Histopathology Flashcards
1
Q
cancellous bone
A
medulla
2
Q
cortical bone
A
compact
3
Q
long bone growth
A
endochondrial ossification
4
Q
failure of calcification at the zone of bone formation
A
results in failure of bone growth
5
Q
features of achondroplasia
A
short limbs
trident hands
NORMAL trunk length
contracted base of skull
6
Q
commonest of the short-limb patters of dwarfism
A
achondroplasia
7
Q
achondroplasia affects how many
A
1/30,000
8
Q
sporadic achondroplasia?
A
75%
9
Q
inheritence of achondroplasia
A
Dominant
10
Q
Intramembranous bone growth
A
(1) flat bones (skull)
fibrous connective tissue
(2) thickening (appostional growth) of the long bones
11
Q
Endochondral bone growth
A
peiphyseal growth lates
lengthening of bone
12
Q
growth plates fuse at:
A
around 16y
13
Q
achondroplasia bone growth
A
restriction in growth of length
architectural disturbance of the growth plates
14
Q
achondroplasia histology
A
disrupted chondrocyte columns
no tidy structure and irregular ossification
15
Q
subsequent ossification
A
well-ordered columns of chondrocytes, enlarge, get to end of bone, undergo calcification
16
Q
achondroplasia genetic abnormality
A
FGFR
1/2/3
inhibits proliferation of chondrocytes
17
Q
osteogenesis imperfecta collagen type
A
type 1
18
Q
type 1 collagen makes up… of matrix
A
90%
19
Q
mild imperfecta
A
limited amount of point mutations
20
Q
defective organic matrix in imperfecta leads to
A
defective mineralisation of bone
21
Q
osteopetrosis defect
A
osteoclast arm of bone forming unit
more formation than resorption
22
Q
whats happening in osteopetrosis
A
thick bone but v fragile due to inadequate collagen 1 mineralisation
23
Q
children with osteopetrosis present
A
defective osteoclasts
bones become increasingly dense leading to disappearance of the marrow and compromised haemopoeisis.
24
Q
how do osteopetrosis patients present?
A
pancytopaenia
treat with bone marrow transplant
25
osteomyelitis
disease of growing skeleton
26
who gets osteomyelitis
18m-18y
| haematological spread
27
main cause of osteomyelitis
s.aureus
then entero and e.coli
28
osteoporosis >50 fractures
men 1 in 10
| women 1 in 3
29
causes of osteoporosis
```
POST-MENOPAUSAL
disuse
diet
drugs (heparin, ethanol, steroids)
endocrine (adrenal failure, testicular or ovarian failure)
```
30
3 osteoporosis fracures
vertebral crush fractures
NOF
Colles'
31
zone of maximum stress in femoral neck
950lb/sq inch
32
osteoporosis histology
trabecula loss and fewer connections to each other
33
trabeculae in osteoporotic vertebra
more loss of vertical
34
peak bone mass
18-20 years
| then plateau then down from 30.
35
treatment for osteoporosis
```
calcium and vit.D
Exercise
Bisphosphonates
Calcitonin
HRT
```
36
osteomalacia
metabolic
| inadequate mineralisation of existing bone matrix
37
most common cause of osteomalacia
lack of activated vit D.
38
aetiology of osteomalacia
Vit.D disturbance (sun, malabsorption)
Kidney disease (tubular and CRF)
IEM- hypophosphate
39
vit D absorption happens in...
jejunum and ileum
40
osteomalacia histology
inadequate mineralisation at site of high bone turnover
surface of bony trabeculae covered by thick layer of unmineralised matrix- osteoid
41
osteomalacia xray
structural weakness at that site and micro fractures
| Looser's Zones.
42
osteitis fibrosa cystica
hyperparathyroidism
43
recklinghausens's diease
hyperparathyroidism
44
osteitis fibrosa cystica
adenoma and hyperparathyroid
45
raised calcium?
think hyperparathyroidism
46
Pagets is....
abnormal coupling of OB and OC
| osteosclerotic and osteoporotic areas
47
pagets increases your risk of
osteosarcoma
48
pagets histology
woven and lemellar mismatch
49
osteosarcoma prevalence
15% of the 1% of bone tumours
50
who gets bone cancer?
<30years
51
types of osteosarcoma
high grade intramedullary
| then parosteal, then periosteal
52
osteosarcoma happens more in children because...
period of maximum skeletal growth.
53
which bone tumour can happen whenever?
paraosteal
54
where are osteosarcomas
metaphyseal bart of bone.
| knee common in high grade
55
osteosarcoma radiology
tumour from medulla towards metaphysis.
mixture of destruction and new formation.
MOTH EATEN
bone formation outside cortex/beneath periosteum=CODMANS TRIANGLE
56
treatment for osteosarcoma
chemo then resect.
