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Histopathology Flashcards

1
Q

Atherosclerosis

A

chronic inflammation in intima of large arteries, characterised by intimal thickening and lipid accumulation

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2
Q

7 steps of atherogensis

A
  1. endothelial injury 2. LDL enters intima and is trapped 3. LDL is coverted into oxidised LDL causing inflammation 4. Macrophages take up oxLDL -> foam cells 5. apoptosis of foam cells cause inflammation and cholesterol core of plaque 6. increase in adhesion molecules on endothelium attracts more macrophages and T cells enetering the plaque 7. Vascular smooth muscle cells form the fibrous cap
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3
Q

Artheroslerotic plaques - 3 components

A
  1. Cells (macrophages, smooth muscle cells, leukocytes) 2. ECM including collagen 3. intracellular and extracellular lipid
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4
Q

Where is most likely for atherosclerosis to occur?

A

Ostia (origins) of major branches. Turbulent flow and low shear stress.

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5
Q

Risk Factors for artherosclerosis a) modifiable (4) b) non-modifiable (3)

A

a) T2DM, HTN, hypercholesterolaemia, smoking b) M>F, FH, age

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6
Q

Angina

A

transient chest pain due to reversible myocardial ischaemeia

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7
Q

Stable Angina

A

chest pain on exertion

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8
Q

Unstable Angina

A

chest pain at rest

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9
Q

Prinzmetal/Variant Angina

A

rare younger patients due to coronary artery spasm

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10
Q

Ischaemia

A

an imbalance between perfusion and myocardial O2 demand

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11
Q

Myocardial Infarction

A

full occlusion pf coronary artery by thrombus overlying a disrupted plaque -> secondary necrosis of myocardium - 20-40mins results in irreversible injury and myocyte death

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12
Q

Complications of MI

A

a) Mechanical - ventricular dysfunction, cardiogenic shock, MR, papillary muscle rupture b)Arrhythmia’s - VF - 90% c) Pericardial - pericarditis, effusion d) systemic - embolisation -> PE

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13
Q

Dressler’s Syndrome

A

Weeks - months post-MI - Pleuritic chest pain - Fever - Pericardial effusion Check ESR

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14
Q

Heart failure Causes (6)

A

the inability of the heart to meet the demands of the tissue 1. IHD 2. Valvular disease 3. Myocariditis 4. HTN 5. dilated cardiomyopathy 6. arrhythmias

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15
Q

Nutmeg Liver

A

An effect of RHF Congestion of portal venous system -> peripheral oedema -> hepatomegaly

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16
Q

Pulmonary oedema (5) symptoms

A

An effect of LHF Congestion of pulmonary circulation - > pink transudate 1. dyspnoea 2. orthopnoea 3. PND “paroxnysnal nocturnal dyspnoea” 4. wheeze 5. fatigue

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17
Q

Signs of RHF (4)

A
  1. Peripheral oedema 2. ascites 3. facial engorgement 4. hepatomegaly
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18
Q

Hypertrophic Cardiac Myopathy a - pattern of inheritance b - most common mutation c - other mutations d - outcome

A

a - autosomal dominant b - BMHC - gene encoding sarcomeric proteins c - MYBP-C, Trop-T d - sudden cardiac death

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19
Q

Hypertrophic Obstructive Cardiomyopathy (HOCM)

A

assymmetric septal hypertrophy means blood is unable to pump past muscle

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20
Q

Arrythmogenic Right Ventricular Cardiomyopathy (ARVC)

A
  • presents in early adulthood - myocyte loss with associated fibrofatty replacement
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21
Q

Acute Rheumatic Fever a - pathogen b - when c - histology (3) d - symptoms (4) e - effects on heart (3) - effect on joints (2) - effects on skin (2) - effects on neuro (2) f - treatment g - chronic problems

A

a - Lancefield group A Strep b - 2-4weeks post Strep throat c - beady fibrous vegetations “verrucae”, Aschoff bodies, Anitschkov myocytes d - fever, tachycardia, malaise, MIGRATING POLYMYALGIA e - “pancarditis” - endocaridits + myocarditis + pericarditis - arthritis + synovitis - erythema marginatum + subcutaneous nodules - encephalopathy + Sydenham’s chorea f - Benzylpenicillin or Erythromycin in pen-allergic g - Mitral valve pathology

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22
Q

Infective Endocarditis (IE)

A

colonisation or invasion of heart valves or mural endocardium by microbe

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23
Q

Causes of IE (6)

A
  1. poor dental hygiene 2. IVDU 3. soft tissue infection 4. dental treatments 5. cannulae/lines 6. cardiac surgery/pacemakers
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24
Q

Predisposing factors of IE (6)

A
  1. rheumatic heart disease 2. mitral valve prolapse 3. calcified valves 4. biscuspid aortic valves 5. prosthetic valves 6. congenital defects
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25
Q

Pathogens in acute IE (2) (previously healthy valve)

A

Staph aureus Strep pyogenes

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26
Q

Pathogens in subacute IE (6) (previous valve pathology)

A

step viridans staph epidermis HACEK Coxiella Mycoplasma Candida

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27
Q

Symptoms of IE (3) Signs of IE (7) Treatment (2)

A

Symptoms - fever - malaise - rigors Signs - anaemia - splenomegaly - new murmur - Roth spots - splinter hemorrhages - Janeway lesions - Osler’s nodes Treatment - Benzylpenicillin + Gentamicin

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28
Q

Pericarditis - 5 types

A
  • inflammation of the percardium 1. Fibrinous - MI, uraemia 2. Purulent - Staph 3. Granulomatous - TB 4. Haemorrhagic - tumour, TB 5. Fibrous (constrictive)
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29
Q

Histological features of chronic bronchitis (2)

A
  1. goblet cell hyperplasia 2. hypertrophy of mucous glands
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30
Q

Histological feature of bronchiectasis

A

permanent dilatation of bronchi - mucus plugging

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31
Q

Histological features of asthma (3)

A
  1. Curschmann spirals (whorls of shed epithelium) 2. eosinophils 3. Charcot-Leyden crystals
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32
Q

Kartagener’s Syndrome - inheritance pattern - pathology - triad

A
  • autosomal recessive - defective cilia motility Triad 1. situs inversus 2. bronchiectasis 3. chronic sinusitis
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33
Q

