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Year 5 Histopath > Histopathology > Flashcards

Histopathology Flashcards

1
Q

What are the special features of Enchondroma?

A

Benign tumours of cartilage

Ollier’s syndrome = multiple enchondromas

Maffuci syndrome = multiple enchondromas + haemangiomas

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2
Q

What can cause pseduogout?

A 
Idiopathic
HyperPTH
DM
Hypothyroid
Wilsons
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3
Q

What are the clinical features of pemphigus?

A

Bullae are easily ruptured

Found on skin AND mucosal membranes

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4
Q

What investigations diagnose pseudogout?

A 
Positively birefringent 
(P for positive and pseudo)
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5
Q

What is seen on electron microscopy for 1o causes of Nephrotic syndrome

A

MC: Loss of podocyte foot processes

MG: Loss of podocyte foot processes
Subepithelial deposits ('Spikey')

FSGS: Loss of podocyte foot processes.

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6
Q

What is the screening programme for breast carcinoma

A

47 - 73 year old women are invited every 3 years for mammography (looks for abnormal areas of calcification or a mass within the breast)

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7
Q

4 types of tubulointerstitial nephritis

A

1) Acute pyelonephritis
2) Chronic pyelonephritis & reflux nephropathy
3) Acute Interstitial nephritis
4) Chronic interstitial nephritis/Analgesic nephropathy

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8
Q

What do you know about mucinous ovarian carcinoma?

A

Mucin secreting cells, similar to those of endocervical mucosa
OR intestinal type - metastatic from appendix in some cases –> pseudomyxoma peritonei
No psammoma bodies

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9
Q

What is the epidemiology of 1o causes of Nephrotic syndrome?

A

MC: Most common in children (75%) with 2nd peak in elderly

MG: Common in adults (~30%)

FSGS: Common in adults (~30%). Most common in Afro-Caribbean

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10
Q

What problems can rapid correction of Na cause?

A

Central pontine myelinolysis - pseudobulbar palsy, paraparesis and locked-in syndrome

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11
Q

Define thrombotic microangiopathy

A

thrombotic microangiopathies are microvascular occlusive disorders characterized by systemic or intrarenal aggregation of platelets, thrombocytopenia, and mechanical injury to erythrocytes. Itresults in thrombosis in capillaries and arterioles, due to an endothelial injury.

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12
Q

What are the symptoms of thin basement membrane disease (benign familial haematuria)?

A

Very rarely a cause of nephritic syndrome - normally exclusively asymptomatic haematuria
Usually asymptomatic - incidentally diagnosed with microscopic haematuria
Renal function is usually normal

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13
Q

Causes of viral encephalitis are:

A

Herpes simplex 1

Rabies

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14
Q

Histology of Bowen’s disease:

A

Full thickness atypia/dysplasia

BM intact - i.e. not invading the dermis

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15
Q

What do you know about Granulosa-Theca ovarian carcinoma?

A

Produce E2

Look for oestrogenic effects - irregular menstrual cycles, breast enlargment, endometrial/breast cancer

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16
Q

Characteristics of keratoacanthoma:

A

Rapidly growing dome shaped nodule
May develop a necrotic, crusted centre
Grows over 2-3 weeks
Clears spontaneously

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17
Q

Define psoriasis:

A

a skin disease marked by well-demarcated red, itchy, scaly patches.

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18
Q

Which area does Chondrosarcoma affect most commonly?

A

Axial skeleton

Femur/tibia/pelvis

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19
Q

What do you know about clear cell ovarian carcinoma?

A

Abundant clear cytoplasm - intracellular glycogen

Hobnail appearance

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20
Q

Clinical presentation of lupus nephritis

A

Depending on site and intrsnity of immune complex deposition, presentation may be:

Isolated urinary abnormalities
Acute renal failure
Nephrotic syndrome
Progeressive chronic renal failure

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21
Q

What are rare causes of osteomyelitis?

A

TB (immunocompromised patients)

Syphilis (congenital/acquired)

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22
Q

What can be seen on angiogram with Buergers disease?

A

Corkscrew appearance from segmental occlusive lesions

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23
Q

How does cervical carcinoma present?

A

Majority of the lesions are benign and common presenting symptoms include:
Pain (mastalgia/mastodynia)
Palpable masses
Nipple discharge

Clinically: Post-coital bleeding
Intermenstrual bleeding
Postmenopausal bleeding
Discharge
Pain

Staged using FIGO system

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24
Q

What are the risks factors for Osteoporosis?

A 
Increased age
Female
Smoking
Poor diet
Low BMI
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25
Q

How does MS usually present?

A

With focal symptoms i.e. optic neuritis, poor coordination.

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26
Q

Which bones are affected in Osteoid Osteoma?

A

Tibia/Femur

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27
Q

What are the special features of Osteochondroma?

