJI - a lot of argument here. I think it is important to note that the question asks for causes of hypoparathyroidism which is the clinical syndrome. It does not ask for causes of raised parathyroid hormone. In end organ resistance the patient may have a raised PTH (irrelevant) but will have the syndrome of hypoparathyroidism (or pseudohypoparathyroidism). Agree with chronic hypocalcaemia as this results in hyperparathyroidism.

**Pathlads: we concur.

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16
Q

BRCA2 oncogene is associated with the following cancers EXCEPT:

Renal cancer
Melanoma
Male breast cancer
Ovarian cancer
Gastric cancer

A

CCF - Renal
Facts below from robbins:

Both BRCA 1 and 2
Breast (3% total, 1>2)
Ovary
Male breast (>in BRCA 2)
Prostate
Pancreas

BRCA1

-Breast cancer tends trip negative, poor diff w “medullary features”
-Ovary tends to be serous type
-Fallopian tube- can remember this as also serous (serous ovarian cancer cells are related to fallopian epithelium embryologically-pathoma lecture)

BRCA2
-Stomach
-Melanoma
-GB, bile duct
Pharynx
Breast also poor diff but ER +Ve

**Pathlads: Just FYI, BRCA2 is a tumour supressor gene. duh.

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17
Q

Phaeochromocyoma is NOT found in:

Organ of Zuckerkandl
Adrenal medulla
Mediastinum
Adrenal cortex
Bladder

A

CCF - Cortex, wrong cell type in this location.

  • Adrenal cortex - site of Adrenocortical carcinoma
    Medulla is pheochromocytoma
    can also be found in bladder, mediastinum, Organ of Zuckerkandl
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18
Q

Adenomatous polyps are NOT a feature of:

Peutz-Jeghers Syndrome
Gardners Syndrome
Villous adenomas
Turcot’s Syndrome
Familial Polyposis

A

CCF - Peutz-Jeghers Syndrome (hamartmatous)

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19
Q

Which of the following is LEAST likely to be true of pulmonary embolism?

Pulmonary infarction usually occurs when there is pre-existing cardiac or lung disease
Haemorrhage can be a sequelae without infarction
Has a higher incidence in patients with burns
The thrombi typically show lines of Zahn
Has a 10% chance of recurrence

A

CCF -Has a 10% chance of recurrence (false - robbins says 30% page 699)

Pulmonary infarction usually occurs when there is pre-existing cardiac or lung disease - T
Haemorrhage can be a sequelae without infarction - T
Has a higher incidence in patients with burns - T (burns - inflammation - hypercoag state)
The thrombi typically show lines of Zahn - T

Additional facts from robbins
-50-80% of emboli are clinically silent; in these cases bronchial artery sustains the viability of the affected lung,
-severe consequences (sudden death, RIght heart failure, shock (pump collapse), typically occur when more thst 60% of the total pulmonary vasculature is obstructed)

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20
Q

Which of the following is NOT TRUE of Rheumatoid nodules?

Centre of the nodule consists of an area of coagulative necrosis
May have one or more necrotic centres
Radially arranged cellular palisades of macrophages and fibroblasts is characteristic
Rheumatic skin nodules and pulmonary nodules are identical histologically
Have an outer fibrous shell

A

Answer: Centre of nodule consists of an read of coagulative necrosis (NOT TRUE)

FROM ROBBINS
- Rheumatoid nodules: necrotising granulomas with a central zone of fibrinoid necrosis surrounded by a prominent rm of activated macrophages and numerous lymphocytes and plasma cells.
- Cutaneous rheumatoid nodules are the most common. They occur in 25% of affected individuals, usually those with severe disease. Less commonly, the form in the lungs, spleen, pericardium, myocardium, heart valves, and aorta.

FROM RADIOPAEDIA/STATDX
- On histology, rheumatoid pulmonary nodules appear identical to nodules found in subcutaneous tissue.
- Rheumatoid nodule is a soft tissue mass with 3 histological zones; central fibrinoid necrosis, intermediate zone palisading, histiocyte-like macrophages, peripheral granulation/fibrous tissue.

**May have one or more necrotic centres: Not mentioned in Robbins/Statdx/Radiopaedia. Probably true.

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21
Q

Post menopausal PV bleeding and endometrial hyperplasia is associated with which of the following ovarian neoplasms?

Granulosa cell tumour
Serous cystadenocarcinoma
Teratoma
Krukenberg tumour
Dysgerminoma

A

Answer: Granulosa cell tumour

FROM ROBBINS
- Granulosa cell tumors are of clinical importance for two reasons: (1) they may elaborate large amounts of extrogen, and (2) they may behave like low-grade malignancies.
- In prepubertal girls (juvenile granulosa cell tumors) they may produce precocious sexual development.
- In adult women, they may be associated with proliferative breast disease, endometrial hyperplasia, and endometrial carcinoma, which eventually develops in 10-15% of women.
- Occasionally, granulos cell tumors produce androgens, masculizing the patient.,
- Histologically, Call-Exner Bodies are seen.

OTHER (From Robbins)
- Serous cystadenocarcinoma is a primary ovarian neoplasms arising from mullerian epithelium.

