Histopathology Flashcards
CT Head non contrast reveals hyperdense enhancement adjacent to the circle of willis.
What is the likely diagnosis?
Subarachnoid haemorrhage
What cancer is associated with the presence of “oat shaped cells” on biopsy?
Small cell lung cancer
What type of murmurs are heard in hyperdynamic circulations - pregnancy, anaemia or severe blood loss?
flow murmur
soft, systolic murmurs heard best at the left lower sternal edge
blood findings in PBC
elevated serum ALP and an elevated anti mitochondrial antibody titre.
Features of Parkinson’s
TRAPS
Tremor
Rigidity (Cogwheel)
Akinesia, bradykinesia
Postural instability
Shuffling gait
Most common solid organ cancer in males
prostate (adenocarcinoma)
treatment of non metastatic prostate cancer
Radical prostatectomy
generally first line in people who can tolerate it and have a new diagnosis of low grade disease
Active surveillance (if surgery not desired/low risk of progression) -> Radical radiotherapy + androgen deprivation if progresses
treatment of metastatic prostate cancer
Docetaxel based chemotherapy
Orchidectomy or anti-androgen therapy (bicalutamide)
what infection predisposes you to squamous cell carcinoma of the bladder
schistosomiasis
What structures, present in the large bowel, represent weak points in the bowel wall and allow for the formation of diverticula?
taenia coli
What is the typical inheritance pattern of Hereditary non-polyposis colorectal cancer/Lynch Syndrome?
Autosomal dominant
Kimmelstiel Wilson nodules found in a renal biopsy are associated with what underlying disease?
Diabetes mellitus
what are the secondary causes of nephrotic syndrome?
diabetes
amyloidosis
What is the first line treatment for severe haemachromatosis?
therapeutic phlebotomy
Thickened basement membrane with spike and dome appearance due to electron dense deposits in the subepithelial layer”
with chronic hep B
Membranous glomerulonephritis
treatment for Wilsons
Trientine
Penicilamine
How are Multiple Endocrine Neoplasias inherited
autosomal dominant
MEN 1
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours
MEN 2a
Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma
Think all the Cs: Calcitonin (medullary thyroid cancer), Calcium (Parathyroid hyperplasia) and Catecholamines (Phaeo)
MEN 2b
Medullary thyroid carcinoma
Phaeochromocytoma
Marfanoid body habitus
Mucosal neuromas
Think B is for Big (marfanoid) and Belly problems (mucosal neuromas)
What is the name given to areas of regenerating mucosa which project into the lumen of the bowel, which may be visualised during a colonoscopy of a patient with ulcerative colitis?
pseudopolyp
Persistent ST elevation post myocardial infarction in the absence of chest pain or other ischaemic features is suggestive of ….
ventricular aneurysm
4 main types of invasive breast cancer
Invasive ductal (most common)
Invasive lobular
Mucinous carcinoma
Tubular carcinoma
Expression of what cell surface receptor may confer a good prognosis in invasive breast carcinoma?
oestrogen receptor or progesterone receptor
Expression of what cell surface receptor may confer a bad prognosis in invasive breast carcinoma?
Herceptin 2
what can HER2 positive breast cancer be treated with
trastuzumab
What is seen on mammography with ductal carcinoma in situ?
microcalcification
What is the most common type of lung cancer in the UK?
(non-small cell) adenocarcinoma
which type of lung cancer is associated with women and non smokers
adenocarcinomas
what paraneoplastic syndromes arise from small cell lung cancer?
ADH → SIADH (Small cell)
ACTH → Cushing’s syndrome (Small cell)
AchR antibodies → myasthenia gravis
Lambert Eaton syndrome
what paraneoplastic syndromes arise from squamous cell lung cancer?
PTH/ PTHrP → primary hyperparathyroidism, hypercalcaemia and bone pain (Squamous cell)
inheritance pattern of benign familial haematuria
autosomal dominant
pre-renal causes of AKI
Most common cause of acute renal failure
renal hypo-perfusion e.g. hypovolaemia, sepsis, burns, acute pancreatitis, and renal artery stenosis.
renal causes of AKI
● Acute Tubular Necrosis (ATN): commonest renal cause of ARF.
● Acute glomerulonephritis.