57
high grade osteosarcoma histology
disorganised sheets of malignant OB
pleiomorphism
nuclear phyperchromatism
irregular islands of non-structural tumour bone
58
most common cause of chronic kidney disease
glomerulonephritis
59
2 important causes of kidney disease
diabetes
| hypertension
60
GFR stages
1. >90
2. 60-90
3A. 45-60
3B. 30-45
4. 15-30
5.<15
61
symptomatic CKD stages
3A and up
62
AKI definition
within 48 hours
| rapid reduction in renal EXCRETORY function
63
oliguric phase of AKI
metabolic acidosis
| increase urea
64
recovery phase of AKI
polyuria
65
nephritic syndrome symptoms
```
haematuria
azotemeia (increase nitrogenous products)
mild oedma
variable proteinuria
mild-moderate hypertension
```
66
nephrotic syndrome symptoms
hypoproteinemia
oedema
hyperlipidaemia
67
commonest cause of nephrotic syndrome
minimal change disease/glomerulopathy
68
minimal change disease
no detectable immune deposit but immune response.
| respiratory infections and immunization
69
diffuse effacement of foot processes
minimal change disease
70
majority of glomerulonephritis are the result of
immune complex deposition in the wall
71
granular immunoflourescence pattern of GN
local deposition of circulating immune complexes
| depostition of antibodies against glomerular component
72
GN in adults vs. kids
kids- good prognosis
| adults- usually permanent compromise
73
major cause of acute nephritis in kids
acute proliferative GN
| after group A strep
74
acute proliferative GN shows:
enxocapillary hypercellularity
lots of neutrophils
closed glomerular capilaries
big glomerulus
75
anti-glomerular basal membrane antibodies
membranous GN
| commonest cause of nephrotic in adults
76
membranous GN histology
marked thickening of GBM
capillaries still open (not in acute proliferative)
interstitial expansion and fibrosis.
77
membranoproliferative GN histology
increased mesangial
localised capillary wall thickness
increased cellularity
pronounced lobulation
78
membranous GN is...
nephritic and nephrotic
| rapidly progressing.
79
tubulointersitial nephritis caused by
inflammatory reactions of tubules and interstitium
80
ATN caused by
ischaemia or toxic tubulary injury
81
ATN histology
focal necrosis and desquamation of cells into lumen.
82
acquired renal cystic disease
mostly post-dialysis
83
nephronophthisis-medullary cystic kidney disease
hereditary
84
ADPKD
adult
1 in 500
bilateral
85
symptoms of ADPKD
```
haematuria
UTI
Abdo mass
hypertension
beri-beri
cysts in other organs.
```
86
ARPKD
1/20,000
large abdo mass at birth
liver abnormalities
87
ARPKD prognosis
death shortly after birth
renal filaure
hypertension
portal hypertension
88
nephronoPHTHisis
medullary cystic disease
89
simple renal cysts
common autopsy finding
| no significance
90
neohroLITHiasis
20-30y
males
recur
91
most common kidney stone
calcium oxalate
| due to hypercalcaemia
92
2nd/3rd/4th most common stones
phosphate- proteus breaks down urea
urate (gout)
Cysteine (IEM)
93
causes of renal stones
```
dehyration
sarcoid hypercalcaemia
cushings
oxalate foods (brocolli)
Bladder obstruction
PCKD
Medullary sponge kidney
Stents, catheters, crystallisation, foreign substances.
```
94
acute inflammatory infiltrate in the interstitium and tubular lumina
acute pyelonephritis
95
chronic pyelonephritis histology
surface of kidney irregular.
irregular scarred area with remaining parenchyma bulging.
MANY colloid filled tubules.
THYROIDISATION of the kidney.
96
hypertensive kidney histology
fibrous intimal thickening or sclerosed renal arterioles
97
benign renal tumours
papillary adenomas (<5mm) fibromas
98
malignant renal tumours
RCC most common
| then 20% TCC
99
RF for kidney RCC
smoking, high blood pressure, heavy metals, obesity, von hippel lindau
100
presentation of kidney RCC
paraneoplastic conditions
mass
haematuria
back pain
101
renal cell histology
clear cytoplasm
102
transitional cell carcioma is at the...
renal pelvis
103
TCC of kidney histology
pelvis growing in a pushing fashion around the medullary renal tubules.
104
normal thyroid
colloid filled acinus
follicular lining
vascular
regulates BMR
105
commonest cause of hypothyroidism
hashimotos
(antibodies to thyroid)
lymphocytic destruction of thyroid
106
deep voice in hypothyroidism
deposition of matrix substances in viscera and skin
107
atrophic thyroid
hashimotos
108
85% of hyperthyroidism cases
Graves
109
causes of hyperthyroidism
```
graves
hyperfunctional multinodular goiter
hyperfunctional adenoma (benign follicular tumour)
```
110
staring gaze, lid lag, exophthalmos
graves
111
diffuse toxic goitre
graves
112
symmetrical enlargement of thyroid
graves.
113
multinodular goitre
usually euthyroid
larger ones may cause dysphagia
lumpy neck.
