EMRCS PATHO 3 Flashcards
A 34 year old lady undergoes an elective cholecystectomy for attacks of recurrent cholecystitis due to gallstones. Microscopic assessment of the gallbladder is most likely to show which of the following?
Dysplasia of the fundus Widespread necrosis Aschoff-Rokitansky sinuses Metaplasia of the fundus None of the above
Aschoff-Rokitansky sinuses are the result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. They may be macroscopic or microscopic. Ashoff-Rokitansky sinuses may be identified in cases of chronic cholecystitis and gallstones. Although gallstones may predispose to the development of gallbladder cancer the actual incidence of dysplasia and metaplastic change is rare. In the elective setting described above necrosis would be rare.
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?
Hydatid cyst Amoebic abscess Hepatocellular carcinoma Simple liver cyst Liver cell adenoma
Amoebic abscess
Liver abscess is the most common extra intestinal manifestation of amoebiasis
Between 75 and 90% lesions occur in the right lobe
Presenting complaints typically include fever and right upper quadrant pain
Ultrasonography will usually show a fluid filled structure with poorly defined boundaries
Aspiration yield sterile odourless fluid which has an anchovy paste consistency
Treatment is with metronidazole
Which of the following are not true of Li-Fraumeni syndrome?
It consists of mutations to the p53 tumour suppressor gene Is likely to be present in a teenager presenting with a liposarcoma It has an autosomal dominant inheritance pattern Affected individuals are unlikely to develop acute myeloid leukaemia Adrenal malignancies are more common than in normal population
They are at high risk of developing leukaemia.
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?
Staphylococcus aureus is the most likely primary cause Recurrence occurs in 60% cases More common in males Crohn's is the most likely secondary cause CT guided drainage is preferable first line management
Classical features include: a limp, back pain and fever. Recurrence rates are about 15-20%. In the UK, Staphylococcus is the commonest primary cause, others include Streptococcus and E.coli. Management is ideally by CT guided drainage.
Which of the following statements relating to parathyroid neoplasms is incorrect?
15% of cases are due to parathyroid carcinoma 80% of cases are due to parathyroid adenomas Parathyroid adenomas are often encapsulated 10% of parathyroid adenomas develop in ectopically located glands 85% of cases of primary hyperparathyroidism are due to solitary adenomas
Parathyroid carcinomas account for up to 5% of tumours. Adenomas are often encapsulated. Lesions that are fibrotic and densely adherent to the gland may be a carcinoma. 85% cases of primary hyperparathyroidism are due to a single adenoma and this is the reason some surgeons favour a focused parathyroidectomy.
A 20 year old girl presents with a thyroid cancer, she is otherwise well with no significant family history. On examination she has a nodule in the left lobe of the thyroid with a small discrete mass separate from the gland itself. Which of the following is the most likely cause?
Follicular carcinoma Anaplastic carcinoma Medullary carcinoma Papillary carcinoma B Cell Lymphoma
Papillary carcinoma is the most common subtype and may cause lymph node metastasis (mass separate from the gland itself) that is rare with follicular tumours. Anaplastic carcinoma would cause more local symptoms and would be rare in this age group.
A 20 year old male presents with a tense, swollen knee joint. There is no history of antecedent trauma. On examination the joint is tense and swollen but there is no sign of injury. Plain x-rays show no fracture or arthritis. What is the most likely explanation?
Rupture of the anterior cruciate ligament Rupture of the medial collateral ligament Tibial plateau fracture Haemophilia A von Willebrands disease
Haemarthrosis without trauma is typically a feature of haemophilia A and B
Without a history of trauma, ligamentous rupture or tibial plateau fractures would be unusual.
Haemarthroses may occur in 45% of patients with severe von Willebrands disease. However, this is rare.
An 18 year old rock climber falls onto his left arm and sustains a large haematoma of the left upper arm. Unfortunately the wound associated with the injury is neglected and it becomes infected. Which of these changes is least likely to occur?
Axillary lymphadenopathy Leucopenia Tenderness Mild pyrexia Local formation of yellow pus
Leucopenia would be unusual and should prompt a search for another cause.
A 17 year old man is identified as having a Meckels diverticulum. From which of the following embryological structures is it derived?
Foregut Hindgut Urachus Cloaca Vitello-intestinal duct
The Meckels diverticulum is a persistence of the vitello-intestinal duct.
Rule of 2’s
2% of population 2 inches (5cm) long 2 feet (60 cm) from the ileocaecal valve 2 x's more common in men 2 tissue types involved
Which of the following is the most common childhood brain tumour?
