Pathology Flashcards

Question

What is the most common cause of hypopituitarism and diabetes insipidus in the post-partum period. A. Sheehan syndrome. B. Lymphocytic hypophysitis C. Adenoma D. Sarcoid E. Tuberculosis

Answer 1

B - Lymphocytic hypophysitis Post-partum pituitary disease: 1. Lymphocytic hypophysitis - most common form of hypophysitis - post-partum women, do NOT need hypotension - headaches disproportionate to mass - anterior and posterior pituitary dysfunction 2. Sheehan Syndrome - post-partum pituitary infarction due to haemorrhagic shock (usually needs blood transfusion) - panhypopituitarism (esp. anterior hormones) - diabetes insipidus is rare (posterior pituitary) Other causes of hypophysitis - Drug-induced E.g. CTLA4 (ipilimumab) - Granulomatous E.g. LCH/TB/sarcoid/Wegener’s

Answer 2

B > C - Lymphocytic hypophysitis more common in females A. False - DI rare B. Lymphocytic hypophysitis - F > M (rare → 1-2% of sella lesions) C. Craniopharyngioma - M = F; bimodal (5-15, >65) D. Rathke’s - rarely symptomatic E. Empty sella syndrome UpToDate: “Unlike diseases that involve the pituitary directly, any of these conditions can also diminish the secretion of vasopressin, resulting in diabetes insipidus. Pituitary lesions alone do not cause diabetes insipidus, since some vasopressin-producing neurons terminate in the median eminencE.”

Answer 3

Answer: E (depending on phrasing) A - False. Fine linear branching, or pleomorphic B - False. Fine linear branching, or pleomorphic C - False. No mass D - False. MRI shows non-mass enhancement E - True

Answer 4

A - False. Arises from transitional zonE. B - False. C - False. PSA is elevateD. D - True. E - False. Late complication.

Answer 5

A - True. PSA nonspecific B - False. Prostate cancer is more common in PZ C - True. Typically peripheral/posterior D - True. PSA nonspecific

Answer 6

A - circumvallate placenta not associated with accreta Circumvallate placenta = small chorionic plate + overhanging extrachoroidal placental tissuE. Associated with premature separation, haemorrhage, IUGR/oligo, abruption.

Answer 7

A StatDx: Progressive multifocal leukoencephalopathy (PML) - Subacute opportunistic infection caused by DNA virus JC polyomavirus (JCV) - JCV infects oligodendrocytes, causes demyelination in immunocompromised patients - Associated with immunosuppression, often AIDS - Multifocal subcortical WM lesions without mass effect or enhancement in AIDS patients Robbins: - Primary infection is asymptomatic - Reactivation causes PML

Answer 8

Answer: Radiation causes restrictive not dilated CM RCM - amyloidosis, radiation, idiopathic DCM - idiopathic, peripartum, alcohol, genetic, myocarditis, haemochromatosis, doxorubicin and sarcoidosis

Answer 9

Answer: Wilson’s disease does not cause CM RCM - amyloidosis, radiation, idiopathic DCM - idiopathic, peripartum, alcohol, genetic, myocarditis, haemochromatosis, doxorubicin and sarcoidosis

Answer 10

Answer: (neuro)cysticercosis Stages: 1. early vesicular - viable parasite with intact membrane 2. colloidal vesicular - dead parasite, turbid fluid, oedema ++ 3. granular nodular - reduced size, reduced oedema 4. calcified nodular - calcified granuloma CNS parasitic infection caused by pork tapeworm, Taenia solium Spinal extraparenchymal form uncommon (5% of cases)

Answer 11

A StatDx - treatment: 100% inspired oxygen To trap air in right heart and prevent embolization to lungs Left lateral decubitus position Trendelenburg (head down) position

Answer 12

A - False. Haemorrhagic infarct due to vessel invasion. B - True. Invasive fungal sinusitis is due to both Aspergillus (80% neutropaenic) and Rhizopus/Mucor (80% diabetes). Angioinvasive Aspergillosis: Characteristic CT findings consist of nodules surrounded by a halo of ground-glass attenuation (“halo sign”) or pleura-based, wedge-shaped areas of consolidation. These findings correspond to hemorrhagic infarcts. In severely neutropenic patients, the halo sign is highly suggestive of angioinvasive aspergillosis.

Answer 13

C A - False. Not associated with high MCA PSV. Oligo. B - False. Mother Rh positive - can’t be Rh incompatibility. C - True. Most common infective cause of fetal anaemiA. D - False. Not associated with high MCA PSV. Oligo. E - False. Oligo. Hydrops DDx 1. Immune - Rh incompatibility (-ve mother +ve fetus) - lesser antibodies 2. Non-immune - infection - anaemia - aneuploidy - mass - arrhythmia

Answer 14

Answer: B. A - False. UC, C. difficile, Crohn’s, ischaemia, ileus B - True. Seen in IBD, UC > Crohn’s C - False. Elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosA. Fissures not described in Robbins. D - False. Splenic flexure and descending > sigmoiD. E - False. Backwash ileitis - terminal ileum only.

Answer 15

Answer: C. A. True. “Autoimmune (formerly called acquired)” is the most common cause (90%). B. True. Secondary PAP is associated with haematopoietic disorder, malignancy, immunodeficiency, silicosis etC. C. False. Congenital has variable but poor prognosis. Spontaneous remission described in autoimmune typE. D. True. “Most cases present during neonatal period or early infancy” - UpToDate E. True. “Autoimmune (formerly called acquired).” StatDx / Robbins: Pulmonary alveolar proteinosis (PAP): Syndrome characterized by accumulation of surfactant in alveoli and terminal bronchioles - Autoimmune (90%) [formerly called acquired] - Secondary - Hereditary and congenital UpToDate: Congenital PAP = disorder of surfactant production/metabolism Primary PAP = disruption of GM-CSF (autoimmune, hereditary) Secondary PAP = underlying condition affects alveolar macrophages (haematologic malignancy, MDS, infection, silicosis)

Answer 16

Answer (of these options): C. A - True. “Autoimmune (formerly called acquired)” (Robbins) B - True. C - Depends. UpToDate: Congenital PAP usually fatal. Can be slowly progressive/stable for many years or severe and progressivE.

Answer 17

A is false. A - IBD not associated (PSC not PBC) B - True. C - True. "I am a 70yo woman with Sjogren's, autoimmune thyroiditis, PBC and an intense rash. AMA." Robbins: “The cardinal feature of PBC is a nonsuppurative destruction of small and medium-sized intrahepatic bile ducts. PBC is primarily a disease of middle-aged women (40-50yo). Associated extrahepatic conditions include the Sjögren syndrome of dry eyes and dry mouth, scleroderma, thyroiditis, rheumatoid arthritis, Raynaud phenomenon, and celiac diseasE.”

Answer 18

Answer: BCS (StatDx) BCS - centrilobular fibrosis Schisto - pipestem (periportal) fibrosis A. HCT - → fibrosis → cirrhosis B. Wilson’s - fatty → hepatitis → cirrhosis (Robbin’s) C. Hep C → 20% have cirrhosis (Robbins) D. BCS - centrilobular congestion, necrosis then fibrosis (not cirrhosis) - Robbins E. Alcohol → leading cause of cirrhosis F. A1AT - childhood OR adult cirrhosis G. Schistosomiasis: ”cut surfaces reveal granulomas and widespread fibrosis and portal enlargement without intervening regenerative nodules… fibrous triads = “pipestem fibrosis” - Robbins. “Hepatic schistosomiasis may cause or simulate cirrhosis from other causes” - StatDx

Answer 19

Probably Budd-Chiari A. BCS - centrilobular congestion, necrosis then fibrosis (not cirrhosis) - Robbins B. Wilson’s - fatty → hepatitis → cirrhosis (Robbin’s) C. HCT → fibrosis → cirrhosis D. A1AT - childhood OR adult cirrhosis E. Hep C → 20% have cirrhosis (Robbins)

Answer 20

D “Dysplastic nevi are important because they may be direct precursors of melanoma” - (Robbins)

Answer 21

A Most common PRIMARY testicular tumours as per age groups: o 1st decade – yolk sac tumour and testicular teratoma o 2nd decade – choriocarcinoma o 3rd decade – embryonal cell carcinoma o 4th decade – seminoma o 7th decade and above – lymphoma and spermatocytic seminoma

Answer 22

E “Aggressive non–Hodgkin lymphomas account for 5% of testicular neoplasms, and are the most common form of testicular neoplasms in men older than age 60 years.” - Robbins Most common PRIMARY testicular tumours as per age groups: o 1st decade – yolk sac tumour and testicular teratoma o 2nd decade – choriocarcinoma o 3rd decade – embryonal cell carcinoma o 4th decade – seminoma o 7th decade and above – lymphoma and spermatocytic seminoma

Answer 23

C is definitely false. E is probably false. A. True. “Large, well-circumscribed” - Robbins B. True. “Solid and cystic components filled with haemorrhagic debris” - Robbin’s C. False. “Mainly in young women” - Robbins D. True. “Most patients are cured following surgical resection of the neoplasm” - Robbins E. False. “Pancreatic manifestations of VHL include simple pancreatic cysts, serous cystadenomas, and neuroendocrine tumors (PNETs).” - RCNA VHL review article

Answer 24

A. False. Temporal lobe most common (approx 50%) B. False. 98% supratentorial. C. False. Peak age 10-30 yo (Radiopaedia) D. False. Usually found children or young adults E. False. Low grade (WHO II), can be anaplastic (WHO III) F. True. Cortical baseD. Can have dural tail. G. True. Cortical baseD. Can have dural tail. H. False. Well-circumscribed macroscopically. I. True. Temporal lobe most common (approx 50%) Robbins: Pleomorphic Xanthoastrocytoma “This tumor occurs most often in the temporal lobe in children and young adults, usually with a history of seizures. The tumor consists of neoplastic, occasionally bizarre, astrocytes, which are sometimes filled with lipids; these cells can express neuronal and glial markers. The degree of nuclear atypia can be extreme and may suggest a highgrade astrocytoma, but the presence of abundant reticulin deposits, relative circumscription, and chronic inflammatory cell infiltrates, along with the absence of necrosis and mitotic activity, distinguish this tumor from more malignant types. The pleomorphic xanthoastrocytoma is usually a low-grade tumor (WHO grade II/III 2016) with a 5-year survival rate estimated at 80%. Necrosis and mitotic activity are indicative of higher grade tumors and predict a more aggressive coursE.”

Answer 25

C is false. A. True - transudative B. True - exudative C. False - transudative D. True - haemothorax E. True - transudative

Answer 26

B is true. A. False - needs to be intrathoracic (unless mets) “Usually such cancers arise within the thoracic cavity” - Robbins B. True - haemorrhagic serositis can be due to pleural neoplasm C. False - transudative

Answer 27

A. False. Probably conditional. B. False. Copper and silver IUD ok for 1.5T (conditional at 3T) C. False. Insulin pump = absolute contraindication D. False. Cochlear implants conditional at 1.5T E. True. Certain shrapnel ok if away from vital organs “Because pellets, bullets, and shrapnel are frequently contaminated with ferromagnetic materials, the risk versus benefit of performing an MR procedure should be carefully considereD. Additional consideration must be given to whether the metallic object is located near or in a vital anatomic structure, with the assumption that the object is likely to be ferromagnetic and can potentially movE.” Source: mrisafety.com

Answer 28

RANZCR 2016: Vasovagal reaction (hypotension and bradycardia) - keep supine, elevate legs - oxygen by mask (6-10L/min) - atropine > adults: 0.6-1.0mg IV q3-5min to max 3mg > paediatric: 0.02mg/kg IV to max 2mg total - IV fluids (N/S or Hartmann’s 20mL/kg

Answer 29

5 = Posterior triangle 1A = submental 1B = submandibular 2 = jugular above hyoid 3 = between hyoid and cricoid 4 = below cricoid 5 = posterior triangle 6 = pre/paratracheal (Delphian)

Answer 30

A. Level 1A or 1B (posterior border SMG divides 1 from 2) 1A = submental 1B = submandibular 2 = jugular above hyoid (2A is anterior to IJV, 2B is posterior) 3 = between hyoid and cricoid 4 = below cricoid 5 = posterior triangle 6 = pre/paratracheal (Delphian)

Answer 31

ANSWER: Hutchinson syndrome is not associated with Wilms tumour. (Hutchinson syndrome defined as limping and irritability from skeletal metastases of neuroblastoma - Radiopaedia) Overgrowth syndromes (WT2 gene) - Beckwith-Wiedemann (omphalocele, macroglossia, hemihypertrophy, cardiac, hepatosplenomegaly) - Sotos (cerebral gigantism) - Perlman syndrome Non-overgrowth syndromes (WT1 gene) - WAGR syndrome (Wilms, aniridia, genital anomalies, retardation) - Denys-Drash (Wilm, male pseudohermaphroditism, proressive glomerulonephritis) Isolated abnormalities - Cryptorchidism - Hemihypertrophy - Hypospadias - Cryptorchidism

Answer 32

B A. T - included in Amsterdam; mean age 45y B. F - Amsterdam criteria requires 3+ relatives C. T - COUGR D. T - COUGR E. T - COUGR Most common CRC syndrome (3%) Autosomal dominant Microsatellite instability (mismatch repair) - MSH2/MLH1 COUGR - colorectal, ovarian, uterine, gastrointestinal & renal tract Amsterdam Criteria: (3/2/1 rule) - 3+ relatives with Lynch-associated cancer - 2+ generations of Lynch-associated cancer - 1+ cancer diagnosed before age 50

Answer 33

B A. T - 60-80% are right sided (UpToDate) B. F - can’t find a stat supporting this (U2D / Robbins / StatDx) C. T - COUGR Most common CRC syndrome (3%) Autosomal dominant Microsatellite instability (mismatch repair) - MSH2/MLH1 COUGR - colorectal, ovarian, uterine, gastrointestinal & renal tract Amsterdam Criteria: (3/2/1 rule) - 3+ relatives with Lynch-associated cancer - 2+ generations of Lynch-associated cancer - 1+ cancer diagnosed before age 50

Answer 34

D is false A. T - Peak age 2-5; 95% <10y (Robbins) B. T - “these patients are presumed to harbor a germline mutation” (Robbins) C. T - “frequency nearly 100% in bilateral Wilms” (Robbins) D. F - Syndromic Wilms only 10% (Robbins) E. T - “Lung metastases in 10-20% at diagnosis” (StatDx) Peak age 3-4 yo (80% of cases below 5yo) 10-20% have 11p13 (WT1) deletion 10-20% have lung mets at diagnosis Overgrowth syndromes (WT2 gene, 15p15): · Beckwith-Wiedemann · Perlman syndrome · Simpson-Golabi-Behmel syndrome · Sotos syndrome Non-overgrowth syndromes (WT1 gene, 11p13): · WAGR syndrome · Denys-Drash syndrome Isolated abnormalities: · Cryptorchidism · Hemihypertrophy · Hypospadias · Sporadic aniridia · Renal fusion

Answer 35

A. F - psoriasis has enthesitis + periostitis B. T - secondary HADD C. T - secondary HADD D. T - Calcific tendinitis, classic primary HADD E. T - Calcific tendinitis, classic primary HADD StatDx: Broad spectrum of musculoskeletal pathology due to hydroxyapatite crystal deposition 1. Primary HADD - calcific tendonitis and bursitis 2. Secondary hydroxyapatite related to underlying disease - End-stage renal disease - Collagen vascular disease - Vitamin D intoxication - Tumoral calcinosis

Answer 36

Answer: Parosteal osteosarcoma lowest grade = least aggressive = least painful Parosteal: low-grade, 20-40F, metaphysis, posterior distal femoral metaphysis, cauliflower-like with string sign and marrow extension Periosteal: intermediate, 15-25M, medial distal femoral diaphysis, densely ossified with no marrow extension Telangiectatic: containing or largely consisting of large blood-filled spaces, 2nd decade, intramedullary, rare

Answer 37

Answer: C. Ileum is most common AND most aggressive A. Stomach <10% B. Duodenum <10% C. Ileum (jejunum + ileum) >40% D. Appendix <25% E. Rectum <25% Well-differentiated neuroendocrine tumor originating in the digestive tract (or less commonly, lung or genitourinary tract)

Answer 38

Answer: A is false A. F - 4:1 M>F B. T C. T - most classic presentation D. T - classic presentation E. T - rare, long-segment Hirschsprung Congenital anomaly of enteric nervous system - Absence of ganglion cells in myenteric & submucosal plexus of intestine - Lack of peristalsis → functional bowel obstruction - Aganglionic segment extends retrograde from anus for variable length with gradual transition to innervated colon

Answer 39

Answer: B Plts >50 INR < 1.5 eGFR >30 (if IV contrast)

Answer 40

Answer: C. Coronary sinus RA is defined by the IVC RV is defined by the moderator band

Answer 41

“In women and nonsmokers, adenocarcinomas are the most common” (Robbins) A. False - 1-5%, M=F, smokers <40. B. False - 14%, smoking associated C. False - 3% D. True - 38%, most common E. False - 20%, smoking-associated “The incidence of adenocarcinoma has increased significantly in the last 2 decades. Adenocarcinoma is now the most common form of lung cancer in women and, in many studies, men as well.” (Robbins) “Cancers in nonsmokers are more likely to have EGFR mutations, and almost never have KRAS mutations”

Answer 42

Answer: D is true A. False - dentinogenesis not seen in type II B. False - kyphoscoliosis in type III C. False - type II is fatal D. True - type I & III have hearing impairment E. False - blue at birth → becomes white Type 1, AD, survives, blue sclera, joint laxity Type 2, AR, dies, blue sclera Type 3, AD, progressive deformity, hearing impairment Type 4, AD, survives, normal sclera dentinogenesis imperfecta in non-lethal forms

Answer 43

Answer: A and C both truE A. True - McCune-Albright = precocious puberty, polyostotic FD & Coast of Maine spots (usually unilateral) B. False - typically ground-glass matrix vs. stippled rings & arcs C. True - facial involvement in leontiasis ossea D. False - polyostotic syndromic presents earlier E. False - spine is rare (<2.5%)

Answer 44

Answer: A. <3h (hyperacute) A. True - oxyHb (T1 iso, T2 bright - Prometheus) B. False - deoxyHb (T1 iso, T2 dark) C. False - intracellular metHb (T1 bright, T2 dark) D. False - extracellular metHb (T1 bright, T2 bright) E. False - extracellular metHb (T1 bright, T2 bright) >28 days

Answer 45

A. True - firm mobile mass B. False - usually no nipple discharge C. False - young women (mean 19-23) D. False - occult on mammogram E. False - usually no nipple discharge F. False - young women (mean 19-23) G. True - “Swiss Cheese” disease hypoechoic multicystic mass Benign localised proliferative breast lesion in young women <30 - presents as a firm mass (no nipple discharge) - inhomogenous hypoechoic with multiple internal cysts (Swisscheese ) - occult on mammogram (or amorphous calcs) - MRI multiple T2 bright cysts, benign kinetics

Answer 46

B is true. A. False - “relatively good prognosis compared to other poorly differentiated carcinomas” (Robbins) B. True - BRCA1 associated carcinoma C. False - triple negative “Basal-like cancer, ER/PR/HER2(-) CK5/6(+)” (StatDx) D. False - circumscribed mass E. False - special type of IDC (ductal not lobular)

Answer 47

B is true. A. False - circumscribed mass. B. True - circumscribed mass C. False - pseudocystic appearance (hypoechoic, posterior enhancement) D. False - rim enhancement (StatDx) E. False - hypoechoic, posterior enhancement

Answer 48

A. False - calcifications uncommon B. True - circumscribed with partially indistinct margins C. Depends - better prognosis than other poorly differentiated cancers D. False - NST “does not meet criteria for special types” (75%) whereas triple negative = basal-like i.E. a special type (10%) IDC: E-cadherin retained ILC: E-cadherin lost in >90%; mostly ER+ve (StatDx) Luminal A (40-50% as per Flinders 2015): ER+ PR+ HER2 - Luminal B (15-20%): ER+ PR+ HER2+ HER2 enriched (10%): ER- PR- HER2+ Basal-like (10-20%): ER- PR- HER2- (triple negative)

Answer 49

A. False - not associated B. True - papillary muscle rupture C. True - free wall rupture (ventricular most common) → haemopericardium → tamponade D. True - Dressler syndrome (fibrinous or fibrinohaemorrhagic) E. True - hypokinesis (causing stasis) + endocardial damage (thrombogenic surface) fosters mural thrombosis F. True - anterolateral wall, mouth > body G. True - posterolateral wall, mouth < body; high rupture risk Contractile dysfunction (LV failure → cardiogenic shock) Arrhythmias Myocardial rupture (free wall, septum, papillary muscle) Ventricular aneurysm Fibrinous pericarditis (Dressler) Mural thrombus Papillary muscle dysfunction Progressive heart failure

Answer 50

Answer: B is true A. False. Failure of LES relaxation; myotomy may cause reflux. B. True. “Intestinal-type metaplasia... a replacement of the squamous esophageal epithelium with goblet cells” (Robbins). C. False. Zenker is pulsion diverticulum above cricopharyngeus. D. False. Aperistaltic lower ⅔ of oesophagus. (StatDx) E. False. Rapid local spread “because the oesophagus lacks a serosa” (Radiographics)

Answer 51

Answer: A. False. “Some serotypes of H. pylori… decrease risk of esophageal adenocarcinoma, because they cause gastric atrophy” (Robbins) B. False. Pharyngeal pulsion diverticulum above cricopharyngeus C. True. “Most esophageal adenocarcinomas arise from Barrett esophagus” (Robbins) D. False. “The most common cause of GE reflux is transient lower esophageal sphincter relaxation” (Robbins)

Answer 52

Answer: C. “Viral hepatitis is the most common cause of jaundice in pregnancy” (Robbins) In a very small subgroup of pregnant women (0.1%), hepatic complications develop that are directly attributable to pregnancy. These disorders include preeclampsia and eclampsia, acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy. In extreme cases, eclampsia and acute fatty liver of pregnancy may be fatal. By Trimester: 1st: hyperemesis gravidarum 2nd/3rd: intrahepatic cholestasis > pre-eclampsia > HELLP > AFLDP (microvesicular steatosis) Recommendations: 1/ cholelithiasis - common, leave alone unless symptomatic 2/ cholecystitis - lap cholecystectomy 3/ liver mass - monitor adenomas (resect if >5cm)

Answer 53

A. True. Commonly invades cavernous sinus. B. True. “Nonfunctional adenomas are likely to come to clinical attention at a later stage… more likely to be macroadenomas” (Robbins) C. True. PRL-secreting adenomas “are most frequent… 30%” (Robbins) D. False. Associated with MEN1 MEN1 = pituitary, pancreas NET, parathyroid MEN2A = MTC + phaeo + parathyroid MEN2b = MTC + phaeo + mucosal neuromas/marfanoid E. True. 20-25% incidental (StatDx) but about 14% (Robbins)

Answer 54

Answer: B is true. A. False - erosions not typical of SLE arthritis B. True - serositis is major criterion C. False - not typical of SLE D. False - common (SLE ILD or CTEPH) but not specific Dx Criteria for SLE: SOAP BRAIN MD - serositis - oral ulcers - arthritis - photosensitivity - bloods (pancytopaenia) - renal (nephritic, nephrotic) - ANA - immunological (dsDNA, Smith, histone) - neurological (seizures, psychiatric) - malar rash - discoid rash

Answer 55

Answer: A is false. A. False. Excellent prognosis - 97% at 10 years. B. True. Usually ER+ PR+ Her2- (StatDx) C. True. Small spiculated mass. D. True. Small spiculated mass. E. True. Mean age 50 (StatDx) Tubular breast cancer (StatDx) - uncommon subtype of IDC - mean age 50 - small spiculated mass (<1cm) - slow growth, well-differentiated, rare metastasis - excellent prognosis (97% at 10 years) - multifocal/multicentric in 10-20% - typically ER+ PR + HER2-

Answer 56

Answer: A - Medullary A. Medullary - usually well defined breast mass B. Tubular - spiculated mass C. Fat necrosis - chronic (>1.5yrs) can be a shadowing spiculated mass D. Sclerosing adenosis - usually microcalc +/- distortion (StatDx) E. DCIS - microcalc +/- mass/distortion (StatDx)

Answer 57

Answer: A - PASH A. PASH - large circumscribed mass in woman of reproductive age (StatDx) B. Sclerosing adenosis - usually microcalc +/- distortion (StatDx) C. Surgical scar - architectural distortion +/- oil cysts D. Tubular - spiculated mass E. ILC - spiculated, distortion, shrinking breast (StatDx)

Answer 58

Answer: B. Uric acid A. False. Struvite - magnesium ammonium phosphate - staghorn calculi, infections with urea-splitting bacteria (Proteus, staph) (Robbins). B. True. Urate - gout, leukaemias. More than half of patients with urate calculi do not have hyperuricaemia or increased urinary excretion of uric acid (Robbins) C. False. Oxalate - hypercalcaemia, & hypercalciuria (hyperPTH, bone diseases, sarcoid, Crohn’s) (Robbins) D. False. Due to genetic defects in absorption of amino acids, leading to cystinuria. Also forms at low urinary pH AlkalOS - oxalate, struvite AcidUC - urate, cysteine

Answer 59

Answer: Osteitis condensans ilii. A. False. Painful asymmetric sacro-iliitis B. False. Painful symmetric sacro-iliitis C. True. D. False. Multiple, focal, subarticular & metaphyseal. E. False. Vertical lucencies lateral to sacral foraminA. Normal stress, osteoporotic bonE. Osteitis condensans ilii: response to mechanical stress (StatDx) - Bilateral, symmetric sclerosis of ilium along sacroiliac joint - No changes along sacral articular surface - Absence of other findings Sacro-iliitis is symptomatic, involves both sides of the joint, with erosions and joint space narrowing +/- subchondral cysts

Answer 60

Answer: B. Endometrioid Bilateral: Serous (high > low), endometrioid, clear cell and metastases A. Mucinous cystadenoca: <5% bilateral (Robbins) B. Endometrioid: 40% bilateral (Robbins) C. Teratoma: “rare” bilateral (Robbins) D. Brenner: 10% bilateral (Robbins) E. Thecoma: 10% of fibroma/fibrothecoma are bilateral (Robbins)

Answer 61

Answer: A. Bilateral: serous (high > low), endometrioid, clear cell and metastases A. Mucinous cystadeno: <5% bilateral (Robbins) B. Clear cell: 40% bilateral (Robbins) C. Serous cystadenoca: 65% bilateral (Robbins) D. Metastasis: >50% bilateral (Robbins)

Answer 62

Answer: C. A. False. B. False. Pseudopolyps in UC > Crohn’s, not C. diff. (Robbins) C. True. 3% progress to toxic megacolon (StatDx) but UC is the most common cause (Radiopaedia). “Fully developed C. difficile–associated colitis is accompanied by formation of pseudomembranes, made up of an adherent layer of inflammatory cells and debris at sites of colonic mucosal injury. While pseudomembranes are not specific and may occur with ischemia or necrotizing infections, the histopathology of C. difficile-associated colitis is pathognomonic. The surface epithelium is denuded, and the superficial lamina propria contains a dense infiltrate of neutrophils and occasional fibrin thrombi within capillaries. Superficially damaged crypts are distended by a mucopurulent exudate that forms an eruption reminiscent of a volcano (Fig. 17-29C). These exudates coalesce to form pseudomembranes.”

Answer 63

Answer: C more likely than D. A. False. Geographic chondroid lesion centrally in metaphysis. B. False. Cartilage-covered, arises from cortical surface, continuous with normal cortex and marrow. C. True. Eccentric lucent epiphyseal lesion with sclerotic margin that often crosses physis into metaphysis as it enlarges (25-50%; StatDx). Prox humerus > prox tibia. D. True. Geographic metaphyseal (53%) or diaphyseal (43%) lesion; metaphyseal ones can cross physis into epiphysis. Typical location proximal tibia; very rare lesion. E. False. Arises from cortical surface; does not have continuous cortex and marrow with underlying bone.

Answer 64

Answer: C. Radial scar A. False. Fine linear branching pleomorphic calcs. B. False. Mammographically occult C. True. “dark star” D. False. Dilated ducts (MG: linear branching lucencies) E. False. Popcorn calcifications.

