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Path > Histo > Flashcards

Histo Flashcards

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
Q

Best investigation for diagnosing heart failure

A

Transthoracic echocardiogram (TTE)

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26
Q

Dilated cardiomyopathy causes. Systolic or diastolic dysfunction?

A

Alcohol
Haemochromatosis

Systolic dysfunction

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27
Q

Hypertrophic cardiomyopathy causes. Systolic or diastolic dysfunction?

A

Genetic
Storage diseases

Diastolic dysfunction

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28
Q

Restrictive cardiomyopathy causes. Systolic or diastolic dysfunction?

A

Sarcoidosis
Radiation-induced fibrosis

Diastolic dysfunction

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29
Q

Hypertrophic cardiomyopathy histology and genetic mutations. What is the significance of the mutations?

A

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

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30
Q

What is hypertrophic obstructive cardiomyopathy (HOCM)?

A

Septal hypertrophy resulting in outflow tract obstruction

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31
Q

What is seen in arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A

Myocyte loss

Fibrofatty replacement

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32
Q

When and in whom does acute rheumatic fever occur?

A

2-4 weeks after strep throat infection

Peak age 5-15

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33
Q

How is acute rheumatic fever diagnosed?

A

Jones

2 major
1 major + 2 minor

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34
Q

What are Jones’ major criteria?

A

CASES

Carditis
Arthritis
Sydenham's chorea
Erythema marginatum
Subcutaneous nodules
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35
Q

Which valves are affected in acute rheumatic fever?

A

Mitral valve (70%)

Can affect both mitral and aortic (25%)

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36
Q

Main pathogen in acute rheumatic fever?

A

Lancefield group A strep

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37
Q

Name of process in acute rheumatic fever by which antibodies to strep cross-react with myocardial antigens

A

Antigenic mimicry

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38
Q

Beady/warty fibrous vegetations (verrucae)
Aschoff bodies (small giant-cell granulomas)
Anitschkov myocytes (regenerating myocytes)
Condition

A

Acute rheumatic fever

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39
Q

Acute rheumatic fever treatment

A

NSAIDs first line

Benzylpenicillin if ongoing infection

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40
Q

Infective endocarditis histology of vegetations

A

Large, irregular masses on valve cusps, extending into chordae

More localised in acute
Smaller and soft thrombi in subacute

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41
Q

Histology of vegetations in non-bacterial thrombotic endocarditis e.g. DIC

(deposition of platelets and fibrin on heart valves)

A

Small, bland vegetations attached to lines of closure

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42
Q

What conditions is Libman-Sacks endocarditis associated with? Describe the histology of the vegetations.

A

SLE, anti-phospholipid syndrome

Small, warty vegetations
Sterile and platelet-rich

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43
Q

Infective endocarditis causes

A 
Poor dental hygiene
IVDU
Cannulae
Pacemakers
etc.
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44
Q

Organisms in acute and subacute infective endocarditis

A

Acute
• Staph. aureus
• Strep. pyogenes

Subacute
• Strep. viridans
• Staph. epidermis
• HACEK

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45
Q

Infective endocarditis feautres

A
  • 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
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46
Q

Criteria used for infective endocarditis diagnosis. What are the major criteria?

A

Duke
2 major
1 major + 3 minor
5 minor

Positive blood culture
Evidence of vegetation/abscess or new regurgitant murmur

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47
Q

Infective endocarditis treatment

A

Broad-spectrum abx

Then treat according to sensitivies

Acute
MSSA - flucloxacillin
MRSA - vancomycin + rifampicin

Subacute
Benzylpenicillin + gentamycin

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48
Q

Causes of aortic regurgiation

A

IE
LV dilation
Connective tissue disease e.g. Marfans

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49
Q

Causes of mitral stenosis

A

Rheumatic fever

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50
Q

Causes of aortic stenosis

A

Calcification

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51
Q

Causes of mitral regurgitation

A 
IE
Connective tissue disease
Post-MI
Rheumatic fever
LV dilation
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52
Q

Which valves are most commonly affected in order in chronic rheumatic valve disease?

A

Mitral > aortic > tricuspid > pulmonary

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53
Q

Middle-aged woman
Short of breath with chest pain
Mid systolic click + late systolic murmur

condition

A

Mitral valve prolapse

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54
Q

Chronic bronchitis time span for diagnosis

A

Productive cough on most days for 3 months over 2 years

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55
Q

Histological features of chronic bronchitis

A

Goblet cell hyperplasia

Mucous gland hypertrophy

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56
Q

2x congenital diseases causing bronchiectasis (airway dilatation and scarring)

A

CF

Kartagener syndrome

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57
Q

Permanent dilation of the bronchi is a histological feature of what diagnosis?

A

Bronchiectasis

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58
Q

Asthma histology

A

SM cell hyperplasia
Curschmann spirals (whirls of shed epithelium)
Eosinophils
Charcot-Leyden crystals (eosinophil protein)

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59
Q

Causes of emphysema

A 
Tobacco smoke (neutrophils -> proteases -> damage)
Alpha-1 antritrypsin deficiency
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60
Q

Complications of emphysema

A 
Cor pulmonale (right side heart enlargement due to pulmonary HTN)
Pneumothorax
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61
Q

Infammatory causes of bronchiectasis

A
  • Post-infectious (e.g. pertussis)

* Abnormal host defence e.g. hypogammaglobulinaemia (primary) and chemotherapy (secondary)

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62
Q

Features of interstital lung disease (restrictive lung disease) on spirometry (3)

A
  • Decreased CO diffusion capacity
  • Decreased lung volume
  • Decreased compliance
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63
Q

Auscultation of interstital lung disease

A

End-inspiratory crackles

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64
Q

Advanced interstitial lung disease appearance on CT CAP

A

Honeycomb

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65
Q

What is granulomatous interstital lung disease associated with?

A

Vasculitidies

There is also a fibrosing, granulomatous, eosinophilic, and smoking related category.

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66
Q

Interstitial lung disease diagnosis

A

High res CT +/- biopsy

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67
Q

Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis histological appearance

A

Honeycomb change
Beginning at periphery of lobule
Sub-pleural

Hyperplasia of type II pneumocytes
Leads to cyst formation

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68
Q

Clinical presentation of Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis

A

Mainly males

Hypoxaemia + cyanosis
Pulmonary hypertension
Clubbing

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69
Q

Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis treatment

A

Steroids
Cyclophosphamide
Azathioprine

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70
Q

Which condition is classically seen in coal miners?

A

Pneumoconiosis

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71
Q

Which lobe does asbestosis tend to affect?

A

Lower lobe

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72
Q

2 fungal granulomatous infections

A

Cryptococcus

Aspergillus

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73
Q

Polypod plugs of loose lung connective tissue condition

A

Extrinsic allergic alveolitis

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74
Q 
Chronic extrinsic allergic alveolitis causes.
• Farmer's lung
• Pigeon fancier's lung
• Malt-workers lung
• Cheese washer's lung
A
  • Farmer’s - mouldy hay (Saccharopolyspora rectivirgula)
  • Pigeon fancier’s - proteins in excreta/feathers
  • Malt-workers - germinating barley (Aspergillus)
  • Cheese washer’s - mouldy cheese (Aspergillus)
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75
Q

How can fibrosis be prevented in extrinsic allergic alveolitis?

