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Pathology and final year > Histopathology > Flashcards

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
Q

histological stages of pneumonia

A

1- consolidation
2- red hepatisation (neutrophilia)
3- grey hepatisation (fibrosis)
4- resolution

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26
Q

Most common types of lung tumours

A

1- SCC (30-50%)
2- adenocarinoma (20-30%)
3- small cell carcinoma (20-25%)
4- large cell carcinoma (10-15%)

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27
Q

features of SCC of the lung

A
  • 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

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28
Q

Features of lung adenocarinoma

A

-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

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29
Q

features of small cell lung cancer

A
  • 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

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30
Q

Large cell carcinoma

A

-poorly differentiated malignant epithelial tunour
-poor prognosis

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31
Q

examples of paranoplastic synromes and what cancer they are associated with

A

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

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32
Q

describe mesothelioma

A

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

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33
Q

Classess of pulmonary hypertension

A

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

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34
Q

hisologial findings of pulmonry oedema

A

intraalveolar fluid

iron laden macrophages (heart failure cells- the iron lady had no heart)

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35
Q

investigations for coeliac

A

ABs:
- anti-endomysin Abs (best)
- anti- transglutaminase
- anti-gliadin

gold standard:
- endoscopy and duodenal biopsy –> crypt hyperplasia and villous atrophy with increased intraepithelial lymphocytes

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36
Q

Cancer associated with coeliac

A

Enteropathy T cell lymphoma
(chronic T cell stimulation)

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37
Q

Cancer associated with chronic H pylori infeciton

A

Mucosal associated lyphoid tissue (MALT) lymphoma

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38
Q

Extra GI manifestations of IBD

A

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

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39
Q

Key difference between UC and CD interms of smoking

A

CD- smoking worsens condition
UC- smoking improves symptoms/ protective

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40
Q

Key features of chrons disease

A

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

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41
Q

Complications of chrons

A

Bowel strictures
fistulae
abscess formation
perforation

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42
Q

Features of UC

A

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

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43
Q

Complications of UC

A

Toxic megacolon
severe haemorrhage
adenocarcinoma (20-30x risk)

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44
Q

Which Abx are associated with C. diff infection

A

the 4 Cs

Cephalosporins
Clindamycin
Ciprofloxacin
Co-amoxiclav

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45
Q

Treatemnt and Mx of C. diff infection

A

Vancomycin or metronidazole
move to a side room

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46
Q

What is carcinoid syndrome

A

group of tumours arising from enerochromaffin cells which causes over production of 5-HT

found in the bowl, lungs, ovaries and testes

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47
Q

Clinical features of carcinoid syndrome and carcinoid crisis

A

Bronchoconstriction
flushing
diarrhoea

crisis:
lifethreatening vasodilation, hypotension
tachycardia
bronchoconstriction
hyperglycaemia

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48
Q

investigations for carcinoid syndrome

A

24hr urnine 5-HIAA (main metabolite of H-HT)

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49
Q

Treatment of carcinoid syndrome

A

ocretide (somatostatin analogue)

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50
Q

Outline the Dukes staging of colorectal cancer

(NB this is out dated)

A

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

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51
Q

Descripe the pathophysiology of FAP

A

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

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52
Q

Describe lynch syndrome

A

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

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53
Q

macrovascular complications of diabetes

A

Ischaemic heart disease
Peripheral vascular disease
CVA

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54
Q

Microvascular complications of DM

A

Diabetic retinopathy
glomerulonephritis
peripheral neuropathy- ulcers

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55
Q

Histological findings in acute pancreatitis

A

coagulative necrosis

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56
Q

histological findings of chronic pancreatitis

A

fibrosis and loss of exocrine tissue parenchyma, duct dilation with thick secretions, calcification

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57
Q

Histological findings in acute hepatitis

A

spotty necrosis

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58
Q

Histological findings in chronic hepatitis

A
  • portal inflammation
  • interface hepatitis (piecemeal necrosis)
  • lobular inflammation
  • bridging of the portal vein to the central vein
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59
Q

what is basophilic stippling and what is it a sign of?

