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Year 5 Pathology > Histopathology > Flashcards

Histopathology Flashcards

1
Q

Stages of Atherosclerotic Plaque formation

A
  1. Endothelial cell injury
  2. Inflamm response in vessel wall: oxidized LDL
  3. Formation stable plaque: vascular smooth muscle phenotype shift
  4. Stenosis or plaque rupture
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2
Q

Non-modifiable risk factors for atherosclerosis

A

Age, sex (M), FHx, type A personality, estrogen deficiency

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3
Q

Modifiable risk factors for atherosclerosis

A

HTN, DM, smoking, hypercholesterolemia, inactivity, lipoprotein Lp(a)

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4
Q

How to differentiate unstable angina from NSTEMI

A

Troponin (raised in NSTEMI)

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5
Q

Signs thrombosis

A

Hx claudication, signs vasc insufficiency, hard arteries, onset over a few hours

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6
Q

Possible sequelae of HTN

A

Hypertensive retinopathy/encephalopathy/cardiomyopathy/nephropathy
CVA, MI
Increased glucose levels

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7
Q

Major causes LV Failure

A

IHD, HTN, valve disease, myocardial disease

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8
Q

Consequences LV failure

A

Pulmonary congestion and edema
Reduced renal perfusion –>salt and water retention, ATN
Reduced CNS perfusion –>encephalopathy

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9
Q

Causes RV failure

A

Left sided failure

Chronic lung pathology–cor pulmonale

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10
Q

Consequences RV failure

A

Portal, systemic, and peripheral congestion
TR
Renal congestion (R>L)

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11
Q

Sequelae HCM

A

Arrhythmias (AF) and sudden death, LV outflow obstruction, CHF

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12
Q

Signs and Sxs HCM

A

Syncope, HF, jerky pulse, double apical impulse, ESM (+/- pansystolic from MR)

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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

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14
Q

Aschoff body

A

Focus of fibrinoid necrosis

Seen in rheumatic fever

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15
Q

Type I respiratory failure-causes

A

Severe pneumonia, PE, asthma, fibrosis, LVF

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16
Q

Type II respiratory failure-causes

A

COPD, neuromuscular disease, severe acute asthma

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17
Q

ECG sign of PE

A

S1Q3T3 (on exams, not real life)

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18
Q

Definition pulmonary hypertension

A

> 25mmHg at rest

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19
Q

Macroscopic findings in asthma

A

Overinflated chest, pathy atelectasis, mucus plugs

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20
Q

Microscopic findings in asthma

A

Edema, eosinophilic infiltrates, smooth muscle and mucosal gland hypertrophy

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21
Q

Chronic bronchitis

A

Chronic cough with sputum production. Most days >3/12 for at least 2 years

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22
Q

Emphysema affects which part of lung

A

Parenchyma distal to terminal bronchioles

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23
Q

Causes bronchiectasis

A

Congenital: CF, severe immunodefic
Acquired: post-infectious, bronchial obstruction

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24
Q

Complications bronchiectasis

A

Chronic H flu infxn,
secondary staph aureus/m catarrhalis/pseudomonas infxn
RVF
Amyloidosis

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25
Q

Extrinsic allergic alveolitis

A

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

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26
Q

Pneumoconioses

A

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

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27
Q

AI causes of pulm fibrosis

A 
Sarcoidosis: non-caseating granulomas and multisystem disease
RA
SLE
Systemic sclerosis
Ank spon
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28
Q

Drug causes of pulmonary fibrosis

A

Bleomycin, Amiodarone, MTX

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29
Q

Non-small cell types of lung cancer

A

Squamous
Adenocarcinoma
Large cell
Undifferentiated/alveolar

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30
Q

Cause of primary spontaneous pneumothorax

A

Apical blebs

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31
Q

Causes of secondary spontaneous pneumothorax

A

COPD, asthma, pulm fibrosis, lung ca

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32
Q

Acquired causes pneumothorax

A

Traumatic, Iatrogenic (central lines, pleural aspiration, barotraumas, pacing wires)