A

Early removal of antigen

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76
Q

Histology of bronchopneumonia, lobar pneumonia, and atypical pneumonia

A

BP - patchy nodular distribution of infection
LP - fibrinosuppurative consolidation
A - interstitial pneumonitis, no intra-alveolar inflammation

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77
Q

What are the 4 stages of lobar pneumonia?

A
  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

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78
Q

What is lung SCC (most common lung tumour) associated with?

A

Smoking (no cilia so mucus can build with procarcinogenic chemicals)

p53 and c-myc mutations

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79
Q

Where does lung SCC spread? Early or late mets?

A

Proximal bronchi
Local spread

Late mets

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80
Q

In whom do lung adenocarcinomas (2nd most common) commonly present?

A

Women and non-smokers

EGFR mutations

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81
Q

How does lung adenocarcinoma spread?

A

Occurs peripherally

Early mets

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82
Q

What is an axample of an atypical adenomatous hyperplasia?

A

Non-mucinous bronchioalveolar carcinoma

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83
Q

How does small cell carcinomas (3rd most common) spread and from what cells do they arise?

A

Centrally, proximal bronchi

Early mets

Neuroendocrine cells

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84
Q

What 3 pathologies are small cell carcinomas associated with?

A

Ectopic ACTH
Lambert-Eaton syndrome (VGCCs attacked)
Cerebellar degeneration

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85
Q

What are small cell carcinomas associated with?

A

Smoking

p53 and RB1 mutations

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86
Q

Most common subtype of small cell carcinoma

A

Oat cell carcinoma

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87
Q

Prognosis of large cell carcinoma

A

Poor

Poorly differentiated malignant epithelial tumour

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88
Q

What can high levels of bradykinin cause?

A

Coughing

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89
Q

What isssues are associated with ERCC1-NSCLC mutations?

A

Poor response to cisplatin

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90
Q

Mesothelioma latent period

A

25-45 years

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91
Q

Virchow’s triad (3 factors important in the development of venous thrombosis)

A

Stasis
Vessel wall injury
Hypercoagulability

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92
Q

Most common cause of acute cor pulmonale

A

PE

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93
Q

What is a saddle embolism?

A

PE at bifurcation of main pulmonary artery

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94
Q

Percentage of pulmonary bed occluded that causes death

A

> 60%

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95
Q

Whilst larger PEs can cause deaths, what can smaller emboli cause?

A

Silent or cause wedge-infarctions (bronchial arteries not cutt off, although pulmonary artery is)

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96
Q

Pulmonary hypertension classification

A

Mean pulmonary arterial pressure >25mmHg at rest

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97
Q

What is class 1 pulmonary HTN associated with?

A

Congenital heart disease (or idiopathic, drugs)

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98
Q

What is class 2 pulmonary HTN associated with?

A

Left heart disease

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99
Q

What is class 3 pulmonary HTN associated with?

A

Lung disease

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100
Q

What is class 4 pulmonary HTN associated with?

A

Chronic thromboembolic pulmonary hypertension (blood clots that don’t dissolve in the lungs but scar)

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101
Q

What is class 5 pulmonary HTN associated with?

A

Unclear

Mutlifactorial mechanism

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102
Q

Main cause of PO

A

LHF

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103
Q

Intra-alveolar fluid
Iron laden macrophages “heart failure cells”
Condition

A

PO

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104
Q

How does diffuse alveolar damage present in adults and neonates?

A

Adults - ARDS

Neonates - Hyaline membrane disease (low surfactant)

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105
Q 
What does this histopathology suggest:
Lung expanded
Firm
Plum-coloured
Airless
A

Diffuse alveolar damage

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106
Q

CXR of diffuse alveolar damage

A

Fluffy white infiltrates in all fields

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107
Q

Cell changes in Barrett’s

A

Squamous to columnar epithelium

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108
Q

Most common oesophageal cancer in the UK

A

Adenocarcinoma

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109
Q

Most common oesophageal cancer in the world and its associations

A

SCC

Alcohol, smoking, HPV
6x more common in Afro-Carribeans

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110
Q

Which part of oesophagus are most SCCs found?

A

Middle 1/3

then lower 1/3, then upper 1/3

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111
Q

Management of oesphageal varices

A

Endoscopy - band ligation

Sclerotherapy

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112
Q

Eosinophilic oesophagitis treatment

A

Steroids

Allergen removal

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113
Q

Are goblet cells present in the stomach?

A

No

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114
Q

WCC involved in acute gastritis

A

Neutrophils

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115
Q

WCC involved in chronic gastritis

A

Lymphocytes and plasma cells

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116
Q

Which part of the stomach does H. pylori preferentially colonise?

A

Antrum

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117
Q

What does a gastric ulcer breach through?

A

Muscularis mucosa into submucosa

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118
Q

Effect of food on gastric and duodenal uclers

A

Gastric - worse

Duodenal - better

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119
Q

What do gastric ulcers look like?

A

Punched out lesions with rolled margins

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120
Q

What is a signet ring carcinoma and where does it metastasise?

A

Malignant adenocarcinoma in the stomach that produces mucin

Mets to ovary = Krukenberg tumour

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121
Q

What is linitis plastica?

A

Stomach adenocarcinoma that spreads to the stomach wall and makes it thicker and more rigid

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122
Q

What can H. pylori infection lead to?

A

MALT lymphoma (B cell non-hodgkin’s)

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123
Q

H. pylori treatment

A

Triple therapy

PPI
Clarithryomycin
Amox / metro

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124
Q

Are gastric or duodenal ulcers more common?

A

Duodenal

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125
Q

Are gastric and duodenal ulcers seen more commonly in older or younger people?

A

Gastric - older

Duodenal - younger

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126
Q

Coeliac disease mediation and protein responsible

A

T cell mediated autoimmune disease to gliadin

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127
Q

Investigations for coeliac disease

A
  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

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128
Q

What is seen on biopsy in coeliac disease?

A

Villous atrophy
Crypt hyperplasia
Lymphocyte infiltrate

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129
Q

Which cancer can 10% of coeliac disease cases progress to if not treated adequately?

A

Duodenal T-cell lymphoma

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130
Q

What is RET proto-oncogene Cr10+ associated with?

A

Hirschsprung’s disease

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131
Q

What is seen on full thickness rectal biopsy in Hirschsprung’s disease?

A

Hypertrophied nerve fibres

No ganglia

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132
Q

Where is bowel ischaemia common?

