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Toni's Pathology > Histopathology > Flashcards

Histopathology Flashcards

1
Q

What locations are most at risk of atherosclerotic plaque formation?

A 
Locations with turbulent flow:
Coronary arteries
AA
Carotid arteries
Iliac arteries
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2
Q

What are the components of an atherosclerotic plaque?

A

Cellular: SMC, macrophages
Extra cellular membrane
Lipids

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3
Q

What are non-modifiable risk factors for atherosclerosis?

A

Age: 5x incr risk >60 yrs
Male
FHx
Genetic risk ?

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4
Q

What are modifiable risk factors for atherosclerosis?

A

HTN: incr risk by 60%
T2DM
Smoking
Hyperlipidaemia

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5
Q

What is the process of atherosclerosis ?

A

Fatty streaks + RF -> atheroma formation
Endothelial dysfunction -> subintimal LDL accumulation
LDL modification + oxidation -> inflammation -> monocyte adhesion
Monocyte -> intima = macrophage -> takes up ox/mod LDL= foam cell
Apoptosis of foam cells -> incr inflammation -> incr adhesion mols -> incr macrophage recruitment
Intimal SM cell recruitment -> fibrous cap

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6
Q

What are the risk factors for mortality with MI?

A

Incr age
Female
DM
Previous MI

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7
Q

What are the histological changes which occur following an MI?

A

Secs: reversible loss of contractility

20-30 mins: irreversible loss of contractility

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8
Q

What occurs when the myocardium is starved of oxygen and nutrients in infarction?

A

60s: potentially reversible loss of contractility - acute HF

20-30 mins: irreversible loss of contractility

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9
Q

What are immediate complications of MI?

A

40%

Cardiogenic shock: due to contractile dysfunction = mortality 70%

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10
Q

What are acute complications of MI?

A

Hours: fatal arrhythmia e.g. VF, or VT
Days: papillary muscle rupture -> mitral regurg
Day 2-3: transmural infarct -> acute pericarditis
Day 3-7: cardiac rupture: ventricular wall-> haemopericardium, septum -> L>R shunt

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11
Q

What are chronic complications of MI?

A

> 1 wk: mural thrombus, ventricular aneurysm, PE
Wks- months: Dresslers pericarditis
Months-yrs: chronic HF

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12
Q

What are the symptoms of Left HF?

A

Dyspnoea
Orthopnoea
PND

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13
Q

What are the symptoms of Right HF?

A

Peripheral oedema
Ascites
Facial engorgement

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14
Q

What are the causes of heart failure?

A 
Ischaemic heart disease
Valve disease
HTN
Myocarditis
Cardiomyopathy
Arrhythmias
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15
Q

What are the complications of heart failure?

A 
Sudden death
Arrhythmias
Systemic emboli
Pulmonary oedema
Hepatic cirrhosis
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16
Q

What are the structural features of cardiac failure?

A

Dilated heart: scarring and thinning of walls

Microscopy shows scarring and replacement of myocardium

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17
Q

What is the process by which heart failure develops?

A

Systolic dysfunction -> physiological adaptation to maintain tissue perfusion
Reduced CO-> RAS -> Na + water retention = oedema
Reduced SV-> sympathetic NS prolonged -> incr TPR -> incr afterload
= dilation, hypertrophy, myocardial fibrosis

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18
Q

What are causes of aneurysm formation?

A

Congenital incl: Marcans
Atherosclerosis
HTN

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19
Q

What is angina pectoris?

A 
Transient ischaemia of myocardium
Stable: seen on exertion, relieved by rest, no plaque disruption
Seen with 75% stenosis
Unstable: occurs at rest
Seen with 90% stenosis
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20
Q

What is prinzmetal angina?

A

Uncommon
Chest pain at rest
Due to coronary artery vasospasm
Unknown aetiology

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21
Q

What are the features of sudden cardiac death?