A

Cartilage capped bony outgrowth

Diaphyseal aclasis/heriditary multiple exostoses = multiple exotoses + short stature + bone deformities

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28
Q

Complications of PID:

A

1) Infertility
2) Increased risk of ectopic pregnancy
3) Intestinal obstruction –> bacteraemia
4) Tubo-ovarian abscess
5) Chronic pelvic pain
6) Peritonitis
7) Plical (fold of tissue) fusion
8) Fitz Hugh Curtis syndrome - RUQ from peri-hepatitis + violin string peri-hepatic adhesions

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29
Q

How do fibroids look?

A

Macroscopically: sharply circumscribed, discrete, round, firm, gray-white tumours. The size is variable
Microscopically: bundles of smooth muscle cells

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30
Q

What are symptoms of Hypercalcaemia?

A

Moans
Stones
Bones
Groans

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31
Q

Name 3 benign neoplastic breast conditions:

A

Fibroadenoma (‘breast mouse’)
Duct papilloma
Radial scar

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32
Q

What are the special features of Osteoma?

A

Bony outgrowths attached to normal bone

Gardner syndrome:
GI polyps + multiple osteomas + epidermoid cysts

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33
Q

Autobodies associated with diffuse scleroderma:

A

Anti Scl-70
Fibrillarin
RNA pol I, II, III
PM-Scl

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34
Q

What is the histology of Osteomalacia/rickets?

A

Excess of unmineralized bone (osteoid)

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35
Q

Define agnosia

A

Loss of ability to recognise objects and people

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36
Q

What are the signs/symptoms of viral meningitis?

A

Mild systemic symptoms
Not unwell
Rash is unusual

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37
Q

Autobodies associated with SLE:

A 
ANA (95%)
Anti dsDNA
Anti-Sm
Drug-induced
Anti-histone
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38
Q

Where are the most common primaries for secondary brain tumours?

A

Lung
Breast
Malignant melanoma

They are well demarcated, solitary or multiple with surrounding oedema

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39
Q

Define pemphigus

A

a skin disease in which watery blisters form on the skin.

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40
Q

Define germ cell origin of ovarian carcinoma and name the subtyopes (3):

A

Derived from germ cells
Usually benign in adults and malignant in children

3 subtypes: Dysgerminoma
Teratoma
Choriocarcinoma

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41
Q

How are invasive breast carcinoma histologically subcategorised?

A

Ductal
Lobular
Tubular
Mucinous

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42
Q

Define Toxic Epidermal Necrolysis (TEN)

A

a potentially life-threatening dermatologic disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death

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43
Q

How is rapidly progressive (crescentic) GN classified?

A

Classification is based upon immunological findings:

Type 1: Anti-GBM antibody against COL4-A3 (collagen type IV)
Type 2: Immune complex
type 3: Pauci-immune/ANCA-associated

Regardless of causes, all are characterised by presence of crescents in the glomeruli.

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44
Q

Histology of psoriasis:

A

Parakeratosis
Loss of granular layer
Clubbing of rete ridges giving “test tubes in a rack” appearance
Munro’s microabscersses

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45
Q

How is thin basement membrane disease caused?

A

Diffuse thinning of GBM caused by mutation in type IV collagen alpha 4 chain
Autosomal dominant

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46
Q

Name 3 premalignant epidermal cutaneous neoplasms

A

Actinic (solar/Senile) keratosis
Keratoacanthoma
Bowen’s disease

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47
Q

What do you know about Endometrioid ovarian carcinoma?

A

Mimics endometrium i.e. from tubular glands

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48
Q

What age does Giant cell affect?

A

20 - 40 years

F>M

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49
Q

What is the histology in chronic dermatitis?

A

Acanthosis
Crusting
Scaling

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50
Q

Buzzwords for a Meningioma are:

A

NF2 (neurofibromatosis type II)

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51
Q

Define idiopathic parkinsons disease

A

Decreased stimulation of the motor cortex by the basal ganglia (caused by death of dopaminergic neurons in the substantia nigra)

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52
Q

What can be seen in histology of Fibrous dysplasia?

A

Chinese letters (misshapen bone trabeculae)

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53
Q

What is seen on X-ray for Osteomalacia/Rickets?

A

Looser’s zones (pseudo fractures)

Splaying of metaphysis

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54
Q

What are the symptoms of Kawasaki disease?

A

Fever > 5 days
Rash - red palms and soles with later desquamation
Conjunctivitis
Inflammation of lips, mouth or tongue (strawberry tongue)
Cervical LN’s
Coronary arteries may be involved with aneurysm formation

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55
Q

How does osteomyelitis present?

A

Pain
swelling
Tenderness

General features of; malaise, fever, chills, leukocytosis

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56
Q

Define Polyarteritis nodosa

A

a very rare vasculitic disease which affects the medium sized vessels. It can affect any organ in the body but commonly the muscles, joints, intestines, nerves and skin are affected

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57
Q

What is the histology of osteosarcoma?