(don't really need to be removed though).
114
thyroid adenoma
benign
euthyroid (usually)
when toxic=hyperthyroidism
solitary follicular nodule in NORMAL surrounding gland.
115
disproportionate nodule
hyperplastic in a nodular background
116
thyroid cancers
80% pappillary
15% follicular
medullary
anaplastic
117
papillary thyroid cancer
cystic
can be multifocal
PSAMMOMA bodies- empty nuclei of epithelium covered papillae cells.
(good prognosis)
118
follicular thyroid cancer
widely invasive
| irregular margins
119
medullary thyroid cancer
```
from C cells (Celly in the middle)
neuroendocrine tumour- secrete calcitonin
amyloid stroma (pink)
MEN 2A/2B
BROWN STAIN POSITIVE
```
120
anaplastic thyroid cancer
old people
aggressive
no response to treatment
die in months
121
primary hyperparathyroidism causes
primary hypercalcaemia
122
primary hyperparathyroid causes
adenoma (95%)- one gland
hyperplasia- both glands
carcinoma- RARE
associated with MEN1/2A/2B
123
symptoms of primary hypercalcaemia
bones
stones (porosis, osteitis fibrosa cystica- cysts eat up Ca2+)
groans
psychiatric overtones
124
causes of secondary hyperparathyroidism
CRF
| also Vit.D/calcium problems, malabsorption, low serum Mg, tissue resistance, pseudohypoparathyroidism
125
Sestamibi scan
radioactive tech99 PARATHYROID GLANDS
126
primary hyperPTH treatment
remove 3.5 glands so they don't have to take Ca and Vit D forever.
127
parathyroid cancer
calcium >3.5
| bone disease, renal stones, mets, laryngeal nerve damage
128
adrenal glands steroids
glucocorticoids (steroid)
mineralocorticoids (aldosterone)
sex steroids (oes and andro)
medulla- adrenaline
129
Primary adrenocortical insufficiency
Addison's disease
130
Addison's disease
```
autoimmune destruction
TB
metastatic cancer
AIDS
congenital hypoplasia
```
131
secondary adreno insufficiency
less ACTH produced
| treatment with steroids
132
in addisons what happens to adrenaline
nothing
| the medulla is unaffected.
133
Addison's symptoms
weakness/tiredness
GI disturbance
hyperpigmentation
hypotension: potassium retained
134
why do we get hyperpigmentation in addisons?
precursor of ACTH and melanocyte stimulating hormone
135
what triggers an adrenal crisis?
infection
trauma
surgery
136
signs of an adrenal crisis
vomiting
abdo pain
hypotension
coma
137
Cushings
pituitary adenoma causing diffuse hyperplasia
138
most common cause of Cushing's
iatrogenic
139
endogenous causes of Cushing's
Pituitary adenoma (CD)
140
adrenal cortical adenoma
most non-functional
| if functional- cushing's syndrome or high aldosterone
141
adrenal cancer
usually FUNCTIONAL
virilism
large and invasive
venous and lymph spread
142
phaeochromocytoma
tumour in adrenal medulla
adrenaline
surgically correctable hypertension
XS urine adrenaline
143
90% of phaeochromocytomas are
unilateral
adrenal
benign
hypertension inducing
144
MEN syndromes
inherited
| proliferative
145
MEN 1:
| 11q, tumor suppressor
Parathyroid adenoma/hyperplasia
Endocrine glands adenoma/hyperplasia
Carcinoid tumours
146
```
MEN 2(a):
10q
```
Parathyroid adenoma/hyperplasia
Medullary thyroid cancer
Phaeochromocytoma
147
```
MEN 2(b)
10q ret
```
Medullary thyroid cancer
| Phaeochromocytoma
148
subtypes of endometrial hyperplasia
simple-cystic hyperplasia
complex hyperplasia
atypical hyperplasia=EIN
149
causes of endometrial hyperplasia
```
obesity
anovulatory cycles
prolonged oestrogen
PCOS
functioning ovarian or adrenal tumours.
```
150
Atypical endometrial hyperplasia
EIN
may progress to adenocarcinoma
may regress with just progesterone
151
Most common malignant tumour of female genital tract
endometrium
152
how many HNPCC get endometrial cancer?
20-30%
153
type 1 endometrial cancner
oestrogen dependent (most common)
154
type 2 endometrial cancer
oestrogen independent.
| postmenopausal
155
ectocervix
squamous epithelium
156
endocervix
mucin secreting columnal
157
risk factors for cervical cancer
```
early age of first intercourse
multiple partners
smoking
genital infections
lots of sex
```
158
HPV
dsDNA
no envelope
anogenital
mucocutaneous
E6+E7 oncogenes- bind to retinoblastoma and p53- expands life span.
159
where does HPV work?
reserve cells of TZ
160
phases of HPV infection
```
latent infection (just one)
productive infection
integration
```
161
high frade CIN and CGIN evolve to
invasive carcinoma
162
how long does it take for CIN to progress to cancer?
