Histo Flashcards
1
Q
what do neutrophil polymorphs indicate
A
acute inflammation
2
Q
what do lymphocytes indicate
A
chronic inflammation
3
Q
lymphocytes + neutrophils =
A
acute on chronic
4
Q
what is the loss of surface epithelium +/- lamina propria with muscularis in tact
A
erosion
5
Q
what is the loss of surface epithelium with depth of tissue loss beyond the muscularis mucosae
A
ulcer
6
Q
ulcer with element of fibrosis
A
chronic ulcer
7
Q
what is dysplasia
A
cytological and histological features of malignancy, basement membrane in tact
8
Q
what are the two roads to GI cancer
A
metaplasia-dysplasia pathway (oesophageal)
adeno-carcinoma pathway (colorectal cancer)
9
Q
features of adenocarcinoma
A
gland forming
mucin secreting
10
Q
features of squamous cell carcinoma
A
make keratin
inter-cellular bridges
11
Q
what is the squamo-columnar junction called in oesophagus
A
Z line
12
Q
what subtype of barrett’s oesophagus carries greater risk
A
goblet cell positive(intestinal type columnar epithelium)
13
Q
stain to highlight intestinal type columnar epithelium
A
methylene blue
14
Q
most common oesophageal malignancy worldwide
A
upper/mid oesopahgeal SCC
alcohol/ cigarettes
15
Q
most common oesophageal malignancy UK
A
distal adenocarcinoma (columnar epithelium transformation)
GORD/ oesophagitis
16
Q
oesophageal varices cause
A
portal HTN: cirrhosis, portal vein thrombosis, IVC obstruction
17
Q
oesophageal varices presentation
A
upper gi bleed, melaena
18
Q
oesophageal varices management
A
fluid resuscitate, terlipressin, scope, PPI infusion
19
Q
should goblet cells be seen in stomach?
A
NO - indicates intestinal type metaplasia
20
Q
what do chief cells produce
A
pepsin
21
Q
what do parietal cells produce
A
intrinsic factor
HCl
22
Q
causes of acute gastritis
A
alcohol consumption, NSAIDs, H. pylori, stress
23
Q
causes of chronic gastritis
A
autoimmune (pernicious anaemia), H. pylori, bile reflux, NSAIDs, CMV if immunosuppressed, crohn’s
24
Q
H. pylori eradication therapy
A
PPI
clarithromycin
amoxicillin or metronidazole
25
h pylori under microscope
gram negative curved rod
26
what is H pylori associated with
MALT, B cell marginal lymphoma
27
what is the main type of gastric cancer
adenocarcinoma (95%)
other 5% are SCC, lymphoma, GIST
28
what are the two types of gastric adenocarcinoma
intestinal - well-differentiated, mucin producing, gland forming
diffuse - sinlge-cell architecture, no gland formation, signet-ring cells
29
what are signet ring cells associated with
diffuse type gastric adenocarcinoma
30
usual type of stomach cell
columnar epithelium
31
most common cause of duodenal ulcers
H pylori
32
coeliac disease changes on biopsy
villous atrophy, crypt hyperplasia
33
lymphocytic duodenitis villous structure
NORMAL
34
examples of non-neoplastic polyps
hyperplastic polyps
inflammatory pseudo-polyps
hamartomatous polyps
35
examples of neoplastic polyps
tubular adenoma
tubulovillous adenoma
villous adenoma
36
polyps with increased risk of cancer
higher villous component, dysplastic features
37
pathology of liver fibrosis
kupferr cells activated
stellate cells activated --> myelofibroblasts
basement membrane secreted
collagen in space of disse
38
features of liver cirrhosis
whole liver fibrosis with nodules of regenerating hepatocytes and distortion of vascular architecture
39
alcoholic hepatitis features
ballooning of cells
mallory denk bodies
apoptosis
pericellular fibrosis
hypoxic zone 3
relatively irreversible
40
most common cause of liver cancer
secondary metastatic disease
41
primary tumours of the liver
hepatocellular carcinoma
hepatoblastoma
cholangiocarcinoma
haemangiosarcoma
42
peri-ductal injury in acute pancreatitis suggests what cause
obstructive cause
43
peri-lobular injury in acute pancreatitis suggests what cause
vascular cause
44
acute pancreatitis pathology
reflux enzymes --> acinar necrosis --> release of more enzymes
release of lipases --> fat necrosis --> soaponification with calcium
45
acute pancreatitis complications
