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Pathology > Histopathology > Flashcards

Histopathology Flashcards

1
Q

Types of non-traumatic haemorrhage? (2)

A
  1. Intraparenchymal Haemorrhage - into the substance of the brain
  2. Subarachnoid Haemorrhage
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2
Q

Intraparenchymal Haemorrhage

a) Causes (5)
b) most common site
c) Symptoms (4)

A

a) - HTN (50%)
- atherosclerosis
- arteriovenous malformations
- Amyloid angiopathy
- CADASIL
b) basal ganglia
c) Raised ICP - headache
- focal neurology
- vomiting
- reduced GCS

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3
Q

What is CADASIL?

Associations? (4)

A
  • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
    Associations
  • progressive dementia
  • mood disorders
  • migraine
  • recurrent subcortical cerebral infarctions
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4
Q

Arteriovenous Malformation

a) where
b) who
c) presentation
d) high/low pressure?
e) treatment

A

a) anywhere in the CNS
b) 2nd - 5th decades
c) - haemorrhage
- seizures
- headache
- focal neurological deficits
d) high pressure - MASSIVE bleed
e) surgery - arteriovenous shunting

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5
Q

Cavernous Angioma - WHAT?

a) where
b) who
c) presentation
d) high/low pressure?
e) treatment

A

“Well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces”

a) anywhere in the CNS
b) >50 years familial association
c) headache, seizures, focal deficits, haemorrhage
d) low pressure - recurrent bleeds
e) surgery

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6
Q

Subarachnoid Haemorrhage

a) Cause
b) who - sex, age
c) most common site
d) Symptoms (3)
e) associations (4)

A

a) ruptured Berry aneurysm (85%)
b) F > M
c) internal carotid bifurcation
d) 1. thunderclap headache
2. vomiting
3. LOC
e) 1. PKD
2. Ehlers Danlos
3. Aortic coarctation
4. vascular malformations

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7
Q

Types of traumatic brain haemorrhage? (2)

A
  1. extra dural

2. sub dural

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8
Q

Extradural Haemorrhage

a) history
b) pathology
c) symptoms (2)
d) intervention

A

a) traumatic injury to side of head
b) skull fracture -> ruptured middle meningeal artery
c) 1. lucid interval
2. LOC
d) surgical evacuation

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9
Q

Subdural Haemorrhage

a) history
b) pathology
c) associations (2)
d) symptoms

A

a) previous minor trauma
b) damaged bridging veins -> slow venous bleed -> brain atrophy
c) 1. elderly
2. alcoholism
d) fluctuating level of conciousness

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10
Q

Concussion?

A

transient LOC and payalysis

recovery in hours or days

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11
Q

Diffuse axonal injury

A

vegetative state

post-traumatic dementia

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12
Q

Meningism (4)

A
  1. stiff neck - Brudzinski’s sign (flexion of knees when chin on chest)
  2. photophobia
  3. headache
  4. positive Kernig’s sign (inability to extend knee when hip is flexed)
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13
Q

Myelitis

  • what
  • causative agent
A
  • disturbance of the nerve transmission of the spinal cord

- Poliovirus

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14
Q

Encephalitis

a) what
b) causative agents (3)
c) symptoms (5)

A

a) inflammation of the brain parenchyma
b) -HSV 1
- Rabies
- arboviruses
c) drowsiness
seizures
behavioural changes
headache
fever

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15
Q

Meningitis

A

inflammatory process in the CSF and meninges

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16
Q

Pathogenesis of neurological deficit in meningitis? (5)

A
  1. direct bacterial toxicity
  2. indirect inflammatory process, cytokine release, oedema
  3. shock
  4. seizures
  5. hypoperfusion
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17
Q

Common causative agents of bacterial meningitis in NEONATES? (3)

A
  1. Group B Strep
  2. E Coli
  3. Listeria (gram +)
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18
Q

Common causative agents of bacterial meningitis in 1 month - 6 years? (2)

A
  1. strep pneumoniae (gram +)

2. haemophilus influenza

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19
Q

Common causative agents of bacterial meningitis in adolescents? (2)

A
  1. Neisseria meningitisis (gram -)

2. Strpe pneumonniae (gram +)

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20
Q

Common causative agents of bacterial meningitis in ELDERLY? (2)

A
  1. Strep pneumoniae

2. E Coli

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21
Q

Meningococcal septicemia?

a) causative agent?
b) signs (3)

A

a) N.meningitidis (gram -)
b) - non-blanching, petichial rash (80%)
- maculopapular rash (13%)
- no rash (7%)

