Histopathology Flashcards
1
Q
Stages of Atherosclerotic Plaque formation
A
- Endothelial cell injury
- Inflamm response in vessel wall: oxidized LDL
- Formation stable plaque: vascular smooth muscle phenotype shift
- Stenosis or plaque rupture
2
Q
Non-modifiable risk factors for atherosclerosis
A
Age, sex (M), FHx, type A personality, estrogen deficiency
3
Q
Modifiable risk factors for atherosclerosis
A
HTN, DM, smoking, hypercholesterolemia, inactivity, lipoprotein Lp(a)
4
Q
How to differentiate unstable angina from NSTEMI
A
Troponin (raised in NSTEMI)
5
Q
Signs thrombosis
A
Hx claudication, signs vasc insufficiency, hard arteries, onset over a few hours
6
Q
Possible sequelae of HTN
A
Hypertensive retinopathy/encephalopathy/cardiomyopathy/nephropathy
CVA, MI
Increased glucose levels
7
Q
Major causes LV Failure
A
IHD, HTN, valve disease, myocardial disease
8
Q
Consequences LV failure
A
Pulmonary congestion and edema
Reduced renal perfusion –>salt and water retention, ATN
Reduced CNS perfusion –>encephalopathy
9
Q
Causes RV failure
A
Left sided failure
Chronic lung pathology–cor pulmonale
10
Q
Consequences RV failure
A
Portal, systemic, and peripheral congestion
TR
Renal congestion (R>L)
11
Q
Sequelae HCM
A
Arrhythmias (AF) and sudden death, LV outflow obstruction, CHF
12
Q
Signs and Sxs HCM
A
Syncope, HF, jerky pulse, double apical impulse, ESM (+/- pansystolic from MR)
13
Q
ARVD
- cause
- genes
- consequences
A
Inflamm and thinning of RV wall. Fibrofatty replacement
Usu AD mutation in cell adhesion genes
Consequences: Arrhythmia, CCF
14
Q
Aschoff body
A
Focus of fibrinoid necrosis
Seen in rheumatic fever
15
Q
Type I respiratory failure-causes
A
Severe pneumonia, PE, asthma, fibrosis, LVF
16
Q
Type II respiratory failure-causes
A
COPD, neuromuscular disease, severe acute asthma
17
Q
ECG sign of PE
A
S1Q3T3 (on exams, not real life)
18
Q
Definition pulmonary hypertension
A
> 25mmHg at rest
19
Q
Macroscopic findings in asthma
A
Overinflated chest, pathy atelectasis, mucus plugs
20
Q
Microscopic findings in asthma
A
Edema, eosinophilic infiltrates, smooth muscle and mucosal gland hypertrophy
21
Q
Chronic bronchitis
A
Chronic cough with sputum production. Most days >3/12 for at least 2 years
22
Q
Emphysema affects which part of lung
A
Parenchyma distal to terminal bronchioles
23
Q
Causes bronchiectasis
A
Congenital: CF, severe immunodefic
Acquired: post-infectious, bronchial obstruction
24
Q
Complications bronchiectasis
A
Chronic H flu infxn,
secondary staph aureus/m catarrhalis/pseudomonas infxn
RVF
Amyloidosis
25
Extrinsic allergic alveolitis
Hypersensitivity penumonitis: immune rxn from inhaled antigens
Occupation related: farmers lung (thermophilic actinomyces), Bird fancier's lung (avian proteins).
