Histopathology Flashcards
1
Q
Atherosclerosis
A
chronic inflammation in intima of large arteries, characterised by intimal thickening and lipid accumulation
2
Q
7 steps of atherogensis
A
- 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
3
Q
Artheroslerotic plaques - 3 components
A
- Cells (macrophages, smooth muscle cells, leukocytes) 2. ECM including collagen 3. intracellular and extracellular lipid
4
Q
Where is most likely for atherosclerosis to occur?
A
Ostia (origins) of major branches. Turbulent flow and low shear stress.
5
Q
Risk Factors for artherosclerosis a) modifiable (4) b) non-modifiable (3)
A
a) T2DM, HTN, hypercholesterolaemia, smoking b) M>F, FH, age
6
Q
Angina
A
transient chest pain due to reversible myocardial ischaemeia
7
Q
Stable Angina
A
chest pain on exertion
8
Q
Unstable Angina
A
chest pain at rest
9
Q
Prinzmetal/Variant Angina
A
rare younger patients due to coronary artery spasm
10
Q
Ischaemia
A
an imbalance between perfusion and myocardial O2 demand
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
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
13
Q
Dressler’s Syndrome
A
Weeks - months post-MI - Pleuritic chest pain - Fever - Pericardial effusion Check ESR
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
15
Q
Nutmeg Liver
A
An effect of RHF Congestion of portal venous system -> peripheral oedema -> hepatomegaly
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
17
Q
Signs of RHF (4)
A
- Peripheral oedema 2. ascites 3. facial engorgement 4. hepatomegaly
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
19
Q
Hypertrophic Obstructive Cardiomyopathy (HOCM)
A
assymmetric septal hypertrophy means blood is unable to pump past muscle
20
Q
Arrythmogenic Right Ventricular Cardiomyopathy (ARVC)
A
- presents in early adulthood - myocyte loss with associated fibrofatty replacement
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
22
Q
Infective Endocarditis (IE)
A
colonisation or invasion of heart valves or mural endocardium by microbe
23
Q
Causes of IE (6)
A
- poor dental hygiene 2. IVDU 3. soft tissue infection 4. dental treatments 5. cannulae/lines 6. cardiac surgery/pacemakers
24
Q
Predisposing factors of IE (6)
A
- rheumatic heart disease 2. mitral valve prolapse 3. calcified valves 4. biscuspid aortic valves 5. prosthetic valves 6. congenital defects
25
Pathogens in acute IE (2) (previously healthy valve)
Staph aureus Strep pyogenes
26
Pathogens in subacute IE (6) (previous valve pathology)
step viridans staph epidermis HACEK Coxiella Mycoplasma Candida
27
Symptoms of IE (3) Signs of IE (7) Treatment (2)
Symptoms - fever - malaise - rigors Signs - anaemia - splenomegaly - new murmur - Roth spots - splinter hemorrhages - Janeway lesions - Osler's nodes Treatment - Benzylpenicillin + Gentamicin
28
Pericarditis - 5 types
- inflammation of the percardium 1. Fibrinous - MI, uraemia 2. Purulent - Staph 3. Granulomatous - TB 4. Haemorrhagic - tumour, TB 5. Fibrous (constrictive)
29
Histological features of chronic bronchitis (2)
1. goblet cell hyperplasia 2. hypertrophy of mucous glands
30
Histological feature of bronchiectasis
permanent dilatation of bronchi - mucus plugging
31
Histological features of asthma (3)
1. Curschmann spirals (whorls of shed epithelium) 2. eosinophils 3. Charcot-Leyden crystals
32
Kartagener's Syndrome - inheritance pattern - pathology - triad
- autosomal recessive - defective cilia motility Triad 1. situs inversus 2. bronchiectasis 3. chronic sinusitis
33
Sign of interstitial lung disease
End inspiratory crackles
34
Histology hallmark of interstitial lung disease
honey comb lung
35
Idiopathic Pulmonary Fibrosis -who -where -presentation (2) -complications (3) -treatment (2)
- M\>F 40-70yo - lower lobes - dyspnoea, non-productive cough - clubbing, pulmonary HTN, cyanosis - steroids, azathioprine, cyclophosphamide
36
Conditions associated with lung fibrosis (4)
1. Rheumatoid arthritis 2. Systemic sclerosis 3. SLE 4. connective tissue disease
37
Pneumoconiosis - who - where - what
- coal workers - upper lobes - non-neoplastic lung reaction to inhalation of mineral dust/inorganic particles
38
Causes of OBSTRUCTIVE lung disease (5)
1. chronic bronchitis 2. bronchiectasis 3. asthma 4. emphysema 5. bronchiolitis
39
Causes of Bronchiectasis a) inflammatory (7) b) congenital (3)
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
40
Hypogammaglobinlinema - what - predisposition - treatment
= primary immune deficiency disease - recurrent infections, predisposed to Strep. pneumonniae, H.influenzae - IVIG
41
Features of RESTRICTIVE lung disease (3)
1. reduced CO diffusion capacity 2. decreased lung volume 3. decreased compliance
42
What is interstitial lung disease?
group of \> 200 disease characterised by inflammation and fibrosis of the pulmonary connective tissue, particularly the peripheral interstitium of the alveolar wall
43
What drug can induce fibrosing lung disease?