A

Malignant chondrocytes

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58
Q

Risk factors for stroke or TIAs are:

A 
Smoking
DM
HTN
FH
past TIAs
OCP
PVD
Alcohol excess
Hyperviscosity e.g. Sickle cell, polycythaemia vera
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59
Q

Which area does osteosarcoma affect most commonly?

A

Knee

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60
Q

Symptoms of IgA nephropathy (Berger disease)

A

Persistent or recurrent frank haematuria, or microscopic haematuria
Presents 1-2 days after a URTI with frank haematuria

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61
Q

Define Gout:

A

a rheumatic disease resulting from deposition of uric acid crystals ( monosodium urate) in tissues and fluids within the body.

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62
Q

Why should you be worried about hyponatraemia post-surgery?

A

1) Overhydration with hypotonic IV fluids

2) Transient increase in ADH due to stress of surgery (vasoconstrictiona nd retention of water)

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63
Q

3 causes of asymptomatic haematuria

A

1) Thin basement membrane disease (benign familial haematuria)
2) IgA nephropathy (berger disease)
3) Alports syndrome

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64
Q

What are the symptoms of PD?

A

TRAP

Tremor
Rigidity
Akinesia
Postural instability

Some develop psychiatric features later in the disease e.g. PD dementia, hallucinations, anxiety

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65
Q

Name 2 causes of Non Traumatic haemorrhage

A

Intraparenchymal haemorrhage

Subarachnoid haemorrhage

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66
Q

Psoriasis is associated with:

A

Arthritis (5-10%)

Nail changes

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67
Q

Epidermal (i.e. from keratinocytes) cutaneous neoplasms can be:

A

Benign
Premalignant
Malignant

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68
Q

Define lichin planus

A

a disease of the skin and/or mucous membranes that resembles lichen.
The aetiology is unknown

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69
Q

Describe and name the crystal in pseudogout?

A

Calcium pyrophosphate crystals

Rhomboid shaped

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70
Q

Describe the S. corneum layer?

A

non-nucleated

Contains keratin

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71
Q

Describe and name the crystal in gout?

A

Urate crystals

Needle shape

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72
Q

Name 2 large vessel vasculitides:

A

Temporal arteritis

Takayasu’s arteritis

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73
Q

Diabetes in 2o Nephrotic syndrome

A

Diffuse GBM thickening on histology

Mesangial matrix nodules - aka Kimmelstiel Wilson nodules

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74
Q

What hypersensitivity reaction is SLE?

A

Type III -immune complex (tissue damage caused by the activation of complement in response to antigen-antibody (immune) complexes that are deposited in tissues.)

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75
Q

Normal pH range

A

7.35 - 7.45

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76
Q

SIgns & Symptoms of PID:

A

Lower abdo pain
Dyspareunia (difficult or painful sexual intercourse)
Vaginal bleeding/discharge
Fever
Adnexal (the appendages of the uterus, namely the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place) tenderness
Cervical excitation

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77
Q

What can pathologically be seen in PD?

A

Lewy bodies are present in affected neurones
Alpha synuclein protein is the main component
Mutations are reported in famililal PD

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78
Q

What normally preceeds Henoch Schonlein purpura

A

URTI

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79
Q

Define keratoacanthoma:

A

a low-grade skin cancer tumor that is similar to squamous cell carcinoma (SCC). It originates in the skin’s pilosebaceous glands, or hair follicles. This skin cancer tumor grows rapidly, in just a few weeks to a few months.

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80
Q

What hypersensitivity can cause contact dermatitis?

A

Type IV e.g. to nickel or rubber

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81
Q

What is the aetiology of primary hyperparathyroidism?

A

Excess PTH production –> increased calcium reabsorption and increased phosphate excretion

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82
Q

What are the commenest group of primary brain tumours?

A

Astrocytomas

Primary tumours originate in the brain, spinal cord or meninges and rarely metastasise outside CNS

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83
Q

Where does seborrhoeic dermatitis affect infants?

A

Cradle cap (large yellow scales on scalp)

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84
Q

What is the clinical presentation of rheumatoid arthritis?

A

Symmetrical
Small joints of hands and feet (spares DIPJ), wrists, elbows, ankles and knees
Usually slow progression

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85
Q

What is the HLA associated with SLE?

A

HLA-DR3

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86
Q

Which renal diseases effect the Tubules & interstitium?

A

1) Acute tubular necrosis

2) Tubulointerstitial nephritis

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87
Q

Buzzwords for a oligodendroma are:

A

Soft
Gelatinous
calcified

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88
Q

What age does chondrosarcoma affect?

A

> 40 years

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89
Q

Define Diffuse scleroderma

A

a type of systemic sclerosis (scleroderma). Systemic scleroderma can affect any part of the body. It often affects the skin, blood vessels, and internal organs, especially the lungs, heart, kidneys, and gastrointestinal tract.

