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Yr 2 EOYS > HD EOYS10 > Flashcards

HD EOYS10 Flashcards

1
Q

What are microcalcifcations found in breast tissue usually made from? [1]

A

Calcium oxalate

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2
Q

The majority of breast disease originates from which part of the breast? [1]

Terminal ductal lobular unit
Intralobular duct
Lactiferous duct
Interlobular duct

A

The majority of breast disease originates from which part of the breast? [1]

Terminal ductal lobular unit
Intralobular duct
Lactiferous duct
Interlobular duct

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3
Q

The nipple has a core of which two tissues mainly? [2]

A

Smooth muscle
Dense irregular loose CT

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4
Q

During pregnancy there is a drastic [increase / decrease] in adipose tissue in breast

During pregnancy there is a drastic [increase / decrease] in connective tissue in breast

A

During pregnancy there is a drastic decrease in adipose tissue in breast

During pregnancy there is a drastic decrease in connective tissue in breast

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5
Q

Pregnancy and breast tissue

[] secretion is also known as exocytosis

Apocrine
Merocrine
Exocrine
Endocrine

A

[] secretion is also known as exocytosis

Apocrine
Merocrine
Exocrine
Endocrine

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6
Q
A

TL: invasive ductal
TR: insitu ductal
BL: invasive lobu
BR: insitu lobular

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7
Q
A

BR; invasive ductal
BL: dcis
TR: invasive lobular
TL: insitu loblar

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8
Q

When should the cranial sutures close?

After 6 months
After 8 months
After 12 months
After 18 months

A

When should the cranial sutures close?

After 6 months
After 8 months
After 12 months
After 18 months

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9
Q

When should the cranial sutures close? [1]

A

After 18 months

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10
Q

What stimulates the release of GH? [3]

When is GH released? [3]

A

Sleep, exercise and hypoglycaemia

Release peaks during deep sleep, 3hrs after a meal and after exercise

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11
Q

Growth hormone deficiency characterised by? [3]

A

Growth hormone deficiency characterised by:

  • decreased growth velocity
  • delayed skeletal maturation
  • in the absence of other explanations

**Normal birth weight and only slighly reduced length **

Normal growth: but after 7 / 8 years growth plateaus (regains after GH treatment)

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12
Q

Why does GH deficiency suggest that GH is only a minor contributor to intrauterine growth? [1]

A

Children with GHD have normal birth weight and only slightly reduced length

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13
Q

If you have short stature or decreased growth rate - what would screening studies try and rule out / discover? [2]

If no findings were found for ^, what would you diagnose? [1]

A

Growth Hormone Deficiency
Another underlying disease

No findings of GHD: Idiopathic short stature

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14
Q

What type of drug is oxandrolone and what does it help to treat? [1]

A

Androgen anoblic steroid: can improve height in Tuner syndrome; but not for ISS

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15
Q

Name two types of ISS [2]

A

constitutional growth delay
familial short stature

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16
Q

When does puberty begin in boys [1] and girls [1]

A

Puberty starts in 95%:
Girls between 8 -13 years
Boys between 9-14 years

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17
Q

What are the 5 stages of James Tanner puberty?

A

Tanner stage 1 = pre-puberty
Tanner stage 2 = start of puberty
Tanner stage 5 = sexual maturity

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18
Q

Roughly how long after pubarche begins does axillary hair growth begin in boys?

2 weeks

2 years

5 years

6 months

A

Roughly how long after pubarche begins does axillary hair growth begin in boys?

2 weeks

2 years

5 years

6 months

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19
Q

Which of these stages occurs last in female puberty?

Pubarche

Thelarche

Menarche

Growth spurt begins

A

Which of these stages occurs last in female puberty?

Pubarche

Thelarche

Menarche

Growth spurt begins

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20
Q

Which cells does FSH act on in males to stimulate sperm production?

Leydig cells

Spermatozoa

Oocytes

Sertoli cells

A

Which cells does FSH act on in males to stimulate sperm production?

Leydig cells

Spermatozoa

Oocytes

Sertoli cells

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21
Q

You are posted in a Paediatric endocrinology placement where you are seeing multiple cases of girls being diagnosed with precocious puberty by your consultant. Precocious puberty is defined as the onset of secondary sexual characteristics before what age?