Sign of interstitial lung disease

A

End inspiratory crackles

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34
Q

Histology hallmark of interstitial lung disease

A

honey comb lung

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35
Q

Idiopathic Pulmonary Fibrosis -who -where -presentation (2) -complications (3) -treatment (2)

A
  • M>F 40-70yo - lower lobes - dyspnoea, non-productive cough - clubbing, pulmonary HTN, cyanosis - steroids, azathioprine, cyclophosphamide
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36
Q

Conditions associated with lung fibrosis (4)

A
  1. Rheumatoid arthritis 2. Systemic sclerosis 3. SLE 4. connective tissue disease
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37
Q

Pneumoconiosis - who - where - what

A
  • coal workers - upper lobes - non-neoplastic lung reaction to inhalation of mineral dust/inorganic particles
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38
Q

Causes of OBSTRUCTIVE lung disease (5)

A
  1. chronic bronchitis 2. bronchiectasis 3. asthma 4. emphysema 5. bronchiolitis
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39
Q

Causes of Bronchiectasis a) inflammatory (7) b) congenital (3)

A

a) inflammatory 1. post-infectious 2. abnormal host defense 3. ciliary dyskinesia 4. obstruction 5. post-aspiration 6. secondary to bronchiolar disease and interstitial fibrosis 7. connective tissue disorders 8. asthma b) congenital 1. CF 2. ciliary diskinesia 3. hypogammaglobulinema

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40
Q

Hypogammaglobinlinema - what - predisposition - treatment

A

= primary immune deficiency disease - recurrent infections, predisposed to Strep. pneumonniae, H.influenzae - IVIG

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41
Q

Features of RESTRICTIVE lung disease (3)

A
  1. reduced CO diffusion capacity 2. decreased lung volume 3. decreased compliance
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42
Q

What is interstitial lung disease?

A

group of > 200 disease characterised by inflammation and fibrosis of the pulmonary connective tissue, particularly the peripheral interstitium of the alveolar wall

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43
Q

What drug can induce fibrosing lung disease?

A

Amiodarone (anti-arrhythmic)

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44
Q

What area of the lung is affected in a) pneumoconiosis b) silicosis c) asbesotosis

A

a - upper lobe b - upper lobe c - lower lobe

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45
Q

Causes of granulomatous interstitial lung disease (3)

A
  1. Sarcoidosis 2. extrinsic allergic alveolitis 3. Vasculitides
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46
Q

Extrinsic Allergic Alveolitis (EAA) - cause - result - histology - who - management

A
  • immune-mediated response to inhaled organic antigens - widespread alveolar inflammation - plugs of connective tissue within alveoli, granuloma formation, organising pneumonia - pigeon fancier’s, farmers, malt-workers, cheese washers - removal of antigen
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47
Q

Wegener’s Granulomatosis - what - features (4) - marker - treatment

A
  • autoimmune vasculitis of small and medium blood vessels 1. conjunctivitis 2.pulmonary disease 3. sinusitis 4. myalgia - c-ANCA - Azathioprine/Methotrexate
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48
Q

Churg-Strauss Syndrome - 6 features

A

small - medium vessel vasculitis Features : - 1. Asthma (wheezing, expiratory rhonchi) 2. Eosinophilia of more than 10% in peripheral blood 3. Paranasal sinusitis 4. Pulmonary infiltrates (may be transient) 5. Histological proof of vasculitis with extravascular eosinophils 6. Mononeuritis multiplex or polyneuropathy

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49
Q

Squamous Cell Carcinoma of lung - risk factors (2) - common mutations (2) - histological features (2) - where - ectopic secretion - metastasis

A
  • M>F, smoker - p53, c-myc - desmosomes (intercellular prickles), keratinisation - centrally located tumours - PTH-like peptide -> hypercalcaemia - late metastasis
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50
Q

Adenocarcinoma of lung - risk factors (2) -common mutation - histological features (3) - where - treatment

A
  • F>M, non-smokers - EGFR mutations - glandular differentiation, gland formation, mucin production - peripherally - tyrosine kinase inhibitors
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51
Q

Small Cell Carcinoma of lung - risk factors - common mutations (2) - histological feature - where - ectopic secretion - associations (2) - metastasis

A
  • smoking - p53, RB1 - arise from neuroendocrine cells - centrally - ACTH - Lambert-Eaton syndrome, cerebellar degeneration - rapid
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52
Q

Large Cell carcinoma of the lung - prognosis - microscopy - ectopic secretions (7)

A
  • very poor - poor differentiation, large cells, large nuclei - ADH, ACTH, PTH, PTHrP, Calcitonin,Serotonin, Bradykinin
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53
Q

Mesothelioma - association - symptoms (3) - time period

A
  • asbestos - 1. chest pain 2. dyspnoea 3. pleural effusion - latent period 25-45years
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54
Q

Risk factors for PE (8)

A
  1. female 2. COCP 3. Preganancy 4. post-surgery 5. immobility 6. cardiac disease 7. malignancy 8. hypercoagulable states
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55
Q

Complications of PE (2)

A
  1. corpulmonale -> RHF 2. cardiogenic shock
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56
Q

Causes of Pulmonary HTN a) primary b) secondary (4)

A

a) idiopathic b) 1. chronic lung disease 2.heart disease 3. recurrent thrombo-emboli 4. AI disorders

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57
Q

Pulmonary oedema - histology

A

iron laden macrophages

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58
Q

Hyaline Membrane Disease (HMD) - who - why - what cells - histology

A
  • prem neonates - insufficient surfactant production - type II pneumocytes - lung expanded, plum coloured
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59
Q

What cells line to oesophagus?

A

proximal 2/3 - squamous epithelium distal 1/3 - columnar epithelium joined by the squamo-coloumnar junction “Z-line”

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60
Q

Treatment of GORD (3)

A
  1. Smoking cessation 2. Weight loss 3. PPI
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61
Q

Barrett’s Oesophagus - what - risk

A
  • SCJ transition, metaplasia of squamous cells to columnar cells - increased risk of Ca
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62
Q

Oesophageal adenocarcinoma - risk factors (6) - where in the oesophagus?