Answer 65

A. False. Staph. aureus is 80-90% of pyogenic osteomyelitis (Robbins). B. Probably False. “In children, localisation of microorganisms in the metaphysis is typical. After growth plate closure, the metaphyseal vessels reunite with their epiphyseal counterparts and provide a route for the bacteria to seed the epiphyses and subchondral regions, which are common sites of infection in the adult.” (Robbins) C. Depends. Children usually haematogenous, adults usually direct spread. D. True. “Brodie abscess is a small intraosseous abscess that frequently involves the cortex and is walled off by reactive bone.” (Robbins) E. False. Staph aureus 80-90% (Robbins) F. False. Sclerosing osteomyelitis of Garre involves mandible - odontogenic infection, onion skin laminar periosteal reaction. G. True. “Dead bone is known as a sequestrum” (Robbins). StatDx: Neonates = Staph, GBS, E coli Normal child = Staph SCD = Staph + Salmonella Normal adult = Staph, enterics IVDU = gram neg like Pseudo and Klebsiella Involucrum is subperiosteal new bone. Cloaca is the draining sinus. Garré sclerosing osteomyelitis (Statdx) - Lytic bone destruction with exuberant periosteal reaction - Periosteal reaction is typically laminar ("onion skin') - Arises from odontogenic (common) or hematologic (uncommon) origin: Look for involved teeth or follicles

Answer 66

Answer: A is true. A. True. Hodgkin arises in a single node or chain of nodes and then spreads to contiguous nodes. B. False. Bone marrow is extranodal. C. False. Hodgkin’s rarely extranodal. D. False. Spinal cord is extranodal. E. False. “Mesenteric nodes and Waldeyer ring rarely involved” Hodgkin’s (Robbins): - More often localised to single axial group of nodes (cervical, mediastinal, para-aortic) - Orderly spread by contiguity - Mesenteric nodes and Waldeyer’s ring rarely involved - Extranodal presentation rare

Answer 67

Answer: Hodgkin’s lymphoma

Answer 68

Answer: A is true A. True. NF2, Familial clear cell meningioma syndrome, multiple meningiomatosis B. ?False. “Expands centripetally within dural sac” C. False. “Slow growing, compresses but does not invade adjacent structures” (StatDx) D. False. Thoracic (80%) > cervical (16%) > lumbar (4%) StatDx Pearls: 1. Tumor dorsal to cord likely meningioma, not schwannoma (nerve roots are anterolaterally located) 2. Thoracic tumor in female patient is more likely meningioma 3. MR features favouring schwannoma over meningioma: Foraminal enlargement, located within lumbar spine, fluid signal on T2WI, rim enhancement.

Answer 69

Answer: D A. False - Upper vaginal involvement does not have a poor prognosis – there is 29% mortality at 5 years (stage IIA disease) B. False - HSIL progression to carcinoma is 10% within 2-10 years (Robbins) C. False - LSIL 10% progress to HSIL at 2 years (Robbins) D. True - Small cell neuroendocrine tumours have a very poor prognosis (Robbins) E. False - HPV vaccination.

Answer 70

Answer: D > E. A. False - SCC is most common subtype of invasive cervical carcinoma (accounts for 80%; second is adenoca 15%) Robbins B. False - High-risk types are 16 & 18 = SCC of cervix, anogenital, oropharynx. Low-risk types are 6 & 11 are genital warts. C. False - Upper vaginal involvement does not have a poor prognosis – there is 29% mortality at 5 years (stage IIA disease) D. True - Death is due to local complications such as ureteric obstruction, pyelonephritis, uraemia. (Robbins) E. True - Metastasis to the lung, liver, bone marrow. (Robbins)

Answer 71

Answer: D A. False - Pelvic side wall involvement (or lower ⅓ vagina) is stage III (Robbins) B. False - “Small cell neuroendocrine tumours have a very poor prognosis” (Robbins) C. False (as above). D. True - Death is due to local complications such as ureteric obstruction, pyelonephritis, uraemia.

Answer 72

Answer: C A. False - “the distinction from leiomyoma is based on nuclear atypia, mitotic index, and zonal necrosis… presence of 10 or more mitoses per HPF” (Robbins). “Benign metastasising leiomyoma… extends into vessels” (Robbins) B. False. “abnormal bleeding” seen in leiomyomas too (Robbins). No way this can be specific. C. True. Leiomyosarcomas “usually arise de novo” (Robbins). Re: leiomyoma “malignant transformation to leiomyosarcoma, if it occurs at all, is extremely rare” (Robbins). D. False. This can be seen with disseminated peritoneal leiomyomatosis, considered benign (Robbins). E. Likely False. “more than half *eventually* metastasise to lungs, bone, brain” (Robbins)

Answer 73

Answer: A is true. DCIS grading based on nuclear atypia, intraluminal necrosis and mitotic activity “nuclear grade and necrosis are better predictors of local recurrence and progression to invasion than architectural type” DCIS grading: (little nim) Low, intermediate or high grade based on > nuclear atypia > intraluminal necrosis > mitotic activity Invasive grading: (big tnm) Nottingham criteria Grade 1 (well Dx) to 3 (poorly Dx) based on > tubule formation > nuclear pleomorphism > mitotic count

Answer 74

Probably C. A. False. Comedo DCIS defined by “high-grade nuclei and areas of central necrosis” - comedo is a specific form of necrosis (Flinders Path). Robbins also mentions”calcifications may also be seen in noncomedo forms of DCIS in association with focal necrosis or intraluminal secretions” B. Probably false. “Nuclear grade and necrosis are better predictors of local recurrence and progression to invasion than architectural type” (Robbins) C. Probably true. “The major risk factors for recurrence are (1) high nuclear grade and necrosis, (2) extent of disease and (3) positive surgical margins” (Robbins)

Answer 75

Answer: D is least clearly linked to microvascular disease The microangiopathy underlies the development of diabetic nephropathy, retinopathy, and some forms of neuropathy. A - True. DM is a classic cause of “necrotising papillitis”. B - True. Kimmelstiel-Wilson lesion (nodular glomerulosclerosis) is the hallmark of diabetic nephropathy. C - True. Autonomic neuropathy is asymmetric due to microvascular disease. D - False. Inflammation & cellular dysfunction +/- vascular insult. E - True. Due to capillary permeability.

Answer 76

Answer: C is least associated with CWP. A. False. “Simple coal worker’s pneumoconiosis is characterised by coal macules (1 to 2mm) and somewhat larger coal nodules” (Robbins). B. False. As above. C. True. Honeycombing is not typical of CWP D. False. PMF = complicated CWP (Robbins) E. False. “Coal macules...are scattered throughout the lung (upper lobes and upper zones of lower lobes more heavily involved), located primarily adjacent to resp bronchioles. In due course, dilation of adj alveoli occurs, sometimes giving rise to centrilobular emphysema.” (Robbins)

Answer 77

Answer: C. PAN spares the lungs PAN: Medium vessel vasculitis “Segmental transmural necrotising inflammation of small to medium sized arteries” Hep B positive (30%) young adult Kidneys > heart > liver > GIT. Spares the lungs. Acute - eccentric transmural inflammation, fibrinoid necrosis Chronic - fibrosis Untreated PAN is typically fatal; 90% remission if treated.

Answer 78

Answer: A. PAN is a cause of renal microaneurysms PAN: Medium vessel vasculitis “Segmental transmural necrotising inflammation of small to medium sized arteries” Hep B positive (30%) young adult Kidneys > heart > liver > GIT. Spares the lungs Acute - eccentric transmural inflammation, fibrinoid necrosis Chronic - fibrosis Untreated PAN is typically fatal; 90% remission if treated.

Answer 79

A - tricuspid and pulmonary valves (right sided). Carcinoid is a well differentiated neuroendocrine tumour which secretes serotonin (5-HT). MAO (lungs, liver) breaks down serotonin. - Carcinoid valvular disease is typically right sided - Left sided disease only in 7% of pts with bronchial carcinoid or R to L shunts Carcinoid syndrome is due to systemic serotonin.

Answer 80

Answer: B A. True - Ulegyria in TERM neonate - shrunken, flattened cortex due to global hypoxic injury (deepest part of the gyrus is most susceptible to ischaemic damage) B. False - seen in adult hypertensive haemorrhage C. True - periventricular cystic leukomalacia in neonates D. True - periventricular leukomalacia is seen in neonates E. True - intraventricular haemorrhage in caudothalamic groove Periventricular leukomalacia: Grade 1. increased periventricular echogenicity for >7 days Grade 2. small periventricular cysts Grade 3. extensive occipital and frontoparietal cysts Grade 4. extensive subcortical cysts Germinal matrix haemorrhage: Grade I - limited to caudothalamic groove (good prognosis) Grade II - into ventricles, no hydrocephalus (good prognosis) Grade III - into ventricles, with hydrocephalus (20% mortality) Grade IV - intraparenchymal (90% mortality)

Answer 81

Answer: A is false. A. False - AcidUC = urate + cysteine. AlkalOS = oxalate + struvite. B. True - Struvite (Mg ammonium phosphate) with urea-splitting bacteria such as Proteus in alkaline urine.

Answer 82

A. True - Struvite (Mg ammonium phosphate) with urea-splitting bacteria such as Proteus in alkaline urine. (Robbins) B. True - Calcium stones (70%) associated with hypercalcaemia and hypercalciuria (⅔) (Robbins). C. False - Staghorn calculi from struvite calculi (Robbins). D. False - 70% of stones are calcium oxalate. E. True - AcidUC = urate + cysteine. AlkalOS = oxalate + struvite. F. False - “More than half of patients with uric acid calculi have neither hyperuricaemia nor increased urinary excretion of uric acid” (Robbins).

Answer 83

Answer: All of these are causes “Papillary necrosis is not specific for analgesic nephropathy, and is also seen in diabetes mellitus, as well as in urinary tract obstruction, sickle cell disease or trait (described later), and focally in renal tuberculosis.” (Robbins) A. True B. True C. True D. True E. True

Answer 84

Answer: B. Papillary RCC is most likely bilateral. A. False - “Usually solitary unilateral” (Robbins) B. True - “Can be multifocal and bilateral” especially hereditary papillary RCC syndrome (Robbins) C. False - In Robbins, bilaterality is only specifically mentioned for papillary RCC (and syndromes - hereditary papillary RCC, VHL etc). D. False - See above.

Answer 85

Answer: C. Chromophobe RCC have the best prognosis. Chromophobe RCC “have an excellent prognosis compared with that of clear cell and papillary cancers” (Robbins)

Answer 86

Answer: A is false. A. False - Hashimoto’s patients “at increased risk for the development of extranodal marginal B-cell lymphomas” (Robbins) B. True - On Tc-99m pertechnetate scan, acute/subacute de Quervain can have a focal defect or large area of decreased/absent uptake due to failure of iodine trapping. During recovery phase, increased uptake before returning to normal (StatDx). C. No comment. D. True - Hashimoto’s patients “at increased risk for developing other autoimmune diseases, both endocrine (T1DM, autoimmune adrenalitis) and nonendocrine (SLE, myasthenia gravis, Sjogren’s)” (Robbins).

Answer 87

Answer: A - No normal intervening brain tissue A. False. No normal intervening brain (capillary telangiectasias have relatively normal intervening brain) (Robbins) B. True. Most common symptom is seizure 50% (Statdx) C. True. D. True. 15-20% of DVAs associated with cavernoma (StatDx) E. True. Are associated with DVAs which can have a large collector vein

Answer 88

A. False. Pseudocapsule of gliotic, hemosiderin-stained brain (Statdx). B. False. No normal intervening brain (Robbins) C. True.Comprise low flow channels that do not participate in AV shunting (Robbins) D. False. Steal phenomenon occurs with AVM & Sturge-Weber E. True. “Foci of old haemorrhage, infarction and calcification frequently surrounding the abnormal vessels.” (Robbins)

Answer 89

Answer: All true. A. True. Gestational choriocarcinoma has better prognosis than nongestational (note: ovary can be either gestation or non-gestational). B. True. “The results of chemotherapy are spectacular and result in nearly 100% remission and high rates of cure” (Robbins). C. True. Can happen after molar pregnancy (usually complete mole), ectopic or normal pregnancy. Can happen months after (Robbins)

Answer 90

Answer: C A. False. Complete is diploid. Partial is triploid. B. False. Complete is diploid. Partial is triploid. C. False. “May manifest many years after a term pregnancy” (Radiographics). Seems less aggressive than chorio based on limited sources. “Localised disease have excellent prognosis - 10-15% die of disseminated disease” (Robbins)

Answer 91

A. True. Complete is diploid. Partial is triploid. B. True. Partial can have fetal parts (complete does not). C. Trueish - 15% of molar pregnancies progress to persistent/invasive (Robbins) D. True - 2.5% of complete moles progress to choriocarcinoma (Robbins) E. False - Partial “not associated with choriocarcinoma” (Robbins) F. True. “Molar pregnancy can develop at any age, but the risk is higher at the two ends of reproductive life, in teenagers and between the ages of 40 and 50 years” (Robbins) G. True. Hydropic villi more seen in complete > partial. GTN – 4 types Invasive mole Choriocarcinoma PSTT placental site trophoblastic tumour Epithelioid trophoblastic tumour Complete 15-20% develop invasive mole 1-2% develop choriocarcinoma Partial mole 1-4% develop invasive mole Choriocarcinoma is very rare (almost never)

Answer 92

Answer: A A. True B. False. Trilateral = 2 x RB + “pineoblastoma” (Robbins). “Trilatera l RB: Bilateral ocular tumors + midline intracranial neuroblastic tumor, typically pineal” (StatDx). Not a germ cell tumour. Quadrilateral adds a suprasellar tumour. C. False. 40% bilateral (StatDx) D. False. 40% inherited (Robbins) E. False - Autosomal dominant.

Answer 93

A. False. “vegetations… can erode into the underlying myocardium and produce an abscess (ring abscess)” (Robbins) B. True. New valvular regurgitation is a major Duke criterion. C. True. “valves of the right heart may also be involved, particularly in IVUD” (Robbins) D. True. Mostly bacterial, but occasionally fungal. “Candida endocarditis is the most common fungal endocarditis, usually in the setting of prosthetic heart valves or IV drug abusers” (Robbins)

Answer 94

A. Probably true. “The vegetations of subacute endocarditis are associated with less valvular destruction than those of acute… although the distinction can be subtle” (Robbins) B. False. Subacute is characterised by lower virulence (eg. viridans streptococci), affecting deformed valves, with less destruction (Robbins)

Answer 95

A. True. Marantic is 1-5 mm and is associated with cancer (esp mucinous adenoca) and sepsis (Robbins). Infective endocarditis vegetations range from few mm to > 1cm (Statdx). B. Acute = destruction of valve leaflets. Subacute = less destruction(Robbins). C. Both acute and subacute can embolise

Answer 96

ANSWER: B is not associated. A. True - Hypertensive nephropathy characterised by hyaline glomerulosclerosis B. False - Ureteric polyps associated with Peutz-Jegher syndrome (also nasal, bronchial, gallbladder, colonic hamartomatous polyps). Desmoids are associated with APC mutation (FAP) and adenomatous colonic polyps. C. True - Chronic schistosomiasis causes squamous metaplasia and predisposes to SCC. D. True - Smoking is a major risk factor for RCC and TCC. E. True - “Diffuse cortical necrosis - uncommon condition occurs most frequently after an obstetric emergency, such as abruptio placentae (premature separation of the placenta), septic shock, or extensive surgery. The cortical destruction has the features of ischemic necrosis.”

Answer 97

A. Goodpasture’s disease

Answer 98

A. X-linked recessive X linked recessive, A is commonest (80%) Haemophilia A: VIII deficiency Haemophilia B (Christmas disease): IX deficiency Haemophilia C: XI deficiency Extremely rare in females because X linked recessive

Answer 99

A. True - Type I decreased synthesis of pro-alpha 1 chain. B. False - Type II dies “perinatal lethal” (Robbins) C. False - type IV has “normal sclerae” (Robbins) Type 1, AD, survives, normal stature, blue sclera, joint laxity Type 2, AR, fatal, blue sclera Type 3, AD, progressive deformity, hearing impairment Type 4, AD, survives, normal sclera

Answer 100

C is true. A - True - (extracranial ICA) B - True - (extracranial ICA) C - False D - True - (splanchnic) E - True - (common iliac arteries) FMD affects extracranial ICA, renal arteries and common iliac arteries. Intimal, intimomedial or medial fibroplasia

Answer 101

Answer: A. A. True - “Enlarged globular uterus without well-defined mass or external contour abnormality - asymmetric uterine wall thickening posterior > anterior” (StatDx) B. False - “Homogenous, round, well-defined myometrial mass” (StatDx)

Answer 102

A. True. Only 5% of primary mucinous cystadenomas and mucinous carcinomas are bilat (Robbins) B. False - “Serous tumours are multicystic OR mass projecting from the ovarian surface” (Robbins). Multiloculated tumour is true, however (internal) papillary projections are a feature of serous tumours. (Robbins) C. True - “Only 5% of primary mucinous cystadenomas and mucinous carcinomas are bilateral… They are multiloculated tumors filled with sticky, gelatinous fluid rich in glycoproteins” (Robbins) Mucinous - surface rarely involved, only 5% bilateral (Robbins) Serous - multicystic lesion in which papillary epithelium is within fibrous cysts (intracystic) or as a mass projecting from the ovarian surface (Robbins)

Answer 103

ANSWER: Yolk sac. “Presence of AFP is highly characteristic of yolk sac tumours” (Robbins) Simplified (Robbins p.979) AFP = yolk sac bhCG = choriocarcinoma (or seminoma in 15%, but lower values than chorio) LDH = nonspecific related to tumour burden

Answer 104

A. False. Corona radiata abnormalities not specifically mentioned. StatDx mentions frontal lobe WM abnormalities. B. False. Presents between 6 and 40 years age (Robbins p.850). C. True - Putamen > caudate > thalami > GP - therefore involves the lentiform (StatDx). Mimics Parkinsonism (Robbins). D. False - Biochemical Dx “based on decrease in serum ceruloplasmin, increase in hepatic copper content, and increased urinary excretion of copper” (Robbins p.850). E and F. False but controversial. New studies showing some increased risk of HCC in the setting of earlier onset cirrhosis

Answer 105

A. True. Autosomal recessive, ATP7B gene. B. False. “Serum copper levels are of no diagnostic value in Wilson’s” (Robbins). Biochem Dx requires “decreased serum ceruloplasmin, increased hepatic iron content and increased urinary excretion of copper” (Robbins). C. False. Haemochromatosis deposits in pancreas causing DM. D. True. “Toxic injury to the brain primarily affects the basal ganglia, particularly the putamen” (Robbins) E. True.

Answer 106

A. True. Steatosis progresses to fibrosis then cirrhosis. B. False. C. False. 6-40 yo. False. Presents between 6 and 40 years age (Robbins p.850) D. False. Involvement is basal ganglia and cerebellum.

Answer 107

Answer: B A. True - strong risk factor B. False - no references support this (Robbins, StatDx etc.) C. True - oncogenic HPV strains. D. Probably True - Articles in literature which both support and dont support association between marijuana and SCC. Usually used with tobacco. E. True. Multiple articles supportive of link between syphilis and tongue SCC. Risk factors: alcohol, tobacco, betel/paan, sunlight

Answer 108

Answer: E is false. A. True - Secondary (pseudo)achalasia B. True - Associated with SCC C. True - Aperistalsis D. True - “incomplete LES relaxation, increased LES tone and aperistalsis” E. False - Increased tone Achalasia triad is 1. incomplete LES relaxation 2. increased LES tone 3. aperistalsis

Answer 109

Answer: A. True - “Follicular = more frequent in areas with dietary iodine deficiency” (Robbins) B. True - Papillary “account for the majority of thyroid carcinomas associated with previous exposure to ionizing radiation” (Robbins)

Answer 110

Answer: A - True (IBD -> PSC -> CCA. Also UpToDate) B - False C - True D - False (UTD: Lynch syndrome, BRCA-1, CF, biliary papillomatosis) E - True F - True (UTD: Lynch syndrome, BRCA-1, CF, biliary papillomatosis) G - True H - False Risk factors (StatDx): - PSC - Fibropolycystic liver disease (choledochal cysts) - Biliary papillomatosis - Parasites (Clonorchis & Opisthorchis), recurrent pyogenic cholangitis - Cholelithiasis & hepatolithiasis - Lynch syndrome - Thorotrast exposure - Chronic liver disease

Answer 111

A. False. - “follows either a viral infection or, rarely, a viral immunisation” (Robbins) B. True - “Within a plaque there is relative preservation of axons” (Robbins) C. True - can be a rare complication of liver transplants

Answer 112

Answer: D is false. A. True - type 1 (endometrioid ca) B. True - type 1 C. True - type 2 D. False - OCP “have a protective effect” against endometrial and ovarian ca. (Robbins p. 421) Type 1 = unopposed estrogen Risk factors: anovulation, PCOS, diabetes, hypertension, obesity, tamoxifen, estrogen producing tumours Type 2 = atrophy Risk factors: endometrial atrophy, thin physique

Answer 113

A. False (type 2 = atrophy) B. False (type 1 is 55-65yr, type 2 is 65-75 yr) (Robbins) C. True D. True (type 1 is indolent, type 2 is aggressive) (Robbins)

Answer 114

Both true. FIGO: PALM-COEN Polyp Adenomyosis Leiomyoma Malignancy Coagulopathy Ovulatory dysfunction Endometrial (hyperplasia, polyp, atrophy) Iatrogenic Not classified

Answer 115

Answer: E (all true) A. True - can protrude into upper vagina B. True - sessile lesion in upper vagina C. True - (also called sarcoma botryoides “grapelike”) D. True - can protrude into upper vagina

Answer 116

A. True B. False more than true C. True D. True E. False more than true F. True G. True (usually serous) CNS: - Haemangioblastoma (cerebellar, retinal, cord) - Endolymphatic sac tumour Pancreas: - Pancreatic cysts (serous) - Neuroendocrine tumours - Adenocarcinoma (rare) Renal: - RCC (clear cell) - Renal cysts Liver: - Hepatic cysts Genitals: - Epididymal cysts - Phaeochromocytoma/extra-adrenal Cutaneous (less than 5%): - Capillary malformations

Answer 117

Answer: A and C both true. A. True - A1AT and IV methylphenidate. B. False - A1AT is panacinar (panlobular) not centrilobular C. True - Right heart failure secondary to respiratory disorder

Answer 118

ANSWER: D A. False - death from decompensated cor pulmonale within 2-5 years in 80% of patients (Robbins p.700) B. False - mean pulmonary arterial pressure >25mmHg (Robbins p. 700) C. False - obliterate alveolar capillaries increasing resistance and increasing pressure (Robbins p.700) D. True - OSA is group 3 cause of pulmonary HTN CLASSIFICATION (NICE 2013) 1 (Primary) Pulmonary arterial hypertension 2 Left heart disease 3 Lung disease/hypoxia 4 CTEPH 5 Multifactorial

Answer 119

ANSWER: C. COP is least associated A. False - typically UIP B. False - can be UIP pattern (Cluster 2) C. True - not UIP D. False - typically UIP E. False - typically UIP Typically UIP: IPF, RA, Asbestosis Sometimes UIP: chronic HP Not UIP: COP In RA, UIP > NSIP

Answer 120

Answer: D. Asbestosis is most associated C could also be true depending on wording A. False - sometimes UIP (Cluster 2) B. False - not UIP C. False - UIP > NSIP D. True - only UIP E. False - not UIP (upper lobe)

Answer 121

A - False. Hyponatraemia. B - False. AHEM/AHLE (Weston-Hurst) seen in young adults, contrary to ADEM in children. C - False. ADEM follows viral infection. D - False. Demyelination “characterised by preferential damage to myelin with relative preservation of axons” (Robbins p. 1283)

Answer 122

Answer: D is false. ADEM is post-viral A. True. Demyelination“characterised by preferential damage to myelin with relative preservation of axons” (Robbins p. 1283) B. True-ish. StatDx: “propensity for frontal and parietooccipital region, thalamus.” C. True. NMO: “More posterior involvement of optic nerve including chiasm and simultaneous bilateral disease” (StatDx). “NMO is a syndrome with synchronous (or near synchronous) bilateral optic neuritis and spinal cord demyelination (Robbins) D. False. Viral only. ADEM: “Acute disseminated encephalomyelitis is a diffuse, monophasic demyelinating disease that follows either a viral infection or, rarely, a viral immunization.” E. True. Classically described following rapid correction of hyponatraemia in alcoholics and liver transplant setting (Radiopaedia)

Answer 123

E. True. “The rare pure choriocarcinoma is the most aggressive NSGCT” (Robbins p.979) Other trivia: “Seminomas tend to remain localised to the testis for a long time” (Robbins p.979) “In the child, differentiated mature teratomas usually follow a benign course. In the postpubertal male all teratomas are regarded as malignant” (Robbins p.979) Testis: choriocarcinoma is worst Ovary: non-gestational choriocarcinoma is worst

Answer 124

Answer: A is true A. True - “Targeted treatment of patients with adenocarcinoma and activating mutations of EGFR… prolongs survival” (Robbins p.718) B. False - “Small cell lung carcinomas are best treated by chemotherapy” (Robbins p.719) C. False - “Approximately 10% of bronchial carcinoids give rise to [carcinoid] syndrome” (Robbins p.720)

Answer 125

Answer: B and E both false A. True. “This disease is characterised by a hypersensitivity reaction to Aspergillus that colonises the airways” (Webb p.197) B. False. StatDx: “CT halo sign pathologically represents haemorrhage around foci of invasive aspergillosis.” C. True. “The primary lesions are usually in the lung, widespread haematogenous dissemination with involvement of heart valves and brain is common.”” (Robbins 388). Case reports in kidney. D. True. “Rhinocerebral Aspergillus infection in immunosuppressed individuals resembles that caused by Mucormycoses” (Robbins p. 389) E. False. StatDx: “CT halo sign pathologically represents haemorrhage around foci of invasive aspergillosis.” Pulmonary aspergillosis can be subdivided into five categories: 1/ saprophytic aspergillosis (aspergilloma) 2/ hypersensitivity reaction (ABPA) 3/ semi-invasive (chronic necrotizing) aspergillosis 4/ airway-invasive aspergillosis (acute tracheobronchitis, bronchiolitis, bronchopneumonia, obstructing bronchopulmonary aspergillosis) 5/ angioinvasive aspergillosis

Answer 126

Answer: B A. True. “the most common clinical manifestation of saprophytic aspergillosis (aspergilloma; non-invasive) is hemoptysis” (Radiographics) B. False. StatDx: Lucency is air-crescent sign due to infarction leading to progrssive cavitation. C. True. “The primary lesions are usually in the lung, widespread haematogenous dissemination with involvement of heart valves and brain is common.”” (Robbins 388). D. True. As above. Pulmonary aspergillosis can be subdivided into five categories: 1/ saprophytic aspergillosis (aspergilloma) 2/ hypersensitivity reaction (ABPA) 3/ semi-invasive (chronic necrotizing) aspergillosis 4/ airway-invasive aspergillosis (acute tracheobronchitis, bronchiolitis, bronchopneumonia, obstructing bronchopulmonary aspergillosis) 5/ angioinvasive aspergillosis.

Answer 127

Answer: A. A - True. BRCA1/BRCA2 associated with pancreatic adenocarcinoma B - False. Li Fraumeni = GBM, breast ca, sarcomas, leukaemia C - False. VHL more associated with pancreatic cysts and neuroendocrine tumours. Rarely result in adenocarcinoma (Radiopaedia) D - False. MEN1 = PPP (organs) = parathyroid, pancreas (islet cell tumours) & pituitary MEN2A = MTC & phaeo + parathyroid hyperplasia MEN2B = MTC & phaeo + marfans/mucosal neuromas E - False. FAP = 5, colon cancer + epidermoid/desmoid/thyroid = Gardner + medulloblastoma = Turcot HPNCC - 8-10x increased risk of pancreatic adenoca.

Answer 128

ANSWER: False. Smoking-related disease. Thromboangiitis obliterans Seen in young male smokers with a lower limb predominance Non-atheromatous vasculitic process Medium/small vessels - typically radial and tibial arteries Improves after cessation of smoking Male smokers <35yo with digital infarcts / autoamputation (think scleroderma in nonsmoking women)

Answer 129

ANSWER: B is false. C is probably false. A. True. Clear cell = T2 bright, hypervascular B. False. Papillary = T2 dark, hypovascular (but it will still enhance) - often bilateral C. Probably False. “Papillary carcinomas are frequently multifocal in origin.” (Robbins p.954) D. True. Requisites: 10% of RCC are multifocal in the same kidney at diagnosis. Chromophobe = T2 iso-bright, hypovascular VHL (chromosome 3) associated with VEGF pathway

Answer 130

Answer: D is even rarer than C Collecting duct (Bellini duct) carcinoma represents approximately 1% or less of renal epithelial neoplasms. Small cell neuroendocrine carcinoma - 60 cases in literature.

