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Matt's Path REVERSE > Histopath > Flashcards

Histopath Flashcards

1
Q

betaHMC mutation

A

Hypertrophic Cardiomyopathy

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2
Q

Erythema marginatum

Subcutaenous nodules

A

Acute Rheumatic Fever

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3
Q

Acute Rheumatic Fever

A

Strep throat infection

Heart: pancarditis (endocarditis, myocarditis, pericarditis) + vasculitis
Joint: arthritis and synovitis
Skin: Erythema marginatum, subcutaneous nodules
CNS: encephalitis, Sydenham’s chorea

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4
Q

Jones Criteria

A

Diagnosis of Rheumatic Fever = group A strep infection + 2 major OR 1 major + 2 minor

Major (CASES)
Carditis
Arthritis
Sydenham's chorea 
Erythema marginatum 
Subcutaneous nodules 
Minor criteria
Fever
Raised ESR or CRP
Migratory arthralgia 
Prolonged PR interval 
Previous rheumatic fever
Malaise
Tachycardia
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5
Q

Beady fibrous vegetations

A

verrucae

Rheumatic fever

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6
Q

Aschoff bodies

A

Small giant-cell granulomas

Rheumatic fever

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7
Q

Anitschkov myocytes

A

regenerating myocytes

Rheumatic fever

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8
Q

Libman-Sacks

A

Associated with SLE and anti-phospholipid syndrome

small (<2mm) “warty” vegetations

Sterile

Platelet rich

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9
Q

Acute infective endocarditis

A

Staph aureus

Strep pyogenes

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10
Q

Subacute infective endocarditis

A

Strep viridans

Staph. epidemris

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11
Q

Culture negative infective endocarditis

A 
Coxiella
Mycoplasma
Candida
Brucella
Chlamydia
Mycoplasma
Bartonella

HACEK
Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella

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12
Q

Tricuspid infective endocarditis

A

IVDU

Staph aureus

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13
Q

Duke Criteria

A

Diagnosis of Infetcive Endocarditis
2 major
1 major = 3 minor
5 minor

Major:
Positive blood culture growing typical IE organism OR 2 positive culture >12 hours apart
Evidence of vegetation/abscess on echo OR new regurgitant murmur

Minor:
Risk factor (prosthetic valve, IVDU, congenital valve abnormalities)
Fever >38
Thromboembolic phenomena
Immune phenomena
Positive blood culture not meeting major criteria

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14
Q

Treatment of infective endocarditis

A

Acute:
Flucloxacillin for MSSA
Rifampicin AND Vancomycin AND Gentamicin for MRSA

Subacute:
Benzylpenicillin AND Gentammicin OR Vancomycin for 4 weeks

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15
Q

Mid-diastolic click and late systolic murmur

A

Mitral valve prolapse

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16
Q

Pericarditis

A

Types

Fibrinous: MI, Uraemia

Purulent: Staphylococcus aureus

Grenulomatous: TB

Haemorrhagic: Tumour, Tb, Uraemia

Fibrous = constrictive (arises from the above)

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17
Q

Pericardial effusion

A

Chronic heart failure

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18
Q

Pericardial effusion

A

Usual cause: Chronic heart failure

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19
Q

Cardiomyopathy

A

Dilated = systolic dysfunction

Hypertrophic = dialstoilic dysfunction

Restrictive = diastolic dysfunction

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20
Q

Charcot-Leyden crystals

A

Asthma

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21
Q

Curschmann spirals

A

Asthma

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22
Q

Goblet cell hyperplasia, hypertrophy of mucous glands

A

Chronic bronchitis

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23
Q

Yellow nail syndrome

A

Yellow dystrophic nails
Pleural effusions
Lymphoedema
Bronchiectasis

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24
Q

Young’s syndrome

A

Rhinosinusitis
Azoospermia
Bronchiectasis

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25
Q

Keratinisation

Intercellular prickles

A

Squamous cell carcinoma

M>F

Most common

Smoking

p53, c-myc mutations

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26
Q

EGFR mutation

mucin vacuoles

A

Adenocarcinoma

F>M

NON-Smokers

glandular differentiation with mucin production

EGFR –> give TKI (tyrosine kinase inhibitor)

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27
Q

RB1 mutation
Ectoptic ACTH
Lambert-Eaton

A

Small cell carcinoma

Arise from neuroendocrine cells

Smoking

P53 and RB1 mutations

Poor prognosis: mets early to bone, adrenal, liver brain

Ectopic ACTH

Cerebellar degeneration

Lambert Eaton: rare autoimmune disorder that is characterized by muscle weakness of the limbs. It is the result of an autoimmune reaction in which antibodies are formed against presynaptic voltage-gated calcium channels

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28
Q

Poorly differentiated malignant epithelium tumour of the lung

A

Large cell carcinoma

Poor prognosis

Large cells

Large nuclei

No evidence of glandular or squamous differentiation

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29
Q

Carcinoid syndrome

A

Flushing
Diarrhoea
Bronchoconstriction

Ectopic serotonin

Tx: Octreotide

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30
Q

ERCC1

A

Poor response to cisplatin

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31
Q

Linitis plastica and signet ring cell

A

Gastric adenocarcinoma

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32
Q

5-ASA

A

Ulcerative colitis

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33
Q

Watershed areas of gut

A

Splenic flexure (SMA transition to IMA)

Rectosigmoid (IMA transition to internal iliac)

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34
Q

Carcinoid crisis

A 
Life-threatening vasodilation
Hypotenion
Tachycardia
Bronchoconstriction
Hyperglycaemia
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35
Q

Enterochromaffin cell origin

A

Serotonin producing

Lung, bowel, ovaries, testes

Carcinoid syndrome

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36
Q

Urinary 5-HIAA

A

Enterochromaffin cell cancer

Carcinoid syndrome

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37
Q

Hypoproteinaemic Hypokalaemic

A

Villous adenoma

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38
Q

Risk factor for adenoma –> adenocarcinoma

A

1) Size (main factor)
2) dysplasia
3) villous component

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39
Q

Juvenile polyposis

A

Autosomal dominant

In children

Haemartomatous polyp

100s

May require colectomy to stop haemorrhage

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40
Q

Peutz–Jeghers syndrome

A

Autosomal dominant -LKB1

Hamartomatous polyps

Hyperpigmented macules on the lips and oral mucosa (melanosis)

Increased risk of intussusception and malignancy

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41
Q

Hyperplastic polyp

A

Shedding of epithelium, cell build up

50-60 yrs

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42
Q

Pseudo polyp

A

IBD (UC)

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43
Q

Microsatellite instability

A

Hereditary non-polyposis colorectal cancer

HNPCC

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44
Q

Colorectal cancer

A

95% adenocarcinoma

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45
Q

Right-sided bowel tumours

A

Iron deficiency anaemia

Weight loss

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46
Q

Left-sided bowel tumours

A

Change in bowel habit

Crampy LLQ pain

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47
Q

CEA

A

colorectal cancer

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48
Q

Accumulation of fat droplets in hepatocytes

A

Hepatic steatosis (fatty liver)

