histopath Flashcards
1
Q
neurofibroma + pilocytic astrocytoma
A
neurofibromatosis type I
2
Q
schwannoma + meningioma
A
neurofibromatosis type II
3
Q
haemangioblastoma
A
von hippel lindau
4
Q
most frequent brain tumour in adults
A
secondary metastases
5
Q
most frequent brain tumour in children
A
pilocytic astrocytoma
6
Q
most common types of brain tumour in children
A
- pilocytic astrocytoma
2. medulloblastoma
7
Q
Pilocytic astrocytoma
A
20% of CNS tumours <14 yo
often cerebellar, optic-hypothalamic, brain stem
MRI: circumscribed lesion
BRAF mutation
piloid hairy cell
often rosenthal fibres and granular bodies
8
Q
piloid ‘hairy’ cell
+/- rosenthal fibres and granular bodies
A
pilocytic astrocytoma
9
Q
astrocytomas eventually become?
A
glioblastomas
10
Q
what is the most aggressive and most frequent brain tumour in adults?
A
de novo glioblastoma (IDH wildtype)
11
Q
a diffuse infiltrating astrocytoma w mutation in the IDH1 or IDH2 gene
A
diffuse astrocytoma
12
Q
what does tumour grade tell us?
A
survival/ prognosis
13
Q
second most common brain tumour in children?
A
medulloblastoma
14
Q
most frequent primary brain tumour in adults?
A
glioblastoma multiforme (90% de novo 10% secondary progression from astrocytoma)
15
Q
brain tumour with round cells w clear cytoplasm (fried eggs) on histology
A
oligodendroglioma
16
Q
what is the 2nd most common primary brain tumour in adults?
A
meningioma
17
Q
senile plaques of beta amyloid protein and neurofibrillary tangles of tau protein
A
alzheimers
18
Q
neuropathology of alzheimer’s disease?
A
extracellular plaques (senile plaques made of beta amyloid)
neurofibrillary tangles
cerebral amyloid angiopathy leading to neuronal loss and cerebral atrophy
19
Q
Beta amyloid proteins cleaved from?
A
APP
20
Q
How are senile plaques formed?
A
beta amyloid proteins congregate and form insoluble plaques
21
Q
parkinsons pathology?
A
loss of dopaminergic neurons in substantia nigra
22
Q
lewy bodies in affected neurons (histology)
A
Parkinsons
and Lewy body dementia
(pathologically indistinguishable)
23
Q
what is the main component of lewy bodies?
A
misfolded alpha synuclein protein
24
Q
tau protein misfolding
A
picks disease
frontotemporal dementia linked to chr 17
corticobasal degeneration
25
Picks disease
fronto temporal atrophy
tau positive Pick bodies
marked gliosis and neuronal loss
balloon neurons
26
what is the inheritance of frontotemporal dementia linked to chr 17?
auto dominant
27
cerebral oedema
excess accumulation of fluid in brain parenchyma
| -> ICP raised
28
what produces CSF?
choroid plexus
29
hydrocephalus non communicating
obstruction of flow of CSF
30
hydrocephalus communication
no obstruction but problems w reabsorption of CSF into venous sinuses
31
normal ICP in adult
7-15 mmHg
32
consequences of raised ICP
herniation of brain structures
| e.g. subfalcine, transtentorial (uncal), tonsillar
33
causes of raised ICP
SOL
| oedema
34
risk factors of stroke
smoking, hypertension, DM, Family history, obesity, past TIAs, peripheral vascular disease, hyperviscosity
arrhythmia e.g. AF
35
what is a high pressure structure which may cause massive bleeding? in the brain
arteriovenous malformations
36
a well-defined malformative lesion composed of closely packed vessels found in the CNS. a low pressure structure that may lead to recurrent bleeds
cavernous angioma
37
rupture of berry aneurysm
sub arachnoid haemorrhage
38
where does rupture of berry aneurysm most often occur?
internal carotid artery bifurcation
39
thunderclap headache, vomiting, LOC
Sub arachnoid haemorrhage
40
what kind of bleed does an arteriovenous malformation cause?
subarachnoid
41
what kind of bleed does a cavernous angioma cause
subarachnoid
42
most common cause of cerebral infarction
cerebral atherosclerosis
43
what pathology do you see on brain infarct?
tissue necrosis
permanent damage in affected area
no recovery
44
what pathology do you see on haemorrhage in brain?
```
bleeding
dissection of parenchyma
fewer macrophages
limited tissue damage
partial recovery
```
45
raccoon eyes
base of skull fracture
46
diffuse axonal injury
commonest cause of coma when no bleed
shear and tensile forces affecting axons
midline structures particular affected. e.g corpus callosum
47
Causes of large droplet fatty change in liver?
```
obesity and DM
protein-calorie malnutrition
Total parenteral nutrition
drugs and toxins e.g. alcohol, corticosteroids
metabolic disorders e.g. wilsons
infections e.g. hepatitis c
```
48
causes of small droplet fatty change
```
alcohol
fatty liver of pregnancy
drugs
toxins
inborn errors of metabolism
Reyes syndrome
infections e.g hepatitis A
```
49
fatty liver hepatitis
hepatocyte ballooning and necrosis
Mallory-Denk bodies
Fibrosis
50
Mallory-denk bodies
fatty liver alcoholic hepaitis
51
most common causes of acute pancreatitis?
1. gallstones
2. alcohol
3. idiopathic
52
how does alcohol lead to acute pancreatitis?
alcohol leads to spasm/ oedema of sphincter of oddi and the formation of protein rich pancreatic fluid which obstructs the pancreatic ducts
53
what enzymes are elevated following acute pancreatitis?
```
serum amylase
serum lipase (more sensitive)
```
54
complications of acute pancreatitis
shock, hypoglycaemia, hypocalcaemia
pancreatic pseudocyst
pancreatic abscess
55
what is the most common cause of chronic pancreatitis?
alcohol
56
histology of chronic pancreatitis
chronic inflammation with parenchymal fibrosis and loss of parenchyma
57
complications of chronic pancreatitis?
malabsorption
diabetes
pseudocysts
carcinoma of pancreas?
58
Xray finding of pancreatic calcifications
Chronic pancreatitis
59
a cyst lined by fibrous tissue and contains fluid rich in pancreatic enzymes or necrotic material
Pancreatic pseudocyst
60
Autoimmune pancreatitis
IgG4 positive plasma cells
61
Most common tumour of the pancreas?
ductal carcinoma
62
risk factors for pancreatic carcinoma?
smoking
BMI and dietary factors
chronic pancreatitis
diabetes
63
most common site of ductal carcinoma
head of pancreas
64
courvoisiers' law: palpable painless gallbladder - most likely?
ductal adenocarcinoma of the pancreas (head)
65
MEN1
3Ps
Pancreatic endocrine neoplasms
pituitary adenoma
parathyroid adenoma/ hyperplasia
66
complications of gall stones
bile duct obstruction
acute and chronic cholecystitis
acute pancreatitis/ chronic
gall bladder cancer
67
most common cause of acute cholecystitis
gall stones
68
most common cause of chronic cholecystitis
gall stones
69
rokitansky-aschoff sinuses
chronic cholecystitis.
| • Diverticula due to long term pressure build up
70
most common cause of gall bladder cancer
gall stones
71
most common type of gall bladder ca
adenocarcinoma
72
oat shaped cells on microscopy - lung ca
small cell carcinoma
73
peripheral tumours in lung
adenocarcinoma
74
Biopsy of GI tract showing non-caseating granulomas w transmural inflammation
crohns disease
75
Biopsy shows villous atropy with crypt hyperplasia and increased intraepithelial lymphocytes
Coeliac disease
76
Biopsy showing signet ring cells and linitis plastica (leather bottle stomach)
gastric carcinoma
77
most common cause of infective endocarditis in IVDU?
staph aureus
78
most common cause of infective endocarditis in normal population?
streptococcus viridans
esp after dental procedures
79
ejection systolic murmur, narrow pulse pressure, slow rising pulse
aortic stenosis
80
nutmeg liver, haemosiderin macrophages in lungs
left heart failure
81
autoimmune complication of MI ~4 wks after. chest pain, fever, pericardial rub
dresslers syndrome
82
complications of MI within 1 week
myocardial rupture, valve incompetence, arrhythmias (most commonly VF/ VT)
83
cardiac complications of rheumatic fever?
```
endocarditis
myocarditis
pericarditis
pancarditis
chronic rheumatic heart disease after many years with fibrosis of mitral and aortic valves
```
84
st vitus dance
rheumatic fever
85
sydenhams chorea
rheumatic fever
86
aschkoff bodies and anitschow cells
rheumatic fever
87
rheumatic fever
following group A B-heamolytic streptococci
| inflammatory condition affecting connective tissue of heart, joints and CNS
88
focal calcification of media of small medium-sized arteries
monckeberg arteriosclerosis
89
progressive loss of myocytes
dilated cardiomyopathy
90
autosomal dom condition causing mutation in the B-myosin heavy chain
hypertrophic obstructive cardiotrophy
91
myocyte hypertrophy and disarray
hypertrophy obstructive cardiotrophy
92
5-hydroxyindoleacetic acid producing tumour
carcinoid syndrome
93
episodic flushing, abdominal cramps and diarrhoea + right sided valve abnormalities
carcinoid syndrome
94
permanent dilation of bronchi and bronchioles secondary to chronic inflammation
bronchiectasis
95
bronchial wall destruction and transmural inflammation
bronchiectasis
96
Ix of bronchiectasis?
high resolution CT scan
97
complications of bronchiectasis
abscess formation
haemoptysis
pulmonary HTN
98
F508 mutation
cystic fibrosis
99
nests of small round hyper chromatic cells that are fragile and possess nuclear moulding - 'oat cells'
small cell carcinoma
100
Lambert-eaton myasthenic syndrome - which lung ca?
small cell carcinoma
101
predominantly central lung ca
small cell ca
102
non-small cell ca comprise?
adenocarcinoma
squamous cell ca
large cell ca
103
gland forming and mucin vacuoles. lung ca
adenocarcinoma
104
lung ca with keratinisation and intracellular prickle desmosomes
squamous cell carcinoma
105
peripheral lung cancers
non small cell ca
106
CXR showing bat wings (alveolar oedema), Kerley B lines, cardiomegaly, upper lobe diversion of blood vessels and effusions
pulmonary oedema - cardiac cause (e.g. heart failure, mitral stenosis)
107
respiratory distress syndrome aka surfactant deficiency aka?
