Histopathology Flashcards

1
Q

What is the evolution of an MI, in terms of histological findings, between hours-weeks/months after

A

under 6 hours- histologically normal (CK-MB also normal)

6-24hrs- loss of nuclei, homogenous cytoplasm, necrotic cell death

1-4 days- infiltration of polymorphs then macrophages to clear debris

5-10 days- removal of debris

1-2weeks- granulation tissue, new blood vessels myofibroblasts, collagen synthesis

weeks-months- strengthening, decellularising scar tissue

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2
Q

common causes of heart failure

A

Ischaemic heart disease
Myocarditis
hypertension
cardiomyopathy
valve disease
arrhythmias

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3
Q

signs of heart failure

A

LHF
pulmonary oedema
dyspnoea, orthopnoea
wheeze
fatigue

RHF
congestion of systemic and portal venous system
Oedema
ascites
facial engorgement
nutmeg liver

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4
Q

Investigations for HF

A

BNP/ NT-proBNP
CXR
ECG
Echo

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5
Q

causes of dilated cardiomyopathy

A

alcohol
thyroid disease
haemachromatosis
idiopathic
viral myocarditis

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6
Q

casues of hypertrophic cardiomyopathy

A

hypertension
valve disease
???

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7
Q

causes of restrictive cardiomyopathy

A

sarcoidosis
amyloidosis
radiation induced

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8
Q

describe hypertrophic cardiomyopathy

A

thick walled heart, heavy and hypercontractile

myocardium cells in dissarray which is arrhythmogenic

autosomal dominant
mutation in the beta-myosin genee most common

cause of sudden cardiac death in young people

HOCM- (obstructive)- septal hypertrophy resulting in outflow obstruction

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9
Q

multisystems affected in acute rheumatic fever

A

heart: pericarditis, myocarditis, endocarditis (pancarditis)

joints: arthritis, synovitis

skin: erythema marginatum, subcutaneous nodules

CNS:encephalopathy, sydenhams chorea

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10
Q

clinical features of rheumatic fever

A

develops 2-4 weeks after strep throat

diagnosis: GAS infection +2major or 1major+2minor

JONES’ MAJOR (CASES)
Carditis
Arthritis
Sydenhams chorea
Erythema marginatum
Subcutaneous nodules

MINOR CRITERIA
Fever
raised CRP/ESR
PR prolongation
arthralgia
previous rheumatic fever
malaise
tachycardia

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11
Q

Histological findings in rheumatic fever

A

Beady fibrous vegetations (verrucae- small warty veg found along closure of valve leaflet)
Aschoff bodies (small giant cell granulomas)
Antischkov myocytes (regenerating myocytes)

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12
Q

Causes of cardiac vegetations

A

Rheumatic heart disease (verrucae)

Infective endocarditis (large vegetations of colonising bacteria)

thrombotic endocarditis (eg. DIC- small vegetation attached to lines of closure)

Libman-sacks endocarditis (small warty vegetations that are sterile and rich in platelets)- SLE

non bacterial thromboemboli

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13
Q

Causative organisms of IE and RFs

A

staph aureus –> IVDU (tricuspid), cannulae, central lines, cellulitis

Strep viridans –> poor dental hygeine/ dental surgery

Strep pyogenes

staph epidermidis –> prosthetic valves

steptococcus bovis –> colon cancer

HAECK

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14
Q

Dukes criteria of IE

A

Major
- positive blood culture of typical IE organism or 2 positive cultures 12hrs apart
- positive finding on echo

Minor
- evidence of immune phenomena(osler, roth)
- evidence of thromboembolic phenomina (janeways, septic abscess, splinter, splenomegaly)
- fever
- risk factor (IVID, prosthetic valve, valve abnormalities)
- positive culture not meeting major criteria

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15
Q

Treatment of acute IE

A

Flucloxacillin (MSSA)
gentamycin+ rifampicin + vancomycin (MRSA)

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16
Q

Treatment for subacute IE

A

benzylpenicillin+ gentamycin or vancomycin for 4 weeks

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17
Q

what classification is used to assess severity of GORD

A

Los Angeles Classification

obese people have GORD and people in LA are obese

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18
Q

what is the progression of disease from GORD-> cancer

A

GORD –> metaplasia (barretts) –> dysplasia –> adenocarcinoma

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19
Q

where is adenocarcenoma of the oesophagus found

A

distal 1/3
associated with barretts

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20
Q

where is SCC of oesophagus found

A

middle 1/3 (50%)
upper 1/3 (20%)
lowe 1/3 (30%)

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21
Q

common lung infectious organism in people with CF

A

Pseudomonas aeruginosa

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22
Q

what is cystic fibrosis?