A

aggregation of ribosomal material

present in beta-thalassaemia and lead poisoning

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60
Q

How does Reyes syndrome present

A

usually following URTI and aspirin consumption in children
acute encephalopathy secondary to severe impairment of liver function

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61
Q

what is budd chiari syndrome

A

occlusion of the portal vein either due to compression or thrombosis

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62
Q

Describe haematochromatosis

A

excessive deposition of iron due to increased absorption from the gut

iron accumulates as haemosiderin in various organs

hyperpigmentation of the skin

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63
Q

Describe Wilsons disease

A

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

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64
Q

complications of alpha1 antitrypsin deficiency

A

failure in production on protease inhibitor alpha 1 anti trypsin

causes hepatitis from accumulation of alpha1 trypsin globules

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65
Q

what is zollinger-ellison syndrome

A

gastric hypersecretion leading to multiple peptic ulcers

diarrhoea

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66
Q

What is fibrous dysplasia and some features

A

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

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67
Q

Describe McCune Albright syndrome

A

rare disorder that affects bone, skin and endocrine systems

features:
fibrous dysplasia of bone
cafe au lait spots
multiple endocrine dysfunction

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68
Q

Which method of cyto-pathology is used in cervical smear

A

liquid based cytology

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69
Q

Histopathology in chronic bronchitis

A

hypertrophy of mucus glands and goblet cell hyperplasia

–> copious amounts of mucus

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70
Q

histological findings in squamous cell carcinoma

A

if well differentiated show keratin pearls and cell junctions (desmosomes) –> characteristic itercellular ‘prickles’

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71
Q

what skin manefestation is associated with coaeliac disease

A

dermatitis herpetiformis

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72
Q

histological finding of lichun planus

A

hyperkeratosis with SAW TOOTHING of rete ridges and basal cell degeneration

lichenoid chronic inflammatory infiltrate

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73
Q

what condition is likely if white cell casts are found on urinanalysis

A

acute pyelonephritis

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74
Q

what condition is likely if red cell casts are found on urinanalysis

A

Glomerulonephritis

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75
Q

Congo red and apple green birefringence positive result sign of

A

Amyloidosis

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76
Q

Positive fontana stain

A

melanoma (stains melanin)

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77
Q

Rhodanine stain positive sign

A

golden brown against blue counterstain

Wilsons disease

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78
Q

Positive prussian blue stain

A

Haemachromatosis

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79
Q

Positive Perl’s stain

A

Haemachromatosis

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80
Q

Positive cytokeratin stain

A

Carcinoma
(positive for epithelial cells)

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81
Q

Positive Ziehl-Neelson stain

A

stains acid fast bacilli - TB

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82
Q

Bright yellow when stain with Rhodamine-Auramine

A

TB

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83
Q

Gomori’s methanamine silver stain with flying saucer shaped cysts

A

Pneumocystic jirovecii

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84
Q

Positive modified kinyoung acid fast stain

A

cryptosporidium parvum

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85
Q

India ink stain showing cells surrounded by halos

A

cryptococcus neoformans

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86
Q

Giemsa stain showing cytoplasmic inclusions

A

Chlamydia psittaci

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87
Q

Positive Fite stain

A

Mycobacterium leprae

(dont fight with my leopard)

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88
Q

Histology features of sarcoidosis

A

multisystem disease of unknnown cause

characteriseed by non-caseating granulomas

Histology: schaumann and asteroid bodies

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89
Q

features, RFs and clinical signs of sarcoidosis

A

RFs
- afro-carribeans
- F>M, 40-60yrs

SOB, cough, chest pain, night sweats.

CXR findings:
- bilateral hilar lymphadenopathy
- pulmonary infiltrates -> fine nodular shadowing

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90
Q

Extrapulmonary manifestations of sarcoidosis

A

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

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91
Q

Investigation findings of sarcoidosis

A

raised Ca2+ (ectopic a1hyroxylase released by activated macrophages)

raised ESR

raised ACE

non-caseating granuloma on histology

restrictive pulmonary findings on spirometry

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92
Q

What is amyloidosis

A

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

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93
Q

what is the most common type of amyloidosis?