hyaline membrane disease
108
extrinsic allergic alveolitis
long-term exposure to inhaled allergen leads to pulmonary fibrosis
109
mucus gland hypertrophy, goblet cell hyperplasia/ metaplasia, mucosal oedema
chronic bronchitis
110
CREST syndrome
```
calcinosis
raynauds
oesophageal dysmotility
sclerodactyly
telangiectasia
```
111
pathogenesis of systemic sclerosis
excessive release of PDGF -> widespread fibroblast activation and multi organ fibrosis
112
'onion skinning' of microvasculature (intimal thickening due to chronic fibrosis)
systemic sclerosis
113
most sensitive antibodies to SLE?
anti-ds DNA
114
cytology of tissues reveals haematoxylin bodies
SLE
115
LE cells visible on microscopy- macrophages that have phagocytosed a haematoxylin body
SLE
116
apple-green birefringence using polarised light and Congo red stain
amyloidosis
117
what amyloid is derived from IgG light chains? and assoc w myeloma
AL
118
amyloid assoc w alzheimers
beta amyloid
119
amyloid derived from serum amyloid assisted protein and assoc w inflammation
AA
120
pANC assoc w?
microscopic polyangitis
| eosinophilic granulomatosis with polyangiitis (churg-strauss)
121
microscopic polyangitis?
a small vessel vasculitis
triggered by microorganisms and drugs
affecting the skin, heart, brain and kidneys
122
histology of affected vessels include fibrinoid necrosis that leads to fragmented neutrophilic nuclei within vessel walls
microscopic polyangitis
123
difference between myasthenia graves and dermatomyositis?
sparing of the ocular muscles
124
heliotrope rash and gottron papules
dermatomyositis
125
dermatomyositis ix
raised creatine kinase levels
| anti Jo1
126
dry eyes dry mouth
sjogrens
127
positive Schirmers test
sjogrens
128
immune mediated destruction of the lacrimal and salivary glands
sjogrens
129
arteritis w no pulses and low BP in arms and cold hands
takayasu arteritis
130
degeneration of substantia nigra and locus coeruleus of the basal ganglia, loss of dopaminergic neurons
parkinsons
131
Lewy bodies made of?
alpha synuclein
132
subarachnoid haemorrhages assoc w which conditions?
Polycystic kidney disease
coarctation of the aorta
fibromuscular dysplasia
133
histology along the CNS include active (containing lymphocytes and macrophages) and inactive (reduced myelin and nuclei) plaques
multiple sclerosis
134
optic neuritis, intranuclear ophthalmoplegia (disruption of medial longitudinal fasciculus) and cerebellar signs + spasticity and weakness of limbs
MS
135
downs assoc w which dementia?
alzheimers
136
damage to the middle meningeal artery
extradural haemorrhage
assoc w severe trauma and fracture to pterion
137
extradural haemorrhage assoc w severe trauma and fracture to pterion, which artery affected?
middle meningeal artery
138
skip lesions and fistulae, transmural inflammation
crohns
139
complications of crohns
thickening of bowel wall leading to bowel obstruction
140
extra intestinal manifestations of crohns
```
arthritis
uveitis
stomatitis
pyoderma gangrenosum
erythema nodosum
```
141
metaplastic columnar epithelial cells in the oesophagus
barrett's oesophagus
142
barrett oesophagus increased risk of ?
adenocarcinoma of the oesophagus
143
main causes of peptic ulcers
h pylori
NSAIDs
zollinger- Ellison
smoking
144
chronic gastritis risk of ?
carcinoma
| MALT lymphoma
145
what is cirrhosis?
diffuse fibrosis of the liver w abnormal architecture (nodules of regenerating hepatocytes) + intra and extrahepatic shunting of blood
146
what cell is repsonsible for fibrosis in liver?
stellate cell activation -> deposit collagen
147
nodules of regenerating hepatocytes + haphazard blood supply (shunting and portal hypertension)
cirrhosis
148
what gene is implicated in Wilsons?
ATP7B gene
149
Mutation in ATP7B gene
Wilsons disease
150
inheritance on wilson's
autosomal recessive
151
Wilsons
multi-organ copper accumulation
-> cirrhosis, behavioural changes, depression, psychosis,
parkinsonism, seizures and dementia
cardiomyopathy
152
kayser- Fleischer rings
wilsons
153
haemochromatosis inheritance?
auto recessive
154
what gene is involved in haemochromatosis?
HFE gene
155
HFE gene
haemochromatosis
156
golden- brown haemosiderin deposition in the parenchyma in many organs
haemochromatosis
157
Perl's Prussian blue stain +
haemochromatosis
158
what organs are involved in haemochromatosis?
liver (cirrhosis)
heart (cardiomyopathy), skin (bronzed pigmentation), pancreas (diabetes)
gonads (atrophy and impotence)
159
most common liver malignancy
hepatocellular carcinoma
160
aflatoxin malignancy
hepatocellular carcinoma
161
alpha fetoprotein marker of malignancy?
hepatocellular carcinoma
| germ cell tumours
162
BHCG malignancy marker?
choriocarcinoma
163
dense accumulation of lymphocytes around bile ducts creating granulomas and total destruction of ducts
primary biliary cirrhosis
164
anti mitochondrial antibodies
PBC
165
risk factors of developing cholangiocarcinoma
Primary sclerosing cholangitis
parasitic liver fluke infection
exposure to medical imaging contrast media
166
PBC assoc with which autoimmune condition?
sjogrens syndrome
167
emphysema in lungs and cirrhosis - deficiency in?
alpha1- antitypsin
lack of inhibition of neutrophil proteases -> destruction of tissues
168
biopsy of bile ducts showing periductal fibrosis that eventually invades the lumen causing concentric onion ring fibrosis
primary sclerosing cholangitis
169
pemphigoid
deep- dermoepidermal junction. autoimmune deep bullous condition
nikolskys sign NEGATIVE. cause bullae do not rupture easily.
- eosinophils recruited to site which destroys the elastic fibres
170
IgG (+C3) binding to hemi-desmosomes in the dermoepidermal junction the skin
pemphigoid
171
pemphigus
superficial blisters. nikolsky sign positive.
172
IgG binding to desmosomes in the intra epidermal region resulting in acantholysis
pemphigus
173
pemphigus which layer is affected
intra epithelial
174
pemphigoid which layer is affected
subepithelial.
175
Steven Johnsons syndrome
severe form of erythema multiforme
involving mucosal surfaces
characterised by epidermal necrosis
176
auspitz sign (pinpoint bleeding when rubbing lesion)
psoriasis
177
salmon pink plaques with silver white scale
psoriasis
178
psoriasis nail changes?
onycholysis
| pitting
179
epidermal dysplasia secondary to sunlight - presents as brown-red warty lesion w sandpaper consistency
actinic keratosis
180
solar elastosis, focal parakeratosis on histology
actinic keratosis
181
actinic keratosis may progress to?
squamous cell carcinoma
182
subtypes of malignant melanoma?
lentigomaligna, acrallentigious, superficial spreading, nodular
183
squamous carcinoma in situ
bowens disease
184
herald patch
pityriasis rosea
185
rodent ulcers
basal cell carcinoma
186
pearly, raised, ulcerated, telangiectasia. skin lesion
basal cell ca
187
red cell and white cell casts, haematuria
nephritic syndrome
188
1-4 days after resp/ GI infection - frank haematuria
IgA nephropathy
189
IgA nephropathy aka
bergers disease
190
deposition of IgA immune complexes in glomeruli
IgA nephropathy
191
most aggressive Glomerulonephritis - end stage renal failure in days to week
rapidly progressive (crescentic) glomerulonephritis
192
most common viral cause of rapidly progressive glomerulonephritis
Hep B
193
causes of rapidly progressive glomerulonephritis
type 1: anti GBM antibody (goodpastures)
type 2: immune complex mediated e.g. SLE
type 3: lack of immune complex e.g. Wegeners or microscopic poluangitis
194
wegeners' rapidly progressive glomerulonephritis pattern of deposition on fluorescence microscopy
absent/ scant immune complex deposition
195
green/ white discharge from breast
duct ectasia
196
microcalcification of well defined lesion in breast
ductal carcinoma in situ
197
leaf like/ artichoke like appearance on histology. rapidly growing tumour
phyllodes tumour
198
peau d'orange, paget's disease of the breast, nipple retraction, tethering, lymphadenopathy
features of invasive carcinoma
199
polyostotic fibrous dysplasia + cafe au lait spots + precocious puberty ?
McCune-Albright Syndrome
200
lytic lesions in the epiphyses -> characteristic soap bubble appearance on Xray
giant cell tumour
201
histology showing multinucleate giant osteoclasts with surrounding ovoid and spindle cells
giant cell tumour
202
looser zones (pseudo fractures)
osteomalacia
203
soap bubble osteolysis + shepherds crook deformity
fibrous dysplasia
204
cotton wool calcification - often in the hands (X-ray)
enchondroma (Ends sounds like hands)
205
painful bone neoplasm, common in children, Xray reveals radiolucent central nidus and sclerotic rim pattern
osteoid osteoma
206
cartilage capped bony outgrowth typically in long bones
osteochondroma
207
non-caseating granulomas + Schaumann and asteroid bodies on histology (multisystem disease)
Sarcoidosis
208
Bilateral hilar lympadenopathy + insidious SOB, cough, chest pain, night sweats
Sarcoidosis
209
Ix showing high Ca, high ACE, high ESR
Sarcoidosis
Ca high due to Vit D hydoxylation by activated macrophages
ACE blood levels increase as the cells surrounding granulomas produce increased amts of ACE
210
multisystem disorder caused by abnormal folding of proteins that are deposited as amyloid fibrils in tissues, disrupting their normal function
amyloidosis
211
primary amyloidoisis
deposition of amyloid L protein
assoc w multiple myeloma
Plasma cells produce amyloid!