5 years

7 years

8 years

9 years

A

You are posted in a Paediatric endocrinology placement where you are seeing multiple cases of girls being diagnosed with precocious puberty by your consultant. Precocious puberty is defined as the onset of secondary sexual characteristics before what age?

5 years

7 years

8 years

9 years

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22
Q

What would the precocious puberty be classified as in girls [1] and boys? [1]

What is most common cause? [1]

A

Reach Tanner stage 2 before age of 8 (female) or 9 (male)

Most common cause is premature production of GnRH (stage 2)

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23
Q

How do you treat precocious puberty? [1]

A

Give GnRH to overstimulate pituitary and desensitised and stops producing gonadotrophins

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24
Q

At what stage of James Tanner puberty is irreversible to treatment for precocious puberty? [1]

A

Stage 3

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25
Q

What would an individual with low or normal serum LH and FSH levels but a normal growth rate be likely to suffering from? [1]

A

GnRH deficiency or Constitutional delay of growth and puberty (CDGP)

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26
Q

What would an individual with low or normal serum LH and FSH levels but a slow growth rate be likely to suffering from? [1]

A

Functional hypogonadotropic hypogonadism

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27
Q

What would an individual with elevated serum LH and FSH levels after 13 /14 years be suffering from? [1]

A

Primary hypogonadism

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28
Q

What are the 3 potential causes of functional hypogonadotropic hypogonadism?

If have a low BMI? [1]
If have a normal BMI? [3]
If have a high BMI? [1]

A

What are the 3 potential causes of functional hypogonadotropic hypogonadism?

If have a low BMI: GI disorder (underfeeding)
If have a normal BMI: hypothyroidsm; hyper-PRL; GHD
If have a high BMI: Iatrogenic (corticoids)

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29
Q

Define impairment, disability and handicap [3]

A

Impairment: any loss or abnormality of psychological, physiological or anatomical structure or function. ( e.g. paralysis of the legs)

Disability: any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. (e.g. Inability to walk)

Handicap: the impact of the impairment or disability on the person’s pursuit or achievement of the goals which are desired by him/her or expected of him/her by society. (e.g. unable to work in a job that requires mobility)

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30
Q

What do you need to take into account when assessing disablity and developmental delay in pre-term children? [1]

A

Preterm birth: need to ensure have a corrected age vs chronological age for developmental purposes up to 2yrs age

(e.g. Born at 28/40weeks at 1 year age is actually like a 9month old developmentally)

31
Q

Which developmental areas do you assess in an assessment? [5]

A
  • Gross motor
  • Fine motor
  • Vision
  • Hearing
  • Speech: Expressive/Receptive/Gestular
  • Social
32
Q

How would you diagnose a suspected Down’s syndrome patient? [2]

A

Fluorescence in situ hybridization (FISH) may be used for rapid diagnosis of trisomy 21 (prenatal diagnosis and postnatal confirmation)

Does not provide information about whether trisomy 21 is secondary to a translocation. Therefore, a FISH test must be confirmed by a complete karyotype analysis

33
Q

Explain the tests you would conduct for a newly diagnosed Downs Syndrome baby and why [4]

A

Cardiac assessment (echocardiogram): Between 40 and 60% of babies with Down syndrome have congenital heart defects

Hearing tests: sensorineural hearing loss identified at newborn hearing screening in children with Down syndrome is higher than in the general population at 4-6%.

Ophthalmology: increase in congenital cataract AND infantile glaucoma

Ensure feeding established and no vomiting: congenital malformations of their gastrointestinal tract

34
Q

Specifically, what type of congenital heart defects do Downs Syndrome children have an increased risk of? [1]

A

atrioventricular septal defects (AVSD)

35
Q

Autistic spectrum disorder refers to the full range of people affected by a deficit in []? [3]

A

Autistic spectrum disorder refers to the full range of people affected by a deficit in social interaction, communication and flexible behaviour.

36
Q

A mutation in which gene can cause bilateral progressive sensorineural hearing loss?

A

Bilateral progressive sensorineural hearing loss with A1555G mutation.

