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1
Q

First cells that arrive at site of inflammation

A

Neutrophils

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2
Q

Granule colours of neutrophils, eosinophils, and basophils

A

Neutrophils - pink
Eosinophils - red
Basophils - blue/black

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3
Q

What suggests a good sputum sample from the alveoli?

A

Pigmented macrophages

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4
Q

What is the presence of horizontal striae seen in eosinophilic oesophagitis also known as?

A

Feline oesophagus

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5
Q

2 histological features of SCC

A 
Keratin production
Intracellular bridges (prickles on edge of cells)
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6
Q

Which part of oesophagus are SCCs found?

A

Upper 2/3s

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7
Q

When is fontana stain positive?

A

Melanin

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8
Q

When is congo red stain positive and how is this seen?

A

Amyloid

Apple green birefringence

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9
Q

When is prussion blue stain positive? Give 2 conditions

A

Iron

Haemochromatosis
Liver cirrhosis

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10
Q

What is CD45 immunohisto stain used to mark?

A

Lymphoid cells

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11
Q

What is cytokeratin immunohisto stain used to mark?

A

Epithelium

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12
Q

What is an organised collection of activated macrophages called, and which cells have a ‘horseshoe nucleus’?

A

Caseating granuloma

Langhan’s cells
monocytes also have this nucleus

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13
Q

Appearances of cardiac tissue in atherogenesis (5 steps)

A
  1. Normal (endothelial injury)
  2. Oedema and inflammation (LDL enters intima and oxidised)
  3. Necrosis and granulation (macrophages become foam cells which apoptose)
  4. Further granulation (more adhesion molecules, more macrophages and T cells)
  5. Dense fibrosis (vascular SM cells)
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14
Q

Which part of the aorta is most affected by atherosclerosis

A

Abdominal > thoracic

More promitent around ostia of major branches - low, oscillatory shear stress

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15
Q

What percentage occlusion is classified as stenosis?

A

70%

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16
Q

After what amount of time is an MI injury irreversible?

A

20-40 mins

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17
Q

MI histology <6 hours

A

Normal

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18
Q

When is loss of nuclei, homogenous cytoplasm, and necrotic cells death seen in MI histology?

A

6-24 hours

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19
Q

When is infiltration of polymorphs then macrophages seen in MI histology?

A

1-4 days

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20
Q

When is removal of debris seen in MI histology?

A

5-10 days

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21
Q

What is seen at 1-2 weeks in MI histology?

A

Granulation tissue, new blood vessels

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22
Q

What does nutmeg liver suggest?

A

Hepatic congestion, ischaemia, and decreased portal flow.

Usually due to congestive heart failure

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23
Q

Pathophysiology of heart failure (2 parts)

A

Cardiac damage ->

1
• Decrease CO
• RAS activation - salt and water retention
• Fluid overload

2
• Decreased SV
• Activated sympathetic NS via baroreceptors
• Increased total peripheral resistance
• Increased afterload
• LVH -> dilatation and poor contractility

