Histopathology Flashcards
Which respiratory pathology is defined as persistent dilatation of the bronchial airways?
Bronchiectasis
Which is the most common genetic disease associated with bronchiectasis?
Cystic fibrosis
Which bacterial infections are common in bronchiectasis?
Haemophilus influenzae, pseudomonas aeruginosa, staphylococcus aureus),
What are the characteristic clinical features of bronchiectasis?
- Cough (Productive, mucoid sputum)
- Dyspnoea
- Haemoptysis
- Pleuritic chest pain
- Wheeze
- Bi-basal crepitations
What is the most common infective cause of bronchiectasis in adult patients?
Pertussis
What are the 4 common congenital cause of bronchiectasis?
- Cystic Fibrosis
- Primary Ciliary dyskinesia
- Hypogammaglobulinaemia
4 - Young’s syndrome
What is Young’s syndrome?
Triad of Rhinosinusitis, azoospermia, and bronchiectasis.
What is the diagnostic test for bronchiectasis?
High-resolution CT
What are the findings associated with HRCT?
- Bronchoarterial ratio >1
- Signet Ring sign – Dilated airways
What are the complications associated bronchiectasis?
Recurrent infections, haemoptysis, cor pulmonale and amyloidosis.
What is the inheritance pattern of cystic fibrosis?
Autosomal recessive
What is the pathogenic mutation associated with cystic fibrosis?
Delta F508 of the CFTR gene
Which test is used to diagnose CF in the newborn blood spot test?
Immunoreactive trypsinogen
What is the diagnostic test for confirming CF (include threshold)?
Positive sweat chloride test (>60 mmol/L).
Decreased secretion of which ion underpins the aetiology of CF?
Chloride
Which bacteria is commonly associated with CF respiratory tract infections?
Pseudomonas aeruginosa
Which is the ABx of choice for the management of Pseudomonas aeruginosa in CF patients?
Ciprofloxacin
What is the first line mucolytic in the management of CF?
Dornase alfa
What are the three pathophysiological principles for the aetiology of asthma?
- Mucous hypersecretion
- Smooth muscle contraction
- Inflammatory cell infiltration.
What is the aetiology of the immediate phase of asthma?
Mast cell degranulation resulting in mediator release
Which IL is responsible for eosinophil recruitment?
IL-5
What are the four histological findings associated with asthma?
Hyperaemia
Eosinophils and goblet cell hyperplasia
Hypertrophic constricted muscle
Mucous plugging
What are Curshmann’s spiral in athma?
Spiral-shaped mucous plug
Which type of crystals are found in eosinophils and basophil granules in asthma?
Charcot Leyden Crystal
What are ‘Heart-failure’ cells?
Iron-laded macrophages
How are oxidised LDLs detected?
Scavenger receptors
Macrophage phagocytosis of OxLDLs forms what?
Foam cells
What are the CXR findings for pulmonary oedema?
Alveolar opacification (batwing appearance), Kerley B-lines, cardiomegaly, fluid in horizontal fissure.
What are heart failure cells?
Iron-laded macrophages
Which disease in neonates is characterised by diffuse alveolar damage?
Hyaline membrane disease
What spirometry finding is observed in restrictive lung disease?
- Reduced FEV1 and FVR – normal ratio (FEV1/FVC ratio >70%).
What are the occupational causes of interstitial lung disease?
- Organic dust – Mould spores, aerosolised bird droppings.
- Mineral dust – Silica, asbestos, coal mine dust, beryllium, and hard metal.
- Inhaled gases – Methane, cyanide.
What are the three advanced disease features in Interstitial Lung Disease?
Digital clubbing, pulmonary hypertension (increased P2 sound), Cor pulmonale.
What HRCT changes are observed in Interstitial Lung Disease?
Honeycomb/ground-glass appearance
What changes on light microscopy are observed in minimal change disease?
None
What is the most common cause of nephrotic disease in children?
Minimal change disease
How are OxLDLs detected?
Scavenger receptors
Macrophage phagocytosis of OxLDLs forms what?
Foam cells
Which aortic section is predisposed to atherosclerosis?
Abdominal aorta (due to low shear stress)
What are the three types of angina?
Stable angina
Unstable angina
Prinzmetal angina
What are the histological findings of cardiomyocytes 6-24 hours of myocardial infarction?
Loss of nuclei, homogenous cytoplasm, necrotic cell death.
At what stage does granulation tissue appear due to microfibroblast activity post-myocardial infarction?
1-2 weeks
Most commmon cause of sudden deeath
VF
When does Dressler’s syndrome occur?
~6-8 weeks post-MI
Persistent ST-elevation >4 weeks post-MI, cause?
Ventricular aneurysm
What is the causative organism for rheumatic fever
Lancefield Group A streptococcus
What are the Major Criteria for Rheumatic Fever?
Carditis
Arthritis
Sydenham’s chorea
Erythema marginatum
Subcutaneous nodules
How is rheumatic fever diagnosed?
Jones Criteria
2 Major
OR
1 Major + 2 Minor
What are the minor criteria associated with Rheumatic fever?
Fever
Raised CRP/ESR
Migratory arthralgia
Prolonged PR
Prev. rheumatic fever
Malaise
Tachycardia
Which cardiac valve is predominantly affected in Rheumatic fever?
Mitral valve (70%)
What term describes cell-mediated immunity and antibodies to streptococcal antigens cross-reacting with myocardial antigens?
Antigenic mimicry
What are the three histological findings observed in rheumatic fever?
- Beady fibrous vegetations (verrucae)
- Aschoff bodies (small giant cell granulomas)
- Anitschkov myocytes (regenerating myocytes)
What term describes small giant cell granulomas?
Aschoff bodies
What term describes regenerating myocytes in rheumatic fever?
Anitschkov myocytes
What is the ABx of choice for the management of rheumatic fever?
Benzylpenicillin
What term describes small warty vegetations in rheumatic heart disease?
Verrucae
What is Libman Sacks endocarditis?
Pathogenesis unknown. Associated with SLE and anti-phospholipid syndrome.
Small (up to 2mm) warty vegetations that are sterile and platelet rich
Which organism is implicated in infective endocarditis associated with poor dental hygeine?
Streptococcus viridians
Which infective endocarditis associated organism is associated with colon carcinoma?
Streptococcus bovis
What are the common causative organisms for acute infective endocarditis?
Staphylococcus aureus (30-40%)
Streptococcus pyogenes (Group A)
Which is the common causative organism associated with acute infective endocarditis associated with prosthetic valves?
Coagulase-negative staphylococcus
Which group of organisms are associated with subacute infective endocarditis?
HACEK Organisms:
Haemophilus, Aggregatibacter, Cardiobacterum, Eikenella, and Kingella.
Which two cardiac valves are predisposed to infective endocarditis?
Aortic valve
Mitral valve
Which valve is predisposed to infective endocarditis in the context of IVDU?
Right-sided valves e.g., Tricuspid valve
What are the thromboembolic symptoms associated with infective endocarditis?
- Splinter haemorrhages (thin red-brown lines along fingernails)
- Petechiae
- Janeway lesions (Painless flat macules on the palms and soles)
- Septic abscess in lungs/brains/spleen/kidney
- Micro-emboli
- Splenomegaly
What immune phenomena is associated with infective endocarditis?
- Osler’s nodes (Tender red/purple nodules on the pads of the fingers and toes)
- Roth spots (Retinal haemorrhages)
- Haematuria due to glomerulonephritis
- Finger clubbing
Which diagnostic criteria is used for the diagnosis of infective endocarditis?
Dukes Criteria
What are the two major criteria (Dukes) for the diagnosis of infective endocarditis?
(‘BE’)
Blood cultures - 2 positive cultures >12 hours apart
Echocardiographic evidence of vegetation on TTE or new regurgitant murmur
What are the minor criteria associated with infective endocarditis (TIMER)?
Thromboembolic phenomena
Immune phenomena
- Risk factors (e.g., prosthetic valve, IVDU, congenital valve abnormalities).
- Fever >38
- Positive blood cultures not meeting major criteria.
What is the ABx of choice for subacute infective endocarditis?
Benzylpenicillin + gentamicin or vancomycin for 4 weeks.
What is the ABx of choice for acute infective endocarditis?
- Acute: Flucloxacillin for MSSA, rifampicin + vancomycin + gentamicin for MRSA.
What is preload?
Initial stretch of cardiomyocytes before contraction – due to ventricular filling - increase Increase stroke volume (Frank-Starling Principle).
What is afterload?
- Afterload = Pressure of vessels (Aortic and pulmonary artery pressures) against which the heart must contract to eject blood Increase in afterload will decrease stroke volume (Inverse relationship).
Causes of Heart failure?
- Ischaemic heart disease
- Myocarditis
- Hypertension
- Cardiomyopathy (Dilated)
- Valve disease
- Arrhythmias
Liver pathology associated with right-sided heart failure?
Nutmeg liver
What is the most common cause of right ventricular failure?
Left ventricular failure due to chronic severe pulmonary hypertension
Features of right sided heart failure?
- Manifestations: Peripheral oedema, ascites, facial engorgement.
N.B: Congestion and stasis of venous blood in RHF = Nutmeg liver.
What type of heart failure is associated with dilated cardiomyopathy?
Systolic dysfunction
Hypertrophic and restrictive heart failure is associated with which type of heart failure?
Diastolic heart failure
What are the three most common causes of restrictive cardiomyopathy?
Sarcoidosis, amyloidosis, radiation-induced fibrosis,
What are the histological findings observed in HOCM?
Myocyte disarray
What is the inheritance pattern associated with HOCM?
Autosomal dominant
Which gene is implicated in the pathology of HOCM?
B-myosin gene
What type of hypertropjhy results in outflow tract obstruction in hocm?
Septal hypertrophy
What term describes myocyte loss with fibrofatty replacement affecting the right ventricle?
Arrhythmogenic Right Ventricular Cardiomyopathy
Define Beck’s triad
Muffled heart sounds, raised JVP and hypotension
What is the most common cause of AKI?
Acute tubular necrosis
What is the most common pre-renal cause of acute tubular necrosis?
Ischaemia (sepsis, hypotension)
Which nephrotoxic drugs result in acute tubular necrosis?
Aminoglycosides, amphotericin B, iodinated contrast, sulfa drugs, acyclovir, calcineurin inhibitors, vancomycin.
Which type of casts are associated with acute tubular necrosis?
Brown muddy casts
Eosinophilia and drug-induced allergy is associated with what type of AKI?
Acute tubulo-interstitial nephritis
Which drugs cause AIN?
Beta-lactam antibiotics, penicillin, NSAIDs, PPIs, allopurinol and 5-ASA.
Which infections are associated with AIN?
Legionella, Leptospira, cytomegalovirus, Streptococcus, and mycobacterium tuberculosis.
Which systemic diseases are associated with AIN?
Sarcoidosis, Sjögren’s disease, systemic lupus erythematosus
What are the common post-renal causes associated with AKI?
Obstruction to urinary flow – stones, tumours, (primary & secondary), prostatic hypertrophy, and retroperitoneal fibrosis.
What are the three primary causes of nephrotic syndrome?
- Minimal change disease
- Membranous glomerular disease
- Focal segmental glomerulosclerosis
What are the three major features of nephrotic syndrome?
- Proteinuria (>3g/24h / protein: creatinine ratio >300 mg/mmol) – frothy urine.
- Hypoalbuminaemia (<30 g/L)
- Oedema – Classically = periorbital
What are the secondary causes of nephrotic syndrome (3)?
Diabetes
Amyloidosis
SLE
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What are the electron microscopy findings in minimal change disease?
Loss of podocyte foot processes
What is the first line management for minimal change disease?
Corticosteroids
Which autoantibody is implicated with membranous disease?
Anti-phospholipase A2 type 2 receptor (Anti-PLA2R)
What are light microscopy findings in membranous glomerular disease?
Diffuse glomerular basement membrane thickening
Spike and Dome appearance is associated with nephrotic syndrome?
Membranous Glomerular Disease
Phosplipae A2 antibodies are associated with which type of nephrotic syndrome?
Membranous glomerular disease
Which type of nephrotic syndrome is most common in Afro-Carribbean people?
Focal Segmental Glomerulosclerosis
Focal Segmental Glomerulosclerosis (FSGS)
Light microscopy findings
Focal and segmental glomerular consolidation and scarring,
Hyalinosis
What histological nodules are associated with diabetic nephropathy?
Kimmelstiel Wilson nodules
Which stain is used in the histological evaluation of amyloidosis?
Congo Red Stain
What is the positive finding following Congo Red staining in amyloidosis?
Apple green birefringence
Kimmelstiel-Wilson lesion are associated with which stage of diabetic nephropathy?
Stage 3
What is stage I of diabetic nephropathy?
Thickened basement membrane
What is stage II of diabetic nephropathy?
Increase in mesangial matrix, without nodules
What is stage 3 of diabetic nephropathy?
nodular lesions/Kimmelstiel-Wilson lesion (KW) – round areas of sclerosis
Advanced glomerulosclerosis is associated with which stage of diabetes nephropathy?
Stage 4
What is azotaemia?
Raised urea and creatinine
What are the manifestations of nephritic syndrome?