10y
163
most common cervical cancer
squamous cell cancer
164
types of ovarian cancer
surface epithelial stromal- MOST COMMON
sex cord stromal
germ cell
metastatic
165
genetic factors and ovarian cancer
BRACA 1 and 2
| HNPCC
166
Borderline epithelial ovary tumours
epithelial proliferation
| no invasion of stroma
167
Adenocarcinoma of ovary
commonest subtype of SEROUS
| present late
168
Germcell tumour ovary
primordian germ cells
most teratoma/dermoid
young girls and children
169
sex cord stromal tumours ovary
granulosa cell
theca sertoli cells
Leydig cells
abnormal oestrogen, inhibin and testosterone
170
metastatic ovarian cancer
FROM stomach, colon, appendix, breast pancreas
| krukenberg- SIGNET RING
171
B lymphoid cell
naive b cell leaves bone marry and enters blood to secondary lymphoid follicles
expresses Ig on surface
172
Secondary b lymphoid follicle
t cell dependent b cell proliferation
antigen dependent
b cells become centeroblasts
centeroblasts make plasma cells and marginal zone b cells.
173
MALT
largest secondary lymphoid organ
surface epithelium with underlying lymphoid follicle and T zone
b and t cells enter the surface epithelium
174
life of a primary t cell
```
thymus
t cell
t cell receptor rearragement
CD4 or CD8 cells
antigen INDEPENDENT process
exit as mature t cells.
```
175
antigen dependent process of T cell
T zone of lymph node or MALT
176
EBV associated with (cancers)
Burkitt
Hodgkin
post transplant lymphoma
AIDS lymphoma
177
Hep C and lymphoma
low grade B cell non-hodg
178
Kaposi sarcoma
HHV8
179
Non hodgkins histo
1-5% malignant in background of inflammatory
| REED STERNBERG
180
Burkitt
EBV
| mature b cell neoplasm
181
prematurity counts for .... of infant deaths
45%
182
cancer counts for ... of child deaths
22%
183
thick bowel secretions makes you think
CF
184
best way to diagnose biliary atresia
livery biopsy
185
congenital cystic adenomatoid malformation
lung has holes
| may present with infection
186
multicystic dysplastic kidney
unilateral
187
kid cancers
leukaemia
CNS
lymphoma
188
stenosis
30% single vessel disease
30% double
40% triple
189
site of stenosis is usually
within first 4cm of LCA
| more distal in RCA
190
non arthero-sclerotic lesions of coronary arteries
emboli
| arteritis (inflammation of vessel wall)
191
2 types of MI
1. full thickness
| 2. subendocardial type (extensive infarct of inner 1/3 of myocardium)- in triple disease
192
Left coronary artery supplies
anterior wall
apex
anterior part of interventricular septum
193
Left circumflex supplies
lateral wall
194
Right coronary artery supplies
posterior wall
| posterior IV septum
195
biggest complication of MI
arrthymia
196
cor pulmonale
R ventricle enlargement
due to pulmonary hypertension due to disease of the lung
right V dilatation and hypertrophy >0.5cm
197
pickwickian syndrome
obesity causing decreased chest movement and subsequent cor pulmonale
198
mitral stenosis
ONLY Rheumatic fever but rare
199
aortic stenosis
most commonly due to calcification of valve
| or a bicuspid congenital valve
200
cardiomyopathy 3 types
dilated
restricted
hypertrophic
201
dilated cardiomyopathy
alcohol
pregnancy
genetic
post-viral
202
restricted cardiomyopathy
amyloid infiltration of myocardium in OLD
203
hypertrophic cardiomyopathy
AD
| asymmetrical LVhypertrophy in YOUNG
204
atherosclerosis more common in
coronary
carotid
distal
femoral arteries
205
Marfans and aneurysms
media in vessels is collagen (Marfans have collagen disorder)
206
Large aneurysms
atherosclerotic
dissecting
syphillis
207
Medium aneurysms
Berry
Mycotic
Traumatic
208
Microaneurysms
Charcot-Bouchard
Diabetic
Cerebral amyloid
209
chrons confined to colon
20%
210
crohns biposy
```
mesentery thickened
oedematous
superficial ulcers at first
ulcers then deepen and coalesce to form transverse and longitudinal ulcers
COBBLESTONE
```
211
crohns histo
transmural inflammation
granulomas (non-nec)
crypt
fissures in muscularis propria--> abscess
fistula formation
fibrosis and stricture formationa (apple coring)
212
UC histology
```
crypt abscesses
neutrophils in lamina propria
architectural distorition
gland branching
loss of normal parallel arrangements.