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49
Q

Ballooning hepaotcytes

Necrosis

Mallory-denk bodies

Fibrosis

Pericellular fibrosis

A

Alcoholic hepatitis

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50
Q

Micronodular cirrhosis

Bands of fibrous tissue

Intra- and extra- hepatic shunting

A

Alcoholic cirrhosis

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51
Q

Neutrophil polymorphs

Mallory-denk

A

Alcoholic hepatitis

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52
Q

Megamitochondria

A

Alcoholic hepatitis

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53
Q

NAFLD

A

Steatosis in non-alcoholics

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54
Q

NASH

A

NAFLD + inflammation

Steatosis + inflammation in non-alcoholics

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55
Q

Interface hepatitis with plasma cells

A

Autoimmune hepatitis

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56
Q

Anti-LKM

A

Type II autoimmune hepatitis

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57
Q

Anti-SMA

A

Type I autoimmune hepatitis

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58
Q

Primary Biliary Cholangitis

A

Autoimmune inflammatory destruction of medium sized INTRAhepatic bile ducts

Slow development of cirrhosis over many years (hence renamed form cirrhosis to cholangitis as can diagnose prior to cirrhosis)

F> M 10:1

Increased serum ALP

Increase cholesterol

Increase IgM (late feature)

Anti-mitochondrial antibodies

NO BILE DUCT DILATATION

Bile duct loss with granulomas

Present with fatigue, pruritis, abdo discomfort

Tx: ursodeoxycholic acid

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59
Q

Primary Scleroisng Cholangitis

A

Inflammation and obliterative fibrosis of EXTRAhepatic and INTRAhepatic bile ducts

Multi-focal stricture formation with dilitation of preserved segments

Onion-skinning fibrosis

M > F

Associated with IBD (Ulcerative colitis)

Increase ALP

p-ANCA

Bile duct dilatation

ERCP: beading of bile duct (multifocal strictures)

Increase in cholangiocarcinoma

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60
Q

Absent aslpha globulin band on electrophoresis

A

A1AT deficiency

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61
Q

Haemorrhagic cystitis

A

Cyclophoshphamide use

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62
Q

Urinary schistosomiasis

A

Squamous cell carcinoma of bladder

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63
Q

Most common bladder tumour

A

Transitional cell (Urothelial) tumour

90% of bladder tumours

Smoker
Aromatic amines

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64
Q

Gleason system

A

Grading of Prostate cancer

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65
Q

Acute bacterial prostatitis

A

E.Coli

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66
Q

Most common germinal tumour

A

Seminoma

95% of testicular tumours are germ cell origin

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67
Q

AFP, HCG and LDH

A

tumour markers for teratoma

  • male peeing on pregnancy test story
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68
Q

Nephrotic syndrome

A

Triad:
>3g/24 hr protein

Hypoalbuminaemia

Oedoema

(+hyperlipidaemia)

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69
Q

Diffuse glomerular basement membrane thickening

A

Membranous glomerular disease

= primary cause of nephrotic syndrome

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70
Q

Primary causes of nephrotic syndrome

A

Minimal change disease

Membranous glomerular disease

Focal segmental glomerulosclerosis

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71
Q

Focal and segmental glomerular consolidation and scarring

A

Focal segmental glomerulosclerosis

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72
Q

Membranous glomerular disease

A

Causes nephrotic syndrome

Common in adults

Diffuse glomerular basement membrane thickening

Loss of podocyte foot processes

Subepithelial spikey depsotis

Can be primary or secondary to SLE, drug, malignancy

Ig and complement in granular deposits along entire GBM

40% ESRF 2-20 yrs

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73
Q

Focal segmental glomerulosclerosis

A

Causes nephrotic syndrome

Common in adults

Focal and segmental glomerular consolidation and scarring

Hyalinosis

Loss of podocyte foot processes

Ig and complement deposited in scarred areas

50% respond to steroids

50% ESFR in 10 years

Primary
Can be due to HIV nephropathy and Obesity

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74
Q

Mesangial matrix nodule = Kimmelstiel Wilson Nodules

A

= Diabetes nephropathy

causes nephrotic syndrome

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75
Q

Apple green birefringence with Congo red stain

A

Amyloidosis

Can cause nephrotic syndrome

Chronic inflammation

TB

RA

Multiple myeloma - AL protein deposition

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76
Q

Nephritic syndrome

A

Manifestation of glomerular inflammation (glomerulonephritis)

Characterised:

Haematuria (coca-cola urine)
Dysmorphic RBCs and red cell casts in urine

May also have:
Oliguria
Increased urea and creatinine
Hypertension
Proteinuria (but sub nephrotic levels)
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77
Q

Causes of Nephritic Syndrome (5)

A

Acute post-infectious glomerulonephritis

IgA nephropathy (Berger Disease)

Rapidly progressive (Cresenteric) Glomerulonephritis (3 types)

Hereditary nephritis (Alport’s syndrome)

Thin basement membrane disease (benign familial haematuria)

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78
Q

HLA-DRB1

A

Goodpasture’s

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79
Q

Acute post-infectious (post-streptococcal) glomerulonephritis

A

Causes Nephritic syndrome

1-3 weeks after Group A alpha-haemolytic strep throat infection

Streptococcus pyogenes

Immune complex deposition

Haematuria, red cell casts, hypertension, proteinuria, oedema,

ASOT titre increased

Decreased C3

LM: increased cellularity
FM: grnaular depsoits of IgG and C3 in GBM
EM: subendothelial humps

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80
Q

IgA Nephropathy (Berger Disease)

A

Commonest cause of glomerulonephritis worldwide (causes nephritic syndrome)

Deposition of IgA complexes in glomeruli

1-2 days after URTI –> Frank haematuria

Persistent or recurring frank haematuria

Can be asymptomatic microscopic haematuria

Can progress to ESRF

FM: Granular deposition of IgA and complement in mesangium

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81
Q

Rapidly progressive (Crescentic) Glomerulonephritis

A

Most aggressive glomerulonephritis - can cause ESRF in weeks

Nephritic syndrome + oliguria and renal failure

All have crescents on LM

3 Types

Type 1: Anti-GBM antibody (Goodpasture’s –> Type IV collagen alpha 3)
Linear deposition of igG in GBM
+pulmonary haemorrhage

Type 2: immune complexes
SLE, IgA, Post-strep
granular/lumps deposition of IgG in GBM/mesangium

Type 3: pauci-immune (Not anti-GBM or immune complexes)

c-ANCA: Wegner’s
p-ANCA: microscopic polyangiitis
Scanty/lack of immune complex deposition

+Vasculitis

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82
Q

Hereditary Nephritis (Alport’s syndrome)

A

Causes Nephritic syndrome
Can be asymptomatic haematuria

x-linked recessive mutation in collagen IV alpha 4 chain

Nephritic syndrome + sensorineural deafness + eye problems (cataracts and lens dislocation)

Presents at 5-20 years and prepossesses to ESRF

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83
Q

Thin Basement Membrane Disease (Benign Familial Haematuria)

A

Asymptomatic haematuria (v.rarely nephritic syndrome)

No decline in renal function

Autosomal dominant mutation in collagen IV alpha 4 chain

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84
Q

Aysmptomatic haematuria

A

Think basement membrane disease

Alport’s

IgA nephropathy

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85
Q

Nephritic syndrome + scanty immune deposition

A

Pauci-immune

Wegners

Microscopic polyangiitis

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86
Q

Nephritic syndrome + sensorineural deafness + lens dislocation

A

Alport’s syndrome

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87
Q

Frank haematuria 2 days post URTI

A

IgA nephropathy

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88
Q

Increased ASOT titre, Low C3 and URTI 3 weeks ago

A

Post-streptococcal GN

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89
Q

Causes of Acute Tubular Injury

A

Commonest cause of acute renal failure

Ischaemia –> prolonged pre-renal AKI

Nephrotoxins (CHARM chain)