Manifestation of glomerular inflammation e.g. glomerulonephritis – syndrome characterised by PHAROH:
* Proteinuria
* Haematuria (coke-coloured urine)
* Azotaemia – raised urea and creatinine.
* Red cell casts – In urine – red cell accumulation and leaks into the tubules.
* Oliguria
* Hypertension
Which nephritic syndrome cause is associated with impetigo or a sore throat?
Acute postinfectious (post-streptococcal) glomerulonephritis
Which organism is implicated in post-infectious glomerulonephritis?
- Lancefield Group A alpha-haemolytic Strep e.g., strep pyogenes
What are the serum investigations for post-streptococcal glomerulnephritis?
Bloods - ASO tire - raised
Complement C3 - Low
What are the electron microscopy findings of post-strep glomerulonephritis?
Subendothelial humps
What is the complication of nephritic syndrome?
End-stage renal failure
When does post-strep glomerulonephritis occur post-strep A infection?
1-3 weeks
Which cell type is implicated in the formation of crescents in rapidly progressive crescenteric glomerulonephritis?
Proliferation of macrophages and parietal cells in the Bowman’s capsule
What is type 1 RPCG?
Anti-BM antibody (Goodpasture’s diseae)
Which auto-antibody is implicated in Goodpasture’s disease?
Anti-GBM
Anti-GBM antibodies are targeted against what?
C-terminal domain of Type IV collagen
What are the extra-renal manifestations of goodpature’s diseae?
Pulmonary haemorrhage
What are the characteristics findings on light microscopy for Goodpasture’s disease?
Crescents
What are type 2 causes of Rapidly Progressive Crescentic GN?
Immune complex mediated e.g., SLE, IgA nephropathy, post-infectious GN, HSP, Alport’s syndrome
What are the fluorescent microscopy findings for anti-GBM disease?
Linear deposition of IgG in GBM
A granular IgG immune complex deposition on GBM is associated with which type of nephritic syndrome?
Immune complex mediated
What is type 3 Rapidly Progressive Crescentic glomerulonephritis?
Pauci-immune
c-ANCA is associated with what renal disease?
Wegener’s granulomatosis
p-ANCA is associated with which renal disease?
Microscopic polyangiitis
What is IgA nephropathy is associated with (aetiology)?
Upper respiratory tract infections or GI illness
What are the characteristic clinical manifestations of IgA nephropathy?
- Macroscopic haematuria - often associated with upper respiratory tract infections or gastrointestinal illness. Haematuria is characteristically recurrent in healthy patients.
- Loin pain
- Proteinuria
What are the renal biopsy findings associated with IgA Nephropathy ?
Mesangial hypercellularity, mesangial matrix expansion
What are the rule of thirds for IgA Nephropathy ?
1/3rd asymptomatic
1/3rd develop CKD
1/3rd develop progressive CKD requiring dialysis
Which classification is used to evaluate IgA Nephropathy ?
Oxford Classification system (MEST-C)
Which monoclonal antibody attenuates the progression of post-streptococcal glomerulonephritis into End-stage renal disease?
Rituximab
What is the inheritance pattern for Alport syndrome?
X-linked dominant
What is the characteristic extra-renal manifestation of Alport Syndrome?
Sensorineural deafness + eye disorders (lens dislocation, cataracts).
What are the clinical manifestations of Alport syndrome?
- Clinical manifestation: Nephritic Syndrome + Sensorineural deafness + eye disorders (lens dislocation, cataracts).
Biopsy finding for Alport syndrome?
Lamellation of the basement membrane.
What is pathogenesis of benign family haematuria?
Diffuse thinning of the GBM (<250 nm thickness) secondary to a mutation in type IV collage alpha
What is the thickness threshold for benign family haematuria?
<250 nm
What are the three common causes of asymptomatic haemturia?
Alport syndrome
Thin basement membrane disease (benign family haematuria)
IgA nephropathy (Berger disease)
What is the cause of haemolytic uraemic syndrome?
Shiga-toxin producing E coli 0157:O7
What is the triad of symptoms associated with HUS?
- Thrombocytopenia
- Microangiopathic haemolytic anaemia
- AKI
Why does thrombotic microangiopathy arise in haemolytic uraemic syndrome?
Due to non-immune erythrocyte mechanical shearing and peripheral blood fragmentation secondary platelet microthrombi
What prodromal illness is associated with HUS?
~5-10-day prodromal illness marked by abdominal pain, vomiting, and diarrhoea (haemorrhagic).
How are STEC infections transmitted?
Following the consumption of contaminated food products e.g., undercooked beef, unpasteurised milk and petting zoos.
Which deficiency should be screened for in haemolytic uraemic syndrome?
ADAMTS13
What are the markers of haemolysis?
Elevated bilirubin
Raised reticulocyte count
Raised LDH
What are the FBC findings for HUS?
Thrombocytopenia (<30)
Anaemia (<8g/dL)
What characteristic RBC cell types are observed on a peripheral blood smear in HUS?
schistocytes and helmet cells
Which agar is used for the confirmatory test for detect shiga-toxin producing E coli?
sorbitol-MacConkey Agar
What are the non-diarrhoea associated causes for thrombotic microangiopathy?
- Defects in the regulation of complement
- ADAMTS13 deficiency
- Drugs (Calcineurin inhibitors)
- Radiation
- Hypertension
- Scleroderma
- Antiphospholipid antibody syndrome (SLE)
What are the pentad of symptoms associated with TTP?
MAHA
Thrombocytopenia
Renal failure
Fever
Neurological symptoms e..g, confusion, seizures
Which genetic deficiency is associated with TTP?
ADAMTS13 deficiency
What is ADAMTS13 deficiency?
Cleaves vWF, deficiency results in the formation of giant vWF multimers - platelet aggregation and fibrin deposition.
What type of hypersensitivity reaction is associated with lupus nephritis?
Type 3 hypersensitivity - marked by the formation of immune-complexes
Which auto-antibody is implicated in the pathogenesis of lupus nephritis?
Anti-dsDNA
Which gender is predominantly affected by lupus nephritis?
Female predominance (9:1)
What is stage 1 of Lupus Nephritis?
Minimal mesangial disease
What stage II of Lupus Nephritis?
Proliferative mesangial
What is stage III of Lupus Nephritis?
Focal
Diffuse changes is associated with which stage of Lupus Nephritis?
Stage 4
Which changes on histology are observed in stage 5 lupus nephritis?
Membranous (Subepithelial immune deposits) - Wire loop capillaries on histology
Stage 6 histology changes for lupus nephritis?
Advanced sclerosis
eGFR parameter for stage 1 CKD?
> 90 mL/min
eGFR parameter for stage 2 CKD?
90-60
eGFR parameter for stage 3a CKD?
60-45
eGFR parameter for stage 3b CKD?
45-30
eGFR parameter for stage 4 CKD?
30-15
eGFR parameter for stage 5 CKD?
<15 (end-stage)
What is the most common cause of CKD?
Diabetes
What is the management for CKD?
Renal replacement therapy
- haemodialysis
-Peritoneal dialysis
-Renal transplant
What are the light microscopy changes observed in hypertensive nephropathy?
Global glomerular collapse and filling of Bowman’s capsule with collagenous material.
What are the multisystem manifestations of adult polycystic kidney disease?
- Multisystem and progressive disease with cyst formation, kidney enlargement and extrarenal organ involvement (e.g., liver, pancreas spleen, and arachnoid membranes).
Which gene is implicated in APKD?
PKD1
What does the PKD1 gene encode?
Polycystin-1
Why is there haematuria in PKD?
Cyst haemorrhage – cyst communicates with the collecting system
Presentation of Adult Polycystic Kidney Disease?
- Hypertension
- Microalbuminuria, proteinuria and haematuria
- Abdominal mass
- Infected cysts
- Stones (Renal in 20% - uric and calcium oxalate).
- Haematuria – Cyst haemorrhage – cyst communicates with the collecting system.
- Aneurysms (Berry)
- Polyuria and nocturia
- Extra-renal cysts e.g., liver, ovaries, pancreas, seminal vesicles.
- Prevalence of hepatic cysts increases with age.
- Systolic murmur – due to mitral valve prolapse.
Why is there a systolic murmur associated with Adult Polycystic Kidney Disease?
Due to mitral valve prolapse
Which classification system is used for Adult Polycystic Kidney Disease?
Mayo Classification system
What is the most common extra-renal manifestation of Adult Polycystic Kidney Disease?
Hepatic cysts
What is the most common cause of urinary calculi?
inadequate hydration and subsequent low urine volume
What is the most common type of urinary calculi?
- Calcium oxalate
What are the common causes implicated in the development of Calcium oxalate stones?
- Hyperparathyroidism, renal calcium leak, hyperoxaluria, hypomagnesemia, and ethylene glycol poisoning.
- Associated with increased gastrointestinal calcium reabsorption.
What are the common causes of uric acid stones?
- (pH <5, high intake of purine foods (e.g., fish, legumes, meat); associated with gout and cancer - rapid cell turnover – TLS.
What are struvite stones composed of?
Magnesium ammonium phosphate stones
Which organism is implicated in the aetiology of struvite stones?
Gram-negative urease positive - proteus sp.
Staghorn calculi are associated with what type of stone?
Struvite stones (Magnesium Ammonium phosphate
What are the most common site for urinary calculi?
pelvic-ureteric junction, pelvic brim, Vesico-ureteric junction.
At which pH does calcium oxalate stones tend to form in?
<7.2
Which types of stones form in alkaline urine?
Calcium phosphate - associated with hyperparathyroidism and renal tubular acidosis
Which dermatome pattern is implicated in renal colic flank pain?
T10 to S4
What is the common microscopic finding associated with renal stones?
Microscopic haematuria
What is the investigation of choice for confirming renal stones?
CT Kub
What is the diameter threshold for a papillary adenoma?
<15 mm
Which syndrome are renal oncocytomas observed in?
Birt–Hogg–Dube Syndrome.
Describe the histology of Renal oncocytoma?
A benign epithelial renal tumour composed of oncocytic cells
Well-circumscribed - circular, associated with a central scar.
Benign mesenchymal renal tumour composed of thick-walled blood vessels, smooth muscle and fat describes which type of renal tumour?
Angiomyolipoma
Tuberous sclerosis is associated with type of benign renal neoplasms?
Angiomyolipoma
What are the macroscopic findings associated with oncocytoma?
Mahogany brown
What are the microscopic findings observed in oncocytoma?
Sheets of oncolytic cells, pink cytoplasm, form nests of cells
What is the commonest form of malignant epithelial renal tumour?
Clear cell renal carcinoma
What are the two types of a malignant epithelial renal tumour?
- Clear Cell Renal Carcinoma
- Papillary renal carcinoma
What is the macroscopic appearance of a clear cell carcinoma?
Golden-yellow tumour with haemorrhagic areas
Which chromosome is implicated in the development of a clear cell renal carcinoma?
Chromosome 3p
What is the diameter threshold for a papillary renal cell carcinoma?
> 15 mm in size
What are the genetic aetiologies implicated in papillary renal cell carcinoma?
Trisomy 7,17 and loss of Y.
A ‘fragile, friable brown tumour’ is associated with what type of renal tumour?
Papillary Renal Cell Carcinoma
What are the microscopic histology findings observed in Papillary Renal Cell Carcinoma ?
Papillary growth-pattern
Papillary Renal Cell Carcinoma is associated with what?
long-term dialysis
What are the two types of papillary renal cell carcinoma?
Type I: Single layer of flatter cells
Type II: More oncolytic cells (worse prognosis)
A well-circumscribed solid brown tumour is associated with what type of malignant renal neoplasm?
Chromophobe Renal Cell Carcinoma
What risk of progression index is implicated for clear-cell renal carcinoma?
Leibovich Risk model
What is the most common renal malignancy in tumour?
NEPHROBLASTOMA/WILM’S TUMOUR
What are the microscopic histological findings observed in nephroblastoma?
Small round blue cells
Which gene is implicated in Nephroblastoma?
WT1 gene
What is WAGR syndrome?
Wilm’s Tumour
Aniridia
Genitourinary anomalies
Mental retardation
What is the histopathology of a Wilm’s tumour?
Well-circumscribed and have a pseudo-capsule.
* Malignant Triphasic Pattern:
What pattern is observed on histology in nephroblastoma?
Malignant triphasic pattern
What is the malignant triphasic pattern observed in a Wilm’s tumour?
- Blastema – Undifferentiated – small, round blue cells with active mitotic activity and overlapping nuclei.
- Epithelial – Rosette-like structures
- Stromal tissues – Mesenchymal cells or loose cellular myxoid areas.
What is the most common type of bladder cancer?
Transitional cell carcinoma
What are the risk factors associated with urothelial carcinoma?
Smoking
Aromatic amines
What is the common presentation of bladder cancer?
Frank haematuria
What are the types of bladder cancer?
Non-invasive papillary urothelial carcinoma
Infiltrating urothelial carcinoma
Flat urothelial carcinoma in situ
Frond-like growths are associated with which type of bladder cancer?
Non-invasive papillary urothelial carcinoma
Which genes are implicated in unstable non-invasive papillary urothelial carcinoma?
RB and TP53 mutations
What are the subtypes of infiltrating urothelial carcinoma?