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90
Q

Macroscopic findings in endometriosis

A

Red-blue to brown nodules - “powder burns”

“Chocolate cysts” in ovaries (endometriomas)

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91
Q

Clinical findings in endometriosis:

A

Nodules/tenderness in vagina, posterior fornix or uterus

Immobile uterus which is retroverted in advanced disease

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92
Q

Minimal Change disease

A

Common in childre (2-3 yrs) and elderly
Loss of podocyte foot processes
No immune deposits
90% respond to steroids

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93
Q

What is the biochem of Osteomalacia/rickets?

A

Normal or low Ca
Decreased PO4
Increased ALP

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94
Q

How is CIN graded?

A

Graded mild, moderate or severe dyskaryosis on cytology but graded CIN 1-3 on histology from biopsy:

CIN 1 = dysplasia confined to lower 1/3 of epithelium
CIN 2 = lower 2/3
CIN 3 = full thickness, but basement membrane intact

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95
Q

Which X-ray changes can be seen in Osteoblastoma?

A

Speckled mineralisation

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96
Q

Which infection may patients with polyarteritis have (30%)?

A

Hep B

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97
Q

Who does Kawasaki disease affect?

A

Children

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98
Q

Postmenopausal bleeding is what until proven otherwise?

A

Endometrial cancer - 10% of postmenopausal bleeding will have malignancy

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99
Q

define Periductal mastitis (+symptoms):

A

Periductal mastitis occurs when the ducts under the nipple become inflamed and infected. It’s a benign condition, which can affect women of all ages but is more common in younger women. Symptoms include: the breast becoming tender and hot to the touch. the skin may appear reddened.
It is mostly in smokers and NOT associated with lactation
Histologially, keratinizing squamous epithelium extends deep into nipple duct orifices

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100
Q

What is a normal cervical histology?

A

Outer cervix is covered by squamous epithelium, the endocervical canalis lined by columnar glandular epithelium. the squamocolumnar junction (SCJ) seperates them.

The transformation zone (TZ) is the area where columnar epithelium transforms into squamous cells (=squamous metaplasia). This is a normal physiological process and is susceptible to malignant change.

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101
Q

Wegener’s granulomatosis is a triad of:

A

1) Upper resp tract: sinusitis, epistaxis, saddle nose
2) Lower resp tract: cavitation, pulmonary haemorrhage
3) kidneys: crescentic, glomerulonephritis

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102
Q

Which X-ray changes can be seen in Osteoid osteoma?

A

Radiolucent nidus with sclerotic rim

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103
Q

Define multiple sclerosis

A

Autoimmune demyelinating disease

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104
Q

Define seborrhoeic keratosis:

A

one of the most common noncancerous skin growths in older adults. A seborrheic keratosis usually appears as a brown, black or light tan growth on the face, chest, shoulders or back. The growth has a waxy, scaly, slightly elevated appearance.

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105
Q

Define invasive lobular

A

cells aligned in single file chains/strands

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106
Q

Name 4 malignant bone tumours

A

Osteosarcoma
Chondrosarcoma
Ewings sarcoma
Giant cell

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107
Q

Which joints are commonly affected in pseudoGout?

A

Knee

Shoulder

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108
Q

Vascular territories commonly affected in strokes are:

A

Anterior vs Posterior territory

Most common is MCA

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109
Q

Histology of Basal cell carcinoma:

A

Mass of basal cells pushing down into the dermis

Palisading (nuclei align in outermost layer)

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110
Q

What is the histology of Osteoporosis?

A

Loss of cancellous bone

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111
Q

What is characteristic of Alzheimer’s?

A

Generalised atrophy of the brain, widened sulci, narrowed gyri and enlarged ventricles

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112
Q

What can be seen on histology of erythema multiforme?

A

Subepidermal bullae

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113
Q

Define apraxia

A

Loss of ability to carry out learned purposeful tasks

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114
Q

Name 2 benign proliferative breast conditions:

A

Fibrocystic disease/Fibroadenosis (breast Lumpiness)

Gynacomastia

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115
Q

Name 4 small vessel vasculitides

A

Wegener’s granulomatosis
Churg Strauss
Microscopic polyangitis
Henoch Schonlein Purpura

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116
Q

Normal bicarbonate range

A

22 - 30 mmol/l

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117
Q

Cerebral infection in the elderly is most likely caused by:

A

Gram -ve bacilli e.g. E.coli

Strep. Pneumoniae

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118
Q

How is IgA nephropathy diagnosed?

A

Biopsy
Fluroescence microscopy shows granular deposition of IgA and complement in mesangium (the thin membrane supporting the capillary loops in renal glomeruli).

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119
Q

What are the risks factors for Hyperparathyroidism??

