EMRCS PATHO 4 Flashcards
A 20 year old man develops acute appendicitis, his appendix is removed and he makes a full recovery. Which of the following pathological processes is least likely to be present in the acutely inflamed tissues?
Altered Starlings forces Sequestration of neutrophils Formation of fluid exudate Formation of granulomas None of the above
Neutrophil polymorphs=Acute inflammation.
Granuloma = Chronic inflammation.
Which of the following disorders is associated with massive splenomegaly?
Acute lymphoblastic leukaemia Acute myeloblastic leukaemia Acute myelomonocytic leukaemia Acute monoblastic leukaemia Chronic granulocytic leukaemia
Chronic leukaemia is more likely to be associated with splenomegaly than acute leukaemia.
Causes of primary chronic inflammation do not include which of the following?
Sarcoidosis Tuberculosis Ulcerative colitis Hip prostheses Chronic cholecystitis
Chronic cholecystitis is caused by recurrent episodes of acute inflammation.
Prosthetic implants may be the site of primary chronic inflammation. A common example clinically is breast implants which may become encapsulated. The subsequent fibrosis then results in distortion and may be painful. Hip implants may be affected in a similar fashion but this is less common.
A 30 year old man is trapped in a house fire and sustains 30% partial and full thickness burns to his torso and limbs. Three days following admission he has a brisk haematemesis. Which of the following is the most likely explanation for this event?
Dieulafoy lesion Curlings ulcers Mallory Weiss tear Depletion of platelets Depletion of clotting factors
Curlings ulcers typically occur secondary to thermal injuries and are caused by loss of GI protective mechanisms. They are at greater risk of perforation than stress ulcers and may also haemorrhage.
A 4 year old presents with sudden onset of dysphagia. He undergoes an upper GI endoscopy and a large bolus of food is identified in the mid oesophagus. He has no significant history, other than a tracheo-oesophageal fistula repair soon after birth. What is the most likely diagnosis?
Barretts oesophagus Benign oesophageal stricture Squamous cell carcinoma of the oesophagus Oesophageal adenocarcinoma Achalasia
Children with tracheo-oesophageal fistulas will commonly develop oesophageal strictures following repair. These may require regular dilations throughout childhood.
A 43 year old man presents with dyspepsia and undergoes an upper GI endoscopy. During the procedure diffuse gastric and duodenal ulcers are identified. A Clo test confirms the presence of Helicobacter pylori infection. What is the most likely explanation for the ulcers?
Decreased gastric motility Increased urease activity Decreased release of mucous and bicarbonate Decreased gastrin levels Increased acid production
Increased acid production
H-Pylori has a number of pathological effects. In this question the main issue is by what mechanism the organism is able to induce both gastric and duodenal ulceration. Without modestly elevated acid levels, the duodenum would not undergo gastric metaplasia. H-Pylori cannot colonise duodenal mucosa and therefore the development of ulcers at this site can only occur in those who have undergone metaplastic transformation (mediated by increased acidity).
A 15 year old boy is admitted with colicky abdominal pain of 6 hours duration. On examination he has a soft abdomen, on systemic examination he has brownish spots around his mouth, feet and hands. His mother underwent surgery for intussusception, aged 12, and has similar lesions. What is the most likely underlying diagnosis?
Li Fraumeni syndrome Peutz-Jeghers syndrome Addisons disease McCune -Albright syndrome Appendicitis
This is most likely to be Peutz-Jeghers syndrome. Addisons and McCune Albright syndrome may produce similar skin changes but the intussusception resulting from polyps combined with the autosomal inheritance pattern makes this the most likely diagnosis.
What is the most likely electrolyte abnormality in a patient with diarrhoea and a soft mass felt on digital rectal examination?
Hyperkalaemia Hypokalaemia Hyponatraemia Hypernatraemia Hypocalcaemia
Large villous adenomas of the rectum may have marked secretory activity and result in the development of hypokalaemia as rectal secretions are rich in potassium.
Which of the following is not included in Multiple Endocrine Neoplasia Type 2b?
Phaeochromocytoma Visceral ganglioneuromas Thyroid medullary carcinoma Zollinger Ellison syndrome Marfanoid features
Zollinger Ellison syndrome MEN IIB Medullary thyroid cancer Phaeochromocytoma Mucosal neuroma Marfanoid appearance
A 52 year old lady presents with an episode of nipple discharge. It is usually clear in nature. On examination, the discharge is seen to originate from a single duct and although it appears clear, when the discharge is tested with a labstix it is shown to contain blood. Imaging and examination shows no obvious mass lesion. Which of the following lesions is most likely?
Duct ectasia DCIS Intraductal papilloma Fat necrosis Breast abscess
Intraductal papilloma usually cause single duct discharge. The fluid is often clear, although it may be blood stained. If the fluid is tested with a labstix (little point in routine practice) then it will usually contain small amounts of blood. A microdocechtomy may be performed.
A 25 year old male pedestrian is involved in a road traffic accident. He sustains multiple injuries and is admitted to the intensive care unit, intubated and ventilated. Over the next week he develops adult respiratory distress syndrome. What is the main reason for hypoxaemia in this condition?