Answer 131

ANSWER: D or E A - True. Microcalcifications are specific for papillary thyroid ca. (Psammoma bodies) B - True. LN calcifications are strongly associated with papillary thyroid ca. C - True. Cystic metastases may be seen in children with papillary thyroid ca. D - False. StatDx describes “chaotic doppler vascularity” which looks very vascular on the images. E - False. Adenoma is usually follicular. Adenoma has well defined margins (StatDx)

Answer 132

Answer = B. A. False. Papillary “often metastasise by way of lymphatics, but the prognosis is excellent” (Robbins) B. True. “most cases death occurs in <1yr due to aggressive growth and compromise of vital structures in the neck” - Robbins C. False. Follicular “little propensity for invading lymphatics, regional lymph nodes rarely involved… vascular (haematogenous) dissemination common” (Robbins) D. False. Papillary “often metastasise by way of lymphatics, but the prognosis is excellent” (Robbins)

Answer 133

A. True. “The term radial scar is a misnomer, as these lesions are not associated with prior trauma or surgery” (Robbins) B. False. “A central nidus of entrapped glands in a hyalinized stroma is surrounded by long radiating projections into stroma” (Robbins) C. False. Long spicules. D. True. High risk lesion. Wide local excision. E. False. Wide local excision. F. False. “Rarely palpable, no skin thickening or retraction” (Robbins) G. False. Wide local excision. H. False. Lucent centre. Black star

Answer 134

Answer: All false. A. False. Sclerosing adenosis is proliferative without atypia. B. False. Moderate-florid is proliferative without atypia; RR = 1.5-2,(lifetime is 5-7%). C. False. Nonproliferative lesions do not increase risk of malignancy D. False. Proliferative disease without atypia (complex sclerosing lesion) E. False. Proliferative disease without atypia increase RR 1.5-2 (lifetime risk 5-7%)

Answer 135

ANSWER: A is false. Desmoid tumour = deep fibromatosis - large infiltrative occasionally painful mass that frequently recur but do not metastasise - teens to 30s; F>M - abdo fibromatosis favours anterior abdo wall - majority are sporadic (APC or beta-catenin gene); association is FAP (Gardner - APC gene) - histo resembles scar - Mx = COX2 inhibitor; tyrosine kinase inhibitor, tamoxifen

Answer 136

A. This is extremely uncommon. B. Aldosterone secreting adenoma causes primary hyperaldosteronism (Conns) C. Secondary hyperaldosteronism is renovascular disease. D. Pregnancy is a cause of secondary hyperaldosteronism (Robbins)

Answer 137

ANSWER: 2* hyperPTH more common than 1* and is most commonly due to chronic renal failure (Radiographics) A. False. 1* hyperPTH: Adenoma (80%) > MEN1 B. False. 1* hyperPTH: Adenoma (80%) > MEN1 C. True. 2* hyperPTH: CKD > low Ca intake > Vit D deficiency D. False. 1* hyperPTH: Adenoma (80%); hyperplasia 10-20% E. False. Paraneoplastic PTHrP is not true PTH. https://pubs.rsna.org/doi/full/10.1148/rg.2016160004

Answer 138

A. False. NF1 not NF2 (Robbins) B. True. Sturge-Weber is an association (StatDx) C. False. MEN2A/MEN2B not MEN1 (Robbins) D. True. TS is associated (StatDx) E. True. vHL is associated (StatDx) F. True. NF1 is associated (Robbins) Phaeochromocytoma hereditary syndromes: MEN2A, 2B (not MEN1) vHL NF1 (not NF2) SDH Sturge-Weber Carney triad

Answer 139

D is true, others false. A. F - Non-neoplastic condition (ectopic tissue). B. F - Asymmetric thickening of posterior myometrium. C. F - Pathogenesis is likely endometrial invagination or endometrial rests in myometrium D. T - “Because adenomyotic endometrium looks like the basalis endometrium, which seldom responds to hormonal stimuli, cyclic changes including degeneration, bleeding, and regeneration are less common in adenomyosis than in endometriosis” E. F - 20% of uteri (Robbins) Endometrial layers: Functionalis: compactum + spongiosum Basalis

Answer 140

A. False. Can’t find anything in Robbins, StatDx or UpToDate to support this. KM curve similar. Prognosis mainly based on staging. B. False. Barrett’s associated with adenocarcinoma. C. True. Risk of oesophageal cancer is increased 50x (UpToDate). D. False. Scleroderma causes atony/aperistalsis of the distal 2/3 of the oesophagus. E. False. “Some serotypes of H. pylori are associated with decreasedrisk of esophageal adenocarcinoma because they cause gastric atrophy” (Robbins p758). F. False. Oesophageal SCC “occurs in adults older than age 45 and affects males four times more frequently than females.” (Robbins p. 759). G. False. Zenkers is pharyngoesophageal “through Killian triangle, an area of muscular weakness between transverse fibers of cricopharyngeus and oblique fibers of lower inferior constrictor” (StatDx)

Answer 141

Answer: B A. False. This describes LCIS B. True. LCIS arises from the TDLU

Answer 142

True. Duct ectasia may present with noncyclical pain, nipple discharge, retraction, inversion orpalpable abnormality.

Answer 143

A. True. Turcots = GI and CNS neoplasm. Type 1 is HNPCC + glioma; Type 2 is FAP + medulloblastoma (StatDx) B. ?False. Gardners has thyroid carcinomas but not specifically MTC. C. False. FAP polyps happen everywhere. D. False. 100% of FAP patients get CRC by age 50. E. True. FAP get adenomas “particularly adjacent to the ampulla of Vater and in the stomach” (Robbins p.809) F. True. HNPCC “tend to occur at younger ages… and are often located in the right colon” (Robbins p.810). G. True. Gardners get “osteomas, thyroid and desmoid tumours, skin cysts” (Robbins p. 806)

Answer 144

ANSWER: A is false. A. False. Hepatocytes secrete bile B. True. Definitely a risk factor C. True. Definitely a risk factor (PSC, RPC) Risk factors (Radiographics): All due to chronic biliary inflammation Liver fluke Recurrent pyogenic cholangitis PSC Viral - HIV, HepB, HepC, EBV Anomaly/malformation (Todani) Environmental - thorotrast + PVC Biliary-enteric drainage Heavy alcohol consumption

Answer 145

Answer: A. False. Age 5-25; most common 10-15yrs. B. True. Metastatic neuroblastoma is a differential; both SRBCs. C. False. Small bone lesion, large soft tissue mass in diaphysis of a long bone. D. False. Chondroblastoma is epiphyseal extends into metaphysis. E. True. Ewings occurs in long bone diaphyses, “especially the femur and flat bones of the pelvis”

Answer 146

Answer: A. False. Metastasises to lung and bone marrow over liver. B. True. Both OM and Ewings present with fever and raised inflammatory markers. C. False. Teratomas favour midline soft tissue locations. D. False. Age 5-25y (most common 10-15y). E. False. Chondrosarcomas usually metaphyseal and have a chondroid matrix.

Answer 147

ANSWER: B is true. A. F - 10-15% inherited in AD trait (Robbins) B. T - BCC and SCC associated with immunosuppression C. F - most commonly arise on sun-exposed surfaces (Robbins) D. F - this is related to melanoma E. F - BCC > SCC >all other cancers

Answer 148

Basically summarised in these Robbins quotes: 1. “There are two distinct precursor lesions to invasive urothelial carcinoma: noninvasive papillary tumors and flat noninvasive urothelial carcinoma. The most common precursor lesions are the noninvasive papillary tumors, which originate from papillary urothelial hyperplasia.” 2. “Pelvic/ureteric “are the exact counterpart of those found in the urinary bladder” Overall most common in bladder (posterolateral) and renal pelvis. Within the ureter, distal (¾) > mid (¼) > proximal (3%). Think about urine stasis.

Answer 149

A. False. “Renal pelvic tumours… are almost invariably small when discovered” due to haematuria, hydronephrosis, pain (Robbins p.956) B. True. Ta = exophytic papillary lesions “relatively benign and do not invade”. Tis = carcinoma in situ or flat tumours. (UpToDate). Also papillary ”[may be low or high grade] and flat urothelial carcinoma in situ (uniformly high grade)”. (Robbins p.968). C. False. “Overall the vast majority of papillary tumours are low grade” (Robbins p. 965) D. False. Major determinant of survival is detrusor involvement. E. False. Flat lesions are “uniformly high grade” (Robbins p.968).

Answer 150

A. True. “The exposed bladder mucosa may undergo colonic glandular metaplasia [cystitis glandularis]… have an increased risk of adenocarcinoma arising in the bladder remnant” (Robbins p.962) B. False. Interstitial cystitis may clinically mimic carcinoma in-situ (Robbins p. 963) but doesn’t increase risk of cancer. C. True. Chronic analgesics → TCC (Robbins p.965) D. True. Smoking “is clearly the most important influence, increasing the risk threefold to sevenfold” for TCC (Robbins p.965) E. True. Ova deposits in bladder wall → squamous metaplasia → SCC; 70% SCC and remainder TCC or adenoca. (Robbins p.965) F. True. “bladder cancer occurs many years after the irradiation” (Robbins p.956) G. True. Cystitis glandularis = colonic metaplasia. Urachal remnant “account for 20-40% of all bladder adenocarcinomas” (Robbins p.962) H. True. “Pure squamous cell carcinomas are nearly always associated with chronic bladder irritation and infection” (Robbins p.967) I. True. Squamous cell carcinomas associated with calculi (UpToDate). J. False. Nothing about this in Robbins or UpToDate. Urothelial Cancer Epidemiology: M>F (3:1), Age 50-80y, Not familial (rare exceptions) Smoking (3-7x risk) Exposures: aryl amine, radiation Medication: analgesics, cyclophosphamide Infection: Schistosoma haematobium

Answer 151

A. True. Urachal remnant “account for 20-40% of all bladder adenocarcinomas” (Robbins p.962) B. True. “The exposed bladder mucosa may undergo colonic glandular metaplasia [cystitis glandularis]… have an increased risk of adenocarcinoma arising in the bladder remnant” (Robbins p.962) C. True. Ova deposits in bladder wall → squamous metaplasia → SCC; 70% SCC and remainder TCC or adenoca. (Robbins p.965) D. False. “Pure squamous cell carcinomas are nearly always associated with chronic bladder irritation and infection” (Robbins p.967) E. False. Squamous cell carcinomas associated with calculi (UpToDate).

Answer 152

A. True. “50% of renal pelvis tumours have pre-existing or concomitant bladder urothelial tumour” (Robbins p. 956) B. False. “A significant issue is that 50% of invasive bladder cancers present with muscle-invasive disease and have a relatively poor prognosis despite therapy.” (Robbins p. 968). C. False. “the major decrease in survival is associated with invasion of the muscularis propria (detrusor muscle). Once [this] occurs there is a 30% 5 year mortality rate.” (Robbins p. 964). D. True. “Patients at high risk of recurrence and/or progression… receive intravesical [BCG vaccine]” (Robbins p.968).

Answer 153

Hippocampus. 60% of patients have circulating serum autoantibodies: - Anti-Hu (lung cancer): Limbic encephalitis - Anti-Ta (testicular germ cell tumors): Limbic encephalitis, brainstem encephalitis Cell surface antigens: - Voltage-gated potassium channels (VGKC) - N-methyl-D-aspartate receptor (NMDAR)

Answer 154

ANSWER: C is true. A. False. Radiology for active disease B. False. Antibodies create by B cells; immune response T-cell mediated. C. True. Baker’s cyst can be due to any cause of synovitis. D. False. Ankylosis is a late feature of RA. E. False. Systemic amyloidosis (SAA) in 5-10% (Robbins)

Answer 155

Answer: B and C. A. False. Sporadic. Irregular kidneys with cysts of variable size. B. True. Dominant. Corticomedullary cystd, shrunken kidneys. C. True. Recessive. Corticomedullary cysts, shrunken kidneys. D. False. Sporadic. Cystic degeneration in end-stage kidneys. E. False. Sporadic. Medullary cysts on excretory urography

Answer 156

ANSWER: C Retroperitoneal nodes. Robbins: Lymphatic spread is common to all forms of testicular cancer; generally retroperitoneal para-aortic nodes are first to be involved. Haematogenous spread is primarily to the lungs. Seminomas remain confined to the testis for a long time and spread mainly to paraaortic nodes – distant spread is rare. Non-seminomas tend to spread earlier and involve haematogenous route more frequently

Answer 157

Answer: D is true. Others all false. A. False. “S. pneumoniae (the pneumococcus) is the most common cause of community-acquired acute pneumonia; the distribution of inflammation is usually lobar.” (Robbins p.707) B. False. “C-reactive protein and procalcitonin, both acute-phase reactants produced primarily in the liver, are significantly elevated in bacterial more than in viral infections.” (Robbins p.702) C. False. “The vast majority are upper respiratory tract infections caused by viruses (common cold, pharyngitis)...” (Robbins p.702) D. True. “Lung abscess is often caused by anaerobic organisms or by mixed infections and frequently occur in debilitated individuals following aspiration of oral flora” (Robbins p. 708). E. False. “Mycoplasma infections are particularly common among children and young adults. They occur sporadically or as local epidemics in closed communities (schools, military camps, and prisons).” (Robbins p.704)

Answer 158

Answer: A is true. A. True. “Thick, mucoid, (often blood-tinged) sputum is characteristic, because the organism produces an abundant viscid capsular polysaccharide, which the patient may have difficulty expectorating.” (Robbins p.703) B. False. P. aeruginosa is “seen in persons with cystic fibrosis, in burn victims, and in patients with neutropenia” (Robbins p. 708). K. pneumoniae is seen in chronic alcoholics. C. False. Strep. pneumoniae is “the most common cause of community-acquired acute pneumonia; the distribution of inflammation is usually lobar.” D. False. “common causes of acute pneumonias in the community include H. influenzae and M. catarrhalis (both associated with acute exacerbations of COPD)” (Robbins p.708). Staph aureus is described as “usually secondary to viral infections”.

Answer 159

Answer: All of these cause lung consolidation. Mycoplasma, PJP and viral pneumonia are reasonable alternatives. A. False. “Consolidation usually limited to 1 lobe, almost always abuts visceral pleural surface; air bronchograms present; lacks extrapulmonary features” (StatDx) B. False. Staph aureus preferentially causes bronchopneumonia. “patient with fever, cough, & multifocal consolidation” (StatDx) C. False. Klebsiella typically causes “lobar pneumonia with bulging fissures” and cavitates in 30-50% (StatDx). D. False. Legionella causes “rapidly progressive, asymmetric lung consolidation” (StatDx)

Answer 160

True. “Mycobacterial osteomyelitis tends to be more destructive and resistant to control than pyogenic osteomyelitis.” (Robbins p. 1196).

Answer 161

A. True. “Malignant transformation within the lining epithelium has been reported but is rare” (Robbins p. 741). B. False. “1 to 4 cm in diameter” (Robbins p. 741). C. True. “Malignant transformation within the lining epithelium has been reported but is rare” (Robbins p. 741). D. True - probably. See above. Not specified in Robbins. E. False. No mention of UV in Robbins

Answer 162

Answer: C is most false. A. True. “Adenomas and carcinomas are about equally common in adults; in children, carcinomas predominate.” (Robbins p. 1132). B. True. Adenoma prefers adults. “Adenomas and carcinomas are about equally common in adults; in children, carcinomas predominate.” (Robbins p. 1132). C. False. “Bilateral idiopathic hyperaldosteronism (IHA)... is the most common underlying cause of primary hyperaldosteronism, accounting for about 60% of cases.” (35% is Conn’s adenoma).

Answer 163

Answer: B is false. A. True. “The laboratory diagnosis of pheochromocytoma is based onthe demonstration of increased urinary excretion of free catecholamines and their metabolites, such as vanillylmandelic acid and metanephrines.” (Robbins p.1137) B. False. This is typical of Conn’s syndrome due to an aldosteronesecreting adrenal adenoma. C. True. “Approximately two thirds of patients with hypertension demonstrate paroxysmal episodes” (Robbins p. 1136) D. True. “Ten percent of pheochromocytomas are extra-adrenal, occurring in sites such as the organs of Zuckerkandl and the carotid body.” (Robbins p. 1136) E. True. “Malignancy is more common (20% to 40%) in extraadrenal paragangliomas, and in tumors arising in the setting of certain germline mutations.” F. True - Probably. “Malignancy is more common (20% to 40%) in extraadrenal paragangliomas, and in tumors arising in the setting of certain germline mutations.”

Answer 164

Answer: B is more incorrect than A. A. True. Drug-induced is “migratory mid and upper lung zone peripheral ground-glass opacities &/or consolidations ± centrilobular nodules” but the tropical/parasitic version has “fine, diffuse reticulonodular opacities in lower lung zones” (StatDx) B. False. “These patients have cough, fever, night sweats, dyspnea, and weight loss, all of which respond to corticosteroid therapy.” (Robbins p. 695). C. True. “The chest radiograph shows diffuse infiltrates, and bronchoalveolar lavage fluid contains more than 25% eosinophils. Histology shows diffuse alveolar damage and many eosinophils. There is a prompt response to corticosteroids.” (Robbins p.695) D. True. “Tropical pulmonary eosinophilia = fine, diffuse reticulonodular opacities in lower lung zones; caused by filarial worms Wuchereria bancrofti and Brugia malayi” (StatDx)

Answer 165

Answer: A is true. A. True. Cortical/subcortical microhaemorrhage. “Lobar > > basal ganglionic hemorrhage.” (StatDx). B. False. “Deep structures (basal ganglia, thalami, cerebellum) > cortex, subcortical WM” (StatDx) C. False. “Medial temporal and inferior frontal cortex… involvement of cingulate gyrus and contralateral temporal lobe highly suggestive” (StatDx).

Answer 166

Answer: B. A. False. Depends on wording - tamoxifen (breast cancer Rx) causes endometrial hyperplasia and increases ca. risk. B. True. Serosal involvement is stage IIIA. C. False. Type 2 endometrial cancer is worse than type 1.

Answer 167

ANSWER: Not clear. Likely seminoma > embryonal carcinoma. Robbins: “In the 15- to 34-year age group, testicular germ cell tumors constitute the most common tumor of men and cause approximately 10% of all cancer deaths.” “Seminomas are the most common type of germ cell tumor, making up about 50% of these tumors. The peak incidence is the third decade and they almost never occur in infants.” “Embryonal carcinomas occur mostly in the 20- to 30-year age group. These tumors are more aggressive than seminomas.”

Answer 168

Answer: E. A. False. Penetrating disease is a feature of Crohn’s. B. False. Transmural inflammation is a feature of Crohn’s. UC inflammation is mucosal and submucosal. C. False. Fibrostenosing disease is due to transmural inflammation, seen in Crohn’s. D. False. Non-caseating granulomas are a hallmark of Crohn’s disease, seen in 35%. Not present in UC. E. True. “Colectomy effectively cures intestinal disease in ulcerative colitis, but extraintestinal manifestations may persist” (Robbins p. 800).

Answer 169

A. False - “Gallstones are present in 35-60% of cases… The proportion of cases of acute pancreatitis caused by excessive alcohol intake varies from 65% in the United States to...5% or less in [France/UK]” (Robbins p.884) B. True. “Macroscopically, the pancreatic substance is red-black from hemorrhage and contains interspersed foci of yellow-white, chalky fat necrosis” (Robbins p. 887). This is the archetype of fat necrosis. C. True. “Hypocalcemia may result from precipitation of calcium soaps in necrotic fat.” (Robbins p.887) Part of Ranson’s criteria

Answer 170

A. True. “95% of GISTs express growth factor receptor with tyrosine kinase activity (c-KIT [CD117])” (StatDx). This is the basis of imatinib (TK inhibitor) treatment. BTrue. “Recurrence or metastasis is rare for gastric GISTs smaller than 5 cm but common for mitotically active tumors larger than 10 cm.” (Robbins p.776). C. False. “The prognosis correlates with tumor size, mitotic index, and location, with gastric GISTs being less aggressive than those arising in the small intestine.” (Robbins p.776) D. False. Carney triad = Malignant epithelial gastric GIST, pulmonary chondroma and extraadrenal paraganglioma (StatDx) E. False. Exophytic “*submucosal* tumor of (GI) tract derived from interstitial cells of Cajal” (StatDx). F. False. “Distinct, not synonymous with leiomyoma/sarcoma” (StatDx) G. False. “Prognosis often depends on tumor size - Poor if > 5 cm” (StatDx); as above, less likely to metastasize if <5cm. H. False. “Stomach is most common site (2/3 of cases); small bowel (especially duodenum) is 2nd most common site” (StatDx) I. True. Associated with NF1, Carney triad, and SDH mutations (Carney-Stratakis syndrome: GIST + paraganglioma) (Robbins). J. False. “Recurrence or metastasis is rare for gastric GISTs smaller than 5 cm but common for mitotically active tumors larger than 10 cm.” K. True. “The prognosis correlates with tumor size, mitotic index, and location” (Robbins p. 776)

Answer 171

A. True. “Histologically the changes in the media are virtually identical to those found in cystic medionecrosis not related to Marfan syndrome” (Robbins p.145). B. True. “The two most common lesions are mitral valve prolapse [and aortic aneurysm]... Although mitral valve lesions are more frequent, they are clinically less important than aortic lesions” (Robbins p.145). MVP develops complications in 3% of cases (Robbins p. 556). C. False. “Typically the patient is unusually tall with exceptionally long extremities and long, tapering fingers and toes. The joint ligaments in the hands and feet are lax, suggesting that the patient is doublejointed; typically the thumb can be hyperextended back to the wrist.” but no mention of pathologic fractures (Robbins p. 145). D. False. Younger. “Aortic dissection occurs principally in two groups of patients: (1) men aged 40 to 60 years with antecedent hypertension (more than 90% of cases) and (2) younger adults with systemic or localized abnormalities of connective tissue affecting the aorta (e.g., Marfan syndrome).” (Robbins p. 504). Marfan’s Syndrome: autosomal dominant CTD due to fibrillin 1 mutation → fragmentation of elastic lamellae → cystic medial degneration

Answer 172

Answer: C is false. A. True. Aganglionic “distal intestinal segment that lacks both the Meissner submucosal and the Auerbach myenteric plexus” (Robbins p.751) B. True. Aganglionic “distal intestinal segment that lacks both the Meissner submucosal and the Auerbach myenteric plexus” (Robbins p.751) C. False. “The rectum is always affected, but the length of the additional involved segments varies widely” (Robbins p.752). D. True. “10% of all cases occur in children with Down syndrome” (Robbins p. 751) E. True. Electrolyte imbalance, megacolon, perforation, sepsis.

Answer 173

A. True. “two groups (1) men aged 40 to 60 years with antecedent hypertension (more than 90% of cases) and (2) younger adults with systemic or localized abnormalities of connective tissue affecting the aorta (e.g., Marfan syndrome)” (Robbins p. 504) B. False. See above. C. True. “5-10% are without intimal tear; dissection is attributed to rupture of aortic vasa vasorum” (StatDx). D. False. “Type A (60%): Involves ascending aorta, ± descending aorta [90% within 10 cm of aortic valve]. Type B (40%): Excludes ascending aorta; involves descending aorta &/or aortic arch.” (StatDx) E. True. “Once a tear has occurred, blood flow under systemic pressure dissects through the media, leading to progression of the hematoma.” (Robbins p. 504). F. False. Type B is distal to subclavian origin, does not involve the great vessels. G. False. “The most frequent preexisting histologically detectable lesion is cystic medial degeneration” (Robbins p.504)

Answer 174

Answer: A A. True. Aspiration typically due to oral anaerobes including Bacteroides spp. B. False. GI commensals commonly seen with bowel obstruction. C. False. This requires septic embolism aspiration Bacteroides spp., mixed anaerobes (most common) septic emboli Staph aureus bacteraemia E. coli, Staph aureus colorectal ca. Strep. bovis (typically causes endocarditis)

Answer 175

Answer: C Retinoblastoma is 10 x more common than rhabdomyosarcoma Rhabdomyosarcoma is the most common mesenchymal tumour of childhood Infantile hemangioma is the most common tumour of infancy *if infantile hemangioma is offered choose this

Answer 176

C Cavernous sinus thrombosis - distended superior opthalmic vein + proptosis - typically a complication of orbital/periorbital cellulitis Dural venous sinus & cortical vein thrombosis - empty delta sign - typically a complication of hypercoagulable state Venous infarcts show: - oedema - expansion, loss of GWMI, T1 low T2/FLAIR high signal - may not restrict diffusion - non-enhancing oedematous brain

Answer 177

Answer: A. A. True. Locomotor ataxia is not typical of Lyme disease. B,C,D,E. False. “Involvement of the nervous system is referred to as neuroborreliosis. Neurologic symptoms are highly variable and include aseptic meningitis, facial nerve palsies and other polyneuropathies, as well as encephalopathy.” (Robbins p. 1275). Lyme disease is essentially confined to northeastern USA (New York, DC, Massachusetts). Def Lyme neuroborreliosis Epi most common vector-borne illness in USA Aet Borrelia burgdorferi - from Ixodes tickbite Path Meningo-polyneuritis, radiculitis Rad enhancing cranial nerves, cauda equina rarely, meningo-encephalitis Rx doxycycline

Answer 178

Answer: A. A. SSPE is due to measles (behavioural changes, diffuse white matter disease, ant → post) B,C,D,E. All prion diseases.

Answer 179

Answer: D. “Unlike other prion diseases, FFI does not show spongiform pathology. Instead, the most striking alteration is neuronal loss and reactive gliosis in the anterior ventral and dorsomedial nuclei of the thalamus; neuronal loss is also prominent in the inferior olivary nuclei.” (Robbins p. 1283). n.b. BSE is in cows; humans get variant CJD from the same agent.

Answer 180

Answer: A A. True. X-linked adrenoleukodystrophy. B. False. Metachromatic leukodystrophy is autosomal recessive. C. False. Alexander is autosomal dominant. D. False. Canavan is autosomal dominant. E. False. Krabbe is autosomal recessive.

Answer 181

Answer: D. Prostate metastases are usually dural. “Lung, breast, melanoma most common primary malignancies” (StatDx) RCC is a classic haemorrhagic metastasis (MRCTBB).

Answer 182

Answer: D. Optic nerve sheath tumours seen in NF1, not NF2. A. True. B. True. C. True. D. False. Optic nerve sheath gliomas are characteristic of NF1. E. True. Juvenile posterior subcapsular cataracts (Chap & Nak). Autosomal dominant disorder, NF2 gene chromosome 22 producing merlin. 50% result from new dominant gene mutation.Neurofibromatosis type 2 (NF2) = inherited syndrome with multiple schwannomas, meningiomas, & ependymomas

Answer 183

A or C (if side-branch is specified) A. Insulinoma: 10% malignant B. Islet cell - nonfunctioning typically large, solid, malignant C. IPMN - 8% overall; 5% side-branch, 60% main duct D. SPEN - low-grade malignancy (WHO) E. PIN - precursor lesion to pancreatic cancer WHO Classification of pancreatic neoplasms Epithelial Tumours: Benign Serous cystadenoma, Acinar cell carcinoma Premalignant Pancreatic intra-epithelial neoplasia IPMN MCN Malignant All other exocrine pancreatic neoplasms

Answer 184

Answer: A 1-3% of female breast cancers Diagnosis by wedge biopsy (NOT a punch biopsy) Single file adenocarcinoma cells Can mimic melanoma if containing melanin

Answer 185

Answer: A. Adenomatoid tumour. (The only consistent answer) Most common (30%) extratesticular neoplasm. Well-defined, solid, hypoechoic mass with peripheral vascularity on color Doppler (StatDx) “Less common diagnoses” on StatDx: 1. Lipoma most common benign neoplasm - often hypoechoic 2. Most common malignant tumors include rhabdomyosarcoma and liposarcoma - large, irregular, heterogeneous masses 3. Papillary cystadenoma of epididymis - seen in 65% of patients with VHL. Often bilateral, young adults. Ill-defined solid-cystic mass with scattered cysts.

Answer 186

Answer: A. Adenomatoid tumour. (The only consistent answer) Most common (30%) extratesticular neoplasm. Well-defined, solid, hypoechoic mass with peripheral vascularity on color Doppler (StatDx) B. Lymphoma in testis. Solitary, multifocal or diffusely infiltrating. Hypoechoic and vascular. May be bilateral. Older (>50). C. Varicocele. Dilated veins of pampiniform plexus > 2-3 mm, increasing with Valsalva. Usually isolated to spermatic cord. (StatDx). D. Torted appendage. Small avascular mass adjacent to testis or between testis & epididymis; variable echogenicity, depending on duration of symptoms; typically hypoechoic acutely. Surrounding hyperemia. (StatDx).

Answer 187

A. Renal papillary necrosis Caused by direct toxicity and ischaemia Paracetamol → glutathione depletion + oxidative metabolites NSAIDs → less vasodilator prostaglandins + IgE hypersensitivity Causes of papillary necrosis include: drugs (NSAIDs) sickle cell disease diabetes mellitus obstruction infection (TB) renal vein thrombosis

Answer 188

Answer: A. Haematuria UpToDate: Most patients asymptomatic with normal renal function If symptomatic, flank pain > haematuria > retroperitoneal haemorrhage Robbins: The clinical importance of angiomyolipoma is due largely to their susceptibility to spontaneous hemorrhage.

Answer 189

Answer: D. Pre-existing maternal liver disease not a risk factor. Known risk factors for pre-eclampsia: General (age >35, previous Hx, family Hx) Vascular (pre-existing DM, HTN, obese BMI >25, CKD) Specific first pregnancy, SLE, anti-phospholipid syndrome Paradoxical decreased risk in smokers

Answer 190

Answer: B is false. A. True. RB-ILD is symptomatic upper lobe centrilobular GGO associated with smoking. B. False. Idiopathic UIP (IPF) has a worse prognosis than NSIP. C. True. Idiopathic UIP (IPF) has a worse prognosis than NSIP. D. True. DIP is basal peripheral GGO in smokers, thin-walled cysts. It has a good prognosis if smoking ceased.