A

Background of IHD + lethal arrhythmia
50% plaque rupture, 25% MI changes
Electrical instability at sites distant from conduction system, near scars from old ?MI

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22
Q

What makes plaques vulnerable in atherosclerosis?

A 
Lots of foam cells
Thin fibrous cap
Few SM cells
Clusters of inflammatory cells
HTN
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23
Q

What are the features of hypertrophic cardiomyopathy?

A 
Myocardial hypertrophy
No ventricular dilatation 
Thick-walled, heavy, hyper-contracting
Histo: myocyte disarray = arrhythmogenic
AD: betaMHC, MYBP-C, Trop-T
Sudden cardiac death
15-20% -> DCM
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24
Q

Dilated cardiomyopathy

A

Causes: idiopathic, alcohol, peripartum, genetic, sarcoidosis, haemochromatosis, myocarditis
Systolic dysfunction
Indirect dysfunction:
IHD, valvular heart disease, htn

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25
Q

Restrictive cardiomyopathy

A

Causes:
Sarcoidosis, amyloidosis, radiation induced fibrosis
Diastolic dysfunction
Indirect dysfunction: pericardial constriction

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26
Q

Hypertrophic cardiomyopathy

A

Causes: genetic, storage diseases
Diastolic dysfunction
Indirect dysfunction: HTN, AS

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27
Q

When does acute rheumatic fever occur and which systems are involved?

A

5-15 yrs
2-4 wks post strep throat infection

Cardiac: endo, myo and pericarditis
Joints: arthritis, synovitis
Skin: erythema marginatum, subcutaneous nodules
Neuro: encephalopathy, Sydenham’s chorea

Also: fever, tachycardia, malaise, migrating polyarthralgia

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28
Q

Why does acute rheumatic fever occur following strep throat infection and what are the histological features?

A

Lancefield gp A strep
Antigenic mimicry: cell mediated immunity and antibodies to strep cross react with myocardial antigens

Verrucae
Aschoff bodies: small giant cell granulomas
Anitschkov myocytes: regenerating myocytes

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29
Q

How is rheumatic fever diagnosed and treated?

A

Jones criteria
Plus raised ESR and ASOT

Benzylpenicillin
Or erythromycin if allergic

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30
Q

What are the features of rheumatic heart disease?

A

Small warty verrucae along valve leaflet lines of closure

Due to antigenic mimicry: cross reaction of anti strep antibodies and cardiac tissue

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31
Q

What are the features of infective endocarditis?

A

Large irregular masses on valve cusps extending into the chordea
Due to colonisation of valves or mural endocardium by microbes

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32
Q

What are the features of non-bacterial thrombotic endocarditis AKA marantic?

A

Small bland vegetations attached to lines of closure formed of fibrin
Due to hypercoagulable states
DIC

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33
Q

What type of endocarditis gives rise to small, warty, platelet rich, sterile vegetations?

A

Libman-Sachs

Assoc with SLE + antiphospholipid synd

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34
Q

What might cause a bacteraemia leading to infective endocarditis?

A

Poor dental hygiene: strep viridans
IVDU: staph aureas
Iatrogenic: central lines, surgery

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35
Q

What factors predispose to endocarditis?

A

Rheumatic heart disease
Valve disease: e.g. Mitral prolapse, calcified valves
Prosthetic valves
Congenital defects: bicuspid aortic valve

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36
Q

What organisms might cause acute endocarditis?

A

Staph aureas
Strep pyogenes
High virulence with large vegetations, spread to aorta

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37
Q

What organisms might cause subacute endocarditis?

A 
Strep viridans
Staph epidermis
HACEK
Coxiella
Mycoplasma
Candida
Low virulence with small vegetations, spreads to chordae
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38
Q

What are the clinical features of endocarditis?

A

Fever, malaise, anaemia, rigors
Splenomeg, new murmur
Roth spots, splinter haemorrhages, janeway lesions, oslers nodes

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39
Q

How is endocarditis diagnosed and treated?

