Aani: Histo general Flashcards
1
Q
How do statins work?
A
Lower cholesterol by inhibiting HMG-coA reductase enzyme needed to make cholesterol in liver
2
Q
What are the components of the atherosclerotic plaque?
A
- Fatty streak (muscle cells/macrophages)
- Fatty core (lipids)
- Fibrous cap (collagen ECM)
3
Q
Differences in symptoms between left and right ventricular failures?
A
LVF: Lung symptoms e.g. orthopnoea, pulmonary oedema, pink exudate, SOB
RVF: Body symptoms e.g. Peripheral oedema, ascites
4
Q
How does congestive heart failure affect the liver?
A
Dilates vessels and gives nutmeg liver appearance. This can lead to fibrosis
5
Q
What are the types of cardiomyopathy?
A
Dilated - dilated vessels, weaker
Hypertrophic - Thickened & enlarged heart, esp heart wall & septum
Restrictive - Stiffer vessels
6
Q
Causes of restrictive cardiomyopathy?
A
Amyloidosis/Sarcoidosis/Fibrosis
7
Q
Causes of hypertrophic cardiomyopathy?
A
Inherited
8
Q
Causes of dilated cardiomyopathy?
A
Alcohol/genetic/idiopathic/CHD/infection
9
Q
Discuss genetics of hypertrophic cardiomyopathy?
A
Mutations in sarcomeric proteins. Examples of mutations: Beta MHC (403 Arg - Gin). MYBP-C Trop-T
10
Q
What criteria is used for Acute Rheumatic Fever diagnosis?
A
Jones Criteria:
Joints (arthritis)
O is Heart (carditis)
Nodules (aschoff bodies)
Erythema Marginatum
Sydenham’s chorea (rapid jerky movements)
These are the major criteria.
Minor criteria include fever, malaise, high ESR and CRP, ASOT, tachycardia, joint pain
11
Q
What are the name of the nodules found in the hearts of Rheumatic Fever pts?
A
Aschoff Bodies
12
Q
Which valves are commonly affected in Rheumatic fever?
A
Mitral ONLY (70%). But can affect mitral and aortic.
13
Q
When does rheumatic fever occur?
A
2-4 weeks following a Strep Pyogenes throat infection (lancefield group A). Group A B haemolytic strep (GAS)
14
Q
How do you diagnose Rheumatic Fever?
A
Jones criteria along with raised ESR and raised ASOT (anti streptolysin O Abs).
15
Q
Treatment of Rheumatic Fever?
A
Benzylpenicillin
or erythromycin if allergic)
16
Q
Which histological features are present in Rheumatic Fever
A
Aschoff bodies (granulomas) Verrucae (beady vegetation) Anitschkov myocytes (regenerating myocytes)
17
Q
Which organism causes acute bacterial endocarditis?
A
Staph A
OR
Coagulase negative staph in prosthetic valve endocarditis)
18
Q
Which organism causes subacute bacterial endocarditis?
A
Strep Viridans
19
Q
Which valves are involved in bacterial endocarditis?
A
Usually mitral and aortic (left sided)
but in IVDU pulmonary and tricuspid (right sided)
20
Q
Which criteria is used for Bacterial endocarditis diagnosis? Explain it
A
Dukes Criteria:
2 major
1 major and 3 minor
5 minor
Major:
- Persistent bacteraemia (>2 positive blood cultures)
- Vegetations on Echo
- Positive cultures for bartonella, coxiella or brucella
Minor:
- Evidence of immune complex formation e.g. janeway lesions
- Bacteraemia not enough for major
- Echo findings not enough for echo
- Fever >38 or high CRP
- Murmur or IVDU
21
Q
How to treat infective endocarditis?
A
Benzylpenicillin and gentamycin
22
Q
Describe the following murmur:
Mitral regurgitation
A
Pan systolic
23
Q
Describe the following murmur:
Arotic regurgitation
A
Early diastolic
24
Q
Describe the following murmur:
Mitral valve prolapse
A
Mid systolic click + late systolic murmur
25
Describe the following murmur:
Aortic Stenosis
Ejection systolic
26
Describe the following murmur:
Mitral stenosis
Diastolic
27
What is COPD?
Group of lung conditions commonly including Chronic Bronchitis and Emphysema
28
What is emphysema? Histology?
Air space enlargement and wall destruction.
| You see loss of alveolar parenchyma distal to the terminal bronchioles
29
What is Chronic bronchitis? Histology? Diagnostic criteria?
Airway dilatation and increased mucus secretions.
On histology you see goblet cell hyperplasia and hypertrophy of mucus glands.
To diagnose you must have had a cough for at least 3 months for 2 consecutive years.
30
Causes of emphysema?
Asthma
Alpha 1 antitrypsin deficiency
Marfans (rare)
31
What are the histological findings in asthma?
Charcot Leyden crystals (seen in allergic disease)
And
Curschmann spirals (shed epithelium whirls)
32
CF: Genetics, inheritance
Autosomal Recessive
Defective CF transmembrane conductase regulator gene (CFTR) on Chr 7q31.2
= defective chloride ion transport
33
What are the types of interstitial lung disease?
Granulomatous (Caused by Tb, sarcoid, fungal, foreign bodies)
Fibrosing lung disease (caused by EAA, connective tissue, idiopathic). Recognising EAA early can prevent progression to fibrosis
34
Which part of the lung does asbestosis affect?
Lower lobe
35
What are the types of lung cancer in order of most common to least common?
```
Squamous cell (type of non small cell)
Adenocarcinoma (type of non small cell)
Small cell carcinoma
Large cell (type of non small cell)
```
36
RF for squamous cell carcinoma? Mutations?
Smoking
| C-Myc/p53
37
Which lung tumour is most common in non-smokers? Which mutation is associated.
Adenocarcinoma
| Associated with EGFR mutation
38
Histology of lung adenocarcinomas?
Glandular differentiation
39
Which paraneoplastic syndromes are associated with Small Cell Carcinoma?
ADH
ACTH
Lambert Eaton
40
Which paraneoplastic syndromes are associated with Squamous cell?
parathyroid- PTH
41
Which drug can be given in lung Adenocarcinoma?
Tyrosine Kinase inhibitor that targets the EGFR e.g. Tarceva
42
Which cells do you see in pulmonary oedema?
Iron laden macrophages (heart failure cells)
43
Causes of pulmonary oedema?
LVF
Hypoxia e.g. high altitude
Capillary damage
44
What are the complications of GORD?