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33
Q

Hepatic failure-definition

A

Clinical syndrome when >90% fn’al capacity of liver is lost

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34
Q

Common causes of acute liver failure

A 
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)
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35
Q

Clinical features acute liver failure

A

Hepatic encephalopathy, irritability/sleep disturbance/disorientation/coma, coagulopathy, conjugated jaundice, infxn (sepsis + MOF), Hepato-renal syndrome/hepato-pulmonary syndrome, progressive fibrosis, cirrhosis

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36
Q

Cirrhosis triad

A

Fibrosis, nodules regenerating hepatocytes, distortion liver architecture

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37
Q

Mech by which EtOH causes liver damage

A

Metabolic byproducts activate hepatic stellate cells, causing fibrosis

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38
Q

Features hemochromatosis

A

Liver: cirrhosis, HCC
Heart: CCF, arrhythmias, constrictive pericarditis
Endocrine: DM, panhypopituitarism, hypogonadotropism, loss libido
Joints: Chondrocalcinosis

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39
Q

PBC

A 
Women>Men
Intrahepatic bile ducts (cholangiocytes)
Pruritis
Raised ALP and GGT
Anti-mitochondrial/IgM Abs
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40
Q

PSC

A

Sclerosis of intra- and extrahepatic ducts
Assoc w UC (75%)
Isolated raised ALP
Risk cholangiocarcinoma

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41
Q

Benign hepatic tumors

A

Hemangioma-most common

Liver cell adenoma

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42
Q

Hepatic hemangioma

A

3% population

Asymptomatic

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43
Q

Liver cell adenoma

A

Young women on COC

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44
Q

Malignant hepatic tumors

A

HCC

Cholangiocarcinoma

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45
Q

HCC

A

Develops on background of cirrhosis/chronic inflamm

1/3 have DNA mismatch repair defect

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46
Q

Cholangiocarcinoma

A

Malignancy of intrahepatic bile ducts
Non-specific presentation: jaundice, weight loss, pruritis, pain
Presents late w/ poor prognosis

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47
Q

Mech and presentation of annular pancreas

A

Failure of ventral bud to migrate

Presents in infancy similarly to pyloric stenosis

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48
Q

Pancreas divisum

A

Incomplete fusion ventral and dorsal buds

Predisposes to chronic pancreatitis, pancreatic ca

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49
Q

Risk factors for reflux esophagitis/GERD

A

Increased IAP: obesity, posture, large meals, EtOH

Hiatus Hernia

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50
Q

Complications GERD

A

Peptic stricture (scarring)
Barret’s (10%)-columnar metaplasia
Adenocarcinoma

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51
Q

Squamous cell esophageal carcinoma-risk factrs and part esoph affected

A

RF: smoking, EtOH, achalasia

Middle third of esoph

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52
Q

Adenocarcinoma of esoph

A

Glandular differentiation
RF: Batrret’s
Lower third esoph

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53
Q

Diffuse gastric adenocarcinoma

A

Normal mucosa
Signet rings cells
Highly infiltrative and aggressive

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54
Q

Gastric lymphoma

A

H pylori
Can lead to marginal cell lymphoma
Responds to Abx

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55
Q

Stromal tumors-cellular path

A

CT origin
Over-expression of Tyr Kin KIT
Exophytic
May be treated with Imantinib

56
Q

Mech celiac disease

A

Inappropriate T cell driven inflamm ->lymphocytic enteritis

57
Q

Extra-intestinal manifestations of IBD

A

Arthritis (ank spon)
Erythema nodosum
Uveitis

58
Q

Concussion damages what structure

A

RAS

59
Q

Diffuse axonal injury

A

Stretching and tearing white matter

Post-traumatic dementia and vegetative states

60
Q

Contusion

A

Hemorrhages on superficial brain structures

Coup and contrecoup

61
Q

Traumatic intracerebral hemorrhage

A

Deep contusions

Assoc with diffuse axonal injury, edema, and SAH

62
Q

Causes cerebral edema

A

Idiopathic
Generalized: Hypoxia, Metabolic disturbance, Trauma, HTN
Local: ischemia, hematomas, tumors

63
Q

Clinical features cerebral edema

A

HA (stretch of receptors around intracranial BVs)-worse in AM and on moving, vomiting (stimulation centres on ponds/medulla), papilledema

64
Q

Complications cerebral edema

A

Vascular damage (central v occlusion –> papilledema, hemorrhage/infarct), CN III/IV damage, CSF outflow obstruction, herniation

65
Q

Benign intracranial HTN

A

HA + papilledema

No focal neurology

66
Q

Gliomas

A

Astrocytomas (60%).