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24
Q

First investigation for suspected heart failure

A

Brain natriuretic peptide

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25
Best investigation for diagnosing heart failure
Transthoracic echocardiogram (TTE)
26
Dilated cardiomyopathy causes. Systolic or diastolic dysfunction?
Alcohol Haemochromatosis Systolic dysfunction
27
Hypertrophic cardiomyopathy causes. Systolic or diastolic dysfunction?
Genetic Storage diseases Diastolic dysfunction
28
Restrictive cardiomyopathy causes. Systolic or diastolic dysfunction?
Sarcoidosis Radiation-induced fibrosis Diastolic dysfunction
29
Hypertrophic cardiomyopathy histology and genetic mutations. What is the significance of the mutations?
Myocyte disarray MYBP-C and Trop-T (high risk of sudden cardiac death) Different mutations result in different amount of hypertrophy and affect incidence of arrhythmias
30
What is hypertrophic obstructive cardiomyopathy (HOCM)?
Septal hypertrophy resulting in outflow tract obstruction
31
What is seen in arrhythmogenic right ventricular cardiomyopathy (ARVC)?
Myocyte loss | Fibrofatty replacement
32
When and in whom does acute rheumatic fever occur?
2-4 weeks after strep throat infection Peak age 5-15
33
How is acute rheumatic fever diagnosed?
Jones 2 major 1 major + 2 minor
34
What are Jones' major criteria?
CASES ``` Carditis Arthritis Sydenham's chorea Erythema marginatum Subcutaneous nodules ```
35
Which valves are affected in acute rheumatic fever?
Mitral valve (70%) Can affect both mitral and aortic (25%)
36
Main pathogen in acute rheumatic fever?
Lancefield group A strep
37
Name of process in acute rheumatic fever by which antibodies to strep cross-react with myocardial antigens
Antigenic mimicry
38
Beady/warty fibrous vegetations (verrucae) Aschoff bodies (small giant-cell granulomas) Anitschkov myocytes (regenerating myocytes) Condition
Acute rheumatic fever
39
Acute rheumatic fever treatment
NSAIDs first line Benzylpenicillin if ongoing infection
40
Infective endocarditis histology of vegetations
Large, irregular masses on valve cusps, extending into chordae More localised in acute Smaller and soft thrombi in subacute
41
Histology of vegetations in non-bacterial thrombotic endocarditis e.g. DIC (deposition of platelets and fibrin on heart valves)
Small, bland vegetations attached to lines of closure
42
What conditions is Libman-Sacks endocarditis associated with? Describe the histology of the vegetations.
SLE, anti-phospholipid syndrome Small, warty vegetations Sterile and platelet-rich
43
Infective endocarditis causes
``` Poor dental hygiene IVDU Cannulae Pacemakers etc. ```
44
Organisms in acute and subacute infective endocarditis
Acute • Staph. aureus • Strep. pyogenes Subacute • Strep. viridans • Staph. epidermis • HACEK
45
Infective endocarditis feautres
* New murmur (MR/AR) * Roth's spots (retinal damage) * Osler's nodes (painful red lesions on hands and feet) * Janeway lesions (painless red lesions on palms and soles) * Splinter haemorrhages * Septic abscesses
46
Criteria used for infective endocarditis diagnosis. What are the major criteria?
Duke 2 major 1 major + 3 minor 5 minor Positive blood culture Evidence of vegetation/abscess or new regurgitant murmur
47
Infective endocarditis treatment
Broad-spectrum abx Then treat according to sensitivies Acute MSSA - flucloxacillin MRSA - vancomycin + rifampicin Subacute Benzylpenicillin + gentamycin
48
Causes of aortic regurgiation
IE LV dilation Connective tissue disease e.g. Marfans
49
Causes of mitral stenosis
Rheumatic fever
50
Causes of aortic stenosis
Calcification
51
Causes of mitral regurgitation
``` IE Connective tissue disease Post-MI Rheumatic fever LV dilation ```
52
Which valves are most commonly affected in order in chronic rheumatic valve disease?
Mitral > aortic > tricuspid > pulmonary
53
Middle-aged woman Short of breath with chest pain Mid systolic click + late systolic murmur condition
Mitral valve prolapse
54
Chronic bronchitis time span for diagnosis
Productive cough on most days for 3 months over 2 years
55
Histological features of chronic bronchitis
Goblet cell hyperplasia | Mucous gland hypertrophy
56
2x congenital diseases causing bronchiectasis (airway dilatation and scarring)
CF | Kartagener syndrome
57
Permanent dilation of the bronchi is a histological feature of what diagnosis?
Bronchiectasis
58
Asthma histology
SM cell hyperplasia Curschmann spirals (whirls of shed epithelium) Eosinophils Charcot-Leyden crystals (eosinophil protein)
59
Causes of emphysema
``` Tobacco smoke (neutrophils -> proteases -> damage) Alpha-1 antritrypsin deficiency ```
60
Complications of emphysema
``` Cor pulmonale (right side heart enlargement due to pulmonary HTN) Pneumothorax ```
61
Infammatory causes of bronchiectasis
* Post-infectious (e.g. pertussis) | * Abnormal host defence e.g. hypogammaglobulinaemia (primary) and chemotherapy (secondary)
62
Features of interstital lung disease (restrictive lung disease) on spirometry (3)
* Decreased CO diffusion capacity * Decreased lung volume * Decreased compliance
63
Auscultation of interstital lung disease
End-inspiratory crackles
64
Advanced interstitial lung disease appearance on CT CAP
Honeycomb
65
What is granulomatous interstital lung disease associated with?
Vasculitidies There is also a fibrosing, granulomatous, eosinophilic, and smoking related category.
66
Interstitial lung disease diagnosis
High res CT +/- biopsy
67
Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis histological appearance
Honeycomb change Beginning at periphery of lobule Sub-pleural Hyperplasia of type II pneumocytes Leads to cyst formation
68
Clinical presentation of Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis
Mainly males Hypoxaemia + cyanosis Pulmonary hypertension Clubbing
69
Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis treatment
Steroids Cyclophosphamide Azathioprine
70
Which condition is classically seen in coal miners?
Pneumoconiosis
71
Which lobe does asbestosis tend to affect?
Lower lobe
72
2 fungal granulomatous infections
Cryptococcus | Aspergillus
73
Polypod plugs of loose lung connective tissue condition
Extrinsic allergic alveolitis
74
``` Chronic extrinsic allergic alveolitis causes. • Farmer's lung • Pigeon fancier's lung • Malt-workers lung • Cheese washer's lung ```
* Farmer's - mouldy hay (Saccharopolyspora rectivirgula) * Pigeon fancier's - proteins in excreta/feathers * Malt-workers - germinating barley (Aspergillus) * Cheese washer's - mouldy cheese (Aspergillus)
75
How can fibrosis be prevented in extrinsic allergic alveolitis?
Early removal of antigen
76
Histology of bronchopneumonia, lobar pneumonia, and atypical pneumonia
BP - patchy nodular distribution of infection LP - fibrinosuppurative consolidation A - interstitial pneumonitis, no intra-alveolar inflammation
77
What are the 4 stages of lobar pneumonia?
1. Consolidation 2. Red hepatisation (erythrocytes, neutrophils, and fibrin in alveoli) 3. Grey hepatisation (fibrosis, erythrocytes broken down) 4. Resolution Acute inflammation turning to chronic Leaving fibrinosuppurative exudate
78
What is lung SCC (most common lung tumour) associated with?
Smoking (no cilia so mucus can build with procarcinogenic chemicals) p53 and c-myc mutations
79
Where does lung SCC spread? Early or late mets?
Proximal bronchi Local spread Late mets
80
In whom do lung adenocarcinomas (2nd most common) commonly present?
Women and non-smokers EGFR mutations
81
How does lung adenocarcinoma spread?
Occurs peripherally Early mets
82
What is an axample of an atypical adenomatous hyperplasia?
Non-mucinous bronchioalveolar carcinoma
83