- Ulceration
- Haemorrhage (melena, haematamesis)
- Barrett's oesophagus
- Perforation
45
What could a pH monitor show in GORD?
Low (acidic) from stomach contents
| High (alkalotic) from bile- this shows worse disease
46
What happens in Barrett's oesophagus?
Metaplasia of oesophageal squamous epithelium into mucin-secreting collumnar epithelium. The SC junction moves proximally towards mouth.
47
RFs for GORD?
Smoking
Obesity
Male
48
Which type of cancer is Barrett's ass. with? Location? What are the steps from metaplasia?
Adenocarcinoma of the oesophagus, therefore in the distal 1/3 of oesophagus.
Metaplasia --> dysplasia (in situ) --> Carcinoma
49
Which types of oesophageal cancer are there? Talk about each?
1. Adenocarcinoma: Lower 1/3. Ass. with barrett's oesophagus. Mucin producing.
2. Squamous cell carcinoma: Middle of oesophagus most common. Ass. with smoking and alcohol. Common in eastern world. Keratin producing therefore blockage symptoms e.g. dysphagia.
Afrocaribbians
50
Which cells would you expect to see in acute gastritis?
| Chronic gastritis?
Acute: neutrophils
Chronic: lymphocytes and plasma cells
51
What can happen when you have Helicobacter Pylori infection in stomach?
1. Gastritis (acute or chronic) which can lead to ulcers
Metaplasia --> dyplasia can lead to:
2. MALT and/or
3. Adenocarcinoma
52
Which ulcers are worse with food?
Stomach ulcers.
| Duodenal ulcers are relieved by food
53
How does H.Pylori cause MALT?
Chronic antigen stimulation causes B cell proliferation which can cause a mutation. These are B cell marginal zone lymphomas
54
Which ulcer is relieved by food?
Duodenal ulcer. However it worse at night
55
Which peptic ulcer is more common?
Duodenal (4 x)
56
Which cells are involved in Coeliac's? Which HLA status?
T cells
| DQ2 and DQ8
57
What is the gold standard for diagnosing Coeliac?
Duodenal biopsy
58
Which rash do Coeliac pts get?
Dermatitis Herpetiformis
59
Which ethnic group get Coelic (EMQ)?
Irish women
60
What is Hirschprung's disease?
Missing ganglion in myenteric plexus so poor gut motility (80% males)
61
What is the first sign of Hirschprung's disease?
Delayed passage of meconium (not within first 48 hours of life)
62
Genetics of Hirschprung's?
RET protooncogene Chromosome 10
63
Signs of Intussusception vs Pyloric stenosis?
```
Intissusception: Telescoping of a segment of bowel (the intussusceptum) into another
Episodic Crying
Colic pain/draws legs up
red current stool
palpable sausage shape mass (RLQ)
Bile stained vomit
Dance's sign (empty RLQ on uss)
```
Pyrloric stenosis:
No bile
Projectile vomiting
Palpable mass in LUQ
64
What causes C.Diff and what happens?
Use of cephalosporin and ciproflox Abx.
| Causes pseudomembranous colitis
65
Diagnosing C.Diff? Tx?
Stool sample. Treat with metronidazole
66
Which part of the colon is affected in Diverticular disease?
Left Colon 90%.
| Right sided in asians (cos we're always right)
67
RFs for diverticulosis?
Old age
Smoking
NSAIDs
Low fibre diet
68
Name for a connection between two epithelial surfaces e.g. when ulcers connect in Crohn's?
Serpentine Ulcer
69
Describe the appearance of the gut in Crohn's? Which abnormalities do you get?
Skip lesions --> cobblestone appearance
| Ulcers called Aphthous ulcers (Rose-thorn ulcers). Often in mouth.
70
Symptoms of Crohn's?
Fever
Abdo pain
Intermittent Diarrhoea
Malabsorption
71
Is Crohn's Deep or superficial?
Deep
72
Is UC deep or superficial?
Superficial
73
Which part of the bowel can UC affect?
UC starts at rectum and ascends proximally but is continuous. Crohn's is skip lesions but can affect any part of the GI tract.
74
When is the small bowel affected in UC?
When severe colitis causes backwash ileitis
75
Symptoms of UC?
Bloody & mucus-y diarrhoea
Crampy abdo pain
Relieved by defacation
76
Complications of Crohn's?
```
Polly Skipped For Ages
Perforation
Stritctures
Fistulae
Abscesses
```
77
Complications of UC?
Toxic megacolon
| Adenocarcinoma
78
Complications of UC?
Toxic megacolon
Adenocarcinoma
Haemorrhage
79
Differences in investigations for Crohn's VS UC?
```
Crohn's will more likely have missing vitamins e.g. B12
Do barium contrast for Crohn's
Crohn's will have ASCA
UC will have pANCA Abs
Rectal biopsy useful for UC
```
80
Which test can be done to differentiate IBD and IBS?
Faecal calprotectin testing
81
Which treatments are used in UC and Crohn's?
Corticosteroids e.g. Prednisolone, hydrocortisone
5 Amino-salicylic-Acid (5-ASA)
Immunosuppressants e.g. Azathioprine, DMARDs e.g. Methotrexate
Abx e.g. Metronidazole
82
How to treat mild and severe Crohn's
1. Mild: prednisolone or hydrocortisone
2. Severe: IV hydrocortisone and metronidazole or 5- ASA (mesalazine or sulphasalazine)
Additional for maintaining remission: Azathioprine, methotrexate, mercaptopurine
TNf alpha inhibs: infliximab or adalimumab
83
How to treat mild and severe UC?
Mild: Prednisolone and mesalazine or sulphasalazine (5 ASA)
(ASA in children)
Severe: admit, IV hydrocortisone + Prednisolone
Azathioprine 2nd line
84
What is carcinoid syndrome?
Carcinoid syndrome is a paraneoplastic syndrome comprising the signs and symptoms that occur secondary to carcinoid tumors. Release of 5-HT serotonin.
85
Which cells are involved in carcinoid syndrome?
Excess circulating serotonin is usually manufactured by ENTEROCHROMAFFIN cell-originated carcinoid tumors in the small bowel or appendix.
86
Symptoms of carcinoid syndrome?
```
Abdo pain
Bronchochonstriction
Flushing (after coffee/alcohol)
Diarrhoea
If severe can progress to Carcinoid crisis
```
87
Symptoms of carcinoid crisis?
```
Vasodilation
Hypotension
Tachycardia
Bronchoconstriction
Hyperglycaemia
```
88
How to investigate for carcinoid syndrome?