  • Krukenberg tumor is a classic metastatic gastrointestinal carcinoma involving the ovaries, characterised by bilateral metastases composed of mucin-producing signet-ring cancer cells, most often of gastric origin.
  • Teratomas, often referred to as dermoid cysts, are tumors of germ cell origin can can be divided into three categories. 1) mature (benign), 2) immatures (malignant), 3) monodermal or highly specialised.
  • Dysgerminoma is the ovarian counterpart of testicular seminoma. Most of these tumors have no endocrine function. A few produce elevated levels of chorionic gonadotropin. They express OCT-3, OCT4, and NANOG transcription factors. They also express receptor tyrosine kinase KIT, with 1/3 having activating mutations in the KIT gene.
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22
Q

Which of the following combinations is FALSE?

Cystic medial degeneration and Marfan syndrome
Gamna Gandy nodules and spleen in portal hypertension
Homer – Wright pseudorosettes and Nephroblastoma
Rasmussen aneurysm and cavitary pulmonary tuberculosis
Obliterative endarteritis of vasa vasorum and Syphylitic aortitis

A

Homer – Wright pseudorosettes and Nephroblastoma -INCORRECT

**SCS: Radiopaedia/Pathoma. These are associated with neuronal origin tumours (medullo, PNET, esthesioneuroblastoma, pineoblastoma)

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23
Q

What is the most common tumour of the parotid gland?

Warthin tumour
Adenocarcinoma
Pleomorphic adenoma
Squamous cell carcinoma
Acinic cell carcinoma

A

Answer: Pleomorphic adenoma.

FROM ROBBINS
- Pleomorphic adenomas represent about 60% of tumors in the parotid, and are less common in the submandibular glands, and relatively rare in the minor salivary glands.
- Warthin Tumor arises almost exclusively in the parotid gland (the only tumor virtually restricted to the parotid) and occurs more commonly in males than females in the 5th-7th decade of life. Smokers have 8 times the risk of non-smokers.

EXTRA (From robbins)
Benign Salivary tumours
- 50%: Pleomorphic adenoma
- 5-10%: Warthins
- 5-10%: other (basal cell adenoma, canalicular adenoma)
- 1%: oncocytoma

Malignant Salivary tumours
- 15%: mucoepidermoid carcinoma
- 10%: adenocarcinoma
- 5%: acinic cell carcinioma
- 5%: adenoid cystic carcinoma
- 3-5%: Malignant mixed tumours
- 1%: Squamous cell carcinoma

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24
Q

What is the most likely cause for siderotic nodules (Gamna-Gandy bodies) in spleen?

Portal hypertension
Chronic lymphocytic leukemia (CLL)
Cardiac failure
Myelofibrosis
Polycythaemia vera