Answer 191

A. False. Splenomegaly is nonspecific. B. True. “Uremia (renal failure)... alters platelet function through uncertain mechanisms” (Robbins p. 121)

Answer 192

Answer: C - most commonly asymptomatic incidental finding. StatDx: Up to 50% of patients asymptomatic small LFTP Large LFTP typically symptomatic - cough, dyspnea, chest pain/discomfort - paraneoplastic syndrome > hypoglycaemia (Doege-Potter syndrome) ?due to IGF-2 > HPOA (Pierre Marie-Bamberger syndrome) ?due to GH > clubbing SFTs and cranial hemangiopericytomas are in the same group. Hemangiopericytomas have more aggressive behaviour Usually asymptomatic or nonspecific pulmonary symptoms Changes shape and location on different CXRs Well defined homogenous mass with low T1 and low T2

Answer 193

Answer: B is false. A. True. Pelvic sidewall (usually) or para-aortic (uncommon) B. False. Haematogenous spread is rare, lungs > liver > bone Histology is SCC (⅔) or adeno (¼), rarely other

Answer 194

Answer: C. Adenosarcoma is oestrogen-sensitive. A. False. “Leiomyosarcomas (malignant smooth muscle tumors) are uncommon, highly malignant myometrial tumors that usually arise de novo” (Robbins p.1021). No relation to hormones. B. False. “Benign endometrioid tumors, called endometrioid adenofibromas… are uncommon” (Robbins p. 1027). No relation to hormones. C. True. “The principal diagnostic dilemma is distinguishing these tumors from large benign polyps. The distinction is important, because adenosarcoma is estrogen-sensitive and responds to oophorectomy.” (Robbins p. 1019). D. False. Low- and high-grade variants. (Robbins p. 1021). No relation to hormones. E. False. MMMTs/carcinosarcomas “the vast majority of these tumors are carcinomas with sarcomatous differentiation”. (Robbins p.1018). No relation to hormones.

Answer 195

Answer: B and D are both false. A. True. “Saccular aneurysms are found in about 2% of the population according to recent data from community-based radiologic studies.” (Robbins p.1270) B. False. “Starts ~ day 3-4 post SAH; peaks ~ 7-9 days, lasts ~ 12-16 days” (StatDx). “In the first few days after the hemorrhage” (Robbins). C. True. Classic presentation. D. False. Growth rate = 3.9% per year (StatDx). Rupture risk for saccular aneurysm Size: Low risk of SA rupture if < 7 mm Growth rate = 3.9% per year 1.8% per year rupture risk ~ 20% of ruptured unsecured SA rebleed in 2/52, 50% in 6 months Shape: Daughter lobe likely ↑ risk of future SAH; Murphy teat = site of recent rupture and possible rebleed if untreated ↑ in females with history of HTN, smoking

Answer 196

Answer: A. A. True. “Absence of esophageal wall serosa → malignancy easily spreads to adjacent structures (trachea, thyroid, aorta)” (StatDx). B. False. Modes of spread are direct invasion, lymphatic spread, haematogenous metastasis. Perineural not mentioned in Robbins or StatDx.

Answer 197

A. True. The single most important factor seems to be Bence-Jones proteinuria, as the excreted light chains are toxic to renal tubular epithelial cells.” (Robbins p.600). B. False. “Decreased production of normal Igs sets the stage for recurrent bacterial infections. Cellular immunity is relatively unaffected.” (Robbins p. 600). C. False. Monoclonal Ig production - the “monoclonal Ig identified in the blood is referred to as an M component, in reference to myeloma” (Robbins p. 600). D. False. “Multiple myeloma usually presents as destructive plasma cell tumors (plasmacytomas) involving the axial skeleton.” (Robbins p.599)

Answer 198

Answer: C is true. A. False. Crohn’s mucosal ulcers with longitudinal fissures, these develop into fistulae. B. False. Fistula = Crohn’s C. True. In UC, isolated islands of regenerative mucosa bulge into the lumen to create pseudopolyps D. False. Creeping fat - mesenteric fat extending around serosal surface in Crohn’s. E. False. IBD-associated arthropathy seen in both UC & Crohn. F. False. Uveitis seen in both UC & Crohn.

Answer 199

Answer: B is true. A. False. Calcification is seen with chronic / recurrent pancreatitis B. True. Classic feature C. False. Narrowing of pancreatic duct D. False. Narrowing of pancreatic duct E. False. Chronic pancreatitis has atrophy and calcifications. Autoimmune pancreatitis (IgG4) Diffuse form: - Sausage like enlargement of the pancreas (smooth contour) with low density halo - Delayed enhancement - Diffuse/segmental narrowing of pancreatic duct - No inflammatory change/pseduocysts Focal form: - Focal mass/enlargement with delayed enhancement

Answer 200

Answer: B. Amyloid angiopathy least likely to involve basal ganglia. A. False. Hypertensive headache favours “deep structures (basal ganglia, thalami, cerebellum) > cortex, subcortical WM” (StatDx) B. True. Cortical/subcortical microhaemorrhage. “Lobar > > basal ganglionic hemorrhage.” (StatDx).

Answer 201

A. True. “may appear in the course of an apparently normal pregnancy, after a miscarriage, or after curettage. Sometimes the tumor does not appear until months after these events”(Robbins p.1041). B. False. “In contrast to choriocarcinomas arising in placental tissue, those arising in the ovary are generally unresponsive to chemotherapy and are often fatal.” (Robbins p. 1031). C. False. “Hydropic villi may embolize to distant sites, such as lungs and brain, but do not grow in these organs as true metastases, and even without chemotherapy they eventually regress.” (Robbins p.1041). D. False. “In complete moles the embryo dies very early in development and therefore is usually not identified” (Robbins p. 1040). E. False. Cholangiocarcinoma is the distractor. F. True. “50% arise in complete hydatidiform moles, 25% in previous abortions, approximately 22% follow normal pregnancies, with the remainder occurring in ectopic pregnancies” (Robbins p.1041). G. False. Depends on question wording though “Nongestational type occurs in prepubertal girls and postmenopausal women. Gestational type occurs during reproductive years. “ (StatDx).

Answer 202

Answer: A. Hepatitis A does not cause cirrhosis nor portal hypertension.

Answer 203

Answer: D > C although counterintuitive A. False. “Extension of infection from the posterior urethra to the prostate, seminal vesicles, and then to the epididymis is the usual course of a neglected gonococcal infection.” (Robbins p. 974) B. False. “Urethritis is classically divided into gonococcal and nongonococcal causes.” (Robbins p. 970). HPV not listed. C. False. “E.coli and other gram negative rods” (Robbins) also similar in StatDx. Chlamydia not listed. D. True. “The testis and epididymis may be affected in both acquired and congenital syphilis, but almost invariably the testis is involved first, and in many cases the epididymis is spared altogether.” (Robbins p. 974)

Answer 204

Answer: C is true. A. False. The Reed-Sternberg cells define Hodgkin disease B. False. Waldeyer’s ring is organised MALT tissue and therefore extranodal (can’t be Hodgkin) C. True. NHL can do whatever it wants. Contiguous extension is a feature of Hodgkin lymphoma (spread from one lymph node to the next) Non-contiguous extension is a feature of Non-Hodgkin lymphoma Waldeyer’s ring is a special kind of mucosal-associated lymphoid tissue (MALT) and therefore is not a site of Hodgkin disease

Answer 205

Answer: A is directly referenced in Robbins A. True. “The inferior vena cava syndrome can be caused by neoplasms that compress or invade the inferior vena cava (IVC) or by thrombosis of the hepatic, renal, or lower extremity veins that propagates cephalad. Certain neoplasms—particularly hepatocellular carcinoma and renal cell carcinoma—show a striking tendency to grow within veins, and these can ultimately occlude the IVC.” (Robbins p.515) B. True - but less true than A. “The superior vena cava syndrome is usually caused by neoplasms that compress or invade the superior vena cava, such as bronchogenic carcinoma or mediastinal lymphoma.” (Robbins p. 515) C. False. Burkitts is often extranodal and favours mandible and ileocaecal region. (Robbins p. 597) D. False. Ascites not mentioned in lymphoma chapter. “Rupture of dilated lymphatics (e.g., secondary to obstruction from a tumor) leads to milky accumulations of lymph designated as chylous ascites (abdomen), chylothorax, and chylopericardium.” (Robbins p. 515)

Answer 206

A. True. “Burkitt lymphoma is believed to be the fastest growing human tumor” (Robbins p. 597) B. True. “Some persons with AIDS or who receive immunosuppressive therapy for preventing allograft rejection develop EBV positive B-cell tumors, often at multiple sites and within extranodal tissues such as the gut or the central nervous system.” (Robbins p. 328) “In allogeneic hematopoietic stem cell and organ transplant recipients, the bowel is also the most frequent site for Epstein-Barr virus-positive B-cell lymphoproliferations.” C. False. “Tumor cells often are latently infected by EBV.” D. True. “Sporadic Burkitt lymphoma most often appears as a mass involving the ileocecum and peritoneum.” (Robbins p.597) E. True. “Endemic Burkitt lymphoma often presents as a mass involving the mandible and shows an unusual predilection for involvement of abdominal viscera, particularly the kidneys, ovaries, and adrenal glands.”(Robbins p.597) F. True. See B. Bolded in Robbins: “In the case of Burkitt lymphoma, it seems that EBV is not directly oncogenic, but by acting as a polyclonal B-cell mitogen, it sets the stage for the acquisition of the (8;14) translocation and other mutations that ultimately produce a full-blown cancer… The role played by EBV is more direct in EBV-positive B-cell lymphomas in immunosuppressed patients.”

Answer 207

A. False. Characteristically serous. “Serous pericarditis is characteristically produced by noninfectious inflammatory diseases, including rheumatic fever, SLE, and scleroderma, as well as tumors and uremia.” (Robbins p.573) B. True. “Hemorrhagic pericarditis can also be found in bacterial infections, in persons with an underlying bleeding diathesis, and in tuberculosis.” (Robbins p.574). C. True. “Fibrinous and serofibrinous pericarditis are the most frequent types of pericarditis… Common causes include acute MI, postinfarction (Dressler) syndrome (an autoimmune response appearing days-weeks after an MI), uremia, chest radiation, rheumatic fever, SLE, and trauma.” D. True. Fibrinous/serofibrinous (see C). E. False. Pericardial effusion but not pericarditis. Not in Robbins table.

Answer 208

A. True. Leiomyosarcomas “thought to arise from the myometrium or endometrial stromal precursor cells, rather than leiomyomas.” (Robbins p. 1020). B. True. “These tumors often recur following surgery, and more than half eventually metastasize hematogenously to distant organs, such as lungs, bone, and brain.” (Robbins p. 1021). C. False. “Leiomyosarcomas occur both before and after menopause, with a peak incidence at 40 to 60 years of age.” (Robbins p. 1020). D. False. See A

Answer 209

A. True. Hyperaldosteronism - hypertension, hypokalaemia. B. True. C. True. D. False. A complication, not cause. E. False. Adrenocortical hyperfunction, not insufficiency. F. False. Causes pulmonary hypertension. G. Maybe, via chronic renal failure - but not on the Robbins list. H. True. Exogenous oestrogens

Answer 210

A. True. “Small bowel (SB) ischemia is usually due to occlusion of SMA or SMV. Colonic ischemia more often due to hypoperfusion; not thrombotic.” (StatDx). B. False. Causes haemorrhagic colitis, Reiter’s syndrome and haemolytic uraemic syndrome, but rarely toxic megacolon or obstruction. (Robbins p.788) C. True. C. diff causes toxic megacolon. “Acute transmural fulminant colitis with neuromuscular degeneration and colonic dilation” (StatDx). D. True. Barotrauma. “Gas dissects down mediastinum, into retroperitoneum, out mesentery, into bowel wall” (StatDx) E. True. Barotrauma. “Gas dissects down mediastinum, into retroperitoneum, out mesentery, into bowel wall” F. True. “Scleroderma and other forms of mixed connective tissue disease. Intramural gas may result from bowel disease itself, associated medications (e.g., corticosteroids), or ischemia” (StatDx).

Answer 211

DDx for intestinal pneumatosis: 1. ischaemia 2. medications (steroids, -mabs) 3. post-procedure (anastomosis, endoscopy via mucosal tear) 4. barotrauma (asthma, COPD, CF, ventilator) 5. scleroderma & mixed connective dissue disease 6. pneumatosis cystoides intestinalis Also pseudo-pneumatosis (faeces)

Answer 212

A. False. 70% “in the peripheral zone of the gland, classically in a posterior location” (Robbins p.985) B. False. “Local extension most commonly involves periprostatic tissue, seminal vesicles, and the base of the urinary bladder.” (Robbins p.985) C. False. “Hematogenous spread occurs chiefly to the bones, particularly the axial skeleton, but some lesions spread widely to viscera.” (Robbins p.986) D. Probably true. “Local extension most commonly involves periprostatic tissue, seminal vesicles, and the base of the urinary bladder.”

Answer 213

Answer: D is false. A. True. “epithelioid type [resembles] adenocarcinoma. Immunohistochemical stains are very helpful in differentiating it from pulmonary adenocarcinoma.” (Robbins p. 724) B. True. All mesothelioma is rare. “Peritoneal mesotheliomas are related to heavy asbestos exposure in 60% of males” (Robbins p.724). C. True. “The presenting complaints are chest pain, dyspnea… recurrent pleural effusions.” (Robbins p.724). D. False. “Concurrent pulmonary asbestosis (fibrosis) is present in only 20% of individuals with pleural mesothelioma.” (Robbins p.724). E. True. “thoracic mesothelioma arises from either the visceral or the parietal pleura” (Robbins p.723) Mesothelioma subtypes: epithelioid → resemble adenocarcinoma on microscopy sarcomatoid biphasic (mixed)

Answer 214

A. False. “They develop most frequently on the anterior and posterolateral aspects of the parietal pleura and over the domes of the diaphragm.” B. False. “Most common along diaphragmatic & posterolateral pleura, typically spare apical, costophrenic & mediastinal pleura” (StatDx). C. True. UIP pattern. “Consider asbestosis in patients with basilar interstitial lung disease and pleural plaques” (StatDx). D. False. “They do not contain asbestos bodies; however, only rarely do they occur in individuals who have no history or evidence of asbestos exposure.” (Robbins p. 692). E. True. "The latent period before the development of lung cancer is 10 to 30 years. Lung cancer is the most frequent malignancy in individuals exposed to asbestos, particularly when coupled with smoking." (Robbins p.713). Listed under adenoca in StatDx.

Answer 215

Answer: E. “In general, black pigment stones are found in sterile gallbladder bile and brown stones are found in infected large bile ducts.” A. False. Black pigment stones. B. False. Black pigment stones. C. False. Cholesterol stones. D. False. Gallbladder hydrops. “Distended gallbladder secondary to chronic obstruction filled with watery mucoid material” Due to chronic obstruction, can massively distend. RUQ pain. Kawasaki’s in kids. Stone, tumour, extrinsic or parasite in adults. (StatDx) E. True. “In general, black pigment stones are found in sterile gallbladder bile and brown stones are found in infected large bile ducts.” (Robbins p. 877). Cholesterol stones cause by ^ cholesterol secretion - fat, female, forty, fertile Pigment stones caused by ^ unconjugated bili - inadequate conjugation > chronic haemolysis (Hb-opathies) > chronic liver disease - deconjugation > biliary parasites - enterohepatic recirculation of unconjugated bilirubin > terminal ileal disease, resection or bypass

Answer 216

Answer: A. Dysgerminoma is least associated. A. False… but still a case report reference in StatDx. B. True. “Some cases demonstrate pseudo-Meigs syndrome with pleural effusion and ascites” (StatDx) C. True. Can present with “ascites or Meigs syndrome” (StatDx) D. True. “1% associated with Meigs syndrome” (StatDx) E. True. “1% associated with Meigs syndrome” (StatDx)

Answer 217

A. True. Facial angiofibromas = major criterion. B. False. Leptomeningeal angiomatosis = Sturge-Weber syndrome C. True. LAM = major criterion. D. True. Renal angiomyolipomas = major criteria. E. True. Hepatic cyst associated with TS (STatDx) but not a diagnostic criterion. F. True. Subependymal giant cell tumour = major criterion. G. True. Retinal hamartomas (& cortical tubers) = major criterion. H. True. Cardiac rhabdomyoma = major criterion. I. False. Mostly sporadic. Distractor for SEGA.

Answer 218

Answer: C is true. A. False. “Unilateral in 60%, bilateral in 40%” (StatDx). B. False. Orbital cavernous venous malformation (“hemangioma”) is the most common ault orbital mass lesion; but “distinct lesion from infantile ("capillary") hemangioma, neoplastic tumor of infancy” (StatDx) using latest ISSVA classification. C. True. “Uveal melanoma disseminates hematogenously and the first evidence of metastasis is typically detected in the liver.” (Robbins p. 1332).

Answer 219

Answer: C. Thrombocytopaenia is a consequence not a cause. A. True. “Amyloidosis of the spleen may be inapparent grossly or may cause moderate to marked splenomegaly (up to 800 g).” Patterns described as “sago spleen” and “lardaceous spleen”. (Robbins p. 261). B. True. “The spleen is affected in about three fourths of cases, but it is enlarged in only one fifth.” (Robbins p. 694). C. False. “With splenomegaly up to 80% to 90% of the total platelet mass can be sequestered in the interstices of the red pulp, producing thrombocytopenia.” (Robbins p. 623). Conversely in ITP “the spleen is normal in size”. D. True. Cardiac cirrhosis induces congestive splenomegaly (Robbins p. 530).

Answer 220

Answer: A is true. Pulmonary nodules can precede MSK findings of RA in Caplan syndrome. A. True. In Caplan syndrome (RA + pneumoconiosis - typically CWP + PMF) - “lung abnormalities may precede bone disease” (StatDx). The original description included patients who developed RA 5-10 years after lung disease. B. False. “RA typically manifests as a symmetric arthritis principally affecting the small joints of the hand and feet.” (Robbins p. 1211) C. False. Even though UIP/NSIP/OP are all seen, honeycombing is an end-stage feature of lung fibrosis. D. False. “Rheumatoid vasculitis occurs predominantly in the setting of long-standing, severe rheumatoid arthritis and usually affects small- and medium-sized arteries, leading to visceral infarction; it may also cause a clinically significant aortitis.” (Robbins p.512). Conversely “1% to 7% of patients with rheumatoid arthritis treated with penicillamine or gold (drugs now used infrequently for thispurpose) develop membranous nephropathy.” (Robbins p. 915).

Answer 221

A. False. Not described in Robbins or UpToDate B. True. Increased cell breakdown → hyperuricaemia → gout C. True. Thrombocytosis with abnormal platelets → prothrombotic and procoagulant (excess vWF binding) D. True. “Transformation to AML, with its typical features, occurs in about 1% of patients.” (Robbins p.619). E. True. “About 25% of patients first come to attention due to deep venous thrombosis, myocardial infarction, or stroke. Thromboses sometimes also occur in the hepatic veins (producing Budd-Chiari syndrome) and the portal and mesenteric veins (leading to bowel infarction).” (Robbins p.619). F. True. “Patients are plethoric and cyanotic due to stagnation and deoxygenation of blood in peripheral vessels.” (Robbins p. 619). UpToDate: Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by clonal proliferation of myeloid cells and an elevated red blood cell mass. Between 95-100% of patients have JAK2 kinase mutation involving exon 14 or 12. PV should be suspected in any patient with an increased red blood cell mass or increased hemoglobin/hematocrit and an arterial oxygen saturation >92 percent. PV should also be suspected in patients with the Budd-Chiari syndrome and portal, splenic, or mesenteric vein thrombosis, particularly women under the age of 45. *Splenomegaly *Thrombocytosis and/or leukocytosis *Thrombotic complications *Erythromelalgia or pruritus

Answer 222

A. False. Due to arteriolosclerosis. B. True. “Widespread hemorrhagic lesions involving the white matter are characteristic of embolization of bone marrow after trauma” (Robbins p.1265) C. False. Robbins describes “evidence of numerous small hemorrhages within the brain (“microbleeds”)” so this is probably not the answer. However “acute hematomas are large, often irregular, with dependent blood sedimentation” (StatDx)

Answer 223

Answer: A is true. A. True. “Approximately 10% of patients [with MG] have a thymoma… 30% of patients (and particularly those who are young) [have] thymic hyperplasia.” (Robbins p.1236) B. False. “shows a bimodal age distribution” (Robbins p.1235) C. False. “Overall mortality has dropped from over 30% in the 1950s to less than 5% with current therapies.” (Robbins p.1236). D. False. “About 85% of patients have autoantibodies against postsynaptic acetylcholine receptors” (Robbins p.1236) E. False. “Diplopia and ptosis due to involvement of extraocular muscles are common and distinguish myasthenia gravis from myopathies, in which involvement of extraocular muscles is unusual” (Robbins p. 1236)

Answer 224

Both false. A. “Latent VZV infection is seen in neurons and/or satellite cells around neurons in the dorsal root ganglia.” (Robbins p.358) B. “[HSV1 & 2] spread to sensory neurons that innervate primary sites of replication... Viral nucleocapsids are transported along axons to the neuronal cell bodies, where the viruses establish latent infection.” (Robbins p. 357)

Answer 225

A. False. But more true than B. “C1-C2 instability rare” B. False. “The skeletal abnormalities are usually not associated with changes in longevity, intelligence, or reproductive status.” (Robbins p.1184). StatDx: Best diagnostic clue: - Flattened vertebral bodies with short pedicles - Interpediculate distance of lumbar spine decreases in caudal direction (reversal of normal relationship) - Severe dwarfism involves trunk and extremities - more obvious in proximal limbs (rhizomelic dwarfism)' Robbins: Achondroplasia is the most common skeletal dysplasia and a major cause of dwarfism. It is an autosomal dominant disorder resulting in retarded cartilage growth. Affected individuals have shortened proximal extremities, a trunk of relatively normal length, and an enlarged head with bulging forehead and conspicuous depression of the root of the nose. It is caused by gain-of-function mutations in the FGF receptor 3 (FGFR3). Approximately 90% of cases stem from new mutations.

Answer 226

A. True. “Virtually all [Down] patients… older than age 40 develop neuropathologic changes characteristic of Alzheimer disease” (Robbins p.163). Due to extra chromosome 21 - APP. B. True. “10-fold to 20-fold increased risk of developing acute leukemia. Both acute lymphoblastic leukemias and acute myeloid leukemias occur. The latter, most commonly, is acute megakaryoblastic leukemia.” (Robbins p.163) C. False. Not described in Robbins or UTD. Annular pancreas is the main hepatobiliary anomaly. D. True. Duodenal atresia occurs in 2.5% off DS (UTD) E. False. Not described in Robbins or UTD. Annular pancreas is the main hepatobiliary anomaly. F. True. “CAVSD 37%, VSD 31%, ASD 15%, PAVSD 6%, Tetralofy of Fallot 5%” (UTD). 40% of DS have congenital cardiac disease (Robbins). G. True. “Approximately 13 percent of individuals with DS have asymptomatic AAI, while spinal cord compression due to the disorder affects approximately 2 percent” (UTD). ~40% have congenital heart disease GIT: duodenal atresia (2.5%) > imperforate anus > esophageal atresia +/- tracheo-esophageal fistula > Hirschsprung disease (1%)

Answer 227

A. True. “Laboratory findings include marked elevation of serum amylase levels during the first 24 hours, followed by a rising serum lipase level by 72 to 96 hours after the beginning of the attack.” (Robbins p.887) B. False. Alcohol is the most common cause of chronic pancreatitis, and a common cause of acute pancreatitis. (Robbins) C. True. “Pseudocysts are localized collections of necrotic and hemorrhagic material that are rich in pancreatic enzymes and lack an epithelial lining.” (Robbins p.889). D. True. Pseudoaneurysm in 10% of severe pancreatitis (StatDx). E. False. “Pseudocysts are localized collections of necrotic and hemorrhagic material that are rich in pancreatic enzymes and lack an epithelial lining.” (Robbins p.889) F. True. Infection more common after 10 days (Atlanta / StatDx); 75% gut-derived/enteric flora

Answer 228

Answer: A. Spleen is not involved in primary haemochromatosis. A. False. Spleen not involved in primary haemochromatosis. B. True. Pancreas involved in primary haemochromatosis. C. True. Liver involved in primary haemochromatosis. D. True. Heart involved in primary haemochromatosis. E. True. Joints involved in both primary and secondary haemochromatosis. “Radiographic signs of hemochromatosis arthropathy may occur prior to other signs of primary hemochromatosis” (StatDx). StatDx: Primary (hereditary) hemochromatosis affects parenchymal cells of liver, pancreas, and heart. Secondary (acquired due to transfusions, Fe intake etc.) hemochromatosis affects RES: Liver, spleen, nodes. However it eventually deposits everywhere including the pancreas, heart, kidneys etc. Both affect joints and skin later

Answer 229

Answer: Taken from Radiopaedia list A. False. B. True. FMD is classic, listed in Robbins. C. False. D. True. PAN is classic. Listed in Robbins. E. True. Behcet’s is a variable vessel vasculitis. Radiopaedia. F. True. Phakomatoses including NF and TS. Radiopaedia. G. True. Connective tissue disorders including Marfan and EhlersDanlos. Radiographics: FMD, atheroma, vasculitis and trauma. Clinical Imaging: FMD, atheroma, phakomatoses, connective tissue disorders, vasculitis and trauma.

Answer 230

Answer: A. Sickle cell disease A. True. “In childhood, the spleen is enlarged... by red pulp congestion… caused by the trapping of sickled red cells in the cords and sinuses. With time, the chronic erythrostasis leads to splenic infarction, fibrosis and progressive shrinkage (autosplenectomy)” (Robbins p. 636). B. False. “Both phagocyte hyperplasia and extramedullary hematopoiesis contribute to enlargement of the spleen, which can weigh as much as 1500 gm.” (Robbins p. 640). C. False. “Moderate splenomegaly is characteristic; in few other hemolytic anemias is the spleen enlarged as much or as consistently. Splenomegaly results from congestion of the cords of Billroth and increased numbers of phagocytes.” (Robbins p. 633). D. False. See B. E. False. “enlargement can cause a syndrome known as hypersplenism, which is characterized by anemia, leukopenia, thrombocytopenia, alone or in combination.” (Robbins p.624). F. False. “Glucocerebrosides accumulate in massive amounts within phagocytic cells throughout the body in all forms of Gaucher disease. The distended phagocytic cells, known as Gaucher cells, are found in the spleen, liver, bone marrow, lymph nodes, tonsils, thymus, and Peyer patches… In type I disease, the spleen is enlarged, sometimes up to 10 kg.” (Robbins p. 153). Summary: B - F cause splenomegaly, which predisposes to infarct but sickle cell causes autosplenectomy due to chronic stasis and recurrent infarcts.

Answer 231

Answer: B is less true than C. E is rare but a classic association. A. True. “Sometimes mobile tumors exert a “wrecking-ball” effect, causing damage to the valve leaflets.” (Robbins p.576). B. Less true than C. “About 90% of myxomas arise in the atria, with a left-to-right ratio of approximately 4:1”. (Robbins p.575). C. True. “Sometimes fragmentation and systemic embolization calls attention to these lesions.” (Robbins p. 576). D. True. “Constitutional symptoms are probably due to the elaboration by some myxomas of the cytokine interleukin-6, a major mediator of the acute-phase response.” (Robbins p.576). E. True. Carney complex. “The major clinical manifestations are due to valvular “ball-valve” obstruction, embolization, or a syndrome of constitutional symptoms, such as fever and malaise. Sometimes fragmentation and systemic embolization calls attention to these lesions.” (Robbins p.576)

Answer 232

Answer: Pericardial effusion is not described in Robbins for a primary cardiac tumour. A. Most false. Direct invasion causes pericardial effusion (UTD) but this is not described in Robbins. B. True. Direct invasion causes arrhythmias (UTD). “[Lipomas] may be asymptomatic, or produce ball-valve obstructions or arrhythmias” (Robbins p. 576). C. True. Systemic and pulmonary embolism (UTD). Described in myxomas (Robbins p. 576). D. True. “wrecking ball” effect (Robbins, UTD). Described in myxomas (Robbins p. 576). E. True. “ball-valve” obstruction (Robbins). Described in myxomas (Robbins p. 576) Mechanisms of symptom production of cardiac tumours (UTD) 1. Direct invasion of myocardium can cause LV dysfunction, arrhythmias, heart block, pericardial effusion. 2. Embolisation. Systemic and pulmonic emboli. 3. Valve damage. Mobile tumours can exert “wrecking ball effect”. 4. Obstruction. Ball valve obstruction 5. Invasion into lungs.

Answer 233

Answer: C and F both false. A. True. “Presumably these injuries rupture vascular sinusoids in the marrow or small venules, allowing marrow or adipose tissue to herniate into the vascular space and travel to the lung.” (Robbins p. 128). B. True. “Typically, 1 to 3 days after injury there is a sudden onset of tachypnea, dyspnea, and tachycardia; irritability and restlessness can progress to delirium or coma.” (Robbins p. 128). C. False. Does cause inflammation (ARDS) but not haemorrhage. “Embolic obstruction of medium-sized arteries with subsequent vascular rupture can result in pulmonary hemorrhage” (Robbins p. 127). D. True. “A diffuse petechial rash (seen in 20% to 50% of cases) is related to rapid onset of thrombocytopenia and can be a useful diagnostic feature.” (Robbins p. 128). E. True. “Microscopic fat globules—sometimes with associated hematopoietic bone marrow—can be found in the pulmonary vasculature after fractures of long bones or, rarely, in the setting of soft tissue trauma and burns.” (Robbins p.128). F. False. “Widespread hemorrhagic lesions involving the white matter are characteristic of embolization of bone marrow after trauma” (Robbins p. 1265).