A

Watershed areas

Splenic flexure (SMA to IMA)
Rectosigmoid (IMA to internal iliac)
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133
Q

Group of people affected by IBD

A

White
Onset in 20s
Smoking worsens Crohn’s
UC is more common

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134
Q

Crohn’s characteristics

A
  • Whole GIT (most common in terminal ileum and caecum)
  • Skip lesions - cobble-stone appearance
  • All layers
  • Increased goblet cells
  • Granulomas (non-caseating)
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135
Q

UC characteristics

A
  • 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
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136
Q

Presentation of CD and UC

A 
CD
• Diarrhoea
• Weight loss
• Upper GI symptoms
• RIF mass

UC
• Bloody diarrhoea
• Left lower quadrant pain
• Tenesmus (inclination to empty bowels)

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137
Q

CD and UC radiology signs/features

A

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)

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138
Q

What is the first CD lesion called?

A

Apthous ulcer

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139
Q

When can the small bowel be affected by UC?

A

Backwash ileitis

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140
Q

Extra-GI manifestations of IBD

A

Both
• Erythema nodosum
• Pyoderma gangrenosum
• Arthritis

CD
• Gallstones
• Oxalate renal stone

UC
• Primary sclerosing cholangitis
• Uveitis

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141
Q

UC complications

A
  • Adenocarcinoma
  • Toxic megacolon
  • 30% require colectomy
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142
Q

IBD imaging

A

CD
• Colonoscopy
• Small bowel enema

UC
• Colonscopy + biopsy
• Sever - flexible sigmoidoscopy (perforation risk)
• Barium enema

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143
Q

CD management

A 
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
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144
Q

UC management

A
  • 5-ASA (topical rectal)
  • Oral corticosteroid

Severe
• IV steroids

Remission

  1. 5-ASA
  2. Azathioprine
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145
Q

What is tested for in pseudomembranous colitis?

A

C diff TOXIN

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146
Q

Pseudomembranous colitis treatment

A
  1. Metronidazole PO

2. Vancomycin PO

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147
Q

What is carcinoid syndrome and its presentation (3)?

A

Tumours of enterochromaffin cell origin producing 5-HT

  • Bronchoconstriction
  • Flushing
  • Diarrhoea
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148
Q

Investigation and treatment of carcinoid syndrome

A

24hr urine 5-HIAA (serotonin metabolite)

Octreotide (somatostatin analogue)

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149
Q

What do villous adenomas leak?

A

Protein and potassium

Leads to hypoproteinaemic hypokalaemia

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150
Q

What is the most important risk factor of an adenoma for malignancy?

A

Large size

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151
Q

Why might a colectomy be required in juveline polyposis?

A

Stop haemorrhage of hamartomatous polyps

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152
Q

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?

A

Peutz-Jeghers syndrome

LKB1

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153
Q

What causes a hyperplastic polyp?

A

Shedding of epithelium and cell build-up

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154
Q

Most common site of colorectal cancer

A

Rectum

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155
Q

Why are NSAIDs protective in colorectal cancer?

A

COX2 over-expressed in most patients

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156
Q

Features of right and left sided colorectal tumours

A

Right
• Iron deficiency anaemia
• Weight loss

Left
• Change in bowel habit
• Crampy LLQ pain

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157
Q

What blood test is used to monitor colorectal cancer?

A

Carcinoembryonic antigen

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158
Q

Colorectal cancer Duke’s staging

A 
A - mucosa
B1 - muscularis propria
B2 - transmural
C1 - muscularis propria, LN mets
C2 - transmural, LN mets
D - distant mets
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159
Q

Number of adenomatous polyps required for diagnosis of familial adenoumatous polyposis

A

> 100

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160
Q

How is Gardner syndrome different to FAP?

A

Extra-intestinal features e.g. osteoma’s and dental caries

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161
Q

Where do mutations occur in Lynch syndrome (HNPCC)?

A

DNA mismatch repair genes

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162
Q

Where do carcinomas usually occur in Lynch syndrome and what other carcinomas is it associated with?

A

Right colon

Endometrial, ovarian, small bowel, transitional cell and stomach carcinoma

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163
Q

Which cells produce secretin and what does it do?

A

S-cells of the duodenum

Controls gastric acid secretion

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164
Q

What is the functional exocrine unit in the pacreas arranged around the ducts?

A

Acinar cells

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165
Q 
What do the following cells produce:
Alpha cells
Beta cells
Delta cells
D1
PP
A

Alpha - glucagon
Beta - insulin
Delta - somatostatin (regulates above cells)
D1 + PP - Pancreatic polypeptide (regulate pancreatic secretion, increased after fastin)

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166
Q

Metabolic syndrome diagnostic criteria

A 
Fasting hyperglycaemia >6
BP >140/90
Central obesity >94cm (M), >80cm (F)
Dyslipidaemia
Microalbuminaemia
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167
Q

Which WCCs attack beta cells in T1DM?

A

CD4+ and CD8+

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168
Q

Sensitive marker for acute pancreatitis

A

Serum lipase

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169
Q

Presentation of acute pancreatitis

A

Severe epigastric pain, relieved by sitting forward

Vomiting

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170
Q

Top 2 causes of pancreatitis

A

Gallstones

Ethanol

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171
Q

Infectious cause of pancreatitis

A

Mumps

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172
Q

What circumscribed formation can acute pancreatitis result in the formation of?

A

Pseudocyst - lined by fibrous tissue, no epithelial lining

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173
Q

Histology of acute pancreatitis

A

Coagulative necrosis (lysosomal enzymes destriyed preventing proteolysis of damaged cells - architecture preserved)

Fat necrosis -> saponification -> hypocalcaemia

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174
Q

Most common cause of chronic pancreatitis

A

Chronic alcohol drinking

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175
Q

Histology of chronic pancreatitis

A

Fibrosis
Loss of exocrine tissue
Duct dilation
Calcification

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176
Q

Presentation of acinar cell carcinoma

A

Fat necrosis and polyarthralgia due to high lipase

18 month median survival

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177
Q

Histology of acinar cell carcinoma

A

Neoplastic epithelial cells with eosinophilic granular cytoplasm

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178
Q

Most common type of pancreatic cancer

A

Ductal adenocarcinoma

Head of pancreas

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179
Q

Main risk factor for pancreatic cancer

A

Smoking

180
Q

Differential features of pancreatic cancer

A

Courvoisier’s sign - painless jaundice and enlarged gallbladder
Steatorrhoea
Trousseau’s syndrome (reucurrent superficial thrombophlebitis)
Virchow’s node

181
Q

Pancreatic cancer marker and level

A

CA19.9 > 70

182
Q

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?

A 
Islet cell (neuroendocrine) tumour
Body or tail
183
Q 
How do the following functional islet cell tumours present:
Insulinoma
Gastrinoma
VIPoma (vasoactive intestinal peptide)
Glucagonoma
A

Insulinoma - hypoglycaemic attacks
Gastrinoma - Zollinger-Ellison syndrome: recurrent ulceration
VIPoma: diarrhoea
Glucagonoma - necrolytic migrating erythema

184
Q

When are non-functional islet cell tumours picked up?

A

Incidentally on imaging or large enough to produce symptoms of local disease / mets

185
Q

What are most gallstones made up of?

A

Cholesterol, radiolucent

186
Q

Cholecystitis presentation

A

RUQ pain

Fever

187
Q

What are Rokitansky-Aschoff sinuses? What else is seen in this condition?