A

Autosomal recessive condition casued by a mutation in the CFTR gene which is responsible for Cl transport

Results in abnormally thick secretions

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23
Q

what is the FEV1/FVC ratio in restrictive disease

A

FEV1 relatively large but FVC reduced
FEV1/FVC >70%

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24
Q

Clinical findings in interstitial lung disease

A

fine end inspiratory crackles
chronic SOB
pulmonary HPTN and cor pulmonale

ground glass/ honeycomb appearance on CTCAP

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25
histological stages of pneumonia
1- consolidation 2- red hepatisation (neutrophilia) 3- grey hepatisation (fibrosis) 4- resolution
26
Most common types of lung tumours
1- SCC (30-50%) 2- adenocarinoma (20-30%) 3- small cell carcinoma (20-25%) 4- large cell carcinoma (10-15%)
27
features of SCC of the lung
- most commonly associated with smoking - p53/c-myc mutation associations - proximal bronchi Histology -keritinisation - intracellular prickles (desmosomes) - can produce PTHrP --> hypercalcaemia progression epithelium --> hyperplasia --> squamous mataplasia --> angiosquamous dysplasia --> carcinoma in situ --> invasive carcinoma
28
Features of lung adenocarinoma
-lung cancer most commonly associated with non-smokers -malignant epithelial tumor with glandular differentiation or mucin production -starts peripherally and mets early histology - glandular differentiation progression - atypical adenomatous hyperplasia --> non mucinous BAC --> mixed pattern adenocarcinoma
29
features of small cell lung cancer
- central - arises from neuroendocrine cells so associated with ectopic ACTH and ADH secretion (cushings, SIADH) - associated with lambert eaton syndrome (40% of LEMS have SCLC) - smoking -p35 and RB1 mutations - mets early to bone, liver, brain and adrenals histology - oat cells
30
Large cell carcinoma
-poorly differentiated malignant epithelial tunour -poor prognosis
31
examples of paranoplastic synromes and what cancer they are associated with
Hyperparathyroidism, hypercalcaemia --> PTHrP secretion (squamous cell carcinoma) SIADH --> ectopic ADH (small cell lung cancer) Cushings syndrome --> ectopic ACTH (small cell lung cancer) carcinoid tumour (lung or GIT) --> serotonin secretion struma ovarii- ovarian tumour which secretes thyroxine
32
describe mesothelioma
cancer arising from either parietal or visceral pleura - spreads widely in pleural space - extensive pleural effusion, chestpain, dyspnoea - asbestos related with 25-45 latent period
33
Classess of pulmonary hypertension
class 1 - pulmonary arterial hypertension class 2 - pulHPTN due to left heart disease class 3- due to lung disease (eg. IDL) class 4 - unclear multifactorial problems
34
hisologial findings of pulmonry oedema
intraalveolar fluid iron laden macrophages (heart failure cells- the iron lady had no heart)
35
investigations for coeliac
ABs: - anti-endomysin Abs (best) - anti- transglutaminase - anti-gliadin gold standard: - endoscopy and duodenal biopsy --> crypt hyperplasia and villous atrophy with increased intraepithelial lymphocytes
36
Cancer associated with coeliac
Enteropathy T cell lymphoma (chronic T cell stimulation)
37
Cancer associated with chronic H pylori infeciton
Mucosal associated lyphoid tissue (MALT) lymphoma
38
Extra GI manifestations of IBD
Malabsorption and iron deficiency --> angular stomatitis Eyes --> anterior uveitis, conjunctivitis skin --> erythema nodosum, pyoderma gangrenosum, erythema multiforme Joints --> migratory asymmetrical polyarthropathy of large joints, sacroiliitis, myositis, ankylosing spondylitis, clubbing liver --> pericholangitis, primary sclerosing cholangitis (UC>CD) inc risk of cholangiocarcinoma
39
Key difference between UC and CD interms of smoking
CD- smoking worsens condition UC- smoking improves symptoms/ protective
40
Key features of chrons disease
can be anywhere along the GIT (mouth to anus) skip lesions cobblestone appearance Transmural inflammation non caseating granulomas (ddx TB colitis) apthous ulcer - first lesion --> serpentine ulcers when join together
41
Complications of chrons
Bowel strictures fistulae abscess formation perforation
42
Features of UC
slightly more common than chrons white>non-white. 20-25yrs distal portion of GIT affected continuous involvement of mucosa superficial inflammation pseudopolyps (islands of regenerating mucosa) BLOODY diarrhoea smoking improves sx backwash ilitits only if whole colon affected and it moves to ilium
43
Complications of UC
Toxic megacolon severe haemorrhage adenocarcinoma (20-30x risk)
44
Which Abx are associated with C. diff infection
the 4 Cs Cephalosporins Clindamycin Ciprofloxacin Co-amoxiclav
45
Treatemnt and Mx of C. diff infection
Vancomycin or metronidazole move to a side room
46
What is carcinoid syndrome
group of tumours arising from enerochromaffin cells which causes over production of 5-HT found in the bowl, lungs, ovaries and testes
47
Clinical features of carcinoid syndrome and carcinoid crisis
Bronchoconstriction flushing diarrhoea crisis: lifethreatening vasodilation, hypotension tachycardia bronchoconstriction hyperglycaemia
48
investigations for carcinoid syndrome
24hr urnine 5-HIAA (main metabolite of H-HT)
49
Treatment of carcinoid syndrome
ocretide (somatostatin analogue)
50
Outline the Dukes staging of colorectal cancer (NB this is out dated)
