Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 5 MEDICINE Pathology > Histopathology > Flashcards

Histopathology Flashcards

1
Q

Breast composition?

A

2 main structures -> large ducts and terminal duct lobular unit

2 types of epithelial cells ->> luminal cells (inside) myoepithelial cells(on outside)

2 types of stroma - interlobular and intralobular stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Presentations of breast disease?

A

breast lump

on screening mammogram

Nipple discharge - evaluated with cytology -> papilloma is most common cause. weak cancer association particularly if discharge is bloody, or there is a mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

investigations for breast disease?

A

Physical examination.
Imaging- Sonography, mammography & MRI
Pathology (cytopathology and/or histopathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe how cytopathology of breast lumps are coded

A

Aspirates of breast lumps are coded C1-5:

C1 = inadequate
C2 = benign
C3 = atypia, probably benign
C4 = suspicious of malignancy
C5 = malignant - KEY!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Inflammatory breast diseases

A

1. duct ectasia
2. acute mastitis
3. fat necrosis
3. galactocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute Mastitis?

A

painful red breast

often seen in lactating women

staphylococcus

histology full of inflammatory cells - mainly neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Duct ectasia? (inflammation and dilation of large breast duct)

A

presents with nipple discharge

sometimes breast pain, masss, nipple discharge

histology -> large swollen duct, see pic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

fat necrosis

A

Caused by trauma, surgery, radiotherapy.

Presents with a breast mass, late stages may show focal calcification.

histopathology - fat globules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Galactocele

A

Cystic dilation of a duct during lactation

Usually multiple ducts

Tender palpable nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Benign breast diseases

A

1. fibrocystic disease - breast lumpiness, hormonal responsiveness
2. fibroadenoma - well circumscribed breast lump
3. phyllodes tumours - enlarging mass in women aged over 50. increased stromal proliferation on histology
4. intraductal papilloma - nipple discharge or asymptomatic. proliferation/enlarged duct on histology
5. radial scar - MIMICs breast cancer!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Proliferative breast diseases

A

1. Usual epithelial hyperplasia - may increase risk for invasive carcinoma
2. Fat epithelial atypia -> may increase risk of ductal carcinoma
3. in situ lobular neoplasia -> affects whole lobule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Malignant breast diseases (most important pathology but not most common)

A

1. Pagets disease - histology shows atypical large cells
2. ductal carcinoma in situ - 85% diagnosed as microcalcification on mammography. can be low or high grade
3. invasive breast carcinomas: breast lump presentation usually
- invasive ductal carcinoma. = MOST common!
- invasive lobular carcinoma
- invasive tubular carcinoma (teardrop histology)
- invasive mucinous carcinoma (clusters cells free floating in mucin)
- basal like carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Histological grading for breast cancers?

state the 3 parameters

A

assessing 1) tubule formation 2) nuclear pleomorphism, and 3)mitotic activity. 

Each parameter is scored from 1-3 and the three values are added together to produce total scores from 3-9.
3-5 points = grade 1 (well differentiated).
6-7 points = grade 2 (moderately differentiated).
8-9 points = grade 3 (poorly differentiated).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

most important prognostic factor in breast cancer?

A

status of the axillary lymph nodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute Esophagitis

A

- GORD is a RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Barrets oesophagus

squamous to columnar metaplasia

A

without goblet cells - gastric metaplasia

with goblet cells - intestinal type metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

adenonocarcinoma of eosophagus

A

reflux therefore lower eosophagus

developed countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

squamous carcinoma of eosophagus

A

developing countries
alcohol and smoking

middle 2/3

make keratin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

oesophageal varices

A

liver disease RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gastritis

A

Acute - NSAIDS, alcohol, h pylori

chronic - ABC - autoimmune, bacteria, chemical - NSAIDS, bile reflux

other:
CMV, strongyloides
IBD (crohns)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Gastric cancer

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Gatrointestinal stromal tumour

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

duodenitis

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

coeliac disease

A

endomysial antibodies

tissue transglutaminase antibodies

villous atrophy with increased intraepithelial lymphocytes

risk of duodenal MALT lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute pancreatitis

causes?
complications?