A

Deep outpouchings in chronic cholecystitis

Thick gallbladder wall

188
Q

Which MEN is associated with the marfanoid phenotype?

A

MEN2B

189
Q

What can annular pancreas present with?

A

Duodenal obstruction ~1 year old

190
Q

Which cells are in zone 1 of the liver?

A

Periportal hepatocytes

Closest to the portal triad (bile ducts, hepatic artery, portal vein)

191
Q

Which cells are in zone 3 of the liver?

A

Perivenular hepatocytes

Most mature
Most metabolically active
Most liver enzymes

Close to hepatic vein

192
Q

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?

A

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
Q

Spotty necrosis in liver condition

A

Acute hepatitis

194
Q

Histopathology of chronic hepatitis (4 steps)

A
  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
Q

What is the diffuse abnormality of liver architecture that interferes with blood flow and liver function?

A

Cirrhosis

196
Q

Fibrotic bridges between portal triad and central vein. Condition

A

Cirrhosis

197
Q

3 main causes of cirrhosis

A
  1. Alcoholic liver disease
  2. NAFLD
  3. Chronic viral hepatitis (hep B/D and C)
198
Q

What drug can cause cirrhosis?

A

Methotrexate

199
Q

Difference between micro and macronodular cirrhosis

A

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
Q

Score for cirrhosis, what is measured, and what it means

A 
Child's Pugh Score (ABCDE)
• Albumin
• Bilirubin
• Clotting (PTT)
• Distention (ascites)
• Encephalopathy

<7 - A
7-9 - B
10+ - C

201
Q

Steatosis and alcoholic cirrhosis macroscopic characteristics

A

Steatosis
• Large, pale, yellow

Alcoholic cirrhosis
• Large, yellow-tan
• Shrinks, becomes non-fatty, and brown

202
Q

Alcoholic hepatitis and NAFLD macroscopic characteristics

A

Large and fibrotic

203
Q

Most common cause of chronic liver disease in the West

A

NAFLD

insulin resistance

204
Q

Which conditions does NAFLD include?

A

steatosis and non-alcoholic steatohepatitis (NASH)

205
Q

Most common groups of people affected by autoimmune hepatitis

A

Young and postmenopausal females

206
Q

Ig causes of type 1 and 2 autoimmune hepatitis

A

Type 1
• ANA
• Anti-SMA
• Anti-actin

Type 2
• Anti-LKM (liver-kidney-microsomal)

207
Q

What is primary biliary cirrhosis and which antibody is positive in this condition?

A

Destruction of medium sized intrahepatic bile ducts

Cholestasis and slow development of cirrhosis over many years

+ve AMA (anti-mitochondrial antibody)

208
Q

What does ultrasound and histology show in PBC?

A

USS - no bile duct dilatation

Histology - bile duct loss with granulomas

209
Q

PBC treatment

A

Ursodeoxycholic acid in early phase (mops up bile salts)

210
Q

Ducts affected in primary sclerosing cholangitis and which antibody is positive in this condition?

A

Extrahepatic and intrahepatic bile ducts
(stricture formation)

+ve p-ANCA

211
Q

Condition associated with PSC

A

UC

212
Q

Ultrasound, ERCP and histology of PSC

A

USS - bile duct dilatation
ERCP - beading bile ducts
Histology - onion skiining fibrosis - concentric

213
Q

What condition are patients with PSC at increased risk of?

A

Cholangiocarcinoma

214
Q

Hepatic adenomas are associated with long term use of which medication?

A

Oral-contraceptive pill

215
Q

Hepatic adenoma presentation and treatment

A

Abdo pain
Intraperitoneal bleeding

Resection if symptomatic, >5cm, or no shrinkage when stopping OCP

216
Q

What is the most common benign hepatic lesion that is usually incidentally picked up?

A

Haemangioma

217
Q

HCC investigations

A

Alpha-fetoprotein

USS

218
Q

Most common malignant liver lesion

A

Secondary tumour - usually from GIT, breast or bronchus

219
Q

Haemochromatosis mutated gene and histology (stain)

A

Mutated HFE Chr 6

Fe deposits in liver stain with Prussian blue

220
Q

Presentation of haemochromatosis

A
  • Skin bronzing or slate grey
  • Diabetes
  • Hepatomegaly
221
Q

Total iron binding capacity (TIBC) in haemochromatosis

A

Low

222
Q

Haemochromatosis treatment

A

Venesection

Desferrioxamine

223
Q

Mallory bodies and fibrosis seen. ATP7B Chr 13 mutation. What is the condition? Which transporter is affected? Which stain can be used?

A

Wilson’s disease
Copper transporting ATPase - decreased biliary Cu excretion
Cu stains with Rhodanine

224
Q

Serum caeruloplasmin, serum copper, urinary copper, and treatment for Wilson’s disease

A

Serum caeruloplasmin - low
Serum copper - low
Urinary copper - high

Lifelong penicillamine

225
Q

Alpha 1 antitrypsin deficiency histopathology (+ stain)

A

A1AT accumulates in hepatocytes

Intracytoplasmic inclusions which stain with Periodic acid Schiff

226
Q

A1AT deficiency presentation and investigations

A

Emphysema, chronic liver disease, neonatal jaundice

Low A1AT
No alpha-globulin band on electrophoresis

227
Q

Top 3 types of renal stones

A
  1. Calcium oxalate
  2. Magnesium ammonium phosphate
    • Due to urease producing organisms which alkanise urine
    • Staghorn calculi
  3. Uric acid
228
Q

Which types of renal stones are common in ethylene glycol poisoning and UTIs?

A

EG poisoning - calcium oxalate

UTIs - magnesium ammonium phosphate

229
Q

BPH is hyperplasia of which cells and mediated by which hormone?

A

Stromal and epithelial cells

Dihydrotestosterone

230
Q

Histology and treatment of BPH

A

Nodule formation
Prostatic epithelial ducts with duct spaces

TURP
5-alpha reductase inhibitors (tamsulosin, finasteride)

231
Q

Common site of prostate cancer site and spread (adenocarcinoma most common form)

A

Peripheral zone of gland
Local spread to bladder
Haematogenous spread to bone

232
Q

PSA in prostate cancer

A

> 4ng/ml is indicative

233
Q

Grading system for prostate cancer

A

Gleason system

234
Q

Most common testicular tumour

A

Germ cell:

Seminoma is most common type

235
Q

When is a teratoma regarded as malignant?

A

When it occurs in a post-pubertal male

236
Q

Biologic makers for germ cell testicular tumours

A

AFP
HCG
LDH

237
Q

Risk factor for germ cell testicular tumour

A

Testicular dysgenesis e.g. cryptorchidism

238
Q

What are the non germ cell tumours which are derived from the stroma and sex cord?