Interstitial pneumonitis and non-caseating granulomas
26
Pneumoconioses
Inflamm lung conditions caused by inhalation of mineral dusts
30 yr lag period
Types:
-Coal dust (coal miners): lung nodules and massive fibrosis
-Silicosis: nodular fibrosis
-Asbestosis
27
AI causes of pulm fibrosis
```
Sarcoidosis: non-caseating granulomas and multisystem disease
RA
SLE
Systemic sclerosis
Ank spon
```
28
Drug causes of pulmonary fibrosis
Bleomycin, Amiodarone, MTX
29
Non-small cell types of lung cancer
Squamous
Adenocarcinoma
Large cell
Undifferentiated/alveolar
30
Cause of primary spontaneous pneumothorax
Apical blebs
31
Causes of secondary spontaneous pneumothorax
COPD, asthma, pulm fibrosis, lung ca
32
Acquired causes pneumothorax
Traumatic, Iatrogenic (central lines, pleural aspiration, barotraumas, pacing wires)
33
Hepatic failure-definition
Clinical syndrome when >90% fn'al capacity of liver is lost
34
Common causes of acute liver failure
```
Acute viral hepatitis (AST >1000): Hep A/B/C, CMV, EBV
Alcoholic hep (AST >300, increased GGT and MCV), drug related hep (paracetamol, NSAIDs, Abx)
```
35
Clinical features acute liver failure
Hepatic encephalopathy, irritability/sleep disturbance/disorientation/coma, coagulopathy, conjugated jaundice, infxn (sepsis + MOF), Hepato-renal syndrome/hepato-pulmonary syndrome, progressive fibrosis, cirrhosis
36
Cirrhosis triad
Fibrosis, nodules regenerating hepatocytes, distortion liver architecture
37
Mech by which EtOH causes liver damage
Metabolic byproducts activate hepatic stellate cells, causing fibrosis
38
Features hemochromatosis
Liver: cirrhosis, HCC
Heart: CCF, arrhythmias, constrictive pericarditis
Endocrine: DM, panhypopituitarism, hypogonadotropism, loss libido
Joints: Chondrocalcinosis
39
PBC
```
Women>Men
Intrahepatic bile ducts (cholangiocytes)
Pruritis
Raised ALP and GGT
Anti-mitochondrial/IgM Abs
```
40
PSC
Sclerosis of intra- and extrahepatic ducts
Assoc w UC (75%)
Isolated raised ALP
Risk cholangiocarcinoma
41
Benign hepatic tumors
Hemangioma-most common
| Liver cell adenoma
42
Hepatic hemangioma
3% population
| Asymptomatic
43
Liver cell adenoma
Young women on COC
44
Malignant hepatic tumors
HCC
| Cholangiocarcinoma
45
HCC
Develops on background of cirrhosis/chronic inflamm
| 1/3 have DNA mismatch repair defect
46
Cholangiocarcinoma
Malignancy of intrahepatic bile ducts
Non-specific presentation: jaundice, weight loss, pruritis, pain
Presents late w/ poor prognosis
47
Mech and presentation of annular pancreas
Failure of ventral bud to migrate
| Presents in infancy similarly to pyloric stenosis
48
Pancreas divisum
Incomplete fusion ventral and dorsal buds
| Predisposes to chronic pancreatitis, pancreatic ca
49
Risk factors for reflux esophagitis/GERD
Increased IAP: obesity, posture, large meals, EtOH
| Hiatus Hernia
50
Complications GERD
Peptic stricture (scarring)
Barret's (10%)-columnar metaplasia
Adenocarcinoma
51
Squamous cell esophageal carcinoma-risk factrs and part esoph affected
RF: smoking, EtOH, achalasia
| Middle third of esoph
52
Adenocarcinoma of esoph
Glandular differentiation
RF: Batrret's
Lower third esoph
53
Diffuse gastric adenocarcinoma
Normal mucosa
Signet rings cells
Highly infiltrative and aggressive
54
Gastric lymphoma
H pylori
Can lead to marginal cell lymphoma
Responds to Abx
55
Stromal tumors-cellular path
CT origin
Over-expression of Tyr Kin KIT
Exophytic
May be treated with Imantinib
56
Mech celiac disease
Inappropriate T cell driven inflamm ->lymphocytic enteritis
57
Extra-intestinal manifestations of IBD
Arthritis (ank spon)
Erythema nodosum
Uveitis
58
Concussion damages what structure
RAS
59
Diffuse axonal injury
Stretching and tearing white matter
| Post-traumatic dementia and vegetative states
60
Contusion
Hemorrhages on superficial brain structures
| Coup and contrecoup
61
Traumatic intracerebral hemorrhage
Deep contusions
| Assoc with diffuse axonal injury, edema, and SAH
62
Causes cerebral edema
Idiopathic
Generalized: Hypoxia, Metabolic disturbance, Trauma, HTN
Local: ischemia, hematomas, tumors
63
Clinical features cerebral edema
HA (stretch of receptors around intracranial BVs)-worse in AM and on moving, vomiting (stimulation centres on ponds/medulla), papilledema
64
Complications cerebral edema
Vascular damage (central v occlusion --> papilledema, hemorrhage/infarct), CN III/IV damage, CSF outflow obstruction, herniation
65
Benign intracranial HTN
HA + papilledema
| No focal neurology
66
Gliomas
Astrocytomas (60%).