A

Duct obstruction -> e.g gallstones, trauma, tumours. periductal injury seen

Metabolic toxic - alcohol, drugs eg thiazides, hypercalcemia, hyperlipidemia

poor blood supply - perilobular injury seen

infection/inflammation

autoimmune - eg igG4 related disease

idiopathic



fat necrosis seen

complications - pseudocyst, abcess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

chronic pancreatitis

A

metabolic/toxic - alcohol 80% AND most key to remember, hemachromatosis

duct obstruction - gallstones, cf

tumours

FIBROSIS - KEY Pathology in chronic pancreatitis vs acute. calcificication seen


complications; malabsorption, Diabetes, pseudocyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Tumours of Pancreas



risk factors

A

Carcinomas - DUCTAL 85% (kras mutations in most cases, adenocarcinomas), Acinar cancers

Cystic neoplasms - serous cystadenoma, mucinous. usually benign

pancreatic endocrine neoplasms - usually non secretory, contain neuroendocrine marker CHROMOGRANIN. can be associated with MEN1. example = insulinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Gallstones and complications

A

chronic cholecystitis = THICKENED GALLBLADDER WALL

Gallbladder cancer - adenocarcinoma

obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

primary or secondary tumours more common?

A

secondary. but primary most common form in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

aetiology of CNS tumours

A

previous radiotherapy to head and neck - increases risk of Meningiomas

familial syndromes -> neurofibromatosis 1 (neurofibromas and astrocytoma)

nuerofibromatosis 2 (shwanomma, meningioma)
etc

Brain Tumour Polyposis syndrome 1-> malignant gliomas

Von Hippel Lindau -> hemangioblastoma

Gorlin Syndrome -> medulloblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

CNS symptoms based on location

A

supratentorial ->siezures, personality changes, focal neurological deficit

infratentorial -> ataxia, cranial nerve palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

types of primary brain tumours

A

Astrocytoma

oligodendroglioma

epyndyoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

describe WHO grading system for primary brain tumours

A

grade 1 = benign e.g. meningiomas
grade 2 = more than 5 years
grade 3 = less than 5 years
grade 4 = less than a year eg GBM


mitotic activity determines grade:
<4 = grade 1
4-20 = grade 2
>20 = grade 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Glial tumours

A

diffuse gliomas: astrocytomas, oligodendogliomas

circumbscribed gliomas: Pilocytic astrocytoma (grade 1)
Subependymal giant cell astrocytoma (grade1)
Ependymomas (usually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

pilocytic astrocytomas

A

BRAF Mutation
well circumbscribed

piloid hairy cells
rosenthal fibres
slow growing/who grade 1

MOST FREQUENT tumour in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

astrocytoma

A

cerebral hemispheres, point mutation in IDH1/1 = better prognosis
WHO 2-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

GBM

A

cerebral hemispheres, IDH1
most aggresive and common glioma.

WHO 1

High cellularity
Neoangiogenesis - very vascular
Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

meningiomas

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

medulloblastoma

A

WHO grade 4, childhood cancer

4 different types?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

most frequent brain tumour in adults?

A

metastatic deposits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

mechanisms of cerebral oedema

A

vasogenic -> disruption of BBB

cytotoxic -> hypoxia, ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

hydrocephalus

A

non communicating -> blockage of cerebral aqueduct

communicating - problems with reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

raised ICP

A

cause: space occupying lesion, oedema, both

can cause brain herniation:
1. subfalcine herniation
2. transtentorial herniaton
3. tonsilar herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Stroke

A

hemorrhage:
1. intraparenchymal hemorrhage (HTN, basal ganglia usually)
2. AVM (high pressure, massive bleeding)
3. Cavernous angioma (low pressure, recurrent bleeding)
4. subarachnoid hemorrhage (berry aneurysm rupture)

ischemic - learn ACA, MCA, PCA territories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

traumatic brain injury?

A

non missile = acceleration/deceleration typically, usually car accidents
missile = penetrating

fractures - ottorrhea (skull base fracture) or rhinorrhea may occur
contusions
diffuse axonal injury - most common cause of coma when no bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What percentage of people with TIA will get an infarct within 5 years?

A

1/3
33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Alzheimer’s disease

A

Extracellular plaques
Neurofibrillary tangles (hyperphosphorylated tau)
Cerebral amyloid angiopathy (CAA)
Hippocampal atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Parkinson’s disease and Parkinson’s +

A

Idiopathic Parkinson’s disease
Drug-induced parkinsonism

- Multiple system atrophy (alpha synuclei!!found mainly glial cells not neuronal cells)
- Progressive supranuclear palsy (most common form of atypical parkinsons, no response to L-dopa. tau found!!!)