A

Secondary hyperPTH –> CRF
Decreased vit D
Malabsorption

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120
Q

Which joints does rheumatoid usually spare?

A

DIP

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121
Q

Normal Gammag GT (GGT)

A

30 - 150 iu/L

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122
Q

What is red degeneration of a fibroid and when does it occur usually?

A

This happens in pregnancy. Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus.

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123
Q

Define thrombotic thrombocytopenic purpura (TTP)

A

Thrombotic thrombocytopenic purpura (TTP) is a blood disorder that causes blood clots to form in small blood vessels. This leads to a low platelet count (thrombocytopenia).

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124
Q

Where does atopic dermatitis effect infants?

A

Face + scalp

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125
Q

What are the 4 key features of connective tissue disease?

A

Inflammation
Fibrosis/scarrign
Vasospasm (including Reynaud’s)
Vascular thrombosis

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126
Q

Define carcinoma in situ:

A

neoplastic epithelial proliferation limited to ducts/lobules by basement membrane

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127
Q

Nephrotic syndrome is characterised by:

A

Proteinuria (>3g/24h) +
Hypoalbuminaemia +
Oedema
(+ Hyperlipidaemia)

Keywords: Frothy urine
Swelling - facially in kids and peripheral in adults

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128
Q

What can cause raised ICP?

A

Oedema

space occupying lesion (e.g. tumour, abscess) –> brain herniation

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129
Q

What are the vascular symptoms in Takayasu’s arteritis?

A

Absent pulse
Bruits
Claudication

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130
Q

Describe Ductal carcinoma in situ

A

Incidence increased dramatically since development of mammography
Appear as areas of microcalcification
10% present with clinical symptoms
Much increased risk of progressing to invasive breast Ca
High, intermediate and low grade

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131
Q

What is the management of pseudogout?

A

NSAIDs or intra-articular steroids

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132
Q

Clinical features of pseudogout?

A

Hot swollen joint with effusion

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133
Q

What happens in endometriosis?

A

Ectopic tissue is still functional, therefore undergoes cyclical bleeding –> pain, scarring and infertility

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134
Q

Characteristics of Bowen’s disease:

A

Intra-epidermal squamous cell carcinoma in situ
Flat
Red
Scaly patches on sun-exposed areas

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135
Q

What do you know about serous ovarian carcinoma?

A

Most common type
Mimics tubal epithelium i.e. columnar epitheliam
Psammoma bodies are common

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136
Q

Describe viral encephalitis

A

May be localised e.g. temporal or frontal lobes OR general

May involve the meninges –> meningoencephalitis

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137
Q

What is the difference between CIN and CGIN?

A

The outside of the cervix is lined by squamous cells. CIN is an abnormality of the squamous cells. CGIN, which stands for cervical glandular intra-epithelial neoplasia, is an abnormality of the glandular cells.

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138
Q

what is the syndrome within microscopic polyangitis?

A

Pulmonary renal syndrome:

Pulmonary haemorrhage
Glomerulonephritis

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139
Q

Define endometriosis

A

an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis.

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140
Q

What can influence how a fracture heals?

A 
Fracture type
Metabolic disorder
Drugs
Vitamin deficiency
Infection
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141
Q

What is the histology of lichen planus

A

Hyperkeratosis with saw-toothing of rete ridges and bvasal cell degeneration

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142
Q

Secondary causes of nephrotic syndrome are:

A

1) Diabetes

2) Amyloidosis

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143
Q

Risk factors for SLE?

A

Drug-induced
Increased in classical complement deficiencies
In afrocarribean
Females

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144
Q

How does hereditary nephritis present?

A

Nephritic syndrome +
sensorineural deafness +
eye disorders (lens dislocation, cataracts)

Presents at 5-20 years with nephritic syndrome, progressing to ESRF

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145
Q

Where does psoriasis effect and what does it look like?

A

Salmon pink plaques with silver scale

Affecting extensor aspects of knees, elbows and scalp

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146
Q

Subtypes of melanoma are:

A

Lentigo maligna melanoma - Flat, slowly growing black lesion on sun-exposed caucasians
Superficial spreading malignant melanoma - irregular borders with variation in colour
Nodular malignant melanoma - can occur on all sites, commoner in young
Acral lentiginous melanoma - palms, soles and sublingual areas

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147
Q

Define microscopic polyangitis

A 
Microscopic polyangiitis (MPA) is a small vessel vasculitis which primarily affects the arterioles, capillaries and venule.  Since patients with this condition often have a positive blood test known as an antineutrophil cytoplasmic antibody (ANCA), it is also a form of “ANCA-associated vasculitis”. Granulomatosis with polyangiitis (GPA/Wegener’s) is a related condition that shares features with MPA including the presence of ANCA.
The cause of MPA is not known.  This condition can affect many organ systems in the body including the skin, nerves, lungs gastrointestinal system, lungs and joints.  It is a treatable condition and the goal of therapy is to stop further damage to the organs from inflammation in the blood vessels.
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148
Q

What are the clinical features of seborrhoeic keratosis:

A

Rough plaques
Waxy
Stuck on
Appear in middle age/elderly

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149
Q

What do you know about Sertoli-Leydig ovarian carcinoma?