A

Answer: Portal hypertension

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25
Which is the most common congenital pancreatic duct anomaly? Pancreas agenesis Ectopic pancreas Pancreas divisum Absent ventral bud Annular pancreas
-Pancreas divisum
26
With regards to Hirschsprung disease, which of the following statements is TRUE? It occurs in approximately 1:5000 live births The rectum is usually not involved The disease is characterized by the presence of ganglion cells in the ganglia and muscle wall of the involved segment Long segment involvement is more common in males 30% of cases occur in patients with Down’s syndrome
LMC - It occurs in approximately 1:5000 live births Robbins pg 755 agree 10% of cases occur in children with downs. Serous neurlogic abnormalities 5% Starts from rectum M>F but difference reducecs as the aganglionic segment enlarges. Never in premature infants (radiopedia)
27
Which of the following is NOT a cause of gynaecomastia? Old age Puberty Prostatic neoplasm Cirrhosis Testicular neoplasm
Answer: Prostatic neoplasm (NOT a cause of gynaecomastia) FROM ROBBINS - Gynecomastia comes under the Proliferative breast disease without atypical classification under the "benign epithelial lesion" umbrella. - Occurs as a result of imbalance between oestrogen's and androgens. Causes - Puberty - Old men (drop in testicular androgen production) - Liver cirrhosis (most important cause as liver metabolises oestrogen) - Drugs: alcohol, marijuana, heroin, ART, anabolic steroids - Klinefelter (XXY) - rare - Testicular neoplasms (leydig or Sertoli cell tumors).
28
Psammoma bodies are described in the following conditions EXCEPT: Mesothelioma Papillary thyroid carcinoma Uterine leiomyoma Serous cystadenocarcinoma of the ovary Meningioma
CCF - Uterine Leiomyoma Psammoa bodies (PAP SMEAR) PApilliary thyroid Pituitary adenoma Serous cystadeocarcinoma MEnginoma/mesothelioma Appendix carcinomd Renal cell.
29
The most common site of osteoid osteoma is the: Femur Ilium Radius Skull Spine
Answer: Femur FROM ROBBINS - Can arise in any bone but have a predilection for the appendicular skeleton. - about 50% of cases involve the femur or tibia, wherein they typically arise in the cortex. FROM STATDX - Cortex: 75% (usually long bones) - Femur > tibia. Together, account for 60% of all osteoid osteomas. - Marrow: 25% - Spine: 10%.
30
Wernicke encephalopathy commonly affects the following sites, EXCEPT: Tectal plate Hypothalamus Putamen Para aqueductal grey matter Mammillary bodies
Answer: Putamen FROM ROBBINS Wernicke encephalopathy is characterised by foci of haemorrhage and necrosis in the maxillary bodies and the walls of the 3rd and 4th ventricles. Lesions in the dorsomedial nucleus of the thalamus seem to be the best correlate for the memory disturbance and confabulation. FROM STATDX/RADIOPAEDIA - Mamillary bodies - Dorsomedial thalami - Tectal plate - Periaqueductal grey matter - Walls of the 3rd-4th ventricles.
31
A 60 year-old man is discharged from hospital 4 days after being diagnosed with myocardial infarction. Which of the following could be a potential danger at this point in time following acute MI? Ventricular aneurysm Myocardial (pump) failure Myocardial rupture Arrhythmia Mural thrombosis
Answer: Myocardial rupture FROM ROBBINS - Ventricular aneurysms are a late complication of large transmural infarcts that experience early expansion. - Contractile dysfunction: Severe "pump failure" occurs in 10-15% of patients following acute MI, generally with large infarcts involving more than 40% of the left ventricle. Has a nearly 70% mortality rate. occurs within 4 hours. - Myocardial Rupture: Occurs most frequently 2-4 days after MI when coagulative necrosis, neutrophilic infiltration, and lysis of the myocardial connective tissue have appreciable weakened the infarct myocardium. Rupture of the free wall (anterolateral wall at the mid-ventricular level) is the most common site. - Arrhythmias: within 4-24 hours of MI. ^not sure who deleted/deleting the original comments from others but basically had all that summarised in 4 lines.... refer to pathoma table for quick read Probs syphillis saj
32
Which of the following associations is FALSE? Mercury and RCC Asbestos and mesothelioma Lead and sarcoma Smoking and oropharyngeal cancer Asbestos and lung cancer
-Lead and sarcoma
33
Bilateral endolymphatic sac tumours are associated with which of the following disorders? Von Hippel-Lindau syndrome Olliers Tuberous sclerosis Neurofibromatosis type 1 Sturge-Weber syndrome
Answer: von Hippel-Lindau disease FROM ROBBINS VHL - Autosomal dominant. - VHL gene on chromosome 3 - 1 in 30-40,000 - Hemangioblastomas of the CNS (most common in cerebellum and retina). - Hemangioblastomas associated with Polycythaemia in 10% of cases. - Cysts involving the pancreas, liver, and kidneys - Propensity to develop RCC and pheochromocytoma. FROM RADIOPAEDIA - 10-15% of patients have end-lymphatic sac tumours. MNEMONIC - HIPPEL H: Haemangioblastoma of CNS I: increased risk of renal cell cancer P: pheochromocytoma P: pancreatic lesions E: Eye and ear dysfunction (retinal haemangioblastoma, end-lymphatic sac tumours) L: liver and renal cysts.
34
The most common primary neoplasm of the paranasal sinuses is: Adenoid cystic carcinoma Lymphoma Sinonasal undifferentiated carcinoma Esthesioneuroblastoma Squamous cell carcinoma
CCF - SCC
35
A 60 year-old woman develops a right sided adenocarcinoma. She has had a few previous colonoscopies, however review of images of the most recent colonoscopy reveals a prominent fold in the region that subsequently developed cancer. Biopsy from this area would have most likely revealed which of the following? Sessile serrated adenoma Peutz-jeghers polyp Tubular Adenoma Hyperplastic polyp Inflammatory polyp
