Miscellaneous 1

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jaz_walker
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273611
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Miscellaneous 1
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2014-05-07 10:26:06
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pathology
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  1. A neonate is noted on newborn baby check to have an unusually large head. Ultrasound shows hydrocephalus. What are the 3 commonest congenital causes of non-communicating hydrocephalus?
    Arnold-Chiari malformation, Dandy-Walker malformation, cerebral aquaduct stenosis
  2. A neonate is noted on newborn baby check to have a soft bulge in the occiput. There is a herneation of brain and meninges. What is this called?
    Encephalocele
  3. True or false regarding congenital disorders of the CNS. Spina bifida occulta involves outpouching of the cord and meninges?
    F - This is spina bifida cystica
  4. A neonate is noted on newborn baby check to have a soft bulge at one of the vertebrae. What is this most likely to be?
    Meningomyelocele (90% of cases) involving CNS tissue and meninges. - Rarely a meningocele (10% of cases)
  5. A fetus is noted on ultrasound to have hydrocephalus. Ultrasound at birth shows prolongation of the cerebellum through the foramen magnum. What is this most likely to be and what kind of hydrocephalus is likely to be present?
    Arnold-Chiari malformation - obstructive hydrocephalus
  6. A fetus is noted on ultrasound to have hydrocephalus. A cyst-like structure is between the cerebellar hempispheres. What is this most likely to be and what kind of hydrocephalus is likely to be present?
    Dandy-Walker malformation - obstructive hydrocephalus
  7. A 43 year old woman complains of tingling and weakness in her hands. There is loss of pain and temperature, but preservation of position and vibration sense. A MRI at level C6 shows a syrinx posterior to the central canal. At operation, a biopsy shows that it is lined by astrocytes. What is this?
    Syringomyelia
  8. A 43 year old woman complains of tingling and weakness in her legs. A MRI at level L3 shows a syrinx in the central canal. At operation, a biopsy shows that it is lined by ependmya. What is this?
    Hydromyelia
  9. A ATOS application mentions that a 34 year old man is claiming disability benefits because of cerebral palsy. He asks you to support his application. On examination you note hypotonia, weakness, uncoordinated movements and intention tremor. What kind of cerebral palsy is this and what proportion of cerebral palsy cases does this constitute?
    ataxic - 10%
  10. A ATOS application mentions that a 34 year old man is claiming disability benefits because of cerebral palsy. He asks you to support his application. On examination you note hypertonia, ankle clonus, extensor plantar response. What kind of cerebral palsy is this and what proportion of cerebral palsy cases does this constitute?
    Spastic cerebral palsy - 70%
  11. A ATOS application mentions that a 34 year old man is claiming disability benefits because of cerebral palsy. He asks you to support his application. On examination you note irregular, involuntary muscle movements. What kind of cerebral palsy is this and what proportion of cerebral palsy cases does this constitute?
    Dystonic cerebral palsy - 10%
  12. A 51 year old woman is in an RTA and sustains a depressed skull fracture. What are they at particularly increased risk for?
    Epilepsy
  13. True or false regarding CNS trauma. In a contusion, the pia-arachnoid is torn?
    F - This is a laceration. In a contusion, it is not torn
  14. True or false regarding CNS trauma. In a laceration there is extravasation of blood?
    T - And also in a contusion
  15. True or false regarding CNS trauma. A gliding contusion occurs at the margin between ventricles and cerebrum?
    F - It occurs at the margin between dura and cerebrum.
  16. A 32 year old man is in a RTA and does not regain consciousness afterwards. He dies soon afterwards. On autopsy there is no obvious lesion. What injury may they have sustained and what two features might you expect?
    Diffuse axonal injury - Small haemorrhagic lesions in the corpus callosum (macroscopic) and widespread tearing of axons at the nodes of Ranvier (microscopic)
  17. A 41 year old female hits her head in a rugby match. She is lucid at first, but 3 hours later falls into a coma. On CT there is a lenticular lesion which does not cross suture lines. What is this?
    Epidural haemorrhage
  18. A 82 year old man presents with decreased consciousness. On CT there is a unilateral crescenteric lesion which crosses suture lines. What is this and which vessels are likely to be responsible?
    Subdural haemorrhage - Bridging veins
  19. A 52 year old woman presents unconscious. No history is known. On CT there is hyperdensity in the Sylvian fissure. What is this and what is the most likely cause?
    Subarachnoid haemorrhage - Ruptured berry aneurysm
  20. A 52 year old woman presents unconscious. No history is known. On CT there is hyperdensity close to the circle of Willis. Which 3 connective tissue disorders can be associated with this kind of haemorrhage?
