Histopath Flashcards
What protein is defective in adult polycystic kidney disease?
Polycystin-1
What sign, which may be visible around the nails, is seen in Graves’ disease and is due to periosteal bone growth in the nail bed?
Thyroid acropachy
What cancer is associated with the presence of “oat shaped cells” on biopsy?
Small Cell Lung Cancer
Which class of lupus nephritis on biopsy may show complete sclerosis of nearly all glomeruli?
Class VI
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
Taenia Coli
Taenia coli are where blood vessels penetrate the mucosa and hence represent weak points in the muscular wall of the colon. These weak points may allow diverticula to form.
Haustra, on the other hand, represent sacculations in the wall of the colon. They are not typically where diverticula form as there is continuous, thick mucosa over the entire surface of the haustral outpouching.
A 18 year old man presenting with nephritic syndrome, cataracts and sensorineural deafness suggests what underyling diagnosis?
Alport’s syndrome
Which common medication are hepatic adenomas associated with?
Oral Contraceptive Pill
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
An example could be the loss of desmosomal connections in pemphigus vulgaris.
Acantholysis
What is the name of the clinical criteria, which include erythema marginatum and sydenham’s chorea, classically used to diagnose Acute Rheumatic Fever?
Jones Criteria
A 24 year old with Ehlers Danlos syndrome presents to the emergency department with a sudden onset severe headache.
She lost consciousness at the onset of the headache and has vomited twice since.
CT Head non contrast reveals hyperdense enhancement adjacent to the circle of willis.
What is the likely diagnosis?
Subarachnoid haemorrhage
Which tumour marker is used in the diagnosis of hepatocellular carcinoma?
Alpha-fetoprotein
Other than zinc, what is the first line pharmacological treatment for Wilson’s disease?
Trientine
Which enzyme, released by neutrophils, does the compound alpha-1 antitrypsin inhibit to prevent the development of emphysema in the lungs?
Neutrophil elastase
A 30 year old woman has experienced a week of progressive retro ocular pain with a loss of visual acuity in the right eye. She does not wear glasses. There is a family history of Type 1 Diabetes.
On examination, there is a right relative afferent pupillary defect with reduced visual acuity. Fundoscopy and intraocular pressure is normal.
What investigation would be diagnostic?
MRI Brain and Optic Nerves
What stain is used to visualise amyloid on histological specimins?
Congo Red
A nephrologist is investigating an elderly gentleman with nephrotic syndrome.
A renal biopsy revealed normal histology when viewed under a light microscopy. There were no immune complexes detected in the biopsy either. There was no amyloid deposition.
Urinary Bence Jones Protein and serum electrophoresis were normal.
The patient responded well to steroids and their renal function is normal.
What is the most likely primary cause of the nephrotic syndrome?
Minimal Change Disease
What type of kidney stone are patients on chemotherapy for chronic lymphocytic lymphoma at increased risk of?
Uric acid
Classically the triad of bronchoconstriction, flushing and diarrhoea is described as what paraneoplastic syndrome?
Carcinoid syndrome
A 60 year old with longstanding alcoholism, weight loss and epigastric pain undergoes a pancreatic biopsy.
The biopsy shows evidence of destruction of exocrine tissue, associated with fibrosis and calcification. Duct dilatation is noted.
There is no elevation in CA-19-9.
What is the likely diagnosis?
Chronic pancreatitis
A histopathologist looks at a piece of excised lung tumour under a microscope.
There is no evidence of glandular or squamous differentiation. The cells are poorly differentiated with large nuclei.
Which histological subtype of lung cancer has these features?
Large Cell Carcinoma
A 67 year old woman with CKD stage 4 is seen in the emergency department. She reports chest pain and a cough which has worsened over the last week. The chest pain is worse when she coughs.
Her partner had a cold two weeks ago.
On examination of the chest wall there is point tenderness adjacent to the sternum bilaterally.
An ECG is normal.
Bloods reveal the following: eGFR 25ml/min Creatinine 160 Urea 12 Troponin I 20 <14
What is the diagnosis?
Costochondritis
A 45 year old diabetic man is investigated for heart failure.
A panel of blood tests shows an elevated serum ferritin in the absence of a fever, with a low total iron binding capacity and elevated transferrin saturation. He recalls that his brother has something wrong with iron in his body.
What is the diagnosis?
Hereditary Haemochromatosis
Kayser Fleischer rings represent the deposition of what substance in the cornea?
Copper
A 20 year old man with liver failure and parkinsonism is a classical history of what condition?
Wilson’s disease
What is the name given to the criteria used for diagnosis of infective endocarditis?