haemorrhagic pancreatitis
hypoglycaemia, hypocalcaemia
pesudocyst, abcess
46
chronic pancreatitis features
fibrosis, duct strictures, loss of paenchyma
main cause = alcohol
47
main type of pancreatic carcinoma
ductal (85%)
other type = acinar
48
other types of pancreatic cancer
cystic neoplasms: - serous cystadenoma
- mucinous cystic neoplasm
neuroendocrine tumours
49
pancreatic neuroendocrine tumour features
associated with MEN1 (pituitary, pancreas and parathyroid)
most commonly in tail
most commonly non-secretory
most common type if secretory = insulinoma
50
pancreatic ductal carcinoma features
95% associated with K-ras mutations
most common in head (60%)
51
nephrotic syndrome triad
hypoalbuminaemia
proteinuria
oedema
52
primary causes of nephrotic syndrome
minimal change disease
membranous glomerular disease
focal segmental glomerulosclerosis
membranoproliferative glomerulonephritis
53
secondary causes of nephrotic syndrome
SLE
diabetes
amyloidosis
54
minimal change disease on electron microscopy
loss of podocyte foot processes
55
minimal change disease management
oral prednisolone
56
most common cause of adult nephrotic syndrome
membranous glomerular disease
57
membranous glomerular disease auto-antibody
anti-phospholipase A2 receptor
58
membranous glomerular disease light microscopy
diffuse GBM thickening
59
membranous glomerular disease electron microscopy
loss of podocyte foot processes
spikey subendothelial deposits
60
membranous glomerular disease management
ACEi/ ARB, Bp control
61
focal segmental glomerulosclerosis light microscopy
focal and segmental scarring, hyalinosis
62
focal segmental glomerulosclerosis electron microscopy
loss of podocyte foot processes
63
focal segmental glomerulosclerosis management
ACEi/ ARB, BP control
50% respond to steroids
64
nephritic syndrome features
proteinuria
haematuria
azootemia (high urea and creatinine)
red cell casts
oliguria
HTN
65
nephritic syndrome causes
acute post-infectious GN
IgA nephropathy (berger's disease)
rapidly progressive GN (cresentic)
Alport's syndrome (hereditary nephritis)
thin basement membrane disease (benign familial haematuria)
66
acute post infectious GN features
1-3 weeks after strep throat or impetigo
67
acute post infectious GN bloods
high antistreptlysin O titer (ASOT)
low C3
68
acute post infectious GN light microscopy
increased cellularity of glomeruli/ mesangium
69
acute post infectious GN electron microscopy
subendothelial humps
70
acute post infectious GN immunofluorescence
granular deposition of IgG + C3
71
acute post infectious GN management
supportive
72
IgA nephropathy features
most common cause of GN worldwide, east/ south asian patients
days after URTI/ GI infection
frank haematuria
deposition of IgA immune complexes
can progress to ESRF
73
IgA nephropathy bloods
high igA
74
IgA nephropathy immunofluorescence
granular deposition of IgA and C3 in mesangium
75
IgA nephropathy rule of thirds
1/3 asymptomatic
1/3 CKD
1/3 progressive ckd --> dialysis/ transplantation
76
rapidly progressive GN features
ESRF within weeks, most aggressive GN
77
rapidly progressive GN type 1 association
anti-GBM antibody
78
rapidly progressive GN type 2 association
immune complex mediated
79
rapidly progressive GN type 3 association
ANCA associated, pauci-immune
80
alport's syndrome features
type 4 collagen mutation
nephritic syndrome
sensorineural deafness
eye disorders (lens dislocation, cataracts, macular retinal flecks)
81
alport's syndrome inheritance
x linked
82
thin basement membrane disease features
asymptomatic microscopic haematuria
renal function normal
excellent prognosis
autosomal dominant
83
most common type of ovarian cancer, with columnar epithelium and psammoma bodies on histology
serous cystadenoma
84
ovarian cancer with mucin secreting cells, NO psammoma bodies. epithelium may resemble GI or endocervical epithelium
mucinous cystadenoma
85
ovarian cancer with tubular glands on histology, with endometriosis as a risk factor
endometroid carcinomas