Amiodarone (anti-arrhythmic)
44
What area of the lung is affected in a) pneumoconiosis b) silicosis c) asbesotosis
a - upper lobe b - upper lobe c - lower lobe
45
Causes of granulomatous interstitial lung disease (3)
1. Sarcoidosis 2. extrinsic allergic alveolitis 3. Vasculitides
46
Extrinsic Allergic Alveolitis (EAA) - cause - result - histology - who - management
- 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
47
Wegener's Granulomatosis - what - features (4) - marker - treatment
- autoimmune vasculitis of small and medium blood vessels 1. conjunctivitis 2.pulmonary disease 3. sinusitis 4. myalgia - c-ANCA - Azathioprine/Methotrexate
48
Churg-Strauss Syndrome - 6 features
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
49
Squamous Cell Carcinoma of lung - risk factors (2) - common mutations (2) - histological features (2) - where - ectopic secretion - metastasis
- M\>F, smoker - p53, c-myc - desmosomes (intercellular prickles), keratinisation - centrally located tumours - PTH-like peptide -\> hypercalcaemia - late metastasis
50
Adenocarcinoma of lung - risk factors (2) -common mutation - histological features (3) - where - treatment
- F\>M, non-smokers - EGFR mutations - glandular differentiation, gland formation, mucin production - peripherally - tyrosine kinase inhibitors
51
Small Cell Carcinoma of lung - risk factors - common mutations (2) - histological feature - where - ectopic secretion - associations (2) - metastasis
- smoking - p53, RB1 - arise from neuroendocrine cells - centrally - ACTH - Lambert-Eaton syndrome, cerebellar degeneration - rapid
52
Large Cell carcinoma of the lung - prognosis - microscopy - ectopic secretions (7)
- very poor - poor differentiation, large cells, large nuclei - ADH, ACTH, PTH, PTHrP, Calcitonin,Serotonin, Bradykinin
53
Mesothelioma - association - symptoms (3) - time period
- asbestos - 1. chest pain 2. dyspnoea 3. pleural effusion - latent period 25-45years
54
Risk factors for PE (8)
1. female 2. COCP 3. Preganancy 4. post-surgery 5. immobility 6. cardiac disease 7. malignancy 8. hypercoagulable states
55
Complications of PE (2)
1. corpulmonale -\> RHF 2. cardiogenic shock
56
Causes of Pulmonary HTN a) primary b) secondary (4)
a) idiopathic b) 1. chronic lung disease 2.heart disease 3. recurrent thrombo-emboli 4. AI disorders
57
Pulmonary oedema - histology
iron laden macrophages
58
Hyaline Membrane Disease (HMD) - who - why - what cells - histology
- prem neonates - insufficient surfactant production - type II pneumocytes - lung expanded, plum coloured
59
What cells line to oesophagus?
proximal 2/3 - squamous epithelium distal 1/3 - columnar epithelium joined by the squamo-coloumnar junction "Z-line"
60
Treatment of GORD (3)
1. Smoking cessation 2. Weight loss 3. PPI
61
Barrett's Oesophagus - what - risk
- SCJ transition, metaplasia of squamous cells to columnar cells - increased risk of Ca
62
Oesophageal adenocarcinoma - risk factors (6) - where in the oesophagus?
1. M\>\>F 2. Caucasian 3. Smoking 4. Barrett's oesophagus 5. obesity 6. radiation therapy - distal 1/3
63
Plummer-Vinson Syndrome
iron deficiency anaemia + dysphagia
64
Squamous Cell Oesophageal Carcinoma - Risk Factors (7) - where in the oesophagus? - prognosis - presentation (4)
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
65
What cells line the stomach?
columnar epithelium
66
Causes of acute gastritis (5) Complications of gastritis (2)
1. aspirin 2. NSAIDs 3. H pylori 4. stress 5. corrosives 1. gastric ulcer formation 2. intestinal Ca
67
Cells involved in acute gastritis
neutrophils
68
Cells involved in chronic gastritis
lymphocytes and plasma cells
69
Symptoms of GASTRIC ulcer (4)
1. epigastric pain 2. weight loss 3. pain worsens with food 4. pain relieved by antacids
70
Histology of gastric ulcer
- breach through muscularis mucosa into submucosa - punches out lesion with rolled margins
71
Treatment of H.pylori (3)
1. PPI 2. Clarithromycin 3. Amoxicillin/Metronidazole
72
Symptoms of DUODENAL ulcer (3)
1. epigastric pain 2. pain is worse at night 3. pain is relieved by food/milk
73
Which is more common duodenal or gastric ulcer?