purple lymphocytes
```
213
crohns and cancer
small bower
214
UC and cancer
colon
215
paralysis of the motor function of the transverse colon
toxic megacolon
216
colon cancer generally starts with
polyps
217
metaplasia
acquired form of altered differentiation
218
dysplasia
abnormal growth and differentiation of tissue
| may be premalignant
219
types of colorectal polyp
Inflammatory
Hamartomatous
Neoplastic
220
inflammatory pseudopolyps
seen in UC and Crohns
inflammatory tissue
hyperplastic mucosa
221
hamartoma
benign tumout like lesion
222
Peutz Jeger
GI polpys
AD- small bowel more
perioral pigmentation
lips, pals, genitalia
223
juvenile polyps
```
cyst glands
normal or inflammed epithelium
SMAD4
80% rectum
bleeding, prolapse
```
224
Peutx Jeger and cancer
73% get carcinoma
225
adenoma=
non reversible dysplasia
disregulated proliferation
premalignant
226
types of adenoma
tubular
tubulovillous
villous
227
flat adenoma
high malignant potential
| associated with NHPCC or FAP
228
polpys more malignant if:
Villous
Big >5cm
Dyslastic
229
polyps that aren't dangerous
hyperplastic polyps
| benign
230
leiomyoma
not malignant
FIBROID
muscularis mucosa
can cause obstruction of ileocaeccal valve
231
colon cancer
women- colon
men- rectum
RECTUM overall
232
all carcinomas start from
adenomas
233
DUKES staging for colon cancer
A- spread to tissue of bowel wall 99% survive
B- all the way through muscularis propria
C1- lymph nodes (even if not all the way though)
C2- apical node 35% survive
D- Distant mets. 5%
234
HNPCC
dominant
younger
RIGHT SIDE
multiple
235
Amsterdam criteria
1. 2 first degree relatives with colorectal cancer
2. 2 successive generations
3. one of the cancers before 50 years
4. FAP excluded
236
FAP
will develop cancer unless we cut them out
entire colon affected
up to thousands
237
liver adenoma
women
associated with OCP
some may become malignant
238
focal nodular hyperplasia
mimics cirrhosis
central car
can become very large
women
239
hepatocellular carcinoma
most common liver cancer
| MEN
240
causes of HCC
```
cirrhosis
Hep B/C (common in Africa)
ASH/NASH
autoimmune hepatitis
A1antitripsin
Wilsons
```
241
HCC on histo
pseudoglandular formation
242
Fibrolamerllar HCC
young people
| no background cirrhosis
243
Hepatoblastoma
children under 5
male
AFP raised
lobulated
light and dark pattern
244
Angiosarcoma
```
rare
arsenic
anabolic steroids
vinyl
old men
```
245
Cholangiocarcioma
aggressive and deadly
chronic inflammation of bile ducts
round glandular
246
Hep A
faecal-oral
can be mild
can lead to liver failure
247
Hep B
body fluids
acute and chronic
can lead to cirrhosis
HCC
248
Hep C
blood
usually chronic
cirrhosis
HCC
249
Hep D
friends with B
| fulminant hepatitis
250
Hep E
food/water
acute/fulminant hepatitis
severe if PREGGERS!
251
fatty liver disease causese
alcohol
obesity
diabetes
drugs
252
fatty liver disease can lead to
fibrosis
cirrhosis
v.common!
253
autoimmune hepatitis
ALT raised.
IgG
ANA +
cirrhosis
254
primary sclerosing cholangitis
```
males AMA/p-ANCA
ulcerative colitis
inflammation and fibrosis of larger intra and extra hepatic bile ducts
can lead to cirrhosis
colon cancer
```
255
primary biliary sclerosis
women AMA
alk phos raised
small bile ducts
cirrhosis
256
Wilson's disease
chromosome 13
copper
childhood presentation
increased risk of HCC
257
Haemochromatosis
chromosome 6
iron
cirrhosis
increased risk of HCC
258
Alpha-1-antitrypsin
```
chromosome 14
protein accumulation in liver
fibrosis
cirrhosis
increased risk of HCC
```
259
how many lung lobes
L-2
R-3
10 segments each have a branch of the artery and a bronchus
260
hyaline membrane disease
preterms
surfactant
cyanosis after birth
261
hyaline histology
alveolar damage and formation of hyaline membrane
262
primary respiratory infection
no underlying cause
263
secondary respiratory infection
```
weakened immune
(loss of cough, ciliary defects, mucus, hypogammaglobulinaemia, pulmonary oedema)
```
264
chronic bronchitis
cough+sputum for 3m in 2 years
265
pneumonia histology
alveoli filled with suppurative exudate
266
abscess vs pneumonia
abscess- fluid filled cavity with pus and lined with granulation tissue (new RBCs and FBs)
267
causes of M.tuberculosis
```
m hominis
m bovis (milk/unpasteurised cheese)
```
268
types of TB
primary
secondary
miliary (mets)
269
TB on histology
```
granulomas
ZN stain (pink)
acid fast bacilli
caseating necrosis
Langerhans multinucleated giant cells are common
resists heat but killed by UV light.