86
ovarian cancer with clear cells, and hobnail appearance on histology. strong association with endometriosis, poor prognosis
clear cell carcinomas
87
most common ovarian cancer in young women, usually benign
dysgerminoma
88
tumour with differentiation into mature tissues e.g. skin, teeth, hair, bone, cartilage
cystic teratoma (aka dermoid cyst)
89
tumour type that secretes hCG and mimics pregnancy
choriocarcinoma
90
ovarian sex cord tumour that secretes oestrogen
symptoms include post-menstrual/ intermenstrual bleeding, endometrial/ breast cancer, breast enlargment
granulosa/ theca cell tumours
91
ovarian sex cord tumour that secretes androgens
symptoms include virilisation, breast atrophy, hirsuitism, enlarged clitoris
sertoli-leydig cell tumours
92
sex cord tumour that doesn't secrete any hormones
benign, 50% associated with meig's syndrome (r sided pleural effusion, ascites)
fibroma
93
high risk hpv strains
16, 18
94
most common type of cervical cancer
SCC (80%)
other 20% = adenocarcinoma
95
red painful breast, tender to touch, hot. neutrophils present on cytology
acute mastitis
96
multiparous 40-60 y/o smoker with greeny brown nipple discharge. cytology shows proteinaceous material and inflammatory cells, histology shows duct dilation, proteinaceous material inside the duct and periductal inflammation.
duct ectasia
97
obese middle aged woman with a painless, firm breast mass after surgery. cytology shows empty fat spaces, histiocytes, multinucleated giant cells. can cause nipple retraction
fat necrosis
98
breast cancer that is almost always found incidentally. no microcalcifications, so doesn't show up on USS or mammography. NO necrosis
lobular carcinoma in situ
99
breast cancer with areas of calcification seen on mammography and with necrosis
ductal carcinoma in situ
100
features of invasive breast carcinoma
peau d'orange, tethering, paget's disease of breast (eczema on nipple), nipple retraction, lymphadenopathy, ulceration, bloody discharge
101
most important prognostic factor for breast cancer
status of axillary lymph nodes
102
ER/PR receptor positive breast cancer prognosis/ treatment
good prognosis
tamoxifen
103
HER2 receptor positive breast cancer prognosis/ treatment
poor prognosis
herceptin
104
breast lumpiness, cyclical (related to menstruation), very common
fibrocystic disease
105
20-30 yo with a freely mobile breast lump, changes in size with menstrual cycle. histology shows stromal and glandular tissue
fibroadenoma
106
enlarging fibroepithelial mass in woman >50. Histology shows leaf-like fronds/ artichoke like appearance, glandular and stromal proliferation, overlapping cells
phyllodes tumour
107
benign cause of bloody nipple discharge in 40-60 yos. cytology shows branching papillary groups of epithelium. histology shows a papillary mass within a dilated duct, papillary mass tends to have fibrovascular core
intraductal papilloma
108
central zone of scarring surrounded by radiating zone of proliferating glandular tissue. stellate mass on mammogram (resembles carcinoma)
radial scar
109
benign bone tumour in woman <30 affecting proximal femur/ ribs/ tibia/ skull.
xray shows soap-bubble osteolysis, shepherd's crook deformity if femur affected.
histology - chinese letters (marrow replaced by fibrous stroma and rounded trabecular bone
fibrous dysplasia
110
benign bone tumour in men aged 10-20 at the ends of longs bones
most common benign bone tumour
x ray shows bony protuberance with cartilage cap - 'mushroom'
osteochondroma
111
benign bone tumour with risk of malignant transformation. Affects fingers and hands of middle aged, can cause pathological fractures.
xray shows popcorn/ cotton wool calcification, o ring sign
echondroma
112
benign bone tumour causing dull pain at night in tibial diaphysis, proximal femur, adolescent boys. pain relieved by aspirin
osteoid osteoma
113
most common primary bone cancer. men aged 10-30 with bone forming at end of long bones, most commonly knee. causes pain and a mass.