A

Secretes androgens

Look for defeminisation (breast atrophy) and virilisation (hirtutism, deepened voice, enlarged clitoris)

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150
Q

Define actinic keratosis:

A

is a rough, scaly patch on your skin that develops from years of exposure to the sun. It’s most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck.

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151
Q

What is the name for intercellular oedema?

A

Spongiosis

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152
Q

Investigations of stroke are:

A

CT/MRI (infarct vs haemorrhage)

Ix for vascular risk: BP, FBC, ESR, U&E, glucose, lipids, CXR, ECG, carotid doppler

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153
Q

Define Pityriasis rosea

A

a mild, noncontagious skin disorder common among children and young adults, and characterized by a single round spot on the body, followed later by a rash of colored spots on the body and upper arms.

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154
Q

Define cervical intraepithelial neoplasia (CIN):

A

potentially premalignant transformation and abnormal growth (dysplasia) of squamous cells on the surface of the cervix at the transition zone. CIN is not cancer, and is usually curable.

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155
Q

What is the appearance of Giant cell on X-ray?

A

Lytic/lucent lesions right up to articular surface

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156
Q

Primary causes of Nephrotic Syndrome are:

A

1) Minimal Change disease
2) Membranous Glomerular disease
3) Focal Segmental Glomerulosclerosis (FSGS)

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157
Q

What is the histology of Pagets disease?

A

Huge osteoclasts w > 100 nuclei

Mosaic pattern of lamellar bone (like a jigsaw puzzle)

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158
Q

Define Limited scleroderma (=CREST)

A

one subtype of scleroderma — a condition that literally means “hardened skin.” The skin changes associated with limited scleroderma typically occur only in the lower arms and legs and sometimes the face and throat. Limited scleroderma can also affect your digestive tract.

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159
Q

What is the histology of osteosarcoma?

A

Sheets of small round cells
CD99 +ve
T 11:22 translocation

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160
Q

What do you know about choriocarcinoma ovarian carcinoma?

A

Secretes hCG

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161
Q

What age does Ewing’s sarcoma affect?

A
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162
Q

What distribution does pityriasis rosea have?

A

Salmon pink rash appears first (=herald patch) followed by oval macules in a christmas tree distribution.

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163
Q

Describe extradural haemorrhage

A

Skull Fracture
Ruptured middle meningeal artery –> rapid arterial bleed
Lucid interval –> LoC

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164
Q

Less common types of psoriasis are:

A

Flexural psoriasis
Guttate psoriasis - raindrop plaque distribution, usually seen 2 weeks post strep throat
Erythodermic/pustular psoriasis

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165
Q

Microscopic findings in endometriosis

A

Endometrial glands and stroma

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166
Q

Which bones are affected in simple bone cyst?

A

Humerus or femur

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167
Q

Define Renal Osteodystrophy

A

a bone disease that occurs when your kidneys fail to maintain proper levels of calcium and phosphorus in the blood. It’s common in people with CKD and affects most dialysis patients.

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168
Q

Define Churg Strauss

A

occurs in patients with a history of asthma or allergy and features inflammation of blood vessels in the lungs, skin, nerves, and abdomen.

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169
Q

When does pityriasis rosea appear and how is it treated?

A

Appears after a viral illness

Remits spontaneousily

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170
Q

Which joints may you see Heberdens nodes and in what disease?

A

DIP joint - Osteoarthritis

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171
Q

Define kawasaki disease

A

a disease in young children with an unknown cause, giving rise to a rash, glandular swelling, and sometimes damage to the heart.

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172
Q

Common presenting symptoms of breats pathology arE:

A

Pain (mastalgia/mastodynia)
Palpable masses
Nipple discharge

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173
Q

Symptoms of viral encephalitis are:

A 
Drowsiness
Seizures
Behavioural changes
Headache
Fever
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174
Q

Describe basal-like carcinomas:

A

Sheets of atypical cells with lymphocytic infiltrate

Stain positive for CK5/6/14

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175
Q

Describe acute pyelonephritis

A

Bacterial infection of the kidney , usually as a result of ascending infection - E.coli

Presents with: fever
chills
sweats
flank pain
renal angle tendernesss
luekocytosis +/- frequency, dysuria and haematuria

Leukocytic casts are seen in urine

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176
Q

What do you know about teratoma ovarian carcinoma?