- Corticobasal degeneration (astrocytic plaques, neuropil threads. tau found!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Fronto-temporal lobar dementias

A

1. picks disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Prion disease

A

general atrophy of brain
spongiform changes
no DNA or RNA, passed on through protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Pick disease

A

Tau positive pick bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Must learn the ABC assessement for alzheimers e.g. A3B1C3 = low alzheimers risk

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Hirschsprungs, volvulus, diverticular disease

A

diverticular disease can cause pain obstruction and importantly FISTULAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Acute colitis causes

A

Infection
Drug/toxin (especially antibiotic)
Chemotherapy
Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

chronic colitis

A

chrons
ulcerative colitis
TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

infectious colitis

A

Viral e.g. CMV
Bacterial e.g. Salmonella
Protozoal e.g. Entamoeba hystolytica
Fungal e.g. candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

psuedomembranous colitis

A

Acute colitis with pseudomembrane formation
Caused by protein exotoxins of Clostridium difficile
Histology: Characteristic microscopic features on biopsy
Laboratory: C. difficile toxin stool assay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ischemic colitis

very red bowel contrast to remaining

A

Arterial Occlusion: atheroma, thrombosis, embolism
Venous Occlusion: thrombus, hypercoagulable states
Small Vessel Disease: emboli, vasculitis
Low Flow States: congestive cardiac failure, haemorrhage, shock
Obstruction: hernia, intussusception, volvulus, adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

chrons disease

A

- cobblestone mucosa with skip lesions
- transmural inflammation -FISTULA risk!
- granuloma formation
- crypt abscesses

extra intestinal: Arthritis
Uveitis
Stomatitis/cheilitis
Skin lesions
Pyoderma gangrenosum
Erythema multiforme
Erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

ulcerative colitis

A

- starts in rectum
- mucosal inflammation
- crypt abscesses

extra intestinal:
Arthritis
Myositis
Uveitis/iritis
Erythema nodosum, pyoderma gangrenosum
Primary Sclerosing Cholangitis

complications:
Adenocarcinoma!! (severe risk compared to chrons)
severe hemorrhage
toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

non neoplastic polyps

A

Hyperplastic polyps and Sessile Serrated Lesions (SSLs imaging different, architecual abnormality extends to base)
Inflammatory (“pseudo-polyps”) (pseudo because no epithelium, just granuloma)
Hamartomatous (Juvenile, Peutz Jeghers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

neoplastic polyps

A

Tubular adenoma
Tubulovillous adenoma
Villous adenoma

adenomas typically asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

congenital atresia

A

failure of bowel to form
can cause obstruction with dilation of proximal bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

congenital duplication of bowel

A

can cause cyst like structure to form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

risk factors for adenoma transformation to carcinoma

A

Size (bigger worse)
Proportion of villous component ( more worse)
Degree of dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Familial Adenomatous polyposis, FAP

A

minimum 100 polypsAPC tumour suppressor gene
virtually 100% will develop cancer within 10 to 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Gardners syndrome?

A

FAP plus extra-intestinal manifestations e.g:
osteomas
desmoid tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Hereditary Non-polyposis Colorectal Cancer (HNPCC) = Lynch Syndrome

A

High frequency of carcinomas proximal to splenic flexure
Poorly differentiated and mucinous carcinoma more frequent
Multiple synchronous cancers
Presence of extracolonic cancers (endometrium, prostate, breast, stomach)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

colorectal cancer

A

98% are adenocarcinoma
If < 50yrs consider familial syndrome

Change of bowel habit
Bleeding
Anaemia
Weight loss
Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

describe the T1, T2, T3, T4 staging for colorectal cancers

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

hepatic stellate cells are activated by?

A

liver injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

cirrhosis classification



complications?

A

- according to size - micronodular or macronodular

- aetiology - alcohol/insulin resitance vs viral hepatitis

portal HTN, hepatic encephalopathy, liver cell cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Acute hepatitis
histopathology?
aetiology?

A

spotty necrosis

viral hepatitis, drugs, auto-immune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

how is chronic hepatitis evaluated histologically

A

severity of inflammation = grade
severity of fibrosis = stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Fatty liver disease

A

- risk factors such as obesity, type 2 diabetes, high blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Alcoholic hepatitis

A

Ballooning! +/- mallory denk bodies
apoptosis
pericellular fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

cirrhosis

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

NAFLD and NASH

A

- histologically similar to alcoholic liver disease
- due to insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Primary biliary cholangitis

A

- bile duct loss with chronic inflammation, chronic granulomas

- anti-mitochondrial antibodies = diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Primary sclerosing cholangitis

A

- periductal bile duct fibrosis
- associated with ulcerative colitis
- increased risk of cholangiocarcinoma
- bile duct imaging = diagnostic