Micropapillary urothelial carcinoma
Plasmacytoid
Nested
Microcystic
How does a flat urothelial carcinoma appear?
Reddish area
Which bladder carcinoma is associated with a high risk of progression?
Flat urothelial Carcinoma
A reddish area (bladder cancer) is associated with what type?
Flat urothelial Carcinoma in Situ
Endemic urinary schistosomiasis causes what type of bladder cancer?
Squamous cell carcinoma
What promotes BPH?
DHT
How is testosterone converted to DHT?
5-alpha-reductase 2
What are the risk factors associated with BPH?
Alcohol, caffeine, and high-dose supplemental Vitamin C.
Diabetes, insulin
Obesity - high levels of oestrogen
Metabolic syndrome
What are the protective factors for BPH?
beta-carotene, carotenoids, and Vitamin A.
What is the clinical presentation of BPH?
- Frequency, nocturia
- Urgency
- Hesitancy
- Poor flow
- Terminal dribbling
- May present with urinary retention, renal failure and UTI.
What is the histopathology findings for BPH?
- Hyperplastic process with increased cell numbers including both glandular and stromal cellular proliferation in the transition zone.
- Occurs in the periurethral zones – hyperplastic stromal nodules.
- Transition zone – Glandular nodular proliferation.
Which zone is affected in BPH?
Transition zone
What are the two classes of drugs for the management of BPH?
Alpha-blockers
5-alpha reductase inhibitors
Name 2 alpha-blockers implicated in the management of BPH?
alfuzosin
tamsulosin
What class of drug is Finasteride?
5-alpha reductase inhibitors
Mechanism of action of 5-alpha reductase inhibitor?
Inhibit intraprostatic conversion of testosterone to DHT
What is the most common cause of malignancy in men?
Prostatic adenocarcinoma
What is the premalignant condition for prostatic adenocarcinoma?
prostatic intraepithelial neoplasia
What is the prognostic indicator for prostatic adenocarcinoma?
Gleason Score
What marker (threshold) is indicative for prostate cancer?
PSA (>4 ng/mL)
What Gleason score is associated with high-volume tumour?
8-10
What are the risk factors for testicular germ cell?
- Cryptorchidism (undescended testes) – 2-4-fold increase (Associated with right-sided),
- LBW/SGA
- Infections – HPV, EBV, CMV.
What is the common presentation for testicular cancer?
Painless lump
What is the most common histological subtype for testicular germ cell cancer?
Seminoma
What is the histological appearance of a seminoma?
Transformed germ cells, and lymphocytes infiltrate with clear polygonal cells.
What are the biologic cell markers associated with post-pubertal testicular cancer?
AFP, HCG, LDH
What are the 6 histological subtypes associated with testicular germ cell cancer?
Seminoma
Embryonal carcinoma
Post-pubertal
Yolk sac tumour
Choriocarcinoma
Teratoma
Which serum markers are raised in testicular germ cells cancers?
AFP, hCH, LDH
Trans-scrotal ultrasound scan findings for testicular germ cell cancer?
Hypoechoic, solid, vascularised tumour
What is the therapeutic intervention for testicular cancer?
Radical inguinal orchiectomy.
What is the risk associated with a trans-scrotal biopsy?
- Risk of local dissemination
Which type of chemotherapy agents is testicular cancer sensitive to?
Platinum-based chemotherapy agents
What are the three types of non-germ cell testicular cancers?
Lymphoma
Leydig cell tumour
Sertoli cell t umour
What drug therapy is used for the management of testicular cancer (name 3)?
Bleomycin
Etoposide
Cistplatin
What is the most common causative organism for epididymitis?
C. Trachomatis, N. Gonorrhoea
What is the common causative organism for Epididymitis in >39 years of age?
E coli
Which HPV strain causes condylomas?
6 and 11
Which penile disease can predispose to penile carcinoma?
chronic lichen sclerosus
Persistent erythematous plaque on the glans penis is associated with which penile disease?
Zoon’s Balanitis
What are the histological features observed in chronic bronchitis?
Goblet cell hyperplasia
Hypertrophy of mucous glands
What are the causes of upper lobe fibrosis?
C - Cystic fibrosis, coal worker’s pneumococcus
H - Hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation therapy
T - Tuberculosis
S - Sarcoidosis, silicosis
What is the pathophysiology of cryptogenic fibrosing alveolitis?
Respiratory alveolar epithelial injury Activation of fibroblasts Dysregulated repair of the alveolar epithelium.
Histology:
* Interstitial inflammation
* Honeycomb change beginning at the periphery of the lobule, usually sub-pleural.
- Hyperplasia of type II pneumocytes causing cyst formation, and honeycomb fibrosis.
* Presence of foci of fibroblasts
* Patchy involvement of the lung by fibrosis.
Hyperplasia of which type of pneumocytes is associated with cryptogenic fibrosing alveolitis?
Type II
What are the risk factors for IPF?
Tobacco exposure, metal, wood dust, and GORD.
What types of crackles are observed in IPF?
Velcro crackles
What class of drug is pirfenidone ?
tyrosine kinase inhibitors
What is the main cause of Pneumoconiosis?
An accumulation of fine inhaled particles e.g., silica, asbestos fibres, beryllium, talc and coal dust Inflammatory reaction within the lung.
- has an upper lobe predilection
Pneumoconiosis typically affects which part of the lung zones?
Upper lobe
What is the term for dust-laden macrophages?
Anthrocytes
What is the histology of Pneumoconiosis ?
- Dust-laden macrophages (anthrocytes) with reticulin fibrosis.
- Halo of focal emphysema surrounding the macules.
What lung cancer is associated with Pneumoconiosis?
Mesothelioma
Adenocarcinoma
What is the histology of granulomatous lung disease?
Mature macrophages, histiocytes and multi-nucleate giant cells.
What are the infectious causes of granulomatous lung disease?
TB, schistosomiasis, aspergillus, cryptococcus, coccidioides, mucor, pneumocystis, parasites.
What histological finding is observed in extrinsic allergic alveolitis?
Polypoid plugs
What types of bodies are associated with cryptogenic organising pneumonia?
Masson bodies
What is the cause of Farmer’s lung?
Saccharopolyspora rectivirgula.
What is the cause of humidifier’s lung?
thermactinomyces spp
What is the cause of Malt-Worker’s lung?
Aspergillus
What stage of lobar pneumonia does Red hepatisation occur?
Stage 2
What is Red hepatisation?
Infiltration of RBCs, neutrophils, and fibrin into the alveolar fluid (appear red and firm (similar to the liver)
What follows Red hepatisation in lobar pnuemonia?
Gray hepatisation
What is Gray hepatisation?
RBC. Break down and is associated with fibrosis (red to gray colour transformation).
Which organisms are implicated in lobar pnuemonia?
Streptococcus pneumoniae
What are the common atypical causes of pneumonia?
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella pnuemophila
Which ethnicity is a demographic risk factor for sarcoidosis?
Afro-Caribbean ethnicity
What are the dermatologic manifestations associated with sarcoidosis?
Erythema nodosum
Lupus pernio
What are the common sites of erythema nodosum?
Bilateral subcutaneous nodules of the shins
Define lupus pernio
Indurated violaceous lesions on the nose, lips, ears, and cheeks. It is a predictive indicator of a poor prognosis.
Which dermatologic manifestation is a poor prognostic indicator for sarcoidosis?
Lupus pernio
Which pulmonary radiology finding is seen in sarcoidosis?
Hilar lymphadenopathy
What are the cardiac conduction abnormalities associated with sarcoidosis?
Complete heart block, first degree AV block (prolonged PR interval >200 ms)
Define lofgren syndrome (triad)?
Arthritis
Erythema nodosum
Bilateral adenopathy
Which serum marker is raised in sarcoidosis?
Angiotensin-converting enzyme
What electrolyte abnormality is observed in sarcoidosis?
Hypercalcaemia
Why does hypercalcaemia occur in sarcoidosis?
Activated macrophages synthesis ectopic 1,25-dihydroxyvitamin-D3
Which enzyme is secreted by macrophages in sarcoidosis resulting in hypercalcaemia?
1-alpha-hydroxylase
Which scoring system is used to assess and stage sarcoidosis?
Muers scoring system
What is the management for sarcoidosis?
Low-dose oral glucocorticoid therapy (moderate 20 mg OD prednisolone)
What autosomal dominant condition is associated with emphysema?
Alpha-1 anti-trypsin deficiency
What is the most common type of emphysema?
Centrilobular - associated with smoking
Centrilobular emphysema is associated with what risk factor?
Smoking
Panacinar loss in emphysema is associated with which cause?
Alpha-1 antitrypsin deficiency
Which 2 enzymes is inhibited in Alpa-1 AT deficiency?
Neutrophil elastase and trypsinize
Which interleukin factor is released by activated macrophages in emphysema?
IL-8
Which protein is deteriorated in emphysema?
Elastin
What are the two patterns of alveolar parenchyma loss in emphysema?
Centrilobular - loss centred on bronchiole
Panacinar - Diffuse loss of alevolae
Which lung cancer is associated with smokers?
Squamous cell cancer
Small cell lung cancer
Which paraneoplastic syndrome is associated with squamous cell lung carcinoma?
PTHrP - hypercalcaemia of malignancy
Squamous cell lung carcinoma (central or peripheral)?
Central pattern
Which type of lung cancer is associated with non-smokers?
Adenocarcinoma
What are the five types of lung cancer?
Small cell lung cancer
Squamous cel cancer
Adenocarcinoma
Large cell carcinoma
Mesothelioma
Which type of lung cancer is associated with a poor prognosis?
Large cell
What is the major risk factor for small cell lung cancer?
Cigarette smoking
Which two genetic associations are implicated in small-cell lung cancer?
TP53 and RB1
Which histological cell type is observed in small cell lung cancer?
Oat cell carcinoma
Which epithelial cell marker is associated with small cell lung cancer?
Cytokeratin - differentiates from lymphoma
Paraneoplastic syndromes are associated with which type of lung cancer?
Small cell lung cancer
Which neoplastic syndromes are associated with small cell lung cancer?
SIADH
Ectopic Cushing’s syndrome
Lambert–Eaton syndrome
Ectopic Cushing’s syndrome in small cell lung cancer is associated with the production of what?
Ectopic ACTH
Presentation of Lambert–Eaton Myasthenic syndrome?
Weakness of proximal arms and legs
Which hormone is implicated in carcinoid syndrome?
Serotonin
What are the histology findings observed in squamous cell lung carcinoma?
Keratinisation
Intracellular bridges (desmosomes)
Which mutation is associated with squamous cell lung carcinoma?
Myc overexpression
What two features are associated with adenocarcinoma?
Glandular differentiation
Mucin production
What is the precursor lesion for adenocarcinoma?
Atypical adenomatous hyperplasia
Which mutation is implicated in the pathogenesis of adenocarcinoma?
Epidermal growth factor receptor (EGFR)
Which type of treatment does EGFR respond to?
Tyrosine kinase inhibitors
What extra-thoracic manifestations are associated with adenocarcinoma?
Superior vena cava obstruction
Phrenic nerve palsy
Horner syndrome
Pericardial effusion
Compression of the brachial plexus
What is the histology of large cell lung carcinoma?
Large cell, large nuclei, prominent nucleoli
(Undifferentiated neoplasm)
KRAS is associated with which types of lung cancer?
Adenocarcinoma
Squamous cell carcinoma
EGFR mutation is associated with which type of lung cancer?
Adenocarcinoma
Which pulmonary malignancy is associated with affecting the parietal/visceral pleura?
Mesothelioma
What is MAP threshold for pulmonary hypertension?
> 25 mmHg at rest
Class 1 pulmonary hypertension is associated with what cause?
idiopathic, hereditary, drugs/toxins, associated with congenital heart disease
Left heart disease is associated with which class of pulmonary hypertension?
Class II
What is the main cause of class III pulmonary hypertension?
Lung disease (ILD)
What cell type lines the oesophagus?
Squamous stratified epithelium (absent goblet cells)
What cell type is present in acute oesophagitis?
Neutrophils
Neutrophilia
Which classification of severity is used to evaluate reflux oesopahgitis?
Los Angeles Classification of severity
Which layers are affected in an ulcer?
Past muscularis mucosa (into the submucosa)
Which layers are affected in an erosion?
Before muscularis mucosa
Which histological change is observed in Barett’s oesophagus?
Metaplasia of squamous mucosa to columnar epithelium
Which malignant change can arise in Barret’s oesophagus?
Adenocarcinoma
The presence of which cell type is associated with intestinal metaplasia?
Goblet cells
Which type of metaplasia confers an increases malignancy risk?
Intestinal metaplasia (With goblet cells)
Which type is the most common oesophageal cancer?
Oesophageal Adenocarcinoma
What are the risk factors for a squamous cell oesophageal carcinoma
Achalasia of cardia, Plummer-Vinson syndrome, nutritional deficiencies, nitrosamines, HPV
Cause of oesophageal varices?
Portal hypertension
Parietal cells secrete what two factors?
HCl and intrinsic factor
Pepsinogen is produced by which type of gastric cell?
Chief cells
What are the most common causes of acute gastritis?
Aspirin
NSAIDs
Corrosives
Acute H.pylori
Severe stress (burns)
Which immune cell type predominates in acute gastritis?