Most common type brain tumor. Slow initially, agressive with time

67
Q

Oligodendrogliomas

A

Slow growing with calcification

Epilepsy

68
Q

Ependymomas

A

Lining of ventricles –>CSF blockage

69
Q

Meningiomas

A

From arachnoid cells.
Most comm adjacent to sinuses
Slow growing but incessant
Lead to compression and skull erosion

70
Q

Neuroepithelial neoplasms

A

Common in kids

Medulloblastoma, Rb, neuroblastoma, ganglioblastoma

71
Q

Alzheimers

A

Short term memory loss
Dysphasia and dyspraxia
Persecutory beliefs
5-10 year survival

72
Q

Vascular dementia

A

Personality change, labile mood, preserved insight.

Stepwise progression

73
Q

Lewy Body dementia

A

Fluctuating cognition, visual hallucinations, parkinsonism.

Worsened by anti-psychs

74
Q

Pick’s disease

A

Frontal lobe/executive fn impairment
Personality change
Preserved memory
Slow progression

75
Q

CJD

A

Seizures, cerebellar ataxia, myoclonic jerks

76
Q

MND

A 
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
Q

Tx for Cushings

A

Decrease steroids, ketoconazole, metyrapone, trilostane

78
Q

MEN I

A

Pituitary adenoma, parathyroid hyperplasia, pancreatic islet tumors

79
Q

MEN IIA

A

Pheo, medullary thyroid, hyperparathyroidism

80
Q

MEN IIB

A

Pheo, medullary thyroid, mucosal neuromas

81
Q

Signs embolism

A

Recent MI, AF, aneurysm; soft artery, bruits, onset over seconds. No evidence previous disease

82
Q

Hemosiderin laden macrophages

A

Aka heart failure cells

Seen mostly in Left heart failure

83
Q

Nutmeg liver

A

Hepatocongestion.

Seen in right heart failure

84
Q

Dressler’s syndrome

A

AI complication 4w post-MI.

CP, fever, pericardial rub

85
Q

Aschoff bodies

A

Granulomas seen in RhF

86
Q

Anitschkow cells

A

Enlarged macrophages in Aschoff bodies.

RhF

87
Q

Monckeberg arteriosclerosos

A

Focal calcification of media (small-med arteries)
>50 years
No inflamm

88
Q

Oat cells

A

Seen in small cell lung carcinoma

89
Q

Hyaline membrane disease

A

Aka respiratory distress syndrome

Pre-term neonates. Surfactant deficiency causes hyaline deposition and hypoxia

90
Q

AA amyloid

A

Associated with inflamm

91
Q

AL amyloid

A

Derived from IgG light chains

Associated with myeloma

92
Q

Alpha-beta2 amyloid

A

Alzheimer’s

93
Q

Beta2 micro globulin amyloid

A

Dialysis patients

94
Q

Duret hemorrhages associated with what complication?