212
secondary amyloidosis
Amyloid formed from serum amyloid A (an acute phase protein) -> secondary to inflammation/ chronic infections
e.g. RA, IBD, TB, IVDU
213
haemodialysis associated amyloidosis
deposition of beta2-microglobulin
214
familial amyloidosis assoc w which condition?
familial Mediterranean fever
AA Amyloid, predominant renal deposition
215
what organs are usually implicated in amyloidosis? + most common
kidney most common- nephrotic syndrome
heart- heart failure, cardiomegaly, conduction defects
liver/spleen - hepatosplenomegaly
tongue- macroglossia
neuropathies
216
scalp tenderness, temporal headache, jaw claudication, raised ESR
temporal arteritis
217
giant cell arteritis assoc w?
polymyalgia rheumatica
218
giant cells + granulomatous transmural inflammation + narrowing of the lumen on histology of vessel
giant cell arteritis
219
IgA mediated vasculitis, assoc w preceding URTI in children. palpable purpuric rash
henoch Schonlein purpura
220
henoch Schonlein purpura
```
preceding URTI
palpable purpuric rash
glomerulonephritis
colicky abdo pain
arthritis
orchtiis
```
221
HSP mx
analgesia
| supportive
222
p-ANCA antibodies against?
myeloperoxidase
223
what does microscopic polyangiitis present w?
renal-pulmonary
pulmonary haemorrhage
glomerulonephritis
224
what does chrug- Strauss aka eosinophilic granulomatosis w polyangiitis present w?
asthma, allergic rhinitis
eosinophilia
later systemic involvement
225
pulmonary haemorrhage
glomerulonephritis
pANCA +
microscopic polyangiitis
226
asthma, allergic rhinitis
eosinophilia
pANCA +
churg- strauss
eosinophilic granulomatosis w polyangiitis
227
what is the treatment for wegeners?
| also for churg-strauss
cyclophosphamide
228
saddle nose, epistaxis
| pulmonary haemorrhage, glomerulonephritis
wegeners
gPA
229
cANCA
wegeners
230
cANCA against?
anti proteinase 3
231
what does Wegener's comprise of?
saddle nose, epistaxis
| pulmonary haemorrhage, glomerulonephritis
232
heavy smoker, 30 yr old, w pain and ulceration of toes and fingers. corkscrew appearance on angiogram
thromboangitis obliterans
Buerger's disease
233
thromboangitis obliterans
usually heavy smokers\
men <35 years
pain and ulceration of toes and fingers. corkscrew appearance on angiogram
234
microaneurysms on the angiography "beading" "rosary sign"
polyarteritis nodosa
235
polyarteritis nodosa associ w which underlying infection?
Hep B
236
polyarteritis nodosa
medium vessel necrotising arteritis involving kidneys and other organs but spares the lungs
"rosary sign" beading on angiography
237
connective tissue disease. ANA Immunofluorescence staining pattern for dermatomyositis and polymyositis
speckled pattern
238
what type of hypersensitivity in SLE?
Type III
immune complex deposition
239
SLE HLA association?
HLA DR3
240
SLE autoantibodies
anti nuclear antibodies (ANA)
anti - dsDNA
Anti-smith
anti-histone (drug induced)
241
What SLE antibody is most specific? (best true -ve)
anti-smith
242
what SLE antibody is most associated with drug-induced SLE?
anti-histone Ab
243
connective tissue disease. ANA Immunofluorescence staining pattern for systemic sclerosis?
nucleolar pattern
244
Kidney histology: 'wire loops' due to Immune complex deposition. + thickened pink glomerular capillary loops
SLE
245
what heart complication is most associated with SLE?
Libman Sacks endocarditis
246
SLE effect on kidneys
deposition of immune complexes on kidney basement membrane -> thickening of BM
247
Malar rash
SLE
248
onion skin thickening of arterioles + increased collagen in skin and organs
Systemic sclerosis (limited/ diffuse)
249
anti-centromere ab
Limited scleroderma
250
anti-topoisomerase ab
diffuse scleroderma
251
anti-scl70 ab
diffuse scleroderma
252
increased collagen in skin and organs + inflammation within or around muscle fibres
diffuse scleroderma
253
scleroderma + pulmonary fibrosis
diffuse scleroderma
254
CREST + microstomia + pulmonary hypertension + only skin distal to elbows and knees affected
Limited scleroderma
255
anti - JO1 antibody recognises which cellular protein?
tRNA synthetase
256
anti-scl70 antibody recognises which cellular protein?
DNA topoisomerase
257
dermatological emergency where sheets of skin detach + nikolsky sign +ve. triggered by drugs e.g. anticonvulsants
stevens Johnsons syndrome
258
Steven Johnsons syndrome vs toxic epidermal necrolysis
TEN >30% body surface involvement
| SJS <10% body surface involvement
259
what drugs can trigger Stevens johns syndrome?
anticonvulsants, sulfonamide antibiotics
260
salmon pink rash (herald patch) arrives first followed by oval macule in Christmas tree distribution
pityriasis rosea
261
pityriasis rosea
appears after viral illness. remits spontaneously
| salmon pink rash (herald patch) arrives first followed by oval macule in Christmas tree distribution
262
atypical melanocytes growing horizontally into epidermis and vertically into dermis
malignant melanoma
263
pagetoid spread of melanocytes "buckshot appearance"
malignant melanoma
264
Malignant melanoma most impt prognostic factor?
breslow thickness
265
malignant melanoma subtype most often occurring on palms, soles and sublingual areas
acral lentiginous melanoma
266
malignant melanoma subtype most often occurring in the younger age group, can occur anywhere
nodular malignant melanoma
267
malignant melanoma subtype - irregular borders with variation in colour
superficial spreading
268
malignant melanoma subtype - occurs on sun exposed areas of elders caucasians. flat, slowly growing black lesion
lentigo maligna melanoma
269
central area of ulceration w raised rim. pearly surface and often with telangiectasia. on the skin
basal cell carcinoma
270
atypia/ dysplasia throughout epidermis, nuclear crowding and spreading though basement membrane into dermis
squamous cell carcinoma
271
rough, sandpaper like scaly lesions on sun-exposed areas
actinic / solar / senile keratoses
272
solar elastosis / parakeratosis
actinic keratosis
273
rough plaques look stuck on , waxy
seborrhoeic keratosis
274
rapidly growing dome shaped nodule which may have a necrotic crusted centre. grows over 2-3 wks and clears spontaneously. with similar histology to SCC
keratoacanthoma
275
intraepidermal squamous cell carcinoma in situ
bowens disease
276
flat red scaly patches on sun exposed skin but BM still intact
Bowens disease
| SqCC in situ
277
coeliac skin manifestation
dermatitis herpetiformis
278
itchy vesicles on extensor surfaces of elbows, buttocks. due to IgA Abs binding to BM and causing sub epidermal bullae
dermatitis herpetiformis
279
Histology of skin shows micro abscesses which coalesce to form sub epidermal bullae. due to neutrophil and IgA deposits at tips of dermal papillae
dermatitis herpetiformis
280
intraepidermal bullae
pemphigus
281
sub epidermal bullae with eosinophils and linear deposition of IgG and C3 along BM
pemphigoid
282
what are the two infections assoc w erythema multiforme?
HSV
| Mycoplasma
283
What are the few drugs that could cause erythema multiforme?
```
NSAIDs
sulphonamides
ALlopurinol
penicillin
phenytoin
```
284
lesions with mother of pearl sheen with fine white network on their surface (wickam's striae) usually on inner surface of wrists and oral mucous membranes
lichen planus
285
wickam's striae
lichen planus
286
inner surface of wrist. histology showing hyperkeratosis with saw toothing of Crete ridges
lichen planus
287
psoriasis koebner phenomenon
lesions form at sites of trauma
288
Type IV T cell mediated hypersensitivity reaction. Cells in plaque have increased proliferation rate. Histology shows parakeratosis, "test tubes in a rack" appearance, and Munro's microabscesses
Psoriasis
289
Psoriasis what type of hypersensitivity reaction?
Type IV T cell mediated
290
guttate psoriasis
rain drop plaque distribution. often 2 weeks post strep throat
291
2 wks prior had strep throat, now has rain drop plaques.
guttate psoriasis
292
Histology: parakeratosis, test tubes in a rack appearance- clubbing of rite ridges, munro's microabscesses
psoriasis
293
what type of hypersensitivity is contact dermatitis
type IV
294
GI polyps + multiple osteomas (bony outgrowths attached to normal bone) + epidermoid cysts
Gardner Syndrome
295
Multiple enchondromas - syndrome?
Olliers syndrome
296
multiple enchondromas + haemangiomas
Maffuci's syndrome
297
Codman's triangle + sunburst appearance on Xray + elevated ALP
Osteosarcoma
298
Most common bone tumours in children
osteosarcoma
| Ewing's sarcoma
299
sheets of small round cells in histology. CD99 +ve. t(11;22) translocation. Bone
Ewing's sarcoma
300
malignant chondrocytes on histology. Xray showing lytic lesion with fluffy calcification. affects the axial skeleton mainly.
chondrosarcoma
301
negatively birefringent crystals
gout
302
what crystals are usually found in the affected gouty joint?
needle shaped urate crystals
303
swan neck and boutonniere deformities. symmetrical arthropathy, with radial deviation of wrist and ulnar deviation of fingers.
rheumatoid arthritis
304
what inflammatory cytokines are implicated in joint destruction in rheumatoid arthritis?
TNFa
| IL6 and IL1 -> induce MMPs and lead to joint destruction
305
histology shows proliferative synovitis w thickening of synovial membranes, hyperplasia of surface synoviocytes, intense inflammatory cell infiltrate, fibrin deposition and necrosis.
rheumatoid arthritis
306
what leads to joint destruction in rheumatoid arthritis
chronic inflammation due to inflammatory cytokines -> panes formation (inflamed synovium) -> cartilage and bone destruction
307
Heberdens nodes and Bouchards nodes
Osteoarthritis
Heberdens (DIPJ)
Bouchards (PIPJ)
308
what type of fracture shows splintered bone on xray but intact soft tissue?
comminuted
309
what process is this?
organization of haematoma (pro-callus) -> formation of fibrocartilaginous callus -> mineralisation of fibrocartilagnious callus -> remodelling of bone along weight bearing lines
fracture repair
310
most common causative pathogen of osteomyelitis in adults?
staph aureus
311
what causative pathogen is implicated in osteomyelitis in patients with sickle cell disease?
salmonella
312
what causative pathogen is implicated in osteomyelitis in IVDU patients? (apart from staph aureus)
pseudomonas
313
whats the most common pathogens causing osteomyelitis in children?
haemophilus influenza
| group B strep
314
Xray changes show mottled rarefaction (decreased density of bone) + lifting of periosteum. Later, showing involucrum (irregular new bone formation) and sequestra.