Neutrophils
Which immune cell type predominates chronic gastritis?
Lymphocytes and plasma cells
H pylori affects which part of the stomach (predominantly)?
Antrum
Autoimmune (atrophic) gastritis is associated with which autoantibody?
Anti-parietal antibodies
H pylori is associated with which type of lymphoma?
Mucosa-associated lymphoid tissue (MALT) lymphoma
Which type of ulcer is relieved by food?
Duodenal ulcer
Which type of ulcer is worse with food?
Gastric ulcer
Incidence of gastric cancer is higher in which demographic?
Japanese
Commonest subtype of gastric cancer?
Adenocarcinoma
Diffuse gastric cancer is associated with what type of carcinoma?
Poorly differentiated signet ring cell carcinoma
What are the two types of gastric cancer?
Intestinal
Diffuse
Which type of gastric cancer is poorly differentiated?
Diffuse
Gastric intestinal metaplasia is associated with which cell type?
Goblet cells
Which enzyme is secreted by h pylori?
Urease
What two toxins are produced by H pylori?
CagA
VacA
Body-predominant atrophic gastritis is associated with which type of dysplasia?
Flat metaplasia-dysplasia
Most common cause of a duodenal ulcer?
H. pylori - antral-predominant strain
What are the histological features associated with Coeliac disease?
Partial villous atrophy
Crypt hyperplasia
Increased intra-epithelial lymphocytes
What is the infective differential diagnosis for coeliac disease?
Tropical sprue
Which antibodies are associated with Coeliac disease?
Anti-endomysial Ab (best sen and spec), anti-tissue transglutaminase (IgA), anti-gliadin
What is the diagnostic investigation for Coeliac disease?
Duodenal/Jejunal biopsy
Pathophysiology of Hirschsprung’s Disease (absence of what type of cell)?
Ganglion cell in the myenteric plexus
Hirschsprung’s Disease is associated with which chromosomal disorder?
Down’s syndrome
What is the diagnostic investigation to confirm Hirschsprung’s Disease?
Full-thickness biopsy
What is the first line management for Hirschsprung’s Disease?
Bowel irrigation
What is the definitive management for Hirschsprung’s Disease?
Resection of constricted segment
Which area of the colon is susceptible to ischaemic colitis?
Splenic flexure
Rectosigmoid
(Watershed areas)
Type of inflammation in Crohn’s disease?
Non-caseating transmural inflammation - full-thickness of the bowel wall (mucosa to the serosa)
Smoking worsens which type of IBD?
Crohn’s diseae
Crohn’s disease affects which bowel segment predominantly?
Terminal ileum
What type of lesions is observed in Crohn’s disease?
Skip lesions
What endoscopic feature is observed in Crohn’s disease?
Cobblestone appearance
What is the first lesion observed in Crohn’s disease?
Aphthous ulcer - deep rose thorn ulcer
Deep rose thorn ulcers forms which type of ulcers in Crohns disease?
Serpentine ulcers
Which hypothesis is implicated in Crohn’s disease?
Hygiene hypothesis – Less food contamination –> Less enteric infection –>Inadequate development of processes that regulate mucosal immune response –> Exaggerated immune response to pathogens.
What extra-intestinal manifestation (ocular) is associated with Crohn’s disease?
Anterior uveitis
What extra-intestinal manifestation (skin) is associated with Crohn’s disease?
Erythema nodosum
Pyoderma gangrenosum
Erythema multiform
Digital clubbing
Complications of Crohn’s disease?
Strictures
Fistulae
Abscess formation
Perforation
Which is the management of mild flares of Crohn’s disease?
Prednisolone
What is the management for severe flares of Crohn’s disease?
IV hydrocortisone, metronidazole
What are the additional therapies for Crohn’s disease?
Azathioprine, methotrexate, Infliximab
Infliximab target (class)
Anti-TNF-Alpha
Ulcerative colitis originates from which part of the colon?
Rectum
Relationship between smoking and UC?
Improves symptoms
What is the histopathology of ulcerative colitis?
Goblet cell depletion, ulcerations, and mucosal crypt arophy
What is a histological marker of active disease in ulcerative colitis?
Crypt abscesses
Which hepatic extraintestinal manifestation is associated with ulcerative colitis?
Primary sclerosing cholangitis
What severe intestinal complication is associated with ulcerative colitis?
Toxic megacolon
What is the risk associated with toxic megacolon?
Adenocarcinoma
What is the first-line management for mild flares of ulcerative colitis?
Prednisolone and mesalazine
What is the remission management for ulcerative colitis?
5-ASA, azathioprine, 6-mercaptopurine
Consider anti-TNF alpha drugs
What types of antibiotics cause a clostridium difficle infection?
Clindamycin, cephalosporins, ciprofloxacin + co-amoxiclav
Colonic complication of C difficile infection?
Pseudomembranous colitis
What are the two toxins produced by c difficile?
Toxin A - Endotoxin
Toxin B - Cytotoxic
What is the antibiotic of choice for C difficle infection?
Vancomycin
Diverticular side predominantly affects which colon?
Left colon/sigmoid colon
What is symptomatic diverticular disease?
Diverticulitis - diverticular bleeding
What are the risk factors associated with diverticular disease?
Low fibre diet
Obesity
Smokers
Drugs -NSAIDs, opiates, steroids
What are the complications associated with diverticular disease?
Fever, peritonism, gross perforation , fistula, obstruction
What is carcinoid syndrome?
Neuroendocrine tumour of the midgut - metastasises of the liver
Cell type of carcinoid syndrome?
Enterochromaffin cells
enterochromaffin cells in carcinoid syndrome produce what?
Serotonin
What are the three main symptoms of carcinoid syndrome?
Bronchoconstriction
Flushing
Diarrhoea
What is the presentation of a carcinoid crisis?
Life-threatening vasodilation, hypotension, tachycardia, bronchoconstriction, hyperglycaemia.
What is the investigation for carcinoid syndrome?
24-hour urine 5-HIAA
What is the pharmacological management for carcinoid syndrome?
Octreotride (somatostatin analogue)
Juvenile polyps affect which layer?
Lamina propria
Juvenile polyps predominantly affects which site of the colon?
Rectosigmoid colon
What is the presentation of juvenile polyps?
Lower gastrointestinal bleeding
What is the inheritance pattern for junvenile polyposis syndrome?
Autosomal dominant
Peutsz Jeghers polyps affect which type of epithelium?
Glandular epithelium, contiguous with the muscularis mucosa
Risk associated with Peutz–Jeghers Polyps?
- Increased risk of intussusception and of malignancy
What type of pattern is observed in hyperplastic polyps?
Serrated saw-tooth pattern
What type of polyps are observed in IBD?
Pseudopolyps
What are the three types of adenomatous polyps?
Tubular
Tubulovillous
Villous
What is the rare complication and laboratory finding observed in adenomatous polyps?
Hypoproteinaemia Hypokalaemia
What type of adenomatous polyp is dark on histology due to an increased nucleocytoplasmic ratio?
Tubular
What is the risk associated with adenomatous polyps?
Adenocarcinoma (5%)
Which type of adenomatous polyps confers for a worse prognosis and increased risk of adenocarcinoma?
Villous adenoma
Which gene is implicated in the pathogenesis of adenomatous polyps?
APC gene
Which genetic inherited syndromes are associated with colorectal cancer?
- Familial adenomatous polyposis
- Lynch syndrome – DNA mismatch repair/microsatellite instability.
Which is the 2nd commonest cause of cancer deaths in the UK?
Colorectal cancer
Which tumour marker is raised in colorectal cancer?
Carcinoembryonic antigen (CEA)
Which two genes are implicated in Lynch syndrome?
MLH1
MSH2
Which staging criteria is used for colorectal cancer?
Duke’s staging
What is the function of the APC protein (FAP)?
Promotes apoptosis in colonic epithelial cells - mutation results in uncontrolled cell growth = adenomas.
What is the characteristic presentation of familial adenomatous polyposis in young children?
Epidermoid cysts on the face, extremities and scalp
What is the diagnostic threshold for determining FAP?
Visualisation of >100 adenomatous polyps on colonoscopy.
What is the lifetime risk of FAP?
increased risk of adenocarcinoma (colorectal cancer)
Inheritance pattern for FAP?
Autosomal dominant
What is the prophylactic management for FAP?
Colectomy
What is the subtype of FAP, marked by osteomas of the mandible and skull, and dental caries?
Gardner syndrome
What three structures form the portal triad?
- Indices of the hexagon = Portal triad:
a. Hepatic artery
b. Bile ducts
c. Portal vein
What term describes the resident macrophages in the liver?
Kupffer cell
Which cell stores vitamin A in the liver?
Stellate cells
Where do Stellate cells reside in the liver?
Within the Space of Disse
Activation of stellate cells form what?
Myofibroblasts - constrict sinusoids and increased vascular resistance
Which zone is closest to the portal triad?
Zone 1
Which zone is susceptible to ALP rise post-damage?
Zone 1
Which zone is closest to the central vein and is associated with metabolic active hepatocytes?
Zone 3
Which zone is prone to ischaemia and metabolic toxins?
Zone 3
Which reaction measures split bilirubin?
Van der Bergh reaction
Direct bilirubin measures what type?
Conjugated
What histological liver finding is seen in acute hepatitis?
Spotty necrosis
Spotty necrosis is associated with what?
Acute hepatitis
Interface hepatitis is characterised by what type of histological finding?
Piecemeal necrosis
What are the four features of chronic hepatitis?
Portal inflammation + fibrosis
Interface hepatitis (necrosis)
Nodules of regenerating hepatocytes
Disturbance of vascular architecture
What type of shunting causes a loss of liver detoxification and the development of hepatic encephalopathy?
Intra-hepatic shunting (fibrous bridge connecting the portal vein with the central vein)
Which type of hepatic shunting causes portal hypertension?
Extra-hepatic shunting
What are the 3 major complications associated with portal hypertension?
Oesophageal varices
Caput medusae
Anorectal varices
What are the two classifications of cirrhosis?
Micronodular (nodules <3mm)
Macronodular (nodules >3 mm)
Micronodular cirrhosis is associated with which cause?
Alcoholic hepatitis
Macronodular cirrhosis is associated with which causes (3)?
viral hepatitis, Wilson’s disease, alpha-1 antitrypsin deficiency.
What are the genetic causes of cirrhosis?
- Haemochromatosis – HFE gene Chr6
- Wilson’s disease – ATP7B gene CHr 13
- Alpha-1-antitrypsine deficiency (A1AT)
- Galactosaemia
- Glycogen storage disease
What are the two biliary causes of cirrhosis?
Primary biliary cirrhosis & primary sclerosing cholangitis
Which scoring criteria is used to indicate the prognosis of cirrhosis?
Modified Child’s Pugh Score
What are the five criteria used in the Child’s Pugh Score?
Albumin
Bilirubin
Clotting prothrombin time
Distension - ascites
Encephalopathy
What are the microscopic characteristics associated with hepatic steatosis?
Accumulation of fat droplets in hepatocytes - reversible
What microscopic histology findings are observed in alcoholic hepatitis?
Hepatocyte ballooning and necrosis
Mallory Denk bodies associated with megamitochondria and fibrosis
What type of bodies (clumped cytoskeleton) are associated with alcoohlic hepatitis on histology?
Mallory Denk Bodies
B1 Deficiency name?
Beri-beri - thiamine
Niacin deficiency causes what?
Pellagra
What are the features of chronic stable alcoholic liver disease (name 4)?
- Palmar erythema
- Spider naevi (>5)
- Gynaecomastia (failure of liver to break oestradiol down)
- Dupuytren’s contracture
What are the three principal features associated with portal hypertension?
- Caput medusae on umbilicus + varices
- Splenomegaly
- Ascites e.g., scrotal oedema and shifting dullness
Non-alcoholic fatty liver disease is associated with what type of metabolic disorders and syndromes?
Type 2 diabetes mellitus
Hyperlipidaemia
Obesity
What is the commonest cause of liver disease worldwide?
Non-alcoholic steatohepatitis
What is the inheritance pattern of Haemochromatosis?
Autosomal recessive
A mutation in which protein is associated with Haemochromatosis?
HFE protein
Retained iron deposition in parenchymal cells as what, in Haemochromatosis?
Hemosiderin
HFE gen regulates the production of which iron regulatory protein?
Hepicdin
What are the main complications associated with Haemochromatosis?
Cirrhosis
Diabetes
Arthropathy
Cardiomyopathy
Hypogonadism
Skin pigmentation
Cirrhosis increases the incidence of what type of cancer?
Hepatocellular carcinoma
What type of gout is associated with Haemochromatosis?
Pseudogout due to calcium pyrophosphate crystals
Iron overload of macrophages in Haemochromatosis can predispose to infection to which organisms?
Listeria, Yersinia enterocolitica and vibrio vulnificus.
What is the serum transferrin saturation in haemochromatosis?
> 45%
What is the ferritin and serum Fe values in haemochromatosis?
Raised
TIBC low or high in haemochromatosis?
Low
What staining is used for the histological diagnosis of haemochromatosis?
Perls Prussian Blue staining
What is the conventional therapy for haemochromatosis?