Answer: Sessile serrated adenoma FROM ROBBINS - Sessile serrated adenomas are more commonly found in the right colon. It is indistinguishable from hyperplastic polyps - Hyperplastic polys are benign epithelial proliferations that are typically discovered in the 6th-7th decades of life. They are most commonly found in the left colon and a smooth, nodular protrusions of the mucosa, often on the crests of mucosal folds. Their chief significance is that they must be distinguished from sessile serrated adenomas. - Inflammatory polyps are most commonly found on the anterior rectal wall. - Tubular adenomas are small, pedunculate polyps. - Peutz-Jeghers syndrome is a rare autosomal dominant syndrome which presents at a median age of 11 years old with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation.
36
Which of the following is NOT a type of Hodgkin’s disease? Lymphocyte rich Mixed cellularity Anaplastic Lymphocyte depleted Nodular sclerosing
CCF - Anaplastic Classic types nodular sclerosing: ≈70% mixed cellularity: ≈25% lymphocyte-rich: 5% lymphocyte depleted: <5% SCS: Lymphocyte deplete, controversial, but worst prognosis. Nodular- good prognosis
37
Which is associated with paragangliomas on histology? Interstitial cells of Cajal Zellballen pattern Councilman bodies Homer Wright rosettes Antoni type A and B tissue pattern
CCF - Zellballen pattern (the nests of chief cells, type1. Type 2 cells are susetenacular cells that sorround the nests) Interstitial cells of Cajal - GIST Councilman bodies - Acute hepatitis - yellow fever strictly Homer Wright rosettes - lots, medullo mainly. Antoni type A and B tissue pattern - schwannoma
38
Which of the following is MOST characteristic of Crohn's disease? Carries a higher risk of developing colonic adenocarcinoma Fistula formation between affected segments of bowel Jejunum is the most common site of involvement Inflammation and ulceration limited to mucosa and submucosa Crypt abscesses and pseudopolyps
CCF - Fistulas **SCS: -Jejunum- incorrect-> Terminal ileum. -The remainder of the options all relate to/define UC.
39
Which of the following is MOST characteristic of secondary tuberculosis? Cavitation Langhan's giant cells Calcification Miliary nodules Positive tuberculin test result
CCF - Cavitation pg 373 robbins
40
Which of the following is FALSE regarding renal cancers? Chromophobe renal cancers may have histological similarity to Oncocytomas Clear cell carcinoma is the most common type Papillary carcinomas are frequently multifocal in origin Papillary carcinomas are the most common type to develop in dialysis associated cystic renal disease Chromophobe carcinomas have worse prognosis when compared to clear cell and papillary types
SCS: chromophobe have best prognosis hence option E is False.
41
The underlying aetiology in cystic fibrosis is an abnormal epithial cell chloride channel. In the lung this results in which changes ? Decreased mucus chloride and increased mucus water absorption Increased mucus chloride and decreased mucus water absorption Increased mucus sodium and increased mucus water absorption Decreased cell sodium and increased cell water absorption Increased cell sodium and increased cell water absorption
SCS-Increased cell sodium and increased cell water absorption
42
BRCA1 and BRCA2 gene mutations account for what percentage of breast cancers: 10-20% 50% 1-10% <1% 20-30%
SCS: 1-10% (3%)
43
Which of the following is LEAST likely with regards to exposure to asbestos? Pleural plaques contain dense collagen, asbestos bodies and calcium Pleural plaques develop in the parietal pleura The pattern of fibrosis differs from that of usual interstitial pneumonia (UIP) only by the presence of asbestos bodies Usually results in serous pleural effusions Fibrosis initially begins around respiratory bronchioles
SCS: Pleural plaques contain dense collagen, asbestos bodies and calcium -pleural PLAQUES should not contain asbestos bodies. -Pleural plaques : parietal>visceral
44
The following are examples of small, round blue cell tumours, EXCEPT Medulloblastoma Meningioma Olfactory neuroblastoma Synovial sarcoma Ewing’s sarcoma
Meningioma-
45
Which of the following pathologic features of invasive lobular carcinoma of the breast is thought to explain the lack of a palpable lesion at clinical examination: Large tumour cells with abundant cytoplasm Small tumour cells with abundant cytoplasm Robust desmoplastic response Small round blue cells Failure to elicit a desmoplastic response
**SCS: Failure to elicit a desmoplastic response
46
Which of the following is MOST correct regarding Sarcoidosis? Schaumann’s bodies and asteroid bodies may be seen in granulomas histologically Central necrosis in granulomas is common Skin lesions occur in 5% of cases Lymph nodes are involves in 50% of cases If the spleen is involved microscopically it is always clinically enlarged
SCS: Schaumann’s bodies and asteroid bodies may be seen in granulomas histologically sarcoid = non necrotising granulomas. Central necrosis is unusual. bilateral lymphadenopathy or lung involvement in 90% of cases.
47
The histological entity most characteristic of Langerhans Cells (as seen in Langerhans cell histiocytosis) is: Birbeck granules Masson bodies Rosenthal fibres Psammoma bodies Reed Sternberg cells
**SCS: Birbeck granules, aka tennis raquet-like cells - these are seen on EM. -Masson bodies- COP. Granulation tissue plugs in airways -rosenthal fibres- JPA -psammoma bodies ( PSaMMoma= Papillary thyroid/RCC/papillary type 2 endometrial ca, Serous ovary, Meningioma, Mesothelioma). - RS- HL
48
Which malignancy is not associated with Lynch (HNPCC) syndrome? Prostate carcinoma Gastric adenocarcinoma Colorectal adenocarcinoma Endometrial carcinoma Breast malignancy
