Histopathology Flashcards
1
Q
What are the layers of the epidermis
(superficial to deep)
A
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Basement membrane
2
Q
What cells make up the epidermis
A
Keratinocytes
3
Q
What is contained within the dermis
A
Collagen
Elastin
Glands
Vascular supply
4
Q
What does hyperkeratosis mean
A
Increase in size of stratum corneum
Increased keratin
5
Q
What does parakeratosis mean
A
Increased nuclei in the stratum corneum
They get retained there
6
Q
What does acanthosis mean
A
Increase in the stratum spinosum
7
Q
What does acantholysis mean
A
Reduced cohesions between keratinocytes
8
Q
What is spongiosis
A
Intercellular oedema
9
Q
What does actinic mean
A
Damaged by the sun
10
Q
What is a benign derm neoplasm
A
Seborrheic Keratosis
11
Q
What do seborrheic keratoses appear like
A
Rough pigmented plaques
Waxy and stuck on
Coin shaped
12
Q
Who do seborrheic keratoses appear in
A
Middle age and elderly
13
Q
What is the histology of seborrheic keratoses
A
Horn cysts
Orderly hyper-proliferation of epidermis
14
Q
What are horn cysts seen in
A
Seborrheic keratosis
15
Q
What are the premalignant derm neoplasms
A
Actinic keratosis
Keratoacanthoma
Bowens disease
16
Q
How do actinic keratoses appear
A
Papule or plaque
Skin is red
White or yellow scaly crusts
17
Q
What skin pathology is described as sandpaper like texture
A
Actinic keratosis
18
Q
Histology of actinic keratosis
A
SPAIN
Solar elastosis
Parakeratosis
Atypia/dysplasia
Inflammation
Not full thickness
19
Q
How does a keratoacanthoma appear
A
Dome shaped nodule with necrotic crusted centre
20
Q
Histology of squamous cell carcinoma
A
Full thickness atypia/dysplasia throughout the epidermis spreading through basement membrane into dermis
Nuclear crowding
21
Q
Histology difference between bowens disease and squamous cell carcinoma
A
SCC is bowens but it spreads through the basement membrane
22
Q
How does bowens disease appear
A
Intra-epidermal squamous cell carcinoma
Flat
Red
Scaly patches
Stand alone
23
Q
What are 2 precursors to SCC
A
Bowens disease
Actinic keratosis
24
Q
Difference between actinic keratosis and bowens disease
A
Bowens disease is full thickness
25
How do basal cell carcinomas appear
Pearly surface
Telengiectasia
26
What is rodent ulcer
Basal cell carcinoma
27
Histology of BCC
Mass of basal cells pushing down into dermis
Palisading (alignment of nuclei in outermost layer)
28
Pathophysiology of amyloidosis
Excess proteins clumpb together to form beta sheets which make up fibrils
These then deposit in the EC space of tissues and cause damage
29
Why is AL amyloidosis called AL
Amyloid 'light'- as excess light chains
30
What is a dyscrasia
Non specific term for disorder of blood
31
What is pathophysiology of AA amyloidosis
In chronic systemic inflammatory responses to infections, cancers and autoimmue conditions there is an excess of serum amyloid A which forms amyloid deposits in tissues
32
What is amyloid protein in AA amyloid
Serum amyloid A
33
What conditions cause AA amyloidosis
Infections- TB, osteomyelitis, IVDU skin infections, familial mediterranean fever
Autoimmine- IBD, RA, Ank spond
Cancer- Hodgkins lymphoma, Renal cell carcinoma
34
What is the most common form of familial amyloidosis
Familial mediterranean fever
35
Where is the amyloid deposition predominant in famial mediterranean fever
Kidney
36
Who does haemodialysis associated amyloidosis occur in
Chronic renal failure patients who are on especially peritoneal dialysis
37
What is the protein deposited in haemodialysis associated amyloidosis
Beta-2-microglobulin
38
What is most common presentation of amyloidosis
Nephrotic syndrome
39
Clinical features of amyloidosis
Carpal tunnel syndrome
Macroglossia
Hepatosplenomegaly
Restrictive cardiomyopathy
Nephrotic syndrome
40
Stain done for amyloidosis
Congo red stain under polarised light
41
Positive amyloid finding on congo red stain
Apple green birefringence- caused by beta pleated sheet configuration
42
What is negative congo red stain colour
Pink/red
43
When are neutrophils involved
Acute inflammation
44
When are macrophages involved
Late acute inflammation
Chronic inflammation like in granulomas
45
When are lymphocytes involved
Chronic inflammation
Lymphomas
46
When are plasma cells involved
Chronic inflammation
Myeloma
47
When are eosinophils involved
Allergic reactions
Parasitic infections
Hodgkins disease
48
When are mast cells involved
Allergic reactions
49
How do mast cells appear on histology
Lots of granules
50
Typical histological features of squamous cell carcinomas (not skin)
Keratin production
Intercellular bridges
Do not form glands
51
How do adenocarcinomas appear histologically
Form glandular epithelium
Form glands that can secrete substances
52
How do transitional cell carcinomas appear
Stretchy epithelium
53
Where do you get stretchy epithelium
Transitional cell carcinomas
54
What is the definition of histochemical stain
Result from the chemical reaction between stain and the tissue
55
What is the definition of immunohisto stain
Involves the antibodies against a specific antigen
56
What is lichenification
When skin becomes leathery and thick
57
What happens to skin if chronic atopic dermatitis
Lichenification
58
Acute histology of dermatitis
Spongiosis
Inflammatory infiltrate in the dermis (neutophils)
Dilated dermal capillaries
59
Chronic dermatitis histology
Acanthosis
Crusting
Hyperparakeratosis
T cells and eosinophil infiltrate
60
What is pathophysiology of seborrheic dermatitis
Inflammatory reaction to yeast infection- malassezia
61
What type of hypersentivity reaction is stevens johnsons syndrome
IV
62
What is the pathophysiology of SJS
Hypersensitivity reaction against the epidermis and mucosa which leads to necrosis of skin which can be wiped off
63
What determines if SJS or toxic epidermal necrolysis
<10% in SJS
>30% in TEN
64
What can cause SJS
Drugs- sulfonamides, carbamezapine
Infection- CMV, mycoplasma
65
How does chronic plaque psoriasis appear
Salmon pink well demarcated red plaques with silver scales
66
Where does chronic plaque psoriasis appear
Extensors of knees, elbows and scalp
67
What is auspitz sign
Rubbing plaque leads to pinpoint bleeding
68
What is the koebner phenomenam
Lesions form at site of trauma- seen in psoriasis
69
Histopathology of psoriasis
Parakeratosis
Loss of granular layer
Clubbing of rete ridges giving test tubes in rack appearance
Munros abscesses
Dilated blood vessels
70
Clubbing of rete ridges giving test tubes in rack
Psoriasis
71
What is pathophysiology of psoriasis
Type IV hypersensitivity reaction
72
When does guttate psoriasis present
Childhood
73
What triggers guttate psoriasis
Post strep throat 2 weeks ago
Typically in children
74
How does guttate psoriasis appear
Small spots
Rain drop plaque distribution