```
270
define congestion
increased volume of blood in affected tissue or part
| not fluid like oedema
271
2 types of oedema
hemodynamic
| due to microvascular injury
272
hemodynamic oedema
increased hydrostatic pressure
decreased osmotic pressure
lymphatic drainage
273
increased hydrostatic pressure
left sided heart failure
mitral stenosis
volume overload
pulmonary vein obstruction
274
decreased osmotic pressure
hypoalbuminaemia (nephrotic etc)
275
oedema due to microvascular injury
infectious
toxins
liquid aspirate
etc.
276
diffuse injury to microvascularture of lungs:
ARDS
277
elderly more commonly have what type of pneumonia?
broncho
278
tidal volume
amount in/ex in normal breath
279
vital capacity
exhaled after max inhale
280
residual volume
air left in lung after ex
281
Total lung capacity
vital capacity and residual volume.
282
FEV1 reduced with
restrictive/obstructive
283
Forced expiratory ratio (FEV1:VC)
low in obstructive
284
obstructive airway diseases
emphysema
chronic bronchitis
bronchiectasis
asthma
285
restrictive airway disases
acute (ARDS)
| chest wall deformity
286
chronic bronchitis in adults caused by
cigarette
| h.influenza and strep pneumoniae
287
smoking and the lungs
decreased ciliary action
direct damage to epithelium
inhibits bacteria clearance
288
pathogenesis chronic bronchitis
```
bronchiolitis
destruction of wall around
centri lobular emphysema
hypersecretion of mucus (hypertrophy of glands)
increased number of goblet cells.
```
289
emphysema
permanent enlargement of airspaces distal to terminal bronchioles
destruction of walls
6 types
290
6 types of emphysema
```
centrilobular
panlobular
paraseptal
irregular
bullous
interstitial
```
291
what is an emphysema?
an air aneurysm
292
smoking causes what type of emphysema?
centri-lobular
bronchioles of upper lobes in particular
dust laden macrophages
293
panlobular emphysema
alpha-1-antitripsin people
all air spaces distal to terminal bronchioles
lower lobes
294
what does alpha 1 antritipsin do?
inhibits collagenase elastase and other proteases
295
paraseptal emphysema
upper lobes
| periphery of lobules
296
irregular emphysema
ACINUS
around old healed scars at apices
air trapping due to fibrosis
297
bullous emphysema
10mm diameter
298
interstitial emphysema
traumatic rupture of airway
can become sub-cutis
bubblewrap skin.
299
bronchiectasis
```
necrotizing
dilation
irreversible
lower lobes
cough-fever-foul smelling purulent sputum
```
300
causes of bronchiectasis
CF
Kartageners
foreign body
necrotizing pneumonia
301
atopic asthma histology
mucus plugs
CRUSCHMANN spirals
CHARCOT LEYDEN crystals
mucus gland hypertrophy
302
non-atopic asthma
aspirin induced
| bronchoconstrictor leukotrines
303
RF for bronchiogenic cancer
```
smoking
asbestos
radiation
oncogenes (C-myc and K-ras)
Scarring
```
304
layers of GI tract
musculais propria
submucosa
muscularis mucosa
mucosa
305
incisors to duodenum
40cm of oesophagus
306
reflux oesophagitis risk factors
```
hiatus hernia
peptic ulcer
smoking
alcohol
excessive vomiting
pregnancy
diabetes
```
307
complications of oesophagitis
stricture
barretts
neoplasia
308
achalasia
distal oesophagus
inflammatory destruction of myenteric ganglion cells
can lead to SCC
309
chagas disease
trypanosoma cruzi
| blood sucking bug
310
barretts metaplasia
replacement of squamous with glandular
| reflux of acid and bile
311
squamo columnar junction
length of barretts between SCJ and GEJ
312
4 types of barretts metaplasia
gastric cardia
gastric body
pancreatic (Rare)
intestinal (most cancerous)
313
oesophagus cancer
```
lower>upper>middle
men
mostly adenocarcinoma with 20% squamous
SCC- poor prognosis
adenocarcinoma- good prognosis
rare but lethal because patients present late
```
314
progression of barretts
normal squamous
barretts
dysplasia
adenocarcinoma
315
psueudo achalasia
stricture due to infection
316
which stomach bit has special cells?
body- glandular
| cardiac and antral have no special cells.
317
types of gastritis
A for autoimmune
B for bacterial
C for chemical
318
type A gastritis
chronic atrophic gastritis
| IM
319
type B gastritis
chronic superficial gastritis
320
type C gastritis
```
reflux gastritis (bile)
reactive gastritis (aspirin, NSAIDS, alcohol)
oedema telangiectasia and lack of inflammatory cells.