Increased lung compliance Reduced diffusion Reduced surfactant Reduced elastase Left to right shunt
The diffuse lung injury, which is associated with loss of surfactant and increased elastase release from neutrophils, results in fluid accumulation. This leads to reduced diffusion, which is the main reason for hypoxaemia.
A 24 year old male was admitted with bloody diarrhea, cramping abdominal pain and weight loss. Colonoscopy revealed a friable, diffusely red mucosa involving the rectum and sigmoid colon. The mucosa was normal proximal to this. The disease progressed with time to involve most of the entire colon, but not the ileum. Many years later, a colonic biopsy shows high grade epithelial dysplasia. What is the most likely initial diagnosis?
Colonic tuberculosis Collagenous colitis Ulcerative colitis Crohns disease Ischaemic colitis
Ulcerative colitis spreads in a progressive distal to proximal manner. Over time a dysplastic transformation is recognised. Such endoscopic findings mandate a minimum of close endoscopic surveillance and if they occur in association with a colonic mass then usually a pancproctocolectomy.
Which virus is associated with Kaposi’s sarcoma?
Human herpes virus 8 Human papillomavirus 16 Human T-lymphotropic virus 1 Epstein-Barr virus Human papillomavirus 18
Human herpes virus 8 Kaposi’s sarcoma
Which of the following is not a feature of Wallerian Degeneration?
May result from an axonotmesis Typically occurs in the peripheral nervous systems The axon remains excitable throughout the whole process The distal neuronal stump is affected Is a component of the healing process following neuronal injury
The axon loses its excitability once the process is established.
A 45 year old woman complains of painful tingling in her fingers. The pain is relieved by hanging the arm over the side of the bed. She has a positive Tinel’s sign at the wrist. Which of the following is most likely to contribute to her diagnosis?
Methotrexate use Crohn's disease Hyperthyroidism Tuberculosis Rheumatoid arthritis
This woman has a diagnosis of carpal tunnel syndrome. Rheumatological disorders are a common cause. Clinical examination should focus on identifying stigmata of rheumatoid arthritis, such as rheumatoid nodules, vasculitic lesions and metacarpophalangeal joint arthritis
A 30 year old male presents with a painless swelling of the testis. Histologically the stroma has a lymphocytic infiltrate. The most likely diagnosis is :
Differentiated teratoma Malignant undifferentiated teratoma Classical seminoma Spermatocytic seminoma Anaplastic seminoma
Seminoma is the commonest type of testicular tumour and is more common in males aged between 30-40 years. Classical seminoma is the commonest subtype and histology shows lymphocytic stromal infiltrate. Other subtypes include:
1. Spermatocytic: tumour cells resemble spermatocytes. Excellent prognosis.
2. Anaplastic
3. Syncytiotrophoblast giant cells: β HCG present in cells
A teratoma is more common in males aged 20-30 years.
A 48 year old women presents with recurrent loin pain and fevers. Investigation reveals a staghorn calculus of the left kidney. Infection with which of the following organisms is most likely?
Staphylococcus saprophyticus Proteus mirabilis Klebsiella E-Coli Staphylococcus epidermidis
Infection with Proteus mirabilis accounts for 90% of all proteus infections. It has a urease producing enzyme. This will tend to favor urinary alkalinisation which is a relative prerequisite for the formation of staghorn calculi.
A 59 year old lady is referred from the NHS breast screening program. A recent mammogram is reported as showing linear, branching microcalcification with coarse granules. Which disease process is the most likely underlying cause of these appearances?
Invasive lobular cancer Lobular carcinoma in situ Cribriform type ductal carcinoma in situ Comedo type ductal carcinoma in situ Fibroadenosis
Comedo type DCIS is usually associated with microcalcifications. Cribriform lesions are usually multifocal but less likely to form microcalcifications. Lobular cancers and in situ lesions rarely form microcalcifications and are difficult to detect using mammography.
A 38 year old lady presents with right upper quadrant pain and nausea. She is otherwise well and her only medical therapy is the oral contraceptive pill which she has taken for many years with no ill effects. Her liver function tests are normal. An ultrasound examination demonstrates a hyperechoic well defined lesion in the left lobe of the liver which measures 14 cm in diameter. What is the most probable underlying cause?
Liver cell adenoma Cavernous haemangioma Mesenchymal hamartoma Cystadenoma Cholangiocarcinoma
Cavernous haemangioma often presents with vague symptoms and signs. They may grow to considerable size. Liver function tests are usually normal. The lesions are typically well defined and hyperechoic on ultrasound. A causative link between OCP use and haemangiomata has yet to be established, but is possible.
In patients with an annular pancreas where is the most likely site of obstruction?
The first part of the duodenum The second part of the duodenum The fourth part of the duodenum The third part of the duodenum The duodeno-jejunal flexure
The pancreas develops from two foregut outgrowths (ventral and dorsal). During rotation the ventral bud and adjacent gallbladder and bile duct lie together and fuse. When the pancreas fails to rotate normally it can compress the duodenum with development of obstruction. Usually occurring as a result of associated duodenal malformation. The second part of the duodenum is the commonest site.