duodenal
74
Biopsy findings in Coeliac Disease (3)
1. villous atrophy 2. crypt hyperplasia 3. lymphocyte infiltrate
75
What rash is associated with Coeliac Disease?
dermatitis herpetiformis
76
What serological markers are associated with Coeliac Disease? (3)
1. Anti-endomysial Ab 2. Anti-tissue transglutaminase 3. Anti-gliadin
77
Symptoms of Coeliac Disease (8)
1. steatorrhoea 2. abdo pain 3. bloating 4. N&V 5. weight loss 6. fatigue 7. IDA 8. failure to thrive
78
Coeliac Disease
T cell mediated autoimmune disease causing gluten intolerance
79
What GI disease is Down's syndrome associated with?
Hirschsprung's
80
Hirschsprung's Disease - what - who - biopsy findings - genetic association - treatment
- absence of ganglion cells in myenteric plexus - M\>\>F - hypertrophied nerve fibres, no ganglia - RET proto-oncogene Cr10+ - resection of affected gut
81
Which is associated with BLOODY diarrhoea - crohn's or UC?
Crohn's
82
"Skip lesions" "cobblestone appearance" "rosethorn ulcers" are associated with which IBD?
Crohn's
83
Complication of UC where the small bowel is involved?
backwash ileitis
84
Severe complication of UC?
toxic megacolon
85
Skin manifestations of IBD (3)
1. erythema nodosum 2. pyoderma gangrenosum 3. erythema multiforme
86
Symptoms of Carcinoid Syndrome (7)
1. flushing 2. diarrhoea 3. bronchoconstriction 4. vasodilation 5. HYPOtension 6. tahcycardia 7. HYPERglycaemia
87
Carcinoid syndrome is associated with which cells?
enterochromaffin cells
88
What do you look for if Carcinoid syndrome is suspected?
24hr urine - 5-HIAA (metabolite of serotonin)
89
gene associated with colorectal adenoma?
APC (adenomatous polyposis coli)
90
Juvenile Polyposis - inheritance pattern - symptoms - risk
- autosomal dominant - PR bleeding from harmatomatous polyps - haemorrhage
91
Peutz-Jeghers Syndrome - pattern of inheritance - mutation - signs (4) - presentation
- 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
92
Risk factors associated with colorectal Ca (6)
1. low fibre diet 2. high fat diet 3. lack of exercise 4. obesity 5. chronic IBD 6. familial syndromes
93
Staging of Colorectal Ca?
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
94
Genes associated with FAP a - autosomal dominant b - autosomal recessive
a - APC b - DNA mismatch repair genes
95
Gardner's Syndrome - what? - features (3)
- similar to FAP but with ecxtra-intestinal features - osteomas, soft tissue tumours, dental caries
96
Lynch syndrome - otherwise known as? - inheritance pattern - mutation - associations (3)
- Hereditary Non-Polyposis Colorectal Cancer (HNPCC) - autosomal dominant - DNA mismatch repair genes 1. endometrial 2. ovarian 3. stomach
97
where is secretin produced? what is it's role?
- S-cells of the duodenum - to cause the pancreas to produce bicarbonate as a buffer
98
where is CCK produced? what is it's role?
- I-cells of the duodenum - causes release of digestive enzymes from the pancreas
99
what do the alpha cells of the islets of Langerhans do?
secrete GLUCAGON to increase blood glucose
100
what do the beta cells of the islets of Langerhans do?
secrete INSULIN to decrease blood glucose
101
what do the delta cells of the islets of Langerhans do?
secrete SOMATOSTATIN to regulate alpha/beta cells
102
what do the D1 cells of the islets of Langerhans do?
secrete H20, a vasoactive peptide
103
Fasting plasma glucose level diagnostic of DM?
\>7 mmol/L
104
Random plasma glucose level diagnostic of DM?
\> 11.1 mmol/L
105
Signs of DM (3)
1. polyuria 2. polydipsia (raised plasma osmolality 3. recurrent infections (hypergylacaemia)
106
Pathology of T1DM
Autoimmune destruction of BETA cells by CD4+ and CD8+ T-lymphocytes
107
Pathology of T2DM
linked to obesity of insulin resistance
108
Complications of DM a) Microvascular (3) b) Macrovascular (3)
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
109
What is a pseudocyst? - and what is it a complication of?