How does small cell carcinomas (3rd most common) spread and from what cells do they arise?
Centrally, proximal bronchi Early mets Neuroendocrine cells
84
What 3 pathologies are small cell carcinomas associated with?
Ectopic ACTH Lambert-Eaton syndrome (VGCCs attacked) Cerebellar degeneration
85
What are small cell carcinomas associated with?
Smoking p53 and RB1 mutations
86
Most common subtype of small cell carcinoma
Oat cell carcinoma
87
Prognosis of large cell carcinoma
Poor Poorly differentiated malignant epithelial tumour
88
What can high levels of bradykinin cause?
Coughing
89
What isssues are associated with ERCC1-NSCLC mutations?
Poor response to cisplatin
90
Mesothelioma latent period
25-45 years
91
Virchow's triad (3 factors important in the development of venous thrombosis)
Stasis Vessel wall injury Hypercoagulability
92
Most common cause of acute cor pulmonale
PE
93
What is a saddle embolism?
PE at bifurcation of main pulmonary artery
94
Percentage of pulmonary bed occluded that causes death
>60%
95
Whilst larger PEs can cause deaths, what can smaller emboli cause?
Silent or cause wedge-infarctions (bronchial arteries not cutt off, although pulmonary artery is)
96
Pulmonary hypertension classification
Mean pulmonary arterial pressure >25mmHg at rest
97
What is class 1 pulmonary HTN associated with?
Congenital heart disease (or idiopathic, drugs)
98
What is class 2 pulmonary HTN associated with?
Left heart disease
99
What is class 3 pulmonary HTN associated with?
Lung disease
100
What is class 4 pulmonary HTN associated with?
Chronic thromboembolic pulmonary hypertension (blood clots that don't dissolve in the lungs but scar)
101
What is class 5 pulmonary HTN associated with?
Unclear Mutlifactorial mechanism
102
Main cause of PO
LHF
103
Intra-alveolar fluid Iron laden macrophages "heart failure cells" Condition
PO
104
How does diffuse alveolar damage present in adults and neonates?
Adults - ARDS | Neonates - Hyaline membrane disease (low surfactant)
105
``` What does this histopathology suggest: Lung expanded Firm Plum-coloured Airless ```
Diffuse alveolar damage
106
CXR of diffuse alveolar damage
Fluffy white infiltrates in all fields
107
Cell changes in Barrett's
Squamous to columnar epithelium
108
Most common oesophageal cancer in the UK
Adenocarcinoma
109
Most common oesophageal cancer in the world and its associations
SCC Alcohol, smoking, HPV 6x more common in Afro-Carribeans
110
Which part of oesophagus are most SCCs found?
Middle 1/3 | then lower 1/3, then upper 1/3
111
Management of oesphageal varices
Endoscopy - band ligation | Sclerotherapy
112
Eosinophilic oesophagitis treatment
Steroids | Allergen removal
113
Are goblet cells present in the stomach?
No
114
WCC involved in acute gastritis
Neutrophils
115
WCC involved in chronic gastritis
Lymphocytes and plasma cells
116
Which part of the stomach does H. pylori preferentially colonise?
Antrum
117
What does a gastric ulcer breach through?
Muscularis mucosa into submucosa
118
Effect of food on gastric and duodenal uclers
Gastric - worse | Duodenal - better
119
What do gastric ulcers look like?
Punched out lesions with rolled margins
120
What is a signet ring carcinoma and where does it metastasise?
Malignant adenocarcinoma in the stomach that produces mucin Mets to ovary = Krukenberg tumour
121
What is linitis plastica?
Stomach adenocarcinoma that spreads to the stomach wall and makes it thicker and more rigid
122
What can H. pylori infection lead to?
MALT lymphoma (B cell non-hodgkin's)
123
H. pylori treatment
Triple therapy PPI Clarithryomycin Amox / metro
124
Are gastric or duodenal ulcers more common?
Duodenal
125
Are gastric and duodenal ulcers seen more commonly in older or younger people?
Gastric - older | Duodenal - younger
126
Coeliac disease mediation and protein responsible
T cell mediated autoimmune disease to gliadin
127
Investigations for coeliac disease
1. Anti-tissue transglutaminase (IgA) 2. Anti-endomysial ab 3. Consider total IgA to rule out other conditions e.g. food allergy Gold standard: Upper GI endoscopy and duodenal biopsy
128
What is seen on biopsy in coeliac disease?
Villous atrophy Crypt hyperplasia Lymphocyte infiltrate
129
Which cancer can 10% of coeliac disease cases progress to if not treated adequately?
Duodenal T-cell lymphoma
130
What is RET proto-oncogene Cr10+ associated with?
Hirschsprung's disease
131
What is seen on full thickness rectal biopsy in Hirschsprung's disease?
Hypertrophied nerve fibres | No ganglia
132
Where is bowel ischaemia common?
Watershed areas ``` Splenic flexure (SMA to IMA) Rectosigmoid (IMA to internal iliac) ```
133
Group of people affected by IBD
White Onset in 20s Smoking worsens Crohn's UC is more common
134
Crohn's characteristics
* Whole GIT (most common in terminal ileum and caecum) * Skip lesions - cobble-stone appearance * All layers * Increased goblet cells * Granulomas (non-caseating)
135
UC characteristics
* Starts at rectum, doesn't pass ileocaecal valve * Continuous * Not beyond submucosa * Crypt abscesses (neutrophil migration) * Decreased goblet cells * Less/no granulomas, fissures or strictures
136
Presentation of CD and UC
``` CD • Diarrhoea • Weight loss • Upper GI symptoms • RIF mass ``` UC • Bloody diarrhoea • Left lower quadrant pain • Tenesmus (inclination to empty bowels)
137
CD and UC radiology signs/features
CD (small bowel enema) • Kantor's string sign • Rose thorn ulcers (can join to form serpentine ulcers) UC (barium enema) • Loss of haustrations • Drainpipe colon • Pseudopolyps (preservation of adjacent mucosa)
138
What is the first CD lesion called?
Apthous ulcer
139
When can the small bowel be affected by UC?
Backwash ileitis
140
Extra-GI manifestations of IBD
Both • Erythema nodosum • Pyoderma gangrenosum • Arthritis CD • Gallstones • Oxalate renal stone UC • Primary sclerosing cholangitis • Uveitis
141
UC complications
* Adenocarcinoma * Toxic megacolon * 30% require colectomy
142
IBD imaging
CD • Colonoscopy • Small bowel enema UC • Colonscopy + biopsy • Sever - flexible sigmoidoscopy (perforation risk) • Barium enema
143
CD management
``` Inducing remission 1. Glucocorticoids / enteral feeding 2. 5-ASA (mesalazine) • Azathioprine / mercaptopurine / methotrexate add-on • Infliximab for refractory disease ``` Maintaining remission 1. Azathioprine /mercaptopurine 2. Methotrexate
144
UC management
* 5-ASA (topical rectal) * Oral corticosteroid Severe • IV steroids Remission 1. 5-ASA 2. Azathioprine
145
What is tested for in pseudomembranous colitis?
C diff TOXIN
146
Pseudomembranous colitis treatment
1. Metronidazole PO | 2. Vancomycin PO
147
What is carcinoid syndrome and its presentation (3)?
Tumours of enterochromaffin cell origin producing 5-HT * Bronchoconstriction * Flushing * Diarrhoea
148
Investigation and treatment of carcinoid syndrome
24hr urine 5-HIAA (serotonin metabolite) Octreotide (somatostatin analogue)
149
What do villous adenomas leak?
Protein and potassium Leads to hypoproteinaemic hypokalaemia
150
What is the most important risk factor of an adenoma for malignancy?
Large size
151
Why might a colectomy be required in juveline polyposis?
Stop haemorrhage of hamartomatous polyps
152
Patient presents with pigmented freckles on the lips, face, palms and soles. Hamartomatous polyps are found in the small bowel and the doctor suggests conservative management. What is the condition and the responsible gene?
Peutz-Jeghers syndrome LKB1
153
What causes a hyperplastic polyp?
Shedding of epithelium and cell build-up
154
Most common site of colorectal cancer
Rectum
155
Why are NSAIDs protective in colorectal cancer?
COX2 over-expressed in most patients
156
Features of right and left sided colorectal tumours