● Thrombotic microangiopathy
post renal causes of AKI
Obstruction to urine flow as a result of stones, tumours (primary & secondary), prostatic hypertrophy and retroperitoneal fibrosis
First line investigation for pancreatic cancer
CT
associated tumour marker for pancreatic cancer
CA19-9
management of pancreatic cancer
palliative chemotherapy (FOLFIRINOX ie 5-FU based)
surgical Whipple’s procedure if curative intent
examples of neuroendocrine tumours arising from the pancreas
Insulinomas - Whipple’s triad of symptoms
Gastrinoma - Zollinger-Ellison syndrome + gastric ulceration
most common cancer in the UK overall
breast
most common cancers in men
Prostate (most common in men)
Lung
Bowel
Head and Neck
Other
most common cancers in women
Breast (most common cancer overall)
Lung
Bowel
Uterus
Other
most deadly cancers in men
Lung (most deadly)
Prostate
Bowel
Oesophagus
Other
most deadly cancers in women
Lung (most deadly)
Breast
Bowel
Cancer of unknown primary
Othe
Which tumour marker is used in the diagnosis of hepatocellular carcinoma?
alpha fetoprotein
most common cause of acute pyelonephritis
E.coli
leukocytic casts in urine
pathophysiology of chronic pyelonephritis
chronic, recurrent bacterial infections
obstruction: renal calculi, posterior urethral valves
urine reflux
pathophysiology of acute interstitial nephritis
drugs e.g. NSAIDs, diuretics, aminoglycosides, PPI
histological features of acute interstitial nephritis
granulomas
eosinophilia
pathophysiology of chronic interstitial nephritis
seen in the elders due to chronic analgesia use
Infection by what organism classically precipitates acute rheumatic fever?
Group A strep (pyogenes)
difference in presentation of post streptococcal glomerulonephritis and IgA nephropathy
Occurs 1-3 weeks after streptococcal throat infection
Presents 1-2 days (earlier than Acute postinfectious GN!) after an URTI with frank
haematuria*
Which hepatobilary pathology is classically associated with an elevated p-ANCA?
Primary Sclerosing Cholangitis
which movement of air is affected in obstructive lung disease
exhalation
which movement of air in affected in restrictive lung disease
inhalation,
therefore fine-end inspiratory crackles heard
stages of lobar pneumonia
1.Consolidation
2. Red Hepatisation (neutrophilia)
3. Grey Hepatisation (Fibrosis)
4. Resolution
diagnostic criteria for Acute Rheumatic fever
Jones
diagnostic criteria for infective endocarditis
Duke’s
minor Jones criteria
Fever
Raised ESR/CRP
Arthralgia (migratory)
Prolonged PR
Previous RF
histological features of Rheumatic fever
Beady fibrous vegetations (verrucae)
Aschoff bodies (small giant-cell granulomas)
Anitschkov myocytes (regenerating myocytes).
treatment of rheumatic fever
benzypencillin
treatment of acute infective endocarditis
flucloxacillin
treatment of subacute infective endocarditis
benzypenicllin + gent/vanc 4 weeks
most commonly affected valve in rheumatic fever
mitral
followed by aortic
what are the benign renal tumours
papillary adenoma
oncocytoma
angiomyolipoma
what are the malignant renal tumours
renal cell carcinoma
nephroblastoma/Wilms
transitional cell carcinoma
ALP > ALT
biliary obstruction
AST > 3x ALT
highly specific for alcoholic hepatitis
ALT raised >1000
toxins, drugs, viruses, ischaemia
where can AST be found
liver
heart
muscle
Which common medication are hepatic adenomas associated with?
oral contraceptive pill
What type of fluid motion produces low sheer stress and is hence protective against the development of atherosclerotic disease?
laminar flow
most common cause of CKD in the UK
diabetes
What condition is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and stroke-like symptoms in an adult?
TTP
How much glucose is given, in grams, for an oral glucose tolerance test for the diagnosis of diabetes?