= a pathological collection of fluid - associated with alcoholic pancreatitis
110
Symptoms of acute pancreatitis (4)
1. severe epigastric pain 2. pain that radiates to to the back 3. pain is relieved on sitting forward 4. vomiting
111
Histology of pancreatitis
coagulative necrosis
112
Causes of CHRONIC pancreatitis (5)
1. alcoholism 2. CF 3. Hereditary 4. Pancreatic duct obstruction 5. Autoimmune (IgG4)
113
Presentation of CHRONIC pancreatitis (3)
1. epigatsric pain radiating to the back 2. malabsorption 3. secondary DM
114
Histology of CHRONIC pancreatitis (4)
1. fibrosis 2. loss of exocrine tissue 3. duct dilatation 4. calcification
115
Histology of Acinar Cell Carcinoma (2)
1. neoplastic epithelial cells with eosinophilic granular cytoplasm 2. immunoreactivity for lipase, trypsin, chymotrypsin
116
Most common pancreatic cancer?
ductal adenocarcinoma (85%)
117
Risk factors of ductal adenocarcinoma (5)
1. M\>F 2. Age \> 60yrs 3. smoking 4. diet 5. genetic (FAP, HNPCC)
118
Signs of pancreatic Ca (12)
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
What is Trousseau's Syndrome?
migrating, recurrent, superficial thrombophlebitis
120
What is Courvoisier's sign?
palapable, painless gallbladder in RUQ
121
What is the tumour marker for pancreatic Ca?
Ca19.9 \> 70IU/mL
122
Where in the pancreas do neuroendocrine tumours normally lie?
tail or body
123
Association with an insulinoma?
hypoglycaemic attacks
124
Association with a gastrinoma?
Zollinger-Ellison syndrome - high acid output Increased risk of ulceration
125
MEN1 associated tumours
"PPP" Parathyroid Pancreas Pituitary
126
MEN2a associated tumours
"PTP" Parathyroid Thyroid Phaeo
127
MEN2b associated tumours
Medullary thyroid Marfanoid phenotype Neuroma Phaeo
128
What comprises a "portal tract"?
1. bile duct 2. hepatic artery 3. portal vein
129
What are centrilobular hepatocytes?
- located near the terminal hepatic vein - very metabolically active
130
What are periportal hepatocytes?
- located near the portal tract - receive blood rich in O2 and nutrients
131
Functions of the liver (6)
1. Metabolism 2. Protein synthesis 3. Storgae 4. Hormone metabolism 5. bile synthesis 6. immune function
132
What are the immune cells of the liver?
Kupffer cells
133
Benign liver tumour associated with OCP?
hepatic adenoma
134
Associations with Hepatocellular Carcinoma (HCC) (7)
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
Most common liver cancer?
Secondary metastasis from other tumours e.g. GI, breast, bronchus
136
What is liver cirrhosis?
diffuse abnormality of liver architecture that interferes with blood flow and liver function
137
Causes of liver cirrhosis (7)
1. Alcoholic liver disease 2. NAFLD 3. Chronic viral hepatitis 4. Autoimmune 5. Biliary causes 6. genetic 7. Drugs
138
Genetic causes of liver cirrhosis (5)
1. Haemachromatosis 2. Wilson's disease 3. Alpha 1 antitrypsin disease 4. Galactosaemia 5. Glycogen storage disease
139
Pathology of liver cirrhosis (4 steps)
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
Score to predict prognosis in liver cirrhosis
Child's Pugh Score
141
Criteria of Child's Pugh Score (5)
1. ascites 2. encephalopathy 3. bilirubin 4. albumin 5. PT time
142
Sites of collateral vessel formation in portal HTN (6)
1. gastro-oesophageal junction 2. rectum 3. L renal vein 4. diaphragm 5. retroperitoneum 6. umbilical vein - caput medusa
143
What is Budd-Chiari syndrome?
occlusion of the hepatic vein causing portal HTN
144
Histology associated with Alcoholic fatty liver disease? (2)
1. steatosis (accumulation of fat droplets in hepatocytes) 2. fibrosis
145
Histology associated with alcoholic hepatitis? (3)
1. hepatocyte ballooning 2. Mallory bodies 3. fibrosis
146
Histology associated with alcoholic cirrhosis?
Micronodular cirrhosis
147
Risk factors for non-alcoholic fatty liver disease? (3)
1. obesity 2. hyperlipidemia 3. DM
148
Type 1 Autoimmune Hepatitis markers (4)
1. ANA 2. anti-SMA 3. anti-actin Ig 4. anti-soluble liver antigen Ig
149
Type 2 Autoimmune Hepatitis marker
Anti-LKM Ig (liver-kidney-microsomal Ig)
150
Is primary biliary cirrhosis associated more with females or males?
females
151
Is primary sclerosing cholangitis associated more with females or males?
males
152
Pathology of primary biliary cirrhosis?