A
  1. M>>F 2. Caucasian 3. Smoking 4. Barrett’s oesophagus 5. obesity 6. radiation therapy - distal 1/3
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63
Q

Plummer-Vinson Syndrome

A

iron deficiency anaemia + dysphagia

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64
Q

Squamous Cell Oesophageal Carcinoma - Risk Factors (7) - where in the oesophagus? - prognosis - presentation (4)

A
  1. alcohol 2. smoking 3. M>F 4. Afro-Caribbean 5. nutritional deficiencies 6. Plummer-Vinson syndrome 7. HPV - middle 1/3 - poor - rapid growth & metastasis - progressive dysphagia, odynophagia, anorexia, weight loss
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65
Q

What cells line the stomach?

A

columnar epithelium

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66
Q

Causes of acute gastritis (5) Complications of gastritis (2)

A
  1. aspirin 2. NSAIDs 3. H pylori 4. stress 5. corrosives 1. gastric ulcer formation 2. intestinal Ca
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67
Q

Cells involved in acute gastritis

A

neutrophils

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68
Q

Cells involved in chronic gastritis

A

lymphocytes and plasma cells

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69
Q

Symptoms of GASTRIC ulcer (4)

A
  1. epigastric pain 2. weight loss 3. pain worsens with food 4. pain relieved by antacids
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70
Q

Histology of gastric ulcer

A
  • breach through muscularis mucosa into submucosa - punches out lesion with rolled margins
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71
Q

Treatment of H.pylori (3)

A
  1. PPI 2. Clarithromycin 3. Amoxicillin/Metronidazole
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72
Q

Symptoms of DUODENAL ulcer (3)

A
  1. epigastric pain 2. pain is worse at night 3. pain is relieved by food/milk
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73
Q

Which is more common duodenal or gastric ulcer?

A

duodenal

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74
Q

Biopsy findings in Coeliac Disease (3)

A
  1. villous atrophy 2. crypt hyperplasia 3. lymphocyte infiltrate
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75
Q

What rash is associated with Coeliac Disease?

A

dermatitis herpetiformis

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76
Q

What serological markers are associated with Coeliac Disease? (3)

A
  1. Anti-endomysial Ab 2. Anti-tissue transglutaminase 3. Anti-gliadin
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77
Q

Symptoms of Coeliac Disease (8)

A
  1. steatorrhoea 2. abdo pain 3. bloating 4. N&V 5. weight loss 6. fatigue 7. IDA 8. failure to thrive
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78
Q

Coeliac Disease

A

T cell mediated autoimmune disease causing gluten intolerance

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79
Q

What GI disease is Down’s syndrome associated with?

A

Hirschsprung’s

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80
Q

Hirschsprung’s Disease - what - who - biopsy findings - genetic association - treatment

A
  • absence of ganglion cells in myenteric plexus - M>>F - hypertrophied nerve fibres, no ganglia - RET proto-oncogene Cr10+ - resection of affected gut
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81
Q

Which is associated with BLOODY diarrhoea - crohn’s or UC?

A

Crohn’s

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82
Q

“Skip lesions” “cobblestone appearance” “rosethorn ulcers” are associated with which IBD?

A

Crohn’s

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83
Q

Complication of UC where the small bowel is involved?

A

backwash ileitis

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84
Q

Severe complication of UC?

A

toxic megacolon

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85
Q

Skin manifestations of IBD (3)

A
  1. erythema nodosum 2. pyoderma gangrenosum 3. erythema multiforme
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86
Q

Symptoms of Carcinoid Syndrome (7)

A
  1. flushing 2. diarrhoea 3. bronchoconstriction 4. vasodilation 5. HYPOtension 6. tahcycardia 7. HYPERglycaemia
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87
Q

Carcinoid syndrome is associated with which cells?

A

enterochromaffin cells

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88
Q

What do you look for if Carcinoid syndrome is suspected?

A

24hr urine - 5-HIAA (metabolite of serotonin)

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89
Q

gene associated with colorectal adenoma?

A

APC (adenomatous polyposis coli)

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90
Q

Juvenile Polyposis - inheritance pattern - symptoms - risk

A
  • autosomal dominant - PR bleeding from harmatomatous polyps - haemorrhage
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91
Q

Peutz-Jeghers Syndrome - pattern of inheritance - mutation - signs (4) - presentation

A
  • autosomal dominant - LKB1 - 1. freckling of lips and around the mouth 2. mucocutaneous hyperpigmentation 3. freckling of palms and soles of feets 4. multiple polyps - intussuseption
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92
Q

Risk factors associated with colorectal Ca (6)

A
  1. low fibre diet 2. high fat diet 3. lack of exercise 4. obesity 5. chronic IBD 6. familial syndromes
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93
Q

Staging of Colorectal Ca?

A

DUKE’S A - confined to mucosa B1 - extending into muscularis propria B2 - transmural invasion C1 - extending into muscularis propria + LN mets C2 - transmural invasion + LN mets D - distant mets

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94
Q

Genes associated with FAP a - autosomal dominant b - autosomal recessive

A

a - APC b - DNA mismatch repair genes

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95
Q

Gardner’s Syndrome - what? - features (3)

A
  • similar to FAP but with ecxtra-intestinal features - osteomas, soft tissue tumours, dental caries
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96
Q

Lynch syndrome - otherwise known as? - inheritance pattern - mutation - associations (3)

A
  • Hereditary Non-Polyposis Colorectal Cancer (HNPCC) - autosomal dominant - DNA mismatch repair genes 1. endometrial 2. ovarian 3. stomach
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97
Q

where is secretin produced? what is it’s role?

A
  • S-cells of the duodenum - to cause the pancreas to produce bicarbonate as a buffer
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98
Q

where is CCK produced? what is it’s role?

A
  • I-cells of the duodenum - causes release of digestive enzymes from the pancreas
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99
Q

what do the alpha cells of the islets of Langerhans do?

A

secrete GLUCAGON to increase blood glucose

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100
Q

what do the beta cells of the islets of Langerhans do?

A

secrete INSULIN to decrease blood glucose

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101
Q

what do the delta cells of the islets of Langerhans do?

A

secrete SOMATOSTATIN to regulate alpha/beta cells

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102
Q

what do the D1 cells of the islets of Langerhans do?

A

secrete H20, a vasoactive peptide

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103
Q

Fasting plasma glucose level diagnostic of DM?