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22
Q

Bacterial meningitis LP

a) appearance
b) predominant cell
c) glucose
d) protein

A

a) turbid/cloudy
b) neutrophils
c) low
d) high

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23
Q

TB meningitis LP

a) appearance
b) predominant cell
c) glucose
d) protein

A

a) fibrin web
b) lymphocytes
c) low
d) high

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24
Q

Viral meningitis LP

a) appearance
b) predominant cell
c) glucose
d) protein

A

a) clear
b) lymphocytes
c) normal
d) normal

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25
Q

Tuberculosis meningitis

a) acute or chronic?
b) who?
c) diagnostic test
d) associations (3)

A

a) chronic
b) immunosuppressed patients
c) Ziehl-neelson stain LP
d) - granulomas
- abscesses
- cerebritis

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26
Q

Common causative agents of viral meningitis in NEONATES? (3)

A
  1. Coxsackie’s
  2. Mumps
  3. HIV
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27
Q

Common causative agents of viral meningitis in children? (4)

A
  1. measles
  2. mumps
  3. varicella-zoster
  4. EBV
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28
Q

Increased risk of spinal infections? (7)

A
  1. increased age
  2. IVDU
  3. DM
  4. long-use systemic steroids
  5. organ transplantation
  6. malnutrition
  7. malignancy
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29
Q

Commonest form of adult brain tumours?

A

metastatic lesions

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30
Q

Common primaries with CNS metastases? (3)

A
  1. Breast
  2. Lung
  3. Malignant melanoma
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31
Q

Commonest group of primary CNS tumours?

A

astrocytomas

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32
Q

Neurofibromatosis type II

a) tumour
b) associations (3)

A

a) meningioma
b) 1. cafe-au-lait macules
2. Lisch nodules (iris)
3. freckling

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33
Q

Ependymoma

a) what
b) causes

A

a) ventricular tumour

b) hydrocephalus

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34
Q

Pilocytic astrocytoma

a) who
b) where
c) characteristic appearance

A

a) children
b) cerebellum
c) piloid “hairy” cell

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35
Q

Oligodendroma

a) who
b) appearance (3)

A

a) adults

b) soft, gelatinous, calcified

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36
Q

Dementia

A

global impairment of cognitive function and personality without impairment of conciousness. This impairment goes beyond what might be expected for normal ageing. Includes memory impairment and at least one of the following cognitive disturbances - aphasia, agnosia, apraxia, or a disturbance in executive functioning.

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37
Q

Aphasia

A

language disorder - expressive or repetitive e.g. finding words

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38
Q

Agnosia

A

loss of ability to recognise an object/people

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39
Q

Apraxia

A

inability to carry out a learned task

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40
Q

Pathological misfolded proteins associated with AD (2)

A
  1. neurofibrillary Tau tangles

2. B-amyloid

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41
Q

MRI changes in AD (4)

A
  1. generalised cerebral atrophy
  2. widened sulci
  3. narrowed gyri
  4. enlarged ventricles
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42
Q

Symptomatic medications used in AD (3)

A
  1. anti-cholinesterases
  2. nACR agonists
  3. glutamate anatgonists
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43
Q

Symptoms associated with Lewy Body dementia (4)

A
  1. day-to-day fluctuations
  2. visual hallucinations
  3. Parkinsonism
  4. recurrent falls
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44
Q

Triad of PD

A
  1. bradykinesia
  2. rigidity
  3. dyskinesia
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45
Q

Pathology of PD

A

loss of dopaminergic neurons of the substantia nigra

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46
Q

Protein associated with familial PD?

A

a-synuclein

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47
Q

Multiple System Atrophy

a) what
b) presentation
c) areas affected (3)

A

a) degenerative neurological disorder
b) Parkinsonism with poor response to Levodopa
c) 1. Shy Drager - autonomic dysfunction
2. Striatonigral - difficulty with movement
3. olivopontocerebellar - difficulty with balance & coordination

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48
Q

Pick’s Disease

a) what
b) inheritance pattern
c) protein involved
d) symptoms

A

a) frontotemporal atrophy
b) autosomal dominant
c) Tau
d) behavioral changes, inhibition, apathy

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49
Q

Multiple Sclerosis

a) what
b) who
c) presentation (2)
d) classification (2)
e) pathology
f) proteins (2)

A

a) autoimmune demyelinating disease
b) F>M, 20-40 years
c) focal neurology 1. optic neuritis
2. poor coordination
d) 1. relapsing & remitting
2. primary progressive
e) plaques with myelin loss
f) 1. Myelin Basic Protein
2. Proteo-lipid Protein

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50
Q

Fracture repair stages (4)