81
Q

hemachromatosis

A

Increased gut iron absorption
gene on chromosome 6 HFe
bronzed diabetes

82
Q

hemosiderosis

A

accumulation of iron in macrophages
blood transfusion

83
Q

Wilsons disease

A

accumulation of copper due to failure of excretion by hepatocytes into bile
chromosome 13 gene
kayser fleicher ring
rhodanine stain for copper

84
Q

autoimmune hepatitis

A

anti-smooth muscle antibodies

85
Q

alpha-1-antitrypsin deficiency

A

intra-cytoplasmic inclusions due to misfolded proteins

86
Q

paracetamol toxicity

A

87
Q

hepatic granulomas

A

PBC, drugs
TB, Sarcoid

88
Q

benign liver tumours

A

1. liver cell adenoma
2. bile duct adenoma
3. hemangioma

89
Q

malignant liver tumours

A

primary and secondary tumours

primary:
1. hepatocellular carcinoma
2. hepatoblastoma
3. cholangiocarcinoma (PSC, worms and cirrhosis association)
4. hemangiosarcoma

90
Q

bone tumour presentation?


investigation?


management?

A

pain, swelling, deformity pathological fracture (in young adult, older think arthritis first)

history of trauma may be misleading
multiple lesions - may be a metastatic process or process involving bone marrow eg lymphoma

osteosarcoma - common around knee

associated disease - eg skin tumour at site or pagets disease


xray = 1st line to evaluate - solitary/,ultiple, extension into local tissue, fracture

specialist centre referral

confirmative diagnosis = needle biospy
core biopsy - irregular trabecular bone, infiltration with cartilage

possibly amputation, chemo

91
Q

State 3 types of malignant bone tumours
most common?

A

Osteosarcoma - bone forming. most common - adolescents
Chondrosarcoma - cartilage forming - age 40 and over
Ewings Sarcoma (undifferentiated) - < age 20

92
Q

osteosarcoma presentation?

xray findings?

A

metaohysis of long bones - knee common, lump, pain, fracture

elevated periosteum (Codmans Triangle)
or sunburst pattern on xray

93
Q

Ewings Sarcoma presentation?



fusion protein associated with?

A

small blue cells
diaphysis of long bones, pelvis - black lesion on xray
fever leukocytosis -> differentials include osteomyelitis, lymphoma

t(11, 22)

94
Q

Differentials for bone tumours?
(tumour like conditions)

A

- fibrous dysplasia!!!
- metaphyseal fibrous cortical defect/ non-ossifying fibroma
- reparative giant cell granuloma
- ossifying fibroma
- simple bone cyst

95
Q

fibrous dysplasia presentation?



histological finding?

management

A

- affects any bone but proximal femur (shepherds crook deformity may occur) most common, rib (lump on chest)

- xray - soap bubble osteolysis - in more than one bone vs osteosarcoma 1 site unless metastatic

- endocrine association - MCcune Albright syndrome

histology- marrow replaced by pink fibrous stroma, rounded and curved trabecular bone

excision but no chemo as benign

96
Q

classify and state the different types of benign bone tumours


most common?

A

Cartilaginous differentiation (produce cartilage)
1. osteochondroma - most common
2. enchondroma
3. chondroblastoma

Bone forming
1. osteoid osteoma
2. osteoblastoma
3. osteoma

97
Q

osteochondroma site predilection?


x ray findings?

A

- end of long bones eg bump at top of humerus or around knee!!
- mimics formation of cartilage eg on femoral head
- flat or sessile (on a stalk)

xray may show outward projection of bone growth

98
Q

enchondroma site predilection?

A

hands and feet - eg pathological fracture in finger
- may show popcorn calcification on x ray

99
Q

giant cell tumour classification?

site predelection?


x ray findings

A

borderlign
benign but can metastize eg to lungs
benign sign - well demarcated
malignant sign - hemorrhage in lesion

end of long bones, mostly knee

histology - sheets of osteoclast giant cells
soap bubble appearance on x ray

100
Q

top cancers that metastize to bone in adults?

A

breast, prostate, lung, kidney, thyroid

101
Q

top cancers that metastize to bone in children?

A

neuroblastoma, wilms tumour, osteosarcoma, ewings sarcoma, rhabdomyosarcoma

102
Q

metastatic disease is usually which parts of bone?

if you see lytic lesions in spine but chest xray is clear and the carcinoma is of an unknown primary, what could be differentials?, how would you investigate?

