Histopath hard to recall Flashcards
What is Verner Morrison syndrome?
The association of secretory diarrhoea with intestinal tumours secreting vasoactive intestinal peptide (VIP) - VIPoma.
U&Es with verner morrison syndrome?
Hypokalaemia
Hyponatraemia
Low chloride
Metabolic acidosis
What is whipple’s disease?
Bacterial infection which causes GI symptoms and affects joints
What stain is diagnostic in whipple’s disease?
periodic acid-Schiff (PAS)-positive macrophages
Gastric adenocarcinoma findings on endoscopy and histology?
Linitis plastica - Thickened rigid gastric wall known as ‘leather bottle stomach’ indicating infiltration into all layers of the gastric wall
Signet ring cells
What is seen on histology of adenocarcinoma in the stomach?
Signet ring cells diffusely infiltrating the mucosa
What is polyarteritis nodosa associated with?
Hep B and C
What conditions are massive splenomegaly seen in?
CML
Myelofibrosis
malaria
kala azar
What conditions cause moderate splenomegaly seen in?
Portal hypertension lymphoma CLL thalassaemia metabolic diseases e.g Gaucher's
what conditions can lead to reactive amyloidosis?
RA
Crohn’s
Differentiation of which cell is regulated by RANK gene product?
Osteoclast
What Covers cortical surface of bone and delivers blood supply?
Periosteum
Bone-forming cells which line endosteal surfaces?
Osteoblasts
Which type of bone is 80-90% calcified and its function is mainly mechanical and protective?
Cortical
which type of bone is immature and usually pathological?
Woven
Histological findings of osteomalacia?
Increased osteoid volume
Widened osteoid seams
Reduced mineralization
Bone biopsy findings in Ewing’s sarcoma?
sheets of cells with small, primitive nuclei and scanty cytoplasm
droplets of glycogen in the cytoplasm of small round cells in the pelvic bones
What Ab can be used to test for Ewing’s sarcoma?
positive immunoreactivity is seen with the MIC2 (CD99) antibody
Electronmicroscopy findings in osteoporosis?
bone thinning and wide separation of trabecular plates
X-ray and bone biopsy findings in osteomyelitis?
X-ray: Mottled rarefaction and lifting of the periosteum
Biopsy: intense neutrophilic inflammatory infiltrate
X ray findings of osteosarcoma?
Lytic lesions
Codman’s triangle
Microscopy findings of osteosarcoma?
pleomorphic mesenchymal cells producing dark-staining osteoid
X-ray findings in osteomalacia?
areas of low density are seen surrounded by sclerotic borders
What is the most common bony tumour?
Osteochondroma
Where do osteochondromas commonly occur?
Around the knee
How do osteochondomas grow and what causes them?
Slowly
Previous trauma
An 18 year old student presents to his GP with focal pain in his left fore-arm which is tender to touch and worsens at night. The pain is relieved with aspirin. An X-ray shows a 1cm are of radio-lucency in the tibia surrounded by dense bone. What is the Dx?
Osteoid osteoma
Blood test results in Ewing’s sarcoma?
Raised ESR
What smoking related chronic lung disease is more likely to result in type 2 respiratory failure?
Chronic bronchitis
Neoplasms found in women aged between 30 and 40 as ovarian masses, usually unilateral. They are usually benign (90%) and are often the largest ovarian neoplasm?
Mucinous Tumour
What ovarian pathology results in Squamous epithelium mixed with intestinal epithelium?
Mature cystic teratoma
Which ovarian tumour consists of Fibrous tissue containing spindle cells and lipid?
Thecoma
Which ovarian tumour consists of Malignant cells surrounded by serous fluid and Psammoma bodies?
Serous cystadenocarcinoma
Which ovarian tumour consists of Malignant signet ring cells containing mucin?
Krukenberg tumour
Which ovarian tumour consists of Germ cells mixed with lymphocytes?
Dysgerminoma
Which Germ cell tumour originating in testis that is radiosensitive and classically presents in the 4th decade?
Seminoma
Very aggressive tumour producing HCG and AFP; neoplastic cells are anaplastic?
Embryonal carcinoma
Nonseminomatous germ cell tumour that has elements derived from all 3 germ cell layers?