A
  1. Pro-callus - organisation of haematoma
  2. formation of fibrocartilaginous callus
  3. mineralisation of fibrocartilaginous callus
  4. remodelling of bone along weight-bearing lines
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51
Q

Factors affecting fracture healing (6)

A
  1. fracture type
  2. neoplasm
  3. metabolic disorder
  4. vitamin deficiency
  5. drugs
  6. infection
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52
Q

Common site of osteomyelitis in adults (3)

A
  1. vertebrae
  2. jaw (2o to dental abscess)
  3. toe (2o to DM ulcer)
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53
Q

Common bacteria causing osteomyetlitis?

a) adults (3)
b) children (2)
c) rare (2)

A

a) 1. Staph aureus
2. Klebsiella
3. E.Coli
b) 1. H influenzae
2. GBS
c) 1. TB
2. syphilis

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54
Q

Normal calcium range

A

2.2-2.6mmol/L

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55
Q

DEXA T score in Osteopenia

A

1 - 2.5 SD below normal

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56
Q

DEXA T Score in Osteoporosis

A

> 2.5 SD below normal

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57
Q

Blood results in Osteoporosis

A

Norm Ca
Norm Phosphate
Norm ALP

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58
Q

Blood results in Osteomalacia

A

Low Ca
Low Phosphate
High ALP

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59
Q

Features of Osteomalacia in an ADULT (2)

A
  1. Bony pain

2. Proximal muscle weakness

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60
Q

Features of Osteomalacia in a CHILD (6)

A
  1. bony pain
  2. bowing tibia
  3. rachitic rosary
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61
Q

What is Paget’s disease?

A

disorder of bone turnover

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62
Q

Features of Paget’s disease (2)

A
  1. lysis

2. sclerosis

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63
Q

Risk factors Paget’s (3)

A
  1. male
  2. > 50 years
  3. caucasian
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64
Q

x-ray findings in osteomalacia?

A

Looser’s zones

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65
Q

Blood results in Paget’s disease?

A

Norm Ca
Norm Phosphate
HIGH ALP

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66
Q

X-ray features found in Paget’s disease (6)

A
  1. cotton wool skull
  2. osteoporosis circumstripta
    3, picture frame vertebra
  3. ivory vertebra
  4. lucency of pelvis
  5. sclerosis of pelvis
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67
Q

Histological features of Paget’s (2)

A
  1. huge osteoclasts

2. mosaic pattern of lamellar bone

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68
Q

Blood results in hyperparathyroidism

A

HIGH Ca
LOW phosphate
Norm ALP

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69
Q

Causes of primary hyperparathyroidism (2)

A
  1. parathyroid adenoma

2. chief cell hyperplasia

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70
Q

Causes of secondary hyperparathyroidism (3)

A
  1. chronic renal failure
  2. vit d deficiency
  3. malabsorption
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71
Q

X-Ray features in hyperparathyroidism (3)

A
  1. Brown’s tumours
  2. salt and pepper skull
  3. subperiosteal resorption of phalanges
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72
Q

clinical features of hyperparathyroidism (6)

A

HYPERcalcemia

  1. Stones - renal
  2. Bones - pain
  3. Groans - pancreatitis
  4. Moans - depression, confusion
  5. polyuria
  6. polydipsia
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73
Q

histological feature of hyperparathyroidism

A

osteitis fibrosa cystica (OFC)

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74
Q

What is renal osteodystrophy?

A

ANY skeletal changes associated with CKD

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75
Q

Blood results in renal osteodystrophy?

A

LOW Ca

HIGH Phosphate

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76
Q

Clinical features of renal osteodystrophy? (3)

A
  1. metabolic acidosis
  2. 2 hyperparathyroidism
  3. alluminium deposition
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77
Q

Factors affecting fracture healing (6)

A
  1. fracture type
  2. neoplasm
  3. metabolic disorder
  4. drugs
  5. vitamin deficiency
  6. infection
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78
Q

What is pseuodarthritis?

A

non-healed fracture “false joint”

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79
Q

Symptoms of osteomyelitis? (6)

A
  1. pain
  2. oedema
  3. malaise
  4. fever
  5. rigors
  6. leukocytosis
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80
Q

X-ray changes in osteomyelitis

  • when
  • what
A
  • 10 days post onset

- lytic destruction of bone

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81
Q

Rare causes of osteomyeltitis (2)

A
  1. TB

2. syphilis

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82
Q

Lyme’s Disease

A

Inflammatory arthropathy as part of a multisystem illness resulting from a tickbite

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83
Q

What skin rash is associated with Lyme’s disease?

A

erythema chronicum migrans

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84
Q

Where are Heberden’s nodes?