Right • Iron deficiency anaemia • Weight loss Left • Change in bowel habit • Crampy LLQ pain
157
What blood test is used to monitor colorectal cancer?
Carcinoembryonic antigen
158
Colorectal cancer Duke's staging
``` A - mucosa B1 - muscularis propria B2 - transmural C1 - muscularis propria, LN mets C2 - transmural, LN mets D - distant mets ```
159
Number of adenomatous polyps required for diagnosis of familial adenoumatous polyposis
>100
160
How is Gardner syndrome different to FAP?
Extra-intestinal features e.g. osteoma's and dental caries
161
Where do mutations occur in Lynch syndrome (HNPCC)?
DNA mismatch repair genes
162
Where do carcinomas usually occur in Lynch syndrome and what other carcinomas is it associated with?
Right colon Endometrial, ovarian, small bowel, transitional cell and stomach carcinoma
163
Which cells produce secretin and what does it do?
S-cells of the duodenum Controls gastric acid secretion
164
What is the functional exocrine unit in the pacreas arranged around the ducts?
Acinar cells
165
``` What do the following cells produce: Alpha cells Beta cells Delta cells D1 PP ```
Alpha - glucagon Beta - insulin Delta - somatostatin (regulates above cells) D1 + PP - Pancreatic polypeptide (regulate pancreatic secretion, increased after fastin)
166
Metabolic syndrome diagnostic criteria
``` Fasting hyperglycaemia >6 BP >140/90 Central obesity >94cm (M), >80cm (F) Dyslipidaemia Microalbuminaemia ```
167
Which WCCs attack beta cells in T1DM?
CD4+ and CD8+
168
Sensitive marker for acute pancreatitis
Serum lipase
169
Presentation of acute pancreatitis
Severe epigastric pain, relieved by sitting forward | Vomiting
170
Top 2 causes of pancreatitis
Gallstones | Ethanol
171
Infectious cause of pancreatitis
Mumps
172
What circumscribed formation can acute pancreatitis result in the formation of?
Pseudocyst - lined by fibrous tissue, no epithelial lining
173
Histology of acute pancreatitis
Coagulative necrosis (lysosomal enzymes destriyed preventing proteolysis of damaged cells - architecture preserved) Fat necrosis -> saponification -> hypocalcaemia
174
Most common cause of chronic pancreatitis
Chronic alcohol drinking
175
Histology of chronic pancreatitis
Fibrosis Loss of exocrine tissue Duct dilation Calcification
176
Presentation of acinar cell carcinoma
Fat necrosis and polyarthralgia due to high lipase | 18 month median survival
177
Histology of acinar cell carcinoma
Neoplastic epithelial cells with eosinophilic granular cytoplasm
178
Most common type of pancreatic cancer
Ductal adenocarcinoma Head of pancreas
179
Main risk factor for pancreatic cancer
Smoking
180
Differential features of pancreatic cancer
Courvoisier's sign - painless jaundice and enlarged gallbladder Steatorrhoea Trousseau's syndrome (reucurrent superficial thrombophlebitis) Virchow's node
181
Pancreatic cancer marker and level
CA19.9 > 70
182
Nests / trabeculae with granular cytoplasm seen in pancreas. What is the cause and which 2 parts of the pancreas is this likely to be seen?
``` Islet cell (neuroendocrine) tumour Body or tail ```
183
``` How do the following functional islet cell tumours present: Insulinoma Gastrinoma VIPoma (vasoactive intestinal peptide) Glucagonoma ```
Insulinoma - hypoglycaemic attacks Gastrinoma - Zollinger-Ellison syndrome: recurrent ulceration VIPoma: diarrhoea Glucagonoma - necrolytic migrating erythema
184
When are non-functional islet cell tumours picked up?
Incidentally on imaging or large enough to produce symptoms of local disease / mets
185
What are most gallstones made up of?
Cholesterol, radiolucent
186
Cholecystitis presentation
RUQ pain | Fever
187
What are Rokitansky-Aschoff sinuses? What else is seen in this condition?
Deep outpouchings in chronic cholecystitis | Thick gallbladder wall
188
Which MEN is associated with the marfanoid phenotype?
MEN2B
189
What can annular pancreas present with?
Duodenal obstruction ~1 year old
190
Which cells are in zone 1 of the liver?
Periportal hepatocytes Closest to the portal triad (bile ducts, hepatic artery, portal vein)
191
Which cells are in zone 3 of the liver?
Perivenular hepatocytes Most mature Most metabolically active Most liver enzymes Close to hepatic vein
192
Endothelial cells don't have a basement membrane in the liver. What is the name of the spaces between them and hepatocytes? Which structures/cells lie in this space and what happens to them during chronic inflammation?
Space of Disse Loss of microvilli and activation of stellate cells (which produce collagen) Stellate cells become myofibroblasts, which deposit collagen in the space
193
Spotty necrosis in liver condition
Acute hepatitis
194
Histopathology of chronic hepatitis (4 steps)
1. Portal inflammation 2. Interface hepatitis (piecemeal necrosis) - can't see border between portal tract and parenchyma 3. Lobular inflammation 4. Bridging from portal vein to central vein
195
What is the diffuse abnormality of liver architecture that interferes with blood flow and liver function?
Cirrhosis
196
Fibrotic bridges between portal triad and central vein. Condition
Cirrhosis
197
3 main causes of cirrhosis
1. Alcoholic liver disease 2. NAFLD 3. Chronic viral hepatitis (hep B/D and C)
198
What drug can cause cirrhosis?
Methotrexate
199
Difference between micro and macronodular cirrhosis
Micro - nodules <3mm e.g. caused by alcoholic hepatitis Macro - nodules >3mm e.g. caused by viral hepatitis and genetic cirrhosis (Wilson's, alpha-1 antitrypsin deficiency)
200
Score for cirrhosis, what is measured, and what it means
``` Child's Pugh Score (ABCDE) • Albumin • Bilirubin • Clotting (PTT) • Distention (ascites) • Encephalopathy ``` <7 - A 7-9 - B 10+ - C
201
Steatosis and alcoholic cirrhosis macroscopic characteristics
Steatosis • Large, pale, yellow Alcoholic cirrhosis • Large, yellow-tan • Shrinks, becomes non-fatty, and brown
202
Alcoholic hepatitis and NAFLD macroscopic characteristics
Large and fibrotic
203
Most common cause of chronic liver disease in the West
NAFLD | insulin resistance
204
Which conditions does NAFLD include?
steatosis and non-alcoholic steatohepatitis (NASH)
205
Most common groups of people affected by autoimmune hepatitis
Young and postmenopausal females
206
Ig causes of type 1 and 2 autoimmune hepatitis
Type 1 • ANA • Anti-SMA • Anti-actin Type 2 • Anti-LKM (liver-kidney-microsomal)
207
What is primary biliary cirrhosis and which antibody is positive in this condition?
Destruction of medium sized intrahepatic bile ducts Cholestasis and slow development of cirrhosis over many years +ve AMA (anti-mitochondrial antibody)
208
What does ultrasound and histology show in PBC?
USS - no bile duct dilatation | Histology - bile duct loss with granulomas
209
PBC treatment
Ursodeoxycholic acid in early phase (mops up bile salts)
210
Ducts affected in primary sclerosing cholangitis and which antibody is positive in this condition?
Extrahepatic and intrahepatic bile ducts (stricture formation) +ve p-ANCA
211
Condition associated with PSC
UC
212
Ultrasound, ERCP and histology of PSC
USS - bile duct dilatation ERCP - beading bile ducts Histology - onion skiining fibrosis - concentric
213
What condition are patients with PSC at increased risk of?
Cholangiocarcinoma
214
Hepatic adenomas are associated with long term use of which medication?
Oral-contraceptive pill
215
Hepatic adenoma presentation and treatment
Abdo pain Intraperitoneal bleeding Resection if symptomatic, >5cm, or no shrinkage when stopping OCP
216
What is the most common benign hepatic lesion that is usually incidentally picked up?
Haemangioma
217
HCC investigations
Alpha-fetoprotein | USS
218
Most common malignant liver lesion
Secondary tumour - usually from GIT, breast or bronchus
219
Haemochromatosis mutated gene and histology (stain)