A

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

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94
Q

describe AA amyloidosis

A

formed from serum amyloid A acute phase protein
build up secondary to chronic infection and inflammation

eg. RA, IBD, TB, lymphoma

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95
Q

what is haemodialysis associated amyloidosis?

A

deposition of beta2 microglobulin

usually occurs in someone with long standing chronic renal failure esp if on peritoneal dialysis

associated with carpal tunnel syndrome

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96
Q

What is familial amyloidosis

A

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

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97
Q

clinical features of amyloidosis

A

multi organ features

KIDNEY: nephrotic syndrome

HEART: restrictive cardiomyopathy, conduction defects, HF, cardiomegaly

hepatosplenomegaly

macroglossia (10%)

neuropathies eg. carpal tunnel syndrome

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98
Q

examples of large cell vasculitides

A

Takayasu’s arteritis
Giant cell arteritis (temporal arteritis)

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99
Q

Describe features of takayasu’s arteritis

A

affects branches of aortic arch
FLAWS
pulseless phases
claudication
cold hands

high rates in japanese women

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100
Q

Describe features of GCA

A

Elderly >50yrs

scalp tenderness eg. when brushing hair
temporal headache
jaw claudication
blurred vision

Ix: raised ESR, temporal artery biopsy

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101
Q

histological findings in GCA

A

granulomatous transmural inflammation, giant cells and skip lesions

102
Q

Management of GCA

A

IMMEDIATE oral prednisolone

103
Q

give some examples of medium cell vasculitides

A

Polyarteritis nodosa
Buerger’s disease
?kawasakis (systemic vasculitis)

104
Q

describe the features of polyarteritis nodosa

A

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
Q

what is string of pearls/ rosary appearance characteristic of?

A

polyarteritis nodosa

106
Q

describe the features of buerger’s disease

A

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
Q

what is a corkscrew appearance on angiogram characteristic of?

A

Buerger’s disease

108
Q

give some examples of small cell vasculitides

A

Granulomatosis with polyangiitis
eosinophilic granulomatosis with polyangitis
microscopic polyangitis
henloch- schonlein purpura

109
Q

saddle node, haemoptysis and haematuria

A

granulomatosis with polyangiitis

110
Q

Describe the features of granulomatosis with polyangiitis

A

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
Q

features of eosinophilic granulomatosis with polyangiitis

A

ASthma, allergic rhinitis, eosinophilia, later systemic involvement

pANCA +ve

112
Q

features of microscopic polyangiitis

A

pulmonary haemorrhage
rapidly progressive glomerulonephritis

pANCA =ve

113
Q

Features of HSP

A

IgA mediated
3-15yrs
preceeding URTI

purpuric rash on buttocks and lower limbs
abdo pain (bleeding)
arthralgia
glomerulonephritis

114
Q

what is a ‘wire-loop’ appearance of the glomeruli characteristic of

A

SLE

115
Q

Histological features of SLE

A
  • wire-loop appearance of glomeruli
  • CNS small vessel angiopathy
  • onion skin lesions in the spleen
  • Libman- Sack endocarditis
116
Q

clinical features of SLE

A

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
Q

antibodies present in SLE

A

anti-ANA (anti-dsDNA, anti-Sm)

anti-smith (most specific)

anti-histone (+ve if drug induced)

118
Q

onion skin thickening of arterioles

A

limited scleroderma (CREST syndrome)

119
Q

difference between diffuse and limited scleroderma

A

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
Q

cutaneous features of dermatomyositis

A
  • heliotrope rash with eyelid oedema
  • grotton papules (erythema of knuckles with raised scaley erruptions)
  • systemic V shaped rash
  • facial rash
121
Q

drop out capillaries and myofibre damage on histology is characteristic of..

A

dermatomyositis

122
Q

which cells in the pancreas secrete the enzymes

A

acinar cells

123
Q

Describe acute pancreatitis

A

acute inflammation causing aberrant release of pancreatic enzymes

124
Q

Causes of acute pancreatitis

A

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
Q

how does duct obstruction by gallstones cause acute pancreatitis?