Teratoma
Commonest malignant cause of testicular mass in those aged under 5?
ALL
Commonest malignant cause of testicular mass in those aged 60?
Diffuse large B cell lymphoma (DLBCL)
A pap smear taken from a chronic granulomatous ulcer shows a necrotic centre, periarteritis and endarteritis obliterans and an intense peripheral cellular infiltrate consisting mainly of mononuclear cells and giant cells. Causative organism?
Treponema pallidum (syphilis)
A 60 year old lady presents with a hard palpable mass in the right breast. The mammography shows that the lump is calcified. FNA results show that the cells in the lump have pleomorphic nuclei and that the lump has a necrotic centre
Ductal Carcinoma in situ
A 23 year old lady comes to the breast clinic because she is worried of having breast cancer as her mother and grandmother both have had the disease. The mammogram finds no abnormality but you think you feel a number of multifocal lumps
Lobular Carcinoma in situ
A fasting blood glucose value above what value (in mmol/L) will confirm a diagnosis of diabetes in an individual with polyuria and polydipsia?
7
What is the most common type of lung cancer in the UK?
Squamous Cell Carcinoma
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
Haematoxylin and eosin stain
Which hepatobilary pathology is classically associated with an elevated p-ANCA?
Primary Sclerosing Cholangitis
What is the first line treatment for severe haemachromatosis?
Therapeutic phlebotomy
What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?
Pseudopolyp
Which hepatobiliary pathology is associated with the finding of “beading” of bile ducts during an endoscopic retrograde cholangiopancreatogram (ERCP)?
Primary Sclerosing Cholangitis
A 3 year old girl has progressive abdominal distension.
On examination there is a firm, smooth, non tender mass in the upper left quadrant of the abdomen. A urine dip shows microscopic haematuria.
What is the likely diagnosis?
Nephroblastoma
In which liver condition will cytoplasmic Mallory Denk Bodies most commonly be found on biopsy?
Alcoholic hepatitis
What type of kidney stone are patients on chemotherapy for chronic lymphocytic lymphoma at increased risk of?
Uric acid
A biopsy specimen from the gastric antrum of a patient is reported as showing evidence of acute gastritis.
What cell of the immune system is found disproportionately in biopsies of acute gastritis?
Neutrophils
A nephrologist is investigating an elderly gentleman with nephrotic syndrome. A renal biopsy revealed normal histology when viewed under a light microscopy. There were no immune complexes detected in the biopsy either. There was no amyloid deposition. Urinary Bence Jones Protein and serum electrophoresis were normal.
The patient responded well to steroids and their renal function is normal.
What is the most likely primary cause of the nephrotic syndrome?
Minimal Change Disease
Clinical Assessment and Imaging are two parts of the “Triple Assessment” for suspected breast malignancy.
What is the final component of Triple Assessment?
Histology
What is the most common cause of a pulmonary embolus?
dvt
A biopsy, taken at autopsy, reads: “There is pathological intimal thickening of the right renal artery with significant occlusion of the luminal space. Immunohistochemical staining reveals the presence of macrophages”
What disease does the report describe?
Atherosclerosis
What kind of cancer is associated with keratin pearls?
SCC
Which organism is classically associated with haemolytic uraemic syndrome?
E coli
What type of bladder cancer is associated with chronic cystitis?
SCC
What is the main hormone produced by delta cells in the pancreas?
Somatostatin
What intracerebral tumour is Multiple Endocrine Neoplasia Type 1 associated with?
Pituitary Adenoma
An 84 year old Asian woman presented to the ED with chest pain of 10 hours duration, which began while watching television. The pain was 9/10 and did not radiate. She reported being under extreme stress since the death of her 50 year old son a week ago.
An ECG revealed ST elevation in V2 and V3. Chest X ray was normal. Troponin and electrolytes were normal. Percutaneous Coronary Intervention was unremarkable with no occlusions and no evidence of atherosclerotic disease. An echocardiogram showed apical akinesis with an ejection fraction of 36%. There was hypertrophy of the interventricular septum. What is the diagnosis?
