Path Recalls 2017 Flashcards

Question

Least true regarding malignant hypertension 1-5% of essential hypertension Can arise in people with previously normal blood pressure Fibrinoid necrosis (or sclerosis) of the arteriole walls Greater than 110mmHg diastolic

Answer 1

**LJS (Robbins): Defined as SBP > 200, DBP > 120 mmHg - this is least true Least true regarding malignant hypertension 1-5% of essential hypertension - yes Can arise in people with previously normal blood pressure yes Fibrinoid necrosis (or sclerosis) of the arteriole walls yes - hyperplastic arterosclerosis with fibronoid necrosis. Greater than 110mmHg diastolic - no (see above)

Answer 2

*SD: I'd say 90% ICA false - 40% AcommA branch, 34% MCA bifurcation, 20% terminal ICA **SCS - I favour “25% present within the first 24 hours with infarct due to vasospasm” as LEAST correct. (Vasospasm occurs 4-14 days). But Sina makes a good point… CCF - boom Sajith "the truth" Senaderra strikes again. *wji - agree with Saj. ICA option maybe said "ICA territory" or something like that. vasospasm first 24h is wrong. Least true regarding berry aneurysms 90 percent internal carotid ~maybe. **LJS - branch point in anterior COW most common (90%) 25% present within the first 24 hours with infarct due to vasospasm -no Can present as an enlarging mass -yes 2% of post mortems -yes

Answer 3

*AJL- Causes demyelination and axonal degeneration no - axons don’t degenerate 20-30 percent mortality -yes (10-20% (RP)) Post viral or vaccination -yes Perivenular -yes Causes demyelination and axonal degeneration -no - axons don’t degenerate

Answer 4

With regard to pleural solitary fibrous tumour? Associated with asbestos -no Hypocalcaemia -no, hypoglycaemia Cant remember the correct answer SD: 20% associated with HPOA 80% from visceral pleura 2-4% hypoglycemia

Answer 5

Small cell lung cancer - yes Neuroendocrine lung tumour most likely to cause hypercalcaemia DIPNET Typical carcinoid Small cell lung cancer - yes *LW: Additional note - is the commonest para neoplastic syndrome of SCC lung cancer.

Answer 6

Most likely associated with hypocalcaemia Primary hyperparathyrodism no Secondary hyperparathyroidism yes Tertiary hyperparathyroidism no CKD. Not enough active Vit D. High levels of phosphate which directly depress calcium. Chronically low calcium causes compensatory increase in PTH.

Answer 7

Least likely to cause gynaecomastia Cirrhosis yes Adrenal hyperplasia no (virilization) Leydig cell tumour yes - hyperoestrogenism. (though can also cause increased virilisation). Sertoli tumour yes - produce aromatase which helps to make oestrogen Congenital adrenal hyperplasia stems from several autosomal-recessive, inherited metabolic errors, each characterized by a deficiency or total lack of a particular enzyme involved in the biosynthesis of cortical steroids, particularly cortisol (Fig. 24-46). Steroid precursors that build behind the defective step in the pathway are channeled into other pathways, resulting in increased production of androgens, which accounts for virilization. Simultaneously, the deficiency of cortisol leads to increased secretion of ACTH, culminating in adrenal hyperplasia.

Answer 8

*AJL - 25% are bilateral yes (*LW - Word for word from Robbins) Orchidopexy corrects increased risk of malignancy - reduces but doesn’t eliminate 10% of 1 year old boys-no. 1% Contralateral testis is almost always normal - *LW: robbins states similar histologic changes may also be seen in contralateral descended testis - so not normal, and hence incorrect.