A

Dukes criteria: 2 maj + 1 min, 3 min + 1 maj or 5 min
Maj: +ve blood cultures, typical organism, evidence of endocard involv.
Min: fever, vasculitic phenomena, immune phenomena, predisposing heart condition/IVDU, micro or echo evidence not meeting maj criteria

Benzylpenicillin + gentamicin

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40
Q

What are the five types of pericarditis and their respective causes?

A 
Fibrinous: MRI or uraemia
Purulent: staphylococcus
Granulomatous: TB
Haemorrhagic: tumour, TB, uraemia
Fibrous: any, e.g. Constrictive
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41
Q

What is a pericardial effusion and what can cause them?

A

Serous fluid in pericardial sac: due to chronic HF
Or
Exudative fluid: due to inflammation, infection, malignancy or AI

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42
Q

What valvular disease might you expect to see in a middle aged woman with SOB + chest pain?

Mid systolic click + late systolic murmur

A

Mitral valve prolapse

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43
Q

What valvular disease might you expect to see in an elderly man with a recent history of syncope?

Systolic murmur at upper right sternal border, with an ejection click

A

Aortic stenosis

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44
Q

What is the pathophysiology underlying acute asthma?

A

Allergen sensitisation
T cell activation
IgE release from plasma cells
.????

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45
Q

What is the Pathophysiology underlying chronic asthma?

A

SMC hyperplasia
Increased mucus production
WBC infiltrates

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46
Q

What histological features are seen in asthma?

A

Eosinophils
Curschmann spirals: shed epithelium
Charcot-Leyden crystals

47
Q

What histological features are seen in chronic bronchitis?

A

Airway damage:
Airway dilation
Goblet cell hyperplasia
Mucous gland hypertrophy

48
Q

What are the complications seen with chronic bronchitis?

A

Recurrent infection
Chronic hypoxia
Pulmonary htn

49
Q

What are the histological features of centrilobular emphysema?

A

Parenchyma damage:
Air space enlargement
Wall destruction
Loss of alveolar parenchyma distal to terminal bronchiole

50
Q

What complications are associated with centrilobular emphysema?

A

Pneumothorax - due to bullae
Respiratory failure
Pulmonary htn

51
Q

What is the cause of pan acinar emphysema?

A

Alpha-1-antitrypsin deficiency

52
Q

What are the features of bronchiectasis?

A

Permanent dilatation and scarring of the bronchi
Cough, purulent sputum + fever
Complications incl: recurrent infections, haemoptysis, pulmonary htn, amyloidosis

53
Q

List some inflammatory causes of bronchiectasis

A 
Post infection
Post inflammation I.e. Aspiration
Obstruction
Asthma
Ciliary dyskinesia
Systemic disease
Secondary to bronchiolar disease + interstitial fibrosis
54
Q

What are congenital causes of bronchiectasis?

A

CF
Hypogammaglobulinaemia
Primary ciliary dyskinesia

55
Q

What are the four categories of interstitial lung disease?

A

Fibrosing
Granulomatous
Eosinophilic
Smoking related

56
Q

How might interstitial lung disease present?

A

SOB, end inspiratory crackles, cyanosis, pulmonary hypertension, cor pulmonale
Restrictive spirometry results
CXR: honeycomb features

57
Q

What conditions are considered to be fibrosing type interstitial lung disease?

A 
Idiopathic pulmonary fibrosis
Pneumoconiosis
Cryptogenic organising pneumonia
Drug induced
Radiation pneumonitis
Assoc with connective tissue disease
58
Q

What are the features of cryptogenic fibrosing alveolitis/idiopathic pulmonary fibrosis?

A

Exertional dyspnoea, non productive cough, cyanosis, pulm htn
Histology:
Progressive, patchy, interstitial fibrosis with loss of normal architecture and honeycomb change, beginning at lobule periphery
Treatment:
Steroids, cyclophosphamide, azathioprine

59
Q

What are the features of pneumoconiosis?