A

DIPJ

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85
Q

Where are Bouchard’s nodes?

A

PIPJ

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86
Q

Most common sites of OA?

A
  1. Vertebrae
  2. hips
  3. knees
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87
Q

What is RA?

A

autoimmune, severe, chronic, relapsing synovitis

88
Q

Gene complexes associated with RA?

A

HLA DR1 & DR4

89
Q

Blood results common with RA? (3)

A
  1. anaemia of chronic disease
  2. raised ESR
  3. 80% RF +ve
90
Q

Characteristic deformities associated with RA (6)

A
  1. radial deviation of wrist
  2. ulnar deviation of fingers
  3. Boutonniere deformity
  4. Swan neck deformity
  5. Z thumbs
  6. Rheumatoid nodules
91
Q

Histological findings in RA (4)

A
  1. Thickening of synovial membranes ( villous)
  2. Hyperplasia of surface synoviocytes
  3. Intense inflammatory cell infiltrate
  4. Fibrin deposition and necrosis
92
Q

X-ray findings in RA (4)

A
  1. soft tissue swelling
  2. juxta-articular osteopenia
  3. decreased joint space
  4. bony erosions
93
Q

Pathognonomic of RA?

A

morning stiffness

94
Q

Crystals found in gout?

A

needle shaped, negatively birefringent, urate crystals

95
Q

Common joint affected in gout?

A

great toe “podagra”

96
Q

Gout

a) Short term treatment
b) Long term treatment
c) Conservative

A

a) Colchicine
b) Allopurinol
c) - lower alocohol intake
- low purine intake

97
Q

Common joints affected in pseudogout? (2)

A
  1. shoulder

2. knee

98
Q

Crystals found in pseudogout?

A

rhomboid shaped, positively birefringent, calcium pyrophosphate crystals

99
Q

Osteosarcoma

  1. who
  2. where
  3. x-ray findings (2)
  4. benign/malignant
A
  1. adolescents
  2. knee (60%)
  3. -Codman’s triangle
    - sunburst appearance
  4. malignant
100
Q

Chondrosarcoma

  1. who
  2. where
  3. x-ray findings (2)
  4. benign/malignant
A
  1. > 40yrs
  2. pelvis
    • lytic lesions
      - fluffy calcification
  4. malignant
101
Q

Tumour marker for Ewing’s sarcoma?

A

CD99

MIC2

102
Q

Translocation in Ewing’s sarcoma?

A

EWS/FLI1 fusion 11/22 translocation

103
Q

Ewing’s tumour

  • who
  • where
  • x-ray appearance
  • benign/malignant
A
  1. teenagers
  2. long bones, pelvis
  3. onion skinning
  4. malignant
104
Q

Giant cell tumour

  • who
  • where
  • type
A
  • F>M 20-40years
  • knee
  • osteoclast-type
105
Q

Enchondroma

A

benign tumour of cartilage

106
Q

Common site of enchondroma? (2)

A
  1. hands

2. feet

107
Q

Ollier’s syndrome

A

mutliple enchondromas

108
Q

Marffuci’s syndrome (2)

A

multiple enchondromas + haemangiomas

109
Q

X-ray features of enchondroma’s (3)

A
  1. lytic lesion
  2. popcorn calcification
  3. O ring sign
110
Q

Common site of osteochondroma

A

Knee (50%)

111
Q

Exostosis

A

benign outgrowth of cartilaginous tissue on bone

112
Q

Diaphyseal aclasis- (3) features

A

Hereditary multiple exostoses

  1. multiple exostoses
  2. short stature
  3. bone deformities
113
Q

Fibrous dysplasia

  • what
  • who
  • age
  • site
A
  • bone replaced by fibrous tissue

- female

114
Q

X-ray findings in fibrous dysplasia (2)

A
  1. Soap bubble osteolysis

2. Shepherd’s crook deformity

115
Q

Albright Syndrome (3)

A
  1. polyostotic dysplasia
  2. cafe au lait
  3. precocious puberty
116
Q

Osteiod osteoma

  • who
  • site
  • malignant or benign
A
  • adolescence
  • tibia/femur
  • benign
117
Q

Osteoma

  • who
  • site
  • feature
A
  • middle aged
  • head/neck
  • bony outgrowths attached to normal bone
118
Q

Gardner’s syndrome (3)

A
  1. GI polyps
  2. multiple osteomas
  3. epidermoid cysts
119
Q

X-ray feature in osteoblastoma

A

speckled mineralisation

120
Q

Common sites of simple bone cyst (2)

A
  1. humerus

2. femur

121
Q

4 layers of epidermis

A
  1. stratum corneum
  2. stratum granulosum
  3. stratum spinosum
  4. stratum basale
122
Q