    Ehlers-Danlos, ADPKD, neurofibromatosis-1
  21. A 71 year old woman with a history of hypertension has a sudden onset of speech loss and right arm weakness which lasts for several days. What are the 3 major causes of this?
    Cerebral infarct (80%), intracerebral haemorrhage, subarachnoid haemorrhage.
  22. A 56 year old woman suffers a sudden loss of consciousness and dies 24 hours later. Autopsy shows swollen, soft tissue with loss of definition between grey and white matter. What kind of cell injury is present and what kind of necrosis occurs?
    Infarct - liquefactive necrosis
  23. A 69 year old man dies suddenly of MI. The brain arteries are shown to have microaneurysms. What are these called and which 2 conditions are they most associated with?
    Charcot-Bouchard microaneurysms - hypertension, diabetic vascular disease
  24. A 69 year old man at autopsy has small haemorrhages in the basal ganglia. What pathological lesion caused these haemorrhages?
    Charcot-Bouchard microaneurysms
  25. A 29 year old woman has a sudden onset of loss of consciousness. CT shows hyperdensity close to the circle of willis. Which 3 locations of the circle of Willis are most likely to have been involved?
    Anterior cerebral artery, junction of internal carotid and middle cerebral,middle cerebral branching.
  26. A neonate presents with a fever. CSF yeilds cloudy fluid and leucocytes. What are the 2 most likely aetiological bacteriae?
    E. Coli and Group B streptococci
  27. A 1 year old female presents with fever. CSF yeilds cloudy fluid and leucocytes. What are the 2 most likely aetiological bacteriae?
    Neisseria meningitidis, strep. Pneumoniae
  28. A 15 year old male presents with a fever and meningism. CSF yeilds cloudy fluid and leucocytes. What are the 2 most likely aetiological bacteriae?
    Neisseria meningitidis, strep. Pneumoniae
  29. A 81 year old woman presents 'off her legs'. CSF yeilds cloudy fluid and leucocytes. What are the 3 most likely aetiological bacteriae?
    Strep. Pneumoniae, neisseria meningitidis, listeria monocytogenes
  30. A neonate presents with a fever. They are managed by ITU for acute meningitis. They continue to handle poorly. Hypoglycaemia, hyponatraemia. What should you be concerned about?
    Waterhouse-Friedrichson syndrome
  31. A 71 year old man presents with change in gait. He had earache the previous week. CT shows a ring enhancing lesion. Patient has a fever and meningism. What is the most likely cause?
    Meningitis with cerebral abscess.
  32. A 71 year old man presents with change in gait. He had earache the previous week. CT shows a ring enhancing lesion. What are the top 3 causes of a ring enhancing lesion?
    Cerebral abscess, metastasis, glioblastoma multiforme
  33. A 84 year old man presents with fever and new onset epilepsy. CT shows a ring enhancing lesion. Patient has a fever and meningism. What are the3 most likely causeative oragnisms?
    Strep. Viridans, staph. Aureus, klebsiella spp/
  34. A 56 year old man has been complaining of sinusitis for 3 days. He suddenly deteriorates and is clinically very unwell, develops seizures and a high fever. CT shows a crescenteric lesion which crosses sutures. What should you consider and what is management?
    Subdural empyema - Surgical evacuation
  35. A 57 year old Pakistani male presents with diplopia. He has a low grade fever and constant headache. CSF shows increased protein and high ICP, with decreased glucose. Chest X ray shows an apical lung lesion. CT is normal. What should you consider and what is management?
    Tuberculous meningitis - intensive antituberculous drugs
  36. A 4 year old female is brought to the GP by her father who is concerned that she has been ill, and has complained of neck stiffness. You diagnose viral encephalitis. What are the 2 most common causative viruses?
    Arboviruses, HSV I and II
  37. A 38 year old female presents with a fever and seizures. CSF has fibrin webs, lymphocytes, high cell count (40), low glucose and slightly raised protein. What is the most likely cause?
    Tuberculous meningitis
  38. A 38 year old female presents with a fever and seizures. CSF is turbid, with neutrophils, 1500 cell count, low glucose, high protein. What is the most likely classification of causes?
    Bacterial meningitis
  39. A 38 year old female with AIDS presents with a fever and seizures. You diagnose fungal meningitis. What are the 2 most common causative fungi?
    Candida albicans, cryptococcus neoformans
  40. A 38 year old female with AIDS presents with a fever and seizures. The infectious disease team diagnose protozoal chronic abscesses. What is the most common cause?