Duke’s Criteria
Infection by what organism classically precipitates acute rheumatic fever?
Streptococcal infection
Which neuroendocrine tumour is associated with Zollinger-Ellison syndrome?
Gastrinoma
A nephrologist is investigating a 40 year old man with nephrotic syndrome.
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane.
The patient’s renal function has continued to decline despite high dose pulsed IV methylprednisolone.
What is the likely primary cause of the nephrotic syndrome?
Membranous Glomerular Disease
A 18 year old man has his urine dipped as part of a pre employment health check.
He has no past medical history and denies any symptoms.
The urine dip shows the presence of microscopic haematuria (+). He says that his father also always has blood in his urine.
What is the likely diagnosis?
Benign familial haematuria
What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson’s disease?
Rhodanine
A HbA1c value of above what value (in mmol/mol) is considered diagnostic for diabetes?
48
A 80 year old man is undergoing elective bilateral knee arthroplasty. He has hypertension but no other past medical history.
During the operation, he develops 2mm ST elevation in leads II and III. The cardiac monitor immediately alarms and alerts the anaesthetist.
A blood test for high sensitivity Troponin is taken and the anaesthetist informs the surgeon.
30 minutes later, the troponin is reported by the lab as normal.
What is the diagnosis?
Myocardial Infarction
Which histological subtype of malignancy are patients with poorly controlled ulcerative colitis at increased risk for?
Adenocarcinoma
Carcinoid syndrome is caused by an excess of what neurotransmitter?
Serotonin
A 68-year-old woman presents to her GP with a non-tender, hard lump with irregular borders in her left breast. She denies any nipple discharge, weight loss or malaise.
She was in a car accident 6 months ago and sustained significant bruising to the chest wall.
She undergoes triple assessment. Ultrasound shows a solid mass with indistinct margins.
The biopsy report is lost however the system recorded that the specimen was benign.
What condition may explain the lump?
Fat necrosis
A 38 year old woman with systemic lupus erythematosus presents to the emergency department.
She reports only passing a small volume of dark brown urine once in the last 3 days. She feels unwell.
Urine dip reveals the presence of haematuria (++) and proteinuria (++). She is hypertensive.
Blood tests reveal an elevated urea and creatinine.
What is the likely cause of the nephritic syndrome?
Rapidly progressive glomerulonephritits
A biopsy sample from a patient with suspected renal cancer is reported as follows:
“There are neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels”
What is the specific histological type of cancer?
Clear cell cancer
A 42 year old woman with Type 1 Diabetes Mellitus is investigated for fatigue and pruritus.
She has an elevated serum ALP and an elevated anti mitochondrial antibody titre.
An ultrasound of the biliary tree shows no gross dilatation.
What is the likely diagnosis?
Primary Biliary Cirrhosis
Which adrenal tumour is most commonly associated with Multiple Endocrine Neoplasia?
Phaeochromocytoma
The Multiple Endocrine Neoplasias (MEN) describe syndromes of associated neoplasias which are inherited in an autosomal dominant fashion.
MEN 1 Pituitary adenoma Parathyroid hyperplasia Pancreatic tumours
Think MEN 1 = PPP
MEN 2A Parathyroid hyperplasia Medullary thyroid carcinoma Phaeochromocytoma Think all the Cs: Calcitonin (medullary thyroid cancer), Calcium (Parathyroid hyperplasia) and Catecholamines (Phaeo)
MEN 2B Medullary thyroid carcinoma Phaeochromocytoma Marfanoid body habitus Mucosal neuromas Think B is for Big (marfanoid) and Belly problems (mucosal neuromas)
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
Diabetes
What tumour marker is most commonly used in the diagnosis of colorectal cancer?
Carcinoembryonic antigen
Which hepatobiliary condition may be described as: fibrosis of bile ducts throughout the biliary tree with associated stricture formation?
Primary Sclerosing Cholangitis
A 16 year old boy is investigated for liver failure. He has markedly increased transaminases.
His mother, aunt and grandmother are all smokers and have COPD.
Blood tests show a low serum copper and low serum caeruloplasmin.
What is the likely diagnosis?
Wilson’s disease
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
Multiple Sclerosis
What is the most common histological type of prostate cancer?
Adenocarcinoma
A 64 year old gentleman with hypertension and Type 2 Diabetes Mellitus presents to the emergency department with sudden onset weakness in his right arm.
Neurological examination in the emergency department is normal.
What is the most likely diagnosis?
Transient Ischaemic Attack
Which protein, detected in the stool of patients with inflammatory bowel disease, reflects the presence of intraluminal neutrophils and hence the presence of intestinal inflammation?