A

>7 mmol/L

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104
Q

Random plasma glucose level diagnostic of DM?

A

> 11.1 mmol/L

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105
Q

Signs of DM (3)

A
  1. polyuria 2. polydipsia (raised plasma osmolality 3. recurrent infections (hypergylacaemia)
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106
Q

Pathology of T1DM

A

Autoimmune destruction of BETA cells by CD4+ and CD8+ T-lymphocytes

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107
Q

Pathology of T2DM

A

linked to obesity of insulin resistance

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108
Q

Complications of DM a) Microvascular (3) b) Macrovascular (3)

A

a) 1. diabetic retinopathy 2. Neuropathy - poor healing ulcers 3. Peripherla Vascular Disease - claudication b) 1. Nephropathy - glomerulonephritis, pyelonephritis 2. Cardiac - MI 3. cerebral - CVA

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109
Q

What is a pseudocyst? - and what is it a complication of?

A

= a pathological collection of fluid - associated with alcoholic pancreatitis

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110
Q

Symptoms of acute pancreatitis (4)

A
  1. severe epigastric pain 2. pain that radiates to to the back 3. pain is relieved on sitting forward 4. vomiting
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111
Q

Histology of pancreatitis

A

coagulative necrosis

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112
Q

Causes of CHRONIC pancreatitis (5)

A
  1. alcoholism 2. CF 3. Hereditary 4. Pancreatic duct obstruction 5. Autoimmune (IgG4)
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113
Q

Presentation of CHRONIC pancreatitis (3)

A
  1. epigatsric pain radiating to the back 2. malabsorption 3. secondary DM
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114
Q

Histology of CHRONIC pancreatitis (4)

A
  1. fibrosis 2. loss of exocrine tissue 3. duct dilatation 4. calcification
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115
Q

Histology of Acinar Cell Carcinoma (2)

A
  1. neoplastic epithelial cells with eosinophilic granular cytoplasm 2. immunoreactivity for lipase, trypsin, chymotrypsin
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116
Q

Most common pancreatic cancer?

A

ductal adenocarcinoma (85%)

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117
Q

Risk factors of ductal adenocarcinoma (5)

A
  1. M>F 2. Age > 60yrs 3. smoking 4. diet 5. genetic (FAP, HNPCC)
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118
Q

Signs of pancreatic Ca (12)

A
  1. cachexia 2. anorexia 3. upper abdo and back pain 4. PAINLESS jaundice 5. pruritis 6. steatorrhoea 7. DM 8. Trousseau’s syndrome 9. ascites 10. abdominal mass 11. Virchow’s node 12. Courvoisier’s sign
119
Q

What is Trousseau’s Syndrome?

A

migrating, recurrent, superficial thrombophlebitis

120
Q

What is Courvoisier’s sign?

A

palapable, painless gallbladder in RUQ

121
Q

What is the tumour marker for pancreatic Ca?

A

Ca19.9 > 70IU/mL

122
Q

Where in the pancreas do neuroendocrine tumours normally lie?

A

tail or body

123
Q

Association with an insulinoma?

A

hypoglycaemic attacks

124
Q

Association with a gastrinoma?

A

Zollinger-Ellison syndrome - high acid output Increased risk of ulceration

125
Q

MEN1 associated tumours

A

“PPP” Parathyroid Pancreas Pituitary

126
Q

MEN2a associated tumours

A

“PTP” Parathyroid Thyroid Phaeo

127
Q

MEN2b associated tumours

A

Medullary thyroid Marfanoid phenotype Neuroma Phaeo

128
Q

What comprises a “portal tract”?

A
  1. bile duct 2. hepatic artery 3. portal vein
129
Q

What are centrilobular hepatocytes?

A
  • located near the terminal hepatic vein - very metabolically active
130
Q

What are periportal hepatocytes?

A
  • located near the portal tract - receive blood rich in O2 and nutrients
131
Q

Functions of the liver (6)

A
  1. Metabolism 2. Protein synthesis 3. Storgae 4. Hormone metabolism 5. bile synthesis 6. immune function
132
Q

What are the immune cells of the liver?

A

Kupffer cells

133
Q

Benign liver tumour associated with OCP?

A

hepatic adenoma

134
Q

Associations with Hepatocellular Carcinoma (HCC) (7)

A
  1. Hep B 2. Hep C 3. haemochromatosis 4. alcoholic cirrhosis 5. Non-Alcoholic fatty Liver Disease (NAFLD) 6. Aflatoxin (from moulds) 7. Androgenic steroids
135
Q

Most common liver cancer?

A

Secondary metastasis from other tumours e.g. GI, breast, bronchus

136
Q

What is liver cirrhosis?

A

diffuse abnormality of liver architecture that interferes with blood flow and liver function

137
Q

Causes of liver cirrhosis (7)

A
  1. Alcoholic liver disease 2. NAFLD 3. Chronic viral hepatitis 4. Autoimmune 5. Biliary causes 6. genetic 7. Drugs
138
Q

Genetic causes of liver cirrhosis (5)

A
  1. Haemachromatosis 2. Wilson’s disease 3. Alpha 1 antitrypsin disease 4. Galactosaemia 5. Glycogen storage disease
139
Q

Pathology of liver cirrhosis (4 steps)

A
  1. chronic inflammation activates STELLATE cells in the space of Disse 2. Activated stellate cells are myofibroblasts which initiate fibrosis, the laying down of collagen in the space of Disse 3. Constriction of sinusoids by myofirboblasts causes increased vascular resistance 4. undamaged hepatocytes regenerate in NODULES within the fibrous septa
140
Q

Score to predict prognosis in liver cirrhosis

A

Child’s Pugh Score

141
Q

Criteria of Child’s Pugh Score (5)

A
  1. ascites 2. encephalopathy 3. bilirubin 4. albumin 5. PT time
142
Q

Sites of collateral vessel formation in portal HTN (6)

A
  1. gastro-oesophageal junction 2. rectum 3. L renal vein 4. diaphragm 5. retroperitoneum 6. umbilical vein - caput medusa
143
Q

What is Budd-Chiari syndrome?