Cisplatin
Heavy metals
Aminoglycosides (Gentamicin)
Radiocontrast medium
Myoglobin

Chain: light chains in multiple myeloma

Histology: necrosis of short segments of tubules

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90
Q

Tubulointerstitial Nephritis

A

A group of renal inflammatory disorders that involve the tubules and interstitium

Acute pyelonephritis = leukocytic casts

Chronic pyelonephritis
Reccurent infections –> scarring of parenchyma

Acute interstitial nephritis
Hypersensitivity reactions to drugs
Fever, skin rash, haematuria, proteinuria, eosinophilia

Chronic interstitial nephritis
Elderly with long-term analgesic consumption (NSAIDs/paracetamol)
Hypertension, anaemia, proteinuria, haematuria

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91
Q

Thrombotic microangipathies

A

Thrombosis
+MAHA
+Thrombocytopenia
+renal failure (mostly in HUS)

Causes
TTP - diffuse, esp in CNS
HUS - confined to kidneys

TTP = headache, altered consciousness
HUS= renal failure
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92
Q

Pre-renal causes of AKI

A 
Hypovolaemia
Sepsis
Burns
Acute pancreatitis
Renal artery stenosis

Pre-renal = most common cause of AKI

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93
Q

Complications of AKI

A 
Metabolic acidosis 
Hyperkalaemia
Fluid overload
HTN
Hypocalcaemia
Uraemia
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94
Q

Renal causes of AKI

A

Acute glomerulonephritis

Acute tubular necrosis (most common renal cause)

Thrombotic MAHA

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95
Q

Post-renal causes of AKI

A

Stones
Tumours (Primary or Secondary)
Prostatic hypertrophy
Retroperitoneal fibrosis

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96
Q

Chronic renal failure stages

A 
GFR 
>90 = stage 1
60-89 = stage 2
30-59 = stage 3
15-29 = stage 4
<15 = stage 5

Start with 15, double, double again, add 30

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97
Q

PKD1

A

Autosomal Dominant

Adult Polycystic Kidney Disease

Chromosome 16 (polycystin 1)

Also PKD2
chromosome 4 (polycystin-2)
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98
Q

Lupus Nephritis

A

Can progress to chronic renal failure

Stage from I - VI

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99
Q

Renal cell carcinoma

A

Clear cell carcinoma - well differentiated

Papillary carcinoma - commonest in dialysis-associated kidney disease

Chromophobe renal carcinoma - pale, eosiophilic cells

Presents: palpable mass, haematuria, costovertebral pain
Paraneoplastic syndrome: polycythaemia, hypercalcaemia, HTN, Cushing’s syndrome, Amyloidosis

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100
Q

RUQ and peri-hepatitis

A

Fits High Curtis Syndrome

Also: violin string peri-hepatic adhesions

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101
Q

“Powder burns”

A

Endometriosis

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102
Q

red-blue to brown nodules

A

Endometriosis

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103
Q

Bundles of smooth muscle

A

Fibroids

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104
Q

Endometrial Cancer

A

Subdivided:

Endometrioid (80%)
Oestrogen excess

Non-endometrioid (205)
Papillary
Serous 
Clear cell
Unrelated to oestrogen --> more aggressive
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105
Q

VIN

A

Graded from I - III

Associated with HPV-16

Usual type: 35-55 years, warty/basaloid SCC

Differentiated type: older women, keratinising SCC (higher rate of malignant transformation)

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106
Q

Vulval Carcinoma

A

Mainly squamous cell carcinoma (arise from VIN)

Or from other skin abnormalities (Paget’s disease of the vulva - adenocarcinoma in situ)

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107
Q

Ovarian Tumour Types

A

Epitheloid cell types
Serous cystadenoma
Mucinous cystadenoma
Endometrioid
Clear cell

Germ cell types
Dysgerminoma
Teratoma
Choriocarcinoma

Sex cord/stroma cell types
Fibroma
Granuloa-theca cell tumour
Sertoli-Leydig cell tumour

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108
Q

Ovarian tumour producing androgens

A

Sertoli-Leydig cell tumour

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109
Q

Ovarian tumour producing b-hCG

A

Choriocarcinoma

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110
Q

Ovarian tumour producing E2

A

Granulosa-theca cell tumour

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111
Q

Hobnail appearance

A

Clear cell ovarian tumour

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112
Q

Psammoma bodies

A

Serous cystadenoma

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113
Q

Clear cytoplasma

A

Clear cell tumour

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114
Q

No Psammoma bodies

A

Mucinous cystadenoma

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115
Q

Oestrogen secreting tumour

A

Mucinous cystadenoma

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116
Q

Causes pseudomyxoma peritonei

A

Mucinous cystadenoma

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117
Q

Keratinising squamous epithelium + breast pain

A

Periductal mastitis

Smokers

Not associated with lactation

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118
Q

Fat necrosis

A

Inflammatory response to damaged adipose tissue

PAINLESS breast mass / skin thickening / mammographic lesion

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119
Q

Fibrocytic Disease

A

Fibrocystic disease (finbroadenosis)

Cystic changes: small cysts form by dilation of lobules
Contain fluid
Often calcified

Fibrosis: inflammation and fibrosis secondary to cyst rupture

Adenosis: increased number of acini per lobule (normally seen in pregnancy)

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120
Q

Finger-like projections into ducts

A

Gynaecomastia

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121
Q

Duct papilloma

A

Benign papillary tumour arising within duct system of breast

Peripheral: within small terminal ducts
Central: within larger lactiferous ducts

Causes bloody discharge

No LUMP

Not seen on mammogram

Ix: galactogram

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122
Q

Stellate pattern of glandular tissue

A

Radial scar

Benign sclerosing lesion

Central scarring surrounded by proliferating glandular tissue in a stellate pattern

Resembles carcinoma on mammogram

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123
Q

BRCA1/2

A

Increase risk of:

Breast cacrinoma
Ovarian caner
Prostate cancer
Pancreatic cancer

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124
Q

Carcinoma in situ (breast)

A

Proliferation limited ti ducts/lobules by basement membrane

Lobullar (LCIS): no calcification, ALWAYS incidental finding on biopsy

Ductal (DCIS): Microcalcifcation on mammogram, much increased risk of breast carcinoma

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125
Q

Invasive breast carcinoma

A

Categorised into ductal, lobular or tubular

Ductal: carcinoma that cannot be subclassified into another group - MOST COMMON

Lobular: cells aloigned in single file chains/ strands

Tubular: Well-formed tubules with low grade nuclei (rarely palpable as <1cm)

Can also be mucinous –> secretes mucin

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126
Q

Triple assessment

A

Examination

Mammorgaphy, USS or MRI

FNA & Cytology

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127
Q

Breast carcinoma prognosis

A

ER/PR receptor positive –> GOOD

HER 2 positive –> BAD

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128
Q

Basal-like carcinoma breast

A

Sheets of atypical cells with lymphocyte infiltration

Stain: CK5/6/14

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129
Q

Phyllodes tumour

A

Interlobular stroma

Typically large, fast-growing masses

Mostly low grade, but can be aggressive

Palpable mass >50 yrs

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130
Q

Low glucose, high protein and high lymphocyte on Lumbar Puncture

A

TB

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131
Q

Neurofibromatosis type II (NF2)