A

Occupational lung disease
Non neoplastic reaction to inhaled inorganic particles
Affecting upper lobe
E.g. Silicosis, asbestosis

60
Q

What are the histological features of a granuloma?

A

Collection of histiocytes, macrophages

With or without multinucelated giant cells

61
Q

What are the features of extrinsic allergic alveolitis/hypersensitivity pneumonitis/ cryptogenic organising pneumonia/ bronchiolitis obliterans organising pneumonia ?

A

Immune mediated lung disorders
Due to prolonged/intense exposure to inhaled organic antigens
Causes widespread alveolar inflammation
Histology: Polypoid plugs of loose connective tissue within alveoli/bronchioles, granuloma formation, organising pneumonia
Acute: fever, chills, chest pain, SOB within hrs, settles over nxt day
Chronic: progressive, persistent, productive cough, SOB, clubbing, severe weight loss

62
Q

Features of bronchopneumonia

A

Low virulence organisms
Elderly/COPD
Patchy peribronchial distribution (often lower lobes)

63
Q

Features of lobar pneumonia?

A 
High virulence organisms
Young individuals
Fibrinosuppurative consolidation:
Red hepatisation: neutrophilia
Grey hepatisation: fibrosis
Resolution:
64
Q

What is pulmonary hypertension?

A

Pulmonary pressure > 25 mmHg

65
Q

What are causes of pulmonary hypertension?

A

Precapillary: vasoconstrictive or emboli
Capillary: pulmonary fibrosis
Post capillary: veno-occlusive disease or left HF

66
Q

Features of pulmonary emboli

A

Large: Impact in main pulmonary arteries ->acute cor pulmonale, cardio genic shock, death if >60% occluded
Small: -> silent / peripheral wedge infarction, repeated infarction -> pulm htn

67
Q

What are the histological features of pulmonary oedema?

A

Intra alveolar fluid
Iron laden macrophages
Diffuse alveolar damage

68
Q

Causes of acute respiratory distress syndrome in adults?

A

Infection
Trauma incl burns
Aspiration

69
Q

What are the histological features of rapid onset respiratory failure?

A

Expanded lungs:
firm
airless
plum coloured

70
Q

Which lung cancers are most associated with smoking?

A

Small cell

Squamous cell

71
Q

Which lung cancer is commonest in non smokers?

A

Adenocarcinoma

72
Q

What are the pathological and histological features of squamous cell carcinoma of the lung?

A

Path: proximal bronchi, local spread, late mets, less chemosensitive
Histo: keratinisation, intercellular prickles
Assoc with: cavitation + hypercalcaemia
Subtypes incl: papillary, basaloid

73
Q

What are the pathological and histological features of adenocarcinoma of the lung?

A

Path: peripheral epithelial tumour w. glandular differentiation or mucin production, metastasises early, EGFR mutations
Histo: glandular differentiation
Cyto: mucin vacuole containing cells

74
Q

What are the pathological and histological features of large cell carcinoma of the lung?

A

Path: poorly differentiated epithelial tumour
Large cells, large nuclei,mprominent nucleoli
Histo: no evidence of glandular or squamous differentiation
Poor prognosis

75
Q

What are the pathological and histological features of small cell carcinoma of the lung?

A

Path: central, proximal bronchi, neuro endocrine cells
V malignant, early mets -> bone, brain, liver, adrenal, 1 yr
Ectopic ACTH, Lambert Eaton, cerebellar degeneration
P53 + RB1 mutations common
Histo: small, undifferentiated, hyperchromatic, oat cells

76
Q

Molecular markers in lung cancer:

ERCC1

A

Poor response to cisplatin

77
Q

Molecular markers in lung cancer:

EGFR

A

Usually seen in adenocarcinoma

Good response to TKI

78
Q

Molecular markers in lung cancer:

Kras

A

Seen in adeno/squamous carcinoma
No response to TKI
Poor prognosis

79
Q

Molecular markers in lung cancer:

EML4-ALK

A

Usually adenocarcinoma

No benefit from TKI

80
Q

Complications seen in lung cancer

A

Bronchial obstruction -> haemoptysis, pneumothorax
Pleural/pericardial invasion -> effusions, tamponade
Mediastinal invasion -> SVC syndrome
Oesophageal invasion -> dysphasia
Chest wall invasion -> pleuritic pain
Nerve invasion -> hoarse voice, horner’s
Paraneoplastic syndromes: SIADH, Lambert Eaton, Cushing’s (HPT with squamous)

81
Q

What is the z line in the oesophagus?