xray shows elevated periosteum (Codman's triangle), mixed sclerotic and lytic lesions, cortical breach, sun-burst appearance
histology shows malignant mesenchymal cells, stain for ALP is positive
osteosarcoma
114
malignany bone tumour that is cartilage producing in axial skeleton, proximal femur/tibia, pelvis, pts aged >40
xray shows lytic lesions with fluffy calcification
chondrosarcoma
115
malignant bone tumour of under 20s, at the diaphysis/ metaphysis of long bones or pelvis.
xray shows onion skinning of periosteum, lytic lesions +/- sclerosis
histology shows sheets of small round cells, CD99 positive, ALP negative
Ewing's sarcoma
116
malignant bone tumour of 20-40 yo women, at knee epiphyses with extension into metaphysis
xray shows lytic appearance, soap-bubble appearance
histology shows giant multinucleate osteoclasts
giant cell tumour
117
RA features
periarticular erosions, osteopenia, soft tissue swelling, subluxations
118
osteoarthritis features
loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis
119
what condition is associated with bamboo spine
ankylosing spondylitis
120
psoriatic arthritis features
new fluffy bone
nail changes - onycholysis, nail pitting
121
reactive arthritis features
seronegative
HLA-B27 associated
sacroiliac and knee joints
associated keratoderma, blennorrhagica, circinate balanitis, enthesitis of achilles tendon
122
psoriasis features
parakeratosis - nuclei within stratum corneum, thick keratin layer, silvery scales
loss of stratum granulosum - auspitz sign
123
purple, pruritic, papules and plaques on inner surface of wrists. white lacy appearance in mouth (wickam striae)
lichen planus
124
ulcer due to underlying disease (colitis, leukaemia, sclerosing cholangitis)
pyoderma gangrenosum
125
pigmented, cauliflower like lesion with a stuck on appearance. histology shows horn cysts and orderly proliferation of epidermis
seborrhoeic keratosis
126
pre-malignant lesion with warty, sandpaper like texture in sun exposed areas. histology shows solar elastosis, parakeratosis, atypia/ dysplasia, inflammation
actinic keratosis
127
superficial skin blisters that easily rupture leading to raw red surface. nikolsky's sign is positive. acantholytic cells on biopsy, mucosal involvement
pemphigus vulgaris
128
antibodies associated with pemphigus vulgaris
desmoglein 1 and 3
129
elderly patient, with tense bullae on flexor surfaces that do not easily rupture
bullous pemphigoid
130
antibodies associated with bullous pemphigoid
anti-hemidesmosome
131
excoriated red area (bullae rupture too easily to see intact), less severe course than pemphigus vulgaris
pemphigus foliaceus
132
initial salmon pink lesion (herald patch) --> multiple oval macules in fir tree distribution
follows an URTI
pityriasis
133
rolled pearly edge with central ulcer and fine telangiectasia in a sun exposed area in an elderly person, does not metastasise
BCC
134
most common type of amyloidosis
AL amyloidosis
associated with paraproteins (e.g. multiple myeloma)
135
AA amyloidosis
associated with chronic infection/ inflammation (RA, crohn's)
136
sarcoidosis features
non-caseating granulomas, lungs most commonly affected, high ACE
associations - erythema nodosum, hypercalcaemia, uveitis
137
fontana stain
positive for melanin, melanoma
138
congo red stain with apple green birefringence under polarised light
amyloidosis
139
rhodanine stain
golden brown against blue background = copper (Wilson's disease)
140
prussian blue stain
blue = iron, haemachromatosis
141
perl's stain
positive = iron, haemachromatosis
142
cytokeratin is used for
epithelial marker, carcinoma
143
cd45 is used for
lymphoid marker, lymphocyte
144
ziehl-neelson stain
red against blue background = TB
145
auramine stain
bright yellow fluorescence = TB
146
gomori's methanamine silver stain
flying saucer shaped cysts = pneumocystis jiroveci
147
modified kinyoung acid fast stain
cryptosporidium parvum