SCS: Breast Cancer -Just remember you will see all of the things on a CT abdo/pelvis/colonography = polyp study -The only exception is CNS tumours - GBM most commonly
49
Cholangiocarcinoma is an important sequelae of: Chronic hepatitis C Autoimmune hepatitis Primary biliary cirrhosis Schistosomiasis Primary sclerosing cholangitis
**SCS: Primary sclerosing cholangitis Hepatidites/PBC - HCC Schistosomiasis: -classically bladder SCC -in the liver: turtle back sign: calcified septa and fibrosis resembling a turtle carapace, considered pathognomonic (radiopaedia). Also Causes cirrhosis, so probs an indirect RF for HCC too?
50
Which of the following malignancies may present with distant metastases and a burnt out primary lesion? Alveolar cell carcinoma of the lung Carcinoid Renal cell carcinoma Germ cell tumour of the testis Lobular breast carcinoma
**SCS: Germ cell tumour of the testis. =Azopadi tumour. Often just see a nodular focus of scar tissue in the nut.
51
Which of the following diseases is NOT linked to prima CNS lymphoma? Congenital immune deficiency syndrome Sjogren’s syndrome Herpes virus infection Systemic lupus erythematosus (SLE) Rheumatoid arthritis
**SCS: Herpes virus infection Robbins: PCNSL- immunosuppression is key risk factor, ass/w with EBV positivity. -DLBCL -2% of extra nodal lymphomas, 1% of CNS tumour Statdx: Summary of subtypes leading to immunodeficiency associated PCNSL: -autoimmune conditions: sjogrens, RA, SLE, crohns - immunodeficiency sundromes: ataxia-telangiectasia, IgA deficiency -iatrogenic immunosuppression: PTLD (transplant), -AIDS.
52
Viridans group streptococci are most likely to cause infective endocarditis in: IV drug user Bicuspid aortic valve Normal valve Libman-Sacks endocarditis Prosthetic valve
**SCS: Bicuspid aortic valve best option -Viridans strep are a relatively banal group of normal flora - likes to colonise compromised valves; causes include bicuspid aortic valve/calcific valvular stenosis, chronic rheumatic valvular disease, mitral prolapse (ass/w Marfans/APCKD). -subacute endocarditis -Prosthetic valve- colonised by staph epidermis -IVDU- staph aureus - tricuspid valve, first valve encountered upon entry to heart. Can hit a normal valve -Merrantic - sterile. SLE.
53
Which of the following is LEAST likely to cause CPPD arthropathy? Ochronosis Haemochromatosis Hypothyroidism Scleroderma Hypomagnesemia
CCF -Scleroderma
54
What is MOST correct regarding radial scar: No follow up required Presents as a palpable mass Is centrally opaque on mammography Aetiolgy is unrelated to ischaemia This result on biopsy requires further follow up
CCF - needs further follow up - i.e WLE
55
Concerning centrilobular emphysema, which of the following is MOST correct? Proximal portion of acinus is normal or near normal, with dominant involvement of distal portion Acini are uniformly involved but disease affects the central zone of secondary pulmonary lobules The acini are uniformly enlarged from level of terminal bronchiole to terminal alveoli Proximal part of acini is enlarged, with relative or complete sparing of distal alveoli Whole acini destroyed leaving irregular lined spaces greater than 1 cm in diameter
CCF - Proximal part of acini is enlarged, with relative or complete sparing of distal alveoli Panacinar: Uniform enlargrment Paraseptal: Proximal normal, distal enlarged Emphysema definiton irreversible enlargement of the airspaces distal to the terminal bronchiole, accompanied by distruction of their walls without obvious fibrosis.
56
In Churg-Strauss syndrome, which of the following is INCORRECT? Blood test results show an elevated p-ANCA in most cases Small vessels are involved Associated with asthma Characterised by necrotizing vasculitis Characterised by granulomatous inflammation
CCF - Blood test results show an elevated p-ANCA in most cases. False - "Positive in less than half of the cases" Robbins. - Although radiopedia says 75% - Stat Dx. says 40% The rest are true
57
The hepatic cell responsible for most forms of hepatic fibrosis is the: Pit cell Hepatocyte Stellate cell Kupffer cell Portal tract fibroblast
SCS- Stellate cell aka “Ito cell” - this term used in other recalls
58
Which of the following is FALSE of IgG4 related disease? Associated with fibrosis (arranged in a storiform pattern) and oblierative phlebitis leading to organ dysfunction in the chronic stage In the acute stage of the disease, serum IgG4 levels are elevated minority of patients histologic hall mark is a dense infiltrate of lymphocytes and IgG4 positive plasma cells Acute disease responds rapidly to steroids Is a relapsing and remitting disease
CCF - In the acute stage of the disease, serum IgG4 levels are elevated minority of patients - False IgG elevated 55-97% (Stat dx) I think the rest are true, combination of robbins, radiopedia, stat dx and google.
59
Which of the following events is the most frequent cause of bilateral posterior border zone infarcts? Internal carotid artery stenosis Common carotid artery embolism Haemodynamic compromise Vertebral artery dissection Cardiac embolism
CCF - Heamodynamic Compromise Unilateral posterior external border zone infarcts have been related to cerebral emboli either of cardiac origin or from the common carotid artery, whereas bilateral infarcts are more likely to be caused by underlying hemodynamic impairment.
60
Which syndrome is best characterized by having phaeochromocytomas / paragangliomas, medullary thyroid cancer, mucosal neuromas and marfanoid habitus? SDH mutation MEN2b MEN2a Von Hippel-Lindau MEN1
-MEN2b
61
What is the most common first site of gallbladder carcinoma dissemination? Lymph nodes Lungs Direct invasion into liver Brain Bones