```
321
gastritis histology
changes in length of glands
increase size of blood vessels
fibrosis
minimal immune inflammation
322
diseases caused by H. pylori
gastritis
ulcer
MALT lymphoma
carcinoma
323
MALT lymphoma and h.pylori
eradiation of pylori with PPI and Abx can regree the lymphoma
324
gastric cancer progression
```
normal mucosa
h pylori creates superficial gastritis
atrophic gastritis
intestinal metaplasia (pre cancerous)
dysplasia
carcinoma
```
325
h pylori likes to hang out...
in the antrum
326
types of stomach cancer
adenocarcinoma
lymphoma
neuro-endocrine tumour
GIST
327
adenocarcinoma of the stomach
```
men
japan
diet (high salt)
h.pylori
poor prognosis if advanced
```
328
gastrointestinal stromal tumour
```
GIST
rare
stomach>small intestine>oesophagus
mutation of tyrosine kinase
give them TK inhibitors!
```
329
coeliac
intraepithelial lymphocytosis
| infiltration of lamina propria by plasma cells and lymphocytes
330
refractory sprue
in coeliac (non-responsive to gluten-free) can indicate developing ulcerative jejunitis
a precursor for lymphoma
ENTEROPATHY ASSOCIATED T CELL LYMPHOMA
331
commonest small bowel protozoa
giardiasis
contaminated water
more in AIDS
332
giardia histology
small intestine mucosa can be normal to inflammed
can see the little buggers
if seen suspect immunosupression
333
small bowel cancers
```
adenomas- benign, polyps
adenocarcinoma- coeliac, crohns, FAP
Lymphoma (b cell-Burkitt, EATL)
GIST
neuro endocrine tumours
```
334
neuroendocrine tumours
carcinoids
if functional and liver mets--carcinoid syndrome
vomiting
abdo pain
nausea
lethargy
335
coopers ligament
CT underlying pectoralis fascia to skin of breast
336
glandular element of breast divided into
branching duct system and
| terminal duct lobular units
337
secretory part of breast
TDLU
338
TDLU connects to
sub-segmental ducts then
segmental ducts to
collecting duct (lactiferous)
which empties to nipple
339
how many collecting ducts in breast?
15-20 per boob
340
ductal lobular normal histology breast
inner epithelium
outer myoepithelium
very different on histology
341
epithelial breast cells
epithelial membrane antigen
342
myoepithlial breast cells
best marker is actin
343
reticulin stain
for basement membrane in breast
344
inflammatory breast things
acute mastitis
chronic mastitis
mammary duct ectasia
fat necrosis
345
proliferative breast things
fibrocytic change
| radial scar
346
benign breast tumours
adenoma
fibroadenoma
papilloma
347
malignant breast tumours
carcinoma
sarcoma
Paget's disease
Phylloides
348
bloody nipple discharge
duct papilloma
| carcinoma
349
peau d'orange breast
carcinoma
| oedema
350
fibrocystic breast change
25-45
| hormonal
351
fibrocystic breast histology
```
TDLU
cysts
fibrosis
apocrine metaplasia
epithelial hyperplasia
calcification
```
352
fibroadenoma
commonest benign breast tumour
| 20-35
353
fibroadenoma histology
proliferating ducts
| connective tissue stroma
354
phylloides
```
leaf like
40-50
benign or malignant
mesenchymal bit is malignant
EXCISE OUT!
```
355
phylloides histology
epithelial and mesenchymal elements.
356
breast cancer RF
```
female
age
oestrogen
obesity
family history
BRCA 1 (17)
BRCA 2 (2)
```
357
BRCA 1
ovary and breast
358
insitu breast cancer
ductal
| lobular
359
invasive breast cancer
ductal
| lobular
360
paget's disease nipple
underlying ductal cancer in 2%
361
paget's nipple histology
involvment of epidermis by malignant ductal cancer cells.
362
breast screening
50-69
| 3 yearly mammogram
363
what is the marker for breast cancer?
microcalcification!
364
microcalcification
not always malignant
not all cancers
usually associated with ductal carcinoma in situ
365
breast cancer histology
stellate lesions
circumscribed soft tissue
density/mass
366
triple approach
breast clinicians
radiologists
pathologists
FNA
core biopsy
367
breast cancer CYTOLOGY staging
```
C1 inadequate
C2 benign
C3 atypia
C4 suspicious of malignancy
C5 Malignant
```
368
breast cancer HISTOLOGY staging
```
B1 normal
B2 benign
B3 benign but uncertain
B4 suspicious of malignancy
B5 malignant
```
a in situ
b invasive
369
babies of diabetic mums
macrosomia
perinatal death
malformation
hypertrophy of langerhans/b cell hyperplasia
370
b cells are stimulated by glucose....
after 24 weeks gestation
371
macrosomia
big organs (liver, heart, adrenals)
lots of fat
30% transient cardiomegaly
372
infants of insulin dependent mums are....