37
Q

What would a mother with A1555G mutation, causing Bilateral progressive sensorineural hearing loss in their child, be be advised to avoid? [1]

A

Mother advised to avoid aminoglycosides

38
Q

Describe the glandular architecture of the breast [4]

A

Secretory alveoli
* Cells in lobules of tubuloalveolar glands release milk

Intralobular ducts
* Collect alveolar secretions and convey them to:

Interlobular ducts
* Coalesce into about 15-25

Lactiferous ducts
* Drain milk toward the nipple

39
Q

What are the components of milk? [2]

A

Merocrine proteins (exocytotic release of protein)
Apocrine proteins / fatty component released in membrane enclosed droplets

40
Q

How does breast tissue change during early infant [1], puberty [1] to pregnancy [1]

A

In early infant: breast tissue is just ducts (lobules at end)

Puberty: lobules grow a bit and divide into 10/12 acini at end found interminal duct lovular unit

Pregnancy: further development of TDLU: grow bigger. cells undergrow hypertrophy and produce merocrine and apocrine proteins

41
Q

Which hormones drive each stage of breast development?:

Young adult [1]
Adult [1]
Lactating adult [2]

A

Young adult: oestrogen stimulates duct growth

Adult: Progesterone: stimulates secretory alveoli

Lacating: Prolactin stimulates milk protein & fat synthesis, oxytocin: milk let down

42
Q

The lactiferous duct is lined by what type of epithelial cell & is supported which type of cell? [2]

A

Lactiferous duct:
* Columnar epithelial cells
* Supported by myoepithelial cells

43
Q

What might mammograpy reveal on breast tissue? [1]

What could they be? [2]

A

Microcalcifications: calcium deposits - usually calcium oxalate

Could be usual duct hyperplasia (benign) OR neoplastic

44
Q

Young women often find palpable lumps, which turn out to be fibrocystic changes. Name 4 ways the fibrocystic changes may occur [4]

A

Fibrosis: dense pink collagen among the lobules
Cysts: often visible without a microscope – thin walled and full of clear fluid (arrow)
Usual duct hyperplasia
Adenosis: too many glands or lobules (proliferation of acini, with 2 layers (inner epithelial and outer myoepithelial), surrounded by basement membrane, without distortion of lobular architecture)

45
Q

What is sclerosing adenosis of breast tissue & is it pathological. Explain your answer [3]

A

Sclerosing adenosis:

  • proliferating lobules are squeezed together: makes them appear small and infiltrating
  • BUT: cuboidal epithelial, myoepithelial cells and basement membrane remain
  • Therefore: Benign
46
Q

Define apocrine metaplasia [1]

Describe cell structure of Apocrine metaplasia [2]

A

Apocrine metaplasia: is a benign fibrocystic change characterized by dilated acini lined by columnar cells with apocrine features.: the transformation of breast epithelial cells into an apocrine or sweat‐gland type of cells

Single layer of cuboidal to columnar cells that have lumpy / scalloped appearance with enlarged nuclei with prominent nucleoli

Secretions are common in the apocrine metaplasia

47
Q

What is the definition of fibroadenomas? [1]

A

Benign breast tumours characterized by proliferation of ducts (adenoma) and stroma (fibro)

48
Q

Describe histological changes in fibroadenomas

A

Ducts & Stroma proliferating:
* Proliferating stoma compressed ducts to slits
* Old fibroadenomas become hyalinized and calcified

Arrowhead: stroma, Arrow: compressed ducts

49
Q

What is the most common type of breast cancer? [1]

A

Invasive ductal carcinoma

50
Q

What is the structure highlighted? [1]

Describe the cells surrounding it [2]

A

Lactiferous Duct - each lobe is drained by a single lactiferous duct that opens into the nipple. It is lined by a double layer of cuboidal or columnar cells surrounded by a sheath of connective tissue with myoid cells.