| Most common type brain tumor. Slow initially, agressive with time
67
Oligodendrogliomas
Slow growing with calcification
| Epilepsy
68
Ependymomas
Lining of ventricles -->CSF blockage
69
Meningiomas
From arachnoid cells.
Most comm adjacent to sinuses
Slow growing but incessant
Lead to compression and skull erosion
70
Neuroepithelial neoplasms
Common in kids
| Medulloblastoma, Rb, neuroblastoma, ganglioblastoma
71
Alzheimers
Short term memory loss
Dysphasia and dyspraxia
Persecutory beliefs
5-10 year survival
72
Vascular dementia
Personality change, labile mood, preserved insight.
| Stepwise progression
73
Lewy Body dementia
Fluctuating cognition, visual hallucinations, parkinsonism.
| Worsened by anti-psychs
74
Pick's disease
Frontal lobe/executive fn impairment
Personality change
Preserved memory
Slow progression
75
CJD
Seizures, cerebellar ataxia, myoclonic jerks
76
MND
```
Progressive w/in 5 yrs
Bulbar
UMN and LMN
Group of neurodegenerative disorders, the most common of which is ALS
Cause ?glutamate receptor/apoptosis
```
77
Tx for Cushings
Decrease steroids, ketoconazole, metyrapone, trilostane
78
MEN I
Pituitary adenoma, parathyroid hyperplasia, pancreatic islet tumors
79
MEN IIA
Pheo, medullary thyroid, hyperparathyroidism
80
MEN IIB
Pheo, medullary thyroid, mucosal neuromas
81
Signs embolism
Recent MI, AF, aneurysm; soft artery, bruits, onset over seconds. No evidence previous disease
82
Hemosiderin laden macrophages
Aka heart failure cells
| Seen mostly in Left heart failure
83
Nutmeg liver
Hepatocongestion.
Seen in right heart failure
84
Dressler's syndrome
AI complication 4w post-MI.
| CP, fever, pericardial rub
85
Aschoff bodies
Granulomas seen in RhF
86
Anitschkow cells
Enlarged macrophages in Aschoff bodies.
| RhF
87
Monckeberg arteriosclerosos
Focal calcification of media (small-med arteries)
>50 years
No inflamm
88
Oat cells
Seen in small cell lung carcinoma
89
Hyaline membrane disease
Aka respiratory distress syndrome
| Pre-term neonates. Surfactant deficiency causes hyaline deposition and hypoxia
90
AA amyloid
Associated with inflamm
91
AL amyloid
Derived from IgG light chains
| Associated with myeloma
92
Alpha-beta2 amyloid
Alzheimer's
93
Beta2 micro globulin amyloid
Dialysis patients
94
Duret hemorrhages associated with what complication?