Acutely unwell patient, with pain, swelling and tenderness of the area.
osteomyelitis
315
what crystals are usually found in pseudo gout? and what shape?
rhomboid shaped, calcium pyrophosphate crystals
316
what mx in acute gout?
analgesia
| NSAIDS / colchicine
317
what chronic mx in gout?
allopurinol (xanthine oxidase inhibitor)
decrease alcohol intake and purine intake (sardines/ liver)
318
what mx in pseudogout?
NSAIDs or intraarticular steroids
319
Wilsons Disease and HyperPTH predispose to gout or pseudo gout?
pseudogout
320
DEXA scan shows T score
osteoporosis
321
why is tetracycline not given to children?
turns immature bone black e.g. teeth
322
reduced bone mineralization + bone pain/ tenderness + looser's zones
Osteomalacia
323
reduced bone mineralization + bowing tibia,, (bowed legs), bone pain, delayed walking, Xray findings of splaying of metaphysis
rickets
324
Very elevated ALP, normal Ca and phosphate.
Pagets disease
325
bone pain, micro fractures, mixed lytic and sclerotic lesions affecting the spine, skull and pelvis most frequently
Pagets disease
326
High Ca + xray shows browns tumours, salt and pepper skull and subperiosteal bone resorption in phalanges.
HyperPTH -> osteitis fibrosa cystica
327
Brown tumours (cyst-like) + loss of bone mass replaced by fibrous tissues
osteitis fibrosa cystica
328
what biochemistry is usually seen in primary hyperPTH
PTH is high or inappropriately normal
High Ca, low PO4
High / normal ALP
329
what cancer commonly produces PTHrP?
paraneoplastic breast cancer/ squamous cell carcinoma
330
which dementia is pathologically indistinguishable from Parkinson's disease?
Dementia w lewy bodies
331
What is the presenting features in Dementia w levy bodies?
psychological disturbances occur early. e.g day to day fluctuations in cognition, visual hallucinations
motor signs of parkinsonism
recurrent falls and syncope
332
what mx for Alzheimers?
mild-mod: anticholinesterases e.g. Donepezil, Galantamine
| mod-severe: memantine
333
a ventricular brain tumour, causing hydrocephalus
ependymoma
334
most common pathogens in a neonate with bacterial meningitis?
GBS
E coli
Listeria
335
most common pathogens in a neonate with viral meningitis?
echovirus
coxsackie virus
mumps virus
HIV
336
most common pathogen(s) in a young child (1 month to 6 years) with bacterial meningitis?
streptococcus penumoniae
| h. influenza (reduced since vaccinations)
337
most common pathogens in young adults and adolescents with bacterial meningitis
neisseria meningitidis
| strep pneumoniae
338
most common cause of bacterial meningitis in elderly
strep pneumoniae
| gram - bacilli e.g. e coli
339
Turbid CSF, predominantly polymorphs, low glucose, high protein
bacterial meningitis
340
clear CSF, predominantly lymphocytes, normal glucose, normal protein
viral meningitis
341
Opalescent (cob web) CSF, predominantly lymphocytes, low glucose, high protein
TB meningitis
342
most common vascular territory affected in a stroke?
middle cerebral artery
343
Mx for stroke:
aspirin +/- dipyridamole
thrombolytics if <3h from event
+/- carotid endarterectomy
Long term: treat HTN, lipids and anticoagulation
344
what medication is indicated in combination with aspirin to prevent stroke in those who have had a TIA/ previous stroke?
dipyridamole
345
triple assessment in breast cancer?
breast examination, mammogram/USS, FNA & cytology / Biopsy
346
single most important prognostic factor in breast cancer?
status of axillary lymph nodes
347
this breast lesion is mostly benign, but can be aggressive therefore excised with wide local excision/ mastectomy. usually relatively big/ palpable mass.
Phyllodes tumour
348
presents as painless breast mass. has the feel of a firm malignant lump so quite worrying for the patient. completely benign, may be caused by trauma, radiotherapy, surgery
fat necrosis
349
painful red breast, fever, during lactation/ breastfeeding
acute mastitis
350
what organism usually causes acute mastitis?
staph aureus via cracks in nipple
351
mx of acute mastitis?
continued expression of milk
antibiotics flucloxacillin
surgical drainage if abscess formed
352
recurrent subareolar abscesses. histology showing keratinising squamous epithelium. common in smokers and not assoc w lactation.
periductal mastitis
353
poorly defined palpable periareolar mass w thicc white/ green nipple secretions. can cause breast pain. cytology of discharge shows proteinaceous material and inflammatory cells.
Duct ectasia
354
granulomatous inflammation and dilation of large breast ducts. with proteinaceous material and inflammatory cells on cytology
duct ectasia
355
breast lumpiness that fluctuates with menstrual cycle. can lead to calcification that gets picked up on mammography
fibrocystic disease/ fibroadenosis
356
breast mouse. most common benign tumour. rubbery, freely mobile mass. changes in response to hormones thus increase in size during pregnancy and calcify after menopause
fibroadenoma
357
breast: central scarring surrounded by proliferating glandular tissue in stellate pattern
radial scar
358
bloody discharge. no lump. not seen on mammogram. benign tumour
duct papilloma
359
hard fixed lump, pagers disease, nipple retraction, peau dorange
breast carcinoma
360
what is the earliest morphological precursor to low grade ductal carcinoma in situ?
flat epithelial atypia (4x risk of developing BrCa)
361
histological grading of breast ca involves which 3 things?
assessment of nuclear pleomorphism, mitotic activity and tubule formation
362
what is the risk of developing breast cancer from this histological finding? in situ lobular neoplasia
7 x risk
363
what is the risk of developing breast cancer from this histological finding? flat epithelial atypia
4 x risk
364
what is the risk of developing breast cancer from this histological finding? usual epithelial hyperplasia
1.5-2x risk
365
area of microcalcifications on mammogram. may have lump/ pagets disease of the nipple.
ductal carcinoma in situ
366
what is the most common breast carcinoma?
invasive ductal BrCa
367
incidental finding on biopsy where cells lack adhesion protein E cadherin. No microcalcifications. RF for subsequent breast carcinoma
lobular carcinoma in situ
368
which receptor does trastuzumab act on?
HER2 Receptor
369
what receptors have to be positive for tamoxifen to work? (breast cancer)
Oestrogen receptor, progesterone receptor
370
ER/PR +ve Breast ca Mx?
Tamoxifen
371
HER2+ve Breast ca mx?
herceptin/ trastuzumab
372
which type of breast cancer is typically ER/PR/HER2 -ve, has a v poor prognosis. shows sheets of atypical cells with lymhocytic infiltrate and stains positive for CK5/6/14. + many mets?
basal like carcinoma
373
HPV proteins E6 and E7 bind and inactivate which two tumour suppressor genes, leading to cervical cancer?
retinoblastoma (E7) and p53 (E6)
374
dysplasia at transformation zone result of infection by which HPV subtypes?
HPV 16, 18, 33
375
Risk factors of CIN/ Cervical Ca?
```
early age at first intercourse
multiple partners
multiparity
smoking
HIV or immunosuppression
COCP
```
376
Meigs syndrome
pleural effusion + ascites + benign ovarian fibroma
377
which ovarian tumour produces oestrogen?
| causing breast enlargement, irregular menstrual cycle, endometrial/br ca
granulosa-theca cell tumour
378
which ovarian tumour produces androgens?
| causing symptoms like virilisation (hirsutism, deepened voice, enlarged clitoris) and defeminisation (breast atrophy)
sertoli-Leydig cell tymour
379
HCG plasma protein. Which tumour?
choriocarcinoma
380
mature tissues seen in tumour (skin, hair, teeth, bone, cartilage). benign
dermoid cyst. mature teratoma
381
AFP assoc w which ovarian tumour?
germ cell tumours. (immature teratomas)
382
which is the most common type of malignant ovarian tumour?
serous cystadenocarcinoma
383
associated with pseudomyxoma peritonei
mucinous cystadenocarcinoma
384
2nd most common type of malignant ovarian tumour?
mucinous cystadenocarcinoma
385
malignant ovarian tumour derived from surface epithelium, psammoma bodies common.
serous cystadenocarcinoma
386
endometriosis is a risk factor for what type of ovarian cancer?
endometrioid ovarian ca
| and clear cell carcinoma
387
ovarian cancer: abundant clear cytoplasm, hobnail appearance, rare but malignant w poor prognosis, assoc w endometriosis
clear cell ovarian ca
388
VIN assoc w which HPV subtype
16
389
Risk factors of Endometrial carcinoma
increased exposure to oestrogen: early menarche, late menopause, tamoxifen, nulliparity, PCOS, obesity
DM, HTN
390
fibroid - what is it?
leiomyoma
benign tumour of smooth muscle origin
causes heavy bleeding, painful periods, pressure effects (urinary frequency, tenesmus), subfertility
391
adenomyosis - what is it?
presence of ectopic endometrial tissue deep within the myometrium
causes heavy bleeding, painful periods, deep dyspareunia
392
most common causes of Pelvic Inflammatory Disease
chlamydia trachomatis
neisseria gonorrhoea
TB and shistosomiasis are common causes in some parts of the world
393
deep dyspareunia, fever, adnexal tenderness and cervical excitation. + RUQ pain and peri-hepatic adhesions
Fitz Hugh Curtis syndrome
RUQ from peri hepatitis and peri hepatitis adhesions
394
PID complications:
```
Fitz hugh curtis
adhesions leading to infertility/ risk of ectopic pregnancy
tubo ovarian abscess
chronic pelvic pain
plical fusion
```
395
how does endometriosis occur?
implantation from retrograde menstrual flow of endometrial cells
metaplastic transformation of coelomic epitherlial cells
vascular or lymphatic dissemination of endometrial cells
396
fixed retorverted uterus, with chocolate cysts and brown "powder burn" nodules on laparoscopy
endometriosis
397
Polycystic Kidney Disease pattern of inheritance?