AI destruction of medium sized INTRAhepatic bile ducts -\> cholestasis -\> SLOW progression to cirrhosis
153
Pathology of primary sclerosing cholangitis?
inflammation and fibrosis or EXTRA and INTRAhepatic bile ducts -\> multifocal stricture formation
154
Marker associated with primary biliary cirrhosis?
Anti-mitochondrial antibodies
155
secondary symptoms of primary biliary cirrhosis? (5)
1. xanthelasma 2. steatorrhoea 3. Vit D malabsorption 4. skin pigmentation 5. inflammatory arthropathy
156
Which biliary disease is associated with BILE DUCT DILATATION on USS?
Primary sclerosing cholangitis
157
Marker associated with primary sclerosing cholangitis?
p-ANCA
158
PSC gives an increased risk of?
cholangiocarcinoma
159
Gene mutation in Haemachromatosis?
HFE gene - causes increase in absorption of iron in the gut -\> iron deposits in liver, heart, pancreas, adrenals, pituitary, joints and skin
160
inheritance pattern of haemachromatosis?
AR
161
inheritance pattern of Wilson's disease
AR
162
inheritance pattern of alpha 1 anti-trypsin deficinecy?
AD
163
Signs of haemachromatosis? (6)
1. skin bronzing 2. hepatomegaly 3. DM 4. cardiomyopathy 5. hypogonadism 6. pseudogout
164
Kayser Fleischer rings....
Wilson's disease = copper deposits in the cornea
165
Gene mutation in Wilson's disease?
ATP7B - causes decreased copper excretion -\> deposition in liver, CNS and iris
166
Pathology of alpha-1-antitrypsin disease? (2)
1) A1AT accumulation in hepayocytes -\> hepatitis 2) lack of A1AT in lungs -\> emphysema
167
emphysema in never smoker plus liver disease?
alpha 1 antitrypsin disease
168
treatment for Wilson's disease?
Penicillamine (chelator)
169
treatment for haemachromatosis?
Desferrioxamine (iron chelator)
170
Most common pathogen causing cystitis?
Gram -ve E.coli
171
Predisposing factors for cystitis? (6)
1. F\>M
2. bladder calculi
3. urinary obstruction
4. DM
5. sexually active
6. instrumentation
172
Most common bladder tumour?
transitional cell tumour
173
Predisposing factors to bladder cancer? (4)
1. M\>F
2. age 50-80years
3. smoking
4. exposure to aromatic amines (rubber, hair dye)
174
Association with schitosomiasis?
Squamous cell carcinoma
175
BPH
- pathology
- symptoms (5)
- dihydrotestosterone-mediate hyperplasia of prostatic stromal and epithelial cells
1. Difficulty urinating
2. Retention
3. Frequency
4. Nocturia
5. Overflow dribbling
176
Treatment of BPH
5a reductase inhibitors (tamsulosin)
177
Most common prostate cancer?
Where within the gland does it arise from?
adencarcinoma
peripheral zone
178
Most common testicular cancer?
germ cell - seminoma
179
Common pathogens causing acute bacterial prostatitis? (3)
1. E.coli
2. enterococci
3. Staph
180
Biological markers for germ cell tumours? (3)
AFP, HCG, LDH
181
Risk factors associated with renal cell carcinomas? (6)
1. smoking
2, obesity
3. HTN
4. unopposed oestrogen
5. heavy metals
6. CKD
182
Symptoms of renal cell carcinoma? (3)
1. haematuria
2. costovertebral pain
3. palapable mass
183
Nephrotic Syndrome (3)
1. proteinuria \> 3g/24h "frothy urine"
2. hypoalbuminaemia
3. oedema "swelling"
184
Primary causes of nephrotic syndrome (3)
1. Minimal change disease
2. Membranous glomerular disease
3. Focal Segmental Glomerulosclerosis (FSGS)
185
Minimal chnage nephrotic syndrome
- who
- EM findings
- response to steroids
- prognosis
- children
- loss of podocytes
- 90%
- most recover
186
Neophrotic syndrome - Membranous glomerular disease
- who
- causes (4)
- light microscopy findings
- EM findings (2)
- Immunofluorscence
- prognosis
- 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
Focal Segmental Glomerulosclerosis
- who
- causes (3)
- light microscopy findings (2)
- EM findings
- immunofluoresence
- prognosis
- Afro-caribbean adults
- obesity, HIV, nephropathy
- scarring, hyalinosis (thickening of walls)
- loss of podocytes
- Ig and complement in scarred areas
- poor - 50% ESRF
188
Secondary causes of nephrotic syndrome? (2)
1. DM
2. Amyloidosis
189
Histological changes seen in diabetic nephropathy? (2)
1. GBM thickening
2. Kimmelstiel nodules
190
Apple green bifringence for congo red stain......