Answer 234

ANSWER: A is true, A True. “The vegetations of prosthetic valve endocarditis are usually located at the prosthesis-tissue interface, and often cause the formation of a ring abscess, which can eventually lead to a paravalvular regurgitant blood leak.” (Robbins p. 563) B False. “Subacute IE is characterized by organisms with lower virulence (e.g., viridans streptococci) that cause insidious infections of deformed valves with overall less destruction.” (Robbins p.559). C False. “Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions.” (Robbins p.559) D False. Acute affects a previously normal valve. See B & C.

Answer 235

ANSWER: A is definitely false. D may be false. A. False. “In about 10% of all cases of endocarditis, no organism can be isolated from the blood (“culture negative”endocarditis)” (Robbins p.560) so 90% are culture positive. B. True. Ring (annular) abscess is frequent in mechanical valve endocarditis. “The vegetations of prosthetic valve endocarditis are usually located at the prosthesis-tissue interface, and often cause the formation of a ring abscess, which can eventually lead to a paravalvular regurgitant blood leak.” (Robbins p. 563) C. True.“Subacute IE is characterized by organisms with lower virulence (e.g., viridans streptococci) that cause insidious infections of deformed valves with overall less destruction.” (Robbins p.559). D. ?False. “Endocarditis of native but previously damaged or otherwise abnormal valves is caused most commonly (50% to 60% of cases) by Streptococcus viridans, a normal component of the oral cavity flora.” (Robbins p. 559). E. True (probably). “In a series of addicted patients admitted to the hospital, more than 10% had endocarditis, which often takes a distinctive form involving right-sided heart valves, particularly the tricuspid.” (Robbins p.424)

Answer 236

ANSWER: UNCLEAR. C? Robbins pg 1088: “The gland may be unilaterally or bilaterally enlarged and firm” and “There is variable enlargement of the thyroid”. Radiopaedia: “Thyroid gland size mostly normal but can occasionally be enlarged or smaller in size”.

Answer 237

ANSWER: D From Robbins (mostly): A. Lambert Eaton = lung, thymic B. Cushings = SCLC, pancreas, neural C. Limbic encephalitis = SCLC, testicular cancer, ovarian teratomas (Radiopaedia) D. Dilated cardiomyopathy = no mention in Robbins (Google says cardiomyopathy can rarely occur in RCC, breast) E. SIADH = SCLC, intracranial neoplasms

Answer 238

ANSWER: E From Robbins (mostly) A. SIADH = SCLC, intracranial neoplasms B. Lambert Eaton = lung, thymic C. Limbic encephalitis = SCLC, testicular cancer, ovarian teratomas (Radiopaedia) D. Cushings = SCLC, pancreas, neural E. Hypocalcaemia is not a paraneoplastic syndrome. Hypercalcaemia = Squamous cell lung cancer, breast, RCC, leukaemia/lymphoma

Answer 239

Answer: A. Choose oesophageal > imperforate anus > duodenal. “Atresia occurs most commonly at or near the tracheal bifurcation and is usually associated with a fistula connecting the upper or lower esophageal pouches to a bronchus or the trachea… Intestinal atresia is less common than esophageal atresia but frequently involves the duodenum. Imperforate anus, the most common form of congenital intestinal atresia, is due to a failure of the cloacal diaphragm to involute.” (Robbins p.750).

Answer 240

B A. True. “50-80% of cases is associated with overt luminal obstruction” (Robbins) B. False. “Initiated by progressive increases in intraluminal pressure that compromise venous outflow” (Robbins) C. True. “most common in adolescents and young adults” (Robbins) D. True. “complications of appendicitis include pyelophlebitis, PV thrombosis, liver abscess and bacteraemia” (Robbins) E. True. “stasis of luminal contents, which favours bacterial proliferation, triggers ischaemia and inflammatory responses” (Robbins)

Answer 241

ANSWER: A is most true. D is also true but depends on phrasing. A. True. “RHD is virtually the only cause of mitral stenosis” (Robbins p.557) B. False. Marantic = non-bacterial thrombotic endocarditis; associated with mucinous adenocarcinomas and sepsis. LibmanSacks Disease = SLE (Robbins p. 561) C. False. “Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions.” (Robbins p.559) D. True. “Infective endocarditis (IE) is characterized by large, irregular masses on the valve cusps that can extend onto the chordae” (Robbins p. 560). “The vegetations of subacute endocarditis are associated with less valvular destruction than those of acute endocarditis,although the distinction can be subtle.” (Robbins p.560).

Answer 242

ANSWER: D (of these options, but check wording on the day) A. False. NBTE = Marantic. Libman-Sacks Disease = SLE B. False. RHD = Gram positive (Group A streptococci) C. False. Subacute vegetations cause less valvular destruction than acute (Robbins) D. Robbins pg 559: “Although fungi and other classes of microorganisms can be responsible, most infections are bacterial” Candida is most common fungus

Answer 243

ANSWER: All false. A. False. “HACEK group (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella) may cause large vegetations > 1 cm” (StatDx) B. False. “Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions.” (Robbins p.560) C. False. Disseminated lesions (e.g. Osler’s nodes, vascular lesions etc.) are part of the Minor Duke’s criteria. D. False. See B.

Answer 244

Answer: D is true. A. False. Gynaecomastia is common in infancy, puberty and middle to older men (UpToDate). B. False. “When bilateral, could be asymmetric in 67%” (StatDx). C. False. “Not causally related to male breast cancer” (StatDx). D. True. Hormone-producing tumours (Testicular tumors: Germ cell, Leydig, Sertoli; Non-testicular tumours: Pituitary, adrenal, liver, lung, renal” E. False. “Not causally related to male breast cancer” (StatDx) n.b. Robbins says “Similar to proliferative disease in women, gynecomastia may be associated with a small increased risk of breast cancer.” DDx: systemic disease (liver, renal failure or ^ thyroid), hormoneproducing tumour, hyperestrogenic (obese ^thyroid), gonadal failure.

Answer 245

ANSWER: A (but check wording, depends if Carney complex, Carney-Stratakis syndrome, or Carney triad) A. False. NF1 not NF2. B. Carney triad or Carney-Stratakis Syndrome, NOT Carney complex. C. True. KIF1Bbeta mutation associated with CMTD and paragangliomas. https://doi.org/10.1530/ERC-11-0170 Paragangliomas and syndromes: - MEN2A, MEN2B - NF1 - VHL - Carney triad (paraganglioma + GIST + pulmonary chondroma) Carney Complex = cardiac myxoma + blue naevi + other features (extracardiac myxomas, pituitary adenoma, testicular tumours, schwannoma) (rare MEN syndrome) Carney-Stratakis Syndrome = paraganglioma + gastric stromal sarcoma

Answer 246

True. From UTD: - 10% of pheos are malignant (Rule of 10s). - 20-25% of extra-adrenal paragangliomas in the abdomen/pelvis/mediastinum are malignant - In the neck, vagale most likely malignant

Answer 247

ANSWER: All false. A. False. “Colorectal adenocarcinoma develops in 100% of untreated FAP patients, often before age 30 and nearly always by age 50.” (Robbins p. 809). B. False. Colonic adenocarcinomas equally distributed over entire length of colon (Robbins) C. False. Colonic adenocarcinomas equally distributed over entire length of colon (Robbins) D. False. Size is more important than architecture (tubular, tubulovillous, villous) (Robbins pg 808)

Answer 248

A. True, ish. “Patients with secondary hyperparathyroidism associated with severe chronic kidney disease usually have parathyroid hyperplasia and frankly low or low-normal serum calcium concentrations. However, with prolonged disease, some patients may develop hypercalcemia.” (UpToDate) B. False. “Prolonged hypophosphatemia produces a number of effects on both the kidney and bone. Distal tubular reabsorption of calcium and magnesium are inhibited, and striking hypercalciuria ensues” (UpToDate) C. False. “Patients with malabsorption or short-bowel syndrome may have higher than normal calcium and vitamin D requirements due to diminished calcium absorption” (UpToDate) D. False. Normocalcaemic. E. False. Normocalcaemic. F. False. Probably referring to milk-alkali syndrome “the triad of hypercalcemia, metabolic alkalosis, and acute kidney injury associated with the ingestion of large amounts of calcium and absorbable alkali… originally described use of milk and sodium bicarbonate for the treatment of peptic ulcer disease” (UpToDate). “Among all causes of hypercalcemia, primary hyperparathyroidism and malignancy are the most common, accounting for greater than 90 percent of cases” (UpToDate) Robbins (Table 24-5): Raised [PTH]: Hyperparathyroidism (Primary (adenoma > hyperplasia), Secondary, Tertiary) Decreased [PTH] Hypercalcemia of malignancy, Vitamin D toxicity, Immobilization, Thiazide diuretics, Familial hypocalciuric hypercalcemia, Granulomatous disease (sarcoidosis)

Answer 249

ANSWER: A. True. “The infiltrating pattern is more common and usually appears as a poorly defined area of diffuse mural thickening and induration.” (Robbins p. 880) B. False. “Gallbladder cancer is at least twice as common in women than in men” (Robbins p. 879). C. False. “The most important risk factor for gallbladder cancer (besides gender and ethnicity) is gallstones which are present in 95% of cases.” (Robbins p. 879). D. False. “Typically they are detected late because of non specific symptoms and hence carry a poor prognosis.” (Robbins p.880).

Answer 250

A. False. Robbins pg 1215 “Hyperuricaemia is necessary but not sufficient for the development of gout” B. False. Robbins pg 1214: Primary form of gout (90% of cases) is where cause is unknown (compared to secondary where high uric acid is due to known underlying disease). Then Robbins pg 1215: “Vast majority of primary gout is caused by increased uric acid biosynthesis for unknown reasons” C. True. “About 20% of those with chronic gout die of renal failure.” (Robbins pg 1216)

Answer 251

Answer = D. A. False. “About half arise in NF1 patients and are assumed to result from malignant transformation of a plexiform neurofibroma. Sporadic cases may arise de novo.” (Robbins p.1249) B. False. Typically optic nerve gliomas; alternatively optic nerve sheath meningiomas C. False. 95% of schwannomas arise from vestibular nerve; bilateral in NF2 D. True. Schwann cells are the neoplastic component of the neurofibroma. “Only the Schwann cells in neurofibromas show complete loss of neurofibromin (a tumour suppressor), indicating they are the neoplastic cells” (Robbins)

Answer 252

Answer = most correct is prob B. A. False. CN9 schwannoma usually at inferior CP angle or jugular foramen B. False. High T2 from Antoni B cells which are loosely packed and prone to cystic degeneration. (Antoni A are densely packed, arranged in fascicles; low T2). C. False. Usually vestibular component of CN8 Jugular foramen anatomy Pars nervosa (anteromedial) - CN9 Pars vascularis (posterolateral) - IJV, CN10, CN11

Answer 253

ANSWER: All false. A. False. “Papillary carcinomas… are typically hemorrhagic and cystic, especially when large.” (Robbins p. 955) B. False. Not for clear cell. “Chromophobe carcinoma… histologic from oncocytoma can be difficult.” (Robbins p. 954). C. False. “With renal vein invasion or extension into the perinephric fat, the [5YS] figure is reduced to approximately 60%” (Robbins p. 955) D. False. vHL associated with clear cell RCC, BHD associated with chromophobe RCC

Answer 254

ANSWER: B UTD: The liver is affected in approximately two-thirds of patients, the lungs in approximately 25 percent, and other organs including the brain, muscle, kidneys, bone, heart, and pancreas in a small proportion of patients.

Answer 255

Answer = B. A. False. Severe infection favours the picture of severe pyogenic infection causing acute suppurative lymphadenitis B. True. “Chronic lymphadenitis is particularly common in inguinal and axillary nodes, which drain relatively large areas of the body and are frequently stimulated by immune reactions to trivial injuries and infections of the extremities” (Robbins) C. False. Fistula/draining sinus to skin is a complication of severe acute lymphadenitis → Under acute nonspecific lymphadenitis: “suppurative infections penetrate through the capsule of the node and track to the skin to produce draining sinuses” (Robbins) D. False.”characteristically lymph nodes in chronic reactions are nontender” (Robbins) E. False. “Systemic viral infections and bacteraemia often produce acute generalised lymphadenopathy” (Robbins)

Answer 256

Leydig, Sertoli (Robbins), germ cell (StatDx) A. True. B. True. C. False

Answer 257

alpha-1 antitrypsin disease one of many causes (Robbins p.857)

Answer 258

A. False. “A considerably smaller fraction of patients with type 2 diabetes progress to end-stage renal disease”; “the progression from overt nephropathy to ESRD is highly variable but by 20 yrs, more than 75% of T1DM and approximately 20% of T2DM with overt nephropathy will develop ESRD” (Robbins) B. True. “Diabetic mononeuropathy which may manifest as sudden footdrop, wristdrop or isolated cranial nerve palsies” (Robbins 1120) C. False. “Myocardial infarction caused by atherosclerosis of the coronary arteries is the most common cause of death in diabetics (Robbins) D. False. Hallmark of macrovascular disease is accelerated atherosclerosis involving the aorta and large and medium sized vessels (coronary arteries are medium sized vessels). Macrovascular complications include MI, which is caused by atherosclerosis of the coronary arteries (Robbins) E. True. “approx 60-80% of pts develop some form of diabetic retinopathy by 15-20yrs post diagnosis” (Robbins)

Answer 259

Answer: All true. A. True. “Ca++ in 25%” B. True. “Most common brain tumor in children < 1 year old… Consider CPP if intraventricular mass in child < 2 years old” (StatDx) C. True. “50% in lateral ventricle (usually atrium)” (StatDx) D. True. “Benign, slowly growing - Malignant progression rare” (StatDx).

Answer 260

A. True. “Neonates, infants; M:F = 4:1” (StatDx) B. False. “Characteristic systemic blood supply & systemic venous drainage” (StatDx) C. True. “Neonates, infants; M:F = 4:1” (StatDx) D. False. Characteristic systemic blood supply & systemic venous drainage” (StatDx)

Answer 261

Answer: C. Congenital lobar overinflation. A. False. “Abnormal mass of pulmonary tissue with varying degrees of cystic change. Communicates with tracheobronchial tree; normal blood supply & venous drainage” (StatDx). B. False. “Sequestered lung. No normal communication to tracheobronchial tree, systemic blood supply” (StatDx). C. True, “Progressive overdistention of a pulmonary lobe due to 1- way valve airway obstruction. Best diagnostic clue = Progressively hyperlucent & hyperexpanded lobe. Initially opaque due to retained fetal lung fluid.” (StatDx).

Answer 262

Answer: C. A. True. Congestive splenomegaly. B. True. Transudative ascites. C. False. Portal biliopathy but not ischaemic hepatitis. D. True. Hypersplenism causes thrombocytopaenia. E. True. Portosystemic shunting.

Answer 263

A. True. “Corticotroph adenomas are usually microadenomas at the time of diagnosis.” (Robbins p.1079

Answer 264

ANSWER: A. Cushing syndrome = hypercortisolism of any cause. Cushing disease = “hypercortisolism due to excessive production of ACTH by the pituitary” (Robbins p. 1079). B. False. “The vast majority of cases of Cushing syndrome are the result of the administration of exogenous glucocorticoids” (Robbins p. 1123). C. “Large destructive pituitary adenomas [develop] after surgical removal of the adrenal glands for treatment of Cushing syndrome… most often because of a loss of the inhibitory effect of adrenal corticosteroids on a preexisting corticotroph microadenoma.” (Robbins p. 1080).

Answer 265

A. True. Enchondroma and low grade chondrosarcoma difficult to differentiate (StatDx) B. True. In Maffucci: 25% risk of enchondromas undergoing malignant transformation into chondrosarcoma by 40yo (rarely can transform into fibrosarcoma) (StatDx) C. False. Olliers = multiple enchondromas D. False. Osteochondroma degeneration occurs in cartilage cap E. False. Chondrosarcoma is mainly metaphyseal or metadiaphyseal. Epiphyseal is uncommon; however an epiphyseal chondroid lesion which is not a chondroblastoma should raise concern for chondrosarcoma as enchondromas do not occur in epiphyses (StatDx) F. False. Enchondromas are metaphyseal/metadiaphyseal and intramedullary. Epiphyseal location is so rare that you should consider chondrosarcoma first (StatDx) G. False. First consider osteochondroma H. False. Enchondroma. I. False. Chondrosarcoma J. False. Multiple osteochondromas (HME).

Answer 266

Answer: A. True. B. False. C. True. Arthritis in B&W: - idiopathic CPPD - haemochromatosis - hyperparathyroidism Robbins adds the following: - OA ("previous joint damage") - ochronosis - diabetes - hypoMg - hypothyroid “The secondary form is associated with various disorders, including previous joint damage, hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism, ochronosis, and diabetes” (Robbins p.1217).

Answer 267

ANSWER: B false. A. True. Congenital has variable but poor prognosis. Spontaneous remission described in autoimmune type. (UpToDate). B. False. “Autoimmune (formerly called acquired) PAP is caused by circulating neutralizing antibodies specific for GM-CSF… [this impairs alveolar macrophages] ability to catabolize surfactant” (Robbins p.696). C. True. See B. D. True. “Secondary PAP is uncommon and is associated with diverse diseases, including hematopoietic disorders, malignancies, immunodeficiency disorders… these diseases somehow impair macrophage maturation or function, again leading to inadequate clearance of surfactant from alveolar spaces.” (Robbins p.697) E. True. “These patients are at risk for developing secondary infections with a variety of organisms.” (Robbins p.697)

Answer 268

A. True. Usually adenocarcinomas. “Cancers in nonsmokers are more likely to have EGFR mutations, and almost never have KRAS mutations” (Robbins p.714) B. True. “Malignant mesotheliomas, although rare, have assumed great importance in the past few decades because of their increased incidence among people with heavy exposure to asbestos” (Robbins p.723) C. False. “Passive smoking (proximity to cigarette smokers) increases the risk for lung cancer development to approximately twice that of nonsmokers.” (Robbins p. 713). D. False. “There is a long latent period of 25 to 45 years for the development of asbestos-related mesothelioma” (Robbins p. 723)

Answer 269

Answer = A is most correct. A. True. “smaller emboli travel out inot more peripheral vessels, where they may cause haemorrhage or infarction” (Robbins) B. False. “About 10% of emboli cause infarction” (Robbins) C. False. “Over the course of time multiple small emboli may lead to pulmonary HTN and chronic cor pulmonale” (Robbins) D. False. >95% originate from thrombi in the deep veins of the leg (Robbins)

Answer 270

Answer: A is false. A. False. “Most common cause: Neuropathy due to diabetes mellitus. Neurosyphilis is cause originally described by Charcot - more commonly involves hips, knees than spine” (StatDx) B. True. StatDx lists pyogenic infection, atypical infection, degenerative disc disease with instability as differentials. Adjacent segment disease is due to abnormal biomechanical stress following spinal surgery. C. True. “Best Diagnostic Clue: Florid destruction of discs and facet joints with preserved bone density, involving 1-2 spinal levels” (StatDx). StatDx Summary: Almost always in lumbar spine Vertebral endplate destruction + facet joint destructive arthropathy Preserved bone density Nonunited fractures Vertebral subluxations Bony debris around vertebrae +/- soft tissue mass Heterogeneous enhancement of vertebrae and soft tissue mass

Answer 271

A is true.

Answer 272

Answer: D. Fallot’s tetralogy is cyanotic. Others are left to right shunts (or not shunts) 1 - Truncus arteriosis 2 - Transposition of the great arteries 3 - Tricuspid atresia/Ebstein’s 4 - Tetralogy of fallot 5 - TAPVR

Answer 273

A. Thrombocytopenia Haemolysis, Elevated LFTs, Low Platelets 3rd trimester, associated with pre-eclampsia

Answer 274

Answer: A. Omphalocele. A. True. “Membrane-covered midline abdominal wall defect with herniation of abdominal contents into base of cord” (StatDx) B. False. “Bowel herniation through right paramedian abdominal wall defect” (StatDx) C. False. “Bowel returns to abdomen by 11-12 weeks” (StatDx)

Answer 275

Answer: A. False. Not listed in StatDx. B. True. “6.7x ↑ maternal a priori risk when isolated” (StatDx) C. True. “4-5% cases of EB with cystic fibrosis” (StatDx) D. False. “4-6% cases of EB from infection” (StatDx) E. True. “10% of 2nd-trimester fetuses with EB develop FGR. EB probably from hypoperfusion to bowel.” (StatDx) F. True. Associated with ingested blood. “Dependent layering in stomach is clue - Look for evidence of prior perigestational hemorrhage as source for blood” (StatDx) StatDx Common: Idiopathic, T21, infection (parvovirus, CMV), CF, ingested blood. Bowel ischaemia rare but important.

Answer 276

ANSWER: C Robbins pg 953: Oncocytomas = tan or mahogany brown, relatively homogeneous, usually well encapsulated, with a central scar in ⅓ of cases, and may achieve a large size (up to 12 cm in diameter)

Answer 277

A. False. “The brain is usually involved following widespread hematogenous dissemination of fungi” (Robbins p.1279). B. False. Extraventricular obstructive hydrocephalus. “Leptomeningeal fibrosis may follow pyogenic meningitis and cause hydrocephalus.” (Robbins p.1273). C. False. Depends on wording: “E. coli and the group B streptococci in neonates; at the other extreme of life, Strep. pneumoniae and Listeria monocytogenes are most common; and Neisseria meningitidis in adolescents and in young adults” (Robbins p. 1272). D. True. “Phlebitis may lead to venous thrombosis and hemorrhagic infarction of the underlying brain.” (Robbins p. 1273)

Answer 278

Answer: B is true. A. False. “Orderly hyperplasias have almost no potential for malignant transformation, but the risk rises to 1% to 2% during the span of 5 to 10 years with mild dysplasia and 5% to 10% with severe dysplasia.” (Robbins p.739) B. True. “The epithelial alterations described above are most often related to tobacco smoke, the risk being proportional to the level of exposure. Indeed, up to the point of cancer, the changes often regress after cessation of smoking.” (Robbins p.739). C. False. “Carcinoma of the larynx is typically a squamous cell carcinoma seen in male chronic smokers.” (Robbins p. 739). D. False. “The tumor usually develops on the vocal cords, but it may also arise above or below the cords, on the epiglottis or aryepiglottic folds, or in the pyriform sinuses.” (Robbins p.740).

Answer 279

ANSWER: A UTD: Pancreas divisum is the most common congenital pancreatic anomaly (10% of individuals)

Answer 280

Answer: B is not inherited. A. True. Autosomal recessive. B. False. C. True. Autosomal dominant. D. True. ARPCKD

Answer 281

Transformation to AML - One study shows that anywhere from 2% to 14% of the time, polycythemia vera changes into AML within 10 years.

Answer 282

Cyanosis - Usually plethoric

Answer 283

Gallstones are associated with polycythaemia vera - rare Hyperuricaemia from increased cell turnover > gout

Answer 284

Thrombocytopenia

Answer 285

Answer: Predisposes to viral infections - Significantly increased risk of bacterial infection Osteoporosis can occur in the absence of lytic lesions - Osteolysis induced by cancer - Less common, as per Robbins Blood has high viscosity - hyperviscosity results from increased circulating serum immunoglobulins and can be seen in multiple myeloma Renal failure is a complication

Answer 286

Not implicated

Answer 287

Plasmacytoma of the head and neck

Answer 288

Answer: The most common cause of renal failure is amyloidosis - Bence Jones proteinuria is most common

Answer 289

Lymphocytosis

Answer 290

Proteus is associated with the formation of struvite stones

Answer 291

Answer: Non-Hodgkin lymphoma has non-contiguous spread Non-Hodgkin lymphoma is associated with Reed Sternberg cells - Hodgkin Hodgkin involves Waldeyer’s ring - false, spares waldeyers and mesentery

Answer 292

Localised to a lymph node group.

Answer 293

Anaplastic (NHL)

Answer 294

The Reed Sternberg cell is an abnormal B cell - Derived from the germinal centre or postgerminal centre B cells

Answer 295

Mycosis fungoides - Treatment goals are palliative

Answer 296

Mycosis fungoides

Answer 297

Most common age 30-40 - usually age 65

Answer 298

Follicular B cell lymphoma - low avidity

Answer 299

Desmoplastic fibroma

Answer 300

Lymphocyte depletion is the most common subtype - nodular sclerosing is most common

Answer 301

Lymphoma in a patient >60yo

Answer 302

Rapid progression is ?hallmark of BL

Answer 303

EBV is seen in almost all cases of Burkitt's lymphoma

Answer 304

Gluten sensitivity - Enteropathic T cell lymphoma

Answer 305

Primary CNS lymphoma

Answer 306

AA is associated with bronchiectasis - also lymphoma

Answer 307

Lymphoblasts - similar to myeloblasts

Answer 308

Nodular sclerosing

Answer 309

Answer: Bone lesions can be painful - Not typically painful Cold agglutinins are positive - 5% had positive cold aglucinins Coombes test are positive - Positive in about 10%

Answer 310

Sickle cell disease

Answer 311

Sickle cell anaemia

Answer 312

Sickle cell trait

Answer 313

Staph aureus with autosplenectomy Sickle cell - a common hereditary haemoglobinopathy, a mutation in the B-globin promotes the polymerization of deoxygenated haemoglobin leading to red cell distortion etc. Staph aureus isn't associated with autosplenectomy

Answer 314

Sickle cell anaemia

Answer 315

Budd Chiari Hepatic venous outflow obstruction, partial or complete obstruction of the hepatic veins.

Answer 316

Budd-chiari syndrome

Answer 317

Answer: Uraemia Due to chronic kidney disease The second condition exemplifying an acquired defect in platelet function. The pathogenesis of platelet dysfunction in uraemia is complex and involves defects in adhesion, granule secretion and aggregation. Splenomegaly : Thrombocytopenia of hypersplenism is caused primarily by increased splenic platelet pooling.

Answer 318

Answer: Biliary ascariasis Schistosomiasis Yes, secondary to portal hypertension Malaria Congestive splenomegaly `

Answer 319

Candida Hepatosplenic candidiasis - multiple microabscesses scattered through the liver and splenic parenchyma

Answer 320

H. influenzae Increased susceptibility to sepsis caused by encapsulated bacteria. The decrease in phagocytic capacity and antibody production that result from asplenia both contribute to the increased risk of sepsis

Answer 321

Congestive splenomegaly is the most common cause of hypersplenism

Answer 322

The red cells are more deformed than usual

Answer 323

Urate stones

Answer 324

Natural killer NK/T cell leukaemia/lymphoma

Answer 325

ANSWER: Bone marrow fibrosis . Relates to polycythaemia vera and essential thrombocytopaenia Transforms to AML :In blast crisis about 2/3 of cases CML transforms into a disease resembling AML. The remainder transform into disease resembling ALL - CML leukaemia foundation Thrombocytosis : Can be present in CML

Answer 326

A: ALL Pick CML if its an option Characteristic of CML and a subset of B-cell acute lymphoblastic leukaemias, can be seen in ALL

Answer 327

Erythrocytosis

Answer 328

Prob this: Lymph node with possible lymphoma - need to assess architecture Lung carcinoma - huge immuno work-up needed for neoadjuvant therapy

Answer 329

Chloroma - Granulocytic sarcoma. Neoplasm of myeloid precursor cells. Need to determine the clonality of cells

Answer 330

Determining the clonality of lymphomas Can rapidly and quantitatively measure several individual cell characteristics, but mainly for identifying cellular antigens expressed by 'liquid' tumours, those that arise from blood-forming tissues. Multiple antigens can be assessed simultaneously on individual cells using combinations of specific antibodies linked to different fluorescent dyes. Recommended for classification and staging of lymphomas.

Answer 331

Answer: c. Vitamin K deficiency A clotting dyscrasia, vital as a cofactor for the enzymatic activation of several key components of the clotting pathway Might be myelofibrosis/myelodysplasia Christmas disease (Haemophilia B) X linked recessive, exclusively in males. Usually presents with clinically significant bleeding or haemarthrosis Lupus anticoagulant A prothrombotic with greater propensity for thrombosis

Answer 332

Plasmacytoma of the head and neck

Answer 333

Natural killer NK/T cell leukaemia/ lymphoma

Answer 334

Leukocytosis

Answer 335

ER+, PR+, HER2- - Tumours are generally of a good prognostic phenotype, being low histological grade and low mitotic index, hormone receptor positive and HER2 -ve.

Answer 336

Loss of E cadherin differentiates LCIS from atypical lobular hyperplasia Breast carcinoma: - Atypical lobular hyperplasia and LCIS. Difference between them is presence of E-cadherin. - Ductal hyperplasia without atypia not associated with increased malignancy.