A

Leydig cell - stroma

Sertoli cell - sex cord

239
Q

What are the following benign renal tumours made up of:
• Papillary adenoma
• Oncocytoma
• Angiomyolipoma

A
  • PA - epithelial with papillary architecture
  • O - Epithelial
  • A - mesenchymal -> fat, blood vessels, muscle
240
Q

Papilliary adenoma normal size and size at which it would be considered malignant

A

<5mm

> 15mm malignant

241
Q

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
A

1) Papillary adenoma

2) Oncocytoma

242
Q

Most common malignant renal tumour

A

Renal cell carcinoma - epithelial tumour

243
Q

Genetic condition risk factor for renal cell carcinoma

A

von Hippel-Lindau disease

244
Q

1st and 2nd most common childhood malignancy

A
  1. ALL

2. Nephroblastoma / Wilms’ (abdo mass in a 2-3yo)

245
Q

Histology renal cell carcinoma types in order of incidence

A
  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
Q

• Small round blue cells
• Epithelial cells trying to form primitive renal tubules
• Stromal component
Condition

A

Nephroblastoma

247
Q

Describe the following types of transitional cell carcinomas
• Non-invasive papillary
• Invasive urothelial carcinoma

A

Non-invasive papillary
• Frond (leaf)-like growths from bladder wall

Invasive urothelial carcinoma
• Solid masses fixed to tissue

248
Q

Where are squamous cell bladder carcinomas common?

A

Countries with endemic urinary schistosomiasis

249
Q

Which cells are dysfunctional in nephrotic syndrome and what are the 4 characteristics of the disorder?

A

Podocytes

  • Proteinuria
  • Hypoalbuminuria
  • Oedema
  • Hyperlipidaemia
250
Q

Light microscopy and electron microscopy of minimal change disease

A

Light - no changes

Electron - loss of podocyte foot processes

251
Q

MCD response to steroids

A

90%

252
Q

Most common cause of nephrotic syndrome

Its changes seen on light and electron microscopy

A

Membranous glomerular disease

Light - diffuse GBM thickening
Electron - loss of podocyte foot processes, subepithelial deposits (spikey)

(poor prognosis)

253
Q

In which groups of people is Focal Segmental Glomerulosclerosis (FSGS) most common?

A

Afro-Caribbean

254
Q

FSGS light microscopy

A

Light - glomerular consolidation and scarring, hyalinosis

255
Q

What do mesangial matrix nodules (Kimmelstiel Wilson nodules) signify?

A

Nephrotic syndrome in diabetes

256
Q

Which condition has caused nephrotic syndrome in a patient with RA, macroglossia, heart failure, and hepatomegaly?

A

Amyloidosis

257
Q 
Proteinuria
Haematuria
Azootaemia (high urea and creatinine)
Red cell casts
Oliguria
Hypertension
Which condition?
A

Nephritic syndrome

258
Q

When does acute postinfectious glomerulonephritis occur and why?

A

1-3 weeks after strep throat (S. pyogenes) or impetigo

Immune complex deposition

259
Q

Microscopy results:
Light - increased cellularity
Electron - subendothelial humps
IF - granular deposits of IgG and C3 in GBM

Condition?

A

Acute postinfectious glomerulonephritis

260
Q

Most common glomerulonephritis worldwide and its presentation

A

IgA nephropathy

Frank haematuria 1-2 days after URTI

261
Q

IgA nephropathy scoring system

A

Oxford MEST-C

262
Q

What is the most aggressive glomerulonephritis and what are the most pronounced symptoms?

A

Rapidly progressive (crescentic) glomerulonephritis

Oliguria

End-stage renal failure within weeks

263
Q

Causes of the 3 types of crescentic glomerulonephritis:

1) Anti-GBM
2) Immune complex
3) Pauci-immune

A

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
Q

IF of 3 types of crescentic glomerulonephritis

A

1 - linear deposition of IgG
2 - granular, lumpy bumpy, deposition of IgG
3 - lack of deposition

265
Q

What is Alport’s syndrome and how does it present?

A 
Hereditary nephritis
• Mutation in type IV collagen alpha 5 chain
• X-linked
• Sensorineural deafness
• Eye disorders
266
Q

What is benign familial haematuria also known as, what is mutated and how does it present?

A

Thin BM disease
• Mutation in type IV collagen alpha 4 chain
• Asymptomatic haematuria - incidental microscopic

267
Q

3 causes of asymptomatic haematuria

A
  • Thin basement membrane disease
  • IgA nephropathy (frank haematuria, raised Cr, more common in Asians)
  • Alport’s syndrome
268
Q

Most common renal cause of acute renal failure

A

Acute tubular injury/necrosis
• Casts block tubules
• Reduced blood supply
• Ischaemia

269
Q

Kidney histopathology:
Loss of brush border
Necrosis of short segments of tubules

Condition

A

Acute tubular injury

270
Q

2 causes of acute tubular injury

A

Hypovolaemia - even if cured

Nephrotoxins e.g. contrast

271
Q

What is the condition where a patient has had an E. coli kidney infection, flank pain, dysuria, haematuria, and leukocytic casts in the urine?

A

Acute pyelonephritis

leukocytic casts following ascending bacterial infection

272
Q

Cause and effect of chronic pyelonephritis

A

Chronic obstruction (e.g. posterior urethral valves) and urine reflux

Inflammation and scarring of parenchyma caused by recurrent bacterial infection

273
Q

What is acute interstitial nephritis caused by and how does it present?

A

Hypersensitiviity to drug e.g. allopurinol and PPIs

Fever, rash, haematuria, eosinophilia days after drug exposure

274
Q

What is chronic interstitial nephritis also known as?

A

Analgesic nephropathy

long-term analgesic consumption in the elderly

275
Q

Who does HUS and TTP usually affect?

A

HUS - children

TTP - adults

276
Q

Coombs test in HUS and TTP

A

Negative, as no autoimmune haemolytic anaemia

277
Q

Most common type of acute renal failure

A

Pre-renal

Acute tubular necrosis is most common RENAL cause

278
Q

Acute polycystic kidney disease mutation and pathological featurs

A

PKD1 Chr16, PKD2 Chr4

Large multicystic kidneys with destroyed parenchyma
Liver cysts (in PKD1)
Berry aneurysms

279
Q

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

A

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
Q

Most common causes of PID in the UK and in other parts of the world

A

UK
• Chlamydia trachomatis
• Neisseria gonorrhoea

Other parts
• TB
• Schistosomiasis

281
Q

Patient has just been treated for PID but has severe RUQ pain. What is the cause?

A

Fitz Hugh Curtis syndrome
• Peri-hepatitis
• Violin string peri-hepatic adhesions

282
Q

2 conditions causing cervical excitation

A

PID

Ectopic pregnancy

283
Q

Macroscopic features of endometriosis

A
  • Red-blue to brown nodules - “powder burns”

* “Chocolate cysts”

284
Q

How is the uterus described in adenomyosis?

A

Globular - diffuse enlargement

285
Q

Macroscopic and microscopic features of fibroids

A

Macro
• Sharply circumscribed, firm, gray-white tumours

Micro
• Bundles of smooth muscle cells

286
Q

What is the most common type of endometrial cancer and its cause?