75
most common type of bladder cancer
transitional cell carcinoma
layers of the skin
corneum
lucidum
granulosum
spinous
basale
seborrhoeic dermatitis is a reaction to which yeast
Malassezia furfur
key histology in psoriasis
parakeratosis
test tubes in a rack appearance
Munro’s microabscesses
most common type of psoriasis
chronic plaque psoriasis
salmon pink papule, extensor surfaces
rash distribution in guttate psoriasis
rain drop plaque distribution
trunk of child
seen 2 weeks after group A strep infection
emergency in psoriasis
erythrodermic/pustular psoriasis
Auspitz sign
rubbing of psoriatic plaques causes pin point bleeding
what are the two associated features in psoriasis
nail changes and arthritis
arthritis multilans ‘telescoping’
6Ps of lichen planus
purple
pruritic
polygonal
papular
plaques
which skin emergency in erythema multiform seen in
TENS and SJS
> 30 TENS
<10 SJS
which autoimmune disease is dermatitis herpetiformis associated with
coeliac disease
IgA binds to basement membrane in extensor surfaces
IgG Ab against what in bullous pemphigoid
hemidesmosomes
IgG Ab against what in pemphigus vulgaris
desmoglein 1 and 3
which malignant skin lesion has a pearly surface and telangiectasia
BCC
which malignant skin lesion has rolled edges and is ulcerative
SCC
most important prognostic factor in melanoma
Breslow thickness
most common subtype of melanoma
superficial spreading
rash description in pityriasis rosea
salmon pink rash/herald patch in Christmas tree distribution
after what infection does pityriasis rosea occur
HHV-6 and HHV-7
What is the most common cause of acute interstitial nephritis?
drugs
include antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs).
Which common medication are hepatic adenomas associated with?
oral contraceptive pill
What is the term used to describe small, tube shaped microscopic particles found in urine?
urinary casts
In the setting of a possible false positive PSA test, what should be done?
repeat test in 2 weeks
In the setting of a possible false positive PSA test, what should be done?
repeat test in 2 weeks
what is the tetrad of nephrotic syndrome
hypoalbuminaemia
proteinuria
oedema
hyperlipidaemia
In the emergency department what imaging is required in the initial workup of a suspected stroke?
why is it important to do?
CT head non contrast
Prior to the use of thrombolytic therapy, a CT head will exclude the presence of a significant haemorrhagic stroke, which has very different management to that of an ischaemic stroke.
symptoms of pancreatic cancer
nausea
reflex
belching
progresses to:
weight loss
jaundice
What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?
acantholysis
decreased cohesion between keratinocytes
spongiosis
intercellular oedema
What monoclonal antibody therapy targets human epidermal growth factor receptor 2 and is used in the treatment of breast cancer?
trastazumab
What protein is defective in adult polycystic kidney disease?
polycystin-1
What kind of cancer is associated with keratin pearls?
squamous cell carcinoma
(hyperkeratotic)
what is the triad of carcinoid syndrome
bronchoconstriction
flushing
diarrhoea
What surgical procedure may be used to treat pancreatic cancer affecting the head, neck and body of the pancreas?
Whipple’s procedure
What sign describes painless jaundice in the presence of a palpable gallbladder?
Courvoisier’s sign
What tumour marker is most commonly used in the diagnosis of colorectal cancer?
carcinoembryonic antigen
What is the most common histochemical stain used to visualise cells for light microscopy, such as that used for diagnosis of cancers?
haemotoxylin and eosin stain
coughing up pink, frothy sputum, SOB, raised JVP, pitting oedema
pulmonary oedema
Whipple triad of symptoms: what are they and what condition are they representative of?
- episodic hypoglycaemia
- central nervous system (CNS) dysfunction temporally related to hypoglycaemia (confusion, anxiety, stupor, paralysis, convulsions, coma)
- dramatic reversal of CNS abnormalities by glucose administration.
Insulinoma
what is the prognosis of a pancreatic adenocarcinoma
very poor
25% 1 year survival
point tenderness adjacent to the sternum bilaterally indicated…
costochondritis
chest pain + raised AST
MI
recent fracture +slightly raised ALP
normal
markers of hepatic synthetic function
PT
albumin
what does HER2 stand for
human epidermal growth factor receptor 2
What is the typical inheritance pattern of Maturity Onset Diabetes of the Young (MODY)?
autosomal dominant
Damage to what muscle within the heart may result in mitral regurgitation?
papillary muscle
painful fluid filled blisters; When you run your finger over the surface of one of the blisters, the roof of the blister easily comes away; biopsy reveals acantholytic cells, however the basal keratinocytes remain attached to the basement membrane.
pemphigus vulgaris
The ECG leads II, III and aVF represent which region of the heart?
inferior wall
A GFR of less than what value is considered reflecting End Stage Renal Failure in chronic kidney disesease?
15
High resolution CT scan reveals bronchial wall thickening with a positive signet ring sign.
bronchiectasis
What is the typical inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?
autosomal dominant
Graded using the Gleason system, what does each number represent?