A

reflux of bile up pancreatic duct followed by damage to acini and release of proenzymes

126
Q

patterns of damage in actute pancreatitis

A

Periductal- necrosis of acinar with obstructive casues

perilobular - furthest away from blood supply so most affected by ischaemic causes

pan lobular - both

127
Q

discribe the process of pancreatitis

A

Activated enzymes –> acinar necrosis –> enzyme release

lipases –> fat necrosis (bind to Ca which forms soaps, yellow white foci on histo)

128
Q

complications of acute pancreatitis

A

pancreatic: pseudocysts, abscess

systemic: shock, hypoglycaemia, hypocalcaemia (fat necrosis)

129
Q

acute pancreatitis with notmal calcium possible cause

A

caused by hypercalcaemia initially and then Ca brought back down to normal by fat necrosis

130
Q

casues of chornic pancreatitis

A

Metabolic:
- ALCOHOL (80%)
- HAEMACHROMATOSIS

duct obstruction
- GALL STONES
- ABNORMAL PANCREATIC DUCT ANATOMY
- CYSTIC FIBROSIS

Tumours

AUTOIMMUNE

131
Q

Pathogenesis of chronic pancreatitis

A

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
Q

complications of chronic pancreatitis

A

malabsorption
DM
pseudocysts
carcinoma

133
Q

what are pancreatic pseudocysts

A

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
Q

what is IgG4 related disease

A

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
Q

Tumours of the pancreas

A

carcinomas
- DUCTAL (85%)
- ACINAR

cystic neoplasms
- SEROUS CYSTADENOMA
- MUCINOUS CYSTIC NEOPLASM

pancreatic neuroendocrine tumours

136
Q

Most common carcinoma of pancreas and breast

A

ductal

137
Q

risk factors of pancreatic carcinoma

A

smoking
raised BMI
chronic pancreatitis
diabetes

138
Q

two preceding lesions of pancreatic carcinoma

A

Pancreatic intraductal neoplasia (PanIN)
Intraductal mucinous papillary neoplasm

139
Q

what is the most common mutation in pancreatic carcinoma

A

K-ras 95%

140
Q

features of carcinoma of the pancreas

A

gritty and grey
invades adjacent structures
tumours of head present earlier

adenocarcinomas

141
Q

most common site of pancreatic carcinoma

A

head (60%)
ductal

142
Q

how can pancreatic carcinomas metastasis (routs of invasion)

A

bile ducts, duodemum
lymphatic spread
blood to the liver
serosa to the peritoneoum

143
Q

describe cystic adenomas of the pancreas

A

contain serous or mucin secreting epithelium

usually benign

144
Q

describe pancreatic endocrine neoplasms

A

usually non secretory
contain neuroendocrine markers eg. chromogranin

may be associated with MEN1

insulinomas most common kind

145
Q

what is an example of a neuroendocrine marker

A

chromogranin

(stain used to diagnose insulinoma)

146
Q

describe gallstones (RFs and types)

A

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
Q

complications of gall stones

A

obstruction - jaundice
cholecytstits
gall bladder cancer
pancreatitis

148
Q

describe chronic cholecystitis

A

chronic inflammation
FIBROSIS and thickening of wall
diverticulae- ROKITANSKY-ASCHOFF SINUSES

90% of pts with chron chol have gall stones

149
Q

what are ROKITANSKY-ASCHOFF SINUSES

A

out pocketing from diverticulae

150
Q

generic complications og GI disease

A

diarrhoea, constipation
bleeding
perforation
fistula
obstruction
systemic illness

151
Q

congenital GI diseases

A

bowel atresia/ stenosis - failure of development of normal lumen of the gut

duplucation

152
Q

describe hirschsprungs disease

A

abscence of ganglion cells in submucosal and mysenteric plexus

starts in rectum

80% male

association with T21

RET proto-oncogene mutation

153
Q

mutation in hirschprungs disease

A

RET proto-oncogene mutation

154
Q

mechanical disorders of bowel

A

adhesions
herniation
extrinsic mass

volvulus (twists of bowel at mesenteric base around vascular pedicle)