Venesection + deferoxamine
What intravenous iron-chelating agent is prescribed in haemochromatosis?
Deferoxamine
What is the inheritance pattern for Wilson’s Disease?
Autosomal recessive
Which electrolyte accumulation is associated with Wilson’s Disease?
Copper
A mutation on which chromosome is implicated in Wilson’s Disease?
Chromsoome 13
Which Wilson’s Disease protein is implicated?
ATP7B - Alters the copper-transporting ATP gene in the liver - responsible for excreting excess copper into bile and out of the body.
Copper is bound to what plasma protein?
Ceruloplasmin
Ceruloplasmin levels in Wilson’s Disease?
Reduced
What is the first decade presentation of Wilson’s Disease?
Hepatic dysfunction
Copper deposits in which specific regions of the brain in Wilson’s Disease?
Subthalamus
Putamen
Cortex
Which characteristic ocular finding is observed in Wilson’s Disease?
Kayser Fleisher rings
What type of metal is copper?
A transition metal - resulting in oxidative stress due to hydroxyl group (Fenton chemistry)
On light microscopy of the liver, what findings are observed in Wilson’s disease?
Mallory bodies + moderate fatty infiltration and glycogen deposition in hepatocytes
What stain is used in Wilson’s Disease?
Rhodamine stain
What term describes the bluish discolouration at the base of the fingernails in Wilson’s disease?
Lunulae ceruleae
What neuropsychiatric manifestations are associated with Wilson’s disease?
- Asymmetrical tremors, drooling, ataxia, personality changes, mask-like facies, and clumsiness.
- Parkinsonism
- Dementia (basal ganglia involvement)
Personality change
Which movement disorders are associated with Wilson’s disease?
- Movement disorder chorea
- Hemiballismus
What are the hepatic manifestations of Wilson’s disease?
- Abdominal pain
- Hepatosplenomegaly
- Jaundice
- Cirrhosis and stigmata of chronic liver disease.
What are the investigations performed for Wilson’s disease?
Circulatory ceruloplasmin level – Low (<20 mg/dL)
Urinary copper levels - >100 mcg/dL
Serum copper – low.
Which copper investigation finding is raised in Wilson’s disease?
Urinary copper levels
What is the mainstay management for Wilson’s disease?
Copper chelation therapy with penicillamine and trientine (lifelong)
What is the inheritance pattern for Alpha-1 anti-trypsin deficiency?
Autosomal dominant
Alpha-1 anti-trypsin is protective against which enzyme?
Neutrophil Elastase
What mutation is implicated in Alpha-1 anti-trypsin deficiency?
SERPINA1 mutation on the chromosome 14.
What stain is used to Alpha-1 anti-trypsin deficiency?
Periodic acid Schiff
What pulmonary complication is associated with Alpha-1 anti-trypsin deficiency?
Emphysema
What are the hepatic manifestations of Alpha-1 anti-trypsin deficiency?
Chronic liver disease
What CXR findings are observed in Alpha-1 anti-trypsin deficiency?
Basilar predominant emphysematous bullae
What serum investigation in Alpha-1 anti-trypsin deficiency?
Serum A1AT - low (<11 micromoles/L)
What is the management for Alpha-1 anti-trypsin deficiency?
IV infusion or pooled human alpha-1 antitrypsin
Which autoantibody is associated PBC?
Anti-mitochondrial antibodies
What disorder is characterised by T-celled mediated inflammation of the small-medium intralobular bile duct epithelium?
Primary Biliary Cholangitis
Destruction of which type of bile ducts causes PBC?
Bile ductular cells and small interlobular bile ducts
What is the presentation of PBC?
- Jaundice
- Pruritus
- Fatigue
- RUQ pain
What are the secondary symptoms of PBC?
- Dry skin, hyperpigmentation, xanthelasma, xanthomas, jaundice and fungal infection of the feet
- Vitamin D malabsorption
- Steatorrhea
- Inflammatory arthropathy
Which LFT parameter is raised in PBC?
ALP
What is the management for PBC?
Ursodeoxycholic acid
What type of fibrosis pattern is associated with PSC?
Onion skin fibrosis due to concentric pattern
What is the female to male ratio for PBC?
Female predominant 9:1
Which autoantibody is associated with primary sclerosing cholangitis?
p-ANCA
What diagnostic radiological modality is implicated in PSC diagnosis?
Cholangiography
What is the characteristic cholangiographic appearance in PSC?
Beads on a string appearance
What is the complication associated with PSC?
Increased risk of cholangiocarcinoma
Which benign hepatic cancer is associated with OCP?
Hepatic adenoma
What is the most common cause of hepatocellular carcinoma?
Chronic liver disease
Which marker is raised in hepatocellular carcinoma?
Alpha-fetoprotein (AFP)
What inflammatory breast disease is associated with inflammation and dilatation of the large breast ducts due to obstruction of milk ducts?
Duct ectasia
What are the risk factors for duct ectasia?
Peri/post-menopausal, smoking, Mulitparity.
What are the symptoms of duct ectasia?
nipple discharge, breast pain, breast mass and nipple retraction.
What cytology findings are associated with duct ectasia?
Proteinaceous and neutrophils only
What is the histology of duct ectasia?
Duct distension with proteinaceous material in it + foamy macrophages.
Proteinaceous material and foamy macrophages is associated with what type of inflammatory breast disease?
Duct ectasia
What type of discharge consistency is associated with duct ectasia?
Thick yellow-green discharge
What is the most common causative organism implicated in acute mastitis?
Staphylococci
On fine need aspiration, what type of immune cell is abundant in acute masttiis?
Neutrophil
What response arises in the breast following trauma and adipose tissue damage?
Fat necrosis
Which benign condition is characterised by painful (tender), red breast associated with fever and is hot to touch?
Acute mastitis
What is a non-lactational cause of acute mastitis?
keratinising squamous metaplasia
What are the causes of fat necrosis?
Trauma, surgery, radiotherapy, nodular panniculitis
On cytology what findings are associated with fat necrosis?
Fat cells surrounded by macrophages (empty fat spaces)
Histiocytes and giant cells
Which two cell types are associated with fat necrosis?
Histiocytes and giant cells
What is a common benign breast disease that occurs in pre-menopausal women and has a hormonal infulence?
Fibrocystic breast disease
What type of benign breast disease exhibits a pattern of presentation associated with the menstrual cycle?
Fibrocystic disease
What histological findings are associated with benign breast disease?
Dilated ducts a+ calcifications
What type of benign breast disease is characterised by a mobile breast mouse?
Fibroadenoma
What is the most common mobile breast lump in women?
Fibroadenoma
What two tissue types form a fibroadenoma?
Arising from the stromal and glandular tissue
What type of benign breast disease is characterised as a leaf-like tumour?
Phyllodes tumour
What is a common benign enlarging mass in women >50 years?
Phyllodes tumour
What is the histology appearance in a Phyllodes tumour?
Overlapping cell layers, cellularity (branching/ leaf-like fronds/ artichoke appearance).
What determines the level of malignancy in a Phyllodes tumour?
Cellularity
Which type of intraductal papilloma is associated with bloody nipple discharge?
Central papilloma
Which type of intraductal papilloma is associated with a clinically silent presentation?
Peripheral papilloma
What type of ductules are associated with a central papilloma?
Large lactiferous ductules
What is the definitive management for an intraductal papilloma?
Excision of the duct
What is the histology finding associated with an intraductal papilloma?
Polypoid mass
Papillary mass within a dilated duct - fibrovascular core
Which benign breast disease is associated with a stellate mass?
Radial scar
What is the histological appearance of a radial scar?
Two distinct areas:
- Central stellate area
- Peripheral proliferation of ducts and acini.
Which proliferative breast disease is associated with aplastic cells and a 7-12x risk of developing invasive breast carcinoma?
In situ lobular neoplasia
What are the three types of proliferative breast disease?
Usual epithelial hyperplasia
Flat epithelial atypia
In situ lobular neoplasia
What is the most common breast carcinoma in women?
Invasive ductal carcinoma
What is the lifetime risk of breast carcinoma?
1 in 8
Which Susceptibility genes are associated with breast carcinoma?
BRCA1/2
Which class of drug is associated with an increased risk of breast carcinoma?
OCP/HRT
When does 3-yearly mammography occur begin and ed in women?
47-73 year-old
What is the non-invasive form of breast carcinoma?
Ductal carcinoma in situ
How does a ductal carcinoma in situ appear on mammography?
Microcalcification
What is the histological appearance of a low-grade ductal carcinoma in situ?
Cribriform/punched-out DCIS
What molecule is positive in a high-grade ductal carcinoma in situ?
E-cadherin
What type of cells is observed in histology in ductal carcinoma in situ?
pleiomorphic cells
Cells lack which adhesive protein in lobular carcinoma in situ?
- Cells lack adhesion protein E-cadherin
On histology, how does invasive lobular carcinoma appear?
Indian file
Indian file on histology is observed in which type of invasive carcinoma?
Invasive lobular carcinoma
What histology finding is seen in invasive ductal carcinoma?
Large, pleomorphic cells (with E-cadherin +ve)
Well-formed tubules on histology are associated with which type of invasive breast carcinoma?
Invasive tubular carcinoma
Which type of invasive breast carcinoma is associated with increased secretion of extracellular mucin?
Mucinous carcinoma
What type of carcinoma is BRCA gene mutation and positive for basal cytokeratin CK5/6 and CK14?
Basal-like Carcinoma
Basal-like Carcinoma is positive for what CK immunohistochemistry molecules? (2)
CK5/6 and CK14.
What type of histological grading is associated with invasive breast carcinoma?
Nottingham Modification of Bloom-Richardson System
What are the three categories assessed for histological grading for invasive breast carcinoma?
- Tubule formation (1-3)
- Nuclear pleomorphism (1-3)
- Mitotic activity (1-3)
What are the three types of receptors in invasive breast carcinoma?
Oestrogen receptor (ER)
Progesterone receptor (PR)
Her2 receptor
Which receptor/mutation is associated with a high grade poor prognosis in invasive breast carcinoma?
HER2 positive (ER/PR negative)
What mutation receptor profile is associated with low-grade invasive breast carcinoma?
ER/PR positive and HER2 negative
What is the most important prognostic factor to determine the severity of invasive breast carcinoma?
Axillary lymph nodes
Which class of drug is used for ER/PR positive breast cancer?
Tamoxifen
Which monoclonal drug is implicated in the management for HER2 positive breast cancer?
Herceptin/Trastuzumab
What must be monitored when using Trastuzumab?
Left ventricular ejection fraction
Tamoxifen increases the risk of which cancer?
Endometrial carcinoma
Difference between TIA and stroke?
TIA <24 hours with complete resolution of symptoms
How many TIAs result in a stroke after 5 years if left untreated?
1/3RD
How long do most TIAs last?
1-5 minutes
What visual disturbance is frequently observed in patients with a TIA?
Amaurosis fugax
What is the commonest vascular artery for a stroke?
Middle cerebral artery
What is the management for a stroke?
Aspirin +/- dipyridamole
What are the common sites affected by a stroke?
Carotid bifurcation or the basilar artery
What causes focal cerebral ischaemia?
Insufficient blood flow to a particular vascular territory
What causes global cerebral ischaemia?
Systemic circulation failure
A stroke in the anterior cerebral artery causes a loss of sensation and weakness in which part of the body?
Contralateral leg
What are the clinical manifestations associated with a stroke in the middle cerebral artery?
Dysphagia
Dyslexia
Weakness and loss of sensation in the contralateral arm
Contralateral leg paresis and cognitive deficits e.g. apathy is associated with a stroke in which artery?
Anterior cerebral artery
A left hemisphere stroke causes what consequence on speech?
Aphasia (in left-hemisphere dominant)
A PCAa stroke affects which two cranial nerves?
CN III and IV
A lacunar infract of the posterior limb of the internal capsule causes pure motor hemiparesis where?
Contralateral arm, leg and face
A lacunar infarct in which part causes hemisensory loss?
Ventral thalamic
A lacunar infarct in the ventral pons and internal capsule results in what clinical presentation?
Ipsilateral ataxia and leg paresis.
A lacunar infarct of the ventral pons or internal capsule causes what specific manifestation?
Dysarthria-clumsy hand syndrome
What is the most common cause of non-traumatic intra-parenchymal haemorrhage?
Hypertension
Where is the commonest affected site for a non-traumatic intra-parenchymal haemorrhage?
Basal ganglia
What type of microaneurysm in the lenticulostriate arteries arises in non-traumatic strokes?
Charcot-Bouchard microaneurysms
What is the commonest cause of a subarachnoid haemorrhage?
Rupture of berry aneurysm
A ruptured berry aneurysm typically affects where?
Internal carotid bifurcation
what are the associations with a subarachnoid haemorrhage?
APKD, Ehlers’s Danlos syndrome, Aortic coarctation
What is the clinical presentation of a subarachnoid haemorrhage?
Sudden-onset thunderclap headache, vomiting, LoC
On CT Ix what sign is observed for a subarachnoid haemorrhage?
Star sign - hyperattenuation around the Circle of Willis
What is the definitive management for a subarachnoid haemorrhage?
Endovascular coiling
What is a well-defined malformation lesion comprised of densely packed vessels and occur at low pressure?