A

Meningioma

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132
Q

Ventricular tumour, hydrocephalus

A

Ependymoma

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133
Q

Indolent, chilhood brain tumour

A

Pilocytic astrocytoma

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134
Q

Soft, gelatinous calcified brain tumour

A

Oligodendroma

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135
Q

Commonest brain tumour (primary)

A

Astrocytomas

Metastatic is more common tumour in CNS (lung, breast, malignant melanoma)

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136
Q

Tau protein Dementias

A

Corticobasal degeneration

Frontotemporal dementia (linked to chromosome 17)

Pick’s disease

Alzheimers (Tau and beta-amyloid)

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137
Q

Alpha-synuclein, ubiquitin

A

Dementia awith Lewy Bodies

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138
Q

Alzheimers

A

Senile plaques of beta-amyloid

Neurofibrillary tangles of Tau

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139
Q

Alpha-synuclein

A

Present in both

Lewy Body Dementia

Parkinson’s disease

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140
Q

Multiple Sclerosis Proteins

A

Myelin basic protein

Proteo-lipid protein

MS plaques show sharp margins of myelin loss

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141
Q

Multisystem Atrophy

A

Shy Drager: Autonomic dysfunction

Striatonigral: difficulty with movement

Olivopontocerebellar: Difficulty with balance and coordination

Can appear very similar to Parkinson’s BUT show poor response to parkinson medications

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142
Q

Loss of cancellous bone

A

Osteoporosis

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143
Q

Looser’s zones

A

Pseudo fractures

= osteomalacia

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144
Q

Brown’s tumour

A

Primary Hyperparathyroidism

Bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.

Brown tumours consist of fibrous tissue, woven bone and supporting vasculature, but no matrix.

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145
Q

Excess of unmineralised bone

A

Osteomalacia

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146
Q

Osteitis fibrosa cystica

A

Osteomalacia

Marrow fibrosis + cysts

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147
Q

Mixed lytic and sclerotic bone

A

Paget’s

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148
Q

Salt and pepper skull

A

Primary hyperparathyroidism

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149
Q

Subperiostal bone resorption in phalanges

A

Primary hyperparathyroidism

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150
Q

Mosaic pattern of lamellar bone

A

Paget’s

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151
Q

Huge osteoclasts

A

Paget’s

> 100 nuclei

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152
Q

Rachitic rosary

A

Prominent knobs of bone at the costochondral joints

= Ricket’s

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153
Q

Decrease bone mineralisation

A

Osteomalacia

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154
Q

X-ray feature of Paget’s

A

Skull
Osteoporosis circumscripta
Cotton wool

Vertebrae
Picture frame
Ivory vertebrae

Pelvis
Sclerosis and lucency

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155
Q

Colchicine

A

Acute treatment of gout

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156
Q

Pseudo-gout crystals

A

Calcium pyrophosphate crystals

Rhomboid shaped

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157
Q

Osteosarcoma

A

Adolescence

Knee 60%

Malignant mesenchymal cells

ALP+ve

Elevated periosteum (Codman’s triangle)

Sunburst appearance

158
Q

Chondrosarcoma

A

> 40 yrs

Axial skeleton, femur, tibia, pelvis

Malignant chondrocytes

Lytic lesion with fluffy clacification

AXIAL SKELETON

159
Q

Ewing’s Sarcoma

A

<20 yrs

Long bone, pelvis

Sheets of small round cells
CD99 +ve

t(11:22)

Onion skinning of the periosteum

160
Q

Giant cell (borderline malignancy)

A

20-40yrs
F>M

Knee-epiphysis

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

Lytic/lucent lesions up to articular surface

161
Q

Codman’s triangle

A

Elevated periosteum

Osteosarcoma

162
Q

Onion skinning of periosteum

A

Ewing’s sarcoma

163
Q

T11:22

A

Ewing’s sarcoma

164
Q

Multinucleate giant cell swith ovoid/spindle

A

Giant cell (borderline)

165
Q

Radiolucent nidus with sclerotic rim

A

Osetoid oesteoma

166
Q

Gardner syndrome

A

multiple osteomas + GI polyps + epidermoid cysts

167
Q

Bony outgrowths attached to normal bone

168
Q

Benign tumours of cartilage

A

Enchondroma

169
Q

Oiler’s syndrome

A

Multiple enchondromas

170
Q

Maffuci’s syndrome

A

Multiple enchondromas + haemangiomas

171
Q

Cotton wool calcification

A

Enchondroma

172
Q

Fibrous dysplasia

A

fibrous tissue in place of bone

173
Q

Albright syndrome

A

Polyostotic dyplasia + cafe au lait spots + precocious puberty

174
Q

Lytic well defined

A

Simple bone cyst

175
Q

Speckled mineralisation

A

Osteoblastoma

176
Q

Auspitz’ sign

A

Rubbing plaques causes pin-point bleeding

Psoriasis

177
Q

“test tubes in racks”

178
Q

Annular target lesion

A

Erythema multiforme

179
Q

IgG to hemidesmosomes + linear IgG at BM

A

Pemphigoid

180
Q

IgG to hemidemosomal and netlike pattern of intercellular IgG

181
Q

Buckshot appearance

A

Malignant melanoma

=pagetoid cells

182
Q

Breslow thickness

A

Most important prognostic factor

183
Q

Malignant melanoma on sun exposed areas

A

Lentigo malignant melanoma

184
Q

SLE

A

Type III hypersensitivity reaction

HLA DR3 (or 2)

Anti-dsDNA
Anti-Sm

(anti-histone if drug induced)

Criteria (4 of 11 ACR)
SOAP BRAIN MD

Serositis
Oral ulcers
Arthritis
Photosensitivty

Blood disorders  (AIHA, ITP, leucopenia)
Renal imvolvement
ANA +ve
Immune phenomena (dsDNA, anti-Sm, Antiphospholipid Ab)
Neuro symptoms

Malar rash
Discoid

185
Q

Limited Scleroderma

A

Anti-centromere

Calcinosis 
Raynaud's
Esophageal dysmotility 
Sclerodactyl
Telangiectasia

Onion skinning around arterioles

Associated with pulmonary hypertension

186
Q

Diffuse Scleroderma

A

Anti-Scl-70

Inflammation within or around muscle fibres

Associated with pulmonary fibrosis

187
Q

Anti-Jo1

A

Dermatomyositis

and polymyositis

188
Q

Herald Patch

A

Pityriasis Rosea

Christmas tree distribution

Post-viral

189
Q

Large vessel vasculitides

A

Takayasu’s arteritis

Temporal arteritis

190
Q

Medium sized vasculitides

A

Polyarteritis nodosa

Kawasaki’s

Buerger’s disease (Thromboangitis obliterans)

191
Q

Small vessel vasculitides

A

Wegner’s (Granulomatosis with polyangiitis)

Churg Strauss (Eosinophilic granulomatosis with polyangiitis)

Microscopic polyangiitis

Henoch Schonlein Purpura

192
Q

Pulseless disease

A

Takayasu’s Arteritis

193
Q

Takayasu’s Arteritis

A

“pulseless”