Tectorial or tonsillar herniation due to tearing of vessels
95
"Rubber hose wall" of bowel
Crohns
96
Peptic ulcers versus erosions
Erosions heal in days and go into mucosa only
| Ulcers take weeks to heal and extend into submucosa
97
Chronic gastritis
H pylori or AI
Lymphocyte infiltration or intestinal metaplasia
Risk carcinoma or MALT lymphoma
98
Gardner's
FAP + osteomas + epidermoid cysts + desmoid tumors
99
Micronodular liver cirrhosis
100
Macronodular liver cirrhosis
>3mm
| Viral
101
ATP7B mutation
Wilson's disease
102
HFE gene mutation
Hemochromatosis
103
Cholangiocarcinoma
Adenocarcinoma of bile ducts
| RF: PSC, live flukes, medical contrast media
104
Erythema multiforme
HSR secondary to infection (HSV, mycoplasma, fungi) or drugs (penicillin, phenytoin, barbiturates)
105
Munro-abscesses
Psoriasis
106
Subtypes melanoma
Lentigomaligna
Acrallentiginous
Superficial spreading
Nodular
107
Bowens disease
Squamous carcinoma in situ
108
Pityriasis rosea
Single scaly salmon colored macule (herald patch)
| Then multiple in fir tree distribution
109
Nephritic syndrome
```
Hematuria
Red and white cell casts (tamm horsefall secretions)
Dysmorphic red cells
Oliguria
HTN
```
110
Muddy (brown) casts (urine)
Acute tubular necrosis
111
IgA nephropathy versus post-strep glomeruli nephritis
Extremely similar on exam questions.
Main differentiator is how often after resp infection....DAYS for IgA and weeks for PSGN.
IgA can also be preceded by GI infections
IgA also usually happens multiple times, irregularly but every few months until eventually subsides (won't usually give you this on exam)
112
Spike and dome deposits on renal question
Membranous glomerulonephritis
113
Duct ectasia
Green/white discharge from breasts.
| >40 multips
114
Fibroadenomas
Mixed tumors.
Rapid growth in pregnancy and menstrual cycle.
Very mobile,
115
DCIS
Focal area calcification on mammogram and central necrosis
116
Phylloides tumor
```
Mixed tumor
Discrete, well circumscribed, mobile
>5cm
>40 years
Artichoke like (or leaf like)
Can be malignant
```
117
Infiltrating ductal carcinoma
Painful lump
| May have Paget's disease of breast, tethering, nipple retraction, LAD, ulceration of mass.
118
Mastitis
Tender to touch, erythematous, edema.
S. Aureus
Breastfeeding mothers.
119
Giant cell tumor
Borderline malignant tumor of osteoclasts.
Lytic lesions in epiphyses (ESP KNEE)
Soap bubble
120
Signs osteomalacia
Pseudofractures (looser zones), craniotabes, bone pain, prox weakness
121
McCune Albright
Cafe-au-lait spots (unilateral)
Precocious puberty
Fibrous dysplasia
122
Renal osteodystrophy
Secondary hyperparathyroidism
| Due to build-up of phosphate, damage to 1-a-hydroxylase, osteosclerosis, aluminum toxicity
123
Ortner's syndrome
Mitral stenosis, enlarged LA, laryngeal nerve palsy
124
Bone pain + soap bubble + shepherd's crook + Chinese letter trabeculae
Fibrous dyplasia
125
Endochondroma
Benign intramedullary cartilage tumor. Oft hands and feet
Oft asxs
If sxs-pain, fractures, swelling
126
Osteosarcoma
Pain and mass near joint
Increased ALP
Codman's triangle
127
Comminuted fracture
Bone splintered
| Soft tissue ok
128
Greenstick fracture
PAEDS.
Abuse
Transverse
129
Compound fracture
Open
| Penetrates skin surface (infection risk)
130
Transverse fracture
Partial or complete
| Oft simple, clean break
131
Impacted fracture
Fracture site "crushed" inwards
132
Chemo for Her2/neu positive breast cancer
Trastuzumab
133
Intraductal papilloma
Bloody discharge
Premenopausal women
Benign (note -oma...not carcinoma)
134
Paget's disease of breast
DCIS that extends up duct to skin/nipple
| Almost always associated with underlying carcinoma
135
Periductal mastitis
SMOKERS. Have relative Vit A deficiency--need vit A to maintain epithelial cells....keratin plugs....infection behind block. Causes mass
Presents with subareaolar mass and nipple retraction