Answer 9

Seminoma yes ``` Most common testicular cancer Yolk sack Teratoma Seminoma yes Choriocarcinoma ```

Answer 10

*AJL- Mostly associated with normal pregnancy - yes 50% (Robbins pg 1042) Spontaneous abortion, hydatidiform mole make up the remainder. Excellent prognosis, 10-15% get disseminated disease **LJS - HCG only moderately elevated. Produces human placental lactogen. Presents with uterine mass, bleeding amenorrhea. Makes up less that 2% of GTD. * LW: a. Associated with markedly elevated BHCG: FALSE - mild rare form of GGT, with less syncitiotrophblasts hence lower BHCG b. Mostly associated with normal pregnancy: sometimes may occur after normal pregnancy, molar pregnancy or even after a terminated pregnancy.)

Answer 11

Regarding choriocarcinoma (False) Better prognosis with non-gestational choriocarcinoma false Frequently metastases at presentation yes Can present up to 2 years after pregnancy yes up to 15 Choriocarcinoma has high propensity for hematogenous spread, and by the time it is discovered, radiographs of the chest and bones may disclose the presence of meta- static lesions. Nongestational choriocarcinomas that arise outside of the uterus are much more resistant to therapy.

Answer 12

Not associated with pre-eclampsia Placental infarcts yes HELLP yes Neurological symptoms no Retroplacental bleed yes **LJS - pre-eclampsia get headaches and visual disturbance but eclampsia defined by CNS involvement - seizures/coma Approximately 10% of women with severe preeclampsia develop microangiopathic hemolytic anemia, elevated liver enzymes, and low platelets, referred to as the HELLP syndrome (Chapter 17). The placenta reveals various microscopic changes, most of which reflect malperfusion, ischemia, and vascular injury. These include (1) infarcts, which are larger and more numerous that those that may be seen in normal full-term placentas, (2) exaggerated ischemic changes in the chorionic villi and trophoblast, consisting of increased syncytial knots, (3) frequent retroplacental hematomas due to bleeding and instability of uteroplacental vessels, and (4) abnormal decidual vessels, which may show thrombi, lack of normal physiologic conversion (described earlier), fibrinoid necrosis, or intraintimal lipid deposition (acute atherosis)

Answer 13

Not associated with sarcoid Membranous glomerulonephritis no Mickulicz - IgG4 disease. Associated with sarcoidosis and sjogren and lymphoma. Used to be considered a form of Sjögren (therefore has similar presentation... salivary gland and lacromal ducts)

Answer 14

True regarding pagets disease of the nipple Eczematous reaction on skin yes Occult DCIS involving the nipple F - not occult, has visible skin change Lactiferous ducts involved in less than 5% no

Answer 15

*AJL- In the skull, facial bones and mandible more commonly involved than the vault yes 20-30% polyostotic 2-3% of polyostotic are McCune-Albright which have coast of maine cafe au lait spots. Maxilla > mandible > frontal bone > ethmoid and sphenoid bones > T-bone

Answer 16

Periosteal has a cleft between the bone and the tumour -false Regarding osteosarcoma (false): Periosteal has a cleft between the bone and the tumour -false Parosteal has significant cartilage component -yes **LJS - periosteal contains lots of chondroid matrix. Parosteal has osteoid matrix. RP. I think this also false High grade surface osteosarcoma has a similar prognosis to conventional -yes *ESG disagree. StatDx parosteal osteosarcoma: Gross path: Contains nodules of cartilage, some on surface, mimicking incomplete cartilage cap Histo: 50% show cartilaginous differentiation.

Answer 17

* *LJS - viral hepatitis * LW agrees Most common cause of jaundice in pregnancy Cholestasis yes HELLP Viral hepatitis Choledocolithiasis

Answer 18

Acute affects previously damage valves -no Least true with regard to endocarditis: Acute causes valve destruction -yes Acute affects previously damage valves -no Strep viridans most common cause of subacute -yes

Answer 19

**LJS - septum primum ASD is big defect, unlikely to be asx But overall ASD more likely to present in adulthood vs VSD *LW: likely incomplete recall with unrecalled correct option. Primum defects commonly associated with other congential heart defects, so likely present early. Least likely to with regard to congenital heart disease Truncus arteriosus carries a poor prognosis yes Septum primum ASD presents early no