Increase in Japanese women

Vacular symptoms: Absent pulse, bruits, claudication

194
Q

Scalp tenderness, headache, jaw claudication

A

Temporal arteritis

195
Q

Temporal arteritis

A

Elderly

Scalp tenderness

Jaw claudication

Blurred vision

Increase ESR

Histo: Granulomatous transmural inflammation + giant cell + skip lesion

196
Q

Hypertrophic Cardiomyopathy

A

betaHMC mutation

197
Q

Acute Rheumatic Fever

A

Erythema marginatum

Subcutaenous nodules

198
Q

Strep throat infection

Heart: pancarditis (endocarditis, myocarditis, pericarditis)
Joint: arthritis and synovitis
Skin: Erythema marginatum, subcutaneous nodules
CNS: encephalitis, Sydenham’s chorea

A

Acute Rheumatic Fever

199
Q

Diagnosis of Rheumatic Fever = group A strep infection + 2 major OR 1 major + 2 minor

Major (CASES)
Carditis
Arthritis
Sydenham's chorea 
Erythema marginatum 
Subcutaneous nodules 
Minor criteria
Fever
Raised ESR or CRP
Migratory arthralgia 
Prolonged PR interval 
Previous rheumatic fever
Malaise
Tachycardia
A

Jones Criteria

200
Q

verrucae

Rheumatic fever

A

Beady fibrous vegetations

201
Q

Small giant-cell granulomas

Rheumatic fever

A

Aschoff bodies

202
Q

regenerating myocytes

Rheumatic fever

A

Anitschkov myocytes

203
Q

Associated with SLE and anti-phospholipid syndrome

small (<2mm) “warty” vegetations

Sterile

Platelet rich

A

Libman-Sacks

204
Q

Staph aureus

Strep pyogenes

A

Acute infective endocarditis

205
Q

Strep viridans

Staph. epidemris

A

Subacute infective endocarditis

206
Q 
Coxiella
Mycoplasma
Candida
Brucella
Chlamydia
Mycoplasma
Bartonella

HACEK
Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella

A

Culture negative infective endocarditis

207
Q

IVDU

Staph aureus

A

Tricuspid infective endocarditis

208
Q

Diagnosis of Infetcive Endocarditis
2 major
1 major = 3 minor
5 minor

Major:
Positive blood culture growing typical IE organism OR 2 positive culture >12 hours apart
Evidence of vegetation/abscess on echo OR new regurgitant murmur

Minor:
Risk factor (prosthetic valve, IVDU, congenital valve abnormalities)
Fever >38
Thromboembolic phenomena
Immune phenomena
Positive blood culture not meeting major criteria

A

Duke Criteria

209
Q

Acute:
Flucloxacillin for MSSA
Rifampicin AND Vancomycin AND Gentamicin for MRSA

Subacute:
Benzylpenicillin AND Gentammicin OR Vancomycin for 4 weeks

A

Treatment of infective endocarditis

210
Q

Mitral valve prolapse

A

Mid-diastolic click and late systolic murmur

211
Q

Types

Fibrinous: MI, Uraemia

Purulent: Staphylococcus aureus

Grenulomatous: TB

Haemorrhagic: Tumour, Tb, Uraemia

Fibrous = constrictive (arises from the above)

A

Pericarditis

212
Q

Chronic heart failure

A

Pericardial effusion

213
Q

Usual cause: Chronic heart failure

A

Pericardial effusion

214
Q

Dilated = systolic dysfunction

Hypertrophic = dialstoilic dysfunction

Restrictive = diastolic dysfunction

A

Cardiomyopathy

215
Q

Asthma

A

Charcot-Leyden crystals

216
Q

Asthma

A

Curschmann spirals

217
Q

Chronic bronchitis

A

Goblet cell hyperplasia, hypertrophy of mucous glands

218
Q

Yellow dystrophic nails
Pleural effusions
Lymphoedema
Bronchiectasis

A

Yellow nail syndrome

219
Q

Rhinosinusitis
Azoospermia
Bronchiectasis

A

Young’s syndrome

220
Q

Squamous cell carcinoma

M>F

Most common

Smoking

p53, c-myc mutations

A

Keratinisation

Intercellular prickles

221
Q

Adenocarcinoma

F>M

NON-Smokers

glandular differentiation with mucin production

EGFR –> give TKI (tyrosine kinase inhibitor)

A

EGFR mutation

mucin vacuoles

222
Q

Small cell carcinoma

Arise from neuroendocrine cells

Smoking

P53 and RB1 mutations

Poor prognosis: mets early to bone, adrenal, liver brain

Ectopic ACTH

Cerebellar degeneration

Lambert Eaton: rare autoimmune disorder that is characterized by muscle weakness of the limbs. It is the result of an autoimmune reaction in which antibodies are formed against presynaptic voltage-gated calcium channels

A

RB1 mutation
Ectoptic ACTH
Lambert-Eaton

223
Q

Large cell carcinoma

Poor prognosis

Large cells

Large nuclei

No evidence of glandular or squamous differentiation

A

Poorly differentiated malignant epithelium tumour of the lung

224
Q

Flushing
Diarrhoea
Bronchoconstriction

Ectopic serotonin

Tx: Octreotide

A

Carcinoid syndrome

225
Q

Poor response to cisplatin

226
Q

Gastric adenocarcinoma

A

Linitis plastica and signet ring cell

227
Q

Ulcerative colitis

228
Q

Splenic flexure (SMA transition to IMA)

Rectosigmoid (IMA transition to internal iliac)

A

Watershed areas of gut

229
Q 
Life-threatening vasodilation
Hypotenion
Tachycardia
Bronchoconstriction
Hyperglycaemia
A

Carcinoid crisis

230
Q

Serotonin producing

Lung, bowel, ovaries, testes

Carcinoid syndrome

A

Enterochromaffin cell origin

231
Q

Enterochromaffin cell cancer

Carcinoid syndrome

A

Urinary 5-HIAA

232
Q

Villous adenoma

A

Hypoproteinaemic Hypokalaemic

233
Q

1) Size (main factor)
2) dysplasia
3) villous component

A

Risk factor for adenoma –> adenocarcinoma

234
Q

Autosomal dominant

In children

Haemartomatous polyp

100s

May require colectomy to stop haemorrhage

A

Juvenile polyposis

235
Q

Autosomal dominant -LKB1

Hamartomatous polyps

Hyperpigmented macules on the lips and oral mucosa (melanosis)

Increased risk of intussusception and malignancy

A

Peutz–Jeghers syndrome

236
Q

Shedding of epithelium, cell build up

50-60 yrs

A

Hyperplastic polyp

237
Q

IBD (UC)

A

Pseudo polyp

238
Q

Hereditary non-polyposis colorectal cancer

HNPCC

A

Microsatellite instability

239
Q

95% adenocarcinoma

A

Colorectal cancer

240
Q

Iron deficiency anaemia

Weight loss

A

Right-sided bowel tumours

241
Q

Change in bowel habit

Crampy LLQ pain

A

Left-sided bowel tumours

242
Q

colorectal cancer

243
Q

Hepatic steatosis (fatty liver)