Over trunk and limbs
75
What is erythodermic psoriasis
Widespread disease with systemic symptoms
76
Where does pustular psoriasis affect
Hands and feet
77
How does pustular psoriasis appear
Red skin with white elevations of pus
78
What are the nail changes seen in psoriasis
Pitting
Onycholysis
Subungal hyperkeratosis
79
Who does flexural psoriasis occur in
Elderly
80
Where does flexural psoriasis occur
Creases in the skin
Groin
Submammary
Natal cleft
81
Histopathology of sarcoidosis
Non-caseating granulomas
Schaumann and asteroid bodies
CD4+
82
What are schaumann and asteroid bodies
Inclusions of protein and calcium
83
Blood findings of sarcoid
Hypercalcaemia
High ACE
High ESR
Anaemia
Leukopaenia
84
Skin findings in sarcoid
Erythema nodosum
Lupus pernio
Skin nodules
85
Eye manifestations of sarcoid
Anterior Uveitis
Posterior uveitis
Uveoparotid fever
Keratojunctivitis
Lacrimal gland enlargement
86
What happens in uveoparotid fever (heerfordt syndrome)
Bilateral uveitis
Parotid enlargement
Potentially facial nerve palsy
87
Joint manifestation of sarcoid
Arthritis
Bone cysts
88
Heart presentation of sarcoid
Cardiomyopathy
Conduction problems
Valvular disease
Pericarditis
89
What is the pathophysiology of bullous pemphigoid
IgG abs bind to hemidesmosomes which anchor epidermis to basement membrane
Leads to detachment of epidermis and formation of SUBdermal bullae
90
What is the pathophysiology of pemhigus vulgaris
IgG binds to desmoglein 1&3 which connect keratinocyes and between mucous membranes
Leads to breaking between layers of epidermis causing INTRAdermal bullae
91
What is difference in bullae between pemphigus vulgaris and bullous pemphigoid
Bullae in bullous pemphigoid are tense on erythematous base- DO NOT rupture
Bullae in pemphigus vulagris are easily ruptured which leads to a raw red surface
Nikolsky positive in pemphigus vulgaris
92
Histopathology of bullous pemphigoid
Subepidermal bulla with eosinophils
Linear deposition of IgG along basement membrane
93
Histopathology of pemphigus vulgaris
Acantholysis
Intradermal bulla
Netlike pattern of IgG
Complement deposition
94
What is the pathophysiology of dermatitis herpetiformis
IgA binds to basement membrane forming subepidermal bulla
95
What is dermatitis herpetiformis associated with
Coeliac
96
How does dermatitis herpetiformis appear
Itchy vesicles on extensors of elbows
Buttocks
97
Histology of dermatitis herpetiformis
Microabscesses which coalesce to form subepidermal bullae
Neutrophil and IgA deposits at tips of dermal papillae
98
How do lichen planus plaques appear
Hyperpigmented
Itchy
Polygonal
Papules
Plaques
Fine white network on the surface called wickams striae
99
Where is lichen planus normally found
Inner surface of wrists
Oral mucous membranes with lacy appearance
100
Histopathology of lichen planus
Hyperkeratosis
Saw toothing of rete ridges
Basal cell degeneration
101
What are wickhams striae
White network on top of plaques seen in lichen planus
102
What are annular target lesions seen in
Erythema multiforme
103
Where are erythema multiforme lesions seen
Extensor surfaces of hands and feet
104
How do erythema multiforme lesions develop
Can become pleomorophic so are anything from macules, papules, petechiae and bullae
105
Causes of erythema multiforme
Infections- HSV, mycoplasma
Drugs- SNAPP
106
SNAPP causes of erythema multiforme
Sulphonamides
NSAIDS
Allopurinol
Penicillin
Phenytoin
107
What causes pityriasis rosea
Appears after viral illness
108
Development of pityriasis rosea
Salmon pink rash apppears first called herald patch
Oval macules in xmas tree distribution then appear
109
What is a herald patch
Erythematous patch with white centre seen in pityriasis rosea
110
What is the scientific word for moles
Melanocytic naevi
111
Histology of melanomas
Atypical melanocytes
Initially radial growth phase then vertical phase
Buckshot appearance in vertical phase
112
Steps of atherogenesis
Endothelial injury
LDL enters subintimal space and gets trapped
LDL oxidised
Oxidised LDL gets taken up by macrophages via scavenger receptors becoming foam cells
Foam cells apoptose which causes cholesterol core
Increase in adhesion molecules on endothelium results in more macrophages and t cells
Vascular smooth cells form fibrous cap
113
What receptors take up oxidised LDL into macrophages
Scavenger
114
Why is abdo aorta more affected by atherosclerosis
Around the origins of major branches there is turbulent blood flow which has a low oscillatory shear stress
115
What are ostia
Origins of major arteries
116
Which blood flow is anti-atherogenic
Laminar
Turbulent is atherogenic
117
How long of severe iscahemia causes myocyte death
20-40 mins
118
Complications of an MI
DARTH VADER
D-death
A- arrythmia
R- rupture
T- tamponade
H- HF
V- valve disease
A- aneurysm of ventricle
D- dresslers syndrome
E- embolism
R- recurrence
119
What can rupture most MI
Due to necrosis:
- Septum causing left to right shift or VSD
- Papillary muscle causing MR
- Ventricular wall causing haemopericardium
120
What valve disease is common post MI
Mitral regurgitation from papillary muscle rupture or necrosis
121
What causes persistent ST elevation post MI
Ventricular aneurysm which can develop for over a month after
122
Difference between pericardial effusion and tamponade
Tamponade is when the fluid obstructs the contractility of the heart
123
What causes fibrinous pericarditis post MI
If MI extends to the epicardium
124
Pericardial complications of MI
Fibrinous pericarditis
Dresslers
Effusion/tamponade
Early infarct associated pericarditis
125
What is a mural thrombus
Clot that sticks to wall of heart
126
When are mural thrombi common
Ventricular aneurysm
127
What is nutmeg liver
The appearance of the liver due to chronic hepatic vein congestion
128
Long term what does nutmeg liver become
Cirrhosis aka cardiac cirrhosis
129
What are haemosedirin laden macrophages
Macrophages which have taken onto red blood cells in lungs after alveolar have burst
AKA heart failure cells
130
Histology post MI
- under 6 hours
- 6-24 hours
- 1-4 days
- 5-10 days
- 1-2wks
- weeks-months
- Normal by histology, CK also normal
- Loss of nuclei, necrotic cell death, homogenous cytoplasm
- Infiltration of polymorphs then macrophages
- removal of debris
- granulation tissue, new blood vessels, collagen synthesis, myofibroblasts
- decullarising scar tissue
131
Histology of heart in HF
Dilated heart with thin walls
Haemosiderin macrophages in lungs
Scarring
Fibrosis and replaced myocardium
132
Pathophysiology of rheumatic fever
Cell mediated immunity and antibodies to strep antigens cross react with myocardial antigens
133
Histology of rheumatic fever
Beady fibrous vegetations
Aschkoff bodies
Anitschow myocytes
134
Treatment for rheumatic fever
Benzylpenicillin