A- confined to mucosa B1- extending to muscularis propria B2- transmural invasion but no nodal involvement C1- extendning to muscularis propria with LN mets C2- transmural invasion with LN mets D- distant mets
51
Descripe the pathophysiology of FAP
Familia adenomatous polyposis mutation in the APC tumor suppressor gene gene C5q1 - 30% autosomal recessive mutation in DNA mismatch repair genes) >100 polyps seen on colonoscopy for diagnosis all will progress to adenocarcinoma if not treated increased risk of ampulla of vater and stomach neoplasia
52
Describe lynch syndrome
Hereditary non-polyposis colorectal cancer autosomal dominant mutation in mismatch repair genes few polyps but fast progression to malignancy <50yrs carcinoma commonly found in caecum also associated with extracolonic cancers ENDOMETRIAL, prostate, ovarian, small bowel, transitional cell and stomach carcinomas
53
macrovascular complications of diabetes
Ischaemic heart disease Peripheral vascular disease CVA
54
Microvascular complications of DM
Diabetic retinopathy glomerulonephritis peripheral neuropathy- ulcers
55
Histological findings in acute pancreatitis
coagulative necrosis
56
histological findings of chronic pancreatitis
fibrosis and loss of exocrine tissue parenchyma, duct dilation with thick secretions, calcification
57
Histological findings in acute hepatitis
spotty necrosis
58
Histological findings in chronic hepatitis
- portal inflammation - interface hepatitis (piecemeal necrosis) - lobular inflammation - bridging of the portal vein to the central vein
59
what is basophilic stippling and what is it a sign of?
aggregation of ribosomal material present in beta-thalassaemia and lead poisoning
60
How does Reyes syndrome present
usually following URTI and aspirin consumption in children acute encephalopathy secondary to severe impairment of liver function
61
what is budd chiari syndrome
occlusion of the portal vein either due to compression or thrombosis
62
Describe haematochromatosis
excessive deposition of iron due to increased absorption from the gut iron accumulates as haemosiderin in various organs hyperpigmentation of the skin
63
Describe Wilsons disease
mutation in copper transport ATPase gene on chromosome 13 failure of the liver to secrete copper-ceruloplasmin complex into the plasma overspil of copper into the blood results in: - liver disease - parkinsonism - kayser fleischer rings
64
complications of alpha1 antitrypsin deficiency
failure in production on protease inhibitor alpha 1 anti trypsin causes hepatitis from accumulation of alpha1 trypsin globules
65
what is zollinger-ellison syndrome
gastric hypersecretion leading to multiple peptic ulcers diarrhoea
66
What is fibrous dysplasia and some features
disorder of children and young adults (woman <30y) fibrous and boney tissue lesions in the ribs, femur, tibia or skull ‘soap bubble’ appearance on Xray indicative of osteolysis presents as bone pain and weakness Histology: - loose fibrous tissue with metaplaplastic woven bone trabeculae --> 'CHINESE LETTERS' formation 3 forms- polyostotic McCune-Albright syndrome (endocrine manefestaions) shepherds crook deformity
67
Describe McCune Albright syndrome
rare disorder that affects bone, skin and endocrine systems features: fibrous dysplasia of bone cafe au lait spots multiple endocrine dysfunction
68
Which method of cyto-pathology is used in cervical smear
liquid based cytology
69
Histopathology in chronic bronchitis
hypertrophy of mucus glands and goblet cell hyperplasia --> copious amounts of mucus
70
histological findings in squamous cell carcinoma
if well differentiated show keratin pearls and cell junctions (desmosomes) --> characteristic itercellular 'prickles'
71
what skin manefestation is associated with coaeliac disease
dermatitis herpetiformis
72
histological finding of lichun planus
hyperkeratosis with SAW TOOTHING of rete ridges and basal cell degeneration lichenoid chronic inflammatory infiltrate
73
what condition is likely if white cell casts are found on urinanalysis
acute pyelonephritis
74
what condition is likely if red cell casts are found on urinanalysis
Glomerulonephritis
75
Congo red and apple green birefringence positive result sign of
Amyloidosis
76
Positive fontana stain
melanoma (stains melanin)
77
Rhodanine stain positive sign
golden brown against blue counterstain Wilsons disease
78
Positive prussian blue stain
Haemachromatosis
79
Positive Perl's stain
Haemachromatosis
80
Positive cytokeratin stain
Carcinoma (positive for epithelial cells)
81
Positive Ziehl-Neelson stain
stains acid fast bacilli - TB
82
Bright yellow when stain with Rhodamine-Auramine
TB
83
Gomori's methanamine silver stain with flying saucer shaped cysts
Pneumocystic jirovecii
84
Positive modified kinyoung acid fast stain
cryptosporidium parvum
85
India ink stain showing cells surrounded by halos
cryptococcus neoformans
86
Giemsa stain showing cytoplasmic inclusions
Chlamydia psittaci
87
Positive Fite stain
Mycobacterium leprae (dont fight with my leopard)
88
Histology features of sarcoidosis
multisystem disease of unknnown cause characteriseed by non-caseating granulomas Histology: schaumann and asteroid bodies
89
features, RFs and clinical signs of sarcoidosis
RFs - afro-carribeans - F>M, 40-60yrs SOB, cough, chest pain, night sweats. CXR findings: - bilateral hilar lymphadenopathy - pulmonary infiltrates -> fine nodular shadowing
90
Extrapulmonary manifestations of sarcoidosis