First number = most common cell type seen. Second number = second most common cell type seen (highest grade)
what constellation of symptoms are seen in infective endocarditis
Clinical features:
● Constitutional:
○ Fever
○ Malaise ○ Rigors
○ Anaemia
● Cardiac:
○ New murmur (MR/AR usually)
● Immune phenomena:
○ Roth spots
○ Osler’s nodes
○ Haematuria due to glomerulonephritis
● Thromboembolic phenomena:
○ Janeway lesions
○ Septic abscesses in lungs/brain/spleen/kidney
○ Microemboli
○ Splinter haemorrhages
○ Splenomegaly
causes of acute infective endocarditis
staph aureus
strep pyogenes
An immune response directed against myelin basic protein and proteo-lipoprotein results in what autoimmune condition?
multiple sclerosis
There is no evidence of glandular or squamous differentiation. The cells are poorly differentiated with large nuclei. Which lung cancer?
large cell carcinoma
poor prognosis
What is the organism typically implicated in acute postinfectious glomerulonephritis?
Group A Streptococcus
i.e. Streptococcus pyogenes
two places prostate cancer usually spreads to
bladder
bone
What sign, which may be visible around the nails, is seen in Graves’ disease and is due to periosteal bone growth in the nail bed?
thyroid acropachy
results in clubbing of the digits
what do the delta cells of the pancreas secrete?
what is its role?
somatostatin
paracrine effect on alpha and beta cells to reduce glucagon and insulin secretion
how does Paget’s disease of the breast present
eczema of nipple then areola, peau d’orange (oedema + pitting of breast)
what is Paget’s disease of the breast associated with
breast cancer
which condition is characterized by apical akinesis and ventricular dysfunction on echocardiogram.
Takotsubo’s Cardiomyopathy
Coronary arteries are usually unobstructed if an angiogram is performed.
which nephrotic syndrome does not respond well to steroids
membranous glomerular disease
A biopsy viewed under light microscopy shows thickening of the glomerular basement membrane.
Immunofluorescence shows the presence of antibody complexes and complement deposits throughout the glomerular basement membrane
membranous glomerular disease
What condition is the presence of granular (“muddy brown”) casts seen in the urine associated with?
Acute Tubular necrosis
which two conditions makes up COPD
chronic bronchitis
emphysema
What type of bladder cancer is associated with chronic cystitis?
squamous cell carcinoma
commonly associated with chronic irritation and inflammation of the bladder.
features of chronic pancreatitis on exploration
destruction of exocrine tissue, associated with fibrosis and calcification
biochemical findings in Wilsons disease
low caeruloplasmin
low serum copper
high urinary copper
how does Wilson’s disease present
- liver disease e.g. liver failure
- neuro disease e.g. Parkinsonism
- kayser fleischer rings
age range for Wilson
young <20
What is the most common pattern of disease progression in Multiple Sclerosis?
relapsing remitting
what does the presence of faecal calprotectin in the stool reflect
presence of intraluminal neutrophils
in which liver condition will cytoplasmic Mallory Denk Bodies most commonly be found on biopsy
alcoholic hepatitis
features of acute interstitial nephritis
● A hypersensitivity reaction, usually to a drug (abx, NSAIDs, diuretics)
● Usually begins days after drug exposure
● Presents with: fever, skin rash, haematuria, proteinuria, eosinophilia
● Histology: inflammatory infiltrate with tubular injury, eosinophils & granulomas
The presence of white cell casts in the urine along with eosinophilia and recent antibiotic use
acute interstitial nephritis
what is seen in the urine on microscopy in acute pyelonephritis
leukocytic casts
lung disease pattern in pulmonary fibrosis
restrictive
low FEV1
lower FVC
increased FEV1/FVC
investigation for pulmonary fibrosis
high resolution CT of the lungs
Two main types of lung cancer - small cell and non small cell.