A

occlusion of the hepatic vein causing portal HTN

144
Q

Histology associated with Alcoholic fatty liver disease? (2)

A
  1. steatosis (accumulation of fat droplets in hepatocytes) 2. fibrosis
145
Q

Histology associated with alcoholic hepatitis? (3)

A
  1. hepatocyte ballooning 2. Mallory bodies 3. fibrosis
146
Q

Histology associated with alcoholic cirrhosis?

A

Micronodular cirrhosis

147
Q

Risk factors for non-alcoholic fatty liver disease? (3)

A
  1. obesity 2. hyperlipidemia 3. DM
148
Q

Type 1 Autoimmune Hepatitis markers (4)

A
  1. ANA 2. anti-SMA 3. anti-actin Ig 4. anti-soluble liver antigen Ig
149
Q

Type 2 Autoimmune Hepatitis marker

A

Anti-LKM Ig (liver-kidney-microsomal Ig)

150
Q

Is primary biliary cirrhosis associated more with females or males?

151
Q

Is primary sclerosing cholangitis associated more with females or males?

152
Q

Pathology of primary biliary cirrhosis?

A

AI destruction of medium sized INTRAhepatic bile ducts -> cholestasis -> SLOW progression to cirrhosis

153
Q

Pathology of primary sclerosing cholangitis?

A

inflammation and fibrosis or EXTRA and INTRAhepatic bile ducts -> multifocal stricture formation

154
Q

Marker associated with primary biliary cirrhosis?

A

Anti-mitochondrial antibodies

155
Q

secondary symptoms of primary biliary cirrhosis? (5)

A
  1. xanthelasma 2. steatorrhoea 3. Vit D malabsorption 4. skin pigmentation 5. inflammatory arthropathy
156
Q

Which biliary disease is associated with BILE DUCT DILATATION on USS?

A

Primary sclerosing cholangitis

157
Q

Marker associated with primary sclerosing cholangitis?

158
Q

PSC gives an increased risk of?

A

cholangiocarcinoma

159
Q

Gene mutation in Haemachromatosis?

A

HFE gene - causes increase in absorption of iron in the gut -> iron deposits in liver, heart, pancreas, adrenals, pituitary, joints and skin

160
Q

inheritance pattern of haemachromatosis?

161
Q

inheritance pattern of Wilson’s disease

162
Q

inheritance pattern of alpha 1 anti-trypsin deficinecy?

163
Q

Signs of haemachromatosis? (6)

A
  1. skin bronzing 2. hepatomegaly 3. DM 4. cardiomyopathy 5. hypogonadism 6. pseudogout
164
Q

Kayser Fleischer rings….

A

Wilson’s disease = copper deposits in the cornea

165
Q

Gene mutation in Wilson’s disease?

A

ATP7B - causes decreased copper excretion -> deposition in liver, CNS and iris

166
Q

Pathology of alpha-1-antitrypsin disease? (2)

A

1) A1AT accumulation in hepayocytes -> hepatitis 2) lack of A1AT in lungs -> emphysema

167
Q

emphysema in never smoker plus liver disease?

A

alpha 1 antitrypsin disease

168
Q

treatment for Wilson’s disease?

A

Penicillamine (chelator)

169
Q

treatment for haemachromatosis?

A

Desferrioxamine (iron chelator)

170
Q

Most common pathogen causing cystitis?

A

Gram -ve E.coli

171
Q

Predisposing factors for cystitis? (6)

A
  1. F>M
  2. bladder calculi
  3. urinary obstruction
  4. DM
  5. sexually active
  6. instrumentation
172
Q

Most common bladder tumour?

A

transitional cell tumour

173
Q

Predisposing factors to bladder cancer? (4)

A
  1. M>F
  2. age 50-80years
  3. smoking
  4. exposure to aromatic amines (rubber, hair dye)
174
Q

Association with schitosomiasis?

A

Squamous cell carcinoma

175
Q

BPH

  • pathology
  • symptoms (5)
A
  • dihydrotestosterone-mediate hyperplasia of prostatic stromal and epithelial cells
    1. Difficulty urinating
    2. Retention
    3. Frequency
    4. Nocturia
    5. Overflow dribbling
176
Q

Treatment of BPH

A

5a reductase inhibitors (tamsulosin)

177
Q

Most common prostate cancer?

Where within the gland does it arise from?

A

adencarcinoma

peripheral zone

178
Q

Most common testicular cancer?

A

germ cell - seminoma

179
Q

Common pathogens causing acute bacterial prostatitis? (3)

A
  1. E.coli
  2. enterococci
  3. Staph
180
Q

Biological markers for germ cell tumours? (3)

A

AFP, HCG, LDH

181
Q

Risk factors associated with renal cell carcinomas? (6)

A
  1. smoking

2, obesity

  1. HTN
  2. unopposed oestrogen
  3. heavy metals
  4. CKD
182
Q

Symptoms of renal cell carcinoma? (3)

A
  1. haematuria
  2. costovertebral pain
  3. palapable mass
183
Q

Nephrotic Syndrome (3)

A
  1. proteinuria > 3g/24h “frothy urine”
  2. hypoalbuminaemia
  3. oedema “swelling”
184
Q

Primary causes of nephrotic syndrome (3)

A
  1. Minimal change disease
  2. Membranous glomerular disease
  3. Focal Segmental Glomerulosclerosis (FSGS)
185
Q

Minimal chnage nephrotic syndrome

  • who
  • EM findings
  • response to steroids
  • prognosis
A
  • children
  • loss of podocytes
  • 90%
  • most recover
186
Q

Neophrotic syndrome - Membranous glomerular disease

  • who
  • causes (4)
  • light microscopy findings
  • EM findings (2)
  • Immunofluorscence
  • prognosis
A
  • adults
  • SLE, drugs, infection, malignancy
  • thickening of glomerular basement membrane
  • loss of podocytes, spikey subepithelial deposits
  • Ig and complement in granular deposits along GBM
  • 40% ESRF
187
Q

Focal Segmental Glomerulosclerosis

  • who
  • causes (3)
  • light microscopy findings (2)
  • EM findings
  • immunofluoresence
  • prognosis
A
  • Afro-caribbean adults
  • obesity, HIV, nephropathy
  • scarring, hyalinosis (thickening of walls)
  • loss of podocytes
  • Ig and complement in scarred areas
  • poor - 50% ESRF
188
Q

Secondary causes of nephrotic syndrome? (2)

