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MRCS-Pathology > Deck 3 > Flashcards

Deck 3 Flashcards

1
Q

RFs for thyroid cancer

A

Modifiable

  • Obesity
  • Radiation in infancy or childhood

Non modifiable:

  • Female
  • FHx
  • Cancer syndromes : FAP
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2
Q

Thyroid cancer genetic?

A

Medullary thyroid ~ 25% familial

Papillary and follicular ~10%

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3
Q

Features of thyroid malignancy on USS

A

Increased vascularity
Solid appearance
Microcalcification

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4
Q

Indications for removal of thyroid nodular goitre

A
  • Cancer
  • Pressure
  • Hyperthyroid resistant to meds
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5
Q

Most common thyroid cancer

A

Papillary (80%)

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6
Q

Causes of hypoparathyroidism

A

Post thyroidectomy
Radiotherapy to head and neck
Low Mg

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7
Q

Difference between primary and secondary hyperaldosteronism

A

Primary: Low renin, high aldosterone
eg aldosterone producing adenocarcinoma

Secondary: high renin, high aldosterone,
eg renal vascular disease, renin secreting tumours

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8
Q

Difference between primary and secondary hyperaldosteronism

A

Primary: Low renin, high aldosterone
eg aldosterone producing adenocarcinoma

Secondary: high renin, high aldosterone,
eg renal vascular disease, renin secreting tumours

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9
Q

What is leukoplakia

A

White patch or plaque on the oral mucosa
Not painful, irregular shape
Cannot be scrapped

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10
Q

Is leukoplakia malignant

A

No, pre-malignant

Improved on stopping smoking and alcohol

Progresses to SCC in 5%

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11
Q

Commonest head and neck cancer

A

SCC

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12
Q

RFs for SSC of oral cavity

A

Alcohol
Smoking
Working with wood dust or nickel dust
Infection: HIV, HPV, EBV

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13
Q

What is radical neck dissection

A

Removal of SCM
Internal jugular vein
Accessory nerve
As well as lymph node levels 1-5

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14
Q

Indications for heart transplant

A

Heart failure secondary to :

  • congenital heart disease
  • valve disease
  • cardiomyopathy
  • Ischaemic heart disease
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15
Q

General transplant criteria

A
  1. no active malignancy
  2. No active HIV or sepsis
  3. Lifestyle: no alcohol or smoking or drugs
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16
Q

Criteria for being a heart organ donor

A

<55 yo
Normal heart investigations (ECG, echo, angio)
No hx of heart disease or chest trauma
No Hep B,C, HIV

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17
Q

Criteria for being a heart organ donor

A

<55 yo
Normal heart investigations (ECG, echo, angio)
No hx of heart disease or chest trauma
No Hep B,C, HIV

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18
Q

Criteria for brainstem dead

A

Known aetiology for irreversible brain damage
Exclusion of reversible causes for coma and apnoea
Absence of brainstem reflexes

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19
Q

Tests of brainstem reflexes?

A
  1. No response to supraorbital pain
  2. Pupils fixed and unresponsive
  3. No corneal reflex
  4. No vestibulo-occular reflex (no eye movement on injecting 50mls of ice cold water in ear)
  5. No gag reflex
  6. No cough in response to bronchial stimulation
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20
Q

Apnoea test

A
  1. Fully Oxygenate pt
  2. Hypoventilate so PCO2 reaches 6.5
  3. Withdraw ventilation

If no respiratory movement even when PCO2 rises by more than 1 (above 6.65), then unlikely to recover

21
Q

Who can declare someone brainstem dead

A

2 doctors 5 years after full GMC registration
At least 1 consultant
2 separate occasions

22
Q

How to reduce allograft rejection

A
  1. blood type matching
  2. Tissue size and type matching
  3. Immunosuppressants
23
Q

Side effects of steroids

A

Skin:

  • bruising
  • thining
  • hirstusm

CVS:

  • HTN
  • retension

GI:

  • fatty liver
  • pancreatitis

Neuro:

  • psychosis
  • insomnia

MSK:

  • osteoporosis
  • AVN

Endocrine:
- diabetes

24
Q

Tumours associated with HIV

A

Kaposi sarcoma
CNS lymphoma
Hodkin’s

25
Q

How does H pylori survive acidic conditions

A
  1. detects low ph and uses its flagella to swim away
  2. burrows through the mucous lining and attaches itself to cells under
  3. produces urease which produces ammonia from urea. Ammonia binds H+
26
Q

How does H pylori lead to ulceration

A

Produces enzymes protease and lipase -> damage gastric mucosa

Damaged protective layer gets further damaged by the stomach acid

Ulcer formation

27
Q

What proportion of patients with H pylori 1. asymptomatic 2. develop ulcers or 3. cancer

A
  1. 80-90%
  2. 10%
  3. 1-2%
28
Q

Which gastric neoplasia associated with H pylori

A

Adenocarcinoma

MALT lymphoma

29
Q

Embryological origin of parathyroid gland

A

3rd and 4th pharyngeal arch

30
Q

Where are parathyroid glands found

A

Usually posterior to thyroid

Sometimes inferior ones are pulled down along with thymus into the mediastinum (both originate from 3rd pharyngeal arch)

31
Q

Where are parathyroid glands found

A

Usually posterior to thyroid

Sometimes inferior ones are pulled down along with thymus into the mediastinum (both originate from 3rd pharyngeal arch)

32
Q

Frozen section use

A

Intra-operative histology review:

  • benign or malignant
  • resection margins
33
Q

What happens during frozen section revie

A

Pathologist fixes the sample using cryostat machine and a microtome before looking under microscope

Quality lower than if it was formalin as the usual fixation agent

34
Q

Parathyroid histology fx

A

Oxyphil cells

Chief cells

35
Q

What happens in type 1 hypersensitivity reaction

A
  1. Initial exposure to antigen -> sensitization of B and T cells
  2. Mast cells with IgE in circulation
  3. If re-exposed: release of histamine leading to inflammation
36
Q

Examples of type 1 hypersensitivity

A

Anaphylaxis

Asthma

37
Q

Pathophysiology of type 2 hypersensitivity

A

IgG and IgM antibodies binds to foreign cell surface antigens
Activates complement pathway
Membrane attach complexes (MAC) destroys the cell membrane

38
Q

Examples of type 2 hypersensitivity

A

Autoimmune haemolytic anaemia

Rheumatic heart disease

39
Q

Pathophysiology of type 3 hypersensitivity

A

Formation of antibody-antigen complexes in circulatory blood
Forms a circulatory immune complex
Deposited in vessels, joint, kidneys etc causing tissue damage

40
Q

Examples of type 3 hypersensitivity

A

SLE

Rheumatoid arthritis

41
Q

Pathophysiology of type 4 hypersensitivity

A

Mediated by T cells attacking the tissue

Takes 48-72hrs

42
Q

Examples of type 4 hypersensitivity

A

Acute transplant rejection
Dermatitis
TB mantoux test
Hashimotos thyroiditis

43
Q

Pathophysiology of type 5 hypersensitivity

A

Stimulatory or inhibitory autoantibodies

Similar to type 2 that IgG or IgM binds to cell surface

Instead inhibits or stimulates the cell to produces something

44
Q

Examples of type 5 hypersensitivity

A

Graves

Myasthenia Gravis

45
Q

Sepsis definition

A

Organ dysfunction secondary to dysregulated host response to infection

Organ dysfunction : increase of 2 or more points on SOFA (sequential organ failure assessment) score

46
Q

qSOFA score use?

A

likelihood of sepsis in pt with a known or suspected infection

47
Q

Granuloma definition

A

Collection of epithelioid macrophages (epithelial formation)

48
Q

Types of granulomatous inflammation

A

Caseating (TB) or Non caseating (Sarcoid, Crohns)

Infective (TB) or non infective (Rheumatoid, corhns)

MRCS-Pathology (11 decks)

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