A

Endometrioid - most of which are adenocarcinomas

Oestrogen excess

287
Q

What types of endometrial cancers are non-endometrioid and in whom do they usually occur?

A

Papillary, serous, clear cell

Elderly women with endometrial atrophy - unrelated to oestrogen

288
Q

Vulval intrapeithelial neoplasia usual and differentiated cell type and differentiated association

A

Usual - warty/basaloid SCC

Differentiated - keratinising SCC (higher risk of malignancy, older women)

289
Q

What type of cells are affected in most vulval carcinomas?

A

SCC

290
Q

Leading cause of death from gynae malignancy in the UK, and top 3 cell types

A

Ovarian cancer

  1. Epithelial
  2. Germ cell
  3. Sex cord/stroma
291
Q

What epithelial ovarian tumour cell types do these descriptions match:

  1. Psammoma bodies
  2. Metastatic from appendix - pseudomyxoma peritonea
  3. Hobnail appearance
A
  1. Serous cystadenoma
  2. Mucinous cystadenoma
  3. Clear cell
292
Q

What is the most common oestrogen-secreting tumour?

A

Mucinous cystadenoma

293
Q

What do teratomas and choriocarcinomas secrete?

A

Teratoma - AFP

Choriocarcinoma - hCG

294
Q

Most common ovarian malignancy in young women sensitive to radiotherapy

A

Dysgerminoma

295
Q

What are mature teratomas also known as?

A

Dermoid cysts

296
Q

Which ovarian tumours are sex cord/stromal and what are they associated with and/or do they secrete?

A

Fibroma
• Meig’s syndrome - ascites + pleural effusion

Granulosa - thecal cell
• E2 - oestrogen effects

Sertoli-Leydig cell
• Androgens - defeminisation and virilisation

297
Q

FIGO staging of ovarian cancer

A

I - ovaries
II - pelvis
III - abdomen + regional LN
IV - outside abdomen

298
Q

How is cervical dysplasia graded on cytology and histology?

A

Cytology - mild, moderate or severe dyskaryosis

Histology
• CIN1 - lower 1/3
• CIN2 - lower 2/3
• CIN3 - full thickness, BM intact

299
Q

Treatment of cervical glandular intraepithelial neoplasia (CGIN)

A

Excistion of entire endocervix - can compromise fertiliy

300
Q

2nd most common cancer in women

A

Cervical carcinoma

301
Q

What medication can increase risk of cervial cancer?

A

COCP

302
Q

Most common cell type involved in cervical cancer

A

SCC

303
Q

Presentation of cervical cancer

A

Post-coital bleeding
Intermenstrual bleeding
Postmenopausal bleeding

304
Q

FIGO staging of cervical cancer

A

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
Q

Breast C1-5 cytopathology meaning

A 
C1 - inadquate sample
C2 - benign
C3 - atypia
C4 - supicion of malignancy
C5 - malignant
306
Q

Normal breast histology

A

Ductal-lobular system lined by inner glandular epithelium

307
Q

Lactational acute mastitis cause, cytology, and treatment

A

Staph infection via cracks in the nipple

Abdundance of neutrophils

Continue breastfeeding + abx

308
Q

Non-lactational acute mastitis cause and treatment

A

Keratinising squamous metaplasia blocks ducts

Abx + treat duct ectasia

309
Q

What is duct ectasia and how does it present?

A

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
Q

What can duct ectasia be mistaken for?

A

Breast cancer on mammography and clinical features

311
Q

Cytology/histology of duct ectasia

A
  • Proteinaceous material

* Macrophages

312
Q

How does fat necrosis present and how does it appear cytologically?

A

Painless breast mass
May mimic carcinoma

Empty spaces, histiocytes, giant cells, fat cells surrounded by macrophages

313
Q

How do fibroadenomas change during pregnancy and menopause?

A

Pregnancy - grow

Menopause - calcify

314
Q

Cytology and histology of fibroadenoma

A

Cytology
• Branching sheets of epithelial
• Bare bipolar nuclei
• Stroma

Histology
• Multinodular mass of expanded intralobular stroma
• Compressed, slit-like ducts

315
Q

How do duct papillomas present?

A

Bloody discharge

316
Q

Histology of duct papilloma?

A

Papillary mass within dilated duct

317
Q

What is a radial scar and what is it called when the lesions are >1cm?

A

Benign scleorsing lesion that looks like a scar

> 1cm - complex sclerosing lesions

318
Q

Histology of radial scar

A

Central, fibrous, stellate patterned area

319
Q

Where does a phyllodes tumour arise from, how does it present, what do the cells look like, and how is it treated?

A

Interlobular stroma, even within existing fibroadenomas

> 50 yrs, palpable mass

Overlapping cell layers

Can be aggressive so excised with wide local excision

320
Q

What does usual epithelial hyperplasia of the breast look like?

A

Growth of glandular tissue and epithelial cells forming fronds

(not precursor lesion)

321
Q

What does flat epithelial atypia of the breast look like?

A

Multiple layers of epithelial cells

4x risk of carcinoma

322
Q

What does in situ lobular neoplasia of the breast look like?

A

Solid proliferation of aplastic cells in acinus with residue areas where you can still see lumen

7-12x risk of carcinoma

323
Q

Breast cancer screening programme

A

Ages 50-70 every 3 years

324
Q

Why are in situ lobular carcinomas always incidental findings?

A

No micocalcifications or stromal reactions

325
Q

What do cells lack in in situ lobular carcinomas?

A

Adhesion protein E-cadherin

326
Q

Most common type of breast carcinoma

A

INVASIVE ductal

327
Q

Histology of invasive ductal and lobular carcinomas

A

I. ductal
• Big, pleiomorphic cells

I. lobular
• Single file chains/strands of cells

328
Q

What is the Nottingham Modification of Bloom-Richardson system used for?

A

Grading of breast carcinoma core needle biopsy

329
Q

What prognosis are ER/PR and HER2 receptor positive carcinomas associated with?

A

ER/PR - good because it predicts response to tamoxifen

HER2 - bad

330
Q

How does tamoxifen and herceptin/trastuzumab work?

A

Tamoxifen - mixed agonist/antagonist of oestrogen at its receptor

Hereceptin/trastuzumab - Ig to HER2

331
Q

Why might you monitor LV ejection fraction during breast cancer treament?

A

Herceptin/trastuzumab has direct toxic effect on myocardium

332
Q

Which breast cancer stains positive for CK5/6/14 and commonly has vascular invasion and distant mets?

A

Basal-like carcinoma

333
Q

Which gene puts males at higher risk of breast cancer, and at what stage are most males when detected?

A

BRCA2 (rather than BRCA1)

Stage III or IV

334
Q

Most common cause of stroke

A

Infarction - cerebral atherosclerosis

335
Q

Most common location of ischaemic stroke

A

MCA

336
Q

When should you give thrombolytics to an ischaemic stroke patient?