Answer 20

**LJS - serous more commonly malignant than mucinous Serous more common than mucinous *AJL agree with LJS. Serous benign - 60%, borderline - 15%, malig - 25% Mucinous benign - 80%, borderline - 10-15%, malig - 5% Which is least likely regarding ovarian tumours Serous carcinoma more common than borderline -yes Serous carcinoma more likely bilateral -yes Mucinous more common than serous -no Mucinous more commonly malignant- no

Answer 21

Most likely cause of partial hepatic fibrosis Budd Chiari yes Alpha-1-antitripsin Wilsons The obstruction of two or more major hepatic veins produces liver enlargement, pain, and ascites, a condition known as Budd-Chiari syndrome. Obstruction of a single main hepatic vein by thrombosis is clinically silent. In the Budd-Chiari syndrome, the liver is swollen and red-purple and has a tense capsule. There may be differential areas of hemorrhagic collapse alternating with areas of preserved or regenerating parenchyma, the patterns are dependent on which small and large hepatic veins are obstructed.

Answer 22

Most true with regard to osteopetrosis ``` Hepatosplenomegally yes Axial more affected than appendicular no No increased risk of fracture no Autosomal recessive form affects the navicular no Autosomal dominant form… no ``` The primary spongiosa, which is normally removed during growth, persists and fills the medullary cavity, leaving no room for the hematopoietic marrow. Affected individuals who survive into their infancy have repeated—often fatal—infections because of leukopenia, despite extensive extramedullary hematopoiesis that can lead to prominent hepatosplenomegaly.

Answer 23

* *LJS - meningioma * LW: as always agrees with LJS; meningiomas usually parasellar in location, and if trurly arises in fossa, more commonly shows hyperostosis rather than expansion relative to other lesions. (https://erc.bioscientifica.com/view/journals/erc/15/4/885.xml) Least likely to cause expansion of the pituitary fossa ``` Meningioma Germinoma Craniopharyngioma Lymphocytic hypophysitis yes Macroadenoma ```

Answer 24

Least correct with regard to macroadenoma: Commonly non-secretory yes PRL production most common yes *AJL - I favour this to be least correct as most common is non secretory... Can invade the cavernous sinus yes Cavernous sinus invasion difficult to determine (medial wall is thin, weak). If tumor exists between cavernous carotid artery and lateral dura = invasion * *SCS: robbins. 9th ed, big version. - Lactotroph: 30% of adenoma “most common type of HYPERFUNCTIONING pituitary adenoma” - Non-secretory: 25-30% - Rarest =‘thyrotroph’ 1% *ESG - disagree that most common is non secretory. From StatDx pituitary macroadenoma: 75% endocrinologically active (symptoms vary) Prolactin-secreting adenoma is most common functional adenoma IVM: RP says Most macroadenomas are non-secretory. ?another least correct option not recalled

Answer 25

Least true with regard to chondrosarcoma Low grade lesions can cause reactive cortical thickening yes 15% arise from benign condroid lesions yes Majority high grade no Most arise in axial skeleton yes A slow-growing, low-grade tumor causes reactive thickening of the cortex, whereas a more aggressive high-grade neoplasm destroys the cortex and forms a soft tissue mass. About 15% of conventional chondrosarcomas are secondary, arising from a preexisting enchondroma or osteochondroma. Fortunately, most conventional chondrosarcomas are grade 1 tumors with 5-year survival rates of 80% to 90% (versus 43% for grade 3 tumors). Chondrosarcomas commonly arise in the axial skeleton, especially the pelvis, shoulder, and ribs. Unlike benign enchondroma, the distal extremities are rarely involved. The clear cell variant is unique in that it originates in the epiphyses of long tubular bones.