Which is more common
small cell
what are the non small cell cancers
adenocarcinoma (40%)
squamous cell (30%)
large cell
other
treatment of limited disease small cell cancer (in one lung only)
Chemotherapy + Radiotherapy
treatment of extensive small cell cancer (metastatic spread in both lungs)
palliative
most common paraneoplastic syndrome in small cell lung cancers
SIADH (15% of patients)
Cushing’s syndrome (5%)
Lambert-Eaton Myasthenic syndrome (3%)
acromegaly
treatment of Stage 1 NSCLC (Small solitary tumour):
surgery
treatment of Stage 2 NSCLC (Large solid tumour or limited local spread):
Surgery followed by chemotherapy or immunotherapy
treatment of Stage 3 NSCLC (lymph node spread or multilobular disease):
Neoadjuvant chemotherapy with surgery
treatment of Stage 4 NSCLC (spread to other lung or distant metastasis):
palliation
3 histological features of sarcoidosis
1- non caseating granulomas
2- Schaumann bodies
3- asteroid bodies
skin involvement in sarcoidosis
erythema nodosum
lupus pernio
eye involvement in sarcoidosis
anterior and posterior uveitis
uveoparatoid fever
keratoconjunctivitis
lacrimal gland enlargement
what is raised in the bloods in sarcoidosis investigation
Calcium
ACE
what spirometry picture is sarcoidosis
restrictive
which layer of the large arteries are affected in atherosclerosis
tunica intima
difference in vessel occlusion in stable and unstable angina
stable: ~70% occlusion
unstable: ~90% occlusion
Prinzmental angina is not causes by atherosclerosis but by
coronary artery spasm
is there muscle death in angina
no
what is the most common cause of sudden death post-MI
VF
occurs in the first 24 hours
if you want to decrease stroke volume, what must be increased
increase the after load
how does cardiac damage affect stroke volume and cardiac output?
what respective changes do they cause?
cardiac output decreased therefore increase RAS activation to retain salt and water
stroke volume decreased therefore stimulate SNS to increase total peripheral vascular resistance
what does the liver become due to stasis of venous blood in it
nutmeg liver
what type of cardiomyopathy does sarcoidosis or amyloidosis cause
restrictive
main mechanism causing aortic stenosis
calcification due to old age
causes of aortic regurgitation
infective endocarditis
Marfans
LV dilation
cause of mitral stenosis
rheumatic fever
causes of mitral regurgitation
infective endocarditis
post MI
which side of the heart does chronic rheumatic fever usually affect
left sides especially mitral valve
what are the two clinical signs of mitral valve prolapse
mid systolic click
late systolic murmur
what usually causes pericardial effusion
chronic heart failure
Mean pulmonary arterial pressure at rest
> 25 mmHg
class 2 pulmonary hypertension
due to left heart disease
class 3 pulmonary hypertension
due to lung disease (eg. ILD)
class 4 pulmonary hypertension
due to many clots overtime which cause fibrosis
what is the acute histological finding in pulmonary oedema
intra-alveolar fluid
what is the chronic histological finding in pulmonary oedema
iron laden macrophages (heart failure cells)
what causes diffuse alveolar damage in adults
ARDS
what causes diffuse alveolar damage in neonates
hyaline membrane disease
insufficient surfactant production in preterm
what is the mechanism of Barretts
intestinal metaplasia of the squamous mucosa
what feature present increases the likelihood of Barrett’s becoming a cancer
goblet cells
which third of the oesophagus is oesophageal carcinoma seen
distal 1/3
as its is associated with Barrett’s
which third of the oesophagus is squamous cell oesophageal carcinoma seen
mostly middle (50%)
what two risk factors are associated with squamous cell oesophageal carcinoma
smoking and alcohol
what are engorged dilated veins due to portal HTN called
varices
is a stomach ulcer pain better or worse with food
worse
is a duodenal ulcer pain better or worse with food
better
what are the two types of gastric cancer
intestinal (well differentiated)
diffuse (poorly differentiated, signet ring cell )
what are the two large vessel vasculitides
takayasu arteritis
temporal arteritis
what structure is affected in Takayasu arteritis
branches of the aorta
signs of Takaysu arteritis
pulseless
claudication
cold hands
what is seen on angiography in polyarteritis nodosa
microaneurysms (string of pearls/rosary beed appearance)
what are the two types of medium vessel vasculitis
polyarteritis nodosa
Buerger’s disease
what underlying infection is seen in polyarteritis nodosa
Hep B
what is the classical appearance seen in angiogram in Buergers disease
corkscrew appearance
which demographic does burgers disease affect mostly
heavy smoking males < 35
how are microscopic polyangiitis and Wegeners similar but how do they differ
both have pulmonary and renal involvement
differ in antibody (pANCA in the former)
in the hexagonal hepatic lobule, what is in the centre
central vein
what is located on the corners of the hepatic lobule
portal triad
(portal vein, hepatic artery, bile duct)
which zone is closest to the portal triad
zone 1
periportal hepatocytes receives the most oxygen
which zone is closest to the central vein of the hepatic lobule
zone 3
perivenular hepatocytes are the most mature and metabolically active cells
which zone of the hepatic lobule is affected first by viral hepatitis
zone 1
which zone of the hepatic lobule is most sensitive to metabolic toxins
zone 3
where are stellate cells found
Space of Disseminated in between sinusoid and hepatocytes
what two things happen to the architecture of the liver in chronic inflammation
loss of microvilli
activation of stellate cells
what do activated stellate cells produce
collagen
what do activated stellate cells become
myofibroblasts
key histological finding in acute hepatitis caused by drugs or viruses
spotty necrosis
what does the severity of inflammation in chronic hepatitis determine
grade
what does the severity of fibrosis in chronic hepatitis determine
stage
4 events that occur when chronic hepatitis becomes cirrhosis
- portal inflammation
- interface hepatitis
- lobular inflammation
- bridging from the portal vein to central vein
what sort of necrosis occurs in interface hepatitis
piecemeal necrosis
what happens in interface hepatitis
cannot see the border between the portal tract and parenchyma
which histolopathological stage is critical in the evolution of chronic hepatitis to cirrhosis
Bridging from the portal vein to central vein.
