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MRCS-Pathology > Deck1 > Flashcards

Deck1 Flashcards

1
Q

What is amyloidosis

A
  • Rare life-threatening condition

- Deposition of abnormal fibrillar protein known as amyloid in the extracellular tissue

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2
Q

Histological fx of amyloidosis

A

Apple green birefringence under polarised light

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3
Q

Classifications of amyloidosis

A

AL: primary
AA: Secondary to chronic inflammation
ATTR: hereditary

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4
Q

ATTR amyloid

A

Autosomal dominant mutation in transthyretin

Similar sx to AL

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5
Q

AL amyloidosis cause

A

AKA immune origin

Profileration of plasma cells -> produce amyloidal immunoglobulins -> precursor t AL amyloid protein

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6
Q

AL amyloid organs

A 
Kidneys
Heart 
Peripheral nerves
Skin
GI
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7
Q

AA amyloid cause

A

Secondary to inflammation

Macrophages produce IL, stimulating hepatocytes -> release amyloid protein A (precursor to amyloid)

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8
Q

Conditions associated with amyloid AA

A

Rheumatoid
IBD
TB

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9
Q

Sx of amyloid AL

A

Kidney: Proteinuria, Nephrotic syndrome
CVS: arrhythmia
NS: peripheral neuropathy
GI: bleeding, obstruction

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10
Q

Sx of amyloid AA

A

Hepatosplenomegally

Protienuria

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11
Q

Dx of amyloid

A

Tissue biopsy

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12
Q

Amyloidosis rx

A

AL: chemo targetting plasma cells producing amyloid antibodies
AA: control the primary cause
ATTR: transplant affected organs (kidneys, liver) but tend to recurr

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13
Q

Prognosis amyloid

A

1-2yrs

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14
Q

Most common cause of death secondary to amyloid

A

Cardiac failure or fatal arrhythmia

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15
Q

Thyroid cancer ass with amyloid

A

Medullary carcinoma

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15
Q

Thyroid cancer ass with amyloid

A

Medullary carcinoma

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16
Q

Causes of aneurysm

A

Atherosclerosis
Trauma
Infection
FHx (genetic disposition)

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17
Q

How does atherosclerosis lead to aneurysm

A

Weakens mechanical structure and reduces recoil -> more pressure of vessel wall
Obstrucs vasa vasorum (degenerative ischaemia of the vessel wall)

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18
Q

Atherosclerosis risk factors

A

Modifiable:
Smoking
High chol diet
HTN

Nonmodifiable:
Age
DM
Male

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19
Q

Operative mortality of AAA repair

A

Elective: 3-5% (MI, CVA, rupture)
Emergency: 50% make it to hospital, 50% of those who make it survive an operation

20
Q

Classification of aortic dissection

A
21
Q

Complications of AAA open repair

A

Immediate: haemorrhage, trash foot
Early: Mesenteric ischaemia, Spinal ischaemia, MI, CVE
Late: Pseudoaneurysm, graft infection, Aorto-enetric fistula, impotence

22
Q

Causes of aortic stenosis

A

Calcification
Bicuspid congenital valve
Infection and damage: rheumatic fever
Autoimmune: SLE

23
Q

Which nerve initially picks up appendicitis pain

A 
Lesser splanchnic (T10) 
Refers to umbilicus
24
Q

Scoring system for appendicitis

A

Alvarado

25
Q

Causes of transudate ascites

A

Raised portal pressure:
Cirrhosis
R sided heart failure
Buddchiari

Reduced oncotic pressure:
Nephrotic syndrome
Hypoprotienaemia (secondary to hepatic failure)

26
Q

Causes of exudate ascites

A

Inflammation (pancreatitis)
Infection
Malignancy
Post radiation

27
Q

Pathophysiology of atherosclerosis

A
  1. Endothelial dysfunction: migration of macrophages -> foam cells and lipid core
  2. Migration of vascular smooth muscle : forming fibrous cap
  3. stenosis of vessel, rupture of cap could lead to thrombosis
28
Q

What is a fibroadenoma of breast

A

Proliferation of epithelial and stromal cells in breast

29
Q

Causes of mastalgia

A

Cyclical
Non cyclical: meds (hormone contraception, antidepressants, antipsychotics)
Extramammary: chest wall/shoulder

30
Q

Mx of cyclical mastalgia

A

Better fitting bra
Pain diary
Flax seed oil/primrose oil

Danazol (antigonadortrophin)

31
Q

Abscess def

A

Pus filled collection surrounded by granulation (macrophages) or fibrotic tissue

32
Q

Peri-ductal mastitis affects what part? which group of patients

A

Inflammation of subareolar ducts presents usually as young smokers

33
Q

Periductal mastatitis sx

A

Nipple retraction
Painful tender red breast
Nipple discharge
Abscess

34
Q

Causes of nipple discharge

A

Benign:

  1. intraductal papilloma
  2. ductal ectasia
  3. periductal mastitis
  4. Gestational

Malignant

35
Q

Commonest cause of developing cholangiocarcinoma

A

PSC
Chronic liver disease
HIV/Hep C

36
Q

Commonest risk factor for cholangiocarcinoma in developing world

A

parasitic liver flukes

37
Q

Primary sclerosing cholangitis (PSC) pathophysiology

A

Non infective non malignant inflammation and stricture of intra and extra hepatic ducts

Associated with UC and HIV

38
Q

Primary billary cirrhosis pathophysiology

A

Progressive inflammation and dammage of the interlobular bile ducts leading to cirrhosis, cholestasis

Associated with autoimmune conditions eg sjogrens or rheumatoid arthritis

39
Q

Tumour markers for Cholangiocarcinoma

A

C19-9

CEA (carcinoembryonic antigen)

40
Q

What are different types of bone tumours

A

Benign: fibroma, osteochondroma

Malignant:

  1. primary:
    - marrow: Myeloma, Ewings
    - stromal tissue: Osteosarcoma, chondrosarcoma
  2. Secondary:
    Thyroid, breast, bronchus, Kidney, prostate
41
Q

Age of Ewings

A

5 to 20

42
Q

Principles of limb salvage surgery in the setting of bone tumours

A

Every pt should be considered if the tumour could be removed with adequate margins

Adequate margins: acceptable low local recurrence.

Remaining limb needs to have: reasonable degree of movement and minimal pain

43
Q

What is the minimum requirement for a viable limb

A

4 components: bone, vessels. nerves, adequate soft tissue

If 2/4 removed, still might be salvageable

But any more needs amputation to be considered

44
Q

Risk factors for C diff

A

Periop abx use
immunosuppression
Old
PPIs

45
Q

Dx of c diff

A 
Acute diarrhoea (>2 stools in 24hrs) with no alternative cause
Stool culture for C diff toxins A and B
Pseudomembranes on colonoscopy
46
Q

C diff Rx

A

Depends on severity (WCC>15, rising Cr, Temp >38)

Low severity: PO metronidazole
High: PO vanc +/- PO metronidazole

Stop the culprit abx

47
Q

Causes of gynocaomastia

A

Physiological: puberty /age

Pathological:

  1. Too much oestrogen
    Leydig tumour
    Obesity
    Liver disease
  2. Too little testosterone
    Klinefelters
    Renal disease
  3. Meds: digoxin, spironolactone

MRCS-Pathology (11 decks)

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