CCF - Direct invasion into liver Two patterns of growth - infiltrating, more common, ulcerates into liver. - Exophytic - grows into lumen, but same time invades the underlying wall. Most adeocarcinomas 5% squamous or adenosquamous, Papillary archetiecture is favourable. Most important risk factor is gallstones - present in 95%. In addition chronic infection.
62
Regarding dysphagia, which is false: Herpes virus is the most common cause of viral oesophagitis Pharyngeal diverticula are more likely unilateral than bilateral Killian-Jamieson diverticula arise posteriorly, above the level of the cricopharyngeus Diffuse oesophageal spasm primarily involves the distal two thirds of the oesophagus A cricopharyngeal bar is a likely contributor if it occupies more than 50% of the lumen
CCF - Killian-Jamieson diverticula arise posteriorly, above the level of the cricopharyngeus - False (Zenkers)
63
Which of the following is LEAST likely with regards to malacoplakia of the urinary system? Most commonly involves the ureters Is commonly associated with E.coli or proteus infection Michaelis Gutmann bodies are typically present Histologically shows infiltration by foamy macrophages Occurs with increasing frequency in transplant recipients
CCF- Most commonly involves the ureters (False, most common in bladder)
64
Which of the following is FALSE regarding (Multiple endocrine neoplasia) MEN type 1 Stomach is the most common site of Gastrinomas in individuals with MEN 1 The most frequent anterior pituitary tumour is a Prolactinoma. Primary hyperparathyroidism is the most common and the initial manifestation of the syndrome They have an increased incidence of thyroid and adrenal cortical adenomas Endocrine tumours of the pancreas are a leading cause of morbidity and mortality
CCF - Stomach is the most common site of Gastrinomas in individuals with MEN 1 - False in the gastrinoma triangle.
65
Regarding prostatic carcinoma, which of the following is LEAST correct? Carcinoma of the prostate is less common in Asia compared with Australia and New Zealand 70% arise in the peripheral zone Local invasion can occur into the seminal vesicles, bladder and ureter 70-80% of males between the ages of 70-80 have foci Histologically there are sheets or cords of cells in dense fibrous stroma
CCF - Histologically there are sheets or cords of cells in dense fibrous stroma False - histologically most are adenocarcinomas with gland patterns - graded via the Gleason score. Rest are true.
66
All of the following statements concerning HCC are true EXCEPT, This tumour may develop in a non-cirrhotic liver Small cell dysplasia is currently favoured over large cell dysplasia as the more likely direct precursor of carcinoma Tumours closely resembling HCC (even with bile formation), termed hepatoid carcinomas, have been described in the stomach, ovary, pancreas and other organs The fibrolamellar variant typically occurs in young patients with chronic hepatitis B or hepatitis C Histologic subtypes include micro trabecular, acinar, clear cell and giant cell
CCF - fibrolamellar variant typically occurs in young patients with chronic hepatitis B or hepatitis C - F without gender prediliction or identifiable predisposing conditions - Robbins OTHER OPTIONS: This tumour may develop in a non-cirrhotic liver - T esp in setting of HBV infection. Small cell dysplasia is currently favoured over large cell dysplasia as the more likely direct precursor of carcinoma - T Small cell directly premalignant. Large cell is at least a marker if increased HCC, may also be premaligannt in setting of HBV. Tumours closely resembling HCC (even with bile formation), termed hepatoid carcinomas, have been described in the stomach, ovary, pancreas and other organs T - The fibrolamellar variant typically occurs in young patients with chronic hepatitis B or hepatitis C - F- Typically under 35, without gender prediliction or identifiable predisposing conditions - Robbins Histologic subtypes include micro trabecular, acinar, clear cell and giant cell - True
67
Which of the following is FALSE of osteogenic sarcoma: Neoplastic bone usually has a coarse lace like architecture Has a bimodal age distribution Has an association with familial retinoblastoma Has equal incidence in flat bones and long bones in those over 25 years of age Telangiectatic sub type histologically mimics giant cell tumours
Course answer: Telangiectatic sub type histologically mimics giant cell tumours CCF - Telangiectatic sub type histologically mimics giant cell tumours - More similar to ABC with fluid-fluid levels. but both GCT and telangeictatic have osteoclast type giant cells. So could be true - although favor as least correct. Bit unsure of has equal incidence in flat bones and long bones in those over 25 years of age ?thoughts OTHER OPTIONS Neoplastic bone usually has a coarse lace like architecture - Probably true - although robbins says fine lacelike. Has a bimodal age distribution - T Has an association with familial retinoblastoma - T
68
Which of the entities listed below confers highest lifetime risk of breast cancer? Adenosis Cyst Duct ectasia Apocrine metaplasia Radial scar
CCF - Radial scar (1.5-2X RR) Facts: Nonproliferative lesions (RR=1) - Cysts, duct ectasia, apocine change, adenosis, fibro without complex features Proliferative lesions without atypia (RR 1.5-2) - Radial scar, papilloma, scerlosing adenitis, Fibro w complex features Proliferative lesions w atypia (RR 4-5) ADH, ALH Carcinoma in situ (RR 8-10) LCIS, DCIS
69
Which pathology is most associated with cardiac rhabdomyoma? Meningioma Renal angiomyolipomas Nonspecific interstitial pneumonia (NSIP) Rheumatoid arthritis Cirrhosis
CCF - AML (TS related)
70
Which of the following is a frequent characteristic of small cell lung cancer? Secretes a parathormone-like hormone Secretes either corticotrophin or anti-diuretic hormone Generally amenable to surgical care at the time of diagnosis More common in in females, and a less clear relation to smoking than other forms of lung cancer Usually in a peripheral rather than in a central location