Mutated HFE Chr 6 Fe deposits in liver stain with Prussian blue
220
Presentation of haemochromatosis
* Skin bronzing or slate grey * Diabetes * Hepatomegaly
221
Total iron binding capacity (TIBC) in haemochromatosis
Low
222
Haemochromatosis treatment
Venesection | Desferrioxamine
223
Mallory bodies and fibrosis seen. ATP7B Chr 13 mutation. What is the condition? Which transporter is affected? Which stain can be used?
Wilson's disease Copper transporting ATPase - decreased biliary Cu excretion Cu stains with Rhodanine
224
Serum caeruloplasmin, serum copper, urinary copper, and treatment for Wilson's disease
Serum caeruloplasmin - low Serum copper - low Urinary copper - high Lifelong penicillamine
225
Alpha 1 antitrypsin deficiency histopathology (+ stain)
A1AT accumulates in hepatocytes | Intracytoplasmic inclusions which stain with Periodic acid Schiff
226
A1AT deficiency presentation and investigations
Emphysema, chronic liver disease, neonatal jaundice Low A1AT No alpha-globulin band on electrophoresis
227
Top 3 types of renal stones
1. Calcium oxalate 2. Magnesium ammonium phosphate • Due to urease producing organisms which alkanise urine • Staghorn calculi 3. Uric acid
228
Which types of renal stones are common in ethylene glycol poisoning and UTIs?
EG poisoning - calcium oxalate | UTIs - magnesium ammonium phosphate
229
BPH is hyperplasia of which cells and mediated by which hormone?
Stromal and epithelial cells Dihydrotestosterone
230
Histology and treatment of BPH
Nodule formation Prostatic epithelial ducts with duct spaces TURP 5-alpha reductase inhibitors (tamsulosin, finasteride)
231
Common site of prostate cancer site and spread (adenocarcinoma most common form)
Peripheral zone of gland Local spread to bladder Haematogenous spread to bone
232
PSA in prostate cancer
>4ng/ml is indicative
233
Grading system for prostate cancer
Gleason system
234
Most common testicular tumour
Germ cell: | Seminoma is most common type
235
When is a teratoma regarded as malignant?
When it occurs in a post-pubertal male
236
Biologic makers for germ cell testicular tumours
AFP HCG LDH
237
Risk factor for germ cell testicular tumour
Testicular dysgenesis e.g. cryptorchidism
238
What are the non germ cell tumours which are derived from the stroma and sex cord?
Leydig cell - stroma | Sertoli cell - sex cord
239
What are the following benign renal tumours made up of: • Papillary adenoma • Oncocytoma • Angiomyolipoma
* PA - epithelial with papillary architecture * O - Epithelial * A - mesenchymal -> fat, blood vessels, muscle
240
Papilliary adenoma normal size and size at which it would be considered malignant
<5mm >15mm malignant
241
1) • Epithelial cells growing in a papilliary or tubopapillary pattern • Well circumscribed cortical nodules ``` 2) • Mahogany brown • Central scar • Sheets / nests of cells • Pink cyrtoplasm ```
1) Papillary adenoma | 2) Oncocytoma
242
Most common malignant renal tumour
Renal cell carcinoma - epithelial tumour
243
Genetic condition risk factor for renal cell carcinoma
von Hippel-Lindau disease
244
1st and 2nd most common childhood malignancy
1. ALL | 2. Nephroblastoma / Wilms' (abdo mass in a 2-3yo)
245
Histology renal cell carcinoma types in order of incidence
1. Clear cell • Golden yellow with haemorrhagic areas • Nests of epithelium with clear cytoplasm 2. Papillary • Friable brown tumour • Papillary/tubopapillary growth 3. Chromophobe • Solid brown tumour • Perinuclear halos • Eosinophillic cells
246
• Small round blue cells • Epithelial cells trying to form primitive renal tubules • Stromal component Condition
Nephroblastoma
247
Describe the following types of transitional cell carcinomas • Non-invasive papillary • Invasive urothelial carcinoma
Non-invasive papillary • Frond (leaf)-like growths from bladder wall Invasive urothelial carcinoma • Solid masses fixed to tissue
248
Where are squamous cell bladder carcinomas common?
Countries with endemic urinary schistosomiasis
249
Which cells are dysfunctional in nephrotic syndrome and what are the 4 characteristics of the disorder?
Podocytes * Proteinuria * Hypoalbuminuria * Oedema * Hyperlipidaemia
250
Light microscopy and electron microscopy of minimal change disease
Light - no changes | Electron - loss of podocyte foot processes
251
MCD response to steroids
90%
252
Most common cause of nephrotic syndrome Its changes seen on light and electron microscopy
Membranous glomerular disease Light - diffuse GBM thickening Electron - loss of podocyte foot processes, subepithelial deposits (spikey) (poor prognosis)
253
In which groups of people is Focal Segmental Glomerulosclerosis (FSGS) most common?
Afro-Caribbean
254
FSGS light microscopy
Light - glomerular consolidation and scarring, hyalinosis
255
What do mesangial matrix nodules (Kimmelstiel Wilson nodules) signify?
Nephrotic syndrome in diabetes
256
Which condition has caused nephrotic syndrome in a patient with RA, macroglossia, heart failure, and hepatomegaly?
Amyloidosis
257
``` Proteinuria Haematuria Azootaemia (high urea and creatinine) Red cell casts Oliguria Hypertension Which condition? ```
Nephritic syndrome
258
When does acute postinfectious glomerulonephritis occur and why?
1-3 weeks after strep throat (S. pyogenes) or impetigo Immune complex deposition
259
Microscopy results: Light - increased cellularity Electron - subendothelial humps IF - granular deposits of IgG and C3 in GBM Condition?
Acute postinfectious glomerulonephritis
260
Most common glomerulonephritis worldwide and its presentation
IgA nephropathy Frank haematuria 1-2 days after URTI
261
IgA nephropathy scoring system
Oxford MEST-C
262
What is the most aggressive glomerulonephritis and what are the most pronounced symptoms?
Rapidly progressive (crescentic) glomerulonephritis Oliguria End-stage renal failure within weeks
263
Causes of the 3 types of crescentic glomerulonephritis: 1) Anti-GBM 2) Immune complex 3) Pauci-immune
1 - anti-GBM against type IV collagen • Goodpastures • HLA-DRB1 association 2 - immune complex • SLE • IgA nephropathy • Post-infectious 3 - Pauci-immune (lack of ab) • c-ANCA (GPA - saddle nose, pulmonary haemorrhage) • p-ANCA (MPA)
264
IF of 3 types of crescentic glomerulonephritis
1 - linear deposition of IgG 2 - granular, lumpy bumpy, deposition of IgG 3 - lack of deposition
265
What is Alport's syndrome and how does it present?
``` Hereditary nephritis • Mutation in type IV collagen alpha 5 chain • X-linked • Sensorineural deafness • Eye disorders ```
266
What is benign familial haematuria also known as, what is mutated and how does it present?
Thin BM disease • Mutation in type IV collagen alpha 4 chain • Asymptomatic haematuria - incidental microscopic
267
3 causes of asymptomatic haematuria
* Thin basement membrane disease * IgA nephropathy (frank haematuria, raised Cr, more common in Asians) * Alport's syndrome
268
Most common renal cause of acute renal failure
Acute tubular injury/necrosis • Casts block tubules • Reduced blood supply • Ischaemia
269
Kidney histopathology: Loss of brush border Necrosis of short segments of tubules Condition
Acute tubular injury
270
2 causes of acute tubular injury
Hypovolaemia - even if cured | Nephrotoxins e.g. contrast
271
What is the condition where a patient has had an E. coli kidney infection, flank pain, dysuria, haematuria, and leukocytic casts in the urine?
Acute pyelonephritis | leukocytic casts following ascending bacterial infection
272
Cause and effect of chronic pyelonephritis
Chronic obstruction (e.g. posterior urethral valves) and urine reflux Inflammation and scarring of parenchyma caused by recurrent bacterial infection
273
What is acute interstitial nephritis caused by and how does it present?