A

above elbow, above knee


multiple myeloma, but also just other parts of body
staining of malignant cells for identification

103
Q

state some soft tissue tumours

A

liposarcoma
melanoma
rhabdomyosarcoma

histological classes (many fall under each):
spindle cell tumour
myxoid tumours
pleomorphic tumour

104
Q

pituitary adenomas peak presentation time?
most common?

A

4th to 6th decade
prolactinoma

105
Q

common causes of hypopituitarism?

manifestation of hypopituitarism?

A

non secreting pituitary adenoma
ischemic necrosis - sheehans, dic, sickle cell
ablation by surgery or radiaiton

children - growth failure
gonadotrophin deficiency - infertility, ammennorhea
hypothyroidism, hypoadrenalism

106
Q

posterior pituitary hormones?

A

ADH oxytocin

107
Q

causes of thyrotoxicosis not associated with thyroid?

A

struma ovarii - ovarian teratoma with ectopic thyroid

exogenous thyroid intake

108
Q

Histology for Hashimotos thyroiditis?

A

lymphocytic infiltrate within germinal centres
hurtle cells -> epithelial cells enlarge and contain eosinophilic cytoplasm

109
Q

Papillary thyroid carcinoma morphology?

A

optically clear nuclei
psammoma bodies - foci of calcifications

painless mass in neck
metastasize to cervcial lymph nodes

110
Q

follicular thyroid carcinoma morphology?

A

Hematogenous spread!!! - metastasize to lungs bone!!!, liver

111
Q

Medullary thyroid carcinoma origin? association?


histological finding?

A

parafollicular C cells
MEN syndrome - 20% cases associated with this and thus seen in younger patients

calcitonin broken down into AMYLOID - stains with congo red -> green colour under polarised light

112
Q

anaplastic carcinoma?

A

very agggressive
most die within a year

113
Q

causes of hyperparathyroidism?

symptoms of primary hyperparathyroidism?

A

solitary adenoma - most common
hyperplasia affecting all 4 glands - may be part of MEN
cancer <1%

normal parathyroid is 50% fat -> empty "cells"

bone changes can be seen in primary and secondary hyperparathyroidism

114
Q

causes of hypoparathyroidism?

clinical manifestations?

A

surgical ablation
congenital absence
autoimmune

neuromuscular irritability
cardiac arrhythmias
fits
cataracts

115
Q

what is secreted in each part of the adrenal gland?

A

116
Q

most common endogenous causes of cushings syndrome?

A

pituitary - most common
adrenal - 30% adenoma or carcinoma, bilateral hyperplasia
ectopic acth - causes adrenals to show bilateral hyperplasia - contrast to exogenous cortisol ingesiton which causes atrophic adrenal glands!!

117
Q

causes of hyperaldosteronism
manifestations?

A

bilateral adrenal hyperplasia - 60%
conns syndrome - 30%
HTN, hypokolemia

118
Q

adrenal insufficiency causes?

A

primary:
- acute - abrupt stopping of steroids
- hemorrhage into adrenals in neonates
- sepsis with DIC - Waterhouse Friderichson Syndrome
- Addisons disease

secondary - pituitary lesion eg non-functioning adenoma

119
Q

name 2 adrenal medulla tumours

A

pheaochromocytoma
neuroblastoma

120
Q

what is the most common cause of thyroid cancer?

A

papillary carcinoma

121
Q

causes of calcium oxalate kidney stones?
most common type of kidney stone

A

hypercalciuria:
- excessive gut ca absorption
- defective absorption ca in proximal tubule
- hyperparathyroidism - rare

122
Q

cause of magnesium ammonium phosphate kidney stones (triple stone)? presentation?

A

infection with urease producing organisms eg proteus
staghorn calculi

123
Q

cause of uric acid kidney stones?

A

believed hyperuricemia - gout, rapid cell turnover

most patients dont acc have hyperuricemia

124
Q

kidney stones complications?

A

colic

large stones -- obstruction, infection, renal failure

125
Q

state 3 benign renal neoplasms

A

1. papillary adenoma - incidental finding. Must be 15 millimeters or less. if not -> carcinoma
2. renal oncocytoma - incidental finding, brown with central are of scarring, nest of oncoytic cells
3. angiomyolipoma -associated with tuberous sclerosis, on histology you see blood vessel, muscle cells, big gat cells. when >4cm can hemmorrhage but typically asymptomatic

126
Q

renal carcinoma
symptom?
state and describe different subtypes
most common?

A

Painless hematuria

1. clear cell renal carcinoma - golden yellow tumour, clear cells on histology - most common
2. papillary
3. chromophobe - look like clear cells, but have sharply defined borders, thickened vascular walls/network

127
Q

Nephroblastoma (Wilms tumour) presentation ?

histology?