Takotsubo’s Cardiomyopathy
A 54 year old gentleman with type 2 diabetes mellitus presents to his GP. He reports seeing blood in his urine. In addition, he has felt feverish and tired for a few weeks. He has no night sweats or weight loss and there is no family history of any medical problems. Physical examination revealed an ejection systolic murmur and a palpable mass in the left upper quadrant of the abdomen.
Blood tests showed an elevated CRP with a normal haemoglobin. Results of the urine dip are below:
Blood ++
Proteinuria ++
What is the cause of this constellation of symptoms?
Infective endocarditis
Which hepatobiliary pathology, associated with a positive antimitochondrial antibody, may show the presence of granulomas on biopsy?
pbc
What is the typical inheritance pattern of Maturity Onset Diabetes of the Young (MODY)?
autosomal dominant
What 2 conditions make up COPD?
Emphysema
Chronic bronchitis
Damage to which artery is commonly associated with an extradural haemorrhage?
Middle Meningeal Artery
Which enzyme, produced by these bacteria, is responsible for the formation of staghorn calculi?
Urease
Which strain of Escheriscia coli is classically associated with haemolytic uraemic syndrome in children who have spent time around farmyard animals?
0157:H7
A 18 year old man presenting with nephritic syndrome, cataracts and sensorineural deafness suggests what underyling diagnosis?
Alport’s syndrome
A CT-KUB from a patient with renal colic reveals the presence of a radiopaque, laminated density which conforms to the shape of the renal pelvis. There is evidence of dilation of the renal calyces. What is the typical chemical composition of this density?
Magnesium Ammonium Phosphate
What histochemical stain would reveal the presence of iron in a liver biopsy with a patient with haemachromatosis?
Prussian blue
What is the inheritance pattern of alport’s syndrome?
X linked recessive
Which protein, detected in the stool of patients with inflammatory bowel disease, reflects the presence of intraluminal neutrophils and hence the presence of intestinal inflammation?
Calprotectin
When are flow murmurs usually heard and what do they sound like?
Soft, systolic murmurs heard best at the left lower sternal edge
Found in hyperdynamic circulations - pregnancy, anaemia or severe blood loss
What is the typical inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?
Autosomal Dominant
What sign describes painless jaundice in the presence of a palpable gallbladder?
Courvoisier’s sign
What protein is defective in adult polycystic kidney disease?
Polycystin-1
What is the most common histological type of prostate cancer?
Adenocarcinoma
Which enzyme, released by neutrophils, does the compound alpha-1 antitrypsin inhibit to prevent the development of emphysema in the lungs?
Neutrophil elastase
Barrett’s oesophagus is a premalignant change associated with what histological malignancy of the oesophagus?
Adenocarcinoma
Other than zinc, what is the first line pharmacological treatment for Wilson’s disease?
Other than zinc, what is the first line pharmacological treatment for Wilson’s disease?
What tumour marker is most commonly used in the diagnosis of colorectal cancer?
Carcinoembryonic antigen
A 32 year old man presents to the emergency department with cola coloured urine. He denies pain or fever. He has had a sore throat for the past five days. He has no other medical history of note and this has not happened before. He also has a non-blanching rash over his legs. What is the likely cause of the nephritic syndrome?
IgA Nephropathy
A 23 year old man visits their GP with a positive pregnancy test, which he did for a joke. A repeat pregnancy test in the surgery is also positive. He denies any sexual activity in the last year. What is the possible underlying diagnosis?
Testicular cancer
A nephrologist is investigating a 45 year old man with nephrotic syndrome. A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane. Some areas are visibly scarred.
Immunofluorescence shows the presence of antibody complexes and complement deposits. There are visible areas of scarring of the glomerular basement membrane, however, some areas appear spared.
What subtype of nephrotic syndrome does this histological pattern and history suggest?
Focal Segmental Glomerulosclerosis
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
Diabetes
A biopsy sample from a patient with suspected renal cancer is reported as follows:
“There are neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels”
What is the specific histological type of cancer?
Clear cell cancer
A GFR of less than what value is considered reflecting End Stage Renal Failure in chronic kidney disesease?
<15mL/min
What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson’s disease?
Rhodanine
A 18 year old man has his urine dipped as part of a pre employment health check. He has no past medical history and denies any symptoms. The urine dip shows the presence of microscopic haematuria (+). He says that his father also always has blood in his urine.