Cavernous angioma
What sign is seen on a T2-weighted MRI in a Cavernous angioma ?
target sign – black ring around lesion.
Which vessel is most likely to be the cause of an extradural haemorrhage?
Middle meningeal artery
A lemon-shaped convex bleed is associated with what type of cerebral haemorrhage?
Extradural haemorrhage
Which veins are affected in a subdural haemroarhage?
Cortical bridging veins
On CT what finding is seen for a subdural haemorrhage?
Crescenteric
Fissure fractures are associated with what two presentations?
- Otorrhoea and rhinorrhoea (i.e. loss of CSF through ear or nose) – Strawcoloured fluid.
What are the two signs associated with a basal skull fracture?
Battle sign
Rancoon eyes
What term defines brain collision with the internal surface of the skull causing a rupture of pia mater?
Contusions
What are the complications of contusions?
Post-traumatic epilepsy, endocrine changes, and neuropsychiatric tissues.
What is the commonest cause of the coma?
Diffuse axonal injury
Which midline structures are predominantly affected in diffuse axonal injury?
corpus callosum, rostral brainstem and septum pellucidum
What are the three types of herniation?
Subfalcine
Transtentorial/uncal
Tonsillar
What type of herniation is characterised by herniation of the singular cortex beneath the flax (midline fold)?
Subfalcine
What type of herniation is characterised by medial/temporal lobe herniation under tentorium?
Transtentorial/uncal
What type of herniation is associated with herniation of the cerebellum resulting in cardiorespiratory arrest?
Tonsillar
What type of hydrocephalus is characterised as non-obstructive?
Communicating
What type of hydrocephalus is caused by a subarachnoid haemorrhage?
Communicating hydrocephalus - block CSF absorption at the arachnoid granulations
What are the causes of communicating hydrocephalus?
Subarachnoid haemorrhage (1/3rd)
Meningitis
What is the commonest cause of non-communicating (Obstructive) hydrocephalus?
Tumours
What are the commonest sites of non-communicating hydrocephalus?
Foramina Monro
Aqueduct of Sylvius and the fourth ventricle
What type of tymouurs are associated with non-communicating hydrocephalus?umo
Ependymoma
Astrocytoma
Choroid plexus papilloma
What type of neonatal malformation is associated with non-communicating hydrocephalus?
Dandy-Walker Formation
Cerebral aqueduct stenosis
Where is CSF produced?
Choroid plexus
How is CSF reabsorbed into the venous system?
Arachnoid granulations via the superior sagittal sinus
CSF drains from the choroid plexus into which ventricle?
Third ventricle
Which structure connects the third and fourth ventricle?
Cerebral aqueduct
What is the first line management for hydrocephalus?
External ventricular drain
What triad of symptoms is associated with idiopathic normal pressure hydrocephalus?
Hakim’s triad - Gait apraxia, urinary incontinence, and cognitive impairment
What age group is affected by idiopathic normal pressure hydrocephalus?
> 65 years of age
What is the management for idiopathic normal pressure hydrocephalus?
VP shunt
What are the two common extra-axial brain tumours?
- Meningothelial cells = meningioma.
- Schwann cells - Schwannoma
What is the commonest form of adult brain tumours?
Secondary tumours (metastatic)
What are the three commonest sources of brain mets?
Lung cancer
Breast cancer
Malignant melanoma
What is the inheritance pattern for neurofibromatosis?
Autosomal dominant
What are the risk factors for brain tumours?
Previous tumours
Radiotherapy to head/neck
- Neurofibromatosis 1&2
Tuberous slcerosis
What is the commonest hereditary cause of brain tumours?
- Neurofibromatosis 1&2
What are the raised ICP symptoms associated with brain tumours?
Headache
Vomiting
Change in mental status
What are the three supratentorial features assoiacaited with brain tumours?
Focal neurological deficit
Seizures
Personality changes
What are the infratentorial clinical features associated with brain tumours?
Ataxia
Cranial nerve palsies
long tract signs - spasticity and hyperreflexia
Which brain tumour is characterised by a fried-egg appearance?
Oligodendrocytoma
Which is the commonest ventricular tumour associated with the onset of hydrocephalus?
Ependymoma
What are the three commonest surgical resection approaches for the management of brain tumours?
Surgical resection
- Craniotomy - Debulking
- Open biopsies - Inoperable but approachable tumours
- Stereotactic biopsy - Open biopsy not indicated.
What chemotherapy agent is indicated in the management of high-grade gliomas?
Temozolomide
What is the commonest class of primary CNS tumours?
Glial tumours
What are the commonest glial tumours?
Astrocytomas
Oligodenddrocytomas
Ependymomam
What is the commonest primary brain tumour in children?
Pilocytic astrocytoma
What histology findings are associated with pilocytic astrocytoma (2)
Rosenthal fibres
Piloid cells
What grade is a pilocytic astrocytoma?
Grade 1
What is the commonest affected site of a pilocytic astrocytoma?
Cerebellum
Which mutation is commonly associated with a pilocytic astrocytoma?
BRAF mutation
Which mutation is associated with longer survival and improved prognosis in a diffuse glioma?
IDH 1/2
Which is the commonest aggressive primary tumour in adults?
Glioblastoma multiforme
What grade is a glioblastoma multiforme?
Grade 4 tumour
What are the three histological findings associated with a glioblatoma multiforme?
- High mitotic index
- High cellularity
- Microvascular proliferation necrosis
What wildetype mutation is assocaited with glioblastoma multiforme?
IDH wildtype
Psammoma bodies are associated with which type of brain tumour?
Meningioma
What characteristic feature is associated with a Meningioma?
Psammoma bodies
Home-Wright Rosettes are associated with which type of brain tumour?
Medulloblastoma
What is the second commonest primary brain tumour in children?
Medulloblastoma
A Medulloblastoma is associated with what characteristic histological finding?
Homer-Wright Rosettes
Small round blue cells
What is the cytology of a Oligodendroglioma?
Round cells with clear cytoplasm (fried egg)
What is a positive prognostic mutation implicated in Oligodendroglioma?
IDH1/2
Which familial syndrome is associated with hemangioblastoma of the cerebellum, brainstem and spinal cord, retina?
VHL
Tuberous sclerosis is associated with which type of brain tumour?
Giant cell astrocytoma
What DEXA scan score is associated with osteoporosis?
T score < -2.5
What is the T-score range for osteopenia?
-1 TO - 2.5
What is the histology of osteoporosis?
Loss of cancellous bone
What is the biochemistry associated with osteoporosis?
Normal
What is the main cause of osteomalacia/rickets?
Low dietary vitamin D, inadequate sunlight, malabsorption syndromes (e.g., colieac disease)
Which anti-convulsant medication is associated with osteomalacia/rickets?
Phenytoin
What are the symptoms associated with rickets?
Bone pain, bowing tibia, rachitic rosary, frontal bossing, pigeon chest, delayed walking
On x-ray what radiological features are associated with osteomalacia?
Looser’s zones
Looser’s zones are associated with what?
Splaying of the metaphysis - pseudofractures
What is the histology of osteomalacia/rickets?
Excess of osteoids
Which marker is raised in osteomalacia?
ALP
What is the biochemistry of osteomalacia/rickets?
Normal to low calcium
Reduced phosphate
Raised ALP
Secondary hyperparathyroidism profile
Primary hyperparathyroidism has what effect on phosphate?
Low serum phosphate due to increased phosphate renal excretion
What are the causes of primary hyperparathyroidism?
Parathyroid adenoma
Hyperplasia
MEN
What are the symptoms of hypercalcaemia?
Hypercalcaemia:
‘Moans, stones, bones, groans, thrones’
Depression/confusion, renal stones, bone pain and #, constipation, pancreatitis,
Polyuria, polydipsia
What types of tumours on X-ray is associated with a collection of multinucleate giant cells in primary hyperparathyroidism?
Brown’s tumours
What is the appearance of the skull in primary hyperparathyrodism?
Salt and pepper skull due to subperiosteal bone resprotion
What is the bone histology for primary hyperparathyroidism?
Osteitis fibrosa cystica (marrow fibrosis + cysts – aka Brown Tumour)
Osteitis fibrosa cystica is associated with what?
Hyperparathyroidism
(primary)
What is the biochemistry profile for primary PTHism?
Raised calcium
Low phosphate
Raised ALP
Raised PTH
Paget’s disease is associated with what neurological manifestations?
Sensorineural deafness and sciatica
Which metabolic bone diseases is associated with Sensorineural deafness?
Paget’s disease
What is the histology appearance associated with Paget’s disease?
Huge osteoclasts with >100 nuclei
Mosaic pattern of lamellar bone
Mosaic pattern of lamellar bone is associated with what metabolic bone disease?
Paget’s disease of the bone
What biochemistry marker is significantly raised in Paget’s disease?
ALP
Renal osteodystrophy is associated with what type of acidosis?
Metabolic acidosis
Which enzyme is implicated in the production of uric acid from xanthine?
Xanthine oxidase
What crystals are associated with gout?
Monosodium urate crystals
Urate becomes insoluble at which pH?
7.40
Which joint is most commonly affected in classic gout?
1st Metatarsalphalangeal joint (MTP) - podagra
What are the precipitating factors for classic gout?
Trauma
Surgery
Starvation, bed rest
Overindulgence in certain high-purine foods and beer.
What are the three features of chronic tophaceous gout?
Polyarticular arthritis
Tophi deposits in ear lobes, fingers and elbows
Urate kidney stones
What is the definitive diagnostic investigation of classic gout?
Polarised microscopy of synovival fluid aspirate from the affected join
What type of crystals are described in gout?
needle-shaped crystals with strong negative bifringence.
Needle-shaped crystals with negative bifringence are associated with what type crystal arthropathy?
Gout
What radiographic features are associated with gout?
Rat-bite erosions
What drugs are used for the management of an acute gout flare?
Anti-inflammatory - NSAIDs or colchicine
Colchicine affects which intracellular molecule?
Tubulin
Allopurinol inhibits which enzyme?
- Xanthine oxidase
Which drug increases urate excretion and is indicated if GFR <50?
- Probenecid
Which two drugs should be avoided in patients on allopurinol?
azathioprine and 6-mercaptopurine
What is the crystal deposition for pseudogout?
Calcium pyrophosphates dehydrate crystals
What is the radiological appearance of pseudogout?
chondrocalcinosis
What are the risk factors associated with pseudogout?
- Hyperparathyroidism
- Hypophosphatemia, hypomagnesaemia
- Metabolic – DM, hypothyroid
- Wilson’s disease
- Haemochromatosis
What does pseudogout typically affect
Acute monoarthritis affecting the knee, hips and shoulders.
What are the characteristic crystals associated with pseudogout?
Positively birefringent rhomboid shaped.
What is the most common bacterial cause of osteomyelitis?
Staphylococcus aureus
What are the most commonly affected sites of Osteomyelitis ?
- Vertebrae
- Jaw (Secondary to dental abscess)
- Toe (Secondary to diabetic skin ulcer)
- Long bones (usually metaphysis)
What what term describes new irregular subperiosteal bone formation?
involucrum
What is the cause of osteomyelitis in sickle cell patients?
Salmonella
Which pathogen is the commonest congenital cause of osteomyelitis?
Syphillis
What two clinical nodes are associated with osteoarthritis?
Heberden’s nodes
Bouchard’s nodes
Heberden’s nodes affects which joint?
DIPJ
Which nodes in osteoarthritis are associated with the PIPJ?
Bouchard’s nodes
What are the four radiological features associated with osteoarthritis?
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts
Which syndromes are associated with osteosarcoma?
Gardner Syndrome, Li-Fraumeni, NFT1, Retinoblastoma
Which cells are implicated in the pathology of osteosarcoma?
Mesenchymal cells producing osteoid and immature bone
What are the commolyn affected sites associated with osteosarcoma?
Common sites:
Metaphysis of long bones:
1. Distal femur
2. Proximal tibia
3. Proximal humerus
4. Middle and proximal femur
What are the clinical features associated with osteosarcoma?
- Worsening pain over weeks to months
- More severe at rest and at night.
- Dull, deep, boring, and relentless
- Mass/swelling – Firm, tender and warm to the touch.
- Decreased range of motion of the affected limb
- Rapid metastases to the lungs.
On plain conventional radiograph what are the 2 characteristic findings in osteosarcoma?
Codman’s triangle
Sunburst appearance
In patients with an unexplained bone swelling (young children), what is the next line?
Urgent direct access X-ray within 48 hours
What is the confirmatory investigation for osteosarcoma?
Bone biopsy
On histology, which marker is positive in osteosarcoma?
ALP positive
What are the histological findings associated with osteosarcoma?
- Highly pleomorphic spindle cell neoplasm with a lace-like appearance.
What is the management for low-grade osteosarcoma?
Wide-grade resection and reconstruction
A chondrosarcoma produces what?
Cartilage
What is the common age group for chondrosarcoma?
> 40- years of age
Which sites are commonly affected by a chondrosarcoma?
Axial skeleton, proximal femur, proximal tibia, pelvis
On radiology - what appearance is evident on a chondrosarcoma?