Hypersensitiviity to drug e.g. allopurinol and PPIs Fever, rash, haematuria, eosinophilia days after drug exposure
274
What is chronic interstitial nephritis also known as?
Analgesic nephropathy | long-term analgesic consumption in the elderly
275
Who does HUS and TTP usually affect?
HUS - children | TTP - adults
276
Coombs test in HUS and TTP
Negative, as no autoimmune haemolytic anaemia
277
Most common type of acute renal failure
Pre-renal Acute tubular necrosis is most common RENAL cause
278
Acute polycystic kidney disease mutation and pathological featurs
PKD1 Chr16, PKD2 Chr4 Large multicystic kidneys with destroyed parenchyma Liver cysts (in PKD1) Berry aneurysms
279
What do the following classes of lupus nephritis involve I - minimal mesangial lupus nephritis II - mesangial proliferative lupus nephritis III - focal lupus nephritis IV - diffuse lupus nephritis V - membranous lupus nephritis VI - advanced sclerosising
I - immune complexes, no structural change II - immune complexes, mild increased mesangial matrix + cellularity III - inflammation and proliferation in <50% glomeruli IV - >50% glomeruli involved V - subepithelial immune complex deposition VI - complete sclerosis of >90% of the glomeruli
280
Most common causes of PID in the UK and in other parts of the world
UK • Chlamydia trachomatis • Neisseria gonorrhoea Other parts • TB • Schistosomiasis
281
Patient has just been treated for PID but has severe RUQ pain. What is the cause?
Fitz Hugh Curtis syndrome • Peri-hepatitis • Violin string peri-hepatic adhesions
282
2 conditions causing cervical excitation
PID | Ectopic pregnancy
283
Macroscopic features of endometriosis
* Red-blue to brown nodules - "powder burns" | * "Chocolate cysts"
284
How is the uterus described in adenomyosis?
Globular - diffuse enlargement
285
Macroscopic and microscopic features of fibroids
Macro • Sharply circumscribed, firm, gray-white tumours Micro • Bundles of smooth muscle cells
286
What is the most common type of endometrial cancer and its cause?
Endometrioid - most of which are adenocarcinomas Oestrogen excess
287
What types of endometrial cancers are non-endometrioid and in whom do they usually occur?
Papillary, serous, clear cell Elderly women with endometrial atrophy - unrelated to oestrogen
288
Vulval intrapeithelial neoplasia usual and differentiated cell type and differentiated association
Usual - warty/basaloid SCC | Differentiated - keratinising SCC (higher risk of malignancy, older women)
289
What type of cells are affected in most vulval carcinomas?
SCC
290
Leading cause of death from gynae malignancy in the UK, and top 3 cell types
Ovarian cancer 1. Epithelial 2. Germ cell 3. Sex cord/stroma
291
What epithelial ovarian tumour cell types do these descriptions match: 1. Psammoma bodies 2. Metastatic from appendix - pseudomyxoma peritonea 3. Hobnail appearance
1. Serous cystadenoma 2. Mucinous cystadenoma 3. Clear cell
292
What is the most common oestrogen-secreting tumour?
Mucinous cystadenoma
293
What do teratomas and choriocarcinomas secrete?
Teratoma - AFP | Choriocarcinoma - hCG
294
Most common ovarian malignancy in young women sensitive to radiotherapy
Dysgerminoma
295
What are mature teratomas also known as?
Dermoid cysts
296
Which ovarian tumours are sex cord/stromal and what are they associated with and/or do they secrete?
Fibroma • Meig's syndrome - ascites + pleural effusion Granulosa - thecal cell • E2 - oestrogen effects Sertoli-Leydig cell • Androgens - defeminisation and virilisation
297
FIGO staging of ovarian cancer
I - ovaries II - pelvis III - abdomen + regional LN IV - outside abdomen
298
How is cervical dysplasia graded on cytology and histology?
Cytology - mild, moderate or severe dyskaryosis Histology • CIN1 - lower 1/3 • CIN2 - lower 2/3 • CIN3 - full thickness, BM intact
299
Treatment of cervical glandular intraepithelial neoplasia (CGIN)
Excistion of entire endocervix - can compromise fertiliy
300
2nd most common cancer in women
Cervical carcinoma
301
What medication can increase risk of cervial cancer?
COCP
302
Most common cell type involved in cervical cancer
SCC
303
Presentation of cervical cancer
Post-coital bleeding Intermenstrual bleeding Postmenopausal bleeding
304
FIGO staging of cervical cancer
0 - CIN I - cervix II - beyond uterus or upper 2/3 vagina III - pelvic side wall or lower 1/3 vagina IV - beyond true pelvis or bladder/bowel mucosa involvement
305
Breast C1-5 cytopathology meaning
``` C1 - inadquate sample C2 - benign C3 - atypia C4 - supicion of malignancy C5 - malignant ```
306
Normal breast histology
Ductal-lobular system lined by inner glandular epithelium
307
Lactational acute mastitis cause, cytology, and treatment
Staph infection via cracks in the nipple Abdundance of neutrophils Continue breastfeeding + abx
308
Non-lactational acute mastitis cause and treatment
Keratinising squamous metaplasia blocks ducts Abx + treat duct ectasia
309
What is duct ectasia and how does it present?
Inflammation and dilatation of large breast ducts • Thick discharge (white, green, brown) • Periductal mastitis / abscess / fistula due to irritation • Can cause undurated mass beneath nipple
310
What can duct ectasia be mistaken for?
Breast cancer on mammography and clinical features
311
Cytology/histology of duct ectasia
* Proteinaceous material | * Macrophages
312
How does fat necrosis present and how does it appear cytologically?
Painless breast mass May mimic carcinoma Empty spaces, histiocytes, giant cells, fat cells surrounded by macrophages
313
How do fibroadenomas change during pregnancy and menopause?
Pregnancy - grow | Menopause - calcify
314
Cytology and histology of fibroadenoma
Cytology • Branching sheets of epithelial • Bare bipolar nuclei • Stroma Histology • Multinodular mass of expanded intralobular stroma • Compressed, slit-like ducts
315
How do duct papillomas present?
Bloody discharge
316
Histology of duct papilloma?
Papillary mass within dilated duct
317
What is a radial scar and what is it called when the lesions are >1cm?
Benign scleorsing lesion that looks like a scar >1cm - complex sclerosing lesions
318
Histology of radial scar
Central, fibrous, stellate patterned area
319
Where does a phyllodes tumour arise from, how does it present, what do the cells look like, and how is it treated?
Interlobular stroma, even within existing fibroadenomas >50 yrs, palpable mass Overlapping cell layers Can be aggressive so excised with wide local excision
320
What does usual epithelial hyperplasia of the breast look like?
Growth of glandular tissue and epithelial cells forming fronds (not precursor lesion)
321
What does flat epithelial atypia of the breast look like?
Multiple layers of epithelial cells 4x risk of carcinoma
322
What does in situ lobular neoplasia of the breast look like?
Solid proliferation of aplastic cells in acinus with residue areas where you can still see lumen 7-12x risk of carcinoma
323
Breast cancer screening programme
Ages 50-70 every 3 years
324
Why are in situ lobular carcinomas always incidental findings?
No micocalcifications or stromal reactions
325
What do cells lack in in situ lobular carcinomas?
Adhesion protein E-cadherin
326
Most common type of breast carcinoma
INVASIVE ductal
327
Histology of invasive ductal and lobular carcinomas
I. ductal • Big, pleiomorphic cells I. lobular • Single file chains/strands of cells
328
What is the Nottingham Modification of Bloom-Richardson system used for?
Grading of breast carcinoma core needle biopsy
329
What prognosis are ER/PR and HER2 receptor positive carcinomas associated with?
ER/PR - good because it predicts response to tamoxifen HER2 - bad
330
How does tamoxifen and herceptin/trastuzumab work?