A

Accumulation of fat droplets in hepatocytes

244
Q

Alcoholic hepatitis

A

Ballooning hepaotcytes

Necrosis

Mallory-denk bodies

Fibrosis

Pericellular fibrosis

245
Q

Alcoholic cirrhosis

A

Micronodular cirrhosis

Bands of fibrous tissue

Intra- and extra- hepatic shunting

246
Q

Alcoholic hepatitis

A

Neutrophil polymorphs

Mallory-denk

247
Q

Alcoholic hepatitis

A

Megamitochondria

248
Q

Steatosis in non-alcoholics

249
Q

NAFLD + inflammation

Steatosis + inflammation in non-alcoholics

250
Q

Autoimmune hepatitis

A

Interface hepatitis with plasma cells

251
Q

Type II autoimmune hepatitis

252
Q

Type I autoimmune hepatitis

253
Q

Autoimmune inflammatory destruction of medium sized INTRAhepatic bile ducts

Slow development of cirrhosis over many years (hence renamed form cirrhosis to cholangitis as can diagnose prior to cirrhosis)

F> M 10:1

Increased serum ALP

Increase cholesterol

Increase IgM (late feature)

Anti-mitochondrial antibodies

NO BILE DUCT DILATATION

Bile duct loss with granulomas

Present with fatigue, pruritis, abdo discomfort

Tx: ursodeoxycholic acid

A

Primary Biliary Cholangitis

254
Q

Inflammation and obliterative fibrosis of EXTRAhepatic and INTRAhepatic bile ducts

Multi-focal stricture formation with dilitation of preserved segments

Onion-skinning fibrosis

M > F

Associated with IBD (Ulcerative colitis)

Increase ALP

p-ANCA

Bile duct dilatation

ERCP: beading of bile duct (multifocal strictures)

Increase in cholangiocarcinoma

A

Primary Scleroisng Cholangitis

255
Q

A1AT deficiency

A

Absent aslpha globulin band on electrophoresis

256
Q

Cyclophoshphamide use

A

Haemorrhagic cystitis

257
Q

Squamous cell carcinoma of bladder

A

Urinary schistosomiasis

258
Q

Transitional cell (Urothelial) tumour

90% of bladder tumours

Smoker
Aromatic amines

A

Most common bladder tumour

259
Q

Grading of Prostate cancer

A

Gleason system

260
Q

E.Coli

A

Acute bacterial prostatitis

261
Q

Seminoma

95% of testicular tumours are germ cell origin

A

Most common germinal tumour

262
Q

tumour markers for teratoma

  • male peeing on pregnancy test story
A

AFP, HCG and LDH

263
Q

Triad:
>3g/24 hr protein

Hypoalbuminaemia

Oedoema

(+hyperlipidaemia)

A

Nephrotic syndrome

264
Q

Membranous glomerular disease

= primary cause of nephrotic syndrome

A

Diffuse glomerular basement membrane thickening

265
Q

Minimal change disease

Membranous glomerular disease

Focal segmental glomerulosclerosis

A

Primary causes of nephrotic syndrome

266
Q

Focal segmental glomerulosclerosis

A

Focal and segmental glomerular consolidation and scarring

267
Q

Causes nephrotic syndrome

Common in adults

Diffuse glomerular basement membrane thickening

Loss of podocyte foot processes

Subepithelial spikey depsotis

Can be primary or secondary to SLE, drug, malignancy

Ig and complement in granular deposits along entire GBM

40% ESRF 2-20 yrs

A

Membranous glomerular disease

268
Q

Causes nephrotic syndrome

Common in adults

Focal and segmental glomerular consolidation and scarring

Hyalinosis

Loss of podocyte foot processes

Ig and complement deposited in scarred areas

50% respond to steroids

50% ESFR in 10 years

Primary
Can be due to HIV nephropathy and Obesity

A

Focal segmental glomerulosclerosis

269
Q

= Diabetes nephropathy

causes nephrotic syndrome

A

Mesangial matrix nodule = Kimmelstiel Wilson Nodules

270
Q

Amyloidosis

Can cause nephrotic syndrome

Chronic inflammation

TB

RA

Multiple myeloma - AL protein deposition

A

Apple green birefringence with Congo red stain

271
Q

Manifestation of glomerular inflammation (glomerulonephritis)

Characterised:

Haematuria (coca-cola urine)
Dysmorphic RBCs and red cell casts in urine

May also have:
Oliguria
Increased urea and creatinine
Hypertension
Proteinuria (but sub nephrotic levels)
A

Nephritic syndrome

272
Q

Acute post-infectious glomerulonephritis

IgA nephropathy (Berger Disease)

Rapidly progressive (Cresenteric) Glomerulonephritis (3 types)

Hereditary nephritis (Alport’s syndrome)

Thin basement membrane disease (benign familial haematuria)

A

Causes of Nephritic Syndrome (5)

273
Q

Goodpasture’s

274
Q

Causes Nephritic syndrome

1-3 weeks after Group A alpha-haemolytic strep throat infection

Streptococcus pyogenes

Immune complex deposition

Haematuria, red cell casts, hypertension, proteinuria, oedema,

ASOT titre increased

Decreased C3

LM: increased cellularity
FM: grnaular depsoits of IgG and C3 in GBM
EM: subendothelial humps

A

Acute post-infectious (post-streptococcal) glomerulonephritis

275
Q

Commonest cause of glomerulonephritis worldwide (causes nephritic syndrome)

Deposition of IgA complexes in glomeruli

1-2 days after URTI –> Frank haematuria

Persistent or recurring frank haematuria

Can be asymptomatic microscopic haematuria

Can progress to ESRF

FM: Granular deposition of IgA and complement in mesangium

A

IgA Nephropathy (Berger Disease)

276
Q

Most aggressive glomerulonephritis - can cause ESRF in weeks

Nephritic syndrome + oliguria and renal failure

All have crescents on LM

3 Types

Type 1: Anti-GBM antibody (Goodpasture’s –> Type IV collagen alpha 3)
Linear deposition of igG in GBM
+pulmonary haemorrhage

Type 2: immune complexes
SLE, IgA, Post-strep
granular/lumps deposition of IgG in GBM/mesangium

Type 3: pauci-immune (Not anti-GBM or immune complexes)

c-ANCA: Wegner’s
p-ANCA: microscopic polyangiitis
Scanty/lack of immune complex deposition

+Vasculitis

A

Rapidly progressive (Crescentic) Glomerulonephritis

277
Q

Causes Nephritic syndrome
Can be asymptomatic haematuria

x-linked recessive mutation in collagen IV alpha 4 chain

Nephritic syndrome + sensorineural deafness + eye problems (cataracts and lens dislocation)

Presents at 5-20 years and prepossesses to ESRF

A

Hereditary Nephritis (Alport’s syndrome)

278
Q

Asymptomatic haematuria (v.rarely nephritic syndrome)

No decline in renal function

Autosomal dominant mutation in collagen IV alpha 4 chain

A

Thin Basement Membrane Disease (Benign Familial Haematuria)

279
Q

Think basement membrane disease

Alport’s

IgA nephropathy

A

Aysmptomatic haematuria

280
Q

Pauci-immune

Wegners

Microscopic polyangiitis

A

Nephritic syndrome + scanty immune deposition

281
Q

Alport’s syndrome

A

Nephritic syndrome + sensorineural deafness + lens dislocation

282
Q

IgA nephropathy

A

Frank haematuria 2 days post URTI

283
Q

Post-streptococcal GN

A

Increased ASOT titre, Low C3 and URTI 3 weeks ago

284
Q

Commonest cause of acute renal failure

Ischaemia –> prolonged pre-renal AKI

Nephrotoxins (CHARM chain)