A

abdominal mass in a child aged 2-5
2nd most common malignancy in child

triphasic:
- small round blue cells
- epithelial component
- stomal component

128
Q

Urothelial carcinoma (Transitional cell carcinoma) definition?

presentation?

3 main subtypes?

A

cancer arising in bladder, renal pelvis, ureters

hematuria

1. non-invasive papillary urothelial carcinoma - frond like growths
2. infiltrating urothelial carcinoma
3. flat urothelial carcinoma in situ - High grade lesion!! presents as red patch

129
Q

BPH symptoms

A

lower urinary tract symptoms

can also present with urinary tract infection, acute urinary retention, renal failure

130
Q

testicular germ cell tumor symptoms (typically malignant)
state different types and describe histology


treatment?

A

painless lump
10% mets signs - back pain, dyspnea, cough

1. Seminoma - clear cells, lymphoid infiltrate
2. embryonal carcinoma - necrotic, prominent nucleoli
3. teratoma - histology shows mix of keratin, cartilage etc, different tissues present - can be malignant vs benign ovarian carcinoma
4. yolk sac tumour
5. choriocarcinoma

chemo

131
Q

state testicular non germ cell tumours

A

Leydig cell tumour - benign
sertoli cell tumour - benign
lymphoma - seen in older men - malignant

132
Q

penile diseases

A

lichen sclerosis - causes phimosis
zoons blanitis - inflammatory disease causing red areas
condylomas
Pyeronie's disease - curving due to scarring and thickening of corpus cavernosum, painful erections
Penile carcinoma

133
Q

scrotal diseases

A

epidermoid cyst, scrotal calcinosis
angiokeratomas
fourniers gangrene
squamous cell carcinoma - very rare

134
Q

grading system for prostate cancer?

A

gleason score

135
Q

Autosomal polycstic kidney disease symptoms?

A

HTN, flank pain, hematuria in adult

berry aneurysms

136
Q

acquired cystic renal disease?

A

can occur in patients with end stage renal disease on dialysis -> risk of papillary renal cell carcinoma

137
Q

Acute tubular injury/ ATN
causes

A

ischemia
toxins
drugs - eg NSAIDS

apoptosis and necrosis of tubular cells

Muddy brown casts

138
Q

Acute tubulo interstitial nephritis
causes

A

infections and drugs eg NSAIDS
interstitial inflammatory infiltrate - eosinophils, granulomas

Hematuria (as it is a nephritis) and pyuria

139
Q

Acute glomerulonephritis

A

erythrocytes, leucocytes casts

crescents in glomeruli - may be due to immune complexes(sle, igA nephropathy, post-infectious glomerulonephritis), pauci-immune (ANCA associated, scanty iG deposits), Anti-GBM(linear deposits of IgG on b membrane - leads to irreversible renal failure

140
Q

Thrombotic microangiopathy risk factors?

A

MAHA
hemolytic uremic syndrome

141
Q

nephrotic syndrome causes?
findings?

A

minimal change disease - effacement of foot processes on EM. no other changes. treat with immunosuppression

fsgs - scarred glomeruli, must exclude other causes of scarring

immune complex disease - membranous glomerulonephritis (subepithelial deposits on outside of gbm, antibody against PLA2R in 75%, autoimmunie usually, must exclude secondary causes)

systemic disease:
- diabetic nephropathy (nodular sclerosis, Kimmelstiel wilson lesion!! aka large nodules)
- amyloidosis - eg AA seen in chronic inflammatory states eg IBD or AL in which 80% patients have multiple myeloma. congo red stain - apple green birefringence
- SLE

142
Q

2 common causes of microscopic hematuria?

A

- thin basement membranes - hereditary defect in type 4 collagen
- igA nephropathy - associated with HSP

143
Q

how many classes of SLE nephropathy are there?

A

6

2 = mesangial pattern of injury

3 = cell proliferation in capillary loops, subendothelial deposits

5 = membranous pattern - subepithelial deposits

144
Q

nephrotic syndrome is proteinuria of more than how many grams per day?

A

3.5g

145
Q

IgA renal disease is scored using?

A

oxford classification system

146
Q

most common cause of kidney failure requiring renal replacement therapy?

A

diabetes

147
Q

lymphocytes and plasma cells are associated with which type of inflammation?

A

chronic - eg IBD

acute = neutrophils, eg in a FLARE of IBD

148
Q

eosinophils are seen in?