This causes blood to bypass hepatocytes and reduces function of liver (intrahepatic shunting)
what is bridging from the portal vein to central vein called
intrahepatic shunting (fibrotic bridges)
top 3 causes of liver cirrhosis
- alcoholic liver disease
- NAFLD
- chronic viral hep
which metabolic disorders can lead to liver cirrhosis
galactosaemia
glycogen storage disease
which drug can lead to liver cirrhosis
methotrexate
how is liver cirrhosis classified
by the size of the regenerating nodueles
MICRO <3
MACRO >3 mm
Scoring system for prognosis of liver cirrhosis
Modified Child’s Pugh Score
the elements of the Modified Child’s Pugh Score
A- albumin
B- bilirubin
C- Clotting
D (distension) - Ascites
E- encephalopathy
Score for Child Pugh A
< 7
Score for Child Pugh B
7-9
Score for Child Pugh C
> 10
which condition do you see hepatocyte ballooning and necrosis
alcoholic hepatitis
is alcoholic cirrhosis micro or macronodular
micro nodular
most common cause of chronic liver disease in the West
NAFLD
when does NAFLD become NASH
steatosis + hepatitis
this can become cirrhosis
HLA association in autoimune hep
HLA-DR3
antibodies in Type 1 autoimmune hep
ANA (antinuclear Ig)
anti-SMA (anti-smooth muscle Ig)
anti-actin Ig
anti- soluble liver antigen Ig
antibodies in Type 2 autoimmune hep
Anti-LKM Ig (anti liver-kidney-microsomal Ig)
histology in PBC
bile duct loss with granuloma
histology in PSC
onion skinning fibrosis
beading/strictures
what cancer increases with PSC
cholangiocarcioma
histological changes seen in post strep glomerulonephritis
Light microscope (LM):↑cellularity of glomeruli
FluorescenceMicroscope(FM): granular deposits of IgG and C3 in GBM
Electron Microscope (EM): Subendothelial humps
Malignant HTN, what is the classic renal finding on histology
fibrinoid necrosis
which two conditions can lead to mucosa associated lymphoid tissue Lymphoma
- H.pylori
- Sjogrens syndrome
Women has acute appendicitis, 5mm tumour found in tip when it’s removed, what sort of tumour might it be?
neuroendocrine tumour
Fibro-epithelial tumour with abundant stromal elements
phyllodes tumour
classical histological findings in phyllodes tumour
“branching”/”leaf-like fronds”/”artichoke appearance”
Breast cancer which has a high, medium and low stage to it
Ductal carcinoma in situ
out of the two breast carcinomas in situ, which one has micro-calcification
ductal carcinoma in situ
no calcification in lobular carcinoma in situ
which breast disease changes in presentation according to the menstrual cycle
fibrocystic disease
which intraductal papillomas cause nipple discharge
Larger lactiferous ducts → central papillomas
A man with AF (Atrial fibrillation) develops fever, nausea, vomiting and pain in his right loin/flank. What is the most likely cause?
renal infarct
A man presents with the symptoms of a UTI and acute onset costovertebral pain. He is found to have pus cells and blood in his urine. What is the most likely cause?