A

Another name for squamo-columnar junction
Betw proximal 2/3 squamous epithelium
And distal 1/3 columnar epithelium

82
Q

What are complications of reflux oesophagitis?

A 
Ulceration
Haemorrhage
Barret's oesophagus
Stricture
Perforation
83
Q

What is Barret’s oesophagus?

A

Intestinal metaplasia of squamous mucosa = columnar epithelium with goblet cells

84
Q

In whom is oesophageal adenocarcinoma usually seen and what are the risk factors?

A

White men
Assoc with Barrett’s oesophagus
RF: smoking, obesity, prev radiation therapy

85
Q

In whom is squamous cell oesophageal carcinoma usually seen and what are the risk factors?

A

Afro Carribean men

RF: ETOH, smoking, achalasia, nutritional deficiencies, nitrosamines, HPV, Plummer Vinsent

86
Q

What are the pathological and histological features of squamous cell oesophageal carcinoma?

A

Presents with: progressive dysphagia, odynophagia, anorexia, weight loss
Path: rapid growth, early spread -> LNs, liver
50% mid 1/3, 30% lower 1/3, 20% upper 1/3

87
Q

What are the pathological features of acute gastritis?

A

Neutrophil infiltrate
Following insult
E.g. Aspirin, NSAIDs, alcohol, corrosives, acute H.pylori

88
Q

What are the pathological features of chronic gastritis?

A

Lymphocytic infiltrate
Following H.pylori insult
(Or: CMV, HIV, HSV, AI, ETOH, smoking)
Complications incl: gastric ulceration or meta -> dysplasia

89
Q

What are the pathological and histological features of gastric ulcers?

A

Epigastric pain +- weight loss
Breach of muscularis mucosa= exposed submucosa
Punched out lesion with rolled margins
Complications incl: IDA, perforation, malignancy

90
Q

What are the pathological features of gastric lymphoma?

A

Chronic antigen stimulation due to H.pylori

Treatment: H.pylori eradication - PPI, clarithromycin, amox/metro

91
Q

What are the histological features of normal duodenal epithelium?

A

Glandular epithelium
Goblet cells
Villous architecture
Brunner’s glands (->alkali)

92
Q

What are the pathological features of duodenal ulcers and their complications?

A

More common than gastric, seen in younger population
Epigastric pain, worse at night, relieved by food
RFs: H.pylori, NSAIDs, steroids, smoking, drugs
Complications: IDA, perforation

93
Q

What are the pathological features of coeliac disease?

A

T cell mediated gluten intolerance -> villous atrophy + malabsorption
Steatorrhoea, abdo pain, bloating, n+v, weight loss, fatigue
FTT, IDA, dermatitis herpetiformis

94
Q

How is coeliac disease diagnosed and treated?

A

Anti endomysial Ab, anti tissue transglutaminase Ab, anti gliadin Ab
Rx: lifelong gluten free diet

95
Q

List causes of mechanical bowel obstruction

A 
Constipation
Diverticular disease
Intussusception
Adhesions
Herniation
Volvulus
96
Q

List causes of acute and chronic colitis

A

Acute: infection, chemotherapy, radiotherapy, drugs?
Chronic: IBD, TB

97
Q

List causes of ischaemia colitis

A 
Vessel occlusion
Small vessel disease
Low flow states
Obstruction
commoner in 'watershed areas' 
Splenic flexure: SMA->IMA, Rectosigmoid: IMA->internal iliac
98
Q

How is C.difficile treated?