Tamoxifen - mixed agonist/antagonist of oestrogen at its receptor Hereceptin/trastuzumab - Ig to HER2
331
Why might you monitor LV ejection fraction during breast cancer treament?
Herceptin/trastuzumab has direct toxic effect on myocardium
332
Which breast cancer stains positive for CK5/6/14 and commonly has vascular invasion and distant mets?
Basal-like carcinoma
333
Which gene puts males at higher risk of breast cancer, and at what stage are most males when detected?
BRCA2 (rather than BRCA1) Stage III or IV
334
Most common cause of stroke
Infarction - cerebral atherosclerosis
335
Most common location of ischaemic stroke
MCA
336
When should you give thrombolytics to an ischaemic stroke patient?
<3 hours
337
Investigation for TIA
Carotid USS
338
Lacunar infarct effects • Internal capsule/pons • Thalamus • Basal ganglia
Pure sensory/motor deficit, dysarthria LOC, hemisensory deficit Hemichorea, Parkinsonism
339
Anterior circulation infarct effects • ACA • MCA
Contralateral leg weakness Confusion Contralateral weakness and sensory loss of face and arm Neglect (right sided infarct) Aphasia (left sided infarct)
340
Posterior circulation infarct effects • PCA • PICA • Basilar
Hemianopia, visual agnosia Vertigo, Ipsilateral ataxia, ipsilateral Horner's Eye problems, locked-in syndrome, memory and behaviour problems
341
Common cause of intraparenchymal haemorrhage stroke?
HTN • Charcot-bouchard microaneurysms in basal ganglia • Rupture
342
Cause of subarachnoid haemmorhage
Ruptured berry aneurysm at internal carotid bifurcation
343
Presentation of subarachnoid haemorrhage
Thunderclap headache, vomiting, and LOC
344
Conditions associated with subarachnoid haemorrhage
Ehler's Danlos Aortic coarctation AV malformations Cavernous angiomas
345
Cause of extradural haemorrhage
Skull fracture - ruptured middle meningeal artery
346
In whom do subdural haemorrhages often occur?
Elderly Alcoholic Usually prev history of minor trauma
347
What can diffuse axonal injury result in?
Vegetative state | Post-traumatic dementia
348
What is a contusion and a coup
Contusion - brain contacts skull Coup - where the impact occurs
349
Most common viral cause of meningitis
Enteroviruses
350
Which meningitis causing microorganism causes a fibrin web appearance in the CSF?
TB
351
What type of encephalitis is caused by measles?
Subacute sclerosing panencephalitis
352
Most primary brain tumour
Glioblastoma (astrocytoma)
353
Neurofibromatosis type II is related to which brain tumour?
Meningioma Vestibular schwannoma Ependymoma
354
Which ventricular tumour causes hydrocephalus?
Ependymoma
355
Which childhood brain tumour is indolent (slow-growing)?
Pilocytic astrocytoma
356
Which slow-growing brain tumour is often found to be soft, gelatinous, calcified and have a fried egg appearance?
Oligodendroglioma
357
Small blue cells and Homer Wright rossettes are indicative of which tumour?
Medulloblastoma
358
Marker for medulloblastoma
Synaptophysin
359
Pilocytic astrocytoma mutation
BRAF
360
Diffuse glioma and diffuse astrocytoma mutation
IDH1/2
361
Which familal syndrome is associated with hamangioblastoma of cerebellum, brainstem, spinal cord, retina, as well as renal cysts and phaeos?
von Hippel-Lindau
362
Which CNS tumours is neurofibromatosis type 1 associated with?
Optic glioma | Pilocytic astrocytoma
363
Pathological proteins in Alzheimer's?
Tau | Beta-amyloid
364
Pathological proteins in Lewy Body dementia
Alpha-synuclein | Ubiquitin
365
Pathological protein in corticobasal degeneration, frontotemporal dementia, and Pick's disease
Tau
366
Staging for Parkinson's and Alzheimer's
Braak staging
367
Patient has tauopathy with limited vertical gaze, early falls, problems with balance, speech, and swallowing. What condition do they have?
Progressive supranuclear palsy
368
Patient presents with optic neuritis and poor coordination. Clinician suspects condition in which myelin basic protein and proteolipid protein are potential autoantigens. What is the condition?
Multiple sclerosis
369
Osteomalacia X ray and histology
XR - Looser's zones (pseudo fractures) | Histology - excess of unmineralised bone (osteoid)
370
Primary hyperparathyroidism bone X ray and histology
XR - Brown's tumours (osteitis fibrosis cystica), salt and pepper skull, subperiosteal bone resorption in phalanges Histology - Brown's tumour
371
Paget's disease of the bone X ray and histology
XR - osteoporosis circumscripta (skull), picture frame vertebral body, pelvis sclerosis and lucency Histology - huge osteoclasts with >100 nuclei, mosaic pattern of lamellar bone (like jigsaw)
372
2 causes of gout
Increased dietary purine intake | EtOH
373
Joints affected in gout
Metatarsophalangeal joint | Lower extremities e.g. knee
374
Investigation finding in gout
Negatively birefringent, needle-shaped urate crystals
375
Acute and long-term medical treatment of gout
Acute - colchicine Long-term - allopurinol
376
Causes of pseudogout
Idiopathic, hyperparathyroidism, DM, hypothyroidism, Wilson's
377
Joints affect in pseudogout
Knee and shoulder
378
Investigation finding in pseudogout
Positively birefringent, rhomboid shaped, calcium pyrophosphate curstals
379
Pseudogout treatment
NSAIDs or intra-articular steroids
380
4 steps of fracture repair
1. Haematoma (pro-callus) organisation 2. Fibrocartilaginous callus formation 3. Fibrocartilaginous callus mineralisation 4. Remodelling of bone along weight bearing lines
381
35 yo presents with 10 days of fever, jaw pain and swelling after dental abscess. X ray shows lytic destruction of bone. What is the condition? What is the likely causative organism, and what would it be if this was an child?
Osteomyelitis Adult - S. aureus Child - Haemophilus influenxa, GBS
382
What can cause osteomyelitis in immunocompromised individuals?
TB -> Pott's disease: Psoas abscess etc.
383
Osteoarthritis joints affected (nodes) and X ray features
DIPJ - Heberden's nodes PIPJ - Bouchard's nodes ``` XR - LOSS • Loss of joint spacess • Osteophytes • Subchondral sclerosis • Subchondral cysts ```
384
Rheumatoid arthritis features
``` Small joints of hands sparing DIPJ, and other joints of the body • Radial deviation of wrist • Ulnar deviation of fingers • Swan neck and Boutonniere deformity • Z-shaped thumb ```
385
Name of multinucleated cell found in synovial membrane in RA
Synovial giant cell (Grimley-Sokoloff cell)
386
Region of bone where growth occurs
Metaphysis
387
Label used to determine the amount of bone growth within a certain period of time
Tetracycline
388
Benign neoplastic bone diseases changes
* Thick endosteal scalloping (resorption of inner layer of cortex) * Intraosseous * Even calcification
389
Malignant bone changes
* Acute periosteal reaction (Codman's triangle, onion skin, sunburst) * Broad border between lesion and normal bone * Varied bone formation * Extraosseous * Irregular calcification
390
Osteosarcoma bone most affected, histology, and XR appearance
Knee Malignant mesenchymal cells, ALP +ve Codman's triangle, sunburst appearance
391
Chondrosarcoma bone most affected, histology, and XR appearance
Axial skeleton, femur, tibia, pelvis Malignant chondrocytes Lytic lesions with fluffy calcification
392
Ewing's sarcoma bone most affected, histology, and XR appearance
Long bones, pelvis Sheets of small round cells, CD99 +ve Onion skinning of periosteum
393
Giant cell malignant bone tumour: bone most affected, histology, and XR appearance
Knee (epiphysis) Osteoclast-type multinucleate giant cells on background of spindle/ovoid cells Lytic/lucent lesions
394
Which benign bone tumour has radiolucent nidus with sclerotic rim (Bull's-eye) on X ray?
Osteoid osteoma
395
Which benign bone tumour occurs in Gardner syndrome, which also presents with GI polyps and epidermoid cysts?