A

allergic reactions
parasitic infections
Hodgkins lymphoma


eg rectal biopsy in child with eosinophils = cows milk intolerance? parasite?

eosinophilic oesophagitis - due to food allergens

149
Q

features of squamous cell carcinomas?

A

keratin
intracellular bridges

150
Q

adenocarcinomas features?

A

mucin production
glands

151
Q

antibodies to what can be used to identify epithelium?

A

cytokeratin

even more specific eg
CK20+ AND CK7- from liver biospy = large bowel cancer primary

152
Q

CD45 is a marker for?

A

lymphoid cells

153
Q

Gilberts syndrome pathology?
presentation?

A

decreased activity of UDP glucoronyl transferase
increased bilirubin only (unconjugated - therefore doesnt enter urine as binds to albumin)

154
Q

what is the best marker of liver function?

A

prothrombin (liver makes clotting factors)

155
Q

alcoholic hepatitis biopsy findings?
treatment?

A

ballooned hepatocytes - white clear cells
mallory hyaline - pink bodies

swollen hepatocytes - bile accumulates in liver - raised bilirubin

stop alcohol
vitamins especially B1
ocassionally steroids

156
Q

3 signs of portal hypertension?

A

caput medusae
spleenomegaly!!!
ascites

NOT hepatomegaly!

157
Q

signs of chronic stable liver disease

A

spider neavi
palmar erythema
dupentryns contracture

158
Q

signs of liver failure?

A

159
Q

common causes of obstructive jaundice? how to differentiate?

A

gallstones - painful, non palpable gallbladder
pancreatic cancer - painless initially, palpable gallbladder

160
Q

osteoporosis causes?

presentation?

investigationa?

A

post menopausal - eostrogen deficiency

steroids is a key risk factor

fractures - wrist hip, vertebral fractures may asymptomatic

serum calcium, phosophorus, alk phos, urinary calcium- typically normal

imaging

bone densitometry - cut off for osteoporosis vs osteopenia

161
Q

Hyperparathyroidism bone findings?

A

osteitis fibrosis cystica

brown cell tumour - multinucleate cells seen on histology

162
Q

what is renal osteodystrophy?

A

comprises all bone changes seen as a result of renal disease eg:
1. osteitis fibrosis cystica
2. osteomalacia
3. osteosclerosis
4. growth retardation
5. osteoporosis

163
Q

osteomyelitis causative organism?

A

s aureus - 90%
salmonella - sickle cell
psuedomonas - IVDU
etc

xray findings usually appear only after about 10 days

new bone formation then lytic destruction (sequestrum)

164
Q

what giant cells are seen in TB osteomyelitis?

name another rare cause of osteomyelitis

A

Langhans type Giant cells

syphilis

165
Q

neuroendocrine tumour immunhistochemical marker?

A

chromogranin, synatophysin

can also stain for specific hormone it secretes - gastrin(eg zollinger ellison syndrome), insulin etc


staging for these tumours are site specific

166
Q

HPV high risk strains? effect?

A

HPV 16 and 18 -> Can cause cervical cancer but als warts like low risk strains

squamous cell carcinoma - always HPV associated
adenocarcinoma - sometimes associated - 20% oof invasive cases

167
Q

endometrial cancer

A

1. endometroid carcinoma
2. serous carcinoma
3. clear cell carcinoma

omentectomy lymphadenectomy + uterine removal if high grade


TCGA classification increasing for eec diagnosis

p53 mutation may be present - can be detected with staining

168
Q

Endometriosis, ovarian cysts

A

169
Q

Ovarian tumours

A

primary
1. epithelial - 65% of all, 95% of malignant - many subtypes eg serous, mucinous
2. sex cord - adult type(FOXL2) and juvenile granulosa cell
3. germ cell - 20%, 95% benign - mature teratoma, immature teratoma(malignant), dysgerminoma, yolk sac, embryonal carcinoma, choriocarcinoma
4. miscellaneous

- screen for BRCA1 AND BRCA2, HNPCC (lynch syndrome)
secondary

170
Q

Lichenoid inflammation

lichen planus
erythema multiforme
Toxic epidermal necrolysis

A

basal cell damage, interface dermaittis

shiny, purple, flat, scaly

171
Q

eczema

A

spongiotic reaction

atopic dermatitis, contact dermatitis, sebbohhreiac

172
Q

psoriasis

A

epidermal hyperplasia

erythematous plaque with white silvery scales on extensor surfaces

173
Q

vesticullobullous rash

A

blistering within or beneath the epidermis


antibodies attacking epidermis
- bullous pemphigoid - subepidermal blisters - > IF shows straight line
- pemphigoid vulgaris - intraepidermal bullae

174
Q

malignant epithelial skin tumours

A

seborrheic keratosis -> benign, stuck-on appearance

Basal cell carcinoma - most common skin cancer -> does not metastize, ptch mutation


squamous cell carcinoma - actinic keratosis, bowens disease (scc in situ so full atypia of epidermis but basement membrane intact), SCC can occur in burns patients, immunocompromised

175
Q

bening mole vs melanoma

A

melanoma staging based on breslow thickness

176
Q

is urobilinogen present in normal urine?