A
  1. DM
  2. Amyloidosis
189
Q

Histological changes seen in diabetic nephropathy? (2)

A
  1. GBM thickening
  2. Kimmelstiel nodules
190
Q

Apple green bifringence for congo red stain……

A

AMYLOIDOSIS

191
Q

Amyloidosis

  • pathology
  • signs (3)
  • consequences (2)
A
  • increased deposition of amyloid proteins in the organs of the body
  • macroglossia, heart failure, hepatomegaly
  • RA, chronic infections
192
Q

Nephritic Syndrome

  • what
  • Signs (6)
A
  • inflammation of the glomerular i.e. glomerulonephritis
    1. haematuria
    2. red cell casts in urine
    3. oliguria
    4. increased urea and creatinine
    5. HTN
    6. Proteinuria
193
Q

Causes of Nephritic Syndrome (5)

A
  1. Post-infectious
  2. Berger’s - IgA Nephropathy
  3. Cresenteric GN
  4. Alport’s - hereditary nephritis
  5. benign familial hameturia
194
Q

Common pathogen causing post-infectious GN?

A

Group A haemolytic Strep pyogenes

195
Q

Post-Strep GN

  • when
  • pathology
  • signs (4)
  • Bloods
  • fluorescence microscopy (2)
A
  • 1-3 weeks post sore throat
  • glomerular damage due to immune complex deposition
  • hameaturia, proteonuria, oedema, HTN
  • High ASOT, low C3
  • IgG and C3 in the GBM
196
Q

What is the most common cause of GN worldwide?

A

Berger’s Disease (IgA nephropathy)

197
Q

Berger’s Disease

  • who
  • pathology
  • when
  • symptom
  • prognosis
A
  • Asian
  • IgA deposition in the glomeruli
  • 1-2weeks after URTI
  • frank haematuria
  • can progress to ESRF
198
Q

What’s the most agressive glomerulonephritis?

A

Crescenteric

199
Q

Three types of Crescenteric GN?

I

II

III

A

Type I - Anti-GBM antibody

Type II - Immune complex mediated

Type III - Pauci-immune/ANCA associated

200
Q

Goodpasture’s syndrome is a

Type I

Type II

Type III

GN?

  • fluorescence microscopy ?
  • other organs?
A

Type I - Anti-GBM antibody against Collagen type IV

  • linear deposition of IgG in GBM
  • YES - lungs
201
Q

SLE is a

Type I

Type II

Type III

GN?

  • immunofluorescence?
A

Type II - immune complex mediated

  • granular IgG immune complexes on GBM
202
Q

Wegener’s granulomatosis is a

Type I

Type II

Type III

GN?

  • fluorescence?
  • other organs?
A

Pauci-immune/ANCA associated

  • lack of immune complex deposition
  • YES - vasculitis - skin, lungs
203
Q

Alport’s Syndrome

  • inheritance pattern
  • pathology
  • Signs (3)
  • prognosis
A
  • X-linked recessive
  • collagen type IV mutation causing hereditary glomerular disease
  • nephritis, sensorineural deafness, eye disorder
  • ESRF
204
Q

Thin basement membrane disease/Benign familial haematuria

  • inheritance pattern
  • symptoms
  • pathology
  • prognosis
A
  • autosomal dominant
  • asymptomatic microscopic haematuria
  • type IV collagen mutation
  • normal renal function
205
Q

Asymptomatic hameaturia? (3)

A
  1. Benign familial haematuria
  2. Alport’s syndrome
  3. IgA nephropathy/Berger’s syndrome
206
Q

Causes of Acute Tubular Injury (6)

A
  1. burns
  2. septicaemia
  3. drugs (gentamicin, NASIDs)
  4. radioraphic contrast agents
  5. myoglobin
  6. heavy metals
207
Q

Signs and symptoms of acute pyelonephritis? (8)

A
  1. fever
  2. chills/sweats
  3. flank pain
  4. renal angle tenderness
  5. leukocytosis
  6. frequency
  7. dysuria
  8. haematuria
208
Q

Most common pathogen of pyelonephritis?

209
Q

Interstitial nephritis

  • when
  • what
  • symptoms (5)
  • causative drugs (4)
A
  • 15 days after exposure
  • hypersensitivity reaction
  • fever, rash, haematuria, proteinuria, eosinophilia
  • Penicillin, Rifampicin, Thiazides, NSAIDs
210
Q

What pathogen is associated with Haemolytic Uraemic Syndrome? (HUS)

  • who
  • signs (3)
  • diagnosis (2)
  • bloods (2)
  • where are the thrombi?
A
  • E.coli
  • children
  • BLEEDINGS - petichiae, melena, haematemesis
  • fragmented RBCs on blood smear, Coombs negative
  • low plts, low Hb
  • thrombi confined to kidneys
211
Q

Thrombotic Thrombocytopaenic Purpura (TTP)

  • who
  • where are the thrombi?
  • signs/symptoms (3)
  • CNS symptoms? (4)
  • diagnosis (2)
  • bloods (2)
A
  • adults
  • throughout the circulation
  • BLEEDING - petichiae, haematemesis, melena
  • headache, low GCS, seizures, coma
  • fragmented RBCs on blood smear, Coombs test neg
  • low plts, low Hb
212
Q

Signs of haemolysis on bloods (3)

A
  1. high reticulocytes
  2. high LDH
  3. high bilirubin -> jaundice
213
Q

Triad of Thrombotic Microangiopathies

A
  1. mircoangiopathic haemolytic anaemia
  2. thrombocytopenia
  3. renal failure (HUS)
214
Q

Complications of acute renal failure (6)

A
  1. HTN
  2. Uraemia
  3. metabolic acidosis
  4. hyperkalaemia
  5. fluid overload
  6. hypocalcemia
215
Q

Pre-renal causes of Acute Renal Failure (5)

  • pathology
A
  • HYPOperfusion
    1. Renal artery stenosis
    2. HYPOvolaemia
    3. sepsis
    4. burns
    5. acute pancreatitis
216
Q

Renal cause of Acute Renal Failure (3)

A
  1. glomerulonephritis
  2. acute tubular necrosis
  3. thrombotic microangiopathy
217
Q

Post-renal causes of Acute Renal Failure (4)

  • pathology
A

OBSTRUCTION

  1. stones
  2. tumours
  3. prostatic hypertrophy
  4. retroperitoneal fibrosis
218
Q

Signs of uraemia (4)

A
  1. fatigue
  2. itching
  3. anorexia
  4. confusion
219
Q

Commonest causes of chronic renal failure?