Answer 26

Woman with history of breast cancer, limp and hip pain 2 weeks, with increased T2 signal surrounding the psoas muscle Psoas tear yes Metastasis of the lesser trochanter Subtrochanteric fracture Subcapital fracture **LJS - lesser trochanter mets, iliopsoas insertion here *LW: agree *AJL - also agree. If it was psoas tear the high signal would be within the muscle not surrounding. **SCS: crack the core; MSK “if you see an isolated “avulsion” of the LT in a seemingly mild trauma/injury in an adult - query a pathological fracture” wji - im in. how many can we fit on this bandwagon.

Answer 27

*LW: UptoDate (again our exams are not): states ---> There may be a statistically significant increased risk with vitamin E, as showhn in large prospective trials. ---> Link between vitamin D and prostate is complex, with conflicting studies with regards to vitamin D deficiency as a common pathway. Vitamin D - *AJL **LJS agree but vitamin D is protective! Big Rob 9th ed p984 SCS - I enjoy the D.

Answer 28

Phaeochromocytoma yes Least frequent with MEN1 Pituitary adenoma Adrenal cortical adenoma Pancreatic islet cell tumour Phaeochromocytoma yes It is now recognized that the spectrum of this disease extends beyond the 3Ps. The duodenum is the most common site of gastrinomas in individuals with MEN-1 (far in excess of the frequency of pancreatic gastrinomas), and synchronous duodenal and pancreatic tumors may be present in the same individual. In addition, carcinoid tumors, thyroid and adrenocortical adenomas, and lipomas are more frequent than in the general population.

Answer 29

Increased excretion of copper into bile - no has reduced excretion

Answer 30

Least likely to cause splenomegaly Biliary acarisis no (helminthic infection, round worm) Cirrhosis Schistosomiasis (causes inflammatory response in the liver leading to fibrosis and cirrhosis) Hepatitis B

Answer 31

Least likely a result of diabetes Calcification of the vas deferans - most common cause Amyloidosis - islet cell amyloidosis (below) Pancreatitis no A form of localised amyloidosis: endocrine amyloid: Microscopic deposits of localized amyloid may be found in certain endocrine tumors, such as medullary carcinoma of the thyroid gland, islet tumors of the pancreas, pheochromocytomas, and undifferentiated carcinomas of the stomach, and in the islets of Langerhans in individuals with type 2 diabetes mellitus.

Answer 32

Least true regarding wilms Dysplastic kidneys risk factor yes Most <2 years old no **LJS - MCDK now not thought to be risk factor for Wilms, several systematic reviews.

Answer 33

True regarding neuroblastoma Metastases can regress in infants yes Frequently lymph node involvement at diagnosis yes VMA for screening yes Infants with localized primary tumors and widespread metastases to the liver, bone marrow, and skin (stage 4S) represent a special subtype, wherein it is not uncommon for the disease to regress spontaneously. The biologic basis of this welcome behavior is not clear. Unfortunately, most (60% to 80%) children present with stage 3 or 4 tumors Because the vast majority of neuroblastomas release catecholamines into the circulation, detection of catecholamine metabolites (VMA and HVA) in urine could, in principle, form the basis for screening for asymptomatic tumors in children. However, two large studies in Europe and North America have failed to demonstrate improved mortality rates with population screening, because most tumors detected had favorable biologic characteristics. Therefore, community-based screening programs for neuroblastomas are not currently advocated.

Answer 34

Least associated with NF2 ``` Meningioma Ependymoma Schwannoma Dural calcification Optic nerve glioma no ```

Answer 35

IPMN yes **LJS - or serous. IPMN typically elderly males, this guy only 50. 75% serous occur in women. * *SCS: Robbins. - SCAs typically in the panc tail. Cysts are typically small, 1-3mm. Macrocystic variants are possible - IPMN- head is typical location;M>F. Additional things- asscociation w pancreatic duct/ductal dilatation. - MCM-95% women. Pancreatic tail. Larger cystic spaces filled w mucin. Encapsulated. Neoplastic potential, on a spectrum. 1/3 of surgically resected specimen harbour invasive adenoca.