OSteoma
396
Which benign bone tumour presents with cotton wool calcifications on X ray, O ring sign, and can cause Ollier's and Maffuci's syndrome (explain these too)?
Enchondroma Ollier's - multiple enchondromas Maffuci's - multiple enchondromas + haemangiomas
397
Which benign bone tumour has a cartilage capped bony outgrowth (mushroom appearance) on X ray and histology? It is also the most common benign bone tumour.
Osteochondroma Can cause diaphyseal aclasis Occurs at metaphysis of long bones near tendon attachment sites
398
Which benign bone tumour has soap bubble osteolysis and Shepherd's crook deformity on X ray and misshapen bone trabeculae "Chinese letters" on histology? Which condition which also presents with cafe au lait spots can also cause this?
Fibrous dysplasia - bone replaced by fibrous tissue Albright syndrome
399
Osteoblastoma X ray feature
Speckled mienralisation
400
What is parakeratosis?
Presence of nuclei in the keratinocytes of the S. corneum (first layer of skin)
401
What is acantholysis?
Loss of intracellular connections between keratinocytes
402
What is spongiosis?
Oedema between keratinocytes
403
Acanthosis, crusting and scaling is a feature of which skin condition?
Chronic dermatitis
404
Which skin condition is an inflammatory reaction to a yeast - Malassezia, causing cradle cap in infants?
Seborrhoeic dermatitis
405
In which condition is Auspitz' sign and Koebner phenomenon seen, and what do they mean?
Chronic plaque psoriasis - most common form (salmon pink plaques with silver scale on extensor surfaces) Auspitz' sign - pin-point bleeding when rubbing plaques together Koebner phenomenon - lesions at sites of trauma
406
Histopathology of chronic plaque psoriasis
Parakeratosis Munro's microabscesses - neutrophils in S. corneum Clubbing of rete ridges "test tubes in a rack"
407
Distribution of flexural, guttate, and erythrodermic/pustular psoriasis
Flexural - groin, natal cleft, sub-mammary Guttate - "rain-drop", 2 weeks post Strep throat E/P - can be just hands and feet, often systemic symptoms
408
3 nail changes in psoriasis
Pitting Onycholysis Subungual hyperkeratosis
409
Clinic features of lichen planus
Pruritic, purple, polygonal, papules and plaques Wickam's striae - fine white network on the surface On inner surface of wrists or oral mucous membrane (lacy appearance) (T cell mediated destruction of lower keratinocytes)
410
Histology of lichen planus
* Hyperkeratosis * Saw-toothing of rete ridges * Basal cell degeneration
411
Erythema multiforme clinical features
Annular target lesions on extensor surfaces of hands and feet
412
Pathophysiology and histology of dermatitis herpetiformis
IgA binds to BM Microabscesses coalesce to form subepidermal bullae Neutrophil and IgA deposits at tips of dermal papillae
413
An old patient has large tense bullae on an erythematous base on forearms, groin, and axillae. What is the pathophysiology and histology of this condition?
Pemphigoid (D=deep) IgG binds to hemidesmosomes of BM Subepidermal bullae Linear deposition of IgG along BM
414
Pemphigus pathophysiology and histology
IgG binds to desmosomal proteins causing intrapeidermal bullae Netlike pattern of intracellular IgG deposits Acantholysis
415
Which part of the skin does follaceus pemphigus affect?
Superficial epidermis
416
Which skin condition causes rough, waxy, stuck-on plaques, with horn cysts (trapped keratin) on histology
Seborrhoeic keratosis | benign
417
Which skin condition has a dome shaped nodule with a necrotic, crusted centre? It may clear spontaneously.
Keratoacanthoma | similar histology to SCC
418
``` Which skin condition has rough, sandpaper like, scaly lesions on sun-exposed areas? Histology shows the following: • Solar elastosis • Parakeratosis • Atypia • Inflammation ```
Actinic keratosis Not full thickness
419
What is Bowen's disease and how does it present?
Intra-epidermal SCC in situ, BM intact Flat, red, scaly patches on sun-exposed areas Full thickness
420
How does skin SCC present differently to Bowen's disease?
May ulcerate Spreads through BM into dermis
421
Patient has "rodent" ulcer with pearly surface + telangiectasia. What would histology show?
Basal cells push down into dermis Palisading (nuclei align in outermost layer)
422
How does melanoma initially spread histologically?
1) Horizontally (radial) | 2) Vertically -> buckshot appearance (pagetoid cells - scattered groups of melanocytes in superficial layers)
423
Most important prognostic factor for BCC
Breslow thickness
424
In whom does lentigo maligna melanoma occur?
Sun exposed areas of elderly White people
425
Which sign is positive in Steven Johnson Syndrome and Toxic Epidermal Necrolysis?
Nikolsky sign
426
Patient has salmon pink rash followed by oval macules in Christmass tree distribution following a viral illness. It then resolves spontaneously. What condition did they have?
Pityriasis Rosea
427
Patient with a leukocytoclastic vasculitis forms large, painful ulcers that don't heal. Histology shows dense neutrophilic infiltrate. Which condition do they likely have?
Pyoderma gangrenosum
428
Signs of polymyositis and dermatomyositis?
Proximal muscle weakness High CK Abnormal EMG DM also has: • Heliotrope rash • Gottron papules
429
A Japanese woman presents with an absent pulse and claudication. Which vasculitis is she likely to have?
Takayasu's arteritis
430
A patient who just had polymyalgia rheumatica presents with jaw claudication and blurred vision. Bloods show high ESR Histology shows granulomatous transmural inflammation and skip lesions. Which condition do they likely have?
Giant cell arteritis
431
What is seen on angiography of polyarteritis nodosa?
Microaneurysms in the kidneys
432
A heavy smoker has corkscrew-shaped vessels from segmental occlusive lesions on angiography. What condition does this patient likely have?
Buerger disease
433
Patient has a saddle nose, sinusitis, pulmonary haemorrhage and crescentic glomerulonephritis. c-ANCA positive. Which condition do they have?
GPA (Wegener's)
434
Patient has asthma and is p-ANCA positive. Which condition do they have?
EGPA (Churg Strauss)
435
Patient has pulmonary haemorrhage, glomerulonephritis and is p-ANCA positive. Which condition do they have?
Microscopic polyangiitis
436
Child has an URTI. Following this, a palpable purple rash appears on the buttocks and patient experiences colicky abdominal pain. Glomerulonephritis is established. What condition does this patient have?
Henoch Schonlein Purpura
437
Most common amyloidosis and what is found in urine of these patients
AL amyloidosis Bence Jones proteins
438
Amyloidosis secondary to chornic infections and inflammation e.g. RA
AA amyloidosis (amyloid A is an acute phase protein)
439
Beta-2-microglobulin is deposited in which amyloidosis type?
Haemodialysis associated
440
Most common familial amyloidosis and targets of inflammation
Familial Mediterranean Fever IL1 produced - inflammation of serosal surfaces (pleura, peritoneum, synovium) Renal deposition of amylod A
441
Familial mediterranean fever treatment
1. Colchicine 2. Anakinra (IL1R antagonist) 3. Etanercept
442
Amyloidosis effect in mouth
Macroglossia
443
What causes apple green birefringence with Congo red stain under polarised light in amyloidosis?
Beta-pleated sheets
444
Which condition has non-caseating granulonas, Schaumann bodies and asteroid bodies on histology?
Sarcoidosis
445
Effect of sarcoidosis on eyes
Anterior uveitis - misting vision and painful red eye Posterior uveitis - progressive visual loss Uveoparotid fever - bilateral uveitis, parotid enlargement Keratoconjunctivitis Lacrimal gland enlargement

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