AMYLOIDOSIS
191
Amyloidosis
- pathology
- signs (3)
- consequences (2)
- increased deposition of amyloid proteins in the organs of the body
- macroglossia, heart failure, hepatomegaly
- RA, chronic infections
192
Nephritic Syndrome
- what
- Signs (6)
- 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
Causes of Nephritic Syndrome (5)
1. Post-infectious
2. Berger's - IgA Nephropathy
3. Cresenteric GN
4. Alport's - hereditary nephritis
5. benign familial hameturia
194
Common pathogen causing post-infectious GN?
Group A haemolytic Strep pyogenes
195
Post-Strep GN
- when
- pathology
- signs (4)
- Bloods
- fluorescence microscopy (2)
- 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
What is the most common cause of GN worldwide?
Berger's Disease (IgA nephropathy)
197
Berger's Disease
- who
- pathology
- when
- symptom
- prognosis
- Asian
- IgA deposition in the glomeruli
- 1-2weeks after URTI
- frank haematuria
- can progress to ESRF
198
What's the most agressive glomerulonephritis?
Crescenteric
199
Three types of Crescenteric GN?
I
II
III
Type I - Anti-GBM antibody
Type II - Immune complex mediated
Type III - Pauci-immune/ANCA associated
200
Goodpasture's syndrome is a
Type I
Type II
Type III
GN?
- fluorescence microscopy ?
- other organs?
Type I - Anti-GBM antibody against Collagen type IV
- linear deposition of IgG in GBM
- YES - lungs
201
SLE is a
Type I
Type II
Type III
GN?
- immunofluorescence?
Type II - immune complex mediated
- granular IgG immune complexes on GBM
202
Wegener's granulomatosis is a
Type I
Type II
Type III
GN?
- fluorescence?
- other organs?
Pauci-immune/ANCA associated
- lack of immune complex deposition
- YES - vasculitis - skin, lungs
203
Alport's Syndrome
- inheritance pattern
- pathology
- Signs (3)
- prognosis
- X-linked recessive
- collagen type IV mutation causing hereditary glomerular disease
- nephritis, sensorineural deafness, eye disorder
- ESRF
204
Thin basement membrane disease/Benign familial haematuria
- inheritance pattern
- symptoms
- pathology
- prognosis
- autosomal dominant
- asymptomatic microscopic haematuria
- type IV collagen mutation
- normal renal function
205
Asymptomatic hameaturia? (3)
1. Benign familial haematuria
2. Alport's syndrome
3. IgA nephropathy/Berger's syndrome
206
Causes of Acute Tubular Injury (6)
1. burns
2. septicaemia
3. drugs (gentamicin, NASIDs)
4. radioraphic contrast agents
5. myoglobin
6. heavy metals
207
Signs and symptoms of acute pyelonephritis? (8)
1. fever
2. chills/sweats
3. flank pain
4. renal angle tenderness
5. leukocytosis
6. frequency
7. dysuria
8. haematuria
208
Most common pathogen of pyelonephritis?
E.coli
209
Interstitial nephritis
- when
- what
- symptoms (5)
- causative drugs (4)
- 15 days after exposure
- hypersensitivity reaction
- fever, rash, haematuria, proteinuria, eosinophilia
- Penicillin, Rifampicin, Thiazides, NSAIDs
210
What pathogen is associated with Haemolytic Uraemic Syndrome? (HUS)
- who
- signs (3)
- diagnosis (2)
- bloods (2)
- where are the thrombi?
- E.coli
- children
- BLEEDINGS - petichiae, melena, haematemesis
- fragmented RBCs on blood smear, Coombs negative
- low plts, low Hb
- thrombi confined to kidneys
211
Thrombotic Thrombocytopaenic Purpura (TTP)
- who
- where are the thrombi?
- signs/symptoms (3)
- CNS symptoms? (4)
- diagnosis (2)
- bloods (2)
- 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
Signs of haemolysis on bloods (3)
1. high reticulocytes
2. high LDH
3. high bilirubin -\> jaundice
213
Triad of Thrombotic Microangiopathies
1. mircoangiopathic haemolytic anaemia
2. thrombocytopenia
3. renal failure (HUS)
214
Complications of acute renal failure (6)
1. HTN
2. Uraemia
3. metabolic acidosis
4. hyperkalaemia
5. fluid overload
6. hypocalcemia
215
Pre-renal causes of Acute Renal Failure (5)
- pathology
- HYPOperfusion
1. Renal artery stenosis
2. HYPOvolaemia
3. sepsis
4. burns
5. acute pancreatitis
216
Renal cause of Acute Renal Failure (3)
1. glomerulonephritis
2. acute tubular necrosis
3. thrombotic microangiopathy
217
Post-renal causes of Acute Renal Failure (4)
- pathology
OBSTRUCTION
1. stones
2. tumours
3. prostatic hypertrophy
4. retroperitoneal fibrosis
218
Signs of uraemia (4)
1. fatigue
2. itching
3. anorexia
4. confusion
219
Commonest causes of chronic renal failure?