Autosomal dominant
398
what gene is involved in polycystic kidney disease?
85%- PKD1 gene on chr 16
15%- PKD2 gene on chr 4
399
common causes of chronic renal failure:
```
diabetes
glomerulonephritis
hypertension and vascular disease
reflux nephropathy
polycystic kidney disease
```
400
large multicystic kidneys with destroyed renal parenchyma, liver cysts, and berry aneurysms
Polycystic Kidney Disease
401
what gene is involved in Polycystic kidney disease, where liver cysts are also seen?
PKD1 gene
on chromosome 16
encoding polycystin-1
402
Polycystic Kidney Disease presentation
haematuria, flank pain, UTI.
usually due to cyst complications such as cyst rupture, cyst infection and cyst haemorrhage
403
what is the categorization of lupus nephritis?
Class I- minimal mesangial lupus nephritis
Class II- mesangial proliferative lupus nephritis
Class III - focal lupus nephritis
Class IV- diffuse lupus nephritis
Class V- membranous lupus nephritis
Class VI- advanced sclerosing
404
lupus nephritis histology showing immune complexes but no structural alteration. Which class?
Class I- minimal mesangial lupus nephritis
405
lupus nephritis histology showing immune complexes and mild/ mod increase in mesangial matrix and cellularity. which class?
Class II- mesangial proliferative lupus nephritis
406
lupus nephritis histology showing active swelling and proliferation in < 50% of glomeruli
Class III - focal lupus nephritis
407
lupus nephritis histology showing involvement of >50% of glomeruli
Class IV- diffuse lupus nephritis
408
lupus nephritis histology showing subepithelial immune complex deposition
Class V- membranous lupus nephritis
409
lupus nephritis histology showing complete sclerosis of >90% of glomeruli
Class VI- advanced sclerosing
410
most common type of renal carcinoma
clear cell carcinoma
411
Golden yellow tumours with haemorrhagic areas. Histology shows nests of epithelial cells with clear cytoplasm set in a delicate cappilary vascular network.
Most common type of renal carcinoma. Well differentiated.
clear cell carcinoma
412
friable brown tumours, most common in dialysis- associated cystic disease. Histology shows epithelial tumours with papillary/ tubopapillary growth pattern. Whch type of renal carcinoma?
Papillary carcinoma
413
Solid brown tumours in the kidney. Histology shows sheets of large cells with distinct cell borders and thick walled vasculature. "pale, eosinophilic cells"
chromophobe (aka pale) renal carcinoma
414
risk factors of renal carcinoma
```
smoking
obesity
HTN
unopposed oestrogen
heavy metals
CKD
```
415
clinical features of Renal carcinoma
palpable mass
haematuria
costovertebral pain
416
most common malignant childhood renal tumour, presents commonly with painless abdo mass. Histology shows undifferentiated 'small blue round cells'
nephroblastoma wilms tumour
417
acute renal failure chemical features
```
metabolic acidosis
hyperK
hyperPO4
fluid overload
HTN
low Ca
Uraemia
```
418
pre renal causes of acute renal failure
caused by renal hypoperfusion
```
e.g.
hypovolaemia
sepsis
burns
renal artery stenosis
```
419
renal causes of acute renal failure
acute tubular necrosis (commonest)
acute glomerulonephritis
thrombotic microangiopathy
420
post renal causes of acute renal failure
obstruction to urine flow
stones, tumours, prostatic hypertrophy, retroperitoneal fibrosis
421
Thrombotic Thrombocytopenia Purpura (TTP) features?
pentad of features
1. fever
2. low platelets
3. MAHA
4. Neuro impairment
5. Kidney impairment
422
haemolytic uraemic syndrome features?
Triad
1. Haemolytic anaemia
2. Uraemia
3. low Pl
423
HUS vs TTP: differences in where thrombi occur
HUS: thrombi generally confined to kidneys
TTP: thrombi throughout circulation esp in CNS
424
assoc with diarrhoea caused by E coli O157 with outbreaks caused by children visiting petting zoos. toxin produced targets renal epithelium causing?
Haemolytic Uraemic Syndrome
425
signs of haemolysis
increased Bilirubin, reticulocytes, LDH
decreased Hb
fragmented RBCs on blood film
426
most common cause of acute pyelonephritis
e coli
427
fever chills, flank pain, leucocytosis, +/- frequency, dysuria, haematuria + White cell casts in urine
acute pyelonephritis
428
causes of chronic pyelonephritis
urine reflux- reflux nephropathy
| chronic obstruction- renal calculi, posterior urethral valves
429
Elderly man on long-term NSAIDS/ paracetamol. Symptoms of HTN, anaemia, proteinuria and haematuria
chronic interstitial nephropathy
analgesic nephropathy
430
hypersensitivty reaction. days after taking drug (ABx, nsaids, diuretics) causing fever, skin rash, haematuria, proteinuria and eosinophilia.
acute interstitial nephritis
431
muddy brown granular casts + histology showing necrosis of short segments of tubules, oedema fluid between tubules
acute tubular necrosis
aka
acute tubular injury
432
most common cause of acute renal failure
acute tubular necrosis
433
causes of acute tubular necrosis
nephrotoxin- drugs, (NSAIDs, gentamicin), radiographic contrast agents, myoglobin, heavy metals
ischaemia- burns, septicaemia
434
1-3 wks after strep throat infection or impetigo
| haematuria, proteinuria and oededma. raised ASOT titre
post streptococcal glomerulonephritis
435
most common pathogenic trigger for post strep glomerulonephritis
strep pyogenes.
a group A alpha haemolytic strep
436
post strep glomerulonephritis- what do you see on ix?
raised anti-streptolysin O titre
| decreased C3
437
1-2 days after upper respiratory tract infection, frank haematuria, or asymptomatic microscopic haematuria
IgA nephropathy
(berger disease)
causes by IgA immune complexes in the glomeruli
438
granular deposition of IgA and complement in mesangium on kidney histology + frank haematuria
IgA nephropathy
439
most aggressive glomerulonephritis- can cause end stage renal failure in days to weeks
rapidly progressive (crescentic) glomerulonephritis
440
Goodpastures syndrome with pulmonary haemorrhage and haematuria. with sudden oliguria and renal failure.
Type 1 crescentic glomerulonephritis (aka rapidly progressive GN)
441
SLE, sudden oliguria and renal failure. light microscopy shows crescents in kidneys.
Type 2 crescentic GN
442
saddle nose, pulmonary haemorrhage and haematuria with sudden onset oliguria and renal failure requiring dialysis
Type 3 crescentic GN (rapidly progressive)
443
Pattern of deposition of IgG in glomerular BM seen in Goodpastures
Linear
444
Pattern of deposition of IgG immune complexes on glomerular BM/ mesangium in SLE/ Ig A nephropathy, post infectious GN
granular
445
nephritic syndrome + sensorineural deafness + eye disorders (lens dislocation, cataracts) in a young adolescent (5-20 yrs old)
Alports syndrome
446
Alports syndrome - mutation in what?
type IV collagen alpha 5 chain
447
What is the inheritance of alports syndrome?
x linked
448
asymptomatic microscopic haematuria. automosal dominant pattern - runs in the family. renal function normal
benign familial haematuria
| thin basement membrane disease
449
in thin basement membrane disease, aka benign familial haematuria, what is the mutation in?
type IV collagen alpha 4 chain
450
what is the filtration barrier made of? in the kidney
```
fenestrated endothelium
basement membrane (Type IV collagen)
podocytes (w foot processes)
```
451
what is the innermost layer (1st layer) of the filtration barrier?
fenestrated endothelium
452
what is the outermost layer (last layer) of the filtration barrier?
podocytes (w foot processes)
453
what is nephrotic syndrome characterised by?
proteinuria (>3g/24h) + hypoalbuminaemia + oedema
+hyperlipidaemia + hypercoagulable state (lostt of ATIII) + increased risk of infection (loss of Ig)
454
swelling of ankles and eyelids + frothy urine
nephrotic syndrome
455
most common cause of nephrotic syndrome in children?
minimal change disease
456
most common cause of nephrotic syndrome in adults?
focal segmental glomerulosclerosis
then membranous
457
light microscopy showing focal and segmental consolidation and scarring, hyalinosis.
focal segmental glomerulosclerosis
458
light microscopy showing diffuse glomerular basememnt membrane thickening
membranous glomerular disease
459
diffuse glomerular BM thickening + Kimmelsteil Wilson nodules
diabetes
460
what drug is associated with haemorrhagic cystitis?
cyclophosphamide
461
Commonest cause of cystitis
E coli
462
tx of acute cystitis?
trimethoprim / nitrofurantoin
463
what is the most common bladder tumour?
transitional cell tumour
464
risk factors of transitional cell tumours
smoking, industrial exposure to aromatic amines
465
painless haematuria, frequency, urgency + smoker of 50 pack year
transitional cell carcinoma
466
diagnosis of transitional cell carcinoma
cystoscopy and biopsy
467
bladder tumour associated w shistosomiasis
squamous cell carcinoma
468
difficulty urinating (terminal dribbling, hesitancy), retention, frequency, nocturia, frequent UTIs. hyperplasia mediated by dihydrotestosterone.
benign prostatic hyperplasia
469
tx of benign prostatic hyperplasia
TURP
| 5a reductase inhibitors
470
what is the most common form of prostate cancer?
adenocarcinoma
471
risk factors of prostate cancer
** family history
age
hormonal and environmental influences. e.g. diet- red meat
472
most common malignant tumour in men?
prostate cancer
473
precursor lesion of prostate cancer?
prostatic interstitial neoplasia
474
Diagnosis and Grading of prostate cancer?
diagnosis by history, examination, PSA >4ng/ml
| Grading by Gleason score
475
severe colicky pain in flank to groin, haematuria
urinary calculi
476
complications of renal stones
obstruction - post renal acute renal failure
| recurrent UTIs
477
most common testicular tumour
seminoma (resembles germ cells)
478
biggest risk factor of germ cell cancer (testicular cancer)
cryptorchidism
- undescended testes
479
in gout/ rapid cell turnover, what types of renal stones are formed
uric acid
480
mx of large renal stones
removed by endoscopic/ percutaneous methods
| shock wave lithotripsy
481
hyper calcaemia - what types of renal stones are formed
calcium oxalate
482
large staghorn calculi -- usually what types of stone would contribute to this
magnesium ammonium phosphate (triple stones)
483
what pattern of inheritance in haemochromatosis?
autosomal recessive
484
what pattern of inheritance in wilson's disease?
autosomal recessive
485
what pattern of inheritance in alpha 1 antitrypsin deficiency?
autosomal dominant
486
ix shows increased Iron, increased ferritin, high transferrin saturation and reduced Total iron binding capacity. + bronzing of skin, hepatomegaly with micronodular cirrhosis, hypogonadis, psuedogout
haemochromatosis
487
mutated HFE gene
haemochromatosis
488
mutated ATP7B gene
wilsons disease
489
Rhodanine stain
for copper in wilsons disease
| stains golden brown
490
Cirrhosis, parkinsonism, psychosis, kayser fleischer rings. microscopy shows mallory bodies and fibrosis. rhodanine stain +ve.
wilsons disease
491
in wilsons disease, ix?
low serum copper
high urinary copper
low serum caeruloplasmin (cu binding protein)
492
alpha 1 antitrypsin - where is it normal synthesized?
hepatocytes
493
alpha 1 antitrypsin deficiency presentation?