A

Tectorial or tonsillar herniation due to tearing of vessels

95
Q

“Rubber hose wall” of bowel

A

Crohns

96
Q

Peptic ulcers versus erosions

A

Erosions heal in days and go into mucosa only

Ulcers take weeks to heal and extend into submucosa

97
Q

Chronic gastritis

A

H pylori or AI
Lymphocyte infiltration or intestinal metaplasia
Risk carcinoma or MALT lymphoma

98
Q

Gardner’s

A

FAP + osteomas + epidermoid cysts + desmoid tumors

99
Q

Micronodular liver cirrhosis

A
100
Q

Macronodular liver cirrhosis

A

> 3mm

Viral

101
Q

ATP7B mutation

A

Wilson’s disease

102
Q

HFE gene mutation

A

Hemochromatosis

103
Q

Cholangiocarcinoma

A

Adenocarcinoma of bile ducts

RF: PSC, live flukes, medical contrast media

104
Q

Erythema multiforme

A

HSR secondary to infection (HSV, mycoplasma, fungi) or drugs (penicillin, phenytoin, barbiturates)

105
Q

Munro-abscesses

A

Psoriasis

106
Q

Subtypes melanoma

A

Lentigomaligna
Acrallentiginous
Superficial spreading
Nodular

107
Q

Bowens disease

A

Squamous carcinoma in situ

108
Q

Pityriasis rosea

A

Single scaly salmon colored macule (herald patch)

Then multiple in fir tree distribution

109
Q

Nephritic syndrome

A 
Hematuria
Red and white cell casts (tamm horsefall secretions)
Dysmorphic red cells
Oliguria
HTN
110
Q

Muddy (brown) casts (urine)

A

Acute tubular necrosis

111
Q

IgA nephropathy versus post-strep glomeruli nephritis

A

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
Q

Spike and dome deposits on renal question

A

Membranous glomerulonephritis

113
Q

Duct ectasia

A

Green/white discharge from breasts.

>40 multips

114
Q

Fibroadenomas

A

Mixed tumors.
Rapid growth in pregnancy and menstrual cycle.
Very mobile,

115
Q

DCIS

A

Focal area calcification on mammogram and central necrosis

116
Q

Phylloides tumor

A 
Mixed tumor
Discrete, well circumscribed, mobile
>5cm
>40 years
Artichoke like (or leaf like)
Can be malignant
117
Q

Infiltrating ductal carcinoma

A

Painful lump

May have Paget’s disease of breast, tethering, nipple retraction, LAD, ulceration of mass.

118
Q

Mastitis

A

Tender to touch, erythematous, edema.
S. Aureus
Breastfeeding mothers.

119
Q

Giant cell tumor

A

Borderline malignant tumor of osteoclasts.
Lytic lesions in epiphyses (ESP KNEE)
Soap bubble

120
Q

Signs osteomalacia

A

Pseudofractures (looser zones), craniotabes, bone pain, prox weakness

121
Q

McCune Albright

A

Cafe-au-lait spots (unilateral)
Precocious puberty
Fibrous dysplasia

122
Q

Renal osteodystrophy

A

Secondary hyperparathyroidism

Due to build-up of phosphate, damage to 1-a-hydroxylase, osteosclerosis, aluminum toxicity

123
Q

Ortner’s syndrome

A

Mitral stenosis, enlarged LA, laryngeal nerve palsy

124
Q

Bone pain + soap bubble + shepherd’s crook + Chinese letter trabeculae

A

Fibrous dyplasia

125
Q

Endochondroma

A

Benign intramedullary cartilage tumor. Oft hands and feet
Oft asxs
If sxs-pain, fractures, swelling

126
Q

Osteosarcoma

A

Pain and mass near joint
Increased ALP
Codman’s triangle

127
Q

Comminuted fracture

A

Bone splintered

Soft tissue ok

128
Q

Greenstick fracture

A

PAEDS.
Abuse
Transverse

129
Q

Compound fracture

A

Open

Penetrates skin surface (infection risk)

130
Q

Transverse fracture

A

Partial or complete

Oft simple, clean break

131
Q

Impacted fracture

A

Fracture site “crushed” inwards

132
Q

Chemo for Her2/neu positive breast cancer

A

Trastuzumab

133
Q

Intraductal papilloma

A

Bloody discharge
Premenopausal women
Benign (note -oma…not carcinoma)

134
Q

Paget’s disease of breast

A

DCIS that extends up duct to skin/nipple

Almost always associated with underlying carcinoma

135
Q

Periductal mastitis

A

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

Year 5 Pathology (6 decks)

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