220
Q

Adult Polycystic Kidney Disease (APKD)

  • inheritance pattern
  • onset
  • common mutations (2)
  • Pathological features (3)
  • Signs/symptoms (3)
  • Complications (3)
  • prognosis
A
  • autosomal dominant
  • 30-40yrs
  • PKD1, PKD2
  • large multicystic kidneys with destroyed parenchyma, liver cysts (PKD1), berry anneurysms
  • haematuria, flank pain, UTI
  • HTN, anneurysms, cyst rupture.infection/haemorrhage
  • dialysis
221
Q

Most common pathogens causing PID?

A
  1. chlamydia trachomatis
  2. neisseria gonorrhoea
222
Q

Presenting symptoms in PID (6)

A
  1. fever
  2. vaginal bleeding/discharge
  3. low abdo pain
  4. deep dysparunia
  5. adnexal tenderness
  6. cervical excitation
223
Q

Fitza Hugh Curtis syndrome….

A

violin-string peri-hepatic adhesions caused by ascending chlamydia infection

224
Q

Complications associated with PID (8)

A
  1. Fitz-Hugh-Curtis syndrome
  2. infertility
  3. risk of ectopic pregnancy
  4. intestinal obstruction
  5. tubo-ovarian abscess
  6. chronic pelvic pain
  7. perotinitis
  8. plica fusion (blunted, fibrotic plicae of salphinx containing inflammatory cells)
225
Q

Endometriosis

A

= presence of endometrial glands or stroma in abnormal locations outside of the uterus

226
Q

Chocolate cysts…

A

endometriomas found on ovaries in endometriosis

227
Q

Adenomyosis

A
  • presence of ectopic endometrial tissue deep within the myometrium
  • disrupts mucle contraction
228
Q

Leiomyoma

  • what
  • description
  • types (3)
A

FIBROID

  • benign tumour of smooth muscle
  • bulky, irregular uterus
    1. intramural
    2. submucosal
    3. subserosal
229
Q

Presentation of fibroids (5)

A
  1. dysmenorrhoea
  2. mennorhagia
  3. deep dyspareunia
  4. pressure effects (frequency, tenemus)
  5. subfertility
230
Q

Leiomyosarcoma

A

rare

normally de novo

post-menopausal women

231
Q

Post-menopausal bleeding…

A

endometrial cancer

232
Q

Endometrial cancer

  • risk factors (8)
  • staging
A

Risk Factors 1) Obesity

2) anovulatory amenorrhoea
3) nulliparity
4) early menarche
5) late menopause
6) tamoxifen
7) DM
8) HTN

Staging - FIGO

233
Q

Most common endometrial cancer?

A

adenocarcinoma

234
Q

Most common endometrial cancers in elderly women?

A

non-endometrioid

1) serous
2) papillary
3) clear cell
- more aggressive

235
Q

What are the normal cells of the vulva?

A

squamous epithelium

236
Q

Most common vaginal intraepithelial neoplasia (VIN)?

A

squamous cell carcinoma

237
Q

Lichen sclerosis

  • who
  • where
  • what
A
  • older women
  • vulva
  • thinning of the epidermis, smooth white appearance
238
Q

Lichen planus

  • what
  • where
A
  • T-cell mediate autoimmune conditions
  • oral, vulval, penile
  • Eruption of purple flat topped papules with mother of pearl sheen.
239
Q

Most common type of ovarian cancer?

A

serous-type epithelial

240
Q

4 types of epithelial ovarian cancers

A
  1. serous - contain psammoma bodies
  2. mucinous - no psammoma bodies
  3. endometrioid - tubular
  4. brenner/clear cell - hobnail appearance (bumpy)
241
Q

3 types of germ cell ovarian tumours

A
  1. dysgerminoma
  2. teratoma
  3. choriocarcinoma
242
Q

MatureTeratoma

  • benign or malignant?
  • contain what?
  • who?
A

benign

well-differentiated cystic lesions containing skin, hair, teeth, bone, cartilage

adults

243
Q

Immature teratoma

  • benign or malignant?
  • who?
  • contains what?
A
  • malignant
  • children
  • immature embryonal tissues
244
Q

Choriocarcinoma’s secrete?

A

hCG

aggressive

young women

245
Q

Granulosa-theca cells tumours

secrete?

signs (3)

A

oestrogen secreting

  1. irregular menstural cycles
  2. breast enlargement
  3. enodmetrial/breast cancer
246
Q

Sertoil-leydig cell tumours

secrete?

signs (4)

A

androgen secreting

“defeminising”

  1. hirsuitism
  2. breast atrophy
  3. deepened voice
  4. enlarged clitoris
247
Q

Risk factors for CIN? (6)

A
  1. early age of first intercourse
  2. multiple partners
  3. multiparity
  4. smoking
  5. HIV
  6. immunosupression
248
Q

cells lining outer cervix?

A

squamous epithelium

249
Q

cells lining endocervical canal?

A

columnar glandular epithelium

250
Q

Virus causing CIN?

A

HPV 16 & 18

251
Q

Risk of cervical cancer in Cervical Intraepithlial Neoplasis 3? (CIN3)

252
Q

Change from CIN to carcinoma?

A

invasion through the basement membrane

253
Q

Most common cervical carcinoma?

A

squamous cell carcinoma

254
Q

Clinical presentation of cervical cancer?