Answer: Secretes either corticotrophin or anti-diuretic hormone. From Robbins Tumors that produce ACTH and ADH are predominantly small cell carcinoma, whereas those that produce hypercalcemia are mostly squamous cell carcinomas.
71
Which syndrome has the lowest association with malignancy? Turcot syndrome Juvenile polyposis syndrome Gardner syndrome Cronkhite-Canada syndrome Peutz Jegher syndrome
CCF - Cronkhite-Canada syndrome
72
Which ovarian lesion is MOST commonly bilateral? Teratoma Brenner Endometroid Thecoma Mucinous adenocarcinoma
CCF - Endometroid (40%)
73
Which of the following is NOT a type of breast ductal carcinoma-in-situ? Micropapillary Cribriform b) c) d) e) Comedocarcinoma Medullary Papillary
CCF - Medullary - type of IDC. Comedo DCIS - Necrosis - High grade pleomoprhic nuclei Non Comedo DCIS - Micropaillary (without fibrovascular core) - Ture papillary (w fibrovascular core) - Cribriform - Solid
74
Which of the following is the MOST correct definition of a hamartoma ? Ectopic rests of normal tissue Aberrant differentiation producing a mass of disorganized but mature specialised cells indigenous to a particular site A benign neoplasm composed of cells native to the organ A benign neoplasm composed of cells foreign to the organ Aberrant differentiation producing a mass of disorganized but immature specialised cells indigenous to a particular site
-Aberrant differentiation producing a mass of disorganized but mature specialised cells indigenous to a particular site Hamartoma is a benign tumour-like malformation that consists of a collection of architecturally disorganised cells located in an area of the body where the cells are normally found
75
A 28 year-old man develops acute renal failure and haemoptysis. Light microscopy reveals a diffuse necrotising and crescentic glomerulonephritis. Linear deposits of immunoglobulins and complement are seen by immunofluorescence along the glomerular basement membranes. What is the best diagnosis? Pulmonary vasculitis Churg-Strauss syndrome Microscopic polyangitis Goodpasture syndrome Wegener's granulomatosis
Answer: Goodpasture's. In anti-GBM antibody induced glomerulonephritis, antibodies bind to intrinsic antigens homogenously distributed along the entire length of the GBM, resulting in a diffuse linear pattern of staining for the antibodies by immunofluorescence techniques. Although anti-GBM antibody-induced glomerulonephritis accounts for fewere than 5% of cases of human glomerulonephritis, it causes severe necrotizing and crescentic glomerular damage and the clinical syndrome of rapidly progressive glomerulonephritis. WEGNERS Pauci-immune RPGN, defined by the lack of detectable anti-GBM antibodies or immune complexes by immunofluorescence and electron microscopy. Most patients with this type of RPGN have ANCAs. This type of RPGN, may be a component of granulomatosis with polyangiitis.
76
Which of the following is FALSE regarding Glioblastoma IDH-wild type? Preferred tumour spread is along compact white matter tracts Preferentially involves subcortical and deep periventricular white matter Macroscopically appears as a reddish grey tumour rind surrounding a central necrotic core Neurofibromatosis type 2 has increased propensity to develop this tumour Necrosis and microvascular proliferation are the histologic hallmarks
-Neurofibromatosis type 2 has increased propensity to develop this tumour
77
Which of the following is FALSE regarding Alzheimer’s disease (AD)? Clumps of Beta Amyloid form plaques in cortical grey matter Cerebral atrophy commonly involves the motor cortex Senile plaques, neurofibrillary tangles and exaggerated neuronal loss are characteristic histologic hall marks Taupathy is a key factor Associated with reduced clearance of the protein aggregates of Beta Amyloid
Cerebral atrophy commonly involves the motor cortex
78
The most common ‘single gene’ mutation associated with hereditary susceptibility to breast cancer include all of the following except: CHEK2 BRCA1 BRCA2 PTEN P53
- PTEN SCS: note PTEN ass/w Cowdens. So INDIRECT but not single gene. Robbins does not list this in its breast cancer single gene mutation list, all the others are included. TP53- LiFraumeni **** PTEN is listed in most recent robbins with high penetrance, CHEK2 moderate. EDWH
79
What is the most likely cause of severe hepatic necrosis? Herpes simplex Hepatitis B Hepatitis C Hepatitis A Cytomegalovirus (CMV)
-Hepatitis B
80
Increased incidence of which of the following is not associated with BRCA1, BRCA2 and their variants? Pancreatic cancer Ductal carcinoma in situ (DCIS) Male breast cancer Prostate cancer Gastrointestinal stromal tumour (GIST)
- Gastrointestinal stromal tumour (GIST)
81
Which of the following is NOT true with regard to Coeliac disease? Genetic testing is positive for HLA B27 antigen status Jejunisation of ileum is shown on small bowel enterography The prevalence of Coeliac disease is higher in Down's syndrome and Diabetes mellitus. At a high risk of developing enterpathy associated with T cell lymphoma Histologically demonstrates villous atrophy and intra epithelial lymphocytosis
- Genetic testing is positive for HLA B27 antigen status SCS: ass/w -HLA DQ2 and 8 -IgA Antibodies against: endomysium, tTg, *gliadin* -IgG antibodies are also useful esp in px w IgA deficiency (increased incidence of coeliacs in this condition) -Refractory disease despite no gluten exposure can herald T cell lymphoma.
82
Which of the following conditions is LEAST likely to be associated with exudative pleural effusion? Mesothelioma Hepatic cirrhosis Tuberculosis Pulmonary embolism Pancreatitis