    Toxoplasma gondii
  41. A 59 year old woman with a renal transplant presents with progressive dementia. The MRI shows demyelinating bilateral periventricular zones which mainly involves white matter. Biopsy confirms diagnosis. What infectious cause should you consider and what is prognosis?
    Progressive multifocal leucoencephalopathy (PML) - very poor (death in few months)
  42. A 73 year old female ex-farm worker presents with a rapidly progressing dementia. She dies wtihin 6 months. Brain histology shows intracellular vacuoles in neurons and glia. What was her cause of death?
    CJD
  43. A 31 year old woman presents with abnormal leg sensation. MRII scan shows CNS plaques. What kinds of cells mediate this reaction and which cells are being attacked?
    T lymphocytes - microglia (this is multiple sclerosis)
  44. A 79 year old woman presents with memory problems. She dies 15 years later of pneumonia. Brain shows reduced weight, neuritic amyloid plaques and neurofibrillary tangles. What is the cause of her memory problems?
    Alzheimer's dissease
  45. A 47 year old chronic alcoholic presents with ataxia, nystagmus and confusion. What should you be concerned about and what is management?
    Thiamine deficiency causing Wernicke's encephalopathy - B1 (thiamine)
  46. A 80 year old female presents with gait problems. She complains of weakness and paraesthesia. Which vitamin may she be deficient in?
    B12 (cyanocobalamin)
  47. A 79 year old man presents with severe memory and speech loss. Brain shows atrophy of cortex and the presence of Pick bodies. Which 2 parts of the brain are most likely to be atrophic?
    Pick's disease - frontal and temporal regions
  48. A 43 year old man presents with memory problems. He has noted a chorea. He comments his father died early of an unknown cause. Genetic testing shows a trinucleotide repeat on chromosome 4. Which 2 parts of the brain are most likely to be atrophic?
    caudate and putamen - Huntingdon's disease
  49. A 10 year old boy complains of muscle weakness. You note a slight scoliosis and slurred speech. Genetic testing confirms the diagnosis. Which 3 parts of the CNS are most likely to be degenerated?
    posterior columns, corticospinal and spinocerebellar tracts
  50. A 17 year old female presents with sudden blindness. No history is available. Blood tests confirm methanol poisoning. What is the mechanism by which acute poisoning causes blindness?
    Optic nerve degeneration.
  51. A 79 year old man is told he has brain cancer. What kind of brain cancer accounts for 50% of brain cancers and what major 4 groups of cell types does it contain?
    Glioma - Astrocytes, oligodendrocytes, ependymal cells, microglia
  52. A 9 year old female presents with seizures. CT shows hydrocephalus. There is a cerebellar cystic lesion with a mural nodule. What is this likely to be, what is prognosis and what syndrome may you consider?
    Pilocytic astrocytoma (good prognosis) - NF-1
  53. What are the 4 gradings of astrocytoma?
    I - pilocytic astrocytoma, II - fibrillary astrocytoma, III - anaplastic astrocytoma, IV - glioblastoma
  54. A 49 year old female presents with seizures. The neuro team diagnose her with a primary brain tumour. What is the most common brain tumour?
    Glioblastoma - poor prognosis
  55. A 49 year old female presents with seizures. The CT shows an ill defined lesion in the white matter of the temporal lobe. Histology shows cells with large nuclei and a perinuclear halo ('fried egg'). What is this?
    Oligodendroglioma
  56. A 20 year old woman complains of leg weakness. MRI spine shows a small lesion in the central canal of the spinal cord. What is this likely to be?
    Ependymoma
  57. What is the most common brain tumour of childhood and what is management?
    Medulloblastoma - it is highly radiosensitive
  58. A 59 year old man presents with seizures. CT head shows a ring enhancing lesion at the grey-white matter boundary, surrounded by oedema. What is this and which 5 places might you then be suspicious of?
    Metastatic tumour - breast, bronchus, kidney, colon, malignant melanoma.
  59. A 59 year old man presents with seizures. CT shows a midline lesion by the frontal lobe. Histology shows laminated calcified psammoma bodies. What is this and what tissue does it arise from?
    Meningioma - Arachnoid mata
  60. A 3 year old child presents with calf wasting and pes cavus. There is a family history. Nerve conduction is impaired, there is demyelinating neuropathy. What is this and what size of axon is lost?
    heriditary motor and sensory neuropathy I - large calibre axons
  61. A 24 year old female presents wtih led weakness. Nerve conduction is normal, there is axonal neuropathy. What is this and what size of axon is lost?
    heriditary motor and sensory neuropathy II - large and small calibre axons
  62. Easter egg:?
    Heriditary sensory and autonomic neuropathies exist, and there are 3 types.
  63. What are the 4 common sites of nerve compression?
    Intervertebral foramina, median nerve (carpal tunnel), ulnar nerve (at medial epicondyle), common peroneal nerve (neck of fibula)
  64. A 77 year old female with known renal failure presents with symmetrical pain and parasthesia of the feet. This improves after dialysis. What is the likely cause of his problems?
    Uraemic neuropathy
  65. Which 5 drugs are most likely to cause peripheral neuropathy?
    isoniazides, sulphonamides, vinca alkaloids, dapsone, chloroquine
  66. A 58 year old factory worker complains of foot paraesthesia and numbess. Which 6 industrial toxins are most likely to cause peripheral nerve damage?
    acrylamide, hexane, organophosphates, lead, arsenic, mercury
  67. True or false regarding Horner's syndrome. Pupillary dilatation is associated?
    F - pupillary constriction
  68. complete ptosis of the upper eyelid is associated?
    F - partial ptosis is associated
  69. enophthalmos is associated?
    T
  70. anhidrosis is associated on the ipsilateral side?
    T
  71. A 26 year old man presents with pallor, headaches, sweating and anxiety. His urinary vanillylmandelic acid level is high. What are you concerned about, which cells is it derived from and which 3 syndromes are associated?
    Phaeochromocytoma (chromaffin cells) - MEN2a+b, von Recklinghausen's disease, von Hippel-Lindau
  72. A baby is born with cardiac heart disease. The mother is concernd that she caused it by drinking alcohol in the 7th week of her pregnancy. During which weeks are cardiac abnormalities most vulnerable?
    4-9th week
  73. A neonate is diagnosed wtih a heart malformation. Which chromosomal abnormality is particularly associated with congenital heart defects?
    Down's syndrome
  74. True or false regarding congenital heart disease. Left to right shunts are typically not cyanotic in infants?
    T
  75. A female is diagnosed with a defect of ostium primum. What other defect is associated?
    Split anterior leaflet of mitral valve.
  76. A neonate has a wide split second heart sound, and a systolc flow murmor over the pulmonary valve. What is the most common cause for this?
    atrial septal defect - due to patent ostium secundum
  77. A female neonate appears breathless, particularly when feeding. You head a machinery like murmur. What infection is associated with this?
    Maternal rubella - this is patent ductus arteriosus
  78. A 15 year old male presents with syncope and headache. Blood pressure is raised in teh upper body, legs are cold and hypotensive. A systolic murmur is just audible. What defect is this and which 2 cardiovascular pathologies are associated?
    Coarctation of the aorta - berry aneurysms, bicuspid aortic valve.
  79. True or false regarding congenital heart disease. Transposition of the great arteries predisposes to aortic dissection?
    F - coarctation of the aorta predisposes
  80. A neonate is diagnosed wtih pulmonary artery stenosis. Which other malformation will be present?
    patent ductus arteriosus
  81. A 61 year old man is told he has arteriosclerosis. What 3 types of arteriosclerosis exist?
    Athersclerosis, Monckeberg's medial calcific stenosis, arteriosclerosis
  82. Which 6 organs are particularly affected by arteriolosclerosis?
    kidney, pancreas, gall bladder, small intestine, adrenals, retina
  83. A 49 year old man is told he has atherosclerosis. What 3 types of medications might be used to reduce his risk of complications?
    antihypertensives, statins, anticoagulants
  84. A 29 year old female with known renal disease presents with malaise and a necrotic ulcer on her foot. You note she has blood pressure of 140/120. What should you be suspicious of, and which 2 organs aer at particularly high risk?
    Malignant hypertension - retina, kidneys
  85. A 29 year old female with known renal disease presents with malaise and pedal oedema. She has a fit and dies soon afterwards. Vessel biopsy shows fibrinoid deposition in vessels, necrotic media, cerebral oedema. What was the cause of her death?
    Malignant hypertension
  86. A 46 year old woman with a history of travel to South America complains of swallowing problems. You find trypanosoma cruzi. What disease does she have and what mechanism of damage does it have?
    Chagas' disease - destruction of hte myenteric plexus.
  87. A 35 year old man presents with nausea, vomiting and weight loss. Endoscopy shows gross hyperplasia of gastric pits, gland atrophy of stomach and mucosal thickness increased. There is hypoalbuminaemia. What are you concerned about and what sequelae worry you?