Cisplatin
Heavy metals
Aminoglycosides (Gentamicin)
Radiocontrast medium
Myoglobin

Chain: light chains in multiple myeloma

Histology: necrosis of short segments of tubules

A

Causes of Acute Tubular Injury

285
Q

A group of renal inflammatory disorders that involve the tubules and interstitium

Acute pyelonephritis = leukocytic casts

Chronic pyelonephritis
Reccurent infections –> scarring of parenchyma

Acute interstitial nephritis
Hypersensitivity reactions to drugs
Fever, skin rash, haematuria, proteinuria, eosinophilia

Chronic interstitial nephritis
Elderly with long-term analgesic consumption (NSAIDs/paracetamol)
Hypertension, anaemia, proteinuria, haematuria

A

Tubulointerstitial Nephritis

286
Q

Thrombosis
+MAHA
+Thrombocytopenia
+renal failure (mostly in HUS)

Causes
TTP - diffuse, esp in CNS
HUS - confined to kidneys

TTP = headache, altered consciousness
HUS= renal failure
A

Thrombotic microangipathies

287
Q 
Hypovolaemia
Sepsis
Burns
Acute pancreatitis
Renal artery stenosis

Pre-renal = most common cause of AKI

A

Pre-renal causes of AKI

288
Q 
Metabolic acidosis 
Hyperkalaemia
Fluid overload
HTN
Hypocalcaemia
Uraemia
A

Complications of AKI

289
Q

Acute glomerulonephritis

Acute tubular necrosis (most common renal cause)

Thrombotic MAHA

A

Renal causes of AKI

290
Q

Stones
Tumours (Primary or Secondary)
Prostatic hypertrophy
Retroperitoneal fibrosis

A

Post-renal causes of AKI

291
Q 
GFR 
>90 = stage 1
60-89 = stage 2
30-59 = stage 3
15-29 = stage 4
<15 = stage 5

Start with 15, double, double again, add 30

A

Chronic renal failure stages

292
Q

Autosomal Dominant

Adult Polycystic Kidney Disease

Chromosome 16 (polycystin 1)

Also PKD2
chromosome 4 (polycystin-2)
293
Q

Can progress to chronic renal failure

Stage from I - VI

A

Lupus Nephritis

294
Q

Clear cell carcinoma - well differentiated

Papillary carcinoma - commonest in dialysis-associated kidney disease

Chromophobe renal carcinoma - pale, eosiophilic cells

Presents: palpable mass, haematuria, costovertebral pain
Paraneoplastic syndrome: polycythaemia, hypercalcaemia, HTN, Cushing’s syndrome, Amyloidosis

A

Renal cell carcinoma

295
Q

Fits High Curtis Syndrome

Also: violin string peri-hepatic adhesions

A

RUQ and peri-hepatitis

296
Q

Endometriosis

A

“Powder burns”

297
Q

Endometriosis

A

red-blue to brown nodules

298
Q

Fibroids

A

Bundles of smooth muscle

299
Q

Subdivided:

Endometrioid (80%)
Oestrogen excess

Non-endometrioid (205)
Papillary
Serous 
Clear cell
Unrelated to oestrogen --> more aggressive
A

Endometrial Cancer

300
Q

Graded from I - III

Associated with HPV-16

Usual type: 35-55 years, warty/basaloid SCC

Differentiated type: older women, keratinising SCC (higher rate of malignant transformation)

301
Q

Mainly squamous cell carcinoma (arise from VIN)

Or from other skin abnormalities (Paget’s disease of the vulva - adenocarcinoma in situ)

A

Vulval Carcinoma

302
Q 
Epitheloid cell types 
Serous cystadenoma
Mucinous cystadenoma
Endometrioid
Clear cell

Germ cell types
Dysgerminoma
Teratoma
Choriocarcinoma

Sex cord/stroma cell types
Fibroma
Granuloa-theca cell tumour
Sertoli-Leydig cell tumour

A

Ovarian Tumour Types

303
Q

Sertoli-Leydig cell tumour

A

Ovarian tumour producing androgens

304
Q

Choriocarcinoma

A

Ovarian tumour producing b-hCG

305
Q

Granuloa-theca cell tumour

A

Ovarian tumour producing E2

306
Q

Clear cell ovarian tumour

A

Hobnail appearance

307
Q

Serous cystadenoma

A

Psammoma bodies

308
Q

Clear cell tumour

A

Clear cytoplasma

309
Q

Mucinous cystadenoma

A

No Psammoma bodies

310
Q

Mucinous cystadenoma

A

Oestrogen secreting tumour

311
Q

Mucinous cystadenoma

A

Causes pseudomyxoma peritonei

312
Q

Periductal mastitis

Smokers

Not associated with lactation

A

Keratinising squamous epithelium + breast pain

313
Q

Inflammatory response to damaged adipose tissue

PAINLESS breast mass / skin thickening / mammographic lesion

A

Fat necrosis

314
Q

Fibrocystic disease (finbroadenosis)

Cystic changes: small cysts form by dilation of lobules
Contain fluid
Often calcified

Fibrosis: inflammation and fibrosis secondary to cyst rupture

Adenosis: increased number of acini per lobule (normally seen in pregnancy)

A

Fibrocytic Disease

315
Q

Gynaecomastia

A

Finger-like projections into ducts

316
Q

Benign papillary tumour arising within duct system of breast

Peripheral: within small terminal ducts
Central: within larger lactiferous ducts

Causes bloody discharge

No LUMP

Not seen on mammogram

Ix: galactogram

A

Duct papilloma

317
Q

Radial scar

Benign sclerosing lesion

Central scarring surrounded by proliferating glandular tissue in a stellate pattern

Resembles carcinoma on mammogram

A

Stellate pattern of glandular tissue

318
Q

Increase risk of:

Breast cacrinoma
Ovarian caner
Prostate cancer
Pancreatic cancer

319
Q

Proliferation limited ti ducts/lobules by basement membrane

Lobullar (LCIS): no calcification, ALWAYS incidental finding on biopsy

Ductal (DCIS): Microcalcifcation on mammogram, much increased risk of breast carcinoma

A

Carcinoma in situ (breast)

320
Q

Categorised into ductal, lobular or tubular

Ductal: carcinoma that cannot be subclassified into another group - MOST COMMON

Lobular: cells aloigned in single file chains/ strands

Tubular: Well-formed tubules with low grade nuclei (rarely palpable as <1cm)

Can also be mucinous –> secretes mucin

A

Invasive breast carcinoma

321
Q

Examination

Mammorgaphy, USS or MRI

FNA & Cytology

A

Triple assessment

322
Q

ER/PR receptor positive –> GOOD

HER 2 positive –> BAD

A

Breast carcinoma prognosis

323
Q

Sheets of atypical cells with lymphocyte infiltration

Stain: CK5/6/14

A

Basal-like carcinoma breast

324
Q

Interlobular stroma

Typically large, fast-growing masses

Mostly low grade, but can be aggressive

Palpable mass >50 yrs

A

Phyllodes tumour

325
Q

TB

A

Low glucose, high protein and lymphocyte on Lumbar Puncture

326
Q

Meningioma

A

Neurofibromatosis type II (NF2)