Lytic with fluffy calcification
On histology what conventional feature is associated with a chondrosarcoma?
myxoid – composed of clear, mucoid substance, or hyaline
Which malignant tumour of the bone is characterised by small round blue cells?
Ewing Sarcoma
Which translocation is implicated in a Ewing Sarcoma?
t (11:22)
Which bone is commonly affected in a Ewing sarcoma?
Midshaft of the long bone
What is the radiological feature associated with a Ewing Sarcoma?
Onion-skin layers of periosteal bone formation
On biopsy what is observed in Ewing Sarcoma?
Small round blue cells (CD99 positive)
Which CD marker is positive in Ewing Sarcoma?
CD99
An osteoclastoma affects which type of cell?
Giant cell tumour
What is the histological appearance of a Osteoclastoma?
Soap bubble appearance
Which benign bone tumour is associated with a Bull’s eye appearance on X-ray?
Osteoid osteoma
Which benign bone tumour is associated with cotton wool/popcorn calcifications on radiology?
Enchondroma
Which benign bone tumour commonly affects the hands?
Enchondroma
A Shepherd’s crook deformity on radiology is associated with which type of benign bone tumour?
Fibrous dysplasia
Name 2 commonest causes of Pelvic inflammatory disease?
- Neisseria gonorrhoea
- Chlamydia trachomatis
Right upper quadrant pain/shoulder tip pain associated with perihepatitis is associated with which complication of pelvic inflammatory disease?
Fitz-Hughs Curtis Syndrome
On bimanual examination what are the three diagnostic findings for PID?
- Uterine tenderness
- Cervical motion tenderness
- Adnexal tenderness - A sensitive marker for endometritis.
What type of infertility is associated with PID?
Tubal factor infertility
Endometriosis predominantly affects which site?
uterosacral ligaments
Which cancer is associated with endometriosis?
Clear cell ovarian tumour
What theory describes the retrograde mensturation in endometriosis?
Sampson’s theory
On examination, what is the common site of uterine tendernss?
Posterior fornix of the uterus
Endometriomas are characterised by what morphological appearance?
Endometriomas
How do endometriotic lesions appear morphologically?
Red-brown nodules or power burns
An enlarged boggy and tender uterus associated with ectopic endometrial glands and stroma deep is associated with what?
Adenomyosis
A fibroid is what?
Benign tumour of smooth muscle
What is the pathological appearance of a fibroid?
- Whitish grey in colour
What fibroid change arises during pregnancy due to an infarction?
Red degeneration
What are the four main types of fibroids?
Subserosal
Intramural
Submucosal
Peunduculated
Which two types of fibroids are associated with an increasesd risk of miscarriage
Submucosal and intramural
Which mutation is most commonly associated with Endometrioid endometrial carcinomas?
PTEN mutations
What is the most common type of endometrial carcinoma?
Adenocarcinoma
What are the three common type 1 endometrial carcinomas
Serous
Endometrioid
Mucinous
Which type of endometrial carcinoma is associated with endometrial atrophy and tp53 mutations?
Serous
Which type of endometrial carcinoma is oestrogen driven?
Type 1
What are two types of type 2 endometrial carcinoma?
Serous carcinoma
Clear cell carcinoma
Which mutation is associated with serous carcinoma?
p53
Stage 1 FIGO endometrial carcinoma affects what?
Cancer ONLY in uterus
Which FIGO classification of endometrial carcinoma affects the cervix in addition to the uterus?
Stage 2
Which FIGO stage of endometrial carcinoma spreads to the pelvic area?
Stage 3
What is the normal vulval histology?
Squamous epithelium
Which HPV strains are assocaited with developing VIN?ia
HPV 16 and 18
The differentiated type of VIN is associated with what?
lichen sclerosis
What is the commonest type of vulval carcinoma?
Squamous cell carcinoma
What is the commonest type of functional ovarian cyst?
Follicular cyst
Follicular cysts contain what type of cell?
Granulomas cell
What are the two type of lutein cysts?
Granulomas lutein cysts
Theca lutein cysts
What type of cyst describes functional cysts of the corpus luteum?
- Granulosa lutein cysts
Granulosa cells produce which hormone?
Oestrogen
Which type of lutein cysts increase with hCG and are associated with pregnancy and hydatidform mole?
Theca lutein cysts
What is the common complication assocaited with a theca lutein cyst?ia
Rupture resulting in a hemiperitoneum
What is the commonest type of ovarian carcinoma?
Epithelial carcinoma
What are the two common types of benign ovarian carcinoma?
Serous and mucinous cystadenoma
What is the common histology of a serous cystadenoma?
Columnar epithelium - Psammoma bodies
Psammoma bodies are associated with which ovarian carcinoma?
Serous cystadenoma
What is the second most common epithelial ovarian cancer?
Mucinous cystadenoma
What is the histology of a mucinous cystadenoma?
Mucin secreting cells
Which mutation is implicated in a mucinous cystadenoma?
K-ras
What peritoneal complication is associated with mucinous cystadenoma?
pseudomyxoma peritonei
Which ovarian tumour is associated with tubular glands?
Endometrioid
Which malignant ovarian tumour is associated with a hobnail appearance with clear cytoplasm?
Clear cell
Which is the female counterpart for a testicualr seminoma?
Dysgerminoma
What is the commonest ovarian tumour in younger women 15-21 years?
Dermoid cyst - teratoma
Which type of teratoma is benign?
Mature (dermoid cysts)
Which type of teratoma is malignant?
Immature teratomas
Immature teratomas secrete what?
AFP
What are the hCG secreting germ cell ovarian tumours?
Yolk sac and choriocarcinomas
Which histological bodies are associated with a Yolk sac ovarian tumour?
Schiller Duval Bodies
Schiller Duval Bodies are associated with which type of ovarian cancer?
Yolk salk
What are the three common types of a sex-cord stromal ovarian tumour?
Granulosa-Theca cell tumour
Sertolli-Leydig Cell tumour
Fibroma
Meig’s syndrome is associated with which type of sex-cord stromal ovarian tumours
Fibroma
Meigs syndrome is characterised by a triad of what?
Fibroma
Ascites
Right-sided pleural effusion
Granulosa-Theca cell tumour produce what?
Produce E2
Call-Exner bodies are associated with whcih type of ovarian cancer?
Granulosa-Theca cell tumour (sex-cord)
What are the clinical presentation of a Sertoli-Leydig cell tumour?
defeminisation (breast atrophy) and virilisation (hirsutism, deepened voice, enlarged clitoris)
Which metastatic tumour is characterised by mucin producing signet ring cells?
Krukenberg tumour
Which scoring system is used to estimate the likliehood of a malignant cyst in the ovaries?
Risk of Malignancy Index
What three parameters are implicated in the calculation of RMI?
Ultrasound
Menopause status
Ca-125 iu/mL
The ectocervix is lined by which cell type?
Squamous epithelium
The endocervix is lined by which cell type?
Columnar epithelium
Which zone describes the area where the columnar epithelium transforms into squamous cells?
Transformation zone
CIN1 one affects which part of the epithelium?
Lower 1/3
CIN2 affects which part of the epithelium?
Basal 2/3rd
Which HPV strains are associated with CIN?
HPV 16 and 18
Which risk factors are associated with cervical cancer?
Cigarette smoking, multiple sexual partners, early age of first intercourse, HIV.
Which oncogenic proteins are produced by the HPV virus and are implicated in the pathogenesis of cervical carcinoma?
E6
E7
Which tumor suppressor gene is inactivated by E6?
P53
Which gene is inactivated by E7?
Retinoblastoma (Rb) gene
What is the most superficial layer of the epidermis?
Stratum corneum
What are the five epidermal layers?
- Stratum corneum
- Stratum lucidum
- Stratum granulosum
- Startum spinosum
- Stratum basale
Which epidermal layers do not contain nuclei or organelles? (2)
Stratum corneum and stratum lucidum
Which epidermal layer is found on the hands and soles of the feet?
Stratum lucidum
Which type of cells on histology is seen in stratum corneum?
Squames or horny cells
Which epidermal layer is most superficial and associated with nuclei?
Stratum granulosum
Which basophilic granules are obsered in the stratum granulosum and are responsible for forming a waterproof barrier?
keratohyalin granules
Which layer describes cellular proliferation in the stratum spinosum?
Malphigian layer
Which antigen-presenting cells are found in the stratum spinosum?
Langerhans cells
Which is the most germinal and deep epidermal layer?
Stratum basale
Which epidermal layer is described as the following:
‘Mitotically active, cuboidal to low columnar cells containing basophilic cytoplasm and a large nucleus’?
Stratum basale
Which cells are found in the stratum basale?
Melanocytes and merkel cells
Which cells is responsible for mechanoreception and release of neuroendocrine substances?
Merkel cell
What are the two dermal layers?
Superficial and reticular layer
Which term describes thickening of the stratum corneum?
Hyperkeratosis
Which histological phenomena is seen in psoriasis?
Parakeratosis
What is parakeratosis?
Retained nuclei in the stratum corneum
What term describes the thickening of the stratum spinosum?
- Acanthosis
What term describes a decreased cohesion between keratinocytes?
- Acantholysis
What is observed in contact dermatitis on a histological dermal and epidermal level?
- Spongiosis with hyperparakeratosis
What term describes fluid collection in the dermis?
spongiosis
Which hypersensitivity reaction is associated with contact dermatitis?
Type IV hypersensitivity
Acanthosis is associated with thickening of which epidermal layer?
Stratum spinosum
Which yeast is implicated in seborrhoec dermatitis?
Malassezia furfur
Which hypersensitivity reaction is implicated in psoriasis?
type IV hypersensitivity
A ‘test tube in a rack appearance’ is associated with which derm disorder (On histology)?
Psoriasis
What are the histological appearances associated with psoriasis?
Parakeratosis, neutrophilia, loss of granular layer, clubbing of rete ridges giving ‘test tubes in a rack’ appearance; Munro’s microabscesses.
Which monoclonal drug is implicated in the management of psoriasis?
secukinumab
secukinumab is associated with which IL?
Anti-IL-17
What is the most common type of Psoriasis?
- Chronic plaque psoriasis
Which type of rash is associated with a raindrop plaque distribution?
Guttate psoriasis
Which bacteria is typically associated with guttate psoriasis ?
Group A beta-haemolytic strep infection
Which psoriasis is associated with an emergency?
- Erythrodermic/pustular psoriasis
Plaques forming along sites of trauma in psoriasis is termed as what?
- Koebner phenomenon
Which term describes pint point bleeding in psoriasis?
Auspitz sign
What hypersensitivity reaction is associated with pemphigus vulgaris?
Type 2
Which proteins are IgG autoantibodies in Pemphigus Vulgaris targeted against?
Desmoglein types 1 and 3
What histological phenomena underpins the pathogenesis of Pemphigus Vulgaris?
Acantholysis in the stratum spinosum
A fishnet-like pattern is seen in which derm disorder on immunofluorescence?
Pemphigus Vulgaris
iS Pemphigus Vulgaris deep or superficial?
Superficial - epidermis
Antibodies against what is involved in Bullous Pemphigoid?
Hemidesmosomes
Which immune cells secrete elastase in Bullous Pemphigoid?
Eosinophils - damages the anchoring proteins and results in subepidermal bullae
Large tense bullae on is seen in which derm disorder?
Bullous Pemphigoid
Which Ig antibodies are involved in dermatitis herpteiformis?
IgA anti-gliadin - cross reaction with tissue transglutaminase
What is the histological appearance of Dermatitis Herpetiformis?
Micro-abscesses – coalesce to form subepidermal bullae; neutrophil and IgA deposits at tips of dermal papillae.
Which term describes the fine white streaks in lichen planus?
Wickham striae
Which histological bodies are seen in lichen planus?
Civette bodies
Saw-toothing of rete ridges and basal cell degeneration is seen in which disorder (derm)?
Lichen planus
Which drugs are implicated in Erythema Multiforme?
Sulphonamides, NSAIDs, allopurinol, penicillin, phenytoin.
What are the viral and bacterial causes of erythema multiforme?
HSV-1, HSV-2 and mycoplasma pneumoniae.
What are the severe disease manifestations of erythema multiforme?
Steven Johnson’s syndrome (SJS)
followed by toxic epidermal necrolysis
What % BSA differentaites SJS with TES?
SJS - 10% TO 30%
TES >30%
Which sign denotes the separation of the epidermis from the underlying dermis?
Nikolsy sign.
Which derm condition is denoted by stuck on dull waxy appearance?
Seborrhoeic Keratosis
Horn cysts are associated with which derm condition?
Seborrhoeic Keratosis
What is the histology of actinic keratosis? (SPAIN)
- Solar elastosis
- Paraketosis
- Atypical cells
- Inflammation
- Non-full thickness
which derm condition is seen with chronic uv sun exposure and is rough w/a sand-paper like appearance?
rough, sandpaper-like, scaly lesions
Which derm disorder is characterised by a dome-shaped skin tumour with a centralised keratinous plug on sun exposed hair baring areas?
Keratoacanthoma
Which benign skin tumour is rapidly growing?
Keratoacanthoma
What is the histology of Keratoacanthoma ?
Central keratin plug with a crateriform appearance
What is the pre-malignant cancer for Squamous cell carcinoma in situ?
Bowen’s disease
What is Bowen’s disease characterised by ?