Glioblastoma multiforme Astrocytoma Medulloblastoma Ependymoma Meningioma
Glioblastoma multiforme is rare in childhood. In contrast, astrocytoma is the commonest brain tumour in children. Medulloblastoma is no longer the commonest CNS tumour in children (Cancer research UK)
A patient is diagnosed with a Klatskin tumour which of the structures listed below is affected by this disease process?
Kidney Stomach Colon Bile duct Spleen
A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.
Which of the following best describes the main pathological feature of generalized osteoporosis?
Reduction in volume of normally mineralized osteoid matrix Increase in volume of normally mineralized osteoid matrix Reduction in volume of abnormally mineralized osteoid matrix Increase in volume of abnormally mineralized osteoid matrix Significant increase in bony trabeculae that are excessively mineralised
Osteoporosis is characterized by reduction of normally mineralized osteoid matrix
A keen surgical trainee is about to embark on her first hemi arthroplasty for a fractured neck of femur. In the anaesthetic room the patient is given 1.2g intravenous co-amoxiclav. There is a possible history of penicillin allergy but the patient is demented and the history is not checked. The patient then develops severe respiratory compromise and haemodynamic collapse. Which pathological process accounts for this event?
Binding of the drug to circulating IgG class antibodies Recognition of the drug by IgE receptors on mast cells Drug initiated formation of hapten-protein complexes Binding of the drug to circulating IgM class antibodies None of the above
Anaphylactic shock:
Antigen recognised by IgE molecules on the surface of mast cells resulting in rapid degranulation with release of histamine and other inflammatory cytokines.
This is a case of anaphylactic shock. In anaphylaxis the mast cells degranulate.
Which of the following hepatobiliary disorders are most classically associated with ulcerative colitis?
Gallstones Primary sclerosing cholangitis Bile duct stones Liver hamartomas Hepatocellular carcinoma
Primary sclerosing cholangitis is an idiopathic inflammation of the bile ducts. It may result in episodes of cholestasis and cholangitis and ultimately result in the need for liver transplantation. It carries a 10% risk of malignant transformation. Crohns disease is associated with gallstones due to impaired entero-hepatic circulation. Apart from PSC, ulcerative colitis does not increase the risk of other liver lesions.
Which of the following is least associated with thrombosis?
Endothelial cell damage Use of tourniquets in surgery Formation of platelet aggregates Thrombocytopenia Carcinoma of the stomach
Thrombocytopenia
All the other options either act directly to promote thrombosis e.g. endothelial cell damage or via changes in consistency or flow of blood.
A 16 year old boy develops a painful swelling of his distal femur. An osteoblastic sarcoma is diagnosed. To which of the following sites is this lesion most likely to metastasise?
Inguinal lymph nodes Common iliac lymph nodes Liver Brain Lung
Sarcomas often metastasise via the haematogenous route and the lung is a common site for sarcoma metastasis. The liver and brain are often spared (at least initially). A smaller number may develop lymphatic metastasis (see above).
Infection with which of the following micro-organisms may result in a clinical picture resembling achalasia of the oesphagus?
Epstein Barr virus Wuchereria Bancrofti Candida Spp Trypanosoma Cruzi Helicobacter Pylori
Infection with Trypanosoma Cruzi may result in destruction of the ganglion cells of the myenteric plexus, resulting in a clinical picture similar to achalasia.
A 72 year old man has been unwell for many years and following his death a post mortem is performed. Tissue is submitted for microscopic evaluation. Evaluation of sections of the myocardium demonstrates evidence of apple green birefringence with polarised light. What is the most likely diagnosis?
Amyloidosis SLE Tuberculosis Disseminated B cell lymphoma Systemic sclerosis
Amyloidosis = apple green birefringence with polarised light
A 50 year old male presents with recurrent episodes of abdominal pain and diarrhoea. Blood tests reveal mild iron deficiency anaemia and an upper GI endoscopy demonstrates multiple ulcers in the first part of the duodenum. What is the most likely diagnosis?
Insulinoma Adenocarcinoma Glucagonoma Gastrinoma Squamous cell carcinoma
Diarrhoea, abdominal pain and multiple ulcers should raise the suspicion of Zollinger Ellison syndrome caused by gastrinoma.
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?
Huntington's disease Myeloma Acute intermittent porphyria Lawrence-Moon-Biedl syndrome Friedreich's ataxia
Neurological signs combined with abdominal pain is acute intermittent porphyria or lead poisoning until proven otherwise.