SKIN: erythema nodosum (tender red nodules on shins), lupus pernio (purple leasons around nose), skin nodules LN: lymphadenopathy, painless and rubbery JOINTS: arthritis, bone cysts EYES: anterior uveitis (painful and misting of vision), posterior uveitis (progressive visual loss), keratoconjunctivitis, lacrimal gland enlargement Hepatosplenomegaly leukopenia, anameia hypercalcaemia HEART: dysrhythmias, restrictive cardiomyopathy FLAWS symptoms
91
Investigation findings of sarcoidosis
raised Ca2+ (ectopic a1hyroxylase released by activated macrophages) raised ESR raised ACE non-caseating granuloma on histology restrictive pulmonary findings on spirometry
92
What is amyloidosis
multisystem disorder caused by abnormal folding of proteins that deposit as amyloid fibrils in tissue, disrupting their normal function lots of forms eg: - beta pleated sheet structure - resistant to enzyme degredation
93
what is the most common type of amyloidosis?
AL amyloidosis deposition of Ig light chain monoclonal Ig free light chains in serum and urine (bence jones protiens) increased bone marrow plasma cells SIMILAR TO MULTIPLE MYELOMA
94
describe AA amyloidosis
formed from serum amyloid A acute phase protein build up secondary to chronic infection and inflammation eg. RA, IBD, TB, lymphoma
95
what is haemodialysis associated amyloidosis?
deposition of beta2 microglobulin usually occurs in someone with long standing chronic renal failure esp if on peritoneal dialysis associated with carpal tunnel syndrome
96
What is familial amyloidosis
most common Familial mediterranean fever characterized by recurrent episodes of fever and serositis (chest, abdomen, joints), leading to painful attacks early during childhood. Amyloidosis is the most fatal complication of FMF
97
clinical features of amyloidosis
multi organ features KIDNEY: nephrotic syndrome HEART: restrictive cardiomyopathy, conduction defects, HF, cardiomegaly hepatosplenomegaly macroglossia (10%) neuropathies eg. carpal tunnel syndrome
98
examples of large cell vasculitides
Takayasu's arteritis Giant cell arteritis (temporal arteritis)
99
Describe features of takayasu's arteritis
affects branches of aortic arch FLAWS pulseless phases claudication cold hands high rates in japanese women
100
Describe features of GCA
Elderly >50yrs scalp tenderness eg. when brushing hair temporal headache jaw claudication blurred vision Ix: raised ESR, temporal artery biopsy
101
histological findings in GCA
granulomatous transmural inflammation, giant cells and skip lesions
102
Management of GCA
IMMEDIATE oral prednisolone
103
give some examples of medium cell vasculitides
Polyarteritis nodosa Buerger's disease ?kawasakis (systemic vasculitis)
104
describe the features of polyarteritis nodosa
renal involvement spares the lungs 30% have underlying hep B microaneurysms on angiography (string of pearls/ rosary bead appearance) 'poly nodes- stings of pearls' histology: fibrinoid necrosis and neutrophil infiltration
105
what is string of pearls/ rosary appearance characteristic of?
polyarteritis nodosa
106
describe the features of buerger's disease
Seen in heavy smokers usually men <35 inflammation of arteries of extremitis- usually tibial and radial pain, ulceration of toes, feet and fingers angiogram: corkscrew appearance from segmental occlusive lesions
107
what is a corkscrew appearance on angiogram characteristic of?
Buerger's disease
108
give some examples of small cell vasculitides
Granulomatosis with polyangiitis eosinophilic granulomatosis with polyangitis microscopic polyangitis henloch- schonlein purpura
109
saddle node, haemoptysis and haematuria
granulomatosis with polyangiitis
110
Describe the features of granulomatosis with polyangiitis
triad of upper resp tract symptoms, lower resp tract symptoms and kidney features ie: epistaxisi, saddle nose pulmonary haemorrhage --> haemoptysis crescenteric glomerulonephritis --> haematuria and proteinuria cANCA
111
features of eosinophilic granulomatosis with polyangiitis
ASthma, allergic rhinitis, eosinophilia, later systemic involvement pANCA +ve
112
features of microscopic polyangiitis
pulmonary haemorrhage rapidly progressive glomerulonephritis pANCA =ve
113
Features of HSP
IgA mediated 3-15yrs preceeding URTI purpuric rash on buttocks and lower limbs abdo pain (bleeding) arthralgia glomerulonephritis
114
what is a 'wire-loop' appearance of the glomeruli characteristic of
SLE
115
Histological features of SLE
- wire-loop appearance of glomeruli - CNS small vessel angiopathy - onion skin lesions in the spleen - Libman- Sack endocarditis
116
clinical features of SLE
SOAP BRAIN MD - Serositis - Oral ulcers - Arthritis - Photosensitivity - Blood disorders (AIHA, AITP, leucopenia) - Renal involvement - ANA +ve - Immune phenomena - Neuro symptoms - Malar rash - Discoid rash
117
antibodies present in SLE
anti-ANA (anti-dsDNA, anti-Sm) anti-smith (most specific) anti-histone (+ve if drug induced)
118
onion skin thickening of arterioles
limited scleroderma (CREST syndrome)
119
difference between diffuse and limited scleroderma
limited- only distal skin involvement. organ involvement rare. associated with pulmonary HPTN diffuse- distal and proximal skin changes. widespread organ involvement, early heart, renal and GI . Associated with pulmonary fibrosis
120
cutaneous features of dermatomyositis
- heliotrope rash with eyelid oedema - grotton papules (erythema of knuckles with raised scaley erruptions) - systemic V shaped rash - facial rash
121
drop out capillaries and myofibre damage on histology is characteristic of..