135
Diagnosis of rheumatic fever
Jones criteria
Group A strep infection and 2 major criteria
Group A strep infection and 1 major+ 2 minor
136
Major jones criteria
Carditis
Arthritis
Sydenhams chorea
Erythema marginatum
Subcut nodules
137
Minor jones criteria
Fever
Raised ESR or CRP
Migratory arthralgia
Malaise
Tachycardia
Prolonged PR interval
History of rheum fever
138
How does rheum fever affect the following
- heart
- joints
- CNS
- skin
- endocarditis, pericarditis, mycocarditis
- arthritis, synovitis
- subcut nodules, erythema marginatum
- encephalopathy, sydenhams chorea
139
What is most common form of prostate cancer in over 50s
Adenocarcinoma
140
What is normal precursor of prostate cancers
Prostatic intraepithelial neoplasia
PIN
141
How is prostate cancer graded
Gleason
142
Rfs for RCC
Smoking
HTN
Obesity
Long term dialysis
Unopposed oestrogen
Heavy metals
143
3 types of malignant renal cancer
Renal cell carcinoma
Nephroblastoma
Transitional cell carcinoma
144
What group of people are nephroblastomas seen in
Childhood- is second most common childhood malignancy
145
Where do transitional cell carcinomas develop
Anywhere in urothelial tract- can be from renal pelvis to urethra
Most commonly in bladder
146
What are the types of renal cell carcinoma
Clear cell 70%
Papillary 15%
Chromophobe 5%
147
Difference in macroscopic appearance of renal cell carcinomas
Clear cell- golden yellow with haemorrhagic areas
Papillary- friable brown
Chromophobe- solid brown
148
Microscopic appearance of clear cell RCC
Nests of epithelium with clear cytoplasm
149
Microscopic appearance of papillary RCC
Papillary tubopapillary growth patter over 5mm
150
Microscopic appearance of chromophobe RCC
Sheets of large cells with distinct cell borders
151
Where do RCC appear from
Typically epithelial cells in the cortex of kidney
152
Microscopic appearance of nephroblastoma
Small round blue cells
153
Types of renal transitional cell carcinomas
Non-invasive papillary
Infiltrating urothelial carcinoma
Flat urothelial carcinoma in situ
154
How do non-invasive papillary urothelial carcinomas appear macroscopically
Frond like growths projecting from the walls
Often multifocal
155
How do non-invasive papillary urothelial carcinomas appear microscopically
The fronds which project are lined with urothelium
156
How do invasive urothelial carcinomas appear
Solid tumours stuck to pelvis
157
What are the 3 bladder tumours
Transitional cell 90%
Squamous cell carcinoma
Adenocarcinoma
158
What causes bladder squamous cell carcinomas
Schistomiasis
159
What causes bladder adenocarcinomas
Arise from intestinal metaplasia or urachal remnants
160
Location of the lung cancers
Proximal bronchi- small cell and squamous
Distal- adenocarcinoma
161
Histology of squamous cell lung cancer
Keratinisation
Intercellular prickles
162
Which lung cancer is associated with hypercalcaemia
Squamous cell carcinoma
PTHrp secretion
163
Histology of adenocarcinomas lung
G;andular differentiation- gland formation and mucin production
164
Which paraneoplastic syndromes are small cell carcinoma are associated with
SIADH
Cushing from ACTH
Lambert eaton
165
What cells does small cell lung cacner arise from
Neuroendocrine
166
Which lung cancers have high relationship to smoking
The S's
167
Histology of small cell carcinoma
Small
Poorly differentiated
Oat cells
168
Histology of large cell carcinoma
Poorly differentiated
Large cells
Large nuclei
Prominent nucleoli
No glandular or squamous differentiation
169
How are tumours staged
TNM
Tumour- invasion
Nodes- lymph nodes involved
Mets
170
What are the 3 benign renal tumours
Papillary adenoma
Oncocytoma
Angiomyolipoma
171
Where are the renal papillae
Where collecting ducts enters the ureters
172
What are papillary adenoma
Renal epithelial tumours with a papillary structure
Less than 5mm
173
What is an oncocytoma
Benign renal epithelial tumour characterised by presence of oncocytes- eosinophillic cytoplasm
174
What are angiomyolipomas made up of
Mesenchymal tumour
Fat
Blood vessels
Muscle
175
What renal cell carcinoma is common in dialysis associated cystic disease
Papillary carcinoma
176
Management of nephroblastoma
Nephrectomy with pre or post op chemo
177
What is myocyte disarray seen in
HCM
178
Where does hypertrophy occur in HOCM
Interventricular septum
179
What is most common gene affected in HOCM
Beta myosin heavy chain
BMHC
180
Most common cause of restrictive CM
Amyloidosis
181
What is libmen sacks endocarditis
Cardiac complication of SLE and APL where get vegetations on endocardium
182
Characteristics of libmen sacks endocarditis vegetations
Warty vegetations that are sterile and platelet rich
183
Organisms which cause acute endocarditis
Staph aureus
Strep pyogenes
184
Organisms which cause sub-acute endocarditis
Strep viridans
Staph epidermis
HACEK
Coxiella
Mycoplasma
Candida
185
What organisms are in HACEK
Haemophilus
Aggregatibacter
Cardiobacterum
Eikenella
Kingella
186
Most common valvular problems in IE
Mitral and aortic regurg
187
Immune phenomena in IE
Roth spots- in eyes
Osler nodes- red painful nodes on hnads or feet
Haematuria from glomerulonephritis
188
Thromboembolic complications of IE
Janeway lesions
Septic abscesses
Microemboli
Splinter haemorrhages
Splenomegaly
189
How is IE diagnosed
Dukes criteria
- 2 major
- 1 major and 3 minor
- 5 minor
190
Major dukes criteria
Positive blood culture growing typical IE organism
Vegetations on echo/new regurg murmur
191
Minor dukes criteria
Risk factor
Fever
Thromboembolic phenomena
Immune phenomena
Positive blood cultures that dont meet major criteria
192
Tx for IE
Start broad spectrum abx then treat according to sensitivities
193
Abx for subacute IE
Benzylpenicillin and gentamycin
OR
Vancomycin
194
Abx for acute IE
Flucloxacillin for MSSA
Rifampicin, vancomycin and gentamicin for MRSA
195
What are 5 benign neoplastic breast conditions
Fibroadenoma- most common
Intraductal papilloma
Radial scar
Phyllodes tumour
Fibrocystic disease
196
What are fibroadenomas
Benign neoplasms of fibrous tissue and glandular tissue
197
What causes fibroadenomas to increase in size
Pregnancy as hormone responsive
198
Cytology of fibroadenoma
Branching sheets of epithelium in antler horn or honeycomb sheets
Bare nuclei and stroma
199
How do intraductal papillomas present
Bloody discharge or clear
Lump
Can be pain
200
Histology of intraductal papilloma
Papillary mass with a dilated duct lined by epithelia
201
What is a radial scar
A benign sclerosing lesion often found on histology
Called scar as what appears like under the microscope histologically
202
Histology of radial scar
Central fibrous stellate area
203
What are radial scars over 1 cm called
Complex sclerosing lesions
204
How does radial scar appear on mammography
Stellate area which can be confused for carcinoma
205
How do phyolldes tumours present
Palpable masses in over 50s
206
How does fibrocystic breast disease present
Lumpiness in breasts which changes according to cycle
207
Histology of fibrocystic breast disease
Fibrous tissue containing cysts with flattened and cuboidal epithelium
208
What are the breast proliferative cancers
A group of intraductal epithelial proliferations which are asymptomatic but can develop into a breast carcinoma
Usual epithelial hyperplasia
Flat epithelial atypia
In situ lobular neoplasia
209
What is the difference between the 3 breast proliferative conditions with regards to their histology
Usual type- growth of epithelial and glandular tissue protruding into lumen in fronds
Flat atypia- multiple layers forming a smaller but regular circular lumen
Intralobular neoplasia- solid proliferation of aplastic cells where can just see the lumen
210
What cancers does BRCA increase the risk of
Breast
Ovarian
Pancreatic
Prostate
211
Wht does pregnancy reduce the risk of breast cancer
There is differentiation of milk producing luminal cells which removes them from pool of potential cancer cells
212
What is pagets disease of the breast
Eczema of nipple then areola- never get eczema on nipple normally
213
What is the screening programme for breast cancer
47-73 year olds invited every 3 years for mammography
214
What is looked for on mammographyin breast cancer screening
Microcalcifications
215
What is difference in detection of lobular and ductal carcinoma in situ
Lobular- always on biopsy as no microcalcification
Ductal- appear as areas of microcalcifications on mammogram. Typically on screening unless get pagets
216
What do lobular breast carcinomas lack
Protein E-cadherin
217
Which breast cancer does pagets develop from
Ductal
218
Histology of ductal carcinoma in situ
Ducts filled with atypical epithelial cells
219
How are invasive breast carcinomas classified
Ductal
Lobular
Tubular
Mucinous
220
Histology of invasvie ductal carcinoma
Carcinoma which isnt classified into another group
Big pleiomorphic cells which invade into the stroma
221
Histology of invasive lobular carcinoma
Well formed tubules with low grade nuclei
222
Histology of breast mucinous carcinoma cells
Produce abundant amounts of extracellular mucin which dissect surrounding tissue
223
How are breast cancers investigated
Triple assessment
Exam, Mammogram, FNA and cytology
224
What receptors are tested for in breast cancer and which has best prognosis
HER2
ER/PR- very good prognosis as will respond to tamoxifen
225
Which drug is used to treat ER/PR positive cancer
Tamoxifen
226
Which drug is used to treat HER 2 positive cancer
Herceptin/trastuzumab- monoclonal Ig to Her2
227
What is problem of herceptin therapy
Direct toxic affect on myocardium
Must monitor LVEF
228
What is most significant prognostic factor in breast cancer
Axillary lymph node involvement
229
Histology of basal like carcinoma
Sheets of markedly atypical cells with lymphocyte involvement
230
What gene associated with male breast cancer
BRCA2- in familial cases at higher risk and not BRCA1
231
What are 2 benign liver lesions
Hepatic adenoma
Haemangioma- most common
232
What is main cause of hepatic adenoma
OCP
233
How do hepatic adenomas present
Abdo pain and intraperitoneal bleeding
234
What is the most common liver malignancy
Secondary metastases from GI tract, breast or lung
235
What are the 5 liver malignancies
Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
Secondary tumours
Haemangiosarcoma
236
What are cholangiocarincomas
Adenocarcinomas which arise from bile ducts
237
Causes of cholangiocarcinoma
PSC
Parasitic liver disease
Chronic liver disease
Congenital liver abnormalities
Lynch syndrome 2
238
Who do hepatoblastomas occur in
Children- they present with an abdo mass
239
What is most common site of pancreactic adenocarcinoma
Head of the pancreas
240
Risk factors for pancreactic adenocarcinoma
Smoking
Diet
HNPCC
FAP
BRCA
241
What is trousseaus syndrome
Superficial thrombophlebitis
242
Presentation of insulinoma
Hypoglycaemic attacks
243
Presentation of gastrinoma
Zollinger Ellison syndrome- high acid output so get recurrent ulceration of the stomach
244
Presentation of a vipoma
Diarrorhoea as VIP- vasoactive intestinal peptide
245
Presentation of glucagonoma
Necrolytic migrating erythema
246
How are neuroendocrine tumours classified
Function- symptoms of hormone excess
Non-function
247
Histology of pancreatic endocrine tumour
Cells arranged in nests or trabeculae with grannular cytoplasm
248
Epithelial anamtomy of oesophagus
Proximal 2/3 squamous epithelium (white)
Distal 1/3 columnar epithelium (pink)
Joined by the squamous columnar junction- Zline
249
GORD pathophysiology and what can lead to
Acid from stomach is refluxed up into oesophagus which causes oesophagitis and maybe- malaena, haemorrhage, haematemesis, stricture, barretts oesophagus
250
What is barrets oesophagus
After chronic GORD can get metaplasia in the oesophagus from squamous epithelia to columnar which have goblet cells
Get upwards movement of the SCJ
251
What are 2 oesophageal cancers
Adenocarcinoma
Squamous cell carcinoma
252
What is main risk factor for oesophageal adenocarcinoma
Barretts oesophagus
Can also be smoking, obesity and radiation exposure
253
Where do you get adenocarcinomas in the oesophagus
Distal 1/3 as associated with barrets oesophagus
254
Risk factors for squamous cell carcinoma of oesophagus
Smoking
Alcohol
255
Where are squamous cell carcinomas normally found in the oesophagus
Middle third
256
What antibiotics cause C.diff
3 C's
Ciprofloxacin
Ceph
Clindamycin
257
What is diagnostic test for c diff
Stool assay for the toxin- PCR
258
Treatment for C diff
Oral vancomycin
259
What is diverticular disease
Low fibre diets cause high intraluminal pressure which causes outpouchings at weak points in the bowel walls
260
Complications of diverticular disease
Diverticulitis- can get peritonism, perofration, fistula, obstruction from fibrosis
261
Where do most outpouchings in diverticular disease occur
Sigmoid
262
What are carcinoid tumours cancers of
Enterochromaffin cells most commonly found in the bowel
263
Where can carcinoid tumours develop from
Most commonly the bowel
Lungs, ovaries and testes
264
What is carcinoid syndrome
Triad of;
Bronchoconstriction
Flushing
Diarrhoea
Caused by excess of serotonin (5-hydroxytryptamine)
265
What is diagnostic test for carcinoid syndrome
24hr urine 5-HIAA
5-hydroxyindoleacetic acid
266
Treatment for carcinoid syndrome
Octreotide- somatostatin analogue
267
What do you get in a carcinoid crisis
Life threatening vasodilation, hypotension, tachycardia, bronchoconstriction and hyperglycaemia
268
How to tell if sputum sample actually contains cells from the alveoli
Will contain macrophages
269
What is the stain for melanin
Fontana
270
What stain is used for haemochromatosis
Prussian blue
271
What is cytokeratin a marker of
Epithelial- if not positive then not a carcinoma
272
Describe the structure of hepatic lobule
In the shape of hexagon with each corner a portal triad. In the centre is a branch of the hepatic vein. Running from the portal triad to the central hepatic vein is a sinusoid
273
What is the structural unit of the liver
Hepatic lobule
274
In what direction does blood and bile run in a hepatic lobule
Blood runs towards the centrilobular vein
Bile runs towards to portal triad
275
How are liver endothelium different
Are spaces in between endothelium which allow for movement of molecules to hepatocytes across the space of disse
276
How are liver cells divided in the hepatic lobule
Zone 1- these are closest to the portal triad (periportal triad)
Zone 2- mid zone
Zone 3- perivenular hepatocytes
277
What are features of perivenular hepatocytes
Most mature and metabolically active
278
Which liver zone is most susceptible to iscahemia
Zone 3 nearest the hepatic vein as least oxygenated
279
Which liver zone is first affected by toxic substances and viral hepatitis
Zone 1
280
What is the immune function of the liver
Antigens from gut reach the liver and are phagocytosed by Kupffer cells
281
What is only protein the liver doesnt produce
Gamma globulins
282
First investigation if suspect pre hepatic jaundice
FBC and blood film
283
Which test determines the proportion of conj vs not bilirubin
Van der bergh
Direct reaction- measures conjugated
Indirect - measures unconjugated
284
What is inheritance of gilberts
recessive
285
What can confirm gilberts
fasting bilirubin
286
What is pathophysiology of gilberts
UDP glucuronyl transferase deficiency
287
Transmission of hep A
Farco oral
288
Can you get Hep A again
No
289
What are soider naevi, duputyrens contracture, palmar erythema etc all signs of
Chronic stable liver disease
290
What are the signs of portal hypertension
Distended veins
Ascites
Splenomegaly
291
Sites of porto-systemic anastamoses
Oesophageal varices
Rectal varices
Umbilical vein
Splen-renal shunt
292
What causes itching in liver disease
Urobilinogen and stercobilingoen
293
Which liver disease causes itching
Post hepatic
294
What is histopathology of acute hepatitis
Spotty necrosis concentrated around the portal triad
295
Where are stellate cells found in the liver
Space of disse
296
Which hepatitis infections can not cause chronic hepatitis
A and E
297
How is chronic hepatits staged and graded
Stage= fibrosis
Grade= inflammation
298
Histopathology of chronic hepatitis
Portal inflammation
Lobular inflammation
Interface hepatitis (piecemeal necrosis)
Bridging from portal vein to central vein
299
What is peacemeal necrosis/ interface hepatitis
Where can't see border between portal tract and parenchyma due to inflammation
300
What is critical stage in hepatitis to cirrhosis interface
Bridging from portal vein to central vein
301
Histopathology of a cirrhotic liver
Hepatocyte necrosis
Fibrosis
Nodules of regenerating hepatocytes
Disturbance of vascular architecture
302
How can liver cirrhosis be classified
Based on the size of the regenerating nodules
- micronodular <3mm
- macronodular >3mm
303
What causes macronodular cirrhosis
Viral
Wilsons
Alpha 1 antitrpsin
304
What causes micronodular cirrhosis
Alcoholic hepatitis
Bilary tract disease
305
What is extrahepatic shunting
When blood backlogs into sites of portosystemic anastamoses
306
What is intrahepatic shunting
When blood goes through the liver but does not contact hepatocytes/not filtered
307
What is gene involved in haemochromatosis
HFE Chr 6
308
What is gene involved in wilsons
ATP7B chromosome 13
309
What is used to predict prognosis in liver cirrhosis
Child pughs score
310
Proper term for fatty liver
Hepatic steatosis
311
Histology of hepatic steatosis
Fat droplets in hepatocytes
312
Histology of alcohol hepatitis
Hepatocyte ballooning and necrosis
Mallory denk bodies
Pericellular fibrosis
Megamitochondria
Mainly seen in zone 3
313
What are mallory denk bodies
Filaments of collagen
314
What colour do mallory bodies stain
Blue- trichome
315
What is the most common cause of chronic liver disease in the west
NAFLD
316
Histology of NASH
Similar to alcohol hepatitis
Mallor denk bodies
Hepatocyte ballooning
317
What is steatosis versus hepatitis
Steatosis is fat accumulation whereas hepatitis is with inflammation
318
What is included in NAFLD
Simple steatosis
NASH
319
What are the antibodies in type 1 and type 2 autoimmune hepatitis
Type 1- anti-SMA, ANA
Type 2- Anti- LKM (liver kidney microsomal)
320
Blood findings of PBC
Raised ALP
Raised cholesterol
Raised anti-mitochondrial antibodies
321
What is US finding of PBC
No bile duct dilatation
322
Histology of PBC
Bile duct loss with granulomas
323
What is PSC
Inflammation and obliterative fibrosis of both intrahepatic and extrahepatic bile ducts
324
What is main association of PSC
UC
325
Blood findings of PSC
High ALP
High p-ANCA
326
US finding of PSC
Bile duct dilation
Dont see this in PBC
327
ERCP finding PSC
Beading of bile ducts
328
Histology of PSC
Onion skinning fibrosis- ocncentric fibrosis
329
What is PSC a main risk factor for
Cholangiocarcinoma
330
What is typical disease course when patients are infected with TB
Infection usually asymptomatic becomes latent in a Gohn focus then gets reactivated in times of immunosuppression to give post primary TB
Primary TB is when get symptoms on initial presentation
331
What is a ghon focus
Primary TB lesion in the pleura
332
Histology of TB
Caseating granulomas
333
Typical presentation of TB
Lung symptoms
Nights sweats etc
334
What are some less common presentations of TB
Mainly seen in immunocompromised patients
Potts disease
Miliary disease
Subacute meningitis
Tuberculoma
335
Main difference between male and female teratomas
Male are normally malignant
336
Where else can teratomas be found
Pineal gland
Base of skull
Mediastinum
Wherever germ cells have originated from
337
What is the main stain for NE tumours
Chromogranin
Can also do synaptophysin, CD56
Then can do individual hormones
338
Where are NE tumours normally found
Gut
Lung
THymus
Skin
339
How are NET graded
Ki-67 index
340
Where are Zollinger Ellison tumours normally found
Pancreas or duodenum
Secrete gastrin which drives acid production
341
Most common cancer in children
Brain tumours
342
How are brain tumours classified
Primary vs secondary
Intra-axial versus extra axial
343
Supratentorial tumour presentatoion
Focal neurology
Seizures
Personality changes
344
Infratentorial tumour presentation
Cerebellar ataxia
Long tract signs
Cranial nerve palsy
345
Where are diffuse gliomas found
Supra-tentorial
346
What brain tumour is found in childhood and is indolent
Pilocytic astrocytoma
347
How do pilocytic astrocytomas appear on MRI
Well circumcised
Cystic
Enhancing lesion
IN CEREBELLUM
348
Histology of pilocytic astrocytoma
Piloid hairy cells
Rosenthal fibres
349
Mutations seen in astrocytoma and oligodendromas
Point mtation in IDH1/2
350
Histology of astrocytoma
Low mitosis
No vascular necrosis or proliferation
IDH1 detected on immunohistochemistry
351
What are gliobastoma mutliforme
Most aggressive and frequent glioma Grade 4
352
MRI findings of glioblastoma multiforme
Heterogenous appearance
353
Where are secondary brain tumours normally seen
Grey/white matter junction
354
Where do medulloblastomas originate from
Neuroepithelial cells
Neuronal precurors of cerebellum
355
Most common brain tumour in children
Pilocytic astrocytoma
2nd- medulloblastoma
356
Difference in communicating vs non communicating hydrocephalus
Non- obstruction in passage of fluid
Communicating -obstruction into the venous sinuses
357
Common site of obstructing CSF flow
Cerebral aqueduct
358
Most common site of brain intra-parenchymal haemorrhage
Basal ganglia
359
Cause of intra parenchymal haemorrhage
HTN in over 50% of cases
360
What are lacunar infarcts
Bleeds which occur in the brain
361
What is a cavernous angioma
Well defined lesion composed of packed vessel with no parenchyma interposed between vascular spaces
Presents with low pressure bleeds- headahce, focal deficits, seizures
362
What is diangosis when target sign on imaging in brain
CAVERNOUS angioma
363
What causes SAH
Berry aneurysm in circle of willis
364
Most common site of berry aneurysm
Internal carotid artery bifurcation
365
What is global cerebral ischaemia
Systemic circulation failure
366
Causes of ischaemia in brain
Extracerebral thrombosis
Embolism from heart or carotid- most often seen in MCA
367
Histology of cerebral infarct
Tissue necrosis
Rarely haemorrhagic
Permenant damage in affeced area
No recovery
368
Histology of cerebral haemorrage
Bleeding
Dissection of parenchyma
Fewer macrophages
Limited tissue damage
Chance of recovery
369
What are common signs of brain fracture on examination
Straw coloured otorrhoea and rhinorhhoea
370
What is battles sign
Bleeding behind ear showing skull base fracture
371
What are contusions
Brain in collision with skull and get surface bruising
372
What is diffuse axonal injury
The long connecting fibers in the brain called axons are sheared as the brain rapidly accelerates and decelerates inside the hard bone of the skull
Usually causes a coma
373
What is chronic traumatic encephalopathy
Effects on brain of repeated trauma to head
374
Neuropathology of Alzheimers
Extracellular plaques of beta amyloid
Neurofibrillatory tangles of Tau
Cerebral beta amyloid angiopathy
Cerebral atrophy
375
Long term imaging finding of AD
Cortical atorphy
Widening of ventricles
Narrowed gyri
Widened sulci
376
How is staining for Tau done
Immunohistochemistry
377
Staging done for alzheimers
Braak
378
Pathophysiology of parkinsons
Reduced stimulation of cortex by basal ganglia due to dopaminergic loss in substantia nigra
379
Histology of lewy body dementia
Alpha synuclein
Ubiquitin
Lewy bodies
380
How does mutiple system atrophy differ to parksinsons
Alpha synuclein in the glial cells not neurones histologically
381
Histology of picks disease
Fronto-temporal atrophy
Marked gliosis and neuronal loss
Ballon neurones
Tau positive pick bodies
382
What is stained positively in frontotmeporal dementia linked to chr 17
Tau
383
Pathophysiology of frontotmeporal dementia linked to chr 17
Defect in tau generation
Only see atrophy unilaterally
384
What are 2 types of barretts oesophagus
Gastric metaplasia- without goblet cells
Intestinal type metaplasia- with goblet cells
385
Most common oesophageal cancer in developed world
Adenocarcinoma
386
Most common oesophageal cancer in developing world
SCC
387
What are 2 types of gastritis
Acute
Chronic
388
Acute gastritis causes
Aspirin
NSAIDS
Alcohol
Corrosives
Hpylori
Crohns
389
Chronic gastritis causes
Autoimmune- pernicious anemia
Bacteria- h pylori in antrum
Chemical- NSAIDS, bile reflux in antrum
390
Complications of H.pylori
Lymphoma
Metaplasia->adenocarcinoma pathway
Ulcers
391
Which Hpylori is most associated with chronic inflammation and ultimately cancer
Cag A
392
Nicher pathogenic causes of gastritis
CMV, strongyloides (threadworm)
393
Difference between gastritis and ulcer
Ulcers breach through muscularis mucosa into submucosa
394
Complications of ulcers in stomach
Bleeding- anamemia, shock
Perforation
395
Histology of gastric epithelial dysplasia
Cytological and histological features of malignancy but doesnt invade through BM
396
Most common cancer in stomach
Adenocarcinoma
397
How are gastric adenocarcinomas classifed
Intestinal- well differentiated
Diffuse- poorly differentiated
398
What are signet ring cells seen in
Diffuse gastric adenocarcinomas
399
Most common cause of gastric ulcer
Hpylori
400
What makes duodenum more vulnerable to H pylori
Increased acid production leaks into duodenum causing gastric metaplasia
401
Pathogens other than H pylori causing duodenal ulcer
CMV
Giardia lamblia- most important
Tropheryma whippeli
402
What causes whipples diseases
Tropheryma whippelii- causes duodenal ulcers and gastritis
403
Main cause of villous atrophy
Coeliac
Only if on gluten though, if not willbe normal
404
Diagnosing coeliac
Tisse transglutaminase ABs
Endomysial
Biopsy but patient must be off gluten
405
Biopsies of coeliac
Villous atrophy
Crypt hyperplasia
See flattened villi
Increased intraepithelial lymphocytes- normal range less than 20 lymphocytes/100 enterocytes
406
What else can present with villous atropy
Tropical sprue
407
Causes of chronic hepatitis
Viral
Drugs
Autoimmune
408
What is haemosiderosis
Accumulation of iron in macrophages from blood transfusions
409
Pathophysiology of alpha-1-antitrypsin
Failure to secrete it
Intra cytoplasmic inclusions due to misfolded protein
Causes hepatitis and pneumonitis
410
Causes of hepatic granulomas
PBC
Drugs
TB
Sarcoid
411
How is calcium stored in the bone
As calcium hydroxapatite
412
What are the types of bone
Cortical and cancellous
413
What is difference in distribution and function of cancellous versis cortical bone
Cortical
- long bones
- 80-90% calcified and mainly protective and mechanical
Cancellous
- vertebrae and pelvis
- 15-25% calcified
- mainly metabolic
414
What is metabolic bone disease
Disordered bone turnover due to imblalance of chemicals and hormones
Leads to osteopenia (loss of bone mass)
415
Whre is gold standard site for bone histology
Iliac crest
416
What is renal osteodystophy
Encompasses all of the bone changes seen in CKD
- osteomalacia
- osteosclerosis
- osteoporosis
- osteitis fibrosa cystica
417
Which viruses have been implicated in pagets disease
Parvomyxovirus
418
When are langhans giant cells seen
Granulomas
419
When does lyme disease affect bones
Very late
Get inflammatory arthropathy
420
What is tophus seen in
Gout
421
What are gout crystals
Negative birefringent needle shaped monosodium urate crystals
422
What are crystals in pseudogout
calcium pyrophosphate in knees
calcium phosphate in knees and shoulders
Rhomboid shaped and positively birefringent
423
Aetiology of pseudogout
Idiopathic
Metabolic- haemochromatosis, primary HPT
Hereditary
Traumatic
424
What are dermoid cysts
Mature cystic teratomas which contain teeth, hair etc from any lineage
Normally found on neck and head
425
Where and in who are primary bone tumours found
Around the knee
In young people and children
426
How can bone tumours present
Pain
Swelling
Deformity
Fractures easily
427
How to diagnose bone tumours
First investigation an XRAY
Desired diagnosis technique a needle biopsy with a jamshidi needle
428
Who does fibrous dysplasia occur in
Females more than men
First 3 decades
429
Where does fibroud dysplasia occur and what is x ray finding
Ribs and proximal femur
Soap bubble osteolysis and shepherds crook deformity if in proximal femur
430
What is fibrous dysplaia associated with
McUne albright syndrome (if polyostotic)- cafe au lait spots and endocrine problems
431
What is soap bubble osteolysis seen in
Fibrous dysplasia
432
Histology of fibrous dysplasia
Chinese letters
(misshapen bone trabeculae)
433
What do you see shephards crook deformity of femur in
Fibrous dysplasia
434
What is most common benign bone tumour
Osteochondroma
435
How do osteochondromas appear histologically and on x ray
Bony protuberance capped in cartilage- histology
Mushroom cap on bone- x-ray
Osteo (bone) chond (cartilage) roma
436
Where do you see osteochondromas
End of long bones
437
How do endchondromas appear histologically
Normal cartilage
438
What appears with cotton wool or popcorn calcifcation
Endochondromas
439
Where do endchondromas appear
"Ends"
Hands for example
440
Sheets of multi-nucleate giant cells on background of spindle cells taken from bone
Giant cell tumours (borderline malignancy)
441
What is most common malignant bone tumour
Metases however not at below elbow and knee
442
What are the 3 malignant bone tumours
Osteosarcoma
Chondrosarcoma
Ewings sarcoma (primitive peripheral neuroectodermal tumour)
443
Who and where do osteosarcomas occur
Adolescent
Normally around the knee
444
What is codmans traingle or elevated perisosteum seen in
Osteosarcoma
445
What are malignant mesenchymal cells seen in
Osteosarcoma
446
X ray finding of osteosarcoma
Elevated periosteum (Codmans triangle)
Sunburst appearnace
447
MOst common primay bnoe sarcoma
Osteosarcoma
448
Who are chondrosarcoma seen in and where are they
Middle age
Axial bones
449
Histology of chondrosarcoma
Malignant chondrocytes
450
What is fluffy calcification seen in
Chondrosarcoma
451
Who are ewings sarcoma seen in and where
Long bones and pelvis
Adolescents
452
Histology of ewings sarcoma
Sheets of small round cells
CD99+VE (MIC 2)
453
What is onion skinning of perisoteum seen in
Ewings sarcoma
454
Which bone tumour can be diagnosed genetically
Ewings sarcoma
T11:22 translocation
455
Difference in ALP staining between malignant bone tumours
Osteosarcoma- postive
Ewings sarcoma- negative
456
What is Radiolucent nidus with sclerotic
rim ‘Bull’s-eye’ seen in
Osteoid osteoma
457
Where are simple bone cysts appear and how do they appear
Humerus and femur
Lytic well defined small fluid fille dlesions
458
Skin findings of SLE
Malar rash
Photosensitive rash
Discoid rash with atrophic centre
459
What is a titre with regards to ANA
The titre is the highest dilution factor at which they are present within their serum
460
What are the autonatibodies in SLE
Anti-DsDNA
Anti-Smith (ribonucleoproteins)
Anti-histone
461
What is signifcance of anti-histone autoantibodies in SLE
That it is drug induced lupus from hydralazine etc
462
Most specific antibodie for SLE
Anti-smith (ribonucleoproteins)
463
Main histological finding with refgards to SLE
Immune complex deposition
464
SLE criteria
4 out of 11
SOAP BRAIN MD
Serositis
Oral ulcers
Arthritis
Photosenstivity
Blood disorders
Renal
ANA+ve
Immune phenomena (autoantibodies)
Neurological signs
Malar rash
Discoid rash
465
Pathophysiology of systemic scelrosis
Fibrosis and excess collagen deposition
466
Types of systemic sclerosis
Diffuse
Limited
Morphoea- if localised to 1 area
467
What is presentation of limited systemic scleorderma
CREST
Calcinosis
Raynauds
Esophageal dysmobility
Scleodactyly
Telengiectasia
468
What is histology of limited systemic scelrosis
Increased collagen deposition
Fibrosis
Arteriole onion skinning appearnace
469
Antibody difference between diffuse and limited systemic scelrosis
Diffuse- anti-scl-70 (anti-topoisomerase)
Limited- anticentromere
REMEMBER AS LACA
470
What is speckled immunofluorescence associated with in ANA testing
Mixed connective tissue disease
471
Differences between limited and diffuse systemic sclerosis
Limited- confined to face and distal aspects of limbs (distal to knee and elbow)- typically CREST
Diffuse- widespread including renal, cardio symptoms
Complication of limited is pulomanry htn whereas is pulm fibrosis in diffuse
472
What is pathophysiology of myositis'
Typically an underlying malignancy
Autoimmune condition agaisnt the muscle
473
Skin findings in dermatomyositis
Gottrons papules- callouses on knuckles
Heliotrope rash- reddening around eyes and face
474
CNS presentation of sarcoid
Meningitis
Cranial nerve palsy
475
What is the classfifcation of vasculitidies
Large vessel
- takayasu
- GCA
Medium vessel
- polyarteritis nodosa
- kawasakis
- thromboangiitis obliterans
Small vessel
- microscopic polyangiitis
- granluomatosis with polyangiitis
- IgA nephropathy
- eosinophillic granluomatosis with polyangiitis
476
Histology of GCA
Granulomatous transmural inflammation + giant cells +
skip lesions
477
Presentation of GCA
Over 50
Preceding polymyalgia rheumatica
eadache over eye
Vision difficulty
478
Presentation of takayasus arteritis
Japanese women
Cold hands
No pulse
Low BP
Claudication
Bruits
479
What is presentation of thromboangiitis obliterans
Heavy smoker and a young man
Feet ulcers
Arterial limb disease
480
Investigation for thromboangiitis obliterans and the findings
Angiogram
Shows corkscrew appearance from segmental occlusive lesions
481
Which vessels does polyarteritis nodosa normally affect
Renal and mesenteric
482
What condition is normally associated with polyarteritis nodosa
Hep B
483
Angiogram finding of polyarteritis nodosa
Microaneurysms on angiography (“string of pearls / rosary
bead appearance
484
Histology of polyarteritis nodosa
fibrinoid necrosis & neutrophil infiltration
485
Hallmarks of polyangiitis with granulomatosis
ENT- saddle nose, sinusitis, episatxis
Lung- pulm heamorrhage, cavitation
Renal- glomerulonephritis
486
AB in polyangiitis with granulomatosis
Cytoplasmic ANCA against proteinase 3
487
AB in eosinophilic polyangiitis with granulomatosis
Perinuclear- ANCA against myeloperoxidase
488
Presentation of eosinophilic polyangiitis with granulomatosis
Asthma
Eosinophilia
Allergic rhinits
Vasculitis evidence
489
Presentation of micropscopic polyangiitis
Renal and pulomary syndrome
490
AB in microsopic polyangiitis
Perinuclear- ANCA against myeloperoxidase
491
Main structure of breast and the 2 epithelial cells
Are large ducts with a termina ductal lobular unit
Luminal and myoepithelial cells
492
2 Most common breast lesions that presents with discharge
Papilloma
2nd- duct ectasia
493
How are aspirates of breast lumps coded
C1- inadequate
C2- benign
C3- atypia, probably benign
C4- suspicion of malignancy
C5- malignant
494
Presentation of duct ectasia
Older women
Multiparous
Green/wihte discharge
Usually discharge sometimes with breast mass and nipple retracition so easily mistaken for cancer
495
Cytology of duct ectasia discharge
Proteinaceous material and inflammatory cells
496
Histology of duct ectasia
Dilated duct
Inspissated secretions
Periductal and interstitial inflammation – granulomatous
497
Most common organism for acute mastitis
Staph
498
Presentation of fat necrosis
Breast mass
Late stages may show calcification
Preceded by trauma, surgery, radiotherapy as is inflam response to damaged adipose tissue
499
Histology of fat necrosis
Central focus of necrotic fat cells surrounded by lipid filled macrophages and neutrophilic infiltrates
500
What is a galactocele
Cystic dilation of a duct during lactaction
501
Presentation of galactocele
Multiple tender palpable nodules
Infection may convert these to acute mastitis or abscesss
502
Histology of pagets breast disease
Cells with abundant pale clear cytoplasm which contains mucin
Large and prominent nuclei
503
What is level of critical artery stenosis
70%
504
What causes prinzmetal angina
Coronary artery spasms
505
What is difference in name of tumour of large vs small nerve tumour
Small- neurofibroma
Larger (spinal cranial nerve)- schwannoma
506
What are gliomas
Tumours of non neuronal cells
Includes astrocytoma, ependymoma, o
ligodendromas etc
507
What is most common primary brain tumour in an adult
Mengioma- mainly occurs in elderly
508
What happens if pia mater torn when brain collides with the skull
Becomes a laceration not a contusion
509
What is name of stain done for copper
Rhodanine
510
Cases which promote coroner referral
o Unknown cause of death
o Sudden or unexpected death (inclusive of all deaths <24hours after admission to hospital)
o Deceased person not seen by a doctor within 14 days before death
o The death is considered suspicious/unnatural/violent
o The death may be due to an accident, self-neglect (i.e. drug-use death) or neglect on the behalf of others
o The death is/could be due to the deceased’s prior employment (including industrial disease)
o The death may be due to an abortion
o The death occurred during an operation or before recovery from anaesthetic
o The death occurred during or shortly after a period of police custody
o The death may be suicide (can only be confirmed by a coroner)
511
How do death certificates work in terms of cause of death
Section 1 is the cause of death can can have 1a, 1b, 1c
1a is the immediate cause
1b caused A
1c caused B etc
The last 1 letter is cause of death
Section 2 includes what lead may have contributed to death ie DM, HTN etc
512
Presentation of the connective tissue myositis'
Proximal muscle weakness
Can get SOB and arrythmias
513
How does wilsons present
Liver cirrhosis- often in kids
Neuro- dementia, seizures and parkinsons
Also seen in eyes, kidneys and heart
514
How can haemochromatosis present
Liver- cirrhosis
Heart- cardiomyopathy
Pancreas- DM
Gonads- atrophy and impotence
515
Blood finding of wilsons
Low caeruplasmin
516
What antibodies suggest that it is drug induced lupus
Anti-histone
517
Which infection of genital tract is associated with spontaneous abortion and chorioamnionitis
Mycoplasma
518
Pathogenesis of staph, strep, coliform bacteria and clostridium causing PID
Secondary to abortion
Start in lymphatics then spread by blood and lymph upwards
519
What is dyskaryosis
Change in the appearance of cells
520
How are HPV infections divided
Latent
- HPV resides in cells but does not produce infective virions
Productive
- DNA replication independant of cells own replication
521
How does HPV transform cells
Produces 2 proteins- E6 and E7 which inactivate tumour suppressor genes
E6- p53
E7- Rb
522
HPV vaccine schedule
Given between 12-13
2nd dose 6-24 months later
523
What tumour suppressor gene mutation is associated with serous endometrial carcinoma in 90% of cases
p53
524
What are the types of ovarian tumours
Epithelial
Sex chord stromal
Germ cell
Miscellaneous
525
Histology of serous cystadenoma
Columnar epithelium
Psammoma bodies
526
Histology of mucinous cystadenoma
Mucin producing cells
527
Which tumours are associated with pseudomyxoma peritonei
Mucinous ovarian adenomas
Appendicular tumours
528
Histology endometrioid ovarian tumours
Tubular glands mimicking the endometrium
529
Histology of clear cells ovarian tuours
Clear cells with clear cytoplasm
Hobnail appearance
530
What ovarian tumours are endometriosis associated with
Clear cell
Endometrioid
531
Difference between immature and mature teratomas in ovaries
Mature
- cystic
- differentiation into mature tissues like skin teeth etc
Immature
- solid
- embryonal tissue
- secrete AFP
532
Which ovarian tumours secrete AFP
Immature teratomas
533
What is most common malignant ovarian tumour in young women
Dysgerminoma (female counterpart to testicular seminoma)
534
What are the ovarian germ cell tumours
Dysgerminoma
Teratoma
Choriocarcinoma
535
What are the ovarian epithelial tumours
Serous
Mucinous
Endometrioid
Clear cell
536
What ovarian tumour secretes HcG
Choriocarcinoma
537
What are the sex chord tumours of ovaries
Granulosa-theca cells
Fibromas
Sertoli-Leydig
538
What do granulosa theca cells produce
E2
Signs include oestrogenic effects- irregular menstrual cycles, breast enlargement, endometrial/breast hyperplasia
539
What do sertoli leydig tumours produce
Androgens- look for signs of breast atrophy, clitoral enlargement, hirsutism, deep voice
540
Histology of granulosa theca cell tumours
Cal-exner bodies
541
Histology of krukenberg tumours
Mucin producing signet ring cells
542
Test for coeliac if IgA deficient
Straight to biopsy
543
What is stained for in parkinsons
Alpha synuclein
544
What do germ cell tumours secrete
AFP
LDH
bHCG