Answer 337

?LCIS is 20-40% bilateral (true as per statdx) DCIS is 20-40% bilateral (not true) – 10%

Answer 338

Invasive lobular carcinoma

Answer 339

Calcification is an incidental finding in LCIS

Answer 340

Metastasises to the brain - favours leptomeninges rather than brain parenchyma

Answer 341

Invasive lobular carcinoma

Answer 342

Both are borderline lesions BIRAD 2 Calcified fibroadenoma Multiple secretory calcification Fat-containing lesions e.g. oil cyst, breast lipoma, hamartoma Cutaneous neruofibroma Intramammary lymph nodes Sebaceous cyst Simple breast cyst

Answer 343

Risk of invasive carcinoma is similar in both breasts

Answer 344

Eventually almost everyone will go on to develop invasive carcinoma FALSE

Answer 345

Associated with BRCA1 - In familial form of breast cancer with BRCA1 gene mutation medullary and mucinous cancers are more common.

Answer 346

Associated with BRCA 1

Answer 347

Referral to a breast surgeon

Answer 348

More than 50% associated with DCIS. (95%+ DCIS)

Answer 349

Pagets is subareolar and DCIS is often occult

Answer 350

DCIS infiltrates the areola and may be mammographically occult

Answer 351

Prognosis is not affected by the presence of DCIS involving the skin

Answer 352

Hypothyroidism – happens in hyper

Answer 353

ANSWER Can be due to lung, liver or pituitary problems Gynecomastia typically presents as two-sided or “bilateral” growth, but in small percentage of men (less than 5-10%), it can present as single-sided “unilateral”.

Answer 354

Lymphocytic mastopathy is related to T2DM The absence of E-cadeherin differentiates ALH from LCIS

Answer 355

Lymphocytic mastitis

Answer 356

ANSWER: Fat necrosis can have calcification Lymphocytic mastopathy occurs in diabetic (no, SLE, Sjogrens and hashimotos)

Answer 357

Fat necrosis

Answer 358

ANSWER Radial scar Sclerosing adenosis – does increase but not highest PASH - Pseudoangiomatous stromal hyperplasia - benign

Answer 359

If Bx shows radial scar, it needs further management

Answer 360

Tubular carcinoma

Answer 361

Radial scar

Answer 362

Tubular carcinoma STARFACE Summation shadow Tumour I.e. invasive breast cancer Abscess Radial scar Fibroadenoma/fat necrosis Adenosis (sclerosing) CE: Other causes, haematoma e.g. post-operative/post-biopsy

Answer 363

Linear branching 1mm smooth calcifications

Answer 364

Prognosis associated with nuclear grade.

Answer 365

Likelihood of recurrence is due to whether there is wide margin of excision

Answer 366

Presents as a palpable mass.

Answer 367

Prognosis is 50% in 5 years.

Answer 368

Sclerosing adenosis - 2 x higher

Answer 369

PASH – benign and circumscribed

Answer 370

It is an incidental finding, no further treatment required

Answer 371

Well defined on Mammo

Answer 372

Most are IDC

Answer 373

Histologically, the vast majority are invasive ductal carcinoma (85-90%) or ductal carcinoma in situ.

Answer 374

False; Angiosarcs of the breast are related to RTX

Answer 375

Mass with axillary nodes this presentation occurs in 30-50% breast lymphoma, R breast involved more than left (60% to 40% respectively) main pathology is DLBCL.

Answer 376

FALSE Papillary carcinoma appears as a stellate mass - The most common mammographic pattern of invasive papillary carcinoma is a round, oval or lobulated mass.

Answer 377

Almost always a papilloma

Answer 378

Cholangiocarcinoma

Answer 379

Mastectomy and lymph node excision

Answer 380

Contains foci of chondroid, osteoid and lipoid (?) metaplasia (can be, but rare) Other two are common

Answer 381

Phylloides

Answer 382

Collagenous spherosis - Myoepithelial proliferative breast disease Myofibroblastoma (looked this up, it does arise in stroma, so it is incorrect).

Answer 383

Skin punch Bx

Answer 384

Von Hippel Lindau

Answer 385

true Adrenal insufficiency Addison’s disease: acute stage: the patient presents with fever, back pain, hypotension, weakness chronic stage: progressive lethargy, weakness, cutaneous pigmentation, weight loss

Answer 386

Primary hyperaldosterone is rarely idiopathic

Answer 387

FALSE b) can rarely present with hypertension and hypokalemia - hyperaldosterosis, Conn syndrome. 10% are not associated with hypertension

Answer 388

all false Cushing disease is caused by an ACTH secreting adrenal adenoma - False Disease is caused by a pituitary adenoma. Syndrome is caused by others Neuroblastoma arises from the adrenal cortex False, arise from adrenal medulla precursors Bilateral metastasis is the most common cause of Addison’s disease - idiopathic autoimmune disorders are the most common cause in developed countries (80% of cases) Conn’s syndrome is due to bilateral adrenal hyperplasia False - Conn syndrome: when primary hyperaldosteronism is due to an aldosterone-producing adenoma

Answer 389

Renal nephrosclerosis and hypertension

Answer 390

Renal papillary necrosis - but not specific for analgesic nephropathy. Necrosis and sloughing of papillary tissue, can result in substantial loss of renal function

Answer 391

Renal artery stenosis

Answer 392

C. NSAIDS and diffuse cortical necrosis - Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury.

Answer 393

a. NSAIDs Mneumonic NSAID: NSAIDS, sickle cell disease, paracetamol, infection (pyelonephritis, TB), DM or diabetes

Answer 394

a. Papillary necrosis

Answer 395

d. Diabetes

Answer 396

Multiple myeloma and recurrent pyelonephritis

Answer 397

a. Chronic glomerulonephritis - rare

Answer 398

b. Less than 10% are associated with obstruction – false, almost all associated with obstruction

Answer 399

Chlamydia with prostatitis

Answer 400

b. Ureteric lesion and fibromatosis

Answer 401

b. CMV nephropathy.

Answer 402

a. HIV nephropathy.

Answer 403

b) Renal failure Primary parathyroid hyperplasia Sporadic (80%): associated with exposure to radiation and lithium Familial (20%): associated with MEN 1 and MEN 2a Secondary parathyroid hyperplasia Renal failure

Answer 404

Diabetic nephropathy

Answer 405

d. Renal artery vasculitis

Answer 406

Extraperitoneal - (60%)

Answer 407

. Alagille syndrome - variable renal involvement, including cystic kidney disease

Answer 408

Liver fibrosis - ARPKD Von Meyenberg complexes - ADPKD Depends on the type of PKD

Answer 409

MCDK associated with downstream/lower urinary tract abnormality

Answer 410

Multicystic renal dysplasia

Answer 411

Medullary sponge kidney

Answer 412

BOTH a. Proteus is associated with the formation of struvite stones Alkalinizes the urine by hydrolyzing urea to ammonia. This leads to precipitation of organic and inorganic compounds which lead to struvite stone formation. b. Multiple myeloma is associated with recurrent pyelonephritis associated with anaemia, renal failure, proteinuria, hypercalcaemia, pathological fractures, amyloidosis, recurrent infections, plasmacytomas, polyneuropathy

Answer 413

Uric acid - Robbins 952, due to high cell turnover

Answer 414

b. Associated with vesico-ureteric reflux Ureteropelvic junction obstruction (UPJO) and vesicoureteric reflux (VUR) are the most common pathological conditions in pediatric urology, with 9%–14% of patients with UPJO likely to have concomitant VUR.

Answer 415

d) Struvite calculus occurs in the setting of infection – Specific infection

Answer 416

Occurs more commonly on the right than the left - FALSE

Answer 417

Angiomyolipomas CAYUSE OS TS

Answer 418

Pancreatic adenocarcinoma

Answer 419

Associated with papillary RCC (Associated with renal haemangioblastoma ALSO NOT TRUE)

Answer 420

TS associated LAM

Answer 421

Haematuria

Answer 422

Family history

Answer 423

a. Hypertension Causes all (paraneoplastic syndromes), but hypertension is most common

Answer 424

Juvenile ARPCKD and transplant - worse liver than kidneys

Answer 425

c. Acquired renal cystic disease?

Answer 426

a) Dialysis associated dysplasia

Answer 427

Neutrophilia

Answer 428

d. Renal cell carcinoma and analgesic abuse Analgesics are associated with UCC, not RCC Urothelial cell risk factors: Smoking Aryl amines Schistosomiasis Long term use of analgesics Heavy long term exposure to cyclophosphamide Irradiation

Answer 429

Lead and sarcoma

Answer 430

Limbic encephalitis

Answer 431

Papillary RCCs are cystic – They can be when large

Answer 432

b. Papillary RCC

Answer 433

c. Chromophobe RCC

Answer 434

Oncocytoma can pathologically look similar to RCC

Answer 435

Oncocytoma

Answer 436

Clear cell carcinoma Average age of onset for sporadic ccRCC is 61yo. VHL RCC is 36yo

Answer 437

Clear cell and oncocytoma can be difficult to differentiate

Answer 438

e. Is associated with a syndrome of deletion of the 11p chromosome

Answer 439

Approximately 50% of unilateral tumours have a germ line mutation False, 10%

Answer 440

d. Hutchison - Radiopaedia, skeletal mets from neuroblastoma

Answer 441

g. Aniline dye - increased risk of bladder cancer (TCC)

Answer 442

a. Adenocarcinoma

Answer 443

A. Urachal remnant

Answer 444

High risk of non-muscle invasive disease is treated with BCG

Answer 445

a. SCC - schistosomiasis predisposes an individual to SCC Bladder calcification: Schistosomiasis, cytotoxic, radiation, interstitial cystitis, TB, TCC

Answer 446

B. Squamous cell carcinoma

Answer 447

TRUE The classic form of presinusoidal portal hypertension is caused by the deposition of Schistosoma oocytes in presinusoidal portal venules, with the subsequent development of granulomata and portal fibrosis.

Answer 448

b. Strongoloides and transmittal (?transitional)

Answer 449

- Bladder calculi

Answer 450

Prostate - mets to dura via vertebral plexus seeding

Answer 451

D. Rarely invades rectum due to Denonvillier fascia

Answer 452

E. Liposarcoma (46%)

Answer 453

ANSWER: Vertical shelf - oesophageal web Most likely Schatzki ‘A’ ring - Occurs in the distal 1/3, above the gastro-oesophageal junction - Robbins 753 - A few cm proximal to the B ring (located at the GOJ, seen in the setting of hiatus hernia) - B ring - represents the junction of the squamous and columnar epithelium (Z-line), usually 1-3mm in length. May obstruct and doesn't change during the examination Adenocarcinoma - Usually occur in the distal 1/3 of the oesophagus - Robbins 758 - SCC is in the middle 1/3 of the oesophagus - Stricture with an irregular (ulcerated) surface. - Arises from Barrets oesophagus, so usually the lower oesophagus d. Barret oesophagus - No, distal 1/3 of the oesophagus - same distribution as adenocarcinoma, of which it’s a precursor. Presents as a high stricture and hiatus hernia. - Long segment stricture in the mid-lower oesophagus. Reticular mucosal pattern with thickened folds. - Associated with reflux

Answer 454

b. Round sessile filling defect in the oesophagus

Answer 455

a. Hepatitis A

Answer 456

a. Oesophageal web with graft vs host disease Also GORD, radiation and Plummer-Vinson syndrome

Answer 457

B. Oesophageal ring with autonomic neuropathy

Answer 458

a. Traction diverticuli affect the mid-oesophagus

Answer 459

Predisposes to adenocarcinoma

Answer 460

Metaplastic columnar epithelium Diagnosis requires detection of metaplastic columnar mucosa above the GOJ

Answer 461

d. H pylori - radiopaedia Considered protective

Answer 462

b. Perineural invasion – Happens and has very poor prognosis

Answer 463

Adeno better prognosis than SCC

Answer 464

a) oesophageal adenocarcinoma most commonly occurs secondary to Barretts (90-100%)

Answer 465

ANSWER. MALT lymphoma - Thickening of the stomach wall with large lateral extension of the tumour b. Diffuse type adenocarcinoma (Linitis plastica) - thickened with small lumen c. Intestinal type adenocarcinoma - tend to be bulky and grow along broad cohesive fronts to form an exophytic mass or an ulcerated tumour d. GIST - usually forms a solitary, well-circumscribed, fleshy, submucosal mass e. Carcinoid - intramural or submucosal masses that create small polypoid lesions. They are yellow or tan in appearance

Answer 466

b. Bilroth II Increased risk of gastric adenocarcinoma post op - Radiopaedia Resection of distal stomach/partial gastrectomy

Answer 467

b. Hyperplastic polyp

Answer 468

c) H. pylori is associated with gastric adenocarcinoma

Answer 469

c. Recurrence of GIST is related to the initial size Recurrence or metastases is rare for gastric GISTs smaller than 5cm, common if >10cm

Answer 470

a. Leiomyoma in the duodenum: 10-20%

Answer 471

a. Low grade appendiceal tumour Mucinous appendiceal tumour is the most common cause

Answer 472

a. Appendix <5% have mets at diagnosis Foregut - rarely metastasize, generally cured by resection Midgut - tend to be aggressive - jejunum and ileum Hindgut - appendix and colorectum, incidentally. Appendix are nearly benign

Answer 473

e. Terminal ileum

Answer 474

a. Distal ileum 40% small intestine, most frequently the terminal ileum - Radiopaedia

Answer 475

a) caecal cancer presents with fatigue and weakness - right-sided cancers present with generalised fatigue and lethargy (or something similarly vague) rather than occult bleeding

Answer 476

b) Stage II

Answer 477

a. Vulval carcinoma predisposes to/has an association with anal cancer Radiopaedia - previous in situ or invasive cervical, vulva or vaginal cancer

Answer 478

a. Cronkhite-Canada

Answer 479

a. Cronkhite-Canada Not associated with malignancy

Answer 480

Peutz-Jegher

Answer 481

Peutz Jehgers

Answer 482

Lynch syndrome - More frequently right sided (70% proximal to the splenic flexure).

Answer 483

c. HNPCC is associated with urothelial cancer 1 - 7%

Answer 484

b. Colorectal cancer in two first degree relatives - autosomal dominant

Answer 485

Turcot syndrome and meningioma UM ACTUALLY ITS Glioblastoma and medulloblastoma

Answer 486

Familial adenomatous polyposis

Answer 487

Cholangiocarcinoma

Answer 488

Gall bladder cancer

Answer 489

b. Adenomas occur in the stomach and duodenum - Diagnosis requires >100 polyps in the rectum, but polyps occur anywhere in the GIT autosomal dominant, with mutation in APC gene Almost everyone has CRC by 35 - 40.

Answer 490

Gardner’s has increased risk of medullary thyroid cancer - papillary

Answer 491

a. Duodenal ulcer DU >GU, 10-20%

Answer 492

Duodenal ulcers are more common than gastric ulcers . Most common in the proximal duodenum - Robbins 766 Greater curvature lesions are associated with malignancy MALT true but rare False, favours the antrum

Answer 493

ANSWER: a. Gastric cancer 2%, MALT lymphoma 1% b. Mantle cell lymphoma A type of NHL. Not associated with HP c. Decreased vitamin B12 Autoimmune gastritis d. Hyperplastic polyps - NF1 85% associated with chronic gastritis +/- HP. 71% regress with eradication of HP e. Duodenal villous atrophy - associated with coeliac disease Associated with both hyperplastic polyps and gastric cancer

Answer 494

a. Kidney - not affected Not centrally involved in GvHD, and so shouldn't be biopsies

Answer 495

c. Transphinteric

Answer 496

b) more common in 3rd trimester - more common in the 2nd

Answer 497

b) Due to impaired arterial blood supply - venous

Answer 498

a. Pyloric stenosis

Answer 499

c) Moderate risk of biliary stasis

Answer 500

c) Imperforated anus 1%

Answer 501

Secondary biliary cirrhosis

Answer 502

c. Commonly spares the rectum

Answer 503

a. Female more than male

Answer 504

all false?

Answer 505

Greatest risk factor is antibiotic usage

Answer 506

C. Mesenchymal hamartoma

Answer 507

b) Nodularity of the jejunal folds in Whipple disease

Answer 508

Crohns Many studies have reported cases with multiple diaphragm-like strictures in the whole gastrointestinal tract that are associated with the chronic use of NSAID

Answer 509

ANSWER Associated with microcytic anaemia -Associated with megaloblastic anaemia (B12 deficiency) b. Associated with subacute combined degeneration of the cord True - associated with B12 deficiency c. Associated with carcinoid True - extensive parietal and chief cell loss, which can lead to intestinal metaplasia d. High gastrin True, greater than H-pylori. Loss of parietal cells which secrete acid and intrinsic factor

Answer 510

IMA emboli

Answer 511

Behcet disease - ulceration of the mucosa, GI bleed

Answer 512

a. Tight atherosclerotic narrowing of the SMA origin

Answer 513

Pseudomembranous colitis and ischaemia

Answer 514

The most common cause is diverticulitis

Answer 515

Crohn disease

Answer 516

a. Pseudopolyps - favours a diagnosis of UC. Moderate in crohns, marked in UC Crypt abscess - common in both Granulomas - not seen in UC. Non-caseating is characteristic of CD Fissures - deep linear fissures are characteristic of CD. Mucosal and superficial involvement in UC Pseudopolyp - marked (mucosal remnants).

Answer 517

Toxic megacolon is more common than in Crohn disease - Seen in both types, but relatively common in UC and rare in crohns There is non-segmental involvement - True There are granulomas - false, a feature of crohns There is marked lymphoid reaction - feature of crohns There is transmural involvement - false feature of crohns

Answer 518

d. Ischaemic colitis is most associated with the rectosigmoid junction

Answer 519

Associated with MALToma - T cell lymphoma is more typical

Answer 520

False, T cell lymphoma more typical

Answer 521

Cholestasis Jaundice - when retention of bilirubin leads to serum levels above 2.0mg/dl. Cholestasis is the impairment of bile flow resulting in retention of bilirubin, bile acids and cholesterol. Can be due to hepatocellular dysfunction, intra-hepatic or extra-hepatic biliary obstruction.

Answer 522

Steatohepatitis - favoured by deranged LFTs OCP presents with cholestasis, budd-chiari syndrome (hepatic vein thrombosis) and hepatocellular adenomas

Answer 523

Can show steatosis early

Answer 524

Increased Ceruloplasmin – reduced ability to produce ceruloplasmin

Answer 525

Coagulative necrosis

Answer 526

Hepatic peliosis is blood filled spaces in the liver

Answer 527

Hepatitis C - hep C rarely causes acute liver failure

Answer 528

Budd-Chiari – Caudate sparing

Answer 529

Hepatitis B - most common, in the developing world, Radiopaedia

Answer 530

Hepatitis B - severe acute hepatitis can occur, or exacerbation of pre-existing HBV infn - Robbins 835

Answer 531

Fulminant liver failure - a contraindication, radiopaedia TIPS - treatment for portal hypertension, where direct communication is formed between a hepatic vein and branch of the portal vein, allowing some portal flow to bypass the liver. Indications: - Acute variceal bleed, with failure of other pharmacological therapy and sclerotherapy - Recurrent variceal bleed - Irretractable ascites - Hepatic hydrothorax - Portal hypertensive gastropathy - Hepatorenal syndrome

Answer 532

Regenerative nodules

Answer 533

Budd-Chiari

Answer 534

Budd-Chiari syndrome - yes, low

Answer 535

Budd-chiari

Answer 536

Alpha-1 anti-trypsin deficiency Panlobular emphysema, hepatic cirrhosis

Answer 537

Autosomal dominant with incomplete penetrance - Penetrance - autosomal recessive. (google)

Answer 538

It is due to excess transport of Copper from the liver into the bloodstream - not quite Deficiency in ATP7B protein causes decreased copper transport into bile FLAIR will show abnormal high signal of the pontocerebellar tract (anterior pontine fibres, pontine tegmental reticular nuclear and middle cerebellar peduncles)

Answer 539

Liver fibrosis Not associated. is associated with ARPKD

Answer 540

a. Crohn’s disease - typically UC - PBC is associated with Sjogren 70%, scleroderma 5%. IBD in general is not associated with PBC Cholestatic liver function tests – may be present in both c. Anti-mitochondrial antigen - most characteristic lab finding of PBC - Robbins 858 d. Elevated AFP – Not associated with PSC or PBC. Related to HCC

Answer 541

More common in males - true, 70%

Answer 542

a. Anti-smooth muscle antibody - antibody titres are usually absent or low - Radiopaedia

Answer 543

Anti-mitochondrial antibody - most characteristic lab finding of PBC - Robbins 858 Radiopaedia: highly sensitive and specific for PBS

Answer 544

Choledochocoele

Answer 545

Involves both intra and extra hepatic radicals

Answer 546

Liver cirrhosis

Answer 547

Inflammatory bowel disease Not associated

Answer 548

Oral contraceptive pill – OCP increases biliary cholesterol secretion, raising the level of cholesterol saturation of bile and predisposing to cholesterol precipitation and gallstone formation

Answer 549

4 1 - fusiform dilation of the extrahepatic bile duct 2 - saccular outpouchings from the supraduodenal extrahepatic bile duct or intrahepatic bile duct 3 - focal dilation of the distal common bile duct into the duodenum (choledochocele) 4 - multiple communicating intra- and extra-hepatic duct cysts 5 - caroli disease

Answer 550

The liver has giant cell granulomas on biopsy False, biopsy of the liver shows an absence of multinucleated giant cells in biliary atresia. 10% associated with heterotaxy syndrome

Answer 551

Beta catenin adenoma has propensity for malignant transformation >5cm catastroph haemorrhage fnh no ocp assoc

Answer 552

Beta catenin subtype occurs in men taking androgenic steroids

Answer 553

More commonly infiltrative than exophytic mass

Answer 554

Peliosis hepatitis is sinusoidal dilatation with blood filled cystic spaces.

Answer 555

Lysosomal storage disorder

Answer 556

More common in women infiltrating type more common

Answer 557

D. Has central scar

Answer 558

No significant association with cirrhosis

Answer 559

Peak incidence in 20s-30s - true, 20 - 40 - Radiopaedia

Answer 560

Cirrhosis and fibrolamellar hepatocellular carcinoma

Answer 561

Primary sclerosing cholangitis - 15% risk

Answer 562

Porcelain gallbladder - associated with gallbladder cancer

Answer 563

central worse than peripheral

Answer 564

Not significantly associated with cirrhosis Not usually with elevated AFP

Answer 565

Major risk factor/association with opisthorchis sinensis

Answer 566

Cholangiocarcinoma

Answer 567

Choledochal cyst - Life time risk of 10 - 15% Radiopaedia

Answer 568

Chronic hepatitis B -

Answer 569

Arises from a normal gallbladder - usually cholelithiasis

Answer 570

Arsenic Thorotrast Rare malignancy, third most common primary liver tumour. Associated with haemochromatosis and NF1. Environmental exposure to thorotrast, arsenic, radiation and vinyl chloride are implicated as risk factors

Answer 571

Alpha-1 antitrypsin deficinecy

Answer 572

A. Arsenic and angiosarcoma

Answer 573

b. Thrombocytosis - platelet count should reduce in pregnancy

Answer 574

Liver problems

Answer 575

Proteinuria

Answer 576

Viral hepatitis- this one world wide

Answer 577

10-20% of patients with gallstones develop pancreatitis - only ~5%

Answer 578

Thyroid disease

Answer 579

Diffuse enlargement

Answer 580

Elevated serum pH

Answer 581

Acute pancreatitis

Answer 582

Most common in late middle aged women

Answer 583

Solid-cystic pseudopapillary neoplasm

Answer 584

Solid pseudopapillary neoplasm - mean age 29yo. young woman 88%,

Answer 585

Insulinoma

Answer 586

Acinar cell carcinoma associated lipase hypersecretion syndrome.

Answer 587

Gastrinoma and GORD - gastritis - dicey

Answer 588

Gastrinoma

Answer 589

Gastrinoma in or adjacent the duodenum

Answer 590

Lymphadenopathy

Answer 591

IPMN is typically in the body or tail - head 50%, tail 7%, uncinate process 4% and elsewhere 39%

Answer 592

false, grandfather lesion

Answer 593

Pancreatic adenocarcinoma

Answer 594

Serous cystadenoma

Answer 595

Serous macrocystic adenoma

Answer 596

Choristoma

Answer 597

Usually HSV 1 in adults

Answer 598

HSVI most common in adults a more common in children and young adults

Answer 599

Haemorrhagic necrosis Necrotising and often haemorrhagic in the most severely affected regions False, enterovirus is the most common cause of meningitis False, 90% of childhood and adult herpes are HSV-1 Anterior and mesial temporal lobes. Bilateral asymmetrical limbic system, medial temporal lobes, insular cortices and inferolateral frontal lobe. Basal ganglia are spares Only 10% will have a history of prior herpetic infection

Answer 600

HSV is characteristically inferior temporal - Anterior and mesial temporal lobes. Bilateral asymmetrical limbic system, medial temporal lobes, insular cortices and inferolateral frontal lobe.

Answer 601

Craniopharyngioma

Answer 602

CJD progresses slowly

Answer 603

Globus pallidus

Answer 604

Quick progression of dementia with motor and sensory dysfunction

Answer 605

Fatal familial insomnia Does not show spongiform pathology

Answer 606

Affects the basal ganglia and gyri early Typically cortical and deep grey matter DWI changes

Answer 607

true, JC virus

Answer 608

John cunningfield virus

Answer 609

Cysticercosis

Answer 610

Locomotor ataxia

Answer 611

Primary CNS Lymphoma - Second most common CNS lesion in AIDS Toxoplasmosis is the most common opportunistic infection

Answer 612

Measles True, caused by persistent, but nonproductive, infection of the CNS by an altered measles virus

Answer 613

Ring enhancing cerebral lesions occlusion of cerebral arteries by septic and thrombotic emboli = focal ischaemic, cerebral haemorrhage or both. Meningeal/parenchymal or vascular wall infn. With numerous microabscess' which can coalesce to form a macroabscess

Answer 614

SSPE (subacute sclerosing panencephalitis) Measles virus

Answer 615

Spongiform encephalopathy - prion

Answer 616

Diffuse axonal injury

Answer 617

Kernohans notch assoc w ipsilateral compression by falx

Answer 618

Pontine haemorrhage is associated with uncal herniation - Duret haemorrhage

Answer 619

Non-communicating can cause rupture of the pineal recess - causes outward bowing of the recesses of the third ventricle

Answer 620

25% infarct within 24 hours secondary to vasospasm – too early

Answer 621

Frontal lobe - maybe

Answer 622

Large haemorrhagic infarcts.

Answer 623

Amyloid angiopathy

Answer 624

ISS - Internal cerebral vein - drains the thalami and periventricular white matter Cavernous sinus Drains the ophthalmic veins and superficial cortical veins Isolated CN III palsy, periorbital and facial swelling and exophthalmos, papilloedema SSS Most common, presents non-specifically with headache/seizure/plegia/ visual changes VoL non spec

Answer 625

Cerebral infarction

Answer 626

Liquefactive necrosis

Answer 627

Corpus callosum

Answer 628

Corpus callosum

Answer 629

B2 (riboflavin) Inflammation of the mucosal membranes of the oral cavity and pharynx

Answer 630

Methanol causes hippocampal damage Preferentially affects the retina, selective bilateral necrosis of the putamen and focal white-matter necrosis

Answer 631

Ethanol and cerebellar damage - in 1% of chronic alcoholics

Answer 632

Leigh syndrome Disease of infancy

Answer 633

Fat soluble material can pass through rapidly

Answer 634

Posterior scleral atrophy

Answer 635

Treatment with desmopressin - this is the treatment

Answer 636

Huntington disease

Answer 637

Early findings are in occipital lobe

Answer 638

Asymmetrical frontotemporal atrophy

Answer 639

Asymmetric frontal and temporal lobe atrophy True, markedly asymmetrical

Answer 640

Superior frontal lobe white matter

Answer 641

Pituitary cancer and gigantism

Answer 642

Macroadenoma can happen after auto-adrenalectomy / bilateral adrenalectomy

Answer 643

MEN2 C complex yes, C triad no

Answer 644

Papillary form is usually solid

Answer 645

Prolactin – Dopamine is unable to have it inhibitory effect

Answer 646

Commonly occurs in MEN2. (MEN 1)

Answer 647

Pit microadenoma commonly causes lactation, amenorrhoea- maybe Pit macroadenoma commonly invades cavernous sinus – depends what commonly means

Answer 648

Lymphocytic hypophysitis

Answer 649

Active plaque shows loss of myelin

Answer 650

ADEM is associated with post bacterial infection – viral and vaccines

Answer 651

Characterised by demyelination and axonal loss

Answer 652

ADEM is caused by bacterial infection Cross-reactivity in immunity to viral antigens

Answer 653

Schwann cells are the neoplastic cells involved in neurofibromas

Answer 654

Both Chiari I and II have syringomyelia

Answer 655

Chiari 1 malformation Congenital (90%): - Myelomeningocele - Chiari I and II malformations - Dandy-Walker malformation - Klippel-Feil syndrome Acquired - Post traumatic, occur in ~5% - Cervical canal stenosis - Post-inflammatory - Secondary to a spinal cord tumour, haemorrhage - Vascular insufficiency

Answer 656

Trauma Metachromatic leukodystrophy

Answer 657

Adrenoleukodystrophy Metachromatic leukodystrophy Autosomal recessive, chromosome 22q13 Alexander disease Chromosome 17q21 Canavan disease Chromosome 17, recessive

Answer 658

Leigh syndrome Disease of infancy

Answer 659

Central neurocytoma

Answer 660

Usually involves grey matter and adjacent meninges

Answer 661

centrla neurocytoma

Answer 662

Medulloblastoma

Answer 663

Medulloblastoma

Answer 664

Astrocytoma

Answer 665

PIlocytic astrocytoma

Answer 666

Pleomorphic xanthoastrocytoma II

Answer 667

By the time of diagnosis, has usually extended into the cisterna magna

Answer 668

Subependymoma occurs in the 4th ventricle Most commonly, but can arise anywhere there is ependyma

Answer 669

JPA Typically presents with signs of raised intracranial pressure

Answer 670

Pleomorphic xanthoastrocytoma 98% supratentorial

Answer 671

Central neurocytoma 70% diagnosed between 20 - 40yo. Typically attached to the septum pellucidum

Answer 672

Arises from the roof of the 4th ventricle

Answer 673

Round cells with abundant cytoplasm Small cells with scant cytoplasm

Answer 674

Contains haemorrhage and necrosis

Answer 675

Something about surrounding SWI indicating haemorrhage

Answer 676

< 3 hours.