AT1A accumulates in hepatocytes where it is synthesized -> hepatitis and cirrhosis
emphysema due to lack of AT1A in the lungs
494
liver stained with periodic acid schiff shows intracytoplasmic inclusions
alpha 1 antitrypsin deficiency
| intracytoplasmic inclusions are the accumulated A1AT unable to be secreted by the hepatocytes
495
Alpha 1 antitrypsin deficiency Ix?
low serum A1AT
| absent alpha-gobulin band on electrophoresis
496
Tx of wilsons disease
lifelong penicillamine (cu chelating agent)
497
tx of haemochromatosis
venesection
| desferrioxamine
498
inflammation and obliterative fibrosis of extrahepatic and intrahepatic bile ducts
primary sclerosing cholangitis
499
ERCP showing beading of the bile duct - multi focal stricture formation with dilation of preserved segments
primary sclerosing cholangitis
500
Primary scleroising cholangitis associated with?
ulcerative colitis
501
Primary scleroising cholangitis increases risk of which cancer?
cholangiocarcinoma
502
PSC assoc with which auto antibodies?
pANCA
anticardiolipin in 66%
antinuclear antibodies in 53%
503
autoimmune inflammatory destruction of medium sized intrahepatic bile ducts. histology: bile duct loss with granulomas
primary biliary cirrhosis
504
antibodies associated with primary biliary cirrhosis
anti mitochondrial antibodies
505
Primary biliary cirrhosis presentation
fatigue, pruritus, abdo discomfort.
xanthelasma, steatorrhoea, vit D malabsorption, inflammatory arthropathy
can tx w ursodeoxycholic acid
506
Primary biliary cirrhosis Ix?
high Alkphos
high cholesterol
high IgM
late high Br
507
autoimmune hepatitis antibodies?
```
Type 1:
anti nuclear antibodies
anti smooth muscle,
anti actin
anti soluble liver antigen
```
Type 2:
antil-LKM (liver kidney microsomal)
508
acute hepatitis histological features?
spotty necrosis
509
hepatic steatosis in non alcoholic, obese individual with hyperlipidaemia/ metabolic syndrome
non alcoholic fatty liver disease
510
non alcoholic steatohepatitis
steatosis: fatty infiltration
hepatitis
can progress to cirrhosis
511
fat droplets in hepatocytes, but still fully reversible if alcohol avoided
large, pale, yellow and greasy liver
fatty liver
512
hepatocyte ballooning and necrosis
mallory-denk bodies
fibrosis
alcoholic hepatitis
513
fatty liver turns into shrunken non fatty, brown liver. micronodular cirrhosis
alcholic cirrhosis.
514
what causes portal hypertension?
prehepatic: portal vein thrombosis
hepatic: cirrhosis
posthepatic: budd-chiari syndrome
515
where do collateral vessels form in portal hypertension?
```
oesophageal varices
rectum
anterior abdominal wall -> caput medusae
retroperitoneum
diaphragm
```
516
portal hypertension tria of?
ascites
splenomegaly
varices e.g oesophageal
517
what staging system is used to indicated prognosis in liver cirrhosis
modified childs pugh score
scores based on ascites, encephalopathy, bilirubin, albumin, prothrombin time
518
hepatocyte necrosis, fibrosis (showing collagen in liver), nodules of regenerating hepatocytes, disruption of liver architecutre
cirrhosis
519
causes of macronodular regeneration of hepatocytes
viral hepatitis, Willsons disease, alpha 1 antitrypsin deficiency
520
causes of micronodular regeneration of hepatocytes
alcoholic hepatitis, biliary tract disease
521
what cell is responsible for the fibrosis seen in liver cirrhosis?
stellate cells
chronic inflammation causes activation of stellate cells in the space of disse. They become myofibroblasts -> initiating fibrosis by deposition of collagen
522
complications of cirrhosis
portal hypertension
hepatic encephalopathy
hepatocellular carcinoma
523
benign liver tumour associated with OCP, presents with abdo pain/ intraperitoneal bleeding
hepatic adenoma
524
which zone in the liver receives more blood rich in nutrients and oxygen
zone 1. near the portal tract
525
which vitamins are stored in the liver
vitamins A, D, B12 and K
526
MEN2A
2Ps, 1 M
| Parathyroid, Medullary thyroid, Phaeochromocytoma
527
MEN2B
1P 2M
Phaeochromocytoma + medullary thyroid + mucosal neuroma
+ marfanoid habitus
528
neuroendocrine tumour assoc w hypoglycaemic attacks
insulinoma
529
neuroendocrine tumour assoc with recurrent peptic ulceration
zollinger- ellison
530
neuroendocrine tumour assoc w diarrhoea
VIPoma
Vasoactive intestinal peptide
531
CA19.9
Pancreatic Carcinoma
532
Pancreatic Carcinoma tumour marker
CA 19.9
533
what are the endocrine functions of the pancreas?
alpha cells - glucagon
beta cells - insulin
delta cells - somatostatin
534
what are the exocrine secretions of the pancreas?
lipases, proteases, amylases
535
fasting hyperglycaemia, HTN, central obesity, dyslipidaemia, microalbuminaemia
metabolic syndrome
536
what is the most sensitive serum marker of acute pancreatitis?
serum lipase
537
Colorectal cancer tumour marker
CEA carcinoembryonic antigen
538
Carcinoembryonic antigen (CEA)
colorectal cancer
539
What staging is used in colorectal cancer
Duke's staging
540
multiple polyps in colon, mucocutaneous hyperpigmentation, freckles around mouth, palm and soles.
peutz jeghers syndrome
aut dominant
541
sterile fibrin and platelet vegetations present on cardiac valves, more commonly affected L sided H valves (mitral> aortic). absence of inflammation or bacteria. Assoc w numerous diseases, esp advanced stage malignancy. recurrent emboli
non bacterial thrombotic endocarditis.
542
non bacterial thrombotic endocarditis?
sterile fibrin and platelet vegetations present on cardiac valves (usually mitral)
absence of inflammation or bacteria.
Assoc w numerous diseases, esp advanced stage malignancy. & recurrent emboli
543
fever, new onset murmur, changing murmur, blood cultures +, Roth spots, laneway lesions, Osler's nodes
Infective endocarditis
544
Libman-sacks endocarditis assoc w?
SLE
545
cystic medial necrosis: affects the aorta, causing focal degeneration of the elastic tissue and muscle fibres in the media, w accumulation of basophilic ground substance
assoc w?
aortic dissection
546
aortic dissection assoc w which syndrome?
Marfans
547
After an MI, histology is normal. (CK-MB also normal)
| how long ago was the MI?
under 6 hours
548
After an MI, histology shows loss of nuclei in the myocardial cells, homogenous cytoplasm, necrotic cell death. how many hours after the MI is it?
6 - 24 hours
549
After an MI, histology shows infiltration of polymorphs then macrophages (to clear up the debris). Debris is present and the cytoplasm is homogeneous so that it is difficult to see the outlines of the myocardial fibres. How long after the MI is it?
1-4 days
550
After an MI, histology shows removal of debris. how long after the MI is it?
5-10 days
551
after an MI, histology shows myofibroblasts, angioblasts, macrophages. The area undergoes repair and a classic young scar with new capillaries is seen with early collagenization. how long after the MI is it?
1-2 weeks
552
after an MI, histology shows strengthening of the area with formation of a decellularizing scar tissue. how long after the MI is it?
weeks to months
553
polymyositis vs dermatomyositis?
both have the same muscle components involved
dermatomyositis has the accompanied skin features - periorbital oedema and heliotrope rash + gottrons papules
also polymyositis tends to have a positive electromyogram result compared to dermatomyositis
554
mutation in gene coding for alpha synuclein and mostly free of Lewy bodies on histology. + parkinsonism
what condition?
familial Parkinsons Disease
555
in Multiple sclerosis, histology shows oedema and macrophages, indicated of an inflammatory diorder of the CNS< with some myelin breakdown. Reactive astrocytosis present. What kind of plaque is this?
early chronic active plaque
556
in Multiple sclerosis, histology shows complete loss of myelin. Some macrophages with contain myelin debris and there will be often very mild perivascular inflammation at this stage with enlarged perivascular spaces. what kind of plaque is this?
late chronic active plaque
557
in multiple sclerosis, histology shows complete loss of myelin w the absence of macrophages. what kind of plaque is this?
chronic inactive plaque
558
In multiple sclerosis, histology shows nearly complete remyelination as a thin myelin with some scattered macrophages and a mild microglial up regulation. what kind of plaque is this?
shadow plaque
559
in multiple sclerosis, histology shows minor changes e.g. oedema and often difficult to recognize. what kind of plaque is this?
active plaque
560
in Alzheimers disease, where is brain atrophy most prominent? (which parts of the brain)
hippocampus (earliest change)
| and frontal lobe
561
what parts of the brain shows cerebral atrophy in Huntington's disease?
caudate nucleus and putamen
562
Papp- Lantos bodies (glial cytoplasmic inclusion bodies) in brain
Multiple system atrophy
563
in H pylori associated gastritis, which part of the stomach is most severely affected?
pyloric antrum
564
Gastritis most severe in the pyloric antrum. what is the most likely cause?