Calprotectin
What tumour marker is associated with pancreatic cancer?
Carbohydrate Antigen 19-9
A CT report for a 74 year old gentleman with shortness of breath and a dry cough mentions the presence of “a honeycomb lung”.
What condition does the gentleman likely have?
Interstitial Lung Disease
A CT-KUB from a patient with renal colic reveals the presence of a radiopaque, laminated density which conforms to the shape of the renal pelvis.
There is evidence of dilation of the renal calyces.
What is the typical chemical composition of this density?
Magnesium Ammonium Phosphate
A 40 year old man is referred to cardiology clinic due to reduced exercise tolerance. He is found to have mitral stenosis.
He previously reported episodes of spontaneous, rapid, jerking movements that he could not control during a period of illness when he was a teenager. His sister had similar symptoms at that time.
What illness may he have had in his youth which has precipitated his heart murmur today?
Acute Rheumatic Fever
An 84 year old woman is seen in the emergency department feeling unwell and with crampy left iliac fossa pain.
The pain started in the midline 3 days ago and has now moved to the left iliac fossa. She has also felt progressively unwell over this time. She reports intermittent haematochezia and constipation.
On examination there is localised guarding and tenderness in the left iliac fossa.
What is the diagnosis?
Diverticulitis
What type of bladder cancer is associated with chronic cystitis?
Squamous Cell Carcinoma
Which organism is classically associated with haemolytic uraemic syndrome?
Escherichia coli
What kind of cancer is associated with keratin pearls?
Squamous Cell Carcinoma
Clinical Assessment and Imaging are two parts of the “Triple Assessment” for suspected breast malignancy.
What is the final component of Triple Assessment?
Histology
What is the name given to dilated veins, commonly found in the oesophagus and are often associated with portal hypertension?
They are a common cause of sudden, life threatening, haematemesis in alcoholics.
Varices
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
Haematoxylin and eosin stain
A 73 year old man presents to his GP with progressive exertional dyspnoea and a dry cough.
On examination there is bilateral digital clubbing and fine end inspiratory crackles on auscultation of the chest.
Chest X ray is normal and spirometry reveals a decreased FEV1, decreased FVC and increased FEV1/FVC ratio.
What specific further investigation would be diagnostic?
High Resolution Lung CT Scan
Investigation of pulmonary fibrosis essentially comprises two things - lung function tests and CT.
Lung Function Tests will typically reveal a restrictive pattern (decreased FEV1, decreased FVC and increased FEV1/FVC ratio)
Chest X rays are typically normal and even normal chest CTs aren’t sensitive enough.
This is because the changes are so small, a very high resolution is needed to identify them.
Hence, the diagnostic investigation of choice is a High Resolution CT Chest.
A HR CT Chest will show honeycombing and ground glass opacities.
What is the typical inheritance pattern of Hereditary non-polyposis colorectal cancer/Lynch Syndrome?
Autosomal Dominant
An elderly woman who lives alone is brought into hospital after being found lying on the ground at home by her daughter this morning. She says she collapsed the previous evening and was unable to reach the phone. You suspect she has a fractured hip. Her bloods show a raised potassium and very high levels of serum creatine kinase. She is found to have very dark urine. What protein is responsible for the dark urine?
Myoglobin
Rhabdomyolysis describes necrosis of muscle and release of intracellular components. It may be caused by traumatic crush injuries. A serum creatine kinase measurement greater than 5 times the upper limit of normal is considered diagnostic. Myoglobin is a protein normally present in urine in small amounts. The muscle breakdown in rhabdomyolysis causes raised serum myoglobin which leads to myoglobinuria. The high levels of myoglobin in the urine are responsible for the dark brown colour. It may occur after vigorous exercise. A urine dipstick test measures the peroxidase activity of erythrocytes and therefore will be positive for blood if myoglobin is present.
What is the typical inheritance pattern of hereditary haemochromatosis?
Autosomal recessive
A histopathologist looks at a piece of excised lung tumour under a microscope.
She notes the presence of mucin and glandular differentiation.
Which histological subtype of lung cancer is associated with mucin production?
Adenocarcinoma
What is the most common histological type of renal malignancy?
Renal cell carcinoma
How many stages, classified by glomerular filtration rate, of chronic kidney disease are there?
5
How much glucose is given, in grams, for an oral glucose tolerance test for the diagnosis of diabetes?
75
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure in children?
Haemolytic Uraemic Syndrome
What is the name of the clinical criteria are used to diagnose infective endocarditis?
Modified Duke Criteria
