Path Exam Recalls from 2003-2005 - Questions Originally Collated by DR, JD Et Al
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Path Exam recalls from 2003-2005 - Questions originally collated by DR, JD et al. Re-arranged by TJP PATH EXAM RECALLS FROM 2003-2005 - QUESTIONS .............................................................1 CHEST...........................................................................................................................................2 CNS .............................................................................................................................................20 ENDO...........................................................................................................................................32 ABDO...........................................................................................................................................35 HEPATOBILIARY AND PANCREAS.....................................................................................................43 HAEM...........................................................................................................................................44 MSK .............................................................................................................................................47 PAEDIATRICS .................................................................................................................................53 BREAST.......................................................................................................................................61 MISC ............................................................................................................................................65 GU................................................................................................................................................69 HEAD AND NECK............................................................................................................................74 O&G .............................................................................................................................................77 CVS..............................................................................................................................................81 Page 1 Explanation of document Dinesh and Julie’s files covering recalls from 2003-2005, collated, renumbered, answers both from their study group’s answers and looking it all up in Robbins. Formatting: Answers are in another style “CorrectAnswer”. Change this to a black color and un- bold to print without answers. Occasional extra text in “HiddenExplanation”. Make this white to hide when printing. CHEST 2005 APRIL PATHOLOGY RECALLED MCQS 1. Pathologist is looking for a gross specimen of adenocarcinoma of the lung to show medical students. He has a specimen of SCC only. RE: Adenocarinoma vs SCC lung a) similar macroscopically b) adeno more common in female, less associated with smoking 2. Staging Ca lung – mass invading mediastinum with mediastinal and hilar nodes. No distant mets. What else is necessary for further staging? a) Size of mediastinal nodes b) Size of mass c) Size of mass and presence of effusion d) Whether lymph nodes are UL or contralateral e) Distance from carina 3. Progress of COP – 2 years after initial Dx on lung wedge resection a) Resolution b) worse with increase subpleural honeycombing c) variable - 30% worse, 50% better, 40% stable d) resolution of alveolitis but persistent honeycombing 4. Prominent pulmonary arteries, least likely cause a) smoker with basal emphysema b) patient with erosive arthropathy c) DM with CRF d) 2y.o. with PDA e) SLE 5. Asbestosis occupational lung exposure with complications: Which is atypical? a) non ca++ plaques b) pleural effusions c) fibrosis d) mediastinal nodes e) diffuse pleural thickening mediastinal nodes are a feature of mesothelioma (StatDx) but not asbestos plaques or asbestosis. A later recall has a ‘more atypical’ option to choose. 6. Non specific pulm fibrosis on bx: atypical cause – a) Chlamydia pneumonia Page 2 b) Sarcoid c) Mason – sanding occupation d) Rheumatoid 7. 