A

true

177
Q

obstructive jaundice signs

A

scratch marks from bile salts in skin
pale stools dark urine

178
Q

must be able to recognise nutmeg liver specimen. what causes this?

A

right sided heart failure

179
Q

how to identify granular deposits on electron micrograph

A

flourescence in whole glomerulus, following glomerular capillaries

180
Q

nephrotic syndrome with
subepithelial deposits on electron micrograph
and granular deposits on imunofluroescence is most likely?

A

membranous glomerulonephritis

181
Q

what happens in Acute tubular injury?

A

ischemia/toxins -> sloughing of cells into lumen -> blockage of tubules -> leaking into interstitium

182
Q

what happens in acute tubulo interstitial nephritis?

A

immune injury. most commonly due to drugs
interstitial inflammatory infiltrate -> eosinophils, granulomas

can also be due to infection eg TB

183
Q

different types of glomerulonephritis?

A

1. Immune complex -> SLE, IgA nephropathy, post infectious glomerulonephritis
2. anti GBM disease - linear deposition of IgG
3. pauci immune -> anti neutrophil cytoplasm antibodies. scanty immunoglobulins, no fluorescence

184
Q

different types of nephrotic syndrome?

A

1.primary glomerular disease, no immune complex - minimal change, focal segmental glomerulosclerosis
2. primary renal disease, immune complex - membranous glomerulonephritis (subepithelial deposits, antibodies against PLA2R in 75% cases)
3. Systemic disease - diabetes(thickening of basement membrane and expansion of mesangium which progresses to nodular/kimettiel wilson lesions then scarring), amyloidosis, SLE

185
Q

what are the 2 most common types of amyloid in the kidney in amyloidosis. describe classic presentation

A

AA amyloid -> derived from acute phase protein called SAA thus patients have chronic inflammatory state eg patient with IBD or recurrent infections

AL amyloid -> derived from immunoglobulin light chains. 80% have multiple myeloma

186
Q

key EM finding in minimal change disease?

A

effacement of foot processes

187
Q

nephotic syndrome is proteinuria of more than?

A

3.5g

188
Q

IgA renal disease is scored using? associates with which vasculitis?

A

oxford classification/ MestC
HSP

189
Q

most common cause of CKD?

A

diabetes

190
Q

most common causes of isolated microscopic hematuria

A

thin basement membranes - eg alport Syndrome
igA nephropathy

191
Q

hypertensive nephropathy histology findings?

A

shrunken kidneys
arteriolar hyalinosis, thickened arteries

192
Q

benign kidney tumour features

A

1. papillary adenoma - max size is 15mm
2. renal oncocytoma - eosinophilic/pink cells
3. angiomyolipoma

193
Q

renal cell carcinoma presentation?

subtypes (learn histology)?

A

painless hematuria
or incidental on imaging

1. clear cell renal carcinoma
2. papillary renal cell carcinoma
3. chromophobe renal cell carcinoma

194
Q

malignant kidney tumour of childhood?

A

nephroblastoma
triphasic pattern

195
Q

Urothelial Carcinoma (previously called transitional cell carcinoma)

A

1. non invasive papillary urothelial carcinoma
2. infiltrating urothelial carcinoma
3. flat urothelial carcinoma in situ - is high grade

196
Q

BPH, Prostate cancer

A

cancer scored using gleason score

197
Q

Testicular germ cell tumours

risk factors?
presention

subtypes

A

undescended testes, low birth weight


painless lump
back pain, cough, dyspnea with mets


1. seminoma - clear polygonal cells with prominent lymphoid infiltrate
2. embryonal carcinoma
3. post-pubertal teratoma
4. yolk sac tumour
5. choriocarcinoma - aggressive, hemorrhagic, necrotic

198
Q

testicular non germ cell tumours

A

lymphoma
leydig cell tumours
sertoli cell tumours

199
Q

A

Year 5 MEDICINE Pathology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions