pathology questions

[winterfire]

plz give explanations also


Q)17 yr old girl with sudden onset abdominal pain, tender left adnexal mass, pregnancy test negative, x ray mass lesion of the left ovary with focal areas of calcifications:
a)malignant surface derived
b)benign surface derived tumor
c)malignant germ cell tumor
d)follicular cyst of the ovary
e)benign germ cell tumor

Q)50 yr old with long smoking history, hopitslised with right sided pyelonephritis, hydronephrosis and dilated ureter, malrodourous vaginal discharge on examination, firm irregular right adnexal mass extending into pelvic side wall, pt experiences vaginal bleeding after examination, Dx:
a)perinephric abcess due to pyelonephritis
b)endometriosis of right ovary
c)invasive endometrial adenocarcinoma
d)invasive ovarian adenocarinoma
e)invasive cervical carcinoma
[what is the right adnexal mass?]

Q)30yr old sexually active male with fever and pain in the right big toe, not relieved with asprin, mother has osteoarthritis, swollen hot tender right toe, labs neutrophilic leucocytosis and left shift. synovial tap will show:
a)neutrophils with negatively birefringent crystals
b)neutrophils with positively birefringent crystals
c)neutrophils with gram negative cocci
d)neutrophils with phagocytosed immunocomplexes
[why not c?]

Q)odynophagia in HIV + pt with white plaque like lesions on buccal mucosa n tongue...organism? [y not cmv?]

[Pharmer]

Q1)Ans> c

malignant surface derived epithelium- serous cystadenocarcinoma is the most common ovarian neoplasm and it contains psammoma bodies which are concentric lamellated calified bodies

Q2)Ans> c

The patient most likely has endometrial carcinoma according to presention which is post menopausal vaginal bleeding, clear or white discharge and possibly enlargement of uterus compressing the adnexa which are closely related structures of the uterus like the ureters. In this case compression of the ureter led to hydronephrosis and superimposed infection causing pyelonephritis.

Q3)> Not sure...sorry

Q4)> This is mostly Candida albicans which causes oral thrus and esophagitis leading to painful swallowing, EBV would cause hairy leukoplabia on lateral side of tongue but no esophagitis and for CMV i do not see the link.

[Pharmer]

Hey for the third question, its reactive arthritis so you wont have organisms in the joints but im confused abt the answer.. it could be D but please cross check

[winterfire]

thank u pharmer


Q1) answer is e...torsion of a cystic teratoma
sudden onset of pain can be due to torsion but is there a specific tumor that can undergo torsion..?

Q2)answer is e (i have no idea y)

Q3) answer is a ( gout)
is podagra specific to gout? but the pt is young and no evidence of any risk factors like tumor lysis so how can it be gout?
i thought it was infectious arthritis (can gram -ve organisms be seen is this case?)
reactive arthritis has other symptoms also right like uveitis and urethritis

Q4) cmv can also cause esophagitis in hiv+ pts so y not cmv?

[Pharmer]

Q1) Any tumor of the ovary causing mass effect can lead to torsion of ovaries.

Q2) ok sorry for that one, you are correct...found it on wiki stage 3B cevical cancer

Q3) Podagra is specific to gout yes according to wiki, and aspiric can compete with uric acid for excretion and exacerbate gout.

Q4) Yes CMV can cause esophagitis but can it cause white plaque?

[pseudomyxoma]

cervical cancer is notorious for laterally spreading to ureters. also 50 years old is not necessarily menopause FYI, the avg age is 51 in the US but thats an average.. it can occur earlier or later and without any evidence to suggest otherwise, dont assume shes menopausal.

for the male who is sexually active.. alot of males are sexually active, dont jump the gun and assume its reactive arthritis unless you have been given hx of recent infection. and even if was reactive arthritis, it would be a medium/large size joint (ie knee), not the toe. toe is pretty specific for GOUT.

epidemiology is key, know it well, evident from the first question. 17 year old girl with an ovarian epithelial cell tumor.. unlikely.. teratoma... very plausible

CMV does not cause white plaque. it causes superficial linear erosions.