Answer 677

Shunting of arterial blood to venous system is rarely seen

Answer 678

There is internal normal brain tissue within lesions.

Answer 679

Prostate – least likely

Answer 680

Prostate All of the above met to dura: breast > prostate > lung, but prostate to dura before intra-axial brain

Answer 681

Choriocarcinoma Haemorrhagic brain mets: melanoma, RCC, choriocarcinoma, thyroid, lung and breast

Answer 682

Metastasis from Chorio?

Answer 683

Most common at S1 & S4

Answer 684

Terminalis ventricularis

Answer 685

A 2cm aneurysm is more likely to rupture than a 1cm aneurysm Aneurysms greater than 10mm in diameter have a roughly 50% risk of bleeding per year

Answer 686

Warthin’s

Answer 687

Warthin tumour ( 70% bilateral, or multiple in one gland superficial, STatDx states all above features)

Answer 688

Anaplastic better prognosis – not a type of parotid lesions

Answer 689

Favours perineural spread

Answer 690

Acinic cell cancer

Answer 691

Arises from pleomorphic adenoma

Answer 692

Acinar cell carcinoma - rare, malignant. 1 - 3% of salivary gland tumours

Answer 693

think we're going with ACC on this one

Answer 694

Increased risk of SCC (rare)

Answer 695

Do occur, but rare, as papillary thyroid carcinoma. Presence of calcification is suggestive of malignancy

Answer 696

Thyroglossal cysts are remnants of vestigial thyroglossal ducts

Answer 697

Posterior triangle

Answer 698

Patients with Hashimoto have an increased risk of Hodgkins lymphoma.

Answer 699

Can have initial hyperthyroidism, followed by a period of hypothyroidism

Answer 700

Rarely malignant

Answer 701

Hodgkin lymphoma as an association

Answer 702

Degenerate thyroid cells, there may be hurthle cells

Answer 703

Subacute granulomatous thyroiditis

Answer 704

Idiopathic orbital inflammation Thyroid eye disease wouldn't be painful

Answer 705

Patients with Graves disease have low TSH levels

Answer 706

Anaplastic thyroid Ca presents with bone mets – Uncommon site for mets (13%), mets are common at diagnosis papill usually solitary follicular to nodes late

Answer 707

Medullary carcinoma is a neuroendocrine tumour.

Answer 708

Papillary thyroid cancer

Answer 709

Medullary has amyloid Lymphoid infiltration in Hashimotos

Answer 710

Medullary carcinoma represents more than 50% of thyroid carcinoma

Answer 711

Nodular and enlarged

Answer 712

In hyperthyroidism nuclear med scan should be the first investigation

Answer 713

Renal failure

Answer 714

Secondary HPTH – Is caused by does not cause but is closest to true

Answer 715

It is a feature of both MEN 1 and MEN 2

Answer 716

If there is bilateral Rb then it means there is an underlying germ line mutation. 30% are bilateral

Answer 717

Retinoblastoma

Answer 718

More common in males - no gender predilection

Answer 719

Keratocytic odontogenic tumour - high tendency to recur after surgical treatment. Due to infiltrative growth pattern

Answer 720

Ondontogenic keratocyst - OKC

Answer 721

Location is the posterolateral wall of the nose - centered on the sphenopalatine foramen

Answer 722

Anteriorly to maxillary sinus

Answer 723

Mucomycosis is associated with diabetic ketoacidosis Occurs in immunocompromised pts - e.g. DKA, neutropaenia leprosy does cause nasal septal perf

Answer 724

Papilloma - HPV 6 and 11 have been identified in 2/3 types

Answer 725

Juvenile laryngeal papillomatosis -HPV

Answer 726

2nd branchial cleft cyst 3rd branchial cleft cyst - must lie posterior to the common or internal carotid

Answer 727

Occurs in the parotid - first

Answer 728

Mullerian duct

Answer 729

Stromal tumour

Answer 730

false condylomas do NOT commonly progress to cancer. - HPV 6 and 11, low risk of transmutation Condylomata acuminata occur on the external genitalia or perineal areas. The normal orderly maturation of the epithelial cell is preserved; dysplasia is not evident.

Answer 731

Rhabdomyosarcoma

Answer 732

Vulval carcinoma predisposes to/has an association with anal cancer

Answer 733

Adenomyosis tends to cause more diffuse uterine enlargement than leiomyomas Early loss of response to the cyclical hormone influence . True - the ectopic endometrial glands within the myometrium do not respond to cyclic ovarian hormones, unlike those of endometriosis

Answer 734

Involved uteruses have a coarsely nodular external contour - Contour is usually preserved

Answer 735

Ovarian more common than uterine

Answer 736

If complex with atypia, 1/3 progress to carcinoma 25 - 50%

Answer 737

Can spread to the serosa - stage 2

Answer 738

All false Tamoxifen is associated with type 2 False - Type 1 Type 1 is associated with atrophy False - Type 2 Type 2 is associated with oestrogen secretion False - in the setting of endometrial atrophy Type 1 is most common, 80% of cases - high oestrogen exposure: obesity, hypertension, diabetes, tamoxifen. Precursor is hyperplasia. Mutant gene is PTEN. Type 2 is serous carcinoma, generally in an older cohort than type 1. Arise in the setting of endometrial atrophy

Answer 739

Type 1 is usually low grade Well differentiated with relatively slow progression and a more favourable outcome. Type 2 tends to be less differentiated and spread early via lymphatics, associated with a poorer prognosis than type 1

Answer 740

Type 2 associated with infertility

Answer 741

Tamoxifen causes endometrial thickening True - causes endometrial hyperplasia in 1 - 20%: Radiopaedia

Answer 742

Endometrial cancer vs post-menopausal uterus

Answer 743

Can spread to the serosa

Answer 744

Endometrial cancer

Answer 745

HNPCC is associated with urothelial cancer

Answer 746

Pregnancy is associated with disseminated peritoneal leiomyomatosis True - usually incidentally discovered in women of reproductive age. A rare benign disorder characterised by multiple vascular leiomyomas growing along the submesothelial tissues of the abdominopelvic peritoneum. Radiopaedia Leiomyosarcoma typically spreads to the brain Eventually metastasize hematogenous to distant organs, such as lung, bone and brain. Robbins 1021

Answer 747

Most commonly presents in women in their 20s and 30s False, occur in ~25% of women of reproductive age, 30 - 40% of women older than 40. The risk of development increases with age

Answer 748

Leiomyoma >10cm has a significant risk of foci of malignancy

Answer 749

Leiomyoma mostly 20 to 30s

Answer 750

Leiomyoma mostly 20 to 30s

Answer 751

Leiomyomas True - may distort the usual smooth uterine contour - Radiopaedia

Answer 752

Multiple leiomyomas

Answer 753

There is not even moderate mitotic activity Mitotic figures are scarce. There is a low mitotic index. Can have rare high mitotic activity

Answer 754

Rhabdomyosarcoma and retinoblastoma Rhabdomyosarcoma is a rare second cancer in hereditary retinoblastoma patients More commonly associated with osteosarcoma

Answer 755

Distinguishing benign from malignant is most difficult in young patients Mitotically active leiomyomas are found in young/pregnant women and caution should be exercised in interpreting them as malignant Development from a leiomyoma is rare True, exceedingly rare, if at all

Answer 756

Leiomyosarcomas are monoclonal proliferations Leiomyoma is a precursor – noted to be very rare

Answer 757

leiomyoma (initially this was adenosarc but i dont fckn buy it. leiomyoma can have little disseminated peritoneal lesions but its benign really)

Answer 758

Adenosarcoma of the endometrium - adenosarcoma of the uterus is a rare tumour that typically originates in the lining of the uterus – endometrium Carcinosarcoma of the cervix -Extremely rare Adenocarcinoma and the vulva – rare, but can develop from glands, most commonly the Bartholin's glands located at the vaginal opening Serous adenocarcinoma and the vagina – adenocarcinoma is a common malignant prevalent in the endometrium, ovary and vagina among other gynae sites. Serous papillary adenocarcinoma (SPAC) is an aggressive subtype with a poor prognosis

Answer 759

Adenocarcinoma has the same HPV risk factors as SCC True - HPV is the greatest risk factor for both.

Answer 760

Upper vaginal involvement has a poor prognosis Stage II disease - Require a radical hysterectomy. Generally 90% 5-year survival rate

Answer 761

Adenocarcinoma of the cervix and HPV

Answer 762

Lichen sclerosis ex and basaloid SCC

Answer 763

Upper vaginal involvement has poorer prognosis

Answer 764

Death is usually due to local pelvic complications

Answer 765

Involves para-aortic nodes first

Answer 766

It is a risk factor for ovarian cancer Ovarian cancer is increased 2 - 3 fold in women with PCOS

Answer 767

ANSWER Serous cystadenocarcinoma - Largest proportion of malignant ovarian tumours, 50 - 80%. ~25% of serous tumours. - Incidence peaks around the 6th-7th decade of life Mucinous cystadenoma - Peak incidence ~30-50yo Granulosa - Uncommon type of ovarian neoplasm, 2 - 5% of ovarian malignancies. Often occur in middle-aged and postmenopausal women, with a peak incidence between 50 - 55yo Serous cystadenoma - Incidence peaks at the 4th - 5th decade of life MMMT - Vry rare, less than 1% of ovarian cancers. - Postmenopausal women, usually between 6th and 8th decades of life Other answers: Choriocarcinoma – non-gestational choriocarcinoma arises in women under 40yo because of germ cell tumour Endometrioid carcinoma – arises in younger women, considered to be oestrogen dependent with a defined precursor lesion Teratoma – tend to be identified in young women, typically around the age of 30yo

Answer 768

Associated with serous ovarian carcinoma Risk of ovarian cancer in both BRCA1 and BRCA2. The frequency of BRCA mutation in high grade serous carcinoma was 25.7% MUCINOUS KRAS

Answer 769

A similar lesion on the left - Frequently

Answer 770

Usually unilateral

Answer 771

Mucinous cystadenocarcioma

Answer 772

Mucinous cystadenoma is common in post-menopausal women

Answer 773

>20 cysts of varying sizes

Answer 774

Ovarian teratomas are associated with limbic encephalitis. TRUE! Correct answer.(SCLC, Testicular, Thymic, Breast) In approximately 60% of cases, antineuronal antibodies are present such as the anti-Hu antibody in small cell lung cancer, the anti-Ta antibody in testicular cancers, anti-NMDA NR1 in ovarian teratomas or anti-NMDA NR2 in SLE patients.

Answer 775

Dysgerminoma

Answer 776

Dysgerminoma

Answer 777

Very rarely transforms into choriocarcinoma - Partial hydatidiform moles (PMs) rarely require chemotherapy and have never previously been proven to transform into choriocarcinoma.

Answer 778

all false, tricked u

Answer 779

Can occur years after a normal pregnancy

Answer 780

Choriocarcinoma can present months after a molar pregnancy - true complete mole paternal only, partial are both

Answer 781

Complete moles have fetal parts

Answer 782

Gestational trophoblastic disease that arises 2 years from last pregnancy has a better prognosis that occurs 15 years after pregnancy. Only up to 12 months.

Answer 783

Partial mole sometimes has foetal parts Associated with markedly elevated bHCG

Answer 784

Complete mole is usually due to 1-2 sperm fertilising an egg devoid of chromosomes

Answer 785

Endometroid Bilateral involvement in 25 - 50% of cases : Radiopaedia

Answer 786

Brenner tumours may be identified as a solid hypoechoic mass

Answer 787

Adenosarcoma and the endometrium - Adenosarcoma of the uterus is a rare tumor of the uterus that typically originates in the lining of the uterus (endometrium). This type of tumor is characterized by both benign (noncancerous) and malignant components (low-grade sarcoma). Carcinosarcomas are malignant tumors that consist of a mixture of carcinoma (or epithelial cancer) and sarcoma (or mesenchymal/connective tissue cancer). Carcinosarcomas are rare tumors, and can arise in diverse organs, such as the skin, salivary glands, lungs, the esophagus, pancreas, colon, uterus and ovaries. Carcinosarcomas of the uterine cervix are extremely rare. Adenocarcinomas of the vulva are also rare, but can develop from glands, most commonly the Bartholin's glands located at the vaginal opening. Adenocarcinoma is a common malignancy that is prevalent in the endometrium, ovary, and vagina among other gynecological sites. Serous papillary adenocarcinoma (SPAC) is an aggressive subtype with a poor prognosis.

Answer 788

Granulosa cell tumour - The peak age at which they occur is 50–55 years, but they may occur at any age.

Answer 789

Juvenile granulosa cell Choriocarcinoma

Answer 790

Sertoli-Leydig cell tumour Aromatase inhibitors. - estradiol

Answer 791

Sertoli cell tumour – nurse cell for spermatogenesis – 3% produce hormones

Answer 792

Leydig cell tumour

Answer 793

Choriocarcinoma

Answer 794

?25% arise post-abortion

Answer 795

More common in premenopausal women compared to post-menopausal

Answer 796

Non-gestational choriocarcinoma is highly sensitive to chemotherapy - False, non gestational is more aggressive, and historically less responsive

Answer 797

Most common in women of reproductive age - In females, it may occur during or outside of pregnancy; non-gestational choriocarcinoma of the ovary typically occurs in prepubertal girls and postmenopausal women.

Answer 798

Thecoma and endometrial thickening and (other endometrial problem). - About 15% of affected patients develop endometrial hyperplasia (EH) and 20% are diagnosed with endometrial cancer.

Answer 799

Retroperitoneal - Stage III

Answer 800

Carcinosarcoma and post-menopausal females Usually 6th-8th decade

Answer 801

Gestation and non-gestational choriocarcinoma have the same prognosis When associated with gestation = gestational, absence of gestation is non-gestational Non gestational is resistant to single-agent chemotherapy and has a worse prognosis than gestational choriocarcinoma

Answer 802

Ovarian carcinoma

Answer 803

Denervation injury results in fatty atrophy

Answer 804

Dysphagia In approximately 50% An inflammatory myositis. Most common acquired in pts over 50yo Usually proximal and distal muscles, usually bilateral but can be asymmetrical. Associated with diabetes mellites 20%, other autoimmune conditions 15%

Answer 805

Nodular fasciitis has irregular margins Well-defined nodules on USS

Answer 806

Fibromatosis of the penis is often ventral Dorsolateral aspect of the penis

Answer 807

Plantar fibromatosis is commonly seen in females All forms of superficial fibromatoses are more common in men

Answer 808

Ureteric lesion and fibromatosis

Answer 809

Undifferentiated pleomorphic sarcoma - most common

Answer 810

Adenomatoid tumour

Answer 811

Chronic lymphoedema and lymphangiosarcoma

Answer 812

Lead and sarcoma

Answer 813

Arsenic and hepatic angiodysplasia

Answer 814

Neurosarcoma of the peripheral nerve

Answer 815

Rhabdomyosarcoma and retinoblastoma

Answer 816

Angiosarcoma Usually superficial or subcutaneous

Answer 817

Leiomyosarcoma typically spreads to the brain

Answer 818

Leiomyosarcomas are monoclonal proliferations

Answer 819

Majority of leimyosarcomas arise de novo and rarely arise from leiomyomas

Answer 820

Liposarcoma Most common ~90%

Answer 821

liposarcoma

Answer 822

Tumours arise from the joint Rare to arise from the joint itself. Don’t arise from synovial structures

Answer 823

Desmoplastic fibroma

Answer 824

Vasculitis spares the kidneys Renal failure in RA is due to amyloidosis

Answer 825

Is a cause for Baker’s cyst

Answer 826

Rheumatoid arthritis

Answer 827

Rheumatoid nodules indicate rapidly progressive disease

Answer 828

Dilated oesophagus

Answer 829

Mononeuritis multiplex

Answer 830

a. Mononeuritis multiplex Compared to RA, oligoarthritis is more common, systemic disease is more frequent, large joints are more affected than small joints, rheumatoid nodules and rheumatoid factor are usually absent, ANA seropositivity is common.

Answer 831

RF negative, Anti-CCP positive

Answer 832

Changes in the type 2 collagen

Answer 833

Calcium pyrophosphate

Answer 834

Positive birifringent crystals

Answer 835

Calcium pyrophosphate

Answer 836

Associated with hyperparathyroidism True - secondary CPPD

Answer 837

Secondary CPPD is associated with haemochromatosis Most common in the knee

Answer 838

Pubic symphysis calcification - CPPD of the pubic symphysis fibrocartilage

Answer 839

20% die of renal failure

Answer 840

Associated with metabolic syndrome

Answer 841

Synovial fluid is a poorer solvent for monosodium urate than plasma

Answer 842

Patients form calcium oxalate renal stones Uric acid nephrolithiasis

Answer 843

Occurs at tendon insertions in psoriatic arthritis. found in the hyaline cartilage, or synovial fluid in scleroderma Pathological deposition of hydroxyapatite is frequent in juvenile dermatomyositis

Answer 844

Focal calcification in the rotator cuff

Answer 845

alll of the above tricked u

Answer 846

Gonorrhoea

Answer 847

a. Commonly seen following gastrointestinal infections Can be due to GIT infection or GU

Answer 848

Seen post GI infection

Answer 849

CMV - rare

Answer 850

Plantar fasciitis

Answer 851

Haematological route of spread is most common

Answer 852

Adjacent cellulitis

Answer 853

Septic arthritis

Answer 854

Anticardiolipin antibodies and symmetric arthritis

Answer 855

Lumbosacral spine is the most common location - false,, typically mid thoracic/thoracolumbar

Answer 856

PVNS associated with synovial inflammation

Answer 857

A. Most commonly seen in the hip

Answer 858

Diffuse form is more common in the upper limb

Answer 859

Cortical erosion

Answer 860

Osteitis condensans ilii

Answer 861

Congenital PAP may resolve at 6 months - requires transplant

Answer 862

Acquired PAP is associated with immunosuppression Secondary PAP- 5-10% present in patients with other precipitating illness e.g. HIV/AIDs Immunosuppression is the secondary PAP. Acquired is autoimmune

Answer 863

FALSE; IGG ANTIBODIES TO GM CSF

Answer 864

Chronic HP affects the lower lobes Acute is mediated by a type 3 (immune complex) reaction. Chronic is mediated by a type 4 (cell-mediated) immune reaction Compliment and immunoglobulins are found within the walls

Answer 865

Fibrosis occurs in the lower zones

Answer 866

Calcium carbonate duct

Answer 867

Associated with HPOA (hypertrophic pulmonary osteoarthropathy)

Answer 868

Incidental finding on imaging

Answer 869

Chronic eosinophic pneumonia is ??? diffuse opacity and not responding to steroids

Answer 870

Permanent enlargement of airspaces distal to the terminal bronchiole

Answer 871

Spontaneous pneumothorax can be due to paraseptal emphysema.

Answer 872

Clinical diagnosis.

Answer 873

Autosomal dominant with incomplete penetrance Autosomal recessive condition

Answer 874

Most asbestos pleural plaques contain asbestos bodies

Answer 875

Silicosis in pulmonary fibrosis predominantly occurs in lower lobes.

Answer 876

Silicosis affects the upper zone

Answer 877

Lower lobe distribution False - upper lobe predominant

Answer 878

Bronchogenic carcinoma F (Robbins – no compelling evidence that CWP predisposes to cancer) also TB? Robbins 8e: “Unlike silicosis (discussed later), there is no convincing evidence that coal dust increases susceptibility to tuberculosis. There is some evidence that exposure to coal dust increases the incidence of chronic bronchitis and emphysema, independent of smoking. Thus far, however, there is no compelling evidence that CWP in the absence of smoking predisposes to cancer.”

Answer 879

Commonly invades mediastinum

Answer 880

Can appear histologically (?and morphologically) identical to adenocarcinoma - Difficult to differentiate histologically if adenocarcinoma does not produce mucin Different now, with immunohistochemical stains

Answer 881

Pleural effusion is usually present

Answer 882

Vinyl chloride

Answer 883

Asbestos workers who smoke have a greater risk of developing mesothelioma than those who do not smoke F amphiboles are more carcinogenic than serpentines, and crocidolite is the most hazardous in the amphibole family Mesothelioma risk related to asbestos exposure only (Not associated with smoking) Bronchogenic carcinoma risk related to asbestos exposure & smoking (asbestos workers who smoke have 80-100 x’s risk c.f. non-smoking, non-exposed population)

Answer 884

Target sign in invasive aspergillosis is due to gelatinous exudate

Answer 885

ABPA is caused by superficial colonization of bronchial mucosa A hypersensitivity reaction to Aspergillus. An immediate (type 1) hypersensitivity reaction to aspergillus antigen accounts for the acute episodes of wheezing and dyspnoea, while an immune complex-mediated (type 3) hypersensitivity within the lobar bronchi leads to bronchial wall inflammation and proximal bronchiectasis.

Answer 886

True - mucormyocosis is an opportunistic pulmonary fungal infection, indistinguishable clinically from invasive pulmonary aspergillosis The reverse halo sign is fairly specific to suggesting the diagnosis - radiologically different

Answer 887

Hypocalcemia - medullary thyroid ca can secrete calcitonin. Small cell mets to bone can cause this too

Answer 888

Carcinoids arise from alveolar lining cells and typically deviate rather than directly involve - least correct. Arise from neuroendocrine cells in bronchial mucosa

Answer 889

Carcinoid arises from metaplastic bronchial epithelial cells

Answer 890

Neuroendocrine cells in lung scar tissue are inconsequential

Answer 891

Typical carcinoid is not a precursor

Answer 892

Haemorrhagic pleural effusion raises concern for malignancy

Answer 893

Renal failure is a common cause of haemorrhagic effusion

Answer 894

Pleural effusion is usually present

Answer 895

Rarely affects the ophthalmic arteries

Answer 896

upper airways

Answer 897

Renal artery vasculitis

Answer 898

Smoking and RB-ILD True weggys; Non-caseating granulomatous C-ANCA positive vasculitis Granulomas and collections of T-lymphocytes, not immune complexes

Answer 899

Klebsiella presents with haemoptysis

Answer 900

Legionella – Atypical infection -> can but less likely to result in overt consolidation

Answer 901

Chronic aspiration with infection from a mouth commensal

Answer 902

Streptococcus pyogenes is the commonest cause of community-acquired pneumonia F Strep pneumonia is most common cause of CAP

Answer 903

Actinomycosis

Answer 904

Pulmonary LCH is commonly seen in adults who smoke

Answer 905

Large bronchi and airways Involves bronchioles - small airways

Answer 906

Represents the form of LCH that has the worst prognosis

Answer 907

Chronic glomerulonephritis – interstitial nephritis

Answer 908

Miculikz syndrome - both are, but this if anything Glandular swelling of the lacrimal and salivary glands. IgG4 disease, but associated with sarcoid - Sjogrens

Answer 909

Lowers vitamin D levels F hypercalcaemia in 10-20% due to ↑ synthesis of 1-α-hydroxylase in granulomas = hypervitaminosis D; assoc/ w/ raised calcitriol levels

Answer 910

Glomerulonephritis

Answer 911

Sarcoidosis

Answer 912

Small cell cancer sarcoid rarely has a necrotic comonents

Answer 913

75% lower lobes probably

Answer 914

Unilateral absence of PERFUSION more likely to due compressing tumour vs massive PE

Answer 915

Hypovolaemic shock F

Answer 916

Chronic small pulmonary emboli

Answer 917

Often occurs several hours after trauma

Answer 918

Chronic recurrent pulmonary embolism

Answer 919

Early lung changes has lower zone predominance Pleural plaques involve both parietal and visceral pleura also but less likely

Answer 920

Pulmonary microlithiasis

Answer 921

While the risk is markedly increased the overall lifetime incidence of mesothelioma with heavy asbestos exposure remains low – in the order of 1 in 1000. (Lifetime risk with high exposure ~10% i.e. 1 in 10)

Answer 922

Adenocarcinoma

Answer 923

Addison’s disease - ?yes, adrenal insufficiency, in the context of bilateral metastases but others also are so

Answer 924

Typical carcinoid is not a precursor

Answer 925

Small cell carcinoma

Answer 926

Bronchial adenoma is always benign and never metastasises

Answer 927

EGFR mutation confers sensitivity to chemotherapy Chemotherapy may increase EGFR mutation

Answer 928

Small cell is peripheral

Answer 929

Peripheral mass, usually as multiple diffuse nodules with tendency to coalescence New 2011 IASLC/ATS/ERS calls it “Adenocarcinoma in situ” now rather than BAC. Occurs as a single nodule or more commonly as multiple diffuse nodules that may coalesce to produce pneumonia-like consolidation Parenchymal nodules appear as solid, grey-white areas – may have a mucinous, grey translucence when secretion is present

Answer 930

Small cell carcinoma is most responsive to chemotherapy (Small cell is sensitive to radiotherapy & chemotherapy, with potential cure rates of 15 – 25 % for localized disease – Robbins p728)

Answer 931

If lung Ca, T4 most likely, T3 if non-transmural involvement

Answer 932

History of a hilar mass 1yr ago, “patient lost to follow up” Robbins – Untreated survival time of 6-17 weeks, treated mean survival 1 year (although sensitive to XRT & chemo – cure rates of 15-25% reported) 

Answer 933

Small cell - T - WHO classified small cell lung cancers into 3 subcategories: oat cell carcinoma, intermediate cell type, and combined oat cell carcinoma. This subclassification has been difficult to reproduce, however, even by expert lung cancer pathologists, and in 1988, the International Association for the Study of Lung Cancer recommended dropping the intermediate cell type from the classification and adding the category of mixed small cell carcinoma and large cell carcinoma. [eMedicine]

Answer 934

Thymolipoma does not compress adjacent structures

Answer 935

SVC syndrome with thymoma - Thymoma is the most common primary tumour arising in the anterior mediastinum and one of the well-known causes of SVCS.

Answer 936

UIP has a better prognosis than NSIP

Answer 937

Traction bronchiectasis

Answer 938

UIP - multiple stages in same lung

Answer 939

Aspirin Associated with pulmonary oedema, also asthma

Answer 940

ANSWR: Metastatic calcification - renal failre Hemosiderosis - Idiopathic pulmonary hemosiderosis - centrilobular Alveolar microlithiasis - Calcification of the interlobular septa

Answer 941

Primary TB

Answer 942

The Ghon focus is characteristic of post-primary (secondary) tuberculosis F (Initial focus of 1° infection + caseous hilar nodes = Ghon complex)

Answer 943

Apical calcified cavitating lesion

Answer 944

Mycobacterium tuberculosis

Answer 945

Pleural effusions more common in primary TB.

Answer 946

Apical calcified cavitating lesion There is no cavity in primary - a cavity will be present with post primary/primary progressive

Answer 947

Asbestosis Reactivation risk factors: High risk: - Spontaneous - Silicosis - HIV/AIDs, - Transplantation - TNF-alpha blockers - Kidney dialysis Moderate risk: - Health care worker - IVDU Low risk - DM - Smoking - Corticosteroid use - Underweight

Answer 948

Isolated organ involvement does occur/ renal or meningeal TB does not imply lung disease T Type IV immune reaction. Occurs ~3wks after exposure. Processed mycobacterial antigens reach draining LNs and are presented in an MHC class II context by dendritic cell macrophages to CD4+ T cells. Helper T cells release IFN which activates macrophages - they then (a) secrete TNF - recruitment and activation of monocytes, differentiate into "epithelioid histiocytes" (granulomatous response), (b) induce NO formation - generates free radicals, and (c) generate reactive O2 species (antibacterial). [Robbins]

Answer 949

Disturbance of chloride channel movement Too little chloride is pumped out CFTR - cystic fibrosis transmembrane conductance regulator, an anion channel that mediates chloride and bicarbonate transport across the apical cell membrane of the epithelial cells lining the airway

Answer 950

2 heterozygotes without the disease have a 25% chance of an offspring with CF An autosomal recessive disease

Answer 951

Defect of sodium transport channel False - the chloride channel, CFTR, mediates chloride and bicarbonate transport across the epithelial cell membrane

Answer 952

Characterised by pseudomonas infection in the lungsT Microbes accumulate in static viscid mucus, resulting in recurrent or chronic infection . Robbins: Pseudomonas aeruginosa (CFTR is cellular receptor for pseudomonas), S. aureus & H. influenza are most common organisms. Goljan: Pseudomonas aeruginosa is most common respiratory pathogen. Also get Aspergillus spp.