A
  1. 14/7 oral metronidazole
  2. 14/7 oral metronidazole
  3. 10-14/7 oral vancomycin
99
Q

Describe the pathophysiology of diverticular disease

A

High intraluminal pressure -> outpouchings at weak points in bowel wall
90% in L colon
Asymptomatic/PR bleeding
Complications: fever, peritonism, gross perforation, fistula, obstruction

100
Q

Epidemiology of Crohn’s

A

F>M
20s
White
Mono zygotes twin concordance 50%

101
Q

Pathophysiology of Crohns

A

Whole GIT involved: apthous mouth ulcers, skip lesions
Non caseating granulomas, transmural inflammation
Fistulae, fissures
Presentation: Intermittent pain, diarrhoea + fevers
Complications: Strictures, fistulae, abscesses, perforation

102
Q

List the extra-GI manifestations of IBD

A

Uveitis + conjunctivitis
Erythema nodosum, pyoderma gangrenosum, erythema multiforme
Clubbing, sacroilitis, myositis, ankylosing spondylitis, pericholangitis
PSC - more common in UC

103
Q

Diagnosis and management of Crohns

A 
ESR + CRP
?barium contrast
Endoscopy
Rx: mild = prednisolone, 
severe = IV hydrocortisone, metronidazole + azathioprine, methotrexate, infliximab
104
Q

Pathophysiology of ulcerative colitis

A

Continuous involvement of bowel mucosa extending proximally from rectum: Extensive superficial broad ulcers, no granulomas
Fissures, fistulae, strictures
Pseudo polyps: regenerating islands of mucosa
Small bowel only affected if there is backwash ileitis
Presentation: bloody diarrhoea, mucus, crampy abdo pain
Complications: severe haemorrhage, toxic megacolon
30% req colectomy in 3 yrs
20-30x risk adenocarcinoma

105
Q

Diagnosis and management of UC

A 
Rectal biopsy, AXR, stool culture
Flexible sig / colonoscopy
Mild: pred + mesalazine
Mod: pred + 5ASA + BD steroid enema
Sev: admit NBM, fluids + IV hydrocortisone, rectal steroids
Remission: 5ASA (azathioprine 2nd line)
106
Q

Describe carcinoid syndrome

A

Bronchoconstriction, flushing + diarrhoea due to:
Heterogenous gp of tumours of enterochromaffin cell origin
Produce serotonin -5HT
Oft found in bowel ( lung, ovaries, testes )
Slow growing

107
Q

Describe carcinoid crisis

A 
Life threatening vasodilation
Hypotension
Tachycardia
Bronchoconstriction 
Hyperglycaemia
108
Q

Describe the diagnosis and treatment of carcinoid syndrome

A

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

Rx: octreotide (somatostatin analogue)

109
Q

Describe FAP: familial adenomatous polyposis

A

Familial syndrome ->untreated -> bowel adenocarcinoma 30yrs
70% AD 5q1 APC gene mut, 30% AR DNA mismatch repair gene mut
>100 adenomatous polyps by 10-15 yrs
Req prophylactic colectomy
Incr risk neoplasia: ampulla of vater + stomach
Hypertrophy of retinal pigment epithelium at birth

110
Q

Describe Gardeners syndrome

A

Like FAP
+ extraintestinal features:
Osteomas, dental caries

111
Q

Describe HNPCC: hereditary non-polyposis colorectal cancer

Aka lynch syndrome

A

AD mut in DNA mismatch repair

R colon: few polyps, fast progression

112
Q

Describe adenomas

A

Benign dysplastic lesions precursor to most adenocarcinomas
Asymptomatic, req regular surveillance
>3.4cm: 45% malignant
Can be tubular, tubulo-villous + villous
Villous= rare but leak protein + K
RF for malig: large size, degree of dysplasia, villous component

113
Q

Describe harmatomatous polyps

A

I

Toni's Pathology (6 decks)

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