H pylori associated gastritis
565
autoimmune chronic gastritis associated w pernicious anaemia in the elderly typically affects which part of the stomach?
stomach body
566
histology of pancreas showing inflammation with parenchymal fibrosis, loss of pancreatic parenchymal elements and duct strictures with formation of intra pancreatic calculi. (Xray shows the calculi well!)
chronic pancreatitis
567
what HLA type is associated with T1DM
HLA DR3/ DR4
568
excessive fluid intake w no orgnanic pathology
psychogenic polydipsia
569
gastric hypersecretion, multiple peptic ulcers and diarrhoea caused by gastric secreting tumour of the pancreatic G cells
zollinger-Ellison syndrome
570
which Hepatitis virus is the only DNA virus?
Hep B
571
continous inflammation extending proximally from rectum. bloody diarrhoea + mucus.
ulcerative colitis
572
skip lesions, can affect whole GI tract from mouth to anus, most commonly in terminal ileum and caecum. Transmural inflammation and non caseating granulomas, thickened walls of the bowel. Rubber hose wall and cobblestone mucosa
crohns disease
573
autosomal dominant mutations in DNA mismatch repair genes. Carcinomas in the colon, with polyps quickly progressing to malignancy. assoc w endometrial, ovarian, small bowel, transitional cell and stomach carcinoma as well.
Hereditary non-polyposis colorectal cancer (HNPCC)
574
autosomal dominant condition caused by mutation in FAP gene. presence of 100s - 1000s of adenomatous polyps
familial adenomatous polyposis
575
bronchoconstriction, flushing, diarrhoea
carcinoid syndrome
576
carcinoid syndrome ix?
24 hr urine 5-HIAA (main metabolite of serotonin)
577
life threatening vasodilation, hypotension, tachycardia, bronchoconstriction, hyperglycaemia. tumours of enterochromaffin cell origin.
carcinoid crisis
too much serotonin
mx: octreotide (somatostain analogue)
578
smoking worsens symptoms in which condition? crohns or ulcerative colitis
crohns
579
backwash ileitis occurs in ?
ulcerative colitis
580
ischaemic colitis - what areas tend to be affected
watershed areas like splenic flexure and rectosigmoid
581
what GI abnormalities are more common in downs?
Tracheooesophageal fistula, Duodenal stenosis/ atresia, imperforate anus, hirschsprungs disease
582
epigastric pain, worse at night, relieved by food and milk. RF: h pylori, drugs e.g. NSAIDS and aspirin, smoking
Duodenal Ulcer
583
complications of Duodenal ulcer:
anaemia (IDA)
| perforation
584
What HLA is associated with coeliac?
HLA DQ2 amd DQ8
585
the most sensitive and specific antibody for coeliac?
anti tissue transglutaminase (IgA)
586
epigastric pain +/- weight loss, worsened with food, relieved by antacids
Gastric Ulcer
Risk factors: H pylori, smoking, NSAIDs
587
chronic h pylori infection -> chronic antigenic stimulation -> increases risk of?
ulcer -> Gastric MALToma
complications: bleeding - anaemia, shock. perforation- peritonitis
588
metaplasia of squamous mucosa in oesophagus to columnar epithelium
Barretts oesophagus
589
barretts oesophagus assoc with increased risk of which cancer?
oesophageal adenocarcinoma
590
oesophageal cancer associated with ETOH and smoking, most commonly found in middle 1/3 of oesophagus. Presenting w progressive dysphagia, odynophagia, anorexia and severe weight loss.
Squamous cell oesophageal carcinoma
591
engorged dilated veins in oesophagus, usually due to portal HTN
oesophageal varices
592
dilatation of the airways and excess mucus production + chronic cough and sputum . histology showing goblet cell hyperplasia and hypertrophy of mucous glands
chronic bronchtiis
593
permanent airway dilatation (of bronchi) and scarring. Associated with cystic fibrosis, kartagener's. chronic cough, purulent sputum.
bronchiectasis
594
histology showing loss of alveolar parenchyma. airspace enlargement and wall destruction. associated with alpha 1 antitrypsin deficiency, connective tissue disease e.g. Marfans
emphysema
595
episodic cough, wheezing and dyspnoea. histology shows curschman spirals, eosinophils, carcot-leyden crystals, smooth muscle cell hyperplasia and excess mucus.
asthma
596
Curshman spirals + Charcot-Leyden crystals on histology
Asthma
597
emphysema complications
bullae may rupture -> pneumothorax
| pulmonary hypertension and cor pulmonale
598
honey comb lung, end inspiratory crackles, features of restrictive lung disease on spirtometry. progressive patchy interstitial fibrosis.
pulmonary fibrosis
599
non-neoplastic lung reaction to inhalation of mineral dusts or inorganic particles. usually affects the upper lobe.
pneumoconiosis
600
Histology showing cogestion -> red hepatization (neutrophilia) -> grey hepatization (fibrosis) -> resolution.
what condition?
lobar pneumonia
601
Mx of Adenocarcinoma of lung
Anti EGFR drugs (erlotinib)
| tyrosine kinase inhibitor
602
which type of lung cancer is commonly associated with ectopic ACTH secretion (Cushings) and lambert-eaton?
small cell carcinoma
603
acute onset SOB, pleuritic chest pain, wedge shaped infarct in lung
pulmonary embolus
604
histology showing intra alveolar fluid + iron laden macrophages. SOB. caused by left heart failure
pulmonary oedema
605
widespread saddle shape ST elevation on ECG
pericarditis
606
complications of MI
VF/ VT
ventricular wall rupture (-> haemopericardium)
septal rupture (L to R shunt, VSD)
papillary muscle rupture (mitral regurg - pansystolic murmur)
607
what is the most common cause of sudden death with MI?
VF
90% of patients develop an arrhythmia following MI
608
progressive loss of myocytes
dilated cardiomyopathy
609
SOB, orthopnoea, Paroxymal nocturnal dyspnoea, wheeze, fatigue. Pulmonary oedema.
+ decreased cardiac output
left heart failure
610
peripheral oedema, ascites, facial engorgement. hepatomegaly.
Right heart failure
611
myocardial hypertrophy without ventricular dilation. Autosomal dominance. heart is thick walled, heavy, hyper contracting.
hypertrophic obstructive cardiomyopathy
may cause sudden cardiac death in young ppl.
612
```
carditis (endocarditis, myocarditis, pericarditis)
arthritis
syndenhams chorea
Erythema marginatum
Subcutaneous nodules
```
Jones major criteria for Rheumatic Fever
613
Rheumatic fever
2-4 wks after strep throat infection
carditis, arthritis, sydenhams chorea, erythema marginatum, subcutaneous nodules
fever, raised CRP/ESR
614
what valve is most commonly affected in rheumatic fever?
mitral
some aortic
615
```
Anitschkov myocytes (enlarged macrophages found within granulomas) + Aschoff bodies (granulmoas)
pathognomonic of ?
```
Rheumatic fever
616
Tx of rheumatic fever?
Benzylpenicillin
617
what is the pathogenesis of rheumatic fever?
molecular mimicry
antibodies to streptococcal antigen cross react with myocardial antigens
618
small warty vegetations found along the lines of closure of valve leaflet - 'verrucae'
rheumatic heart disease
619
small, warty vegetations that are sterile and platelet rich. assoc w SLE and anti phospholipid syndrome
libman sacks endocarditis
620
most common cause of infective endocarditis overall, in those w prosthetic valves, and in IVDU
staph aureus
621
most common cause of subacute infective endocarditis
strep viridans
usually on damaged heart valves
622
what are the immune phenomena of infective endocarditis?
roth spots
oslers nodes
heamaturia due to glomerulonephritis
623
what are the thromboembolic phenomena of infective endocarditis?
```
janeway lesions
septic abscesses in brain/ lungs/ spleen/ kidney
microemboli
splinter haemorrhages
splenomegaly
```
624
what valves are usually involved in infective endocarditis? and in IVDU users?
usually left sided, mitrac and aortic valves
IVDU: right sided valves
625
collection of histiocytes and macrophages with or without multinucleate giant cells
granuloma
626
centrally located lung tumours
small cell lung carcinoma
| squamous cell lung cancer
627
what part of the lungs does asbestosis tend to affect
lower lobes
628
histopathology of spongiosis of epidermis and perivascular chronic inflammatory infiltrate in the dermis
eczema
629
fracture penetrates skin surface and is also known as an open fracture
compound fracture
630
bone breaks and the two ends are pushed towards each other
impacted fracture
631
subchondral sclerosis, subchondral cysts, loss of joint space and osteophytes. (LOSS)
osteoarthritis
632
bamboo spine
ankylosing spondylitis
633
circinate balanitis, keratoderma blenorrhagicum
reiters
| reactive arthritis
634
arthritis + erythema chronicum migrans (BIG target)
lyme disease
| caused by borrelia burgdorferi
635
osteomyelitis in big toe is usually secondary to?
diabetic skin ulcer
636
Histology core biopsy codeof breast tissue. B5=?
Malignant
5a = ductal carcinoma in situ
5b= invasive carcinoma
637
cysts in patients on dialysis
acquired cystic disease
638
what does stag horn calculi in the kidney predispose to?
hydronephrosis -> renal scarring and atrophy
639
what organisms are likely to cause triple stones consisting of magnesium, ammonium and phosphate?
urease-producing organisms e.g. proteus.
640
basophils are a poor prognostic factor in which haematological malignancy?
chronic myeloid leukaemia
641
in which part of the nephron do most urinary calculi form?
collecting duct
642
angina at rest suggesting what % stenosis?
90%
643
ECG showing ST depression changes in the anterior leads?
there is likely to be obstruction of the left anterior descending artery (left circumflex artery obstruction will involve lateral leads). ST depression is suggestive of subendocardial necrosis due to ischaemia of the inner 1/3 of the heart muscle. (transmural infarction involving all layers will cause ST elevation).
644
what is the most significant independent risk factor of coronary heart disease?
family history
645
which subtype of invasive breast cancer forms tubules with low-grade nuclei?
tubular
646
basal like carcinoma- what cytokeratins?