A 
shows differentiation toward somatic structures
Mature teratomas (dermoid cyst): Benign; usually cystic
Differentation of germ cells into mature tissues e.g. skin, hair, teeth, bone, cartilage

Immature teratomas: malignant, usually solid; contains immature, embryonal tissue

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177
Q

What is seen on light microscopy for 1o causes of Nephrotic syndrome

A

MC: No changes

MG: Diffuse glomerular basement membrane thickening

FSGS: Focal and segmental glomerular consolidation and scarring, Hyalinosis - abnormal accumulation of a clear (hyaline) substance in body tissue

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178
Q

How do fibroids present clinically?

A

Heavy menstrual bleeding
Dysmenorrhoea
Pressure effects (i.e. urinary frequency, tenesmus)
Subfertility

In pregnancy: red degeneration of fibroids (Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus)

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179
Q

Signs & symptoms of HUS and TTP:

A

decreased platelets -> bleeding (petechiae, haematemesis, melena)
MAHA -> pallor and jaundice

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180
Q

What are the symptoms of osetomalacia?

A

Bone pain/tenderness

Proximal muscle weakness

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181
Q

Histolgy of Polymyositis:

A

Endomysial inflammation infiltrate

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182
Q

What are the special features of Osteoid Osteoma?

A

Small benign bone forming lesion

Night pain - relieved by aspirin

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183
Q

Describe the pathophys of pemphigus:

A

IgG Abs binds to desmosomal proteins –> intraepidermal bulla

PemphiguS Bullae are Superficial

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184
Q

What is Kernig’s sign

A

having the person lie flat on the back, flex the thigh so that it is at a right angle to the trunk, and completely extend the leg at the knee joint. If the leg cannot be completely extended due to pain, this is Kernig sign.

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185
Q

Define polymyositis

A

(“inflammation of many muscles”) is a type of chronic inflammation of the muscles (inflammatory myopathy) related to dermatomyositis and inclusion body myositis.

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186
Q

Temporal arteritis has an overlap with:

A

polymyalgia rheumatica

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187
Q

What is the biochem of Renal osteodystrophy?

A

Decreased Ca
Increased PO4
Secondary hyperPTH
Metabolic acidosis

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188
Q

Define pagets disease:

A

Paget’s disease chronically disrupts the normal cycle of bone renewal and repair, causing bones to become weakened and enlarged/deformed

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189
Q

What can be seen on angiography in polyarteritis nodosa?

A

Microaneurysms

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190
Q

How are fibroids affected by oestrogen?

A

Fibroids are stimulated by oestrogen.
Enlarge during pregnancy
Regress post-menopause

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191
Q

Autobodies associated with Polymyositis & dermatomyositis:

A

Anti Jo-1 (=tRNA synthetase)

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192
Q

Define tubular carcinomas

A

Well-formed tubules with low grade nuclei. rarely palpable as

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193
Q

Describe duct papilloma:

A 
A benign papillary tumour arising within the duct system of the breast. It can be within small terminal ductules (peripheral papillomas) or larger lactiferous ducts (central papillomas)
Causes bloody discharge
No lump
Not seen on mammogram
Treatment: Galactogram
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194
Q

What is the most common cause of infarction

A

Cerebral atheroclerosis

Can also be caused by embolism from intra/extra cranial plaques

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195
Q

Describe endometroid endometrial carcinoma:

A

Related to oestrogen excess - usually in peri-menopausal women
Risk factors include: E2 excess (obesity, anovulatory amenorrhoea e.g PCOS, nulliparity, early menarche, late menopause, tamoxifen.
DM, HTN
Mainly adenocarcinomas (85%) but may show squamous differentiation

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196
Q

How is MS classified?

A 
Primary progressive (10% - get continually worse)
Relapsing remitting (better between episodes but progresses over years)
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197
Q

Define Cervical glandular intraepithelial neoplasia (CGIN)

A

less common and more difficult to diagnose on cytology than CIN
Treatmentrequires excision of entire endocervix which can compromise fertility

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198
Q

Which joints may you see Bouchard’s nodes and in what disease?

A

PIP joint - Osteoarthritis

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199
Q

Pathogical features of APCKD

A

Large multicystic kidneys with destroyed renal parenchyma
Liver cysts (in PKD1)
Berry aneurysms

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200
Q

Histology of actinic keratosis:

A

SPAIN

Solar elastosis
Parakeratosis
Atypia/dysplasia
Inflammation
Not full thickness
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201
Q

Whate are the 6 types of increased ICP?

A 
Uncal
Central (transtentorial)
Cingulate (subfalcine)
Transcalvarial
Upward
Tonsillar
202
Q

What do you know about fibroma ovarian carcinoma?

A

No hormone production

50% associated with Meig’s syndrome (ascites + pleural effusion)

203
Q

Describe intraparenchymal haemorrhage

A

50% due to HTN
onset ois abrupt
can cause charcot-bouchard microaneurysms (likely to rupture)
Common site is the basal ganglia

204
Q

Where does lichen plaus occur?