acute pyelonephritis
Patient with a pancreatic mass following acute pancreatitis
pancreatic pseudocyst
Patient with a history of severe abdominal pain; during cholecystectomy the surgeons noticed grey specks around and on the pancreas
acinar cell carcinoma
multifocal fat necrosis
On doing a patient’s nephrectomy they notice a mass in the kidney that extends into the the renal vessels and into the perinephric fat
angiomyolipoma
Man goes deaf with bowed legs
Paget’s disease
which cerebral haemorrhage is characterised by sudden onset thunderclap headache, LoC and vomiting
subarachnoid
which cerebral haemorrhage is characterised by bridging veins with slow venous bleed
subdural
which cerebral haemorrhage is characterised by rapid arterial bleed, lucid interval then LoC
epidural
“lemon” shape haemorrhage
epidural
“banana” shape haemorrhage
subdural
most common site of intraparenchymal haemorrhage of the brain
basal ganglia
where do most subarachnoid haemorrhages occur
bifurcation of the carotids
Patient with HIV, raised ICP, new onset epilepsy
primary CNS lymphoma
Low TSH and high T4 following viral infection, what is the diagnosis
viral thyroiditis/ De Quervains
Which thyroid cancer most commonly metastasises to the lymph nodes
papillary
What virus increases risk of nasopharyngeal cancer
EBV
cerebral haemorrhage associated with gradual headache, fluctuating consciousness
and behaviour changes
subdural
which are the non-traumatic and traumatic cerebral haemorrhages
traumatic: epidural and subdural
non-traumatic: intraparenchymal and subarachnoid
where has a Krukenberg tumour metastasised from
gastric
what liver change occurs in diabetics
NAFLD or NASH
due to insulin resistance
most common brain tumour in children
astrocytoma (pilocytic)
indolent childhood tumour
2nd most common brain tumour in children
medulloblastoma
most common brain tumour in adults
glioblastoma
2nd most common brain tumour in adults
meningioma
main mutation in pilocytic astrocytoma
BRAF
main mutation in GBM
IDH wildtype
what mutation in diffuse glioma is associated with longer survival and better response to chemo and radiotherapy
IDH mutation
which brain tumours are associated with psammoa bodies
meningioma
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this
haemochromatosis
most common oesophageal carcinoma seen in the uk
adenocarcinoma
most common in Caucasians
A woman develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan. What is the likely diagnosis?
viral thyroiditis
which causes of hyperthyroidism have high uptake
Graves
Toxic Multinodular Goitre
Toxic adenoma
iodine uptake scan pattern in graves
diffuse
iodine uptake scan pattern in toxic multinodular goitre
mulitple hot nodules
iodine uptake scan pattern in toxic adenoma
solitary hot nodule
which causes of hyperthyroidism have a low uptake
De Quervains/ viral
Postpartum thyroiditis
ectopic
two drugs that can cause hypothyroidism
lithium
amiadorone
which thyroiditis causes a stony hard thyroid
Riedel’s thyroiditis
What type of section is done for urgent diagnosis during surgery
intra-operative frozen section
What type of shunt is seen in Tetralogy of Fallot
right to left
primary bone tumour affecting the knee commonly
osteosarcoma
what is raised in osteosarcoma
ALP
X-ray findings in osteosarcoma
Codman triange
sunburst appearance
highly malignant bone tumour
Ewings
affects <20s
malignant bone tumour affecting over 40s
chondrosarcomas
(malignant proliferation of chondrocytes)
x-ray finding in chondrosarcoma
lytic lesions with fluffy calcification
most common benign bone tumour
osteochondroma
x ray sign for enchondroma
cotton wool calcification
x ray sign for osteiod osteoma
bulls eye
in which inherited disease is fibrous dysplasia seen
McCune Albright Syndrome
x ray findings in fibrous dyplasia
Soap bubble osteolysis
Shepherd’s crook deformity
What is the difference in bullae in pemphigus vulgaris and bullous vulgaris?
Bullous: large tense fluid fluid, on flexural surfaces, do not rupture as easily as pemphigus.
Pemphigus: easily ruptured, found on mucosal and skin. Nikolsky sign positive
what is bicalutamide and what is it used for
androgen antagonist
metastatic prostate cancer
neoplastic cells with transparent cytoplasm. Cells are arranged in nests with intervening blood vessels.
which renal cancer?
clear cell
in what condition are waxy urinary casts seen
CKD