2 yearly HRCT. Not typical cause of pulm changes a) SLE b) RA c) PAN d) Wegeners 8. R hilar mass with histology showing high cellularity, intercellular bridges, eosinophilic cytoplasm. Cause: a) SCLC b) SCC c) AdenoCa d) Bronchogenic cyst 9. Carcinoid – which is atypical a) bronchiectasis b) 8cm cystic lesion c) lobar collapse d) endobronchial location 10. Fat embolism features are not a) CNS, skin changes b) Headache c) Onset within 6/24 d) Cerebral haemorrhage 11. Legionella is a) Gram neg bacillus b) Gram pos cocci c) Fungus d) Parasite 12. Cryptococcus neoformans atypical changes include a) solitary 3cm lung mass b) milary disease or multiple nodules c) basal ganglia lesions d) basal meningitis e) Vasculitis in basal cerebral vessels -StatDx: no mention of vasculitis for brain crypto 13. Which are not true: a) ABPA due to colonisation of aspergillus in bronchi b) Halo lesions – invasive aspergillosis due to central cavitation 14. Re: PE, which is true A) pulmonary haemorrhage due to reperfusion of infarcted lung B) 30% recur after 1st DVT C) equal distribution in all lobes Page 3 15. Symptoms of asthma and granuloma on Bx. Cause: a) sarcoid b) hypersensitivity c) BOOP d) Bronchiolitis obliterans 16. RE TB a) Mantoux test can’t tell prior infection from active infection b) 1/10000 of primary infections are symptomatic c) Mantoux test is negative in overwhelming infection 17. Centrilobular emphysema affects the: a) All airway distal to terminal bronchiole b) Alveolar sacs only c) alveolar ducts but not alveolar sacs 18. RE Mesothelioma a) 10-20% have asbestosis b) plaques have asbestos bodies neither of these statements are correct April 2005 Path 19. Concerning fat embolism, which of the following statements is least correct? a. Over 80% of fat emboli are asymptomatic b. Features of fat embolism include hypoxia, thrombocytopenia, and CNS symptoms c. symptoms are usually established within 6 hours of trauma/fracture d. neurological manifestations include irritability, restlessness, confusion, and coma e. 20-50% of cases are associated with purpuric rash 20. The pathogenic agent of Legionnaires disease is L. pneumophilia. This agent is best described as a? a. gram negative bacteria b. spore forming coccus c. helminth d. protozoa e. richettsia 21. 35 yo outpatient HRCT request “Late onset asthma, worsening dyspnoea, initially episodic, and now chronic. Biopsy shows granuloma:. Which of the following is most likely with this history? a. Silicosis b. TB c. Hypersensitive pneumonitis d. Sarcoid e. Histoplasmosis 22. Concerning centrilobular emphysema, which of the following is most correct? a. The acini are uniformly enlarged from level of terminal bronchiole to terminal alveoli b. proximal part of acini enlarged, relative or complete sparing of distal acini c. proximal portion of acinus normal or near normal, with dominant involvement of distal portion d. whole acini destroyed leaving irregular lined spaces greater than 1 cm in diameter e. acini uniformly involved but disease effects central zone of secondary pulmonary lobules Page 4 23. Pulmonary adenocarcinoma vs squamous cell carcinoma. Which of the following is most correct? a. The two are macroscopically similar b. adenocarcinomas are more likely to show cavitation c. adenocarcinoma is more likely to be peripheral, and affect women d. adenocarcinomas have a stronger associated with emphysema/chronic airway disease e. adenocarcinoma is more likely to show massive lymphadenopathy and extrathoracic disease compared with SCC 24. Patient with a markedly thickened pleura encasing one lung. Which of the following statement is most correct? a. Only approximately 10-20% of people with mesothelioma will have associated lower lobe fibrosis b. mesothelioma and metastatic adenocarcinoma have markedly different appearances on light microscopy c. presence of asbestos bodies on pleural biopsy suggest change is more likely reactive/fibrosis d. granuloma in pleural tissue suggests chronic irritation rather than a neoplastic +/- infective aetiology e. apical lung lesion suggests it is most likely infective in nature 25. A chest CT request states: “pulmonary carcinoid”. Which of the following indings would be least expected? a. Bronchiectasis b. 1cm endobronchial mass confined to a mainstem bronchus c. 8 cm cystic mass d. Pneumonia e. hilar lymphadenopathy (25%, more common in atypical) 26. Concerning PE, which of the following is most correct? a. Approximately 40% lead to infarction b. emboli affect upper, mid and lower zones equally but not lobes equally c. in the young, PE more frequently leads to infarction d. In the presence of a predisposing cause, secondary episodes may occur up to 30% e. pulmonary haemorrhage in PE implies reperfusion of an infarct 27. 57 yo. Man has a non specific pulmonary fibrosis. Which of the following is least likely to be related? a. past employment as stone mason b. history of an erosive arthropathy c. history of chlamydial infection d. history of previous chemotherapy e. muscle biopsy - non-caseating granuloma 28. Least likely finding in invasive aspergillosis a. Cerebral vessel changes b. Can mimic mucormucosis c. Lung lesion can resemble a target due to central cavitation d. involvement of brain, kidneys, heart valves 29. A patient has prominent pulmonary artery, which of the following Page 5 histories is least likely cause of pulmonary arterial hypertension? a. 38 yo smoker with basal emphysema b. 32 yo female whose mother