A

<3 hours

337
Q

Investigation for TIA

A

Carotid USS

338
Q

Lacunar infarct effects
• Internal capsule/pons
• Thalamus
• Basal ganglia

A

Pure sensory/motor deficit, dysarthria
LOC, hemisensory deficit
Hemichorea, Parkinsonism

339
Q

Anterior circulation infarct effects
• ACA
• MCA

A

Contralateral leg weakness
Confusion

Contralateral weakness and sensory loss of face and arm
Neglect (right sided infarct)
Aphasia (left sided infarct)

340
Q

Posterior circulation infarct effects
• PCA
• PICA
• Basilar

A

Hemianopia, visual agnosia

Vertigo, Ipsilateral ataxia, ipsilateral Horner’s

Eye problems, locked-in syndrome, memory and behaviour problems

341
Q

Common cause of intraparenchymal haemorrhage stroke?

A

HTN
• Charcot-bouchard microaneurysms in basal ganglia
• Rupture

342
Q

Cause of subarachnoid haemmorhage

A

Ruptured berry aneurysm at internal carotid bifurcation

343
Q

Presentation of subarachnoid haemorrhage

A

Thunderclap headache, vomiting, and LOC

344
Q

Conditions associated with subarachnoid haemorrhage

A

Ehler’s Danlos
Aortic coarctation
AV malformations
Cavernous angiomas

345
Q

Cause of extradural haemorrhage

A

Skull fracture - ruptured middle meningeal artery

346
Q

In whom do subdural haemorrhages often occur?

A

Elderly
Alcoholic

Usually prev history of minor trauma

347
Q

What can diffuse axonal injury result in?

A

Vegetative state

Post-traumatic dementia

348
Q

What is a contusion and a coup

A

Contusion - brain contacts skull

Coup - where the impact occurs

349
Q

Most common viral cause of meningitis

A

Enteroviruses

350
Q

Which meningitis causing microorganism causes a fibrin web appearance in the CSF?

A

TB

351
Q

What type of encephalitis is caused by measles?

A

Subacute sclerosing panencephalitis

352
Q

Most primary brain tumour

A

Glioblastoma (astrocytoma)

353
Q

Neurofibromatosis type II is related to which brain tumour?

A

Meningioma
Vestibular schwannoma
Ependymoma

354
Q

Which ventricular tumour causes hydrocephalus?

A

Ependymoma

355
Q

Which childhood brain tumour is indolent (slow-growing)?

A

Pilocytic astrocytoma

356
Q

Which slow-growing brain tumour is often found to be soft, gelatinous, calcified and have a fried egg appearance?

A

Oligodendroglioma

357
Q

Small blue cells and Homer Wright rossettes are indicative of which tumour?

A

Medulloblastoma

358
Q

Marker for medulloblastoma

A

Synaptophysin

359
Q

Pilocytic astrocytoma mutation

A

BRAF

360
Q

Diffuse glioma and diffuse astrocytoma mutation

A

IDH1/2

361
Q

Which familal syndrome is associated with hamangioblastoma of cerebellum, brainstem, spinal cord, retina, as well as renal cysts and phaeos?

A

von Hippel-Lindau

362
Q

Which CNS tumours is neurofibromatosis type 1 associated with?

A

Optic glioma

Pilocytic astrocytoma

363
Q

Pathological proteins in Alzheimer’s?

A

Tau

Beta-amyloid

364
Q

Pathological proteins in Lewy Body dementia

A

Alpha-synuclein

Ubiquitin

365
Q

Pathological protein in corticobasal degeneration, frontotemporal dementia, and Pick’s disease

A

Tau

366
Q

Staging for Parkinson’s and Alzheimer’s

A

Braak staging

367
Q

Patient has tauopathy with limited vertical gaze, early falls, problems with balance, speech, and swallowing. What condition do they have?

A

Progressive supranuclear palsy

368
Q

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?

A

Multiple sclerosis

369
Q

Osteomalacia X ray and histology

A

XR - Looser’s zones (pseudo fractures)

Histology - excess of unmineralised bone (osteoid)

370
Q

Primary hyperparathyroidism bone X ray and histology

A

XR - Brown’s tumours (osteitis fibrosis cystica), salt and pepper skull, subperiosteal bone resorption in phalanges

Histology - Brown’s tumour

371
Q

Paget’s disease of the bone X ray and histology

A

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
Q

2 causes of gout

A

Increased dietary purine intake

EtOH

373
Q

Joints affected in gout

A

Metatarsophalangeal joint

Lower extremities e.g. knee

374
Q

Investigation finding in gout

A

Negatively birefringent, needle-shaped urate crystals

375
Q

Acute and long-term medical treatment of gout

A

Acute - colchicine

Long-term - allopurinol

376
Q

Causes of pseudogout

A

Idiopathic, hyperparathyroidism, DM, hypothyroidism, Wilson’s

377
Q

Joints affect in pseudogout

A

Knee and shoulder

378
Q

Investigation finding in pseudogout

A

Positively birefringent, rhomboid shaped, calcium pyrophosphate curstals

379
Q

Pseudogout treatment

A

NSAIDs or intra-articular steroids

380
Q

4 steps of fracture repair

A
  1. Haematoma (pro-callus) organisation
  2. Fibrocartilaginous callus formation
  3. Fibrocartilaginous callus mineralisation
  4. Remodelling of bone along weight bearing lines
381
Q

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?

A

Osteomyelitis

Adult - S. aureus

Child - Haemophilus influenxa, GBS

382
Q

What can cause osteomyelitis in immunocompromised individuals?

A

TB -> Pott’s disease: Psoas abscess etc.

383
Q

Osteoarthritis joints affected (nodes) and X ray features

A

DIPJ - Heberden’s nodes
PIPJ - Bouchard’s nodes

XR - LOSS
• Loss of joint spacess
• Osteophytes
• Subchondral sclerosis
• Subchondral cysts
384
Q

Rheumatoid arthritis features

A 
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
Q

Name of multinucleated cell found in synovial membrane in RA

A

Synovial giant cell (Grimley-Sokoloff cell)

386
Q

Region of bone where growth occurs

A

Metaphysis

387
Q

Label used to determine the amount of bone growth within a certain period of time

A

Tetracycline

388
Q

Benign neoplastic bone diseases changes

A
  • Thick endosteal scalloping (resorption of inner layer of cortex)
  • Intraosseous
  • Even calcification
389
Q

Malignant bone changes

A
  • Acute periosteal reaction (Codman’s triangle, onion skin, sunburst)
  • Broad border between lesion and normal bone
  • Varied bone formation
  • Extraosseous
  • Irregular calcification
390
Q

Osteosarcoma bone most affected, histology, and XR appearance

A

Knee

Malignant mesenchymal cells, ALP +ve

Codman’s triangle, sunburst appearance

391
Q

Chondrosarcoma bone most affected, histology, and XR appearance

A

Axial skeleton, femur, tibia, pelvis

Malignant chondrocytes

Lytic lesions with fluffy calcification

392
Q

Ewing’s sarcoma bone most affected, histology, and XR appearance

A

Long bones, pelvis

Sheets of small round cells, CD99 +ve

Onion skinning of periosteum

393
Q

Giant cell malignant bone tumour: bone most affected, histology, and XR appearance

A

Knee (epiphysis)

Osteoclast-type multinucleate giant cells on background of spindle/ovoid cells

Lytic/lucent lesions

394
Q

Which benign bone tumour has radiolucent nidus with sclerotic rim (Bull’s-eye) on X ray?