CK5/6 and CK14
647
which subtype of malignant breast cancer produces abundant quantities of extracellular mucin?
mucinous
648
acute mastitis. what inflammatory cell is likely to be found in high quantities in the tissue?
neutrophil
649
what proteasome inhibitor to treat multiple myeloma?
bortezomib.
650
which zone of the hepatic lobule is more susceptible to injury by toxins?
zone 3.
| has more mature haptocytes w more enzymes that will convert toxins into active metabolites
651
how are drugs most likely to affect renal function?
acute interstitial nephritis.
e.g antibiotics, analgesics, diuretics
652
goodpasture's syndrome. what molecular target are the antibodies targeted against?
non-collagenous domain of a3 unit of type IV collagen
653
in thin membrane disease, what molecular target are antibodies targeted against?
a4-unit of type IV collagen
654
in Alport's syndrome, what molecular target are antibodies targeted against?
a5-unit of type IV collagen
655
what renal cell cancer shows pale eosinophilic cells on biopsy?
chromophobe renal cell carcinoma
| also seen in benign oncocytoma
656
what monoclonal antibody can be used to treat haemolytic uraemia syndrome?
eculizumab: anti-C5 antibody
targets the C5 complement of the complement system
657
bronchiectasis + liver cirrhosis. what stain can be used to detect the intracytoplasmic inclusions?
periodic acid schiff stain.
alpha 1 antitrypsin deficiency.
658
what does grade indicate about hepatocellular carcinoma?
| and stage?
inflammation.
stage- fibrosis.
659
histopathology coding for breast sample from B1 to B5?
B1 = normal breast tissue. B2 = benign abnormality. B3= lesion of uncertain malignant potential. B4= suspicious of malignancy. B5= malignant (a = DCIS, b= invasive carcinoma)
660
single most impt prognostic factor for breast cancer?
axillary lymphadenopathy
661
stap aureus is gram ?, catalase?, coagulase?
triple +. gram +, catalase and coagulase +
662
subcorneal (upper layer of epidermis) bullae formation. very thin/ superficial bullae.
pemphigus foliaceus
663
term for intercellular oedema?
spongiosis
664
term for loss of keratinocyte cohesion
acantholysis
665
avg turnover rate of keratinocytes?
| and what is the average turnover rate in psoriasis?
56 days.
in psoriasis- 7 days.
epidermis gets thicker due to increased turnover of keratinocytes. with small abscesses within epidermis.
666
• Present in oral cavity as white lines, purply/silvery lines around the wrist/arm.
lichen planus
667
in lichen planus, where does the reaction occur causing pathology?
Reaction occurs at the basement membrane (dermoepidermal junction) causing death of the basal keratinocytes.
668
an inflammatory dermatosis, usually a manifestation from other systemic diseases. Ulcer, painful, rolled edge and looks similar to a skin carcinoma . Histology - filled w inflammatory cells. assoc w IBD, sarcoidosis, malignancy
Pyoderma Gangrenosum
669
Central area of ulceration with rolled edges and pearly white rim around it.
Basal Cell Carcinoma.
| Do not metastasise but locally destructive.
670
rodent ulcer
BCC
671
Invagination of overlying epidermis within the dermis. The lesion has a layer of epidermis around and is filled with keratin. Once infected, smells pungent and like cheese.
Epidermoid cyst.
smooth, film, with central punctum. doesn't transilluminate/ not mobile.
672
which skin cancer has higher rate of recurrence? BCC/SCC?
SCC.
Likelihood of local recurrence is much higher with perineal (nerve cell) invasion as the cancer cells travel down using the nerve cell.
673
what is responsible for selectivity of the filtration barrier of the kidney?
podocyte slit diaphragm.
674
Polycystic Kidney Disease- inheritance pattern?
autosomal dominant.
renal failure from 40-70 yrs due to cysts compressing rest of parenchyma -> no functioning nephrons
675
PCKD assoc w?
liver cysts and berry aneurysms
676
why does acute tubular injury cause failure of glomerular filtration?
* Blockage of tubules by casts
* Leakage of fluid from tubules to interstitium reducing flow
* secondary haemodynamic changes (as tubule get injured, glomerulus gets signal to decrease GFR)
677
causes of crescentic glomerulonephritis (rapidly progressive)
Type 1: anti GBM disease
Type 2: immune complex mediated.
Type 3: pauci immune assoc w ANCA
678
causes of immune complex associated crescentic glomerulonephritis
SLE, IgA nephropathy, post-infectious GN.
Granular IgG immune complex deposition on GBM.
679
What sort of IgG deposition on glomerular BM in goodpastures syndrome?
Linear
680
pathology of pauci-immune crescentic Glomerulonephritis?
* Usually associated with anti-neutrophil cytoplasm antibodies (ANCA).
* These antibodies cause neutrophil activation leading to glomerular necrosis
681
Mx of crescentic glomerulonephritis
Correct diagnosis and treatment are urgent – aggressive immunosuppression or plasma exchange.
leads rapidly to irreversible renal failure.
682
renal impairment in diabetics? mesangial expansion + proteinuria followed by nodular sclerosis in the glomerulus
diabetic glomerulosclerosis
683
Glomeruli look normal apart from effacement of foot processes on EM.
minimal change disease.
684
glomeruli develop segmental scars. + nephrotic syndrome
focal segmental glomerulosclerosis
685
microscopic haematuria. familial. autosomal dominant.
thin basement membrane disease.
| type IV collage alpha 4 chain mutation.
686
commonest glomerulonephritis worldwide
IgA nephropathy
687
complications of GORD
ulceration, haemorrhage, perforation, stricture, Barrett's oesophagus
688
inflammation of oesophagus assoc w allergic reaction to food. spasm of the muscle leads to dysphagia.
eosinophilic oesophagitis
tx: steroids + remove allergen
689
complications of gastric ulcer
bleeding -> anaemia/ shock, perforation leading to peritonitis
690
where is cortical bone found?
long bones, 80% of skeleton.
| appendicular. mainly mechanical and protective.
691
where is cancellous bone found?
verterbrae and pelvis. axial. mainly metabolic.
692
glucocorticoid effect on osteoclasts?
Early, transient increase in osteoclast survival, cancellous osteoclasts, bone resorption
693
glucocorticoid effect on osteocytes
Increased apoptosis -> decreased canalicular circulation -> decreased bone quality
694
glucocorticoid effect on osteoblasts
* Decreased osteoblastogenesis
* Increased apoptosis
* Early and continual decrease in cancellous osteoblasts, synthetic ability and bone formation
695
pathogenesis of gall bladder causing acute pancreatitis?
• Gallstone stuck distal to where the common bile duct and pancreatic ducts join leads to: reflux of bile up the pancreatic duct followed by damage to acini with release of proenzymes which then become activated
696
pancreatic intraductal neoplasia precursor to?
ductal carcinoma
697
what mutation is highly assoc w ductal carcinoma?
k-ras
698
why does pancreatic cancer lead to VTE?
mucin produced by cancer cells causes blood to be thicker
699
histology of rheumatoid arthritis
```
Proliferative synovitis with
o Thickening of synovial membranes (villous)
o Hyperplasia of surface synoviocytes
o Intense inflammatory cell infiltrate
o Fibrin deposition and necrosis
```
700
what is the inflamed synovium at the articular surface called?
pannus
701
pseudgout causes
sporadic, haemochromatosis, hypoMg, low pO4, osteoarthritis, hereditary, traumatic
702
Familial adenomatous polyposis inheritance pattern?
auto dominant
703
what gene involved in familial adenomatous polyposis?
APC tumour suppressor gene
| on chr5q21
704
Multiple (100s) adenomas in GI tract + multiple osteomas of skull/ mandible + dental caries + epidermoid cysts, demoed tumours + post surgical mesenteric fibromatoses
Gardners syndrome
705
Hereditary Non Polyposis Colorectal Cancer HNPCC assoc w which gynae ca
endometrial, ovarian
706
HNPCC inheritance pattern?
auto dominant
707
Dukes Staging
o A = confined to wall of bowel
o B = through wall of bowel
o C = lymph node metastases
o D = distant metastases
708
what makes a vulnerable plaque?
• Lots foam cells, thin fibrous cap, few smooth muscle cells, clusters inflammatory cells
709
what does the left anterior descending artery supply?
ant wall LV, ant septum, apex
710
what does the right coronary artery supply?
post wall LV, post septum, post RV
711
what does the Left circumflex artery supply?
lat LV not apex
712
myocardial rupture after MI - what is most commonly affected?
free wall most common, septum less common, papillary muscle least common.
713
what carcinogens does smoke contain?
Polycyclic aromatic hydrocarbons, N Nitrosamines, Nicotine, Phenols, Nickel, Arsenic
714
what mutation suggests good response to tyrosine kinase inhibitors e.g. erlotinib?
EGFR mutation
715
what mutation predicts non response to anti EGFR therapy?
k-rase
716
Cytology of nipple discharge shows proteinaceous material, inflammatory cells only.
Duct ectasia
717
A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue.
radial scar.
| stellate lesions on screening mammograms
718
most common type of urinary calculus
calcium oxalate
719
most common renal carcinoma. Grossly appear as golden yellow tumours with haemorrhagic areas.
clear cell renal cell carcinoma
720
second most common renal carcinoma. Grossly appear as friable brown tumours.
papillary renal cell carcinoma
721
renal cell tumour. appears as solid brown tumours. 5% of all renal carcinomas.
chromophobe renal cell carcinoma
722
bilateral metastases composed of mucin producing signet ring cells. most often of gastric origin or breast
krukenberg tumours
723
sterile fibrin and platelet vegetations on cardiac valves. assoc w advanced stage malignancy. recurrent emboli
non bacterial thrombotic endocarditis.
NBTE - source of thromboembolism to brain, heart, kidneys.
724
strep agalactiae is an e.g. of?
GBS
725
what murmur is most consistent with acute rheumatic fever?
mid diastolic murmur at mitral region (mitral stenosis)
726
what mutation is assoc w poorer response to cisplatin in tx of non small cell lung cancer?
ERCC1
727
epidermal hyperplasia, increased thickness of stratum spinosum.
acanthosis
728
thickening of stratum corneum and increased keratin
hyperkeratosis
729
retention of nuclei in stratum corneum. mode of keratinization
parakeratosis
730
cellulitis most common cause?
strep pyogenes