Hyperkeratosis

A

increase in keratin in stratum corneum

123
Q

Parakeratosis

A

nuclei present in stratum corneum

124
Q

Acanthosis

A

increase in stratum spinosum

125
Q

Acantholysis

A

decrease in cohesions between keratinocytes

126
Q

Spongiosis

A

intercellular oedema

127
Q

Lentiginous

A

linear pattern of melanocyte proliferation within epidermal basal cell layer - reactive or neoplastic

128
Q

Pemphigus Vulgaris

  • who
  • where (2)
  • appearance
  • involvement of mucous membranes?
  • cause
A
  • middle aged
  • flexures, head
  • flaccid, painful blisters
  • yes
  • IgG mediate autoantibodies against antigens in the epidermis (Superficial)
129
Q

Dermatitis herpetiformis

  • who
  • where (3)
  • appearance
  • involvement of mucous membranes?
  • associated conditions (2)
A
  • young adults
  • elbows, knees, buttocks
  • vesicles, papules, excoriations
  • rare
  • gluten-sensitivity, lymphoma
130
Q

Discoid eczema

  • who
  • where
  • what
A
  • M>F
  • limbs
  • pruitic coin-shaped lesions
131
Q

Atopic dermatitis/eczema

  • infants - where
  • adults - where
  • chronic
  • histology
A
  • face, scalp
  • flexural areas
  • strong atopic FH, lichenification
  • spongiosis
132
Q 
Contact dermatitis 
- type of hypersensitivity reaction?
appearance (3)
- where 
- common allergens (3)
- histology
A
  • type IV
    1. pruritis
      1. erythema
      2. oedema
  • ear lobes, wrists, neck
    1. nickel
      1. rubber
      2. PPD
  • spongiosis
133
Q

Yeast involved in seborrhoeic dermatitis?

A

Malassezia furfur

134
Q

Seborrhoeic dermatitis

  • where a) infants
    b) adults
  • histology (2)
A

a) cradle cap - yellow scales on scalp
b) eyebrow/eyelid/face/anterior chest/external ear
- 1) acanthosis
2) dilated dermal capillaries

135
Q

Psoriasis

  • what
  • where (3)
  • histology (3)
  • associations (2)
A
  • chronic, inflammatory dermatosis with well-demarcated red scaly plaques with silver-scale
  • extensor aspect of knees, elbows, scalp
  • 1) parakeratosis
    2) clubbing of rete’s ridges “test tubes in a rack”
    3) Munro’s microabscesses
  • 1) nail changes
    2) arthritis
136
Q

Auspitz’s sign

A

rubbing psoriatic plaques causes pin-point bleeding

137
Q

Koebner phenomenon

A

psoriatic lesions form at sites of mild trauma

138
Q

Flexural psoriasis (4)

A

groin, axillae, sub-mammary folds, natal cleft

139
Q

Guttate psoriasis

  • what
  • where
  • who
  • association
A
  • “rain-drop” plaque distribution
  • widespread
  • children
  • post- Strep throat
140
Q

Erythrodermic psoriasis

A
  • widespread, life-threatening

- systemis symptoms

141
Q

Pustular psoriais

  • who
  • where
A
  • sterile deep-seated lesions
  • smokers
  • palms & soles
142
Q

Nails changes associated with psoriasis (3)

A
  1. pitting
  2. onkyiolysis
  3. subungual hyperkeratosis

POSH

143
Q

Bullous Pemphigoid

  • who
  • where (2)
  • appearance
  • immune mediated
  • involvement of mucous membranes?
  • cause
A
  • elderly
  • trunk, limbs
  • tense, fluid-filled blisters
  • IgG
  • no
  • autoantibodies against antigens between dermis and epidermis (Deep)
144
Q

Lichen Planus

  • appearance (5 P’s)
  • where (4)
  • histology
A 
- Pruritic
Purple
Polygonal
Papules
Plaques
- forearms, legs, palmar wrists, oral mucosa
- saw-toothing of Rete ridges
145
Q

Wickam’s striae

A

fine white network of streaks seen on oral mucosa in lichen planus

146
Q

PemphiguS

A

bullae are Superficial

147
Q

PemphigoiD

A

bullae are Deep

148
Q

Erythema multiforme

  • what
  • appearance (2)
  • where (2)
  • causes (2)
A
  • self-limiting inflammatory condition
  • annular target lesions (most common)
    pleomorphic: macules, papules, weals, vesicles, bullae, petechiae
  • hands, feet
  • 1) Infection - Herpes simplex, mycoplasma
    2) Drugs - Penicillin, anti-malarials
149
Q