    Menetrier's disease - it is premalignant
  88. A 51 year old man presents with epigastric pain. On liver biopsy you note hydropic degeneration. What cause may you consider?
    viral hepatitis
  89. A 51 year old man presents with epigastric pain. On liver biopsy you note focal necrosis. What cause may you consider?
    viral or drug induced hepatitis
  90. A 51 year old man presents with epigastric pain. On liver biopsy you see centrilobular necrosis. What cause may you consider?
    paracetamol toxicity
  91. A 51 year old man presents with epigastric pain. On liver biopsy you see coagulative necrosis. What cause may you consider?
    ischaemia
  92. A 67 year old woman complains of jaundice. On liver biopsy you see cirrhosis. What are the 3 commonest causes of cirrhosis?
    Alcoholic liver disease, cryptogenic, chronic hepatitis (B+C)
  93. A 67 year old woman complains of jaundice. On liver biopsy you see cirrhosis. What are the 2 treatable but rare causes of cirrhosis?
    Haemochromatosis, wilson's disease
  94. true or false regarding liver disease. Cystic fibrosis can cause cirrhosis?
    TRUE
  95. A 79 year old man complains of abdominal distension. You find shifting dullness and drain a low protein ascites. What are the 4 causes of this?
    cirrhosis, constrictive pericarditis, cardiac failure, hpoalbuminaemia
  96. A 79 year old man complains of abdominal distension. You find shifting dullness and drain a high protein ascites. What are the 6 causes of this?
    malignancy, peritonitis, pancreatitis, budd-chiari syndrome, hypothyroidism, lymphatic obstruction
  97. A 48 year old man presents with new onset diaetes. High ferritin and iron. What are you considering?
    Haemochromatosis, wilson's disease
  98. True or false regarding wilson disease. It is autosomal recessive?
    T
  99. True or false regarding wilson disease. Ceruloplasmin is low?
    T
  100. A 49 year old man is diagnosed with Wilson disease. Which 3 organs are most affected?
    liver, brain (psychiatric), eye (kayser fleischer rings)
  101. A 5 year old child has an upper respiratory tract infection and takes aspirin to lower the temperature. They suffer a sudden drop in consciousness. Microvesicular fatty hepatic degeneration. Which syndrome are you worried about and what is the mechanism of brain injury?
    Reye syndrome - acute encephalopathy with cerebral oedema
  102. A 25 year old woman presents wtih dark urine and jaundice. LFT shows hyperbilirubinaemia, moderately raised AST and ALT. Hyperglobulinaemia, raised ESR. What aer you considering?
    Autoimmune hepatitis
  103. A 47 year old female with a fever is noted to have a liver abscess. What is the most likely aetiological bacterium and where is it most likely to have arisen from?
    E. Coli (and then streptococci) - Ascending from biliary stract
  104. true or false regarding liver disease. Toxoplasma gondii rarely cause liver abscesses?
    T - but e. Histolytica is a rere but possible cause
  105. What predisposes to hepatic adenoma and what is the major complication?
    oestagen containing contraceptive - rupture, leading to intra-abdominal bleeding
  106. A 33 year old male is suspected to have a gastric carcinoma. On laparotomy, a liver metastasis is seen (but not biopsied). Later the team discover there was no original carcinoma. What did they mistake for a metastasis?
    Bile duct adenoma
  107. What do aflatoxins predispose to?
    Hepatocellular carcinoma
  108. A 49 year old man is diagnosed with adenocarcinoma of the biliary tree (cholangiocarcinoma). What 2 predisposing factors are known and what is prognosis?
    Chronic inflammatory disease (particularly sclerosing cholangitis) and chinese liver flues (clonorchis sinensis) - poor prognosis
  109. A 49 year old body builder presents with jaundice. Biopsy shows multifocal haemorrhagic nodules in the liver. What are you concerned about and what is prognosis?
    Angiosarcoma - poor prognosis
  110. True or false about biliary cirrhosis. Primary biliary cirrhosis involves granulomas?
    T
  111. True or false about biliary cirrhosis. ERCP shows a patent and non-dilated biliary tree in primary sclerosing cholangitis?
    F - shows a 'beaded' appearance of fibrous strictures with segmental dilatation
  112. True or false about biliary cirrhosis. PSC involves antimitochondrial antibodies?
    F - this is PBC (primary biliary cirrhosis)
  113. True or false about biliary cirrhosis. PSC involves hypergammaglobulinaemia?
    T
  114. What are the 4 main causes of bowel strangulation?
    Herniation, intussusception, volvulus, adhesions

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