Answer 36

*AJL - Pseudomebranous colitis and ischaemic colitis Infectious colitis and pseudomembranous colitis - No. Robbins says pseudomembranes with c.diff, ischaemia and necrotising infections. I think this mean ‘infectious colitis’ doesn’t count.

Answer 37

*AJL - Mean survival is 14 months with advanced stage (vs serous with 42 months) - Radiopaedia. I suspect the wrong answer was remembered but hopefully we all still learned something. StatDx: Overall much better prognosis than other subtypes of epithelial ovarian cancer - 5-year overall survival in patients with *localized* disease exceeds 90% Patients with *advanced-stage* primary mucinous carcinomas (stage III or IV) have significantly shorter overall survival compared to patients with advanced-stage serous carcinoma - Estimated median survival between 12 and 33 months compared to 42 months WJI disagree. FIGO stage 2 is pelvic peritoneal disease and 5yr survival is 70% (statdx) so if peritoneal disease is limited to the pelvis answer is correct **SCS Stage 1: 90%, 2: 70%, 3: 39%, 4: 17% (stat dx gives numbers for malignant epithelial tumours in general)

Answer 38

Most likely regarding mixed mullerian tumours Homologous with endometrial, mesenchymal elements yes Heterologous with epidermal and neural elements - F? Combination/collision of two different germ cell lines - F Majority of ovarian carcinosarcomas are monoclonal, suggesting they are metaplastic carcinomas High-grade malignant epithelial (carcinoma) and malignant mesenchymal (sarcoma) elements Either carcinomatous or sarcomatous component may predominate Epithelial element is most commonly serous carcinoma Homologous OCS contains malignant stromal elements native to ovary, whereas heterologous OCS contains sarcomatous tissue not normally found in ovary, e.g., cartilage, osteoid, and rhabdomyoblasts

Answer 39

* *LJS - painless hard mass (fibrotic), diffc ddx from ca clinically * AJL agree. ?bad recall (maybe was most likely?) Diabetic mastopathy least likely ``` WJI: Painful -false Difficult to distinguish from tumour clinically-true Soft mass-false Thought to be autoimmune-true ``` **SCS:Also ass/w autoimmune thyroid disease and Type 1 DM. ADB-RP Diabetic mastopathy manifests clinically as a large, painless, hard breast mass that is usually clinically indistinguishable from breast cancer.ts exact pathogenesis is poorly understood and likely multifactorial, possibly relating to an immunologic reaction,

Answer 40

Lobular comparatively more common than ductal when compared to females - no Least likely regarding male breast cancer Lobular comparatively more common than ductal when compared to females no Papillary comparatively more common than in females 50% have lymph nodes at presentation - T SCS: robbins. -Dissemination follows the same pattern as in women, and axillary lymph node involvement is present in about HALF of cases at the time of diagnosis. -Kleinfelters ass/w male BC (3-8% of cases) -Incidence in men is only 1% of that in women. 4-14% attributed to BRCA2 ER positivity is more common in males

Answer 41

Aortic valve prolapse no Least likely post acute MI ``` Pericarditis yes Mitral valve prolapse yes Aortic valve prolapse no Mural thrombus yes Myocardial rupture yes ```

Answer 42

Ballooning of the epiphyses yes Most true regarding haemophilia Autosomal recessive no Most commonly affects the shoulder no Most common cause of death is HIV/AIDS no Ballooning of the epiphyses yes **SCS Overgrowth of both epiphyses and metaphyses (Erlenmeir flask appearance) due to hyperaemia. Gracile diaphyses.

Answer 43

Most commonly associated with renal papillary necrosis NSAIDS yes Steroids Mnemonic: AD SPORT C (see radiopaedia, lists causes in deacending order of frequency). First two are analgesics and diabetes… Note a prior recall was similar, but in reverse asking which IS NOT a cause (renal arterial occlusion) where as renal vein thrombosis is….