DM
220
Adult Polycystic Kidney Disease (APKD)
- inheritance pattern
- onset
- common mutations (2)
- Pathological features (3)
- Signs/symptoms (3)
- Complications (3)
- prognosis
- 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
Most common pathogens causing PID?
1. chlamydia trachomatis
2. neisseria gonorrhoea
222
Presenting symptoms in PID (6)
1. fever
2. vaginal bleeding/discharge
3. low abdo pain
4. deep dysparunia
5. adnexal tenderness
6. cervical excitation
223
Fitza Hugh Curtis syndrome....
violin-string peri-hepatic adhesions caused by ascending chlamydia infection
224
Complications associated with PID (8)
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
Endometriosis
= presence of endometrial glands or stroma in abnormal locations outside of the uterus
226
Chocolate cysts...
endometriomas found on ovaries in endometriosis
227
Adenomyosis
- presence of ectopic endometrial tissue deep within the myometrium
- disrupts mucle contraction
228
Leiomyoma
- what
- description
- types (3)
FIBROID
- benign tumour of smooth muscle
- bulky, irregular uterus
1. intramural
2. submucosal
3. subserosal
229
Presentation of fibroids (5)
1. dysmenorrhoea
2. mennorhagia
3. deep dyspareunia
4. pressure effects (frequency, tenemus)
5. subfertility
230
Leiomyosarcoma
rare
normally de novo
post-menopausal women
231
Post-menopausal bleeding...
endometrial cancer
232
Endometrial cancer
- risk factors (8)
- staging
Risk Factors 1) Obesity
2) anovulatory amenorrhoea
3) nulliparity
4) early menarche
5) late menopause
6) tamoxifen
7) DM
8) HTN
Staging - FIGO
233
Most common endometrial cancer?
adenocarcinoma
234
Most common endometrial cancers in elderly women?
non-endometrioid
1) serous
2) papillary
3) clear cell
- more aggressive
235
What are the normal cells of the vulva?
squamous epithelium
236
Most common vaginal intraepithelial neoplasia (VIN)?
squamous cell carcinoma
237
Lichen sclerosis
- who
- where
- what
- older women
- vulva
- thinning of the epidermis, smooth white appearance
238
Lichen planus
- what
- where
- T-cell mediate autoimmune conditions
- oral, vulval, penile
- Eruption of purple flat topped papules with mother of pearl sheen.
239
Most common type of ovarian cancer?
serous-type epithelial
240
4 types of epithelial ovarian cancers
1. serous - contain psammoma bodies
2. mucinous - no psammoma bodies
3. endometrioid - tubular
4. brenner/clear cell - hobnail appearance (bumpy)
241
3 types of germ cell ovarian tumours
1. dysgerminoma
2. teratoma
3. choriocarcinoma
242
MatureTeratoma
- benign or malignant?
- contain what?
- who?
benign
well-differentiated cystic lesions containing skin, hair, teeth, bone, cartilage
adults
243
Immature teratoma
- benign or malignant?
- who?
- contains what?
- malignant
- children
- immature embryonal tissues
244
Choriocarcinoma's secrete?
hCG
aggressive
young women
245
Granulosa-theca cells tumours
secrete?
signs (3)
oestrogen secreting
1. irregular menstural cycles
2. breast enlargement
3. enodmetrial/breast cancer
246
Sertoil-leydig cell tumours
secrete?
signs (4)
androgen secreting
"defeminising"
1. hirsuitism
2. breast atrophy
3. deepened voice
4. enlarged clitoris
247
Risk factors for CIN? (6)
1. early age of first intercourse
2. multiple partners
3. multiparity
4. smoking
5. HIV
6. immunosupression
248
cells lining outer cervix?
squamous epithelium
249
cells lining endocervical canal?
columnar glandular epithelium
250
Virus causing CIN?
HPV 16 & 18
251
Risk of cervical cancer in Cervical Intraepithlial Neoplasis 3? (CIN3)
30%
252
Change from CIN to carcinoma?
invasion through the basement membrane
253
Most common cervical carcinoma?
squamous cell carcinoma
254
Clinical presentation of cervical cancer?