51
Q

Difference between lactating and non-lactating mammory glands histoligically

A

R: Lactating

52
Q

What type of breast cancer is depicted? [1]

A

classic invasive lobular carcinoma

53
Q

What type of breast cancer is depicted? [1]

A

ductal carcinoma in situ (DCIS)

54
Q

What type of breast cancer is depicted? [1]

A

DCIS

55
Q

What alteration to the breast tissue has occured? [1]

A

Figure 2 – Histology showing ductal carcinoma in-situ (DCIS), demonstrating the malignant cells confined to the mammary ducts

56
Q

What type of pathology is depicted in this breast tissue?

Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma

A

What type of pathology is depicted in this breast tissue?

Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma

57
Q

What type of pathology is depicted in this breast tissue?

Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma

A

What type of pathology is depicted in this breast tissue?

Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma

58
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

Apocrine metaplasia with eosinophilic cytoplasm and apical snouts involving dilated cysts. Notice the transition from single to multiple layered epithelium to true papillary configuration in the same cystic space.

59
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia - abundant eosinophilic granular cytoplasm, prominent nucleolus and apocrine snouts.

60
Q

What change to breast tissue is depicted here? [1]

A

Microcalcifications tend to be less common in fibrocystic change than in carcinoma. They tend to be coarse and irregular.

61
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

Some of the larger cysts in fibrocystic change may have a bluish appearance from outside (blue-domed cysts). The cyst lining is flattened or absent in some cases. In the center of this image, cysts are lined by apocrine epithelium. Note the focus of adenosis above it.

62
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

Sclerosing adenosis is a benign hyperplastic process that may be mistaken for carcinoma. The average age at presentation is about 30 yrs. The lesion retains is lobular configuration and is more cellular centrally.

63
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

The proliferating tubules may be elongated and have attenuated lumens. There is preferential preservation of myoepithelial cells in the tubules and epithelial cells are less conspicuous. Some degree of lobular fibrosis is usually present.

64
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
The tubules and glands in a fibroadenoma are lined by cuboidal or low columnar epithelium with uniform nuclei and surrounded by a myoepithelial layer. The stroma is made up of loose connective tissue. If the stroma is hypercellular, the diagnosis of phyllodes tumor should be excluded.

Sclerosing adenosis
Apocrine metaplasia

65
Q

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

A

Which change to breast tissue is depicted here

Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia

Higher magnification view of intracanalicular pattern in a fibroadenoma. The stromal connective tissue invaginates into the glandular epithelium and appears to be contained within it.

66
Q

Which breast pathology is depicted here? [1]

A

Lobular carcinoma-in-situ (LCIS) is a non-palpable lesion which is usually an incidental finding in breasts removed for other reasons. It is multicentric in 70% of cases and bilateral in 30% to 40% of cases. The lobules are distended with uniform round or oval, medium sized cells. The nuclei are uniform and normochromatic. This image shows LCIS involving several lobules. A few uninvolved lobules can be seen on the right.

67
Q

What is this breast pathology depicted? [1]

A

Ductal carcinoma in situ

The tumor cells with high nuclear grade nearly fill the lumen in this example of DCIS. The cytoplasmic borders are sharply demarcated.

68
Q

What breast pathology is depicted here [1]

A

High power view of cribriform DCIS showing microcalcifications.

69
Q

What breast pathology is depicted here? [1]

A

This case of high-grade invasive ductal carcinoma was composed mostly of solid areas, showed no evidence of tubule formation and was assigned score of 3 for tubule formation.

70
Q

Which of the these photos is invasive ductal or invasive lobular breast cancer? [2]

A

L: invasive ductal carcinoma showed tubule formation
R: Invasive lobular carcinoma The tumor cells are arranged in slender linear strands one to two cells across

71
Q

Which of the these photos is invasive ductal or invasive lobular breast cancer? [2]

A

R: invasive ductal carcinoma showed tubule formation
L: Invasive lobular carcinoma

72
Q

Which of the following best describes the slide

Stromal fibrosis
Cysts
Adenosis
Apocrine metaplasia

A

Cysts

(apocrine are more eosinophilic)

73
Q

Which of the following best describes the slide

Stromal fibrosis
Cysts
Adenosis
Apocrine metaplasia

A

Apocrine metaplasia

74
Q

Label the folllowing with

Stromal fibrosis
Cysts
Adenosis
Apocrine metaplasia

A

Yr 2 EOYS (58 decks)

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