diverticular disease

155
Q

describe diverticular disease

A

low fibre diet
high intraluminal pressure
90% in left colon
outpouching of bowel

pseudodiverticula if doesnt contail all of the layers of bowel

156
Q

complications of diverticular disease

A

pain
diverticulitis
perforation
fistula
obstruction

157
Q

causes of acute and chronic inflammatory disorders of large bowel

A

acute
- infection (CMV, salmonella, entamoeba hystolitica, candida)
- drug/ toxin (esp Abx)
- chemo
- radiation

chronic
- IBD
- TB

158
Q

examples of infective colitis

A

CMV- especially in immunocompromised eg. pts with IBD on medication

salmonalla
entamoeba hystolitica
candida

159
Q

pseudomembranous colitis

A

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
Q

pathology in splenic flexure likely to be casued by..

A

ischaemia

161
Q

RFs for IBD

A

genetic predisposition to abnormal host immunoreactivity
infection (mycobacteria, measles)
microbiome

162
Q

what organ contains the highest concentration of neuroendocrine cells

A

GUT

163
Q

examples of non-noeplastic polyps

A

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
Q

describe peutz jeghers

A

hamartomatous polyps
characteristic pigmentation around the lips soles and palms

autosomal dominant- LKB1

165
Q

describe adenomas of large bowel

A

look darker than normal tissue
epithelial proliferation and dysplasia

types:
tubular
tubulovillus
villous- hypoproteinaemic hypokalaemia becuase they leak K and protein

166
Q

RFs for adenomas to develop into cancer

A

size
number of polyps
villous adenoma
high degree of dysplasia

167
Q

most common sites for adenoma and carcinoma

A

rectum and sigmoid

168
Q

familial polyp syndromes

A

Peutz jeghers
FAP
lynch syndrome (HNPCC)

169
Q

where is the mutation in FAP

A

chromosome 5q21 mutation in APC TSG

170
Q

what is gardiners syndrome

A

FAP plus extra-intestinal manifestations

eg. osteomas
desmoid tumours

171
Q

RFs of colorectal carcinoma

A

familial
low fibre, high fat diest
obesity
poor exercise
chronic IBD
adenoma

172
Q

describe the TNM staging of colorectal cancer

A

Tumour, nodes, metastasis

173
Q

what is a normal villous: crypt ratio

A

3-5:1

174
Q

what is a normal number of lymphocytes in the small bowel

A

less than 20 intraepithelial lymphocytes/ 100 epithelial cells

175
Q

characteristic findings of coeliac on biopsy

A

crypts increase (hyperplasia)as they are regenerating and replacing damaged epitheliasal cells

villous atrophy as damaged

increased intraepithelial lymphocyets

176
Q

other causes of villous atrophy

A

drug associated enteropathy
giardia
H pylori gastritis

177
Q

other causes of increase intra epithelial lymphocytes

A

food hypersensitivity
infection eg. giardia, H pylori
NSAIDS
RA, SLE, autoimmune enteropathy

178
Q

management of coeliac

A

dietary management (exclue wheat, barley and rye)

advice RE long term complications: malabsorption, lymphoma, osteomalacia

MDT: pt support groups, dieticians, family support, gastroenterologist

179
Q

Renal disease associated with Abs to phospholipase A2 receptor

A

membranous glomerulonephritis (nephrotic syndrome)

180
Q

types of nephrotic syndrome

A

minimal change disease
membranous glomerulonephritis
focal segmental

181
Q

types of nephritic syndrome

A

-post strep glomerulonephritis
-IgA nephropathy (Bergers)
-rapidly progressive disease
-Alports syndrome
-thin BM disease

182
Q

pancreatic cancer tumour marker

A

CA19-9

183
Q

complications of MI

A

contractile dysfunction -> cardiogenic shock
congestive cardiac failure
arrhythmias
mitral regurg (due to LV infact causing papillary muscle dysfunction)
dresslers pericarditis (weeks/months after)

184
Q

Histological finding:
whirls of shed epithelium (curschmann spirals), eosinophils and charcot-Leyden crystals

A

Asthma

185
Q

ground glass/ honeycomb appearance in CT

A

interstitial lung disease

186
Q

types of interstitial lung disease and examples

A

FIBROSING
-idiopathic pulmonary fibrosis
- pneumoconiosis
- drug induced (eg. methotrexate, chemo)