327
Q

Ependymoma

A

Ventricular tumour, hydrocephalus

328
Q

Pilocytic astrocytoma

A

Indolent, chilhood brain tumour

329
Q

Oligodendroma

A

Soft, gelatinous calcified brain tumour

330
Q

Astrocytomas

Metastatic is more common tumour in CNS (lung, breast, malignant melanoma)

A

Commonest brain tumour (primary)

331
Q

Corticobasal degeneration

Frontotemporal dementia (linked to chromosome 17)

Pick’s disease

Alzheimers (Tau and beta-amyloid)

A

Tau protein Dementias

332
Q

Dementia awith Lewy Bodies

A

Alpha-synuclein, ubiquitin

333
Q

Senile plaques of beta-amyloid

Neurofibrillary tangles of Tau

A

Alzheimers

334
Q

Present in both

Lewy Body Dementia

Parkinson’s disease

A

Alpha-synuclein

335
Q

Myelin basic protein

Proteo-lipid protein

MS plaques show sharp margins of myelin loss

A

Multiple Sclerosis Proteins

336
Q

Shy Drager: Autonomic dysfunction

Striatonigral: difficulty with movement

Olivopontocerebellar: Difficulty with balance and coordination

Can appear very similar to Parkinson’s BUT show poor response to parkinson medications

A

Multisystem Atrophy

337
Q

Osteoporosis

A

Loss of cancellous bone

338
Q

Pseudo fractures

= osteomalacia

A

Looser’s zones

339
Q

Primary Hyperparathyroidism

Bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.

Brown tumours consist of fibrous tissue, woven bone and supporting vasculature, but no matrix.

A

Brown’s tumour

340
Q

Osteomalacia

A

Excess of unmineralised bone

341
Q

Osteomalacia

Marrow fibrosis + cysts

A

Osteitis fibrosa cystica

342
Q

Paget’s

A

Mixed lytic and sclerotic bone

343
Q

Primary hyperparathyroidism

A

Salt and pepper skull

344
Q

Primary hyperparathyroidism

A

Subperiostal bone resorption in phalanges

345
Q

Paget’s

A

Mosaic pattern of lamellar bone

346
Q

Paget’s

> 100 nuclei

A

Huge osteoclasts

347
Q

Prominent knobs of bone at the costochondral joints

= Ricket’s

A

Rachitic rosary

348
Q

Osteomalacia

A

Decrease bone mineralisation

349
Q

Skull
Osteoporosis circumscripta
Cotton wool

Vertebrae
Picture frame
Ivory vertebrae

Pelvis
Sclerosis and lucency

A

X-ray feature of Paget’s

350
Q

Acute treatment of gout

A

Colchicine

351
Q

Calcium pyrophosphate crystals

Rhomboid shaped

A

Pseudo-gout crystals

352
Q

Adolescence

Knee 60%

Malignant mesenchymal cells

ALP+ve

Elevated periosteum (Codman’s triangle)

Sunburst appearance

A

Osteosarcoma

353
Q

> 40 yrs

Axial skeleton, femur, tibia, pelvis

Malignant chondrocytes

Lytic lesion with fluffy clacification

AXIAL SKELETON

A

Chondrosarcoma

354
Q

<20 yrs

Long bone, pelvis

Sheets of small round cells
CD99 +ve

t(11:22)

Onion skinning of the periosteum

A

Ewing’s Sarcoma

355
Q

20-40yrs
F>M

Knee-epiphysis

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

Lytic/lucent lesions up to articular surface

A

Giant cell (borderline malignancy)

356
Q

Elevated periosteum

Osteosarcoma

A

Codman’s triangle

357
Q

Ewing’s sarcoma

A

Onion skinning of periosteum

358
Q

Ewing’s sarcoma

359
Q

Giant cell (borderline)

A

Multinucleate giant cell swith ovoid/spindle

360
Q

Osetoid oesteoma

A

Radiolucent nidus with sclerotic rim

361
Q

multiple osteomas + GI polyps + epidermoid cysts

A

Gardner syndrome

362
Q

Oesteoma

A

Bony outgrowths attached to normal bone

363
Q

Enchondroma

A

Benign tumours of cartilage

364
Q

Multiple enchondromas

A

Oiler’s syndrome

365
Q

Multiple enchondromas + haemangiomas

A

Maffuci’s syndrome

366
Q

Enchondroma

A

Cotton wool calcification

367
Q

fibrous tissue in place of bone

A

Fibrous dysplasia

368
Q

Polyostotic dyplasia + cafe au lait spots + precocious puberty

A

Albright syndrome

369
Q

Simple bone cyst

A

Lytic well defined

370
Q

Osteoblastoma

A

Speckled mineralisation

371
Q

Rubbing plaques causes pin-point bleeding

Psoriasis

A

Auspitz’ sign

372
Q

Psoriasis

A

“test tubes in racks”

373
Q

Erythema multiforme

A

Annular target lesion

374
Q

Pemphigoid

A

IgG to hemidesmosomes + linear IgG at BM

375
Q

Pemphigus

A

IgG to hemidemosomal and netlike pattern of intercellular IgG

376
Q

Malignant melanoma

=pagetoid cells

A

Buckshot appearance

377
Q

Most important prognostic factor

A

Breslow thickness

378
Q

Lentigo malignant melanoma

A

Malignant melanoma on sun exposed areas

379
Q

Type III hypersensitivity reaction

HLA DR3 (or 2)

Anti-dsDNA
Anti-Sm

(anti-histone if drug induced)

Criteria (4 of 11 ACR)
SOAP BRAIN MD

Serositis
Oral ulcers
Arthritis
Photosensitivty

Blood disorders  (AIHA, ITP, leucopenia)
Renal imvolvement
ANA +ve
Immune phenomena (dsDNA, anti-Sm, Antiphospholipid Ab)
Neuro symptoms

Malar rash
Discoid

380
Q

Anti-centromere

Calcinosis 
Raynaud's
Esophageal dysmotility 
Sclerodactyl
Telangiectasia

Onion skinning around arterioles

Associated with pulmonary hypertension

A

Limited Scleroderma

381
Q

Anti-Scl-70

Inflammation within or around muscle fibres

Associated with pulmonary fibrosis

A

Diffuse Scleroderma

382
Q

Dermatomyositis

and polymyositis

383
Q

Pityriasis Rosea

Christmas tree distribution

Post-viral

A

Herald Patch

384
Q

Takayasu’s arteritis

Temporal arteritis

A

Large vessel vasculitides

385
Q

Polyarteritis nodosa

Kawasaki’s

Buerger’s disease (Thromboangitis obliterans)

A

Medium sized vasculitides

386
Q

Wegner’s (Granulomatosis with polyangiitis)

Churg Strauss (Eosinophilic granulomatosis with polyangiitis)

Microscopic polyangiitis

Henoch Schonlein Purpura

A

Small vessel vasculitides

387
Q

Takayasu’s Arteritis

A

Pulseless disease

388
Q

“pulseless”

Increase in Japanese women

Vacular symptoms: Absent pulse, bruits, claudication

A

Takayasu’s Arteritis

389
Q

Temporal arteritis

A

Scalp tenderness, headache, jaw claudication

390
Q

Elderly

Scalp tenderness

Jaw claudication

Blurred vision

Increase ESR

Histo: Granulomatous transmural inflammation + giant cell + skip lesion

A

Temporal arteritis

Matt's Path REVERSE (18 decks)

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