8x more likely to have major malformation
373
coloboma
keyhole in eye
374
diabetses and the placenta
single umbilical artery
villous maturity
villous oedema
variable villous vascularity
375
clinodactyly
curved 5th finger
376
AVSD and downs
deficient AV septum
377
complete AVSD
large ventricular component beneath either or both the superior or inferior bridging leaflets of the AV valve. The defect involves the whole area of the junction of the upper and lower chambers of the heart
378
partial AVSD
In the partial AVSD, there is a defect in the primum or inferior part of the atrial septum but no direct intraventricular communication
379
anencephaly
missing major bit of brain
380
encephalocele
sac like protrusions from the brain
381
hydranencephaly
brain's cerebral hemispheres are absent to varying degrees and the remaining cranial cavity is filled with cerebrospinal fluid
382
iniencephaly
a defect to the occipital bone, spina bifida of the cervical vertebrae and retroflexion (backward bending) of the head on the cervical spine
383
hyrtl anastomosis
unique communicating vessel between 2 umbilical arteries that regulates even distribution
384
wharton's jelly
mucus
connective tissue in umbilical cord
gelly
insulates umbilical blood vessels.
385
furcate cord insertion
umbilical vessels separate and fork
lose protection from Wharton's Jelly
liable to thrombosis and damage
386
velamentous cord insertion
the umbilical cord inserts into the fetal membranes (choriamniotic membranes) not the usual middle of placenta
387
amnion
innermost membrane that encloses the embryo
388
chorion
the outermost membrane surrounding an embryo
389
decidua
the thick layer of modified mucous membrane which lines the uterus
390
yolk sac
a membranous sac containing yolk attached to the embryos
391
amnion nodules
nodules on the fetal surface of the amnion, and is frequently present in oligohydramnios
392
circummarginate
insertion of the membranes away from the placenta without a distinct ridge at the point of insertion
393
chorion frondosum
the embryonic portion of the placenta
394
cotyledon
Each cotyledon consists of a main stem of a chorionic villus as well as its branches and subbranches
395
hofbauer cells
oval eosinophilic histiocytes with granules and vacuoles found in the placenta, which are of mesenchymal origin, in mesoderm of the chorionic villus, particularly numerous in early pregnancy.
396
testes lymph
para-aortic
397
testicular lobules
250
| each has 4 seminiferous tubules
398
seminiferous tubules contain
sertoli cells and germ cells
399
sperm
spermatagonium
spermatocyte
spermatid
spermatazoon
400
interstitium cells testes
Leydig cells
401
rete testis
hilus
receives luminal contents from tubules
emptes to efferent ducts
402
efferent ducts
12-15 tubules in head of epididymus
403
epididymus
connects efferent ducts to vas deferens
404
vas deferens
empties into prostatic urethral at
| velumontanum
405
cryptorchidism
most unilateral
sterility
germ cell tumours
need to operate before 6 years
406
mumps orchitis
painful due to stretched tunical albugenia
| usually tests become atrophic and bilateral infertility
407
idiopathic granulomatous orchiditis
uncommon
unilateral
middle aged men
reaction to extravasated sperm??
408
syphilis orchitis
rare
| granulamatou inflammation with central necrosis (gumma)
409
ecto/endo/meso
ecto- skin, brain, spinal cord
meso- everything else except...
endo- gut
410
most germ cell tumours are
malignant.
| painless unilateral testes enlargement
411
kleinfelters increases your risk of
germ cell tumours
412
types of germ cell tumours
```
in situ (intratubular)
invasive
```
413
invasive germ cell tumours
seminoma
non-seminiferoud (embyo, yolk sac, chorio, teratoma)
mixed
414
seminoma vs. non seminoma treatment
seminoma- radiotherapy
| non-seminoma- chemotherapy
415
commonest type of testicular tumour
seminoma
416
classical seminoma histology
sheets of rounded cells with clear cytoplasm and variable lymphocytic infiltrate
417
spermatocytic seminoma
old
mixed population of small, intermediate and giant cells
good prognosis
418
non-seminiferous EMBRYONAL
20-30 years
aggressive
cells are anaplastic and arranged in glands, alvoli, solid or papillary growth.
usually mixed.
419
non-seminiferous YOLK SAC
<3years
Schiller-Duval bodies
serum AFP raised
420
non-seminiferous CHORIOCARCINOMA
rarely pure form
cyto and syncitioblasts
MALIGNANT hightly
raised hCG
421
non-seminiferous TERATOMA
can have mature or immature tissue
second most common in kids
good prognosis
adult form rare
422
mixed testicular tumours
treated as non-seminoma
423
spread of testicular tumours
```
rete testis
epididymus
para-aortic lymph
mediastinal lymph
lung, liver, bone
```
424
staging germ cell tumours
1: testis
2. testis+para aortic
3. testis +mediastinal or sypraclavicular lymph
4. mets
425
prostate anatomy
5 lobes
inner zone- nodular hyperplasia
outerzone- carinoma
426
increased weight of prostate in BPH
60-100gms (from 20)
427
prostate cancer aetiology
blacks>whites>asians
428
gleason's score
grading the growth pattern
429
staging prostate cancer
A not palpable
B palpable confined
C extracapsular
D metastasis
430
normal PSH
50-60 <5