Urinary 24 hour 5HIAA measurement (metabolite of 5HT (seratonin))
89
Treatment for carcinoid syndrome?
Octreotide (somatostatin analogue)
90
Which genes are implicated in neoplastic colon polyps?
APC gene
K-Ras activation
LOF of p53
91
What types of non neoplastic colon tumours are there?
1. Juvenille Polyposis - in infants (bleeding)
2. Peutz Jeghers - many polyps . Freckles seen around mouth. Increased risk of malignancy
3. Hyperplastic polyps - shedding of epithelium. Seen on 50-60 y/o
4. Pseudopolyps e.g. IBD
92
Which tumour suppressor is linked to Peutz-Jegher's syndrome?
LKB1 loss
93
Which staging is used in colorectal cancer?
Dukes staging
94
Which type of carcinoma are most colorectal cancers?
Adenocarcinoma (98%)
95
Why are NSAIDs protective in Colorectal cancer?
NSAIDs inhibit the cyclooxygenase (COX)-1 and COX-2 enzymes, which are involved in the synthesis of prostaglandins and so reduce inflammation
96
Which chemo is given in colorectal cancer in palliation?
5 Flurouracil
97
Surgical treatment options for colorectal cancers?
Less than 2cm from anal sphincter? Abdominoperoneal resection (removes whole rectum anus and sigmoid colon)
More than 2cm from anal sphincter? Anterior resection - removes tumour and can create an anastamosis with anus.
Ascending colon cancer/prox transverse? Right hemicolectomy
Descending colon cancer/distal transverse? Left hemicolectomy
Transverse colon cancer? Extended right hemicolectomy
98
Which familial colon syndromes are there?
FAP
Gardners
HNPCC
99
What is FAP? Which gene?
Familial Adenomatous Polyposis
Over 100 polyps needed to diagnose this.
Most will become adenocarcinoma before age 30 so do prophylactic colectomy
AD C5q1 mutation on APC gene
100
What is Gardners syndrome?
Like FAP but with extra-intestinal features e.g. dental caries and osteomas
101
What is HNPCC?
Hereditary Non Polyposis Colorectal Cancer i.e. Lynch Syndrome
Fast progression to cancer. Associated with extra-colonic cancers e.g. ovarian, stomach etc.
102
Which hormones regulate pancreatic enzyme release? Which cells are they released from?
Cholecystokinin (CCK) - released from I cells of duodenum
| Secretin - released from S cells of duodenum
103
Which cells of the pancreas release which hormones?
Alpha: Glucagon
Beta: Insulin
Delta: Somatostatin (regulates insulin and glucagon)
104
What is metabolic syndrome?
It is a cluster of conditions that increase your risk of heart disease, diabetes and stroke.
```
It includes:
Hypertension >140/90
High BMI (central obesity) >94 cm in men and 80cm in women
Dyslipidaemia
Microalbuminaemia
Fasting blood glucose high
```
105
What is the criteria for diagnosing diabetes mellitus?
Random plasma glucose >11.1 mmol/l
| Fasting plasma glucose >7 mmol/l
106
Macrovascular complications of DM?
Cardiac - MI
Renal - Glomerulonephritis/pyelonephritis
Cerebral - Cerebrovascular accident
107
Microvascular complications of DM?
Diabetic retinopathy
| Peripheral vascular - poor healing ulcers e.g. diabetic foot
108
Causes of acute pancreatitis?
```
Idiopathic
Gallstones
Ethanol
Trauma/tumours
Scorpion venom
Mumps
Autoimmune
Steroids
Hyperlipidaemia
ERCP
Drugs e.g. thiazides
```
109
Pain in acute pancreatitis (features)?
Sharp epigastric
Relieved by sitting forward
Radiates to the back
(Vomiting)
110
Which cells will you see in autoimmune pancreatitis?
IgG4+ plasma cell
111
Acinar cell carcinoma histological features?
Eosinophils
Granular cytoplasm
Lipase and trypsin immunoreactivity
112
What is Schmid Triad?
Triad presentation seen in Acinar Cell carcinoma:
- fat necrosis
- polyarthritis
- eosinophilia
113
What blood results would you expect in Pancreatic carcinoma of the head? including liver enzymes and tumour markers.
```
High bilirubin
Low Hb
High calcium
High ALP/GGT
High Ca19.9 > 70IU/mL
```
114
Which specific signs could you see in Pancreatic carcinoma of the head?
1. Trousseau's syndrome - Thrombophlebitis (vessel inflammation due to blood clots) Ass. with pancreatic, gastric and lung cancer
2. Troisier's Sign (virchow's node)
3. Courvoisier's sign (painless jaundice + palpable gallbladder)
115
Which kinds of neuroendocrine tumours are there?
Functional (hormone excess) and non-functional (picked up incidentally).
Functional: Gastroma; Zollinger-Ellison syndrome (HIGH ACID)
Insulinoma
Glucagonoma
116
What is MEN and what are the types?
Multiple Endocrine Neoplasia
MEN 1
MEN 2A
MEN 2B
117
What is MEN1?
Endocrine neoplasia of the:
1. Anterior Pituitary
2. Parathyroid
3. Pancreas
118
What is MEN2A?
Thyroid
Parathyroid
Phaeochromacytoma
119
What is MEN2B?
Medullary Thyroid Carcinoma
Phaeochromacytoma
Commonly marfinoid features and mucosal neuromas - tongue bubbles
120
Which mutation leads to MEN2?
RET Protooncogene
121
Which multiple endocrine neoplasm affects the pancreas?
MEN1
122
Which multiple endocrine neoplasm presents with marfinoid features?
MEN2B
123
Which multiple endocrine neoplasm has the highest chance of developing medullaty thryoid carcinoma?
MEN2B
124
Which multiple endocrine neoplasm affects the parathyroid and the thyroid?
MEN 2A
| it can present with phaeocromacytoma
125
What is the name given to outpouchings of gallbladder epithelium into the gallbladder muscle layer?
Rokitansky–Aschoff sinuses
| Not necessarily abnormal but ass. with cholecystitis
126
What is the portal tract of the liver made up of?
Bile duct
Portal vein
Hepatic artery
127
Which liver cells in the hepatic lobule are most metabolically active?
Perivenular cells near the centre of the lobule, around the hepatic central vein. Zone 3
128
Which liver cells in the hepatic lobule receive the most O2 and nutrients?
Zone 1, periportal
129
What is the name of the structure that contains the portal tracts in the liver?
Sinusoids
130
What kind of cells feature in all adenocarcinomas?
Mucin-secreting Glands
131
Which tumour marker is high in HCC?
AlphaFetoProtein (AFP)
132
Causes of cholangiocarcinoma?
Bild duct cancer. Adenocarcinoma so mucin-secreting
Lynch syndrome 2 (HNPCC)
Primary Sclerosing Cholangitis
Parasitic infection
133
What happens when there is increased resistance to blood flow through the liver?
This creates portal hypertension so there is intra and extra hepatic shunting.
Intra: Bypassing of hepatocytes straight from portal vein to central hepatic vein.
Extra: Oesophageal varices and haemorrhoids
134
What is alpha1anti-trypsin associated with?
Liver cirrhosis
| COPD - Emphysema
135
Which liver cell stores Vitamin A?
Stellate Cell
136
Describe the stages of liver cirrhosis?
1. Hepatocyte damage and necrosis
2. Inflammation activates stellate cells in the space of disse that become myefibroblasts and initiate fibrosis by depositing collagen in the space of disse
3. Some hepatocytes regenerate and form nodules]
4. There is disruption of the liver architecture
Cirrhosis is reversible if treated aggressively
137
What causes micronodular cirrhosis?
<3mm nodules (AnuBear is small)
Alcoholic hepatitis
Biliary tract disease
138
What causes macronodular cirrhosis?
>3mm nodules
Viral hepatits
Alpha 1 antitrypsin deficiency
Wilson's disease
139
At what raised portal pressure do the dilation symptoms/changes begin?
10-12 mmHg
140
What are the main categories of liver cirrhosis?
ANA Got Big Veins
1. Alcoholic
2. Non Alcoholic fatty liver disease (NAFLD)
3. Viral Hep
4. Genetic
5. Auto-immune hep
6. Billiary causes
141
What are the types of alcoholic liver cirrhosis?
Alcoholic steatosis
Alcoholic hepatitis
Alcoholic cirrhosis
142
What do you see in alcoholic hepatitis?
key cells are neutrophil polymorphs
| You see mallory denck bodies and hepatocyte ballooning
143
Types of NAFLD?
Steatohepatitis
Simple steatosis
Similar to alcoholic liver disease but seen in FAT non-alcoholics. Due to high levels of lipids.
Common in pts with metabolic syndrome
144
Auto-immune hepatitis HLA Ass?
HLA-DR3
145
Types if auto-immune hepatitis?
type 1 and type 2
Type 1: ANA, anti SMA and anti-actin
Type 2: Anti LKM
146
Billiary causes of hepatic cirrhosis?
Primary Billiary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC)
147
Key features of PBC
Primary Billiary Cholangitis (PBC): B in it, Big (opposite). These ones try to trick you.
Auto-immune destriction of intra-hepatic bile ducts
Anti Mitochondrial Abs seen
Loss of bile ducts seen (no duct dilatation) so NOT big.
Raised ALP and IgM
148
Key features of PSC
Primary Sclerosing Cholangitis (PSC): S in it, Small (opposite).
Auto-immune fibrosis of intra and extra hepatic bile ducts.
Autoantibodies seen
DILATED bile ducts , BIG
Raised ALP and pANCA
Diagnose via ERCP - will show beading of bile ducts because multifocal strictures are created and there is dilatation of preserved bile duct
High risk of progression to cholangiocarcinoma
149
What are the genetic causes of liver cirrhosis?
Haemochromatosis
Wilson's disease
Alpha 1 antitrypsin deficiency
150
What gene is mutated in haemochromatosis?
```
HFE gene (can be screened for) on Cr 6
Human haemochromatosis protein
```
151
What happens in haemochromatosis?
Increased gut iron absorption which deposits in the liver, heart, kidneys, skin etc. This causes damage to the parenchyma
152
How to test for haemochromatosis?
- Iron in the liver- prussian blue stain
| - Iron studies. high serum Fe, high serum ferritin, low TIBC
153
Treatment of haemochromatosis?
Desferrioxamine
| Venesection
154
Wilson's disease mutation?
ATP7B
| Chr 13
155
What happens in wilson's disease? Symptoms?
```
Caeruloplasmin is not created so copper cannot be excreted into the bile. This leads to a build up of copper so it gets deposited in the brain and liver. It also spills out into blood and goes into kidneys.
Itchiness
Yellowness
Tremors/Psychosis/Dementia
Vom
Ascites
Kayser Fleischer Rings
```
156
Investigations for Wilson's disease?
Rhodanine stain
Mallory bodies & steatosis on microscopy
Copper tests:
Low serum copper (because of low caeruloplasmin)
High urinary copper
Low caeruloplasmin
157
What is the opposite of Wilson's disease?
Menke's disease (complete deficiency in copper) due to ATP7A mutation
158
Which part of the brain is most affected in Wilsons disease?
Lenticular nuceli - they appear brown because of the copper deposition
159
Treatment of Wilson's disease?
Penacillamine FOR LIFE
160
When should you suspect A1AT?
When there is cirrhosis in combination with emphysema. In children you get neonatal jaundice
161
Histology/Ix of A1AT?
- Intracytoplasmic Inclusions of A1AT which stain with Periodic acid schiff staining technique
- No alpha globulin band on electrophoresis
162
Side effects of cyclophosphamide?
Haemhoragic cyctitis
Bladder cancer
Infertility
163
Types of bladder cancer?
Transitional cell
Squamous ce
Adenocarcinoma
164
Which is the most common type of bladder cancer?
Urothelial carcinoma/Transitional cell carcinoma (TCC)
165
RFs for transitional cell bladder carcinoma?
Smoking
| Aromatic amines
166
Symptoms of transitional cell carcinoma?
```
Painless haematuria
Urgency
Frequency
Pyelonephritis
Hydronephritis
```
167
Diagnosis of bladder cancer?
Cystoscopy and biopsy
168
Which organism is ass. with squamous cell carcinoma?
Schistosomiasis
169
Symptoms of Benign Prostatic Hyperplasia and reasons why these symptoms occur?
```
Retention
Dribbling
Frequency
Nocturia
The enlarged prostate presses/blocks the bladder
```
170
Treatment of BPH?
1. Alpha blocker e.g. Doxazosin
2. TURP Transurethral resection of prostate
3. 5alpha reductase inhibitor e.g. Finasteride
171
How to grade and investigate prostate cancer?
Grade: Gleason system
Investigate: Biopsy and PSA (high over 4ng/ml is indicative)
172
Treatment of prostate cancer?
1. Observe
2. Prostatectomy
3. Radiotherapy
173
Types of testicular cancers and which is more common?
Germ cell 95% - Seminoma (most common), Yolk Sac tumour, Choriocarcinoma, Teratoma
Non germ cell 5% - Leydig cell, sertoli cell
174
Biological markers for Germ cell teratomas?
hCG
AFP
LDH
175
Causes of pre-renal AKI?
Hovolaemia, sepsis, renal artery stenosis
176
Categorise renal causes of AKI
Glomerular
Tubular/interstitial
Vessels
177
Overall symptoms of AKI?
```
Reduced GFR
Acidosis
Hypertension/fluid overload
Hypocalcaemia
Hyperkalaemia
Uraemia
```
178
What are the key features of nephrotic syndrome?
Proteinuria (>3.5g/day)
| Hypoalbuminaemia (<30g/L)
179
Primary causes of nephrotic syndrome?
Minimal change
membranous glomerular disease
Focal segmental Glomerulosclerosis (FSGS)
180
Most common cause of nephrotic syndrome in kids?
Minimal Change
181
What do you see on electron microscopy of Membranous Glomerular Disease?
Loss of podocyte foot processes. Spikes due to deposits.
| On IF you see granular deposits along the GBM
182
Which primary nephrotic syndrome cause has the worst prognosis?
Focal Segmental Glomerulosclerosis -50% chance of end stage renal failure in 10 years
183
Secondary causes of nephrotic syndrome?
Diabetic nephropathy
Amyloidosis
SLE
184
What are Kimmelstiel Wilson Nodules?
Diabetic glomerulosclerosis allows proteins through the glomerulus and they accumulate in the Bowman's Capsule and form these nodules.
They are Periodic Acid Schiff Positive
185
What are the differences between the types of Amyloidosis?
Type 1 is AA, serum amyloid associated protein. Ass. w/TB and chronic infection
Type 2 is AL, light chains- ass. with MM.
186
What are the key features in nephritic syndrome?
Cocacola urine
| Red and white casts in urine
187
What are the causes of glomerulonephritis?
```
thin CHIPS
Thin basement membrane
Crescentric glomerulonephritis
Hereditary (alports)
IgA nephropathy (berger)
Post-Strep GN
```
188
Causes of crescentric GN?
Pauci immune
Anti-GBM
Immune complex mediated
189
Talk about the 3 types of crescentric GN
GOOD CROISSANT PASTRIES
GBM
COMPLEX
PAUCI
ALL 3 will show crescents in glomeruli because of damage and cell accumulation in bowman's space.
Pauci immune - ass. with pANCA and cANCA
Anti GBM - Goodpasture's. Diagnostic test is fluroscopy, you'll see a band of IgG on GBM. Abs against type 4 collagen a3
Immune complex mediated - will see granular deposition of IgG immune complexes in mesangium or GBM. Caused by SLE, IgA and Post infectious
190
What is Alport's syndrome?
Mutation in collagen type 4 alpha 5 chain
Affects kidneys, eyes and defness
Presents Age 5-20
191
What is IgA nephropathy?
Also known as BERGER disease.
Commonest GN worldwide
IgA immune complex deposition. IgA will be v high.
Doesnt usually cause nephritic syndrome
192
When does IgA nephropathy present
After upper resp tract infection and frank or microscopic haematuria
193
What is thin basement membrane disease?
```
Mutation in type 4 alpha chain 4 collagen
Causes thinning of GBM
Common 5% of people
AD
Doesnt usually cause nephritic syndrome
```
194
What are the causes of Tubular/interstital damage that causes AKI?
ATN (caused by drugs/toxins/ischaemia)
and
```
Tubulointerstitial Nephritis
(caused by acute or chronic pyelonephritis due to UTIs or caused by acute or chronic interstitial nephritis caused by hypersensitivity reaction to drugs)
```
195
Which thrombotic microangiopathy is sometimes diarrhoea associated?
HUS
| Caused by E.Coli 0157, often kids at petting zoo
196
What are the causes of vessel damage AKI?
HUS and TTP
HUS - kids. confined to kidneys
TTP - adults. Systemic thrombi throughout circulation
197
Causes of CKD?
```
Diabetes
Glomerulonephritis
Pyelonephritis
Hypertension
Polycystic Kidney Disease
```
198
What happen in polycystic kidney disease?
Cysts within the nephrons dilate and press onto the kidney and cause nephron loss. Can cause haematuria, flank pain and UTIs
199
Which mutations are associated with polycystic kidney disease?
PKD1 on Chr 16 and PKD2 on Chr 4
200
What else are Polycystic kidneys associated with?
Berry aneurysms in circle of Willis and cysts in liver (in PKD1)
201
What is the name of the PID complication that causes peri-hepatic adhesions
Fitz Hugh Curtis syndrome
| Violin string adhesions
202
What are the types of endometrial carcinoma?
Endometroid 80% - oestrogen dependent PERIMENOPAUSAL women.
Non-endometroid 20% - Clear cell/serous/papillary unrelated to oestrogen excess. OLDER women.
In endometroid there is an accumulation of 4+ gene mutations
203
RFs for vulvular carcinoma?
```
VIN
Lichen sclerosis
Pagets disease of vulva
Smoking
HPV
```
80% are squamous cell
Labia Majorum is most common site
204
Which form of gestational trophoblastic disease (GTD) is ass. with progression to cancer?
COMPLETE moles and choriocarcinoma (placental origin)
205
What do choriocarcinomas secrete? Which cells secrete it?
bHCG (from synctiotrophoblasts)
206
What are the types of ovarian tumours?
EGS
Epithelial
Germ Cell
Sex Cord
```
Epithelial: SCEM
Serous
Clear Cell
Endometroid
Mucinous
```
Germ Cell: DTC
Dysgerminoma
Teratoma
Choriocarcinoma
Sex Cord: FGS
Fibroma
Granulosa-theca cell
Sertoli-Leydig
207
Which histo finding do you see in Serous ovarian tumours?
Psammoma Bodies
208
Which type of Epithelial ovarian tumours are most common?
Serous
209
What is the appearance of clear cell ovarian tumours?
Clear cytoplasm with hob like appearance
210
What is the name of a stomach tumour that metastasises to the ovaries and what would you see?
Mucinous KRUKENBERG tumour. You would see signet ring cells (from gastric tumour)
211
What is the name of the ovarian tumour with bits of different cells in them like teeth, hair, nails etc.
Cystic Teratoma or Dermoid Cyst
212
Which syndrome is associated with ovarian fibromas? What is the syndrome?
Meig's syndrome.
Pleural effusion
Ovarian cancer
Ascites
213
Describe Granulosa-Theca cell tumours of the ovaries?
Oestrogen producing- so look for oestrogenic effects e.g. breast enlargements, irregular menstruation
214
Describe Sertoli-Leydig ovarian tumours?
they secrete androgens- look for defeminisation e.g. hirsutism, enlarged clitoris, deep voice
215
How does the HPV virus cause cancer?
It has 2 proteins E7 and E6.
They inactivate tumour suppressor genes.
E6 does p53
E7 does Retinoblastoma
These changes cause increased proliferation
216
Which strands of HPV are associated with cervical cancer?
16 and 18
217
Describe the cell types of the cervix
Outer: squamous
Inner: Collumnar
Separated by squamou-collumnar junction (transformational zone)
218
Which part of the cervix is susceptible to malignant change?
transformational zone
219
Describe the grading of CIN
1: distal 1/3 dysplasia
2: lower 2/3
3: full thickness but BM intact
220
RFs for cervical cancer
```
Younger age at first sex
Multiple sexual partners
Smoking
Multiparity
Immunosuppression
```
221
Which type of cervical carcinoma is more common?
Squamous cell (80%) then 20% adenocarcinoma + others
222
How do women get acute mastitis?
Staph infection via cracks in nipples - stasis of milk contributes. Pts get fever and red, painful, swollen breast
223
Which type of mastitis is not associated with breastfeeding? Histology?
Periductal mastitis - seen in smokers. Histologically you see keratinizing squamous epithelium
224
Which breast condition presents with thick white nipple secretions?
Duct ectasia. Caused by inflammation and dilatation of large breast ducts. Proteinaceous material inside - mimics appearance of cancer on mammography.
225
How does fat necrosis occur in the breast? What do you see histologically?
Damage to adipose tissue in the breast causes infiltration of inflammatory cells and causes painless breast mass. You will see inflamm cells around the fat cells
226
What are fibrocystic breast changes?
Benign Proliferative. Exaggerated response to normal hormones that causes small cysts in the breast -often fluid filled (green/yellow on FNA) and can be calcified. Cysts can rupture and cause fibrosis or fat necrosis.
227
Which age do people get fibroadenomas? Give details about fibroadenomas.
20-30. Response to hormones, englarge during pregnancy. Calcify during menopause. Benign. Mobile.. Can shell out the large >3cm ones
228
What does it mean if you see epithelial hyperplasia in the breast?
It is a risk for invasive carcinoma.
229
What is the male equivalent of fibroadenoma?
It is an exaggerated response to oestrogen so you get gynaecomastia
230
Which breast condition commonly causes bleeding from nipple?
Duct papilloma (peripheral ones don't usually bleed but central ones do).
Ix: galactogram
Tx: excision
231
Which condition can look like a star shaped cancer on mammogram?
Radial scar - scarring around glandular tissue in stellate pattern
232
RFs for breast cancer?
- Hormone exposure (E2) - early menarche, late menopause, OCP
- Age
- FH
- Genetics BRCA1/BRCA2
- Smoking
- Obesity
233
Which Chromosome loss causes low grade susceptibility?
16q loss and 1q gain
234
What is the histological hallmark of ductal carcinoma in situ?
Punched out spaces that are regular and round
| Microcalcifications
235
What are the symptoms of a worrying breast malignancy?
Skin changes e.g. eczematous/paget's breast/peau d'orange
- hard fixed lump
- nipple retraction
236
Which breast cancer has sheets of atypical cells?
basal-like carcinoma
237
Which breast cancer has lines of single file strands?
Invasive lobular (indian file)
238
Which breast cancer has well formed tubules?
Tubular carcinoma
239
Which receptors are screened for in neoplastic breast lesions?
HER2
E2 (oestrogen)
PR (progest)
240
Which breast receptors are associated with a good prognosis? bad prognosis?
```
E2/PR = good Will respond to tamoxifen
HER2 = bad
```
241
Which treatment can you give against HER2 receptor?
Herceptin (trastuzumab)
242
What is the key prognostic factor in breast cancer prognosis?
Axilliary LN presence
243
What are the effects of tamoxifen?
Antagonist to breast E2 receptor but agonist to bone/uterus E2 receptor, so increased risk of uterine cancer (i.e. endometrial)
244
What does basal-like breast carcinoma stain positive for?
CK5/6/14
245
What are phyllodes tumours? Treatment?
Breast tumours mostly benign but can be malignant. Arise from breast stromal tissue
High cellularity & mitotic activity = more likely to be malignant.
>50 years old but also in young
Tx: Wide local excision
246
What age is the national breast screening programme for?
47-73
247
What FNA grade would you give to a DCIS? Invasive?
DCIS: B5a
Invasive: B5b
248
When do you give thrombolytics in a stroke?
If its been less than 3 hours since the event
249
What is the cause of most subarachnoid haemorrhages?
ruptured berry aneurysms
250
Causes of raised intracranial pressure?
SOL - neoplasia, abscess, bleed
Cerebral oedema - hydrocephalus (accumulation of CSF; communicating = poor reabsorption of CSF into sinuses. non-communicating = blockage of aqueduct)
Tx: stent
251
What is Kernig's sign?
When thigh is flexed and knee at 90 degrees, extension of knee causes pain. It indicates SAH or meningitis
252
What is often the first presentation of NF1?
Cafe Au Lait spots. Pts must have 3-5 to warrant investigation.
253
What is neurofibromatosis?
AD
| Cause lesions in the skin, nervous system and skeleton.
254
Which Chr is the mutated NF1 gene on?
17q11
255
Which Chr is the mutated NF2 gene on?
22q12.2
256
Which brain tumours are seen in children?
```
Medulloblastoma
Hairy cell (pilocytic astrocytoma)
```
257
Which brain tumours are hairy cell?
Astrocytomas - pilocytic
258
What is glioblastoma?
A type of astrocytoma.Quite bad.
| Grade 4 - very invasive
259
Which brain tumours are grade 4 on WHO grading?
Glioblastomas
| Medulloblastomas
260
Which codeletion is important for oligodendromas?
1p19q
261
What are the features of dementia?
```
A global impairment of cognitive function without impairment of consciousness
Aphasia
Apraxia
Agnosia
Amnesia
```
262
Which staging is used in Alzheimers disease?
Braak
263
Alzheimer's is associated with which proteins?
TAU protein becomes hyperphosphorylated (you see intracellular neurofibrillary tangles of tau protein)
B amlyoid protein accumulates to form extracellular senile plaques
264
Which Braak stages would be clinical azlheimer's?
5 and 6
265
Which dementias involve the Tau protein?
Frontotemporal dementia including Picks disease (Accumulation of pick bodies made of tau protein)
And Alzheimer's
266
What causes the loss of colour in Parkinson's?
Neuromelanin loss in substantia nigra, caused by dopaminergic metabolism
267
What are lewy bodies?
Aggregates of protein Alpha Synuclein
268
Which neuro condition involve Alpha Synuclein?
1. Parkinson's
2. lewy body dementia
3. Multiple System Atrophy - but pathology is in the glial cells
269
Which proteins are seen in MS? (multiple sclerosis)
MBP and PLP
Myelin Basic Protein and
Proteo-lipid Protein
270
What is MS?
Autoimmune demyelination of neurones - needed for axon conduction
271
How does PTH increase calcium?
PTH binds to osteoblasts which upregulate the RANK ligand so more RANK can bind to RANK receptor which leads to osteoclast differentiation and survival.
Osteoclasts bind to bone and digestive enzymes break down collagen 1. and release calcium from bone
272
How is calcium release from bone regulated?
PTH releases it
| OPG (osteoprotegerin) competes with RANK to control levels of calcium release.
273
Which drug can protect against osteoporosis?
Denosumab - mimics OPG
274
What type of crystals do you get in gout?
Urate crystals
275
What type of crystals do you get in pseudogout?
Calcium Pyrophosphate crystals
276
Management of gout?
Acute: Colchine
LT: Allopurinol
277
Which organisms cause osteomyelitis?
Neonates: Group B Strep, H. Influenza
Adults: Staph A, E.Coli, Kleb
Rare: syphilis, lyme disease (borrelia burgdoferi by ixodes dammini), TB (Pott's disease)
278
Featyres of osteoarthritis?
```
Heberden's nodes (DIPS)
Bouchards nodes (PIPS)
```
279
Which Abs are in RA?
Rheum factor IgM alone
| or IgG in immune complexes
280
Which cells are seen in histology of RA?
Grimley-Sokoloff Cells (if you have Rh Arth you might wanna hide it by wearing GRIM SOCKs)
281
Which age and joint is affected in osteosarcomas?
Adolescence
| Knee
282
Which are the malignant bone tumours?
OCE
Osteosarcoma
Chondrosarcoma
Ewing's Sarcoma
283
Describe the features of Ewing's sarcoma
VERY malignant
<20 years (Harry was <20 when Hedwig died)
There is onion skinning of the periostium
T11:22 translocation (Harry was 11 when he got Hedwig)
CD99+ve
Long bones
284
Describe the features of Osteosarcoma
```
Malignant
<30 years
Knee
ALP +
Codman's triangle
Sunburst appearance
OSTIN THE COD IN THE SUN
```
285
Describe the features of Chondrosarcoma
>40 years
Axial skeleton - pelvis etc
Malginant chondrocytes
Lytic lesions with fluffy calcifications
286
When there is fluffy calcification on Xray what could it be?
Chondrosarcoma
| Enchondroma
287
Describe features of enchondroma
Benign tumours of cartilage
Affects hands and feet
Cotton wool calcifications on Xray
Middle aged
Ollier's syndrome: multiple enchondromas
Maffuci's syndrome: Multiple enchondromas and haemangiomas
288
Describe the features of Osteochondroma
Mimics cartilage around the bone- cartilage capped bony outgrowths seen
289
Describe the features of Fibrous dysplasia
Bone replaced by fibrous tissue
Can present with cafe au lait spots if Albright syndrome
Chinese letters on histology
Soap bubble osteolysis and Shepherds crook deformity
290
Which bone disease is borderline malignant/benign?
Giant Cell. You get osteoclast type multinucleate giant cells
291
What are the types of inflammatory dermatoses?
Spongiotic
Psoriasiform
Vescicular Billous
Granulomatous
292
What are the types of spongiotic dermatitis? What is the histology?
Contact (type 4 hypersensitivity reaction to jewellery etc)
Atopic (eczema)
Seborrhoeic (inflam reaction to yeast Malassezia) -cradle cap
Histology:
Sponginess
Inflammatory infiltrates
Chronic; Acanthosis, crusting
293
What is the sign when you rub a rash and you get pinpoint bleeding?
Auspitz' sign in psoriasis (i was 15 when diagnosed, went to Autzwits when i was 15)
294
When lesions form at sites of trauma in psoriasis, what is it called?
Koebner's phenomenon
295
What nail/hand changes do you get in psoriasis?
```
POSHA
Pitting
Onchylosis
Subungual Hyperkeratosis
Arthritis
```
296
Histo features in psoriasis?
Loose granulocell layer, parakeratosis, neutrophils instead of eosinophils
297
Describe lichen planus?
```
Saw tooth ridges, hyperkeratosis
Purple
Puritic
Papules
Plaques
Mother of pearl sheen
Wickham Striae
Inner surface of wrists or mouth
```
298
Causes of erythema multiforme rash?
HSV 1
| Mucoplasma Pmneumoniae
299
Describe erythema multipforme
Target lesions
Subepidermal bullae
Seen in HSV1/mycoplasma. Drug reactions e.g. Antimalarials, penicillin
300
What are the 3 forms of Vesicular Bullous skin inflammations and where are they in the layers of the skin?
Dermatitis Herpatiformis -Subepidermal
Pemphigoid - Subepidermal
Pemhigus Vulgaris - Intraepidermal
301
Differences between pemphigus and pemphigoid?
Pemphigus is superficial and intraepidermal They are easily ruptured and you see IgG deposits intrcellularly.
Pemphigoid is deep and subdermal. They are NOT easily ruptured and are big/balloon like.
302
What are the malignant skin neoplasms?
Basal cell carcinoma (does not kill)
| Small cell carcinoma (metastatic!)
303
What is the name for a squamous cell carcinoma that doesn't metastasize (in situ)?
Bowen's disease
304
Describe the basal cell carcinoma?
Rodent ulcer
Slow growing
Pearly surface with telangiectasia and rolled edge
Basiloblue cells
305
Describe squamous cell carcinoma?
Flat/red/scaly/sun-exposed areas
Spreads through BM into dermis
Atypia
Nuclear crowding
306
Which stain is used for Melanomas?
Fontana Stain
307
Which scale is used for melanomas?
Breslow's thickness
308
Describe malignant melanomas
```
Keratinocytes in dermis = bad
Vertical growth of melanocytes into dermis
Buckshot appearance (pagetoid cells)
```
309
How to test for malignant melanoma?
Fontana stain
| Biopsy will show + melanin
310
What are the conditions when there are patches of skin detachment and how do you define each one?
Stephen Johnsons Syndrome (<10% of skin)
| Toxic Epidermal Necrolysis (TEN) >30%
311
What happens in SJS/TEN?
Drug reaction - fly like symptoms then rash and blistering
| Drugs e.g. Lamotrigine and Abx
312
What is the name of the sign in SJS/TEN where there is prominent mucosal involvement?
Nikolsky's sign
| the little girl was a polish girl called Nikola
313
Describe pityriasis Rosea
```
Salmon pink rash
Starts with a herald patch
Christmas tree distribution
Face usually unaffected
After viral illness
Resolves from 12 weeks to 5 months
```
314
What do you see on Immunoflurescence if you have MIXED connective tissue disease?
Speckled pattern of ANA appearance
315
Which HLA is ass. with SLE?
HLA DR3 (or DR2)
316
Which HLA is ass. with Scleroderma?
HLA DR5 / HLA DRw8
317
Which Abs do you see in SLE?
```
ANA
Anti-dsDNA
Anti-Smith (only 30% have it but if they have it it's SLE)
Anti-histone (for drug related SLE)
Anti-Phospholipid
```
318
Symptoms of SLE?
```
SOAP BRAIN MD - need 4/11
Serositis (lung/heart/abdo)
Oral ulcers
Arthritis
Photosensitivity
Blood (pancytopaenia)
Renal involvement (proteinuria - nephrotic)
ANA +
Immune cells e.g. Anti dsDNA, anti phospholipid
Neuro symptoms
Malar rash
Discoid rash
```
319
What do you see on SLE histology?
LE bodies
Libman Sack endocarditis
Onion skin lesions
320
Difference between limited and diffuse scleroderma?
```
Limited = CREST (scleroderma only on fingers)
Diffuse = Scleroderma anywhere, widespread organ involvement and skin is tight esp over chest
```
321
Which Abs do you see in each of the sclerodermas?
Limited: Anti centromere
Diffuse: Anti topoisomerase/Anti-Scl-70 and Anti-fibrillarin
322
What do you see on limited scleroderma histology?
Onion skin thickening of arterioles
323
RFs for SLE?
Female
40 years old
Afro carabbean
SLE is a type 3 hypersensitivity i.e. immune complex mediated
324
What is CREST?
```
Calcinosis
Raynauds
Esophageal dysmotility
Scleroderma
Telangiectasia
```
325
What actually is scleroderma?
Thickening of skin due to excess collagen deposits- causes symptoms in crest e.g. oesophageal dysmotility
326
Order of colour change in raynauds?
When Blood Returns
White
Blue
Red
327
Which Ab is seen in polymyositis and dermatomyositis?
anti-Jo1
328
What is myositis? What investigations can you do?
Inflammation of the muscles
| Raised creatinine Kinase and abnormal EMG
329
Cutaneous features of dermatomyositis?
Heliotrope rash and Gottron papules
330
What are all the vasculitides?
Large vessel:
1. Takaysu's arteritis
2. Temporal arteritis
Medium vessel:
1. Kawasaki's
2. Polyarteritis Nodosa (PAN)
3. Buerger's disease
Small vessel:
1. Wegener's granulomatosis
2. Churg Strauss
3. Henoch schonlein purpura
4. Microscopic polyangiitis
331
In which vasculitis conditions do you get a non-palpable temporal artery?
Temporal arteritis AND takayasu's arteritis
332
What are the key features of takayasu's arteritis?
Japanese women
pulseless disease
Bruits, claudication
333
Histology of temporal arteritis?
Giant cells
High ESR
Skip lesions
334
Features of Kawasaki's disease?
```
<5 years
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet red
Fever >5 days
```
335
Features of Wegeners?
| Which Ab?
```
Triad:
ENT (epistaxis, saddle nose, sinusitis)
Upper resp tract: haemorrhage/cavitation
Kidneys: cresentric glomerulonephritis
cANCA
Anti PR3
```
336
Features of Churg Strauss?
```
Vasculitis
Asthma - think eosinophilia init
Granulomas with Eosinophilia - this is what causes the
pANCA
Anti MPO
```
337
Features of microscopic polyangiitis
```
Pulmonary renal syndrome: same as Wegeners without URT signs
-Pulmonary haemorrhage
-Glomerulonephritis
pANCA
Anti MPO
```
338
Age of Henoch Schonlein Purpura?
<10 y/o
339
What happens in Henoch Schonlein Purpura (HSP)?
```
Preceded by a URTI
palpable Purpuric rash over limbs and buttocks
Abdo pain
Glomerulonephritis
Arthritis
Orchitis (testicular inflammation)
```
340
Which stain is used to detect amyloidosis?
Congo red
341
What do you see under polarised light in amyloidosis?
Apple green birefringence
342
Features of amyloidosis?
```
Macroglossia
Carpel tunnel syndrome
Nephrotic syndrome
Hepatosplenomegaly
Heart Failure
```
343
Most common familial amyloidosis?
Familial medetarranean fever -VERY high IL1 production
344
What causes amyloidosis?
Deposition of misfolded amyloid proteins in normal tissue disrupting function. Beta pleated sheet configeration
345
What are the different types of amyloidosis?
1. Primary- AL - light chains, bence jones proteins, ass. with MM (most dont have MM)
2. Secondary AA (systemic, serum AA)
RA, TB, IBD associated
3. Familial
4. Haemodialysis ass.- deposition of beta 2 microglobulin
346
What are the histological features of sarcoidosis?
Non-caseating granulomas
Shaumann bodies
Asteroid bodies
347
What are Shaumann bodies?
Calcium and protein inclusions inside of Langhans giant cells as part of a granuloma.
348
Mnemonic for Sarcoidosis features?
```
HAHA JC SMELLS
Hepatosplenomegaly
ACE (high)
Hilar lymphadenopathy
Anterior uveitis
Joints
Calcium (high)
Skin nodules
Myocardial involvement
Erythema nodosum
Lupus pernio
Leukopenia
Shaumann bodies
```
349
Which patient group is Sarcoidosis often seen in?
Afrocarrabeans, females
350
How do you diagnose sarcoid?
```
High ESR
High Calcium
Calciurea
High ACE
Bronchial biopsy - granulomas, asteroid bodies, giant cells, shaumann bodies
CXR: lymphadenopathy
```