- Hepatic cirrhosis
83
Which of the following is MOST suggestive of multiple myeloma? Increased tracer uptake in TC99 m MDP bone scan Serum IgG kappa M protein Marked splenomegaly Increased serum alkaline phosphatase Hypocalcaemia
- Serum IgG kappa M protein
84
Which of the following is NOT a feature of Alzheimer’s disease? Lewy bodies Granulovacuolar degeneration amyloid Neurofibrillary tangles Hirano bodies Senile plaques
SCS: Lewy bodies Radiopaedia: -Lewy bodies are intracellular cytoplasmic inclusions which result from abnormal Alpha-synuclein metabolism (hence overarching term of synucleinopathies) -These are found in Parkinsons disease and Lewy Body dementia -Not found in Alzheimers dementia
85
Which if the following is LEAST likely to cause hyperthyroidism? Toxic multinodular goitre Hashimoto’s thyroiditis Graves disease Toxic adenoma Reidel’s thyroiditis
-Reidel’s thyroiditis Toxic multinodular goitre - yes Hashimoto’s thyroiditis - yes Graves disease - yes Toxic adenoma - yes
86
Which is LEAST associated with Von Hippel Lindau? Spinal haemangioblastoma Pancreatic adenocarcinoma Clear cell renal carcinoma Phaeochromocytoma Hepatic cysts
Pancreatic adenocarcinoma - RARE radiopaedia states all - Spinal haemangioblastoma - 13-50% Pancreatic adenocarcinoma - yes rare Clear cell renal carcinoma - yes (67%) Phaeochromocytoma - yes 25-30% Hepatic cysts - yes
87
Which of the following is LEAST likely to involve basal ganglia? Huntington's disease Fahr syndrome Lead poisoning Carbon monoxide poisoning Amyloid angiopathy
- Amyloid angiopathy
88
Which of the following is NOT a recognized association of H. pylori infection? Gastric adenocarcinoma Marginal zone B cell lymphoma Peptic ulcer disease Atrophic gastritis Gastrointestinal mesenchymal tumours
-Gastrointestinal mesenchymal tumours
89
Which of the following is NOT a cause of generalized reduction in bone density? Mastocytosis Infiltrative metastatic disease Osteomalacia Hyperparathyroidism Osteoporosis
- Mastocytosis
90
The syndrome of multiple enchondromas and haemangiomas is known as: McCune-Albright syndrome Maffuci’s syndrome Gardner syndrome Alagille syndrome Ollier’s disease
-Maffuci’s syndrome
91
According to the Ann Arbor classification, a patient with Hodgkin lymphoma affecting the three lymph node regions within the neck and chest and no other sites of involvement has which stage disease? Stage II Stage IIIES Stage III Stage IIIE Stage I
- Stage II
92
Which of the following is FALSE with regard to Hypertrophic Obstructive Cardiomyopathy (HCM) ? On cross section, the ventricular cavity loses its round - oval shape and is compressed into a 'banana' like configuration In most cases the disease is transmitted by autosomal dominant type inheritance Histology demonstrates extensive myocyte hypertrophy and myofiber disarray Essential feature is massive myocardial hypertrophy usually without ventricular dilation There is marked thickening of the ventricular septum and the free wall
-There is marked thickening of the ventricular septum and the free wall
93
Which of the following is NOT a true association of drug-induced pulmonary disease? Beta-agonists and bronchospasm Bleomycin and pneumonitis and fibrosis Aspirin and pulmonary fibrosis Nitrofurantoin and hypersensitivity pneumonitis Amiodarone and pneumonitis and fibrosis
-Aspirin and pulmonary fibrosis Bleomycin and pneumonitis and fibrosis - true Amiodarone and pneumonitis and fibrosis - true EH - assuming it's means to say beta-ANTAGONIST, as beta agonists i.e. salbutamol, are treatment for bronchospasm.
94
Regarding tuberculous infection of the brain and meninges, which of the following is LEAST correct? May present with cranial nerve palsies May cause infarcts due to obliterating endarteritis May present with mass like lesions that resemble gliomas Inflammatory exudate is typically distributed over the convexities It is usually symptomatic
- Inflammatory exudate is typically distributed over the convexities
95
Calcification in a large paraspinal abscess without new bone formation or sclerosis most likely represents which of the following entities? Haemangioma Tuberculosis Pyogenic infection of the spine Aspergillosis Bronchogenic carcinoma
-Tuberculosis
96
What is the most common site of traumatic thoracic aortic injury? Distal descending aorta Aortic root Abdominal aorta Proximal descending aorta Aortic arch
-Proximal descending aorta
97
Which of the following is FALSE about Rheumatoid pulmonary nodules? May vary in size from a few mm in diameter up to about 7cm Usually asymptomatic More frequent in male patients with positive rheumatoid factor Histologically consist of a central zone of acellular fibrinoid necrosis surrounded by a zone of pallisading epithelioid cells and a collar of lymphocytes, plasma cells and fibroblasts Histologically differ from subcutaneous rheumatoid nodules
Histologically differ from subcutaneous rheumatoid nodules - SAME
98
What is the most common type of secretory pituitary adenoma: Lactotroph Corticotroph Thyrotroph Somatotroh Gonadotroph
- Lactotroph
99
Potentially vulnerable or unstable coronary plaques are characterised by which of the following findings? Lipid rich core Mast cell infiltration Thick fibrous caps Thick distention of the lumen Dense calcification
-Lipid rich core
100
The following are recognized epidemiological forms of Kaposi sarcoma (KS) EXCEPT, AIDS associated KS with widespread visceral dissemination Young African men presenting with lymphadenopathy Transplant related KS with immune suppression. Associated with hamodialysis Chronic/classic/European KS in elderly men presenting with cutaneous plaques of lower extremities
-Associated with hamodialysis

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