1. post-coital bleeding
2. intermenstrual bleeding
3. postmenopausal bleeding
4. discharge
5. pain
255
Mastitis
- pathogen
- symptoms (4)
- who
- treatment (3)
- staph
- fever, pain, red breast, cracked nipples
- breastfeeding mum's
- Abx, continue breastfeeding, surgical drainage
256
Histology of periductal mastitis
- who does it affect?
- keratinsing squamous epithelium deep into nipple duct orifices
- smokers
257
Mammary Duct Ectasia
- who
- symptoms (2)
- pathology
- multiparous women aged 40-60yrs
- thick white nipple secretions, perareolar mass
- granulomatous inflammation of dilated large breast ducts
258
Fat necrosis
- presentation
- common story
- pathology
- 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
Fibrocystic Disease
- presentation
- pathology
- lumpy breasts
- cystic changes with inflamation, fibrosis and adenosis caused by an exggerated response to hormones
260
Causes of gynaecomastia (4)
1. alcohol
2. age
3. liver cirrhosis
4. testicular tumour
261
Fibroadenoma
- what
- where
- commonly affects
- description (3)
- benign tumour from stroma
- multiple and bilateral
- 20-30yrs old
- rubbery, freely mobile, variable size
262
Duct Papilloma
- what
- presentation
- benign papillary tumour of he duct system of the breast
- bloody discharge, no lump
263
Radial scar
- benign sclerosing lesion - central scarring surrounded by proliferating gl;andular tissue in stellate pattern
- resembles carcinoma on mammogram
264
Risk factors for breast cancer (8)
1. susceptibility genes (BRCA1/BRCA2)
2. Oestrogen exposure
3. age 75-80yrs
4. FH
5. Race (caucasian)
6. obesity
7. tobacco
8. alcohol
265
what is the most common breast cancer?
ductal carcinoma in situ
266
What age is the UK screening programme for breast cancer?
47 - 73 years
267
What percent of lobular carcinoma in situ are bilateral?
20-40%
268
What percent of DCIS are HER2+?
1/3
269
How does DCIs look on a mammogram?
areas of microcalcification
270
Presentation of breast cancer? (4)
1. painless lump
2. peau d'orange
3. nipple retraction
4. Paget's disease
271
Histology on invasive lobular carcinoma in situ?
"bulls eye pattern" cells are aligned in single file chains/strands
272
Mucinous carcinoma
produce abundant quantities of extracellular mucin
273
What does a triple assesment involve?
1. Examination
2. Radiology - Mammography/USS/MRI
3. Cytology - FNA
274
Histological grading of breast cancers (3)
1. nuclear pleomorphism
2. tubule formation
3. mitotic activity
275
What is Tamoxifen?
Oestrogen receptor antagonist
276
What is Herceptin?
- side effect
- monoclonal Ig to Her2
- toxicity to myocardium
277
Basal-like carcinoma
- sheets of atypical cells with lymphocyctic infiltrate, triple negative
278
Phyllodes tumour
- what
- who
- prognosis
- presentation
- histology
- interlobular stroma tumour
- \>50 yrs
- mostly benign, some can be agressive
- palpable mass
- grow in a "leaflike" pattern
279
Causes of cerebral oedema (2)
Result (1)
1) Vasogenic oedema - BBB disrupted
2) Cytogenic - secondary to cellular injury
- Increased ICP
280
Nomrla volume of CSF?
90-150ml
281
Causes of hydrocephalus (2)
a) Obstructive - actual obstruction to flow of CSF
b) Non-obstructive - impaired reabsorption, no obstruction to flow
282
3 common types of brain herniation
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
How many strokes per year in UK?
3rd common cause of death in UK?
100,000
Stroke
284
Stroke definition
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
Definition of TIA
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
Symptoms of Stroke? (8)
- fast onset of symptoms
F - face drop
A - arms - paralysis, weakness
S - speech slurred
(T - time to call)
- numbness, loss of vision, dysphagia
287
Symptoms of TIA (3)
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
Most common vascular territory hit in a stroke?
Symptoms (4)
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
Mx of Stroke
a) acute (3)
b) long term (3)
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
Mx of TIA
a) Acute (2)
B) Long term (3)
a) Acute
1. Aspirin + Dipyridamole
2. Carotid enaterectomy
b) Long term
1. Control HTN
2. Control hyperlipidemia
3. anticoagulants
291
Risk Factors for Cerebrovascular disease? i.e. cerebral artherosclerosis (3)
1. HTN
2. DM
3. Smoking
292
Common sites for cerebral artherosclerosis? (3)
1. extracerebral arteries
2. carotid bifurcation
3. basilar artery
293
Types of Haemorrhage
a) Non traumatic (2)
b) Traumatic (2)
a) Non-Traumatic
1. Intraparenchymal haemorrhage
2. Subarachnoid haemorrhage
b) Traumatic
1. Subdural
2. Extradural