Dermatitis herpetiformis

  • association
  • appearance
  • distribution (3)
A
  • Coeliac disease
  • pruritic vesicles
  • extensor surfaces of elbows, knees, buttocks
150
Q

Pathophysiology of dermatitis herpetiforms

A

IgA mediated, bind to BM and cause subepidermal bullae

151
Q

Seborrhoeic keratosis

  • benign or malignant?
  • appearance
  • who
A
  • Benign
  • well defined “stuck on” plaques
  • middle age/elderly
152
Q

Solar lentigo/Actinic Keratosis

  • who (2)
  • where (4)
  • histology (5) SPAIN
A
  • middle aged, high sun exposure
  • face, distal limbs, bald scalp, dorsal hands
    S - solar elastosis
    P - parakeratosis
    A - atypis
    I - inflammation
    N - not full thickness
153
Q

Keratocanthoma

  • appearance (3)
  • presentation (2)
  • histology
A
  • crusty nodule with necrotic centre
  • rapidly growing over 2-3 weeks, clear spontaneously
  • similar to SCC
154
Q

Bowen’s Disease/SCC in situ

  • appearance (3)
  • risk factors (2)
  • histology (2)
A
  • red, flat, scaly patches
    1. sun exposure
      1. HPV 16
    1. no dermal invasion
      1. BM intact
155
Q

SCC

  • appearance (4)
  • histology
A
  1. nodular
  2. hyperkeratotic
  3. rapidly growing
  4. may ulcerate
    - dermal invasion through BM
156
Q

BCC “Rodent ulcer”

  • what
  • appearance (3)
  • risk factors (5)
  • histology
A
  • most common cancer in humans
    1. rolled edge
      1. telangectasia
      2. pearly surface
    1. age
      1. fair skin
      2. high UV exposure
      3. radiation
      4. immunosuppression
  • palisading = nuclei align at outermost layer
157
Q

Risk factors associated with malignant melanoma (5)

A
  1. caucasian
  2. female
  3. age >30yrs
  4. sun exposure in childhood
  5. xeroderma pigmentosa
158
Q

Histology of Malignant Melanoma (2)

A
  1. atypical melanocytes

2. “buckshot appearance” of vertical pagetoid cells

159
Q

Subtypes of Malignant Melanoma (4) SLAN

A
  1. Superficial spreading melanoma - irregular border & variation in colour
  2. Lentigo melanoma - more common in elderly
  3. Acral melanoma - darker skins, occurs on palms/soles/subungual
  4. Nodular malignant melanoma - 50-60yrs
160
Q

Hutchinson’s sign

A

pigmentation of the nail in acral melanoma

161
Q

Breslow’s thickness

A
  • prognostic factor in melanoma

3. 5mm 50% 5 year survival

162
Q

Pityriasis Rosea

  • appearance (2)
  • cause
A
  • salmon pink herald patch, followed by oval macules afterwards in a Christmas tree distribution
  • post-viral illness
163
Q

Pityriasis vesicolor

  • appearance (2)
  • where (3)
  • cause
A
  • well defined macular lesions variable in colour
  • chest, upper arms, back
  • M.furur fungal infection
164
Q

SJS

  • what
  • causes
  • % body surface
A
  • mucocutaneous necrosis at at least 2 mucosal sites
  • ## drugs - abx, anticonvulsants
165
Q

TEN

  • what
  • causes
  • % body surface
  • histology (2)
A

Toxic Epidermal Necrosis
drug-induced
>30%
full thickness epidermal necrosis with subepidermal detachment

166
Q

What is SLE?

A

Systemic Lupus erythematosus
multisystemic autoimmune disorder where autoantibodies are made against a variety of autoantigens causing tissue damage due to immune complex formation & deposition and complement formation

167
Q

Which type of hypersensitivity reaction is SLE?

A

Type III

168
Q

Laboratory results in SLE? (2)

A
  1. HIGH ESR

2. Norm CRP

169
Q

HLA association in SLE?

A

HLA DR2/DR3

170
Q

Autoantibodies involved in SLE? (3)

A
  1. ANA
  2. Anti-dsDNA
  3. Anti-Sm
171
Q

Histological features (5)

A
  1. LE bodies
  2. kidney - immune complex deposition
  3. CNS - small vessel angiopathy
  4. spleen - onion skin lesions
  5. heart - Libman-Sack endocarditis
172
Q

Signs & symptoms in SLE (11)

SOAP BRAIN MD

A

S - serositis
O - oral ulcers
A - arthritis
P - photosensitivity

B - blood disorders (AIHA, ITP, leucopenia)
R - renal involvement 
A - ANA +
I - immune phenomena 
N - neuro symptoms

M - malar rash
D - discoid rash

173
Q

What condition in pregnancy is associated with SLE?