What is the likely diagnosis?
Benign familial haematuria
A nephrologist is investigating a 40 year old man with nephrotic syndrome. A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane. Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane. The patient’s renal function has continued to decline despite high dose pulsed IV methylprednisolone.
What is the likely primary cause of the nephrotic syndrome?
Membranous Glomerular Disease
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
Taenia Coli
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
An example could be the loss of desmosomal connections in pemphigus vulgaris.
Acantholysis
Which class of lupus nephritis on biopsy may show complete sclerosis of nearly all glomeruli?
Class VI
What cancer is associated with the presence of “oat shaped cells” on biopsy?
Small Cell Lung Cancer
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?
Thrombotic Thrombocytopenic Purpura
What is the name given to the criteria used for diagnosis of infective endocarditis?
Duke’s criteria
What type of fluid motion produces low sheer stress and is hence protective against the development of atherosclerotic disease?
Laminar Flow
Which common medication are hepatic adenomas associated with?
OCP
A 55 year old gentleman with newly bipolar disorder is seen by a psychiatrist. An ECG is performed as part of the workup for starting lithium, a mood stabiliser. His past medical history includes an anterior STEMI 4 months ago.
The ECG shows ST elevation in leads V2, V3, V4 and V5. He denies chest pain, breathlessness or any other symptoms. What is the diagnosis?
Ventricular aneurysm
What further imaging is indicated for a transient ischaemic attack when neurological symptoms have resolved?
Carotid Ultrasound
Which lobe of the brain does HSV encephalitis classically affect?
Temporal
The ECG leads V1 and V2 represent which specific region of the heart?
Septal region
Classically the triad of bronchoconstriction, flushing and diarrhoea is described as what paraneoplastic syndrome?
Carcinoid syndrome
Histological findings of left heart failure?
Dilated ventricles
Thin walls
Nutmeg liver
Haemosiderin macrophages in lungs
Histological features of rheumatic fever related myocarditis?
Aschkoff bodies
Anitschow cells causing dilatation of mitral ring - hence mitral regurge
what is Monckenberg arteriosclerosis?
Focal calcification of medium sized vessels
Mutation in HOCM?
Beta-myosin heavy chain
What do tumours in carcinoid syndrome secrete?
5-HIAA
Which type of lung cancer demonstrates chromatin smudging and nuclear moulding?
Small cell lung cancer
Histological features of chronic bronchitis?
Mucus gland hypertrophy
Goblet cell hyperplasia
Mucosal oedema
4 types of amyloid proteins and what immunoglobulin are they derived from and what disease are they associated with?
AA: serum amyloid assisted protein - inflammation
AL: IgG light chains - MM
Alpha-beta2: Alzheimer’s
Beta2: Dialysis
Histological findings of microscopic polyangitis?
Fibrinoid necrosis leading to fragmented neutrophilic nuclei within vessel walls
Features of dermatomyositis?
Heliotrope rash
Gottron’s papules
High CK
What is Duret haemorrhage associated with?
Tentorial and cerebellar tonsil herniation
Difference between Gardener’s syndrome and FAP?
Gardener’s has extra-intestinal growths - osteomas, epidermoid cysts, desmoid tumours
USS features of liver cirrhosis?
Irregular echogenicity demonstrating nodules
What does aflatoxin increase risk of?
Hepatocellular carcinoma
Histological findings of psc?
Periductal fibrosis which eventually causes concentric onion-ring fibrosis
What is auspitz sign and what is it associated with?
Pin point bleeding
Psoriasis
Histological features of actinic keratosis?
Solar elastosis
Focal parakeratosis
Atypical cells
Inflammatory infiltrates
What type of nephritic syndrome does goodpasture’s cause?
Rapidly progressive glomerulonephritis
How to tell the difference between ductal carcinoma in situ and lobular carcinoma in situ?
DCIS: Usually unilateral with microcalcification and necrosis
LCIS: Bilateral and multifocal with no calcification
Xray findings of giant cell tumours?
Lytic lesions esp around knee with characteristic soap bubble appearance
Histological findings of giant cell tumours?
Multinucleated giant osteoclasts
Surrounded by ovoid and spindle cells
What is a looser zone and when is it seen?