A

Osteoid osteoma

395
Q

Which benign bone tumour occurs in Gardner syndrome, which also presents with GI polyps and epidermoid cysts?

A

OSteoma

396
Q

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)?

A

Enchondroma

Ollier’s - multiple enchondromas
Maffuci’s - multiple enchondromas + haemangiomas

397
Q

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.

A

Osteochondroma

Can cause diaphyseal aclasis

Occurs at metaphysis of long bones near tendon attachment sites

398
Q

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?

A

Fibrous dysplasia - bone replaced by fibrous tissue

Albright syndrome

399
Q

Osteoblastoma X ray feature

A

Speckled mienralisation

400
Q

What is parakeratosis?

A

Presence of nuclei in the keratinocytes of the S. corneum (first layer of skin)

401
Q

What is acantholysis?

A

Loss of intracellular connections between keratinocytes

402
Q

What is spongiosis?

A

Oedema between keratinocytes

403
Q

Acanthosis, crusting and scaling is a feature of which skin condition?

A

Chronic dermatitis

404
Q

Which skin condition is an inflammatory reaction to a yeast - Malassezia, causing cradle cap in infants?

A

Seborrhoeic dermatitis

405
Q

In which condition is Auspitz’ sign and Koebner phenomenon seen, and what do they mean?

A

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
Q

Histopathology of chronic plaque psoriasis

A

Parakeratosis
Munro’s microabscesses - neutrophils in S. corneum
Clubbing of rete ridges “test tubes in a rack”

407
Q

Distribution of flexural, guttate, and erythrodermic/pustular psoriasis

A

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
Q

3 nail changes in psoriasis

A

Pitting
Onycholysis
Subungual hyperkeratosis

409
Q

Clinic features of lichen planus

A

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
Q

Histology of lichen planus

A
  • Hyperkeratosis
  • Saw-toothing of rete ridges
  • Basal cell degeneration
411
Q

Erythema multiforme clinical features

A

Annular target lesions on extensor surfaces of hands and feet

412
Q

Pathophysiology and histology of dermatitis herpetiformis

A

IgA binds to BM

Microabscesses coalesce to form subepidermal bullae
Neutrophil and IgA deposits at tips of dermal papillae

413
Q

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?

A

Pemphigoid (D=deep)

IgG binds to hemidesmosomes of BM

Subepidermal bullae
Linear deposition of IgG along BM

414
Q

Pemphigus pathophysiology and histology

A

IgG binds to desmosomal proteins causing intrapeidermal bullae

Netlike pattern of intracellular IgG deposits
Acantholysis

415
Q

Which part of the skin does follaceus pemphigus affect?

A

Superficial epidermis

416
Q

Which skin condition causes rough, waxy, stuck-on plaques, with horn cysts (trapped keratin) on histology

A

Seborrhoeic keratosis

benign

417
Q

Which skin condition has a dome shaped nodule with a necrotic, crusted centre? It may clear spontaneously.

A

Keratoacanthoma

similar histology to SCC

418
Q 
Which skin condition has rough, sandpaper like, scaly lesions on sun-exposed areas? Histology shows the following:
• Solar elastosis
• Parakeratosis
• Atypia
• Inflammation
A

Actinic keratosis

Not full thickness

419
Q

What is Bowen’s disease and how does it present?

A

Intra-epidermal SCC in situ, BM intact

Flat, red, scaly patches on sun-exposed areas
Full thickness

420
Q

How does skin SCC present differently to Bowen’s disease?

A

May ulcerate

Spreads through BM into dermis

421
Q

Patient has “rodent” ulcer with pearly surface + telangiectasia. What would histology show?

A

Basal cells push down into dermis

Palisading (nuclei align in outermost layer)

422
Q

How does melanoma initially spread histologically?

A

1) Horizontally (radial)

2) Vertically -> buckshot appearance (pagetoid cells - scattered groups of melanocytes in superficial layers)

423
Q

Most important prognostic factor for BCC

A

Breslow thickness

424
Q

In whom does lentigo maligna melanoma occur?

A

Sun exposed areas of elderly White people

425
Q

Which sign is positive in Steven Johnson Syndrome and Toxic Epidermal Necrolysis?

A

Nikolsky sign

426
Q

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?

A

Pityriasis Rosea

427
Q

Patient with a leukocytoclastic vasculitis forms large, painful ulcers that don’t heal. Histology shows dense neutrophilic infiltrate. Which condition do they likely have?

A

Pyoderma gangrenosum

428
Q

Signs of polymyositis and dermatomyositis?

A

Proximal muscle weakness
High CK
Abnormal EMG

DM also has:
• Heliotrope rash
• Gottron papules

429
Q

A Japanese woman presents with an absent pulse and claudication. Which vasculitis is she likely to have?

A

Takayasu’s arteritis

430
Q

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?

A

Giant cell arteritis

431
Q

What is seen on angiography of polyarteritis nodosa?

A

Microaneurysms in the kidneys

432
Q

A heavy smoker has corkscrew-shaped vessels from segmental occlusive lesions on angiography. What condition does this patient likely have?

A

Buerger disease

433
Q

Patient has a saddle nose, sinusitis, pulmonary haemorrhage and crescentic glomerulonephritis. c-ANCA positive. Which condition do they have?

A

GPA (Wegener’s)

434
Q

Patient has asthma and is p-ANCA positive. Which condition do they have?

A

EGPA (Churg Strauss)

435
Q

Patient has pulmonary haemorrhage, glomerulonephritis and is p-ANCA positive. Which condition do they have?

A

Microscopic polyangiitis

436
Q

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?

A

Henoch Schonlein Purpura

437
Q

Most common amyloidosis and what is found in urine of these patients

A

AL amyloidosis

Bence Jones proteins

438
Q

Amyloidosis secondary to chornic infections and inflammation e.g. RA

A

AA amyloidosis (amyloid A is an acute phase protein)

439
Q

Beta-2-microglobulin is deposited in which amyloidosis type?

A

Haemodialysis associated

440
Q

Most common familial amyloidosis and targets of inflammation

A

Familial Mediterranean Fever

IL1 produced - inflammation of serosal surfaces (pleura, peritoneum, synovium)
Renal deposition of amylod A

441
Q

Familial mediterranean fever treatment

A
  1. Colchicine
  2. Anakinra (IL1R antagonist)
  3. Etanercept
442
Q

Amyloidosis effect in mouth

A

Macroglossia

443
Q

What causes apple green birefringence with Congo red stain under polarised light in amyloidosis?

A

Beta-pleated sheets

444
Q

Which condition has non-caseating granulonas, Schaumann bodies and asteroid bodies on histology?

A

Sarcoidosis

445
Q

Effect of sarcoidosis on eyes

A

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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