148
india ink stain
yeast cells surrounded by halos = cryptococcus neoformans
149
giemsa stain
cytoplasmic inclusions = chlamydia psittaci
150
fite stain
mycobacterium leprae
151
what is aflatoxin from aspergillus a risk factor for
hepatocellular carcinoma
152
chronic bronchitis histology
mucus gland hypertrophy, goblet cell hyperplasia/ metaplasia
153
microscopic polyangitis features
small vessel vasculitis, immune complexes
affects skin, heart, brain, kidneys
pANCA association
154
condition with a thickened aortic arch, leading to no palpable pulses, reduced blood pressure in arms and hands
takayasu arteritis
155
inclusion bodies deposited in alpha-synuclein neurons
parkinsons
156
features of subdural haemorrhage
between dura and arachnoid due to tear in bridging vein
caused by trauma
raised ICP
haematoma development takes 48hrs
157
conditions associated with SAH
polycystic kidney disease, aortic coarctation, fibromuscular dysplasia, Berry aneurysm, HTN
158
features of an extradural haemorrhage
middle meningeal artery rupture from pterion fracture
lucid interval
159
intracerebral haemorrhage
HTN --> hyaline arterioscleorsis, charcot-bouchard aneurysms
160
crohn's disease extra-intestinal manifestations
artheritis
ankylosing spondylosis
stomatitis, uveitis
derm lesions (pyoderma gangrenosum, erythema nodosum)
161
crohn's disease features
transmural inflammation, skip lesions, fistulae
non-caseating granulomas
162
haemachromatosis features
autsomal recessive
cirrhosis, diabetes, bronzed skin, cardiomyopathy, gondal atrophy, impotence
163
primary biliary cirrhosis features
jaundice, xanthelasma, pruritis
raised ALP, GGT, IgM, cholesterol
associated with sjogren's
164
what is adenocarcinoma of the bile ducts called
cholangiocarinoma
165
cholangiocarcinoma risk factors
primary sclerosing cholangitis
parasitic liver fluke infection
exposure to imaging contrast media
166
alpha1-antitrypsin deficiency features
emphysema
cirrhosis
167
primary sclerosing cholangitis features
periductal fibrosis
concentric onion ring fibrosis
168
symptomatic individual with a fasting glucose over what number indicates diabetes
7
169
most common type of lung cancer in uk
adenocarcinoma
170
hepatobiliary pathology associated with pANCA
primary sclerosing cholangitis
171
mallory denk bodies on liver biopsy
alcoholic hepatitis
172
chemo for CLL increases risk of which type of kidney stone
uric acid
173
keratin pearls in which cancer
squamous cell carcinoma
174
what do pancreatic delta cells produce
somatostatin
175
positive anti-mitochondrial antibody, hepatobiliary disease with granulomas
primary biliary cirrhosis
176
most common cause of chronic renal failure in UK
diabetes
177
MODY inheritance
autosomal dominant
178
IBD with non-caseating granulomas
crohn's
179
18 year old man with nephritic syndrome, cataracts and sensorineural deafness
Alport's
180
honeycomb lung
interstitial lung disease
181
stain for iron
prussian blue
182
pancreatic cancer marker
ca 19-9
183
stool marker for IBD
calprotectin
184
wilson's disease treatment
zinc
trientine
185
ECG leads 2,3 and aVF represent which region of heart
inferior wall
186
positive male pregnancy test
testicular cancer
187
kimmelstiel wilson nodules on renal biopsy
diabetes
188
epigastric pain that worsens after eating is which kind of peptic ulcer
gastric
189
renal cancer with neoplastic cells with transparent cytoplasm. cells are arranged in nests with interveneing blood vessles
clear cell cancer
190
acute rheumatic fever criteria
jones criteria
191
IBD with transmural inflammation
crohn's
192
oat shaped cells on biopsy
small cell lung cancer
193
infective endocarditis criteria
dukes criteria
194
lucid interval
extradural
195
bronchoconstriction, flushing and diarrhoea
carcinoid syndrome
196
waxy casts in urine
CKD
197
epithelial casts in urine
acute tubular necrosis
198
fatty casts in urine
nephrotic syndrome