Pseudo-fracture
Osteomalacia
Bone findings in precocious puberty?
Fibrous dysplasia - trabeculae which lack osteoblastic rimming
How does Paget’s cause high output heart failure?
Bone marrow infiltration of weak woven bone
Xray findings of osteoid osteoma?
Central nidus (lucent) with sclerotic rim (opaque)
Which joints do osteochondroma affect?
Large
Which joints do enchondroma affect?
Small
What is libman sacks endocarditis associated with?
SLE
Histology in first 6 hours post MI?
Normal
Histology in first 6-24 hours post MI?
Contraction band necrosis
Loss of nuclei
Homogenous appearing cytoplasm
Histology 1-4 days post MI?
Debris left by necrosis
Homogenous cytoplasm making it difficult to see myocardial fibres
Infiltration of polymorphs and macrophages
Onion skin intimal thickening of small arteries?
Scleroderma
Where is most affected in h pylori gastritis?
Pyloric antrum
Progressive, chronic granulomatous inflammation of bile ducts?
PBC
Features of fibrous dysplasia?
Soap bubble osteolysis
Shepherd’s crook deformity
Chinese letter irregular trabeculae
Tumour composed of benign hyaline cartilage? Cotton wool calcification on X-ray
Enchondroma
Ewing’s sarcoma translocation and immunophenotyping?
t(11;22)
negative ALP
CD99 positive
Xray of osteosarcoma?
Codman’s triangle
Mixed sclerotic and lytic lesion in metaphysis
Periosteal reaction
Stages of lobar pneumonia?
- Congestion
- Red hepatisation
- Grey hepatisation
- Resolution
Which part of the lung does pneumoconiosis affect?
Upper lobes
Which part of the lung does asbestosis affect?
Lower lobes
What do white cell casts in urine suggest?
Pyelonephritis
What does eosinophiluria suggest?
Tubulointerstitial nephritis
4 features on microscopy of Wilm’s tumour?
Immature looking glomerular structures
Primitive small cell blast tissue
Epithelial tubules
Stroma with spindle cells and striated muscle
Core biopsy codes for breast cancer?
B1: normal breast tissue B2: benign abnormality B3: uncertain potential of malignancy B4: suspicious of malignancy B5: malignant B5a: DCIS B5b: invasive carcinoma
Most common cause of glomerulonephritis worldwide?
IgA nephropathy
Define crescents
Accumulation of proliferating epithelial cells in Bowman’s space
What is margination?
Redistribution of leukocytes towards a vessel’s wall by slowing the flow of blood
What type of macrophages in all TB granulomas?
Epithelioid macrophages
Penetration through which layer of skin indicates that a scar will develop?
Basement membrane
What substance is produced in a lobar pneumonia?
A purulent exudate
Where would the most cellular injury occur in the liver of someone who was exposed to carbon tetrachloride?
Centrilobular hepatocytes
What feature would indicate carcinoma is present within areas of dysplasia on a biopsy of the cervix?
Separate nests of dysplastic squamous cells in the dermis
Histology of pancreas in CF?
Pancreatic acinar atrophy
What is a strong epidemiological risk for development of nasopharyngeal carcinoma?
EBV
Brown macule which on histology shows proliferation of bland nevus cells in dermis. No mitotic figures identified - what is dx?
Intradermal nevus
Which cancer is associated with the presence of E cadherins? Which are E-cadherin negative?
E-cadherin present = Invasive ductal carcinoma
E-Cadherin negative = Invasive lobular carcinoma
Different stages of DCIS?
High
Medium
Low
Most common cause of constrictive pericarditis in developing world?
TB
What is the most common cause of myocarditis
viral infection/chagas disease
What is the most common cause of portal vein thrombosis
cirrhosis
Which underlying pathology is commonly associated with nephrotic syndrome in adults
Membranous glomerulonephritis
What is the equivalent of a dysgerminoma in a testis?
Seminoma
Which virus is associated with nasopharyngeal carcinoma?
EBV
An extradural/ epidural haemorrhage is caused by damage to which blood vessel?
Middle meningeal artery
What is the mechanism behind pulmonary oedema due to liver disease?
Decreased osmotic pressure
Which brain tumour occurs near the surface of the brain and is frequently asymptomatic?
Meningioma