Answer 953

Kleinfelters

Answer 954

Juvenile papillomatosis

Answer 955

Monochorionic pregnancy indicates a monozygotic gestation

Answer 956

MCDA or MCMA

Answer 957

May occur in 20% of twin pregnancies

Answer 958

Up to 1 in 8 pregnancies start as twin pregnancy, but one fetus dies

Answer 959

Twin to twin transfusion is arteriovenous and arterioarterio. Dichorionic pregnancy can be homozygous (right word?)

Answer 960

There are two separate placentas

Answer 961

Dichorionic arising from monozygotic

Answer 962

Lymphocytic hypophysitis - far more common than sheehan Diabetes insipidus with posterior pituitary involvement

Answer 963

Viral hepatitis

Answer 964

Physiological gut herniation

Answer 965

Parvovirus B19 – most common infectious cause of non-immune hydrops

Answer 966

Large gastroschisis

Answer 967

Paroxysmal SVT

Answer 968

Paroxysmal SVT

Answer 969

Placenta accreta

Answer 970

Velamentous

Answer 971

Placental abruption

Answer 972

Placenta membranacea

Answer 973

Placenta percreta

Answer 974

Interstitial line sign is seen in cornual ectopic

Answer 975

Liver problems

Answer 976

Hydatiform mole

Answer 977

they all are (tricked u)

Answer 978

thrombocytopaenia

Answer 979

HELLP syndrome causes severe thrombocytopenia

Answer 980

Proteinuria

Answer 981

Hypertension and proteinuria occur in eclampsia

Answer 982

false, usually hyper

Answer 983

Senile osteoporosis has no gender preference 

Answer 984

Predisposes to viral infections  Bacterial not viral 

Answer 985

Vitamin D deficiency   Inadequate intake/absorption and deficiency of metabolism 

Answer 986

Hypocalcaemia HYPERPARATHYROIDISM = LOW CA++, HIGH PH04 HYPOPARATHYROIDISM = HIGH CA++, LOW PH04

Answer 987

Secondary hyperparathyroidism - chronic hypocalcaemia = secondary, typically renal failure

Answer 988

Bone changes of primary hyperparathyroidism is due to osteomalacia  False, osteomalacia is due to Vit D deficiency. Primary hyperparathyroidism causes osteoporosis 

Answer 989

1. Chronic dialysis 

Answer 990

Hepatosplenomegaly

Answer 991

Alpha thalassaemia  - beta thalassaemia 

Answer 992

All osteogenesis imperfect is associated with defective dentogenesis  

Answer 993

Defect of type 1 collagen synthesis

Answer 994

Bone changes of osteopetrosis can be reversed with stem cell transplant

Answer 995

Instability of atlantoaxial joint

Answer 996

Changes in McCune Albright variant are commonly unilateral

Answer 997

McCune Albright includes hypercortisolism  

Answer 998

Hearing loss is due to involvement of the external ear canal   Usually compression of the vestibulocochlear nerve or middle ear ossicles 

Answer 999

Low output cardiac failure  

Answer 1000

Cushings 

Answer 1001

Thalassaemia major  

Answer 1002

Cirrhosis  ? or maybe chronic pancreatitis

Answer 1003

Hereditary spherocytosis

Answer 1004

Parosteal osteosarcoma is a lower grade compared to periosteal   Parosteal < Periosteal < Telangiectasia  second and fourth answers also a bit true

Answer 1005

Parosteal osteosarcoma – most likely since benign 

Answer 1006

periosteal chondroma 

Answer 1007

Osteoclastic 

Answer 1008

intracortical 

Answer 1009

Chondromyxoid fibroma – most likely  Metaphyseal, long bones  NOF also migrate from physis with growth

Answer 1010

It is sporadic  

Answer 1011

Clear cell chondrosarcoma occurs in the pelvis   Tubular long bones 85-90% 

Answer 1012

Clear cell chondrosarcoma – children

Answer 1013

Most chondrosarcomas are high grade

Answer 1014

Enchondroma and chondrosarcoma can have similar radiological and pathological appearances

Answer 1015

Terminal phalanx enchondroma

Answer 1016

most likely malignant if long bone  - more likely to have malignant transformation

Answer 1017

Mostly solitary

Answer 1018

associated with diaphyseal aclasia

Answer 1019

Thickness of the cartilage cap

Answer 1020

Arise in metaphysis   Epiphysis or apophysis characteristicall

Answer 1021

Tumour centered in the metaphysis - False, epiphysis and apophyses

Answer 1022

Arise from the diaphysis

Answer 1023

Chondroblastoma

Answer 1024

Differential includes neuroblastoma   True, <5yo

Answer 1025

Both false – not more benign 

Answer 1026

Commonly occurs in the extremities

Answer 1027

Osteomyelitis is a clinical differential

Answer 1028

Peak age incidence is in the early twenties (third decade) - false

Answer 1029

Testis  

Answer 1030

Most common in children

Answer 1031

When large, can invade into the surrounding soft tissues  

Answer 1032

Metastases to lung have a poor prognosis ~5% and have excellent prognosis

Answer 1033

Peak incidence at the age at which the physis is closing

Answer 1034

Arise from the metaphysis  

Answer 1035

Eccentric location Usually arise from the metaphysis

Answer 1036

Presentation as a small tumour located centrally in the medulla of a long bone

Answer 1037

Predominantly medullary and metaphyseal

Answer 1038

Lead and sarcoma  

Answer 1039

Skull base chondrosarcoma arises from the petrous apex Arises from the petro-occipital (petro-clival) fissure

Answer 1040

Mostly solid, rather than cystic

Answer 1041

Brodie’s abscess involves the cortex - may be false

Answer 1042

In immunocompetent tend to be multi focal

Answer 1043

TB of the spine, it affects disc later than pyogenic / tends to spare the disc

Answer 1044

Bone marrow oedema of anteromedial tibial plateau Would be lateral femoral condyle and posterolateral tibial plateau

Answer 1045

Duodenal web

Answer 1046

false 95% risk

Answer 1047

periventricular

Answer 1048

Increased lung volumes (can have patchy opacity

Answer 1049

Usually contains cystic components True ~ 70%

Answer 1050

Congenital diaphragmatic hernia Same as CPAM, but stomach also pulled up

Answer 1051

Approximately 50% of unilateral tumours have a germ line mutation – 1%

Answer 1052

Hutchinson syndrome - Hutchinson syndrome is a seldom-used term to denote a syndromic presentation of children with skeletal metastases from neuroblastoma. (WAGR – Wilms, aniridia, genitourinary and retardation )

Answer 1053

Bleeding into dentate

Answer 1054

Neonate more susceptible to subdural haematomas

Answer 1055

Cystic hygroma

Answer 1056

Associated with introduction of antibiotics

Answer 1057

spermatocytic seminoma lymphoma

Answer 1058

Spermatocytic seminoma

Answer 1059

Lymphoma - typically bilateral

Answer 1060

Lymphoma in patient > 60 year of age.

Answer 1061

Yolk sac tumour

Answer 1062

Yolk-sac tumour

Answer 1063

Yolk sac tumour - most common in infants and children up to 3yo

Answer 1064

Yolk sac tumour peak age 5-15 - most common childhood testicular tumour (80%), with most cases occurring before the age of two years

Answer 1065

Choriocarcinoma - 20-30yo

Answer 1066

It is composed of pure synctiotrophoblastic cells

Answer 1067

Lymphatic spread begins with iliac and groin lymphadenopathy

Answer 1068

Ipsilateral retroperitoneal nodes

Answer 1069

Retroperitoneal nodes Lung

Answer 1070

they all are

Answer 1071

Seminoma – In the testes Teratoma – In general. Most common NSGCT

Answer 1072

Cryptoorchism

Answer 1073

Uniform grey color

Answer 1074

Embryonal tumour

Answer 1075

Teratoma rarely occurs in isolation, mostly mixed type

Answer 1076

Gleason score 3+4 has a better prognosis than Gleason score 4+3

Answer 1077

Rarely involves the rectum due to the Denonvillier fascia

Answer 1078

Chlamydia with prostatitis

Answer 1079

Adenomatoid tumour

Answer 1080

Is composed mostly of nodules of fibrostromal tissue

Answer 1081

Usually arises in the peripheral zone

Answer 1082

Diabetes ?obesity

Answer 1083

HPV - more genital warts

Answer 1084

Most will spontaneously descend by one year

Answer 1085

Bilateral in 25% - Robbins 972

Answer 1086

Infertility resolves with orchiopexy

Answer 1087

cryptorchidism

Answer 1088

Cryptoorchism

Answer 1089

Merkel cell - UV is a risk factor, occurs in the elderly 7th/8th decades of life

Answer 1090

SLE - true, probably least true

Answer 1091

Scc happens in severe sun-burned lesion (True) Melanoma happens in non sun-exposed region (True)

Answer 1092

Dysplastic nevus

Answer 1093

Uveal melanoma likes to met to the liver

Answer 1094

In early disease, metastases are usually haematogenous rather than lymphatic Least correct, typically lymphatic > haematogenous

Answer 1095

Juvenile subcapsular cataract – NF2

Answer 1096

Acoustic schwannoma - NF2

Answer 1097

Diabetic nephropathy

Answer 1098

Neurosarcoma of the peripheral nerve

Answer 1099

Sarcoidosis

Answer 1100

Affects the dentate nucleus

Answer 1101

Multiple suggests NF2 mutation.

Answer 1102

Optic nerve glioma – NF1

Answer 1103

Other GI anomalies (pyloric stenosis)

Answer 1104

Secondary biliary cirrhosis

Answer 1105

Large gastroschisis

Answer 1106

Commonly spares the rectum

Answer 1107

Pyloric stenosis

Answer 1108

Angiomyolipomas

Answer 1109

Hereditary haemorrhagic telangiectasia is associated with mucosal telangiectasias and an increased incidence of AVMs in the brain and lungs

Answer 1110

Leptomeningeal angioma = Sturge-Weber

Answer 1111

Pancreatic adenocarcinoma

Answer 1112

Associated with renal haemangioblastoma

Answer 1113

The most common intradural extramedullary lesions is a meningioma True, 20-30%, schwannoma 15-50%, then neurofibroma

Answer 1114

Left ventricle hypertrophy

Answer 1115

Left ventricular hypertrophy Secondary to aortic regurgitation

Answer 1116

Mitral valve annular calcification is associated with mitral regurgitation True - in exceptional cases

Answer 1117

Valve prolapse - this most incorrect, pathology described ball valve obstruction and secondary valve destruction from a “wrecking ball” type effect from the pedunculated atrial myxoma

Answer 1118

Pericardial effusion

Answer 1119

Fever – there is a case study of this though

Answer 1120

Haemangioma

Answer 1121

AML – TS

Answer 1122

Angiomyolipomas A radiographic manifestation of tuberous sclerosis Rhabdomyoma - a benign myocardial tumour, considered the most common fetal cardiac tumour. Strongly associated with tuberous sclerosis (>50%) and renal abnormalities Most common in the ventricles (left > right) Hamartomatous lesion consisting of cardiac muscle tissue.

Answer 1123

Valve prolapse False - valve obstruction

Answer 1124

Can cause valve damage - Causes valve obstruction Calcification in ~50% 60-75% in the left atrium, followed by right atrium Usually solitary 90%, multiple in familial forms – Carney complex Right myxoma can cause pulmonary tumour emboli Can cause valvular obstruction – no damage Can become infected

Answer 1125

Tricuspid and pulmonary valves Thickened tricuspid and pulmonary valve leaflets Enlarged right atrium Systemic venous hypertension: enlarged azygos and superior vena cava Pulmonary stenosis GIT carcinoids - first hit the right heart valves.

Answer 1126

Yellow central area with red-blue rim - neutrophilic infiltrates

Answer 1127

Left ventricular free wall is the most common site of cardiac rupture (in Robbins this is stated true)

Answer 1128

Acute aortic regurgitation.

Answer 1129

Ventricular tachycardia ?re-entry tachycardia apical thrombus - lad mitral valve - anterolateral valve supplied by lad and lcx, posterolateral by rca sa node rca (sometimes lcx), av node rva LCX perfuses the posterior third of the septum, if dominant. If not dominant, it perfuses the majority of the left ventricular myocardium with the LAD. LCx specifically supplies the lateral wall of the left ventricle

Answer 1130

AV conduction block SA node supplied RCA, LCX in 47%. AV node mainly RCA In a right dominant circulation (80% of individuals) the RCA perfuses the entire right ventricular free wall, the posterobasal wall of the left ventricle and the posterior 1/3 of the ventricular septum

Answer 1131

Aortic regurgitation Seems to be more due to dissection

Answer 1132

Haemopericardium = rupture

Answer 1133

Dressler syndrome occurs in the initial days following AMI A delayed immune-mediated or secondary pericarditis - weeks to months after a MI

Answer 1134

Ventricular arrhythmia

Answer 1135

Dressler’s syndrome and acute fibroexudative effusion post myocardial infarction

Answer 1136

Non-bacterial thrombotic endocarditis is associated with SLE - if no better option

Answer 1137

Patients with IVDU is most associated with right sided valves.

Answer 1138

There is a ?size difference between marantic and acute endocarditis.

Answer 1139

Vegetation >1cm in size

Answer 1140

everything except "acute affects damged valves " true

Answer 1141

Fused valve leaflets – Rheumatic heart disease

Answer 1142

Subacute bacterial endocarditis is complicated by emboli and aneurysms

Answer 1143

Liebman-Sacks vegetations occur on the pulmonary valve - Sterile fibrofibrinous vegetations which develop anywhere, but have a propensity for the left valves, especially mitral - Occur in the setting of SLE Ankylosing spondylitis causes mitral valve incompetence - Rarely can cause mitral valve regurgitation - Aortic regurgitation Spherocytic anaemia is a complication of valve replacement - Microangiopathic haemolytic anaemia can be due to prosthetic valves - these are intravascular haemolysis. Hereditary spherocytosis is extravascular haemolysis - sphistocyte

Answer 1144

Larger vegetations True - larger in acute, smaller in subacute. Staph A vs Strep viridians

Answer 1145

Subacute bacterial endocarditis is complicated by aneurysms and emboli True.

Answer 1146

Aortic valve infection can spread to the pericardium through the valve ring

Answer 1147

Acute infective endocarditis involves previously damaged/abnormal valves False - involves healthy native valves

Answer 1148

Related to cystic medial necrosis

Answer 1149

Abdominal aortic aneurysm

Answer 1150

Inflammatory aneurysm is more common in younger patients?

Answer 1151

Atherosclerotic plaques begin at a random location early in disease

Answer 1152

5-10% no intimal tear identified

Answer 1153

Haemorrhage into the media

Answer 1154

PFO usually closes by 2 years of age ( FO closes by 2 yrs)

Answer 1155

Tetralogy of Fallot

Answer 1156

VSD can have delayed presentation in adult – Eisenmenger syndrome

Answer 1157

Last option was the answer

Answer 1158

VSD – 40%

Answer 1159

Mitral stenosis Overriding aorta RV hypertrophy Subvalvular or valvular right ventricular outflow tract stenosis - pulmonary Subaortic ventricular septal defect

Answer 1160

Diastolic dysfunction

Answer 1161

Wilson – scant data on cardiomyopathy in Wilson’s

Answer 1162

Diastolic dysfunction

Answer 1163

Dilated cardiomyopathy Causes restrictive cardiomyelopathy

Answer 1164

Tricuspid and pulmonary

Answer 1165

Positional or stress testing in each limb is essential for diagnosis.

Answer 1166

Pericarditis

Answer 1167

Hypothyroidism causes pericarditis

Answer 1168

Constrictive pericarditis

Answer 1169

TB is haemorrhagic Serous pericarditis - non infectious inflammatory diseases - rheumatoid, SLE, scleroderma, tumours and uraemia Fibrinous and serofibrinous- the most frequent types, secondary to acute MI, post infarction, uraemia, chest radiation Purulent or suppurative - active infection Haemorrhagic - usually malignant neoplasm or bacterial infections. Caseous pericarditis - tuberculous until proven otherwide

Answer 1170

radiation Constrictive - idiopathic is most common Pericardial injury - previous cardiac surgery #2, radiotherapy #3, post-myocardial infarction (dressler syndrome) Infection Sarcoidosis Metabolic disorder - uraemia

Answer 1171

Mitral and aortic

Answer 1172

Subacute endocarditis is a classical long term complication

Answer 1173

Shy Drager Syndrome – type of MSA MSA C – cerebellar. Pons, medulla and cerebellum small. -> hotcross bun (pontine) MSA P – extrapyramidal. Low T2 + high T1 in putamen MSA A – autonomic (Shy dragger). PSP – Atypical parkinsons. Midbrain atrophy -> hummingbird. Midbrain : pons area calculation

Answer 1174

Schwannoma - Round or lobulated well delineated encapsulated tumours arising eccentrically from parent nerve and can be separated from it (c/w plexiform neurofibromas) nf2 not nf1. spinal nerves usually not cutaneous and spinal. no malignant degen.

Answer 1175

answer: Ganglioneuroma (Neurogenic neoplasm of sympathetic ganglia. Nerve fibres, schwann cells, mature ganglion cells and mucous matrix) 2.Ganglioglioma 3.Neurofibroma (Each fascicle is infiltrated by neoplasm – not possible to separate lesion from nerve) 4.Schwannoma (most common in 5th to 6th decade except in NF-2) 5.Neuroblastoma (Malignant tumour of sympathetic chain. Small round blue cells + schwannian stroma cells)

Answer 1176

Lymphoma – 1° (Most common in immunosuppressed patients)

Answer 1177

answer: Meningioma (Cystic or necrotic change may be present - most often in parasagittal tumours (3 – 14%)) 1. Haemangioblastoma (60% are cystic masses with mural nodule that usually abuts pial surface) 2.JPA (Cerebeallar JPA 30% of total of JPA - Well-circumscribed mass with large cyst, and small reddish-tan mural nodule) 3.PNET (commonly cystic) 5.Schwannoma (cystic change is common) 6.DNET (Well-defined “pseudocystic” lesion (high water content))

Answer 1178

CJD patients live for <12 months, vCJD can live for a few years.

Answer 1179

Rosenthal fibres often present = eosinophilic bodies within astrocyte processes up to 100% 5YS Rosenthal fibers Pilocytic astrocytoma glioma pineal tumor Alexander’s disease long-standing gliosis

Answer 1180

adjacent to nose Most common Hemispheric convexity (20%) Parasagittal (25%) → may occlude SSS Very common Sphenoid ridge, wing (15 – 20%) → may involve optic canal, wing meningiomas often en plaque – extensive dural involvement. Usually extra-cranial extension into calvarium, orbit or soft tissue Olfactory groove (5 – 10%) Common Parasellar (5 – 10%) CR p79 Case 63 Cavernous sinus 66% partially or totally encase carotid artery 33% narrow the artery Less common CPA, along clivus (posterior fossa – 10%) Tentorium cerebelli Foramen magnum Rare Optic nerve sheath (<2%) Extracranial (nose, sinuses, skull (intraosseous)) Intraventricular usually trigone of (L) lateral ventricle most common trigonal mass in adults Spinal canal (M : F = 1:10 ) mostly thoracic region Sylvian fissure Paediatric age group

Answer 1181

hippocampus

Answer 1182

4.Dandy Walker F - assocd with dysgenesis of the CC in 20-25% (cf. primary involvemt) 1.GBM T - most commonly spread via direct extension along WM tracts, including the CC - classic butterfly pattern. 2.Marchifava Bignami T - primarily affects the CC - acute form affects the genu & splenium, chronic form affects the body. 3.DAI T - classic triad of GW junction, dorsolateral brainstem, and CC (most commonly eccentrically and in the splenium). 5.Lymphoma T - differ from GBM as usually less peritumoral oedema,

Answer 1183

Hurthle cells -T - mononuclear inflammatory infiltrate containing small lymphocytes, plasma cells, and well-developed germinal centers. The thyroid follicles are small and are lined in many areas by epithelial cells with abundant eosinophilic, granular cytoplasm, termed Hurthle cells. Hurthle cells seen in: Hashimotos Follicular adenoma 2.Fibrosing nodules - F - Reidel's thyroiditis 3.Psammoma bodies - F - in papillary thyroid carcinoma. Concentrically calcified structures.

Answer 1184

Lewy Bodies F - eosinophilic intracytoplasmic inclusions found in some neurones in Parkinson's disease.

Answer 1185

Angiogenesis T - WHO grade IV. Supratentorial PNETs had highly branched capillaries with extensive endothelial cell hyperplasia. Glomeruloid arrays of microvessels extended from the capillaries. Small fragments of endothelial tubes were scattered throughout the tumor.

Answer 1186

Typically involves superior frontal lobes - F - abnormal signal and enhancemen t of medial temporal and inferior frontal lobes. Affects limibic system: temporal lobes, insula, subfrontal area and cingulate gyri typical. Age 50-70 years - T - can occur at any age, with highest incidence in adolescents and young adults. Bimodal distribution by age with 1st peak occurring younger than 20y (primary infection), and second occuring in those older than 50y (reactivation of latent infection). 3.Common presentation is headache - T - fever, headache, seizures, +/- viral prodrome. 4.May present with seizures, ataxia and lethargy - T - altered mental status, focal or diffuseneurologic deficit (<30%)

Answer 1187

1.Ganglioneuroma - T - The most well-differentiation lesions (in the neuroblastoma spectrum) - see ganglion cells and Schwann cells, and neuroblasts are no longer present. 2.Ganglioglioma - F - tumor of neoplastic astrocytes (rarely oligodendrocytes) and ganglioncells. 3.Neurofibroma - F - PNST arise from cells of the peripheral nerve (Schwann cells, perineural cells, fibroblasts) - attached to nerve, but can be separated from it 4.Schwannoma - F - PNST - see ans 3. 5.Neuroblastoma - F- small, primitive-appearing cells with dark nuclei, scant cytoplasm,and poorly defined cell borders growing in solid sheets. Certain NBs may have some degreeof differentiation with clusters of larger cells resembling ganglion cells.

Answer 1188

Wilms tumour - F - classic Wilms tumor comprised of 3 cell types - Blastemal cells (undifferentiated cells), Stromal cells (immature spindle cells and heterologous skeletal, cartilage, osteoid, or fat), and epithelial cells (Glomeruli and tubules). 1.Neuroblastoma - T - small, primitive-appearing cells with dark nuclei, scant cytoplasm,and poorly defined cell borders growing in solid sheets. 2.Ewing’s sarcoma - T - monotonous sheets of small round blue cells with hyperchromatic nuclei and scant cytoplasm. 3.Rhabdomyosarcoma - T - subtypes Botryoid and spindle cell (leiomyomatous / Embryonal / Alveolar / Undifferentiated. Histo of embryonal and alveolar types - cells have scant cytoplasm and a centrally placed round nucleus that occupies the majority of the cell. 5.Retinoblastoma - T - sheets, trabeculae and nests of small blue cells with scant cytoplasm. Ewing's sarcoma family of tumors (EFT) includes Ewings sarcoma, extraosseous Ewing's sarcoma,more differentiated neuroectodermal tumors (PNET: previously AKA neuroepithelioma, adultneuroblastoms, Askin's tumor of chest wall).

Answer 1189

Normal disorganised tissue in normal position - T - cellular elements are mature and identical to those found in remainder of organ, but do not reproduce the normal architecture of the surrounding tissue. Tumor-like malformation with tissues of particular part of body arranged haphazardly, usually with excess of one or more of its components.

Answer 1190

Involvement of post ⅔ superior temporal gyrus & parietal lobe - F - spared posterior aspect of superior temporal gyrus and pre- and postcentral gyri. Unremarkable parietal and occipital lobes. Picks disease / Frontotemporal dementia - nonspecific songioform degneration, with gliosis and neuronal loss, sometimes with Pick cells and bodies. 25-40% of FTD is familial. 10-30% of patients with positive family history have tau mutations (Tauopathy). 1.Asymmetrical atrophy - T - worse atrophy of dominant hemisphere 2.Predominant frontal lobes - T - anterior frontotemporal atrophy. 3.Cortical atrophy - T - thin cortex. Gliosis of corticl gray matter. Soft, retracted subcortical white matter. Almost complete loss of large pyramidal neurons, diffuse spongiosis and gliosis.

Answer 1191

.Giant cell arteritis - F - GCA is a chronic vasculitis of large and medium sized vessels. Mean age at Dx is approx 72yo, and the disease essentially never occurs in individuals younger than 50yo (UpToDate).

Answer 1192

Anaplastic thyroid cancer in a 29 year old - F - older patients, mean age 65yo 1.Craniopharyngioma in a 42 year old - T - Bimodal age distribution (peak 5-15yo; papillary craniopharyngioma >50y). 3.Bowel cancer in a 32 year old - T - peak incidence for CRC is 60-70yo. CRC in a young person, preexisting UC or one of teh polyposis syndromes must be suspected. 4.Cholangiocarcinoma in a young adult with emphysema - T - a-1-antitrypsin deficency predisposes to cholangiocarcinoma.

Answer 1193

4.Multipolar cells with microcysts, and bipolar cells with Rosenthal fibres - T - classic "biphasic" pattern of two astrocyte populations: compacted biplar cells with Rosenthal fibers (electron dense GFAP staining cytoplasmic inclusions); Loose-textured multipolar cells with microcysts, eosinophilic granular bodies. 1.Associated with NF2 - F - NF1. 15% of NF1 patients develop PAs (most commonly in optic pathway). Upt o 1/3 of patients with optic pathway PAs have NF1. 2.50% are solid - F - 40% solid with necrotic center, heterogeneous enhancement. 10% solid, homogeneous. 50% non enhancing cyst with enhancing mural nodule. 3.Prognosis is less than 70% 5year survival rate - F - median survival rates at 20y >70%

Answer 1194

Very radio sensitive. Excellent prognosis even if it extends retro-orbitally - F - enuleation usually is indicated for large tumors with not visual potential, blind, painful eyes, and/or tumors that extend into the optic nerve. External beam XRT was original globe-sparing treatment for Rb. Risk of tumor recurrence following ext XRT 7%, occurring within 40months. Also risk of secondary cancers with XRT. 2.Carriers of RB gene have a 90% risk - T - If a mutant RB allele arises in the germ line, it can be transmitted as a dominant trait, and carriers are at high risk (>90% risk for most mutations) for retinoblastoma. Robbins. 3.Can get extraocular Retinoblastomas - T - trilateral RB = bilateral RB with neuroectodermal pineal tumor. Quadrilateral RB = trilateral RB with 4th focus in suprasellar cistern. Dahnert 6th.

Answer 1195

paraganglioma, chemodectoma, and carotid body tumors can be used interchangeably - F - multiple names: glomus tumor, chemodectoma, endothelioma, perithelioma, sympathoblastoma, fibroangioma, sympathetic nevi. Paragangliomas are classified based on their location, innervation, and microscopic appearance. Would need to specify location for paraganglioma / chemodectoma to be able to use interchangeably with carotid body tumor. 2.carotid body tumors often adherent to vessels resulting in incomplete excision and recurrence of 10% - T - Shamblin classification - Type I are localized and easily removed; type II adherent and partially surround carotid vessels; type III adherent and completely surround carotid vesels and extremely difficult to resect often requiring resection of ICA and vein graft interposition. Prevalence of local recurrence and local invasion - 40-50% of glomus jugulare tumors, 17% for vagal paragangliomas, and about 10% for carotid body tumors. 3.glomus jugulare and carotid body paragangliomas are the most common head and neck paragangliomas - T - conflicting reports regarding the prevalence of these 2 subtypes some saying one is more prevalent, some saying the other is. 4.paragangliomas have bipphasic or biphenotypic pattern and composed of chief cells and sustentacular cells

Answer 1196

majority of newborns have systemic signs of disease, of which about half have CNS involvement - F - most infected newborns appear normal. 10% have systemic signs of disease (hepatosplenomegaly, petechiae, chorioretinitis, jaundice, and IUGR). 55% with systemic disease have CNS involvement (microcephaly, parenchymal Ca+, SNHL, seizures, hypotonia or hypertonia). 1.characteristic inclusions - T - CMV inclusion-bearing cells. Prominent cytomegatic cells with intranuclear and intracytoplasmic inclusions can be readily identified. Hallmark is cytomegaly with viral nuclear and cytoplasmic inclusions. 2.ependymal & subependymal involvement - T - may affect any cell type by striking tendency for virus to localise in teh epehdymal and subependymal regions of brain. Replicates in ependyma, germinal matrix, and capillary endothelia. 3.may cause haemorrhage - T - results in severe necrotising ventriculo-encephalitis with massive necrosis, haemorrhage, ventriculitis and choroid plexusitis

Pathology Flashcards

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