A
  1. post-coital bleeding
  2. intermenstrual bleeding
  3. postmenopausal bleeding
  4. discharge
  5. pain
255
Q

Mastitis

  • pathogen
  • symptoms (4)
  • who
  • treatment (3)
A
  • staph
  • fever, pain, red breast, cracked nipples
  • breastfeeding mum’s
  • Abx, continue breastfeeding, surgical drainage
256
Q

Histology of periductal mastitis

  • who does it affect?
A
  • keratinsing squamous epithelium deep into nipple duct orifices
  • smokers
257
Q

Mammary Duct Ectasia

  • who
  • symptoms (2)
  • pathology
A
  • multiparous women aged 40-60yrs
  • thick white nipple secretions, perareolar mass
  • granulomatous inflammation of dilated large breast ducts
258
Q

Fat necrosis

  • presentation
  • common story
  • pathology
A
  • painful breast mass
  • older woman hit her breast on something a few weks previously then developed a breast lump
  • inflammatory reaction to damamged adipose tissue
259
Q

Fibrocystic Disease

  • presentation
  • pathology
A
  • lumpy breasts
  • cystic changes with inflamation, fibrosis and adenosis caused by an exggerated response to hormones
260
Q

Causes of gynaecomastia (4)

A
  1. alcohol
  2. age
  3. liver cirrhosis
  4. testicular tumour
261
Q

Fibroadenoma

  • what
  • where
  • commonly affects
  • description (3)
A
  • benign tumour from stroma
  • multiple and bilateral
  • 20-30yrs old
  • rubbery, freely mobile, variable size
262
Q

Duct Papilloma

  • what
  • presentation
A
  • benign papillary tumour of he duct system of the breast
  • bloody discharge, no lump
263
Q

Radial scar

A
  • benign sclerosing lesion - central scarring surrounded by proliferating gl;andular tissue in stellate pattern
  • resembles carcinoma on mammogram
264
Q

Risk factors for breast cancer (8)

A
  1. susceptibility genes (BRCA1/BRCA2)
  2. Oestrogen exposure
  3. age 75-80yrs
  4. FH
  5. Race (caucasian)
  6. obesity
  7. tobacco
  8. alcohol
265
Q

what is the most common breast cancer?

A

ductal carcinoma in situ

266
Q

What age is the UK screening programme for breast cancer?

A

47 - 73 years

267
Q

What percent of lobular carcinoma in situ are bilateral?

268
Q

What percent of DCIS are HER2+?

269
Q

How does DCIs look on a mammogram?

A

areas of microcalcification

270
Q

Presentation of breast cancer? (4)

A
  1. painless lump
  2. peau d’orange
  3. nipple retraction
  4. Paget’s disease
271
Q

Histology on invasive lobular carcinoma in situ?

A

“bulls eye pattern” cells are aligned in single file chains/strands

272
Q

Mucinous carcinoma

A

produce abundant quantities of extracellular mucin

273
Q

What does a triple assesment involve?

A
  1. Examination
  2. Radiology - Mammography/USS/MRI
  3. Cytology - FNA
274
Q

Histological grading of breast cancers (3)

A
  1. nuclear pleomorphism
  2. tubule formation
  3. mitotic activity
275
Q

What is Tamoxifen?

A

Oestrogen receptor antagonist

276
Q

What is Herceptin?

  • side effect
A
  • monoclonal Ig to Her2
  • toxicity to myocardium
277
Q

Basal-like carcinoma

A
  • sheets of atypical cells with lymphocyctic infiltrate, triple negative
278
Q

Phyllodes tumour

  • what
  • who
  • prognosis
  • presentation
  • histology
A
  • interlobular stroma tumour
  • >50 yrs
  • mostly benign, some can be agressive
  • palpable mass
  • grow in a “leaflike” pattern
279
Q

Causes of cerebral oedema (2)

Result (1)

A

1) Vasogenic oedema - BBB disrupted
2) Cytogenic - secondary to cellular injury
- Increased ICP

280
Q

Nomrla volume of CSF?

281
Q

Causes of hydrocephalus (2)

A

a) Obstructive - actual obstruction to flow of CSF
b) Non-obstructive - impaired reabsorption, no obstruction to flow

282
Q

3 common types of brain herniation

A

1) Transtentorial/Uncal - medial emporal lobe compressed against tentorium and puts pressure on the brainstem
2) Subfalcine/Cingulate - cingulate gyrus is displace dunder the falx cerebri
3) Tonsillar - “coning” cerebellar tonisls displaced through the foramen magnum cuaing brainstem compression

283
Q

How many strokes per year in UK?

3rd common cause of death in UK?

A

100,000

Stroke

284
Q

Stroke definition

A

A stroke is a clinical syndrome characterised by rapidly developing clinical symptoms and / or signs of focal, and at times global loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin

285
Q

Definition of TIA

A

TIA is caused by a clot; the blockage is temporary.TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. Unlike a stroke, when a TIA is over, usually causes no permanent injury to the brain.

286
Q

Symptoms of Stroke? (8)

A
  • fast onset of symptoms

F - face drop

A - arms - paralysis, weakness

S - speech slurred

(T - time to call)

  • numbness, loss of vision, dysphagia
287
Q

Symptoms of TIA (3)

A
  1. symptoms for less than 24hrs
  2. Amaurosis fugax “curtain coming down vertically into the field of vision of one eye”
  3. Carotid bruit
288
Q

Most common vascular territory hit in a stroke?

Symptoms (4)

A

Middle Cerebral Artery “MCA”

  1. contralateral hemiparesis of lower half of face
  2. contralateral hemiparesis of UL and LL
  3. sensory loss of contralateral face, UL, LL
  4. aphasia
289
Q

Mx of Stroke

a) acute (3)
b) long term (3)

A

a) Acute
1. Aspirin +/- dipyridamole (vasodilator)
2. throbolytics (if <3hrs) e.g. TPA
3. carotid endarterectomy
b) Long term
1. control HTN
2. control hyperlipidemia
3. Anticoagulants

290
Q

Mx of TIA

a) Acute (2)

B) Long term (3)

A

a) Acute
1. Aspirin + Dipyridamole
2. Carotid enaterectomy
b) Long term
1. Control HTN
2. Control hyperlipidemia
3. anticoagulants

291
Q

Risk Factors for Cerebrovascular disease? i.e. cerebral artherosclerosis (3)

A
  1. HTN
  2. DM
  3. Smoking
292
Q

Common sites for cerebral artherosclerosis? (3)

A
  1. extracerebral arteries
  2. carotid bifurcation
  3. basilar artery
293
Q

Types of Haemorrhage

a) Non traumatic (2)
b) Traumatic (2)

A

a) Non-Traumatic
1. Intraparenchymal haemorrhage
2. Subarachnoid haemorrhage
b) Traumatic
1. Subdural
2. Extradural

Pathology (7 decks)

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