Keratinocyte atypia - seen throughout the entire epidermis - full -thickness but with an intact membrane
What HPV strains are associated with Bowen’s disease?
HPV 16 and 18
What is the second most common skin cancer?
Squamous cell carcinoma
What are the pre-existing conditions for SCC of the skin?
Bowen’s disease
What is the tumour diameter for SCC of the skin?
> 2 cm
What is the difference between Bowen’s disease and SCC, in terms of histology?
Atypical keratinocytes with abundant eosinphillic or glassy-pink cytoplasms invading the dermis and spreading through the basement membrane
Which skin cancer is characterised by an ill-defined keratotic or warty nodule that easily ulcerates?
Squamous cell carcinoma
What is the most common form of skin cancer?
Basal cell carcinoma
What is the appearance of a basal cell carcinoma?
Pearly or shiny nodule on the head and neck area + overlying telangiectasia
What is the histological appearance for a basal cell carcinoma?
Palisading (nuclei align in the outermost layer)
What are the three types of melanocytic naevi?
Junctional
Compound
Intradermal
Which of the melanocytic naevi is nested in the epidermis?
Junctional - reside within the stratum basale
Which melanocytic naevus is associated with the epidermis and dermis?
Compound
Which melanocytic naevus is nested in the dermis?
Intradermal
Which activating mutation is associated with malignant melanoma?
BRAF V600 protein kinase
What are the two phases of malignant melanoma?
Radial growth phase - grow horizontally in the epidermis
Vertical growth phase - vertical growth into the dermis
What type of appearance is evident on malignant melanoma during the vertical growth phase?
Buckshot appearance - pagetoid cells
What is the prognostic factor for malignant melnoma?
Breslow thickness
Which is the most common type of malignant melnoma?
Superficial spreading
Which is the second commonest malignant melanoma + most aggressive type?
Nodular
Which melanoma is typically seen in the palm or sole or under the nail?
- Acral lentiginous malignant melanoma
Which melanoma is seen on sun-damaged skin?
- Lentigo Maligna
Which freckle is obserbed in lentigo maligna?
Hutchinson’s melanocytic freckle
Which viruses cause pityriasis rosea?
HHV-6 and -7
What is the pattern of rash seen in Pityriasis Rosea?
Christmass tress pattern
What does Pityriasis Rosea begin as?
Herald patch
What is the female to male ratio for SLE?
9:1
Which type of hypersensivity reaction is associated with SLE?
Type 3
Which HLA types are associated with SLE?
HLA-DR3 and HLA-DR15
Which is the commonest antibody associated with SLE?
Anti-dsDNA
Which is the most specific autoantibody associated with SLE?
anti-spliceosome protein Smith (Sm)
Which autoantibody is associated with drug-induced SLE?
Anti-histone
Which complements are low in active SLE?
Low C3 and C4
On renal biopsy what is the charactersitic appearance in SLE?istics
Wire loop appearance
What type of histological lesion is seen in the spleen for SLE?
Onion skin lesion
Which histological heart finding is seen in SLE?
Libman-sacks endocarditis
Which autoantibody is associated with limited scleroderma?
Anti-centromere
What is CREST in limited scleroderma?
- Calcinosis (calcium deposit on tip of thumb)
- Raynaud’s phenomenon (white blue red)
- Oesophageal dysmotility
- Sclerodactyly
- Telangiectasia
What is the vascular histology for limited scleroderma?
Onion skin appearance
Which auto-antibody is associated with diffuse scleroderma?
Anti-SCL70
A patient with puffy fingers, erythema, pruritus, accompanied by skin induration, dryness and hyperpigmentation is associated w/what?
Diffuse scleroderma
Which autoantibody is associated with polymyositis?
Anti-Jo-1
Which disorder is characterised by symmetric involvement of the pelvic girdle muscles - difficulty raising arms and standing up + constitutional symptoms?
Polymyositis
What is the diagnostic investigation for polymyositis?
EMG-guided biopsy
Which viruses can precipitated the onset of dermatomyositis?
Coxsackie B virus, parvovirus, and enterovirus
Which auto-antibody is associated with interstitial lung disease in dermatomyositis?
Anti-Jo-1
What type of rash is associated with Dermatomyositis?
Heliotrope rash
What papules are associated with Dermatomyositis?
Gottron’s papules
Which blood markers are raised in Dermatomyositis?
Creatine kinase and ESR
What is the management for Dermatomyositis?
High-dose glucocorticosteroids (e..g, oral prednislone 0.5-1 mg/kg/day)o
What are the late-stage manifestations of Dermatomyositis?
Dysphagia, aspiration pneumonia
Which large vessel vasultis is associated with pulseless disease?
Takayasu’s arteritis
What is the commonest affected site in Takayasu’s arteritis?
Subclavian artery
In which demographic, does Takayasu’s arteritis most likely affect?
Japanese women
What is the complication associated with Takayasu’s arteritis?
Hypotensive retinopathy
Commonest affected site for Giant cell arteritis?
Superficial temporal arteries
HLA associated with giant cell artertis?
HLA-DR4
What is the diagnostic investigation for giant cell arteritis?
Temporal artery biopsy
What is the first-line investigation associated with giant cell arteritis?
ESR (raised >50 mm/hour)
Polyarteritis nodosa is associated with which viral infection?
Hepatitis B
On angiography which medium veseel vasculitis is associated with a strings of pearls/rosary bead appearance?
Polyarteritis nodosa
Which medium vessel disease is associated with segmental arterial occlusions aka corkscrew appearance on contrast angiography?
Berger’s disease
What is the characteristic angiographic appearance associated with Berger’s disease?
Corkscrew appearance
Which medium vessel vasculitis is common in heavy smoking men <50 years?
Berger’s Disease (Thromboangitis Obliterans):
What are the three pathological hallmarks with GPA?
- Granulomatous inflammation in the upper or lower respiratory tract
- Necrotising vasculitis
- Segmental glomerulonpehritis
Which disease is associated with saddle nose deformity, pulmonary hemoarrhage ad segmental glomerulnephritis?
Granulomatosis with polyangiitis
What nasal complication is associated with Granulomatosis with polyangiitis ?
Saddle nose deformity + subglottic stenosis
Which auto-antibody is associated with Granulomatosis with polyangiitis ?
c-ANCA
c-ANCA is targets which enzyme?
Proteinase-3
Which vasculitis is associated with both asthma and eosinphillia?
Eosinophilic Granulomatosis with polyangiitis
Which auto-antibody is concerned with Eosinophilic Granulomatosis with polyangiitis?
pANCA
pANCA targets which enzyme?
myeloperoxidase
Which type of glomerulonephritis is associated with microscopic polyangitis?
Pauci-immune - RPGN
What is amyloid?
fibrillar proteins - aggregate into insoluble cross-beta-pleated sheets
What is THE most common type of amyloidosis?
Primary AL
Primary AL amyloidosis is associated with what?
Multiple myleoma
What is the cause of secondary amyloidosis?
Serum amyloid A - acute phase protein
Secondary (AA) amyloidosis is associated with which autoimmune disorders?
Rheumatoid arthritis, ankylosing spondylitis, IBD
Which protein deposition is associated with haemodialysis associated amyloidosis?
Beta-2-microglobulin
Haemodialysis-associated amyloidosis is associated with which clinical manifestation?
Carpal tunnel syndrome
What is the inheritance pattern of familial mediterranean fever?
Autosomal recessive
What type of cardiomyopathy is associated with amyloidosis?
Restrictive cardiomyopathy
What is the stain implicated with amyloidosis?
Congo red stain
What is the stain used to detect melanoma?
Fontana stain
Which stain is used for Wilson’s disease?
Rhodanine stain
Cytokeratin stain, stains positive for what?
Epithelial cells
CD45 stain, stains positive for what?
Lymphoid cells
Which stain is used for confirming acid-fast bacilli?
Zihel-Neelson stain
Which stain is used for confirming pneumocystic jirovecci?
Methanamine silver stain
Which stain is used to confirm cryptosporidium parvum?
Kinyoung acid fast stain
Which cells secrete vasoactive peptide?
D1 cells
Most common cause of acute pancreatitis?
Gall stones
What is the second most common cause of acute pancreatitis?
Ethanol
What electrolyte abnormality is a consequence of pancreatitis?
Hypocalcaemia (due to saponification)
Periductal inflammation in acute pancreatitis is associated with necrosis of which type of cell?
Acinar cell
Which two enzymes are elevated in acute pancreatitis?
Lipase and amylase
Which enzyme marker is more sensitive for acute pancreatitis?
Lipase
What is the histology of acute pancreatitis?
Coagulative necrosis
What is the prognostic scoring system for acute pancreatitis?
Modified Glasgow Criteria
What is the most significant causative risk factor for chronic pancreatitis?
Ethanol
What is the diagnostic histological pancreatic appearance for chronic pancreattis?
Pancreatic calcifications
Which enzyme marker is associated with chronic pancreatitis?
Faecal elastase
Which is the commonest cancer of the pancreas?
Ductal adenocarcinoma of the pancreas
Which part of the pancreas is affected most by cancer?
Head of the pancreas
Which mutation is associated the most with pancreatic carcinoma?
K-ras mutation
What host response is associated with dense fibrosis in ductal pancreatic carcinoma?
Desmoplastic response
Which glands are associated with pancreatic carcinoma on histology?
Abortive glands and mucin secretion
What clinical sign is characteristic of pancreatic carcinoma?
Courvoisier sign
What derm manifestation is associated with pancreatic carcinoma?
Trousseau syndrome
Which biomarker is raised in pancreatic carcinoma?
CA19-9
What is the surgical procedure for pancreatic adenocarcinoma?
Whipple’s procedure
Which rare pancreatic carcinoma is associated with eosinophilic granular cytoplasm?
Acinar cell carcinoma
What are the three types of cystic neoplasms (pancreas)?
Serous cystic neoplasm
Intraductal papullary neoplasm
Mucinous cystic neoplasms
Which pre-cancerous neoplasm is found int he tail of the pancreas and is filled with thick tenacious mucin?
Mucinous cystic neoplasm
Which cystic neoplasm is associated with the head of the pancreas?
Intraductal papillary mucinous neoplasm
Which pancreatic neuroendocrine tumour is associated with gastrin secretion?
Zollinger-Ellison Syndrome
Which genetic endocrine disorder predisposes the development of neuroendocrine tumours of the pancreas?
MEN type 1
What is the characteristic derm manifestation associated with a glucagonoma?
- Necrolytic migratory erythema
Which pancreatic neuroendocrine tumour is associated with watery diarrhoea and hypokalaemia?
VIPoma
What are the non-functional peptides? (4)
Chromogranin A
Pancreatic polypeptide
Alpha-subunit
Beta-subunit
Gallstones are predominantly made out of what?
Cholesterol (radiolucent)
Which gallstones are radio-opaque?
Pigment stones
An infarct to which artery results in neglect?
Right Middle Cerebral artery ap
Which drug is palliative for colorectal cancer?
fluorouracil
Which is the most common type of cancer in men?
Prostate cancer
Second most common cancer cause of death in the UK?
Colorectal cancer
Most common cancer-related death in the UK?
Lung cancer
Most prevalent cancer in the UK for women?
Ovarian cancer
Which extracellular protein is associated with deposits in Alzheimer’s dementia?
Beta-amyloid deposits
Which protein is responsible for disrupting the cytoskeleton and forming NFTs in Alzheimer’s dementia?
Tau protein
Which pathology is associated with deposits of protein in blood vessel walls in dementia?
Cerebral amyloid angiopathy
Most common site of cerebral atrophy in Alzheimer’s dementia?
Hippocampus
Which enzyme cleaved amyloid precursor protein?
Beta-secretase
What staging is used for tau protein?
Braak staging
Physostigmine is what class of drug?
Anti-cholinesterase
Memantine is what class of drug?
NMDA receptor anatagonist
Which neurones are depleted in Parkinson’s disease?
Dopaminergic neurone depletion
Which part of the brain is first affected in Parkinson’s disease?
Substantia nigra in the basal ganglia to the striatum
Lewy bodies are formed from what?
alpha-synuclein
Which cells are affected in mlptiple system atrophy?
Glial cells
Ataxial rigidity + tauopathy + downgaze =?
Progressive Supranuclear Palsy
Which disease is assocaitiaedted with a cortical knife blade atrophy and behavioural change?
Pick’s disease
Which protein is associated with FTD?
TDP-43 protein
Most common bacterial cause of osteomyelitis?
Staph aureus
What terms describes irregular new bone formation in osteomyelitis?
Involucrum
What change describes necrotic cortex in osteomyelitis?
Sequestrum
Most common cause of osteomyelitis in children?
Haemophilus influenzae, and group B strep
Most common cause of osteomyelitis in immunocompromised patients?
Tuberculosis
Most common congenital cause of osteomyelitis?
Syphilis
Which is a common bone tumour associated in patients >40 years and affects the axial skeleton and proximal tibia?
Chondrosarcoma
Which benign bone tumour is associated with a sclerotic rim?
Osteoid osteoma
Which benign bone disorder is associated with a mushroom cap?
Osteochondroma
Which type of prion disease can be diagnosed with 100% specificity using a tonsillar biopsy?
Variant CJD