dermatomyositis
122
which cells in the pancreas secrete the enzymes
acinar cells
123
Describe acute pancreatitis
acute inflammation causing aberrant release of pancreatic enzymes
124
Causes of acute pancreatitis
duct obstruction: - GALL STONES (50%) - TRAUMA - TUMORS metabolic/toxic - ALCOHOL (33%) - DRUGS (eg. thiazides) - HYPERCALCAEMIA - HYPERLIPIDAEMIA poor blood supply - SHOCK (ischaemia) - HYPOTHERMIA infection/inflammations - VIRUSES (eg. mumps) autoimmune - IgG4 related disease idiopathic
125
how does duct obstruction by gallstones cause acute pancreatitis?
reflux of bile up pancreatic duct followed by damage to acini and release of proenzymes
126
patterns of damage in actute pancreatitis
Periductal- necrosis of acinar with obstructive casues perilobular - furthest away from blood supply so most affected by ischaemic causes pan lobular - both
127
discribe the process of pancreatitis
Activated enzymes --> acinar necrosis --> enzyme release lipases --> fat necrosis (bind to Ca which forms soaps, yellow white foci on histo)
128
complications of acute pancreatitis
pancreatic: pseudocysts, abscess systemic: shock, hypoglycaemia, hypocalcaemia (fat necrosis)
129
acute pancreatitis with notmal calcium possible cause
caused by hypercalcaemia initially and then Ca brought back down to normal by fat necrosis
130
casues of chornic pancreatitis
Metabolic: - ALCOHOL (80%) - HAEMACHROMATOSIS duct obstruction - GALL STONES - ABNORMAL PANCREATIC DUCT ANATOMY - CYSTIC FIBROSIS Tumours AUTOIMMUNE
131
Pathogenesis of chronic pancreatitis
Similar to acute chronic inflammation with parynchyman fibrosis and loss of parencyma duct strictures with calcified stones with secondary dilations FIBROSIS AND SCARRING associated with atrophy of the acini CALCIFICATION
132
complications of chronic pancreatitis
malabsorption DM pseudocysts carcinoma
133
what are pancreatic pseudocysts
associated with both acute and chronic pancreatitis lined by fibrous tissue (no epithelial lining) fluid rich in pancreatic enzymes or necrotic material connect with ducts risks compresion of surrounding structures infected perforate releasing enzymes
134
what is IgG4 related disease
characterised by large numbers of IgG4 positive plasma cells may involve pancreas, bile ducts and other parts diagnosis by immunohistochemistry responds well to steroids
135
Tumours of the pancreas
carcinomas - DUCTAL (85%) - ACINAR cystic neoplasms - SEROUS CYSTADENOMA - MUCINOUS CYSTIC NEOPLASM pancreatic neuroendocrine tumours
136
Most common carcinoma of pancreas and breast
ductal
137
risk factors of pancreatic carcinoma
smoking raised BMI chronic pancreatitis diabetes
138
two preceding lesions of pancreatic carcinoma
Pancreatic intraductal neoplasia (PanIN) Intraductal mucinous papillary neoplasm
139
what is the most common mutation in pancreatic carcinoma
K-ras 95%
140
features of carcinoma of the pancreas
gritty and grey invades adjacent structures tumours of head present earlier adenocarcinomas
141
most common site of pancreatic carcinoma
head (60%) ductal
142
how can pancreatic carcinomas metastasis (routs of invasion)
bile ducts, duodemum lymphatic spread blood to the liver serosa to the peritoneoum
143
describe cystic adenomas of the pancreas
contain serous or mucin secreting epithelium usually benign
144
describe pancreatic endocrine neoplasms
usually non secretory contain neuroendocrine markers eg. chromogranin may be associated with MEN1 insulinomas most common kind
145
what is an example of a neuroendocrine marker
chromogranin (stain used to diagnose insulinoma)
146
describe gallstones (RFs and types)
RFs: F>M native americans disorders of bile metabolism oral contraceptive (oestrogen) rapid weight loss types: - cholesterol gall stones (more than 50%)- single and radiolucent - pigment stones (contain Ca salts of unconjugated bilirubin) - usually multiple and radio-opaque on AXR
147
complications of gall stones
obstruction - jaundice cholecytstits gall bladder cancer pancreatitis
148
describe chronic cholecystitis
chronic inflammation FIBROSIS and thickening of wall diverticulae- ROKITANSKY-ASCHOFF SINUSES 90% of pts with chron chol have gall stones
149
what are ROKITANSKY-ASCHOFF SINUSES
out pocketing from diverticulae
150
generic complications og GI disease
diarrhoea, constipation bleeding perforation fistula obstruction systemic illness
151
congenital GI diseases
bowel atresia/ stenosis - failure of development of normal lumen of the gut duplucation
152
describe hirschsprungs disease
abscence of ganglion cells in submucosal and mysenteric plexus starts in rectum 80% male association with T21 RET proto-oncogene mutation
153
mutation in hirschprungs disease
RET proto-oncogene mutation
154
mechanical disorders of bowel
adhesions herniation extrinsic mass volvulus (twists of bowel at mesenteric base around vascular pedicle) diverticular disease
155
describe diverticular disease
low fibre diet high intraluminal pressure 90% in left colon outpouching of bowel pseudodiverticula if doesnt contail all of the layers of bowel
156
complications of diverticular disease
pain diverticulitis perforation fistula obstruction
157
causes of acute and chronic inflammatory disorders of large bowel
acute - infection (CMV, salmonella, entamoeba hystolitica, candida) - drug/ toxin (esp Abx) - chemo - radiation chronic - IBD - TB
158
examples of infective colitis
CMV- especially in immunocompromised eg. pts with IBD on medication salmonalla entamoeba hystolitica candida
159
pseudomembranous colitis
following Abx therapy disrupting the microbiome allowing c diff to flourish c. dif releases toxin diagnosis look for c. dif toxin in stool assay 'mushroom cloud' on histology
160
pathology in splenic flexure likely to be casued by..
ischaemia
161
RFs for IBD
genetic predisposition to abnormal host immunoreactivity infection (mycobacteria, measles) microbiome
162
what organ contains the highest concentration of neuroendocrine cells
GUT
163
examples of non-noeplastic polyps
hyperplastic and sessile serrated lesions (flat on bowel) pedunculated polyp- stalk ataching inflammatory polyps hamartomatous- malformed architexture of normal tissue (juvenile polyposis, peutz jeghers)
164
describe peutz jeghers
hamartomatous polyps characteristic pigmentation around the lips soles and palms autosomal dominant- LKB1
165
describe adenomas of large bowel
look darker than normal tissue epithelial proliferation and dysplasia types: tubular tubulovillus villous- hypoproteinaemic hypokalaemia becuase they leak K and protein
166
RFs for adenomas to develop into cancer
size number of polyps villous adenoma high degree of dysplasia
167
most common sites for adenoma and carcinoma
rectum and sigmoid
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familial polyp syndromes
Peutz jeghers FAP lynch syndrome (HNPCC)
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where is the mutation in FAP
chromosome 5q21 mutation in APC TSG
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what is gardiners syndrome
FAP plus extra-intestinal manifestations eg. osteomas desmoid tumours
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RFs of colorectal carcinoma
familial low fibre, high fat diest obesity poor exercise chronic IBD adenoma
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describe the TNM staging of colorectal cancer
Tumour, nodes, metastasis
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what is a normal villous: crypt ratio
3-5:1
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what is a normal number of lymphocytes in the small bowel
less than 20 intraepithelial lymphocytes/ 100 epithelial cells
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characteristic findings of coeliac on biopsy
crypts increase (hyperplasia)as they are regenerating and replacing damaged epitheliasal cells villous atrophy as damaged increased intraepithelial lymphocyets
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other causes of villous atrophy
drug associated enteropathy giardia H pylori gastritis
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other causes of increase intra epithelial lymphocytes
food hypersensitivity infection eg. giardia, H pylori NSAIDS RA, SLE, autoimmune enteropathy
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management of coeliac
dietary management (exclue wheat, barley and rye) advice RE long term complications: malabsorption, lymphoma, osteomalacia MDT: pt support groups, dieticians, family support, gastroenterologist
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Renal disease associated with Abs to phospholipase A2 receptor
membranous glomerulonephritis (nephrotic syndrome)
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types of nephrotic syndrome
minimal change disease membranous glomerulonephritis focal segmental
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types of nephritic syndrome
-post strep glomerulonephritis -IgA nephropathy (Bergers) -rapidly progressive disease -Alports syndrome -thin BM disease
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pancreatic cancer tumour marker
CA19-9
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complications of MI
contractile dysfunction -> cardiogenic shock congestive cardiac failure arrhythmias mitral regurg (due to LV infact causing papillary muscle dysfunction) dresslers pericarditis (weeks/months after)
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Histological finding: whirls of shed epithelium (curschmann spirals), eosinophils and charcot-Leyden crystals
Asthma
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ground glass/ honeycomb appearance in CT
interstitial lung disease
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types of interstitial lung disease and examples
FIBROSING -idiopathic pulmonary fibrosis - pneumoconiosis - drug induced (eg. methotrexate, chemo) GRANULOMATOUS - sarcoidosis - extrinsic allergic alveolitis - vasculitides (GPA, churg-strauss, microscoping polyangiitis)
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features of idiopathic pulmonary fibrosis
40-70y M>F progressive exertional dyspnoea non-productive cough signs: fine end-expiratory crackles pulmonary hypertension +/- cor pulmonale(RHF) clubbing honeycomb/ ground glass appearance on CT (hyperplasia of type 2 pneumocytes causing cyst formation)
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lung disease associated with coal miners
pneumoconiosis - asbestososis mesothilioma/ adenocarcinoma or fibrosis
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Causes of granulomatous lung lesion
Infectious: TB cryptococcus aspergillus pneumocystis chronic granulomatous disease (inherited immune deficiency in NADPH) non-infecitous: Sarcoidosis granulomatosis with polyangiitis
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treatment of H.pylori
Triple therapy: PPI clarythromycin amoxicillin
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what do the different endocrine cells of the pancreas secrete
alpha cells- glucagon beta- insulin delta- somatostatin D1- vasoactive peptide stimulates secretion of H20 into the pancreas Pancreatic polypeptide- self regulates secretion
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what exocrine enzymes does the pancreas secrete
amylase lipase proteases
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different patterns of damage to the pancreas and associated causes
periductal- necrosis of acinar cells near ducts- suggests obstructive cause perilobular- necrosis of edge of lobules (furthest away from blood supple)- suggest ischaemic causes panlobular
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what is the most sensitive marker of acute pancreatitis
serum lipase
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managament of pancreatic carcinoma
whipples procedure (removal of tumour) palliative chemotherapy with 5-Fluorouracil
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Testicular tumours and tumour markers
germ cell: seminoma - bHCG, LDH yolk sac- AFP choriocarcinoma - bHCG teratoma- ?
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what is spotty necrosis a sign of in the liver
acute hepatitis
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what are the histopathological findings of chronic liver disease
- portal inflammation - piecemeal necrosis (cannot see the border between portal tract and parenchyma) - lobular inflammation - bridging from portal vein to central vein- intrahepatic shunting
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histopathology of cirrhosis
hepatocyte necrosis fibrosis nodules of regenerating hepatocytes disturbance of vascular architecture
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what is used to indicate the prognosis of liver cirrhosis and what does it involve?
Modified child pugh score (ABCDE) Albumin Bilirubin Clotting (PT) Distension (ascites) Encephalopathy
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causes of micronodules (regenerating nodules in the liver)
alcoholic hepatitis, biliary tract disease
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causes of macronodules (regenerating nodules in the liver)
viral hepatitis, wilsons disease, alpha A1 antitrypsin deficiency
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how to score the components of the child pugh score
Albumin: >35- 1 28-35 -2 <28 - 3 Bilirubin <34 - 1 34-50 - 2 >50 - 3 Clotting PT <4 - 1 4-6 - 2 >6 - 3 distension none -1 mild -2 moderate/severe -3 Encephalopathy none -1 mild -2 marked -3 sore <7 (45% 5yr survival) 7-9 (20% 5yr survival) >9 (<20% 5yr survival)
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describe the stages of alcoholic liver disease
1. fatty liver large, pale, yellow and greasy liver accumulation of fat droplet in the hepatocytes fully reversible if alcohol avoided 2. alcoholic hepatitis large, fibrotic liver hepatocyte balloning and necrosis due to accumulation of fat water and proteins MALLORY DENK BODIES fibrosis 3. alcoholic cirrhosis shrunken, non fatty, brown micronodular cirrhosis bands of fibrous tissue
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what causes NAFLD and what are the features
obesity with hyperlipidaemia DM a risk factor 1. simple steatosis- fatty infiltration 2. non-alcoholic steatohepatitis- can progress to cirrhosis
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what is the most common type of liver cancer
secondary metastases (GI, breast, bronchus)
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types of liver cancer
BENIGN hepatic adenoma haemangioma MALIGNANT hepatocellular carcinoma- AFP cholangiocarcinoma - adenocarcinoma arising from bile ducts, 90% associated with gall stones haemangiosarcoma - vascular endothelium, highly invasive hepatoblastoma secondary tumours
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inherited causes of cirrhosis and their inheritance pattern
Haemachoromatosis- AR Wilsons - AR alpha a1- antitrypsin deficiency- AD
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describe haemachoromatosis
AR mutation in HFE gene at 6p21.3 increased gut Fe absorption which deposits in the liver, heart, pancreas, adrenals, pituitary, joints and skin PRUSSIAN BLUE stain in histology Signs skin bronzing DM hepatomegaly cardiomyopathy high Fe, high ferritin, low TIBC, >45% transferrin saturation Rx venesection desferrioxamine
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describe wilsons disease
v. v rare present 11-14yrs AR mutation in ATP7B which encodes for copper transporting ATPase low Cu excretion and deposition in liver, CNS and iris Rhodanine stain in histology mallory bodies signs liver disease parkinsonism, psychosis, dementia kayser fleischer rings low caeruloplasmin, low serum Cu, high urinary Cu Rx life long penicillamine
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describe alpha a1 antitrypsin deficiency
AD failure to secrete A1AT into the blood so it accumulates in the hepatocytes lack of A1AT in lungs -> emphysema stain with periodic acid schiff signs neonatal jaundica emphysema and chronic liver disease low serum A1AT absent alpha globulin band on electrophoresis
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Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
diabetes
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what is the composition of bone?
65% inorganic- calcium hydroxyapatite (99% Ca, 85% phos, 65% Na and Mg) 35% organic- bone cells and protein matrix
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describe bone geography
from outermost layer to inner periosteium --> matrix --> cortex proximal diaphysis --> metaphysis --> epiphysis
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what are the bone cells
osteoblasts- build bone (single nucleus) osteoclasts- chew bone (multinucleated, large cell, macrophage family) osteocytes - sit in lacunae
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describe the activation of osteoclasts
osteoblasts RANKL binds to RANKR on osteoclast precursor cells this upregulates NFKb and triggers maturation into fully functioning osteoclast
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where do you take a bone biopsy from to investigate metabolic bone disease
ileac crest
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RFs for osteoporosis
>age post menopausal smoking XS alcohol female long term immobility poor diet low BMI thyroid disease steroids cushings drugs eg: GNRH antagonists
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what is a distal radial fracture called?
Colles fracture
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what is a brown cell tumour and what is it characteristic of
hyperparathyrosididm many multinucleated giant cells with haemorrhage aka Osteitis fibrosa cystica (increased bone resorption)
221
what is a key feature of pagets on histology
Huge osteoclasts with >100 nuclei Mosaic pattern of lamellar bone (like a jigsaw puzzle)
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chinese lettering on histology soap bubble lytic lesions shepherds crook deformity
fibrous dysplasia
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features of endrochondroma
affects hands and fingers O ring sign cotton wool calcification of matrix
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features of osteosarcoma
adolescence M>F knees Xray- sunburst appearance, codmans triangle (uplifting of periosteum) Histo- malignant mesenchymal cells Bloods- raised ALP
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features of osteochondroma
>40s axial skeleton/ femur/ tibia/ pelvis histo- malignant chondrocytes Xray- lytic lesions with fluffy calcification
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Features of ewings sarcoma
<20yrs F>M Histo: sheets of small round cells CD99+ t(11;22) EWS:Fli1 translocation XRAY: onion skinning of periosteium
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McCune albright syndrome
fibrous dysplasia precocious puberty cafe au lait spots
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Gardiners syndrome
multiple GI polyps multiple osteomas epidermal cysts
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common infectious agents of osteomyelitis and sites
adult- 90% staph aureus jaw and vertebrea- 2 to dental absecess toe- 2 to diabetic foot children- Haemophilus influenzae, GBS Sickle cell patients - salmonella Immunosuppressed- TB- spine (Potts disease: psoas abcess and skeletaldeformity) congenital- syphilis IVDU- pseudomonas
230
Xray features of osteoporosis
LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts
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typical joints affected in osteoarthritis
Knees hip back Distal interphalangeal joints (DIPJ)- Heberdens nodes Proximal interphalangeal joints (PIPJ)- Bouchards nodes
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special giant cells seen in RA
Grimly-Soholoff cells
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process of fracture healing
1. organisation of haematoma and periosteum proliferation 2. fibocartilaginous callus deposition 3. mineralisation of fibrinous deposition 4. remodelling
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types of fracture
simple compound greenstick comminuted impacted
235
crystal type in gout and pseudo gout
gout: urate crystals- negatively birefringent needles Pseudogout: calcium pyrophosphate crystals - positively birefringent Pseudo-Pos
236
Xray features of gout and pseudogout
gout: rat bite erosions pseudo: white lines of chondrocalcinosis
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most common cancers world wide (male and female combined)
1. breast (15%) 2. prostate (14%) 3. Lung (13%) 4. bowel (11%)
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commonest cause of acute interstitial nephritis
drugs
239
The ECG leads V1 and V2 represent which specific region of the heart?
septal region
240
medication associated with hepatocarcinoma
OCP
241
mucin producing cancer
adenocarcinoma
242
whats the term given to non turbulent blood flow
laminar flow
243
how many grams of glucose is given in an OGTT
75g
244
what histological type of bladder cancer most common?
transitional cell
245
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
acantholysis
246
What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?
trastuzumab trust us you mab
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defective protein in adult polycystic kidney disease
polycystin 1 PKD1 gene found on chromosome 16
248
painless palpable mass and jaundice - what is the name of this sign?
Courvoisier's sign
249
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
250
presence of which receptor is associated with poor breast cancer prognsosis?
HER2