A

Anti-phospholipid syndrome

autoimmune hypercoagulable state promoting blood clots, increases risk of miscarriage and still birth

174
Q

Scleroderma

A

“tight-skin”

multi-systemic autoimmune condition involving Th17 and Th2 cells promoting widespread inflammation which recruits fibroblasts and results in fibrosis

175
Q

Limited scleroderma

  • what
  • signs and symptoms (5)
  • fatal complication
A 
- limited to skin changes in face and distal limbs to elbow & knees
C - calcinosis
R - Rayanud's phenomenon
E - oesophagealdismotility 
S - sclerodactyly
T - telangiectasia 
- pulmonary hypertension
176
Q

Which autoantibody is involved in limited scleroderma?

A

anti-centromere

177
Q

HLA association with scleroderma?

A

HLA DR6 & HLA DRw8

178
Q

Which autoantibodies are involved in diffuse scleroderma? (3)

A
  1. anti Scl-70
  2. Fibrillarin
  3. RNA polymerase
179
Q

What difference is there in diffuse scleroderma?

A

skin changes can occur throughout the entire body with widespread organ involvement

180
Q

Organ involvement associated with diffuse scleroderma? (3)

A
  1. lungs - pulmonary fibrosis
  2. renal
  3. GI
181
Q

Histological finding in limited scleroderma? (2)

A
  1. increased collagen in skin and organs

2. onion skin thickening of arterioles

182
Q

Type of hypersensitivity reaction involved in Dermatomyositis?

A

Type III

183
Q

Type of hypersensitivity reaction involved in Polymyolitis?

A

Type IV

184
Q

Autoantibody associated with dermatomyositis?

A

Anti-Jo 1 - tRNA synthetase

185
Q

Autoantibody associated with polymyositis?

A

anti-signal recogition peptide antibody

186
Q

Signs and symptoms associated with dermatomyositis? (4)

A
  1. proximal muscle weakness
  2. Rash a) heliotrope rash
    b) Gottron’s papules
  3. malaise
  4. pulmonary fibrosis
187
Q

Investigations in dermatomyositis? (4)

A
  1. skin biopsy
  2. MRI
  3. EMG - abnormal
  4. CK - HIGH
188
Q

Difference between dermatomyositis and polymyolitis?

A

DM - immune mediate vasculitis

PM - immune complexes outside of capillaries cause damage to myofibres

189
Q

Sarcoidosis

A

multisystem disease of unknown cause, characterised by non-caseating granulomas

190
Q

Prevelance of sarcoidosis? (3)

A

F>M
afro-Caribbean
young adults

191
Q

Histological findings in Sarcoidosis? (3)

A
  1. non-caseating granulomas
  2. Schaumann bodies
  3. Asteroid bodies
192
Q

Effects on lungs in sarcoidosis? (3)

A
  1. bilateral hilar lymphadenopathy
  2. fibrosis
  3. lymphocytosis
193
Q

Skin conditions in sarcoidosis? (3)

A
  1. erythema nodosum
  2. lupus pernio
  3. skin nodules
194
Q

Eyes conditions in sarcoidosis? (3)

A
  1. anterior/posterior uveitis
  2. uveoparotid fever
  3. keratoconjuncitivitis sicca
195
Q

Uveoparotid fever?

A

bilateral uveitis + parotid gland enlargement + facial nerve palsy

196
Q

Effects on liver in sarcoidosis? (4)

A
  1. hepatitis
  2. hepatomegaly
  3. cholestasis
  4. cirrhosis
197
Q

Effects on heart in sarcoidosis? (3)

A
  1. dysrhythmias
  2. cardiomyopathy
  3. conduction defects
198
Q

Laboratory results in Sarcoidosis? (3)

A
  1. hypercalcemia
  2. HIGH ESR
  3. HIGH ACE
199
Q

Why hypercalcemia in sarcoidosis?