GRANULOMATOUS
- sarcoidosis
- extrinsic allergic alveolitis
- vasculitides (GPA, churg-strauss, microscoping polyangiitis)

187
Q

features of idiopathic pulmonary fibrosis

A

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)

188
Q

lung disease associated with coal miners

A

pneumoconiosis
- asbestososis mesothilioma/ adenocarcinoma or fibrosis

189
Q

Causes of granulomatous lung lesion

A

Infectious:
TB
cryptococcus
aspergillus
pneumocystis
chronic granulomatous disease (inherited immune deficiency in NADPH)

non-infecitous:
Sarcoidosis
granulomatosis with polyangiitis

190
Q

treatment of H.pylori

A

Triple therapy:
PPI
clarythromycin
amoxicillin

191
Q

what do the different endocrine cells of the pancreas secrete

A

alpha cells- glucagon
beta- insulin
delta- somatostatin
D1- vasoactive peptide stimulates secretion of H20 into the pancreas
Pancreatic polypeptide- self regulates secretion

192
Q

what exocrine enzymes does the pancreas secrete

A

amylase
lipase
proteases

193
Q

different patterns of damage to the pancreas and associated causes

A

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

194
Q

what is the most sensitive marker of acute pancreatitis

A

serum lipase

195
Q

managament of pancreatic carcinoma

A

whipples procedure (removal of tumour)
palliative chemotherapy with 5-Fluorouracil

196
Q

Testicular tumours and tumour markers

A

germ cell:
seminoma - bHCG, LDH
yolk sac- AFP
choriocarcinoma - bHCG
teratoma- ?

197
Q

what is spotty necrosis a sign of in the liver

A

acute hepatitis

198
Q

what are the histopathological findings of chronic liver disease

A
  • portal inflammation
  • piecemeal necrosis (cannot see the border between portal tract and parenchyma)
  • lobular inflammation
  • bridging from portal vein to central vein- intrahepatic shunting
199
Q

histopathology of cirrhosis

A

hepatocyte necrosis
fibrosis
nodules of regenerating hepatocytes
disturbance of vascular architecture

200
Q

what is used to indicate the prognosis of liver cirrhosis and what does it involve?

A

Modified child pugh score (ABCDE)

Albumin
Bilirubin
Clotting (PT)
Distension (ascites)
Encephalopathy

201
Q

causes of micronodules (regenerating nodules in the liver)

A

alcoholic hepatitis, biliary tract disease

202
Q

causes of macronodules
(regenerating nodules in the liver)

A

viral hepatitis, wilsons disease, alpha A1 antitrypsin deficiency

203
Q

how to score the components of the child pugh score

A

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)

204
Q

describe the stages of alcoholic liver disease

A
  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
205
Q

what causes NAFLD and what are the features

A

obesity with hyperlipidaemia
DM a risk factor

  1. simple steatosis- fatty infiltration
  2. non-alcoholic steatohepatitis- can progress to cirrhosis
206
Q

what is the most common type of liver cancer

A

secondary metastases
(GI, breast, bronchus)

207
Q

types of liver cancer

A

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

208
Q

inherited causes of cirrhosis and their inheritance pattern

A

Haemachoromatosis- AR
Wilsons - AR
alpha a1- antitrypsin deficiency- AD

209
Q

describe haemachoromatosis

A

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

210
Q

describe wilsons disease

A

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

211
Q

describe alpha a1 antitrypsin deficiency

A

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

212
Q

Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?

A

diabetes

213
Q

what is the composition of bone?

A

65% inorganic- calcium hydroxyapatite (99% Ca, 85% phos, 65% Na and Mg)

35% organic- bone cells and protein matrix

214
Q

describe bone geography

A

from outermost layer to inner
periosteium –> matrix –> cortex

proximal
diaphysis –> metaphysis –> epiphysis

215
Q

what are the bone cells

A

osteoblasts- build bone (single nucleus)
osteoclasts- chew bone (multinucleated, large cell, macrophage family)
osteocytes - sit in lacunae

216
Q

describe the activation of osteoclasts

A

osteoblasts RANKL binds to RANKR on osteoclast precursor cells
this upregulates NFKb and triggers maturation into fully functioning osteoclast

217
Q

where do you take a bone biopsy from to investigate metabolic bone disease

A

ileac crest

218
Q

RFs for osteoporosis

A

> age
post menopausal
smoking
XS alcohol
female
long term immobility
poor diet
low BMI
thyroid disease
steroids
cushings
drugs eg: GNRH antagonists

219
Q

what is a distal radial fracture called?