A

Vit D hydroxylation is activated by the macrophages

200
Q

Effects on the kidneys in sarcoidosis? (2)

A

due to hypercalcemia…

1) renal calculi
2) nephrocalcinosis

201
Q

Takayasu’s arteritis

  • what kind of vasculitis
  • who
  • what
  • symptoms (3)
A
  • Large vessel
  • Japanese women
  • “pulseless” disease due to fibrosis of the aorta and its main branches, absent pulses in the upper extremities
  • 1) absent pulse
    2) bruits
    3) claudication
202
Q

Temporal Arteritis “Giant Cell Arteritis”

  • what kind of vasculitis
  • who
  • what
  • symptoms (4)
  • association
  • histology (3)
  • laboratory findings (1)
A
  • large vessel
  • elderly
  • chronic lymphocytic inflammation
  • 1) scalp tenderness
    2) temporal headache
    3) blurred vision
    4) jaw claudication
  • polymyalgia rheumatica
  • 1) granulomatous transmural inflammation
    2) giant cells
    3) skip lesions
  • HIGH ESR
203
Q

Polyartheritis Nodosa (PAN)

  • what kind of vasculitis
  • what
  • type of hypersensitivty reaction
  • pathology
  • common feature
  • associations
  • organ spared
  • histology (3)
A
  • medium vessel
  • necrotising arteritis causing fibrosis
  • type III
  • microanneurysms form everywhere
  • renal involvement
  • underlying Hep B
  • lungs
  • 1)polymorphs
    2) lymphocytes
    3) eosinophils
204
Q

Kawasaki’s Disease

  • what kind of vasculitis
  • who
  • symptoms (5)
  • severe complication
A
  • medium vessel
  • children 5 days
    2) erythematous palms and soles with desquamation
    3) strawberry tongue
    4) cervical lymphadenopathy
    5) oedema of lips, mouth, tongue
  • coronary artery involvement causing aneurysm
205
Q

Buerger’s Disease

  • what kind of vasculitis
  • who (3)
  • what
  • symptoms (3)
  • pathology
A
  • medium vessels
  • 1) men
    2) heavy smokers
    3)
206
Q 
Wegener's Granolomatosis 
"Granulomatosis with polyangitis" 
- type of vasculitis 
- type of hypersensitivity reaction
- triad (ELK)
- autoantibody specific 
- key features (3)
A
  • small vessel
  • type II
  • 1) ENT - upper resp tract - sinusitis, epstaxis
    2) Lung - lower resp tract - cavitation
    3) Kidney
  • cANCA
  • 1) saddle nose
    2) pulmonary haemorrhage
    3) crescenteric glomerulonephritis
207
Q

Churg Strauss

  • type of vasculitis
  • type of hypersensitivity reaction
  • features (AEV)
  • specifc autoantibody
A
  • small vessel
  • type II
    Asthmas, Allergic rhinitis
    Eosinophilia
    Vasculitis
  • pANCA (anti MPO)
208
Q

Microscopic polyangitis

  • type of vasculitis
  • type of hypersensitivity reaction
  • features (2)
  • specific autoantibody
A
  • small vessel
  • type II
    1) pulmonary haemorrhage
    2) glomerulonephritis
  • pANCA (anti MPO)
209
Q

Henoch Schonlein Purpura HSP

  • type of vasculitis
  • Immune mediated
  • who (2)
  • preceding illness
  • presentation (5)
A
  • small vessel
  • IgA
  • children girls
  • URTI
    1) palpable pupuric rash over lower limb extensor surface and buttocks
    2) collicky abdo pain
    3) haematuria (gloemrulonephritis)
    4) orchitis
    5) arthritis
210
Q

What is amyloidosis?

A

multisystem disorder caused by abnormal folding of proteins that are deposited as amyloid fibrils in tissues, disrupting their normal function

211
Q

Primary amyloidosis

  • type of amyloid
  • presentation (4)
A
  • light-chain amyloid
    1) monoclonal Ig
    2) free light chains in serum and urine
    3) Bence jones proteins in urine
    4) increased bone marrow plasma cells
212
Q

Secondary amyloidosis
- type of amyloid
Causes (3)

A
  • Amyloid A
    1) autoimmune - RA, AS, IBD
    2) Chronic infection - TB, osteomyelitis, IVDU
    3) Non-immune - renal carcinoma, Hodgkin’s
213
Q

Haemodialysis associated amyloidosis is associated with deposition of which protein?

A

B-2-microglobulin

214
Q 
Familial Amyloidosis 
- association 
- inflammatory factor 
serosal surfaces affected (3)
- type of amyloid
- predominant feature
A
  • Familial Mediterranean Fever
  • IL-1
    1) pleura
    2) peritoneum
    3) synovium
  • amyloid A
  • renal deposition
215
Q

Clinical features of Amyloidosis (5)

A 
Renal - nephrotic syndrome
Cardio - conduction defects, heart failure
Liver/spleen - organomegaly 
Tongue - macroglossia 
Neuropathies - carpal tunnel
216
Q

Histology associated with Amyloidosis?

A

Apple green birefringence with Congo Red stain under polarised light (due to misfolded beta pleat)

Pathology (7 decks)

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