A

Colles fracture

220
Q

what is a brown cell tumour and what is it characteristic of

A

hyperparathyrosididm

many multinucleated giant cells with haemorrhage

aka Osteitis fibrosa cystica (increased bone resorption)

221
Q

what is a key feature of pagets on histology

A

Huge osteoclasts with >100 nuclei

Mosaic pattern of lamellar bone (like a jigsaw puzzle)

222
Q

chinese lettering on histology
soap bubble lytic lesions
shepherds crook deformity

A

fibrous dysplasia

223
Q

features of endrochondroma

A

affects hands and fingers
O ring sign
cotton wool calcification of matrix

224
Q

features of osteosarcoma

A

adolescence
M>F
knees

Xray- sunburst appearance, codmans triangle (uplifting of periosteum)

Histo- malignant mesenchymal cells

Bloods- raised ALP

225
Q

features of osteochondroma

A

> 40s
axial skeleton/ femur/ tibia/ pelvis

histo- malignant chondrocytes

Xray- lytic lesions with fluffy calcification

226
Q

Features of ewings sarcoma

A

<20yrs
F>M

Histo: sheets of small round cells
CD99+
t(11;22) EWS:Fli1 translocation

XRAY: onion skinning of periosteium

227
Q

McCune albright syndrome

A

fibrous dysplasia
precocious puberty
cafe au lait spots

228
Q

Gardiners syndrome

A

multiple GI polyps
multiple osteomas
epidermal cysts

229
Q

common infectious agents of osteomyelitis and sites

A

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
Q

Xray features of osteoporosis

A

LOSS

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

231
Q

typical joints affected in osteoarthritis

A

Knees
hip
back

Distal interphalangeal joints (DIPJ)- Heberdens nodes

Proximal interphalangeal joints (PIPJ)- Bouchards nodes

232
Q

special giant cells seen in RA

A

Grimly-Soholoff cells

233
Q

process of fracture healing

A
  1. organisation of haematoma and periosteum proliferation
  2. fibocartilaginous callus deposition
  3. mineralisation of fibrinous deposition
  4. remodelling
234
Q

types of fracture

A

simple
compound
greenstick
comminuted
impacted

235
Q

crystal type in gout and pseudo gout

A

gout: urate crystals- negatively birefringent needles

Pseudogout: calcium pyrophosphate crystals - positively birefringent
Pseudo-Pos

236
Q

Xray features of gout and pseudogout

A

gout: rat bite erosions
pseudo: white lines of chondrocalcinosis

237
Q

most common cancers world wide (male and female combined)

A
  1. breast (15%)
  2. prostate (14%)
  3. Lung (13%)
  4. bowel (11%)
238
Q

commonest cause of acute interstitial nephritis

A

drugs

239
Q

The ECG leads V1 and V2 represent which specific region of the heart?

A

septal region

240
Q

medication associated with hepatocarcinoma

A

OCP

241
Q

mucin producing cancer

A

adenocarcinoma

242
Q

whats the term given to non turbulent blood flow

A

laminar flow

243
Q

how many grams of glucose is given in an OGTT

A

75g

244
Q

what histological type of bladder cancer most common?

A

transitional cell

245
Q

What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?

A

acantholysis

246
Q

What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?

A

trastuzumab

trust us you mab

247
Q

defective protein in adult polycystic kidney disease

A

polycystin 1
PKD1 gene
found on chromosome 16

248
Q

painless palpable mass and jaundice - what is the name of this sign?

A

Courvoisier’s sign

249
Q

What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?

A

Haematoxylin and eosin stain

250
Q

presence of which receptor is associated with poor breast cancer prognsosis?

A

HER2

Pathology and final year (21 decks)

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