A

Usually on the inner surfaces of wrists

Can also affect oral mucous membranes where the lesions have a lacy appearance

205
Q

Define invasive breast carcinoma:

A

Malignant epithelial tumours which infiltrate within breast, capacity to spread to distant sites.

206
Q

What are the characteristic deformaties of rheumatoid?

A

Z shaped thumb
Swan neck and Boutonniere deformity of fingers
Radial deviation of wrist and ulnar deviation of fingers

207
Q

What are the clinical features of pemphigoid?

A

Large tense bullae on erythmatous base
Often on forearms, groin and axillae
In the elderly

Bullae do not rupture as easily as pemphigus

208
Q

What can be seen on a FBC in churg strauss?

A

Eosinophilia

209
Q

Multiple system atrophy is characterised by:

A

Shy Drager: Autonomic dysfunction
Striatonigral: Difficulty with movement
Olivopontocerebellar: Difficulty with balance and co-ordination

210
Q

Management of a TIA is:

A

Aspirin +/- dipyridamole
+/- carotid endartectomy

Long term: treat HTN, decrease lipids, anticoagulateAspirin +/- dipyridamole
+/- carotid endartectomy

211
Q

Which renal diseases effect the glomerulus?

A

1) Nephrotic syndrome - breakdown of selectivity of glomerular filtration barrier
2) Nephritic syndrome

212
Q

What are the signs/symptoms of bacterial meningitis?

A 
Marked systemic symptoms
Unwell
Rash
Drowsy
Coma
septic shock
213
Q

What is the name for a decrease in cohesions between keratinocytes?

A

Acantholysis

214
Q

What are the special features of Fibrous dysplasia?

A

A bit of bone is replaced by fibrous tissue

Albright syndrome = polyostotic dysplasia + cafe au lait spots + precocious puberty

215
Q

Define Neurodegenerative disease

A

Progressive, irreversible condition leading to neuronal loss

216
Q

Staging classification of CRF

A

5 stages depending on GFR:

Stage 1: (>90) Kidney damage with normal renal function (often proteinurea)
Stage 2: (60-89) Mildly imparied
Stage 3: (30-59) Moderaterly impaired
Stage 4: (15-29) Severly impaired
Stage 5: (,15 or if being treated with renal replacement therapy) Renal failure - generally requires replacement therapy

217
Q

What is the appearance of Chondrosarcoma on X-ray?

A

Lytic lesion with fluffy calcification

Axial skeleton

218
Q

Define fat necrosis:

A

Inflammatory reaction to damaged adipose tissue
Presents as painless breast mass/skin thickening/mammographic lesion
Caused by trauma, radiotherapy or surgery

219
Q

Buzzwords for a Ependymoma are:

A

Ventricular tumour

Hydrocephalus

220
Q

Define mammary duct ectasia:

A

Duct ectasia of the breast or mammary duct ectasia or plasma cell mastitis is a condition in which the lactiferous duct becomes blocked or clogged.
This is the most common cause of greenish discharge.
Mammographically can mimic breast cancer.
Occurs mainly in multiparous 40-60yr old women
Poorly defined palpable periareolar mass with thick, white nipple secretions
Caused by granulomatous inflammation and dilation of large breast ducts
Cytology - proteinaceous material, inflammatory cells

221
Q

What is the histology of acute dermatitis?

A

Spongiosis
Inflammatory infiltrate in dermis
Dilated dermal capillaries

222
Q

What conditions predispose churg strauss?

A

Ashtma

Allergic rhinitis

223
Q

Symptoms, causes and treatment of acute mastitis

A

Symptoms: painful, red breast and fever
Causes: almost all occur during lactation and breast-feeding as a result of staphylococcal infection via cracks in the nipple. Involved breast tissue is necrotic and infiltrated by neutrophils
Tx: continued expression of milk + antibiotics +/- surgical drain

224
Q

What is the histology of temporal arteritis?

A

Increased ESR
Granulomatous transmural inflammation
Giant cells
Skip lesions

225
Q

Define chronic renal failure

A

Progressive, irreversible loss of renal function characterised by prolonged symptoms and signs of uraemia (fatigue, itching, anorexia and if severe eventually confusion)

226
Q

What age does osteosarcoma affect?

A

Adolescence

227
Q

Define Henoch Schonlein purpura

A

a disorder that causes inflammation and bleeding in the small blood vessels in your skin, joints, intestines and kidneys. The most striking feature of Henoch-Schonlein purura is a purplish rash, typically on the lower legs and buttocks.

228
Q

Define acute renal failure

A

the abrupt loss of kidney function, resulting in the retention of urea and creatinine

229
Q

What is Koebner phenomenon in psoriasis?

A

Lesions form at the site of trauma

230
Q

Common organisms causing PID

A

In UK:

1) Chlamydia trachomatis
2) Neisseria gonorrhoea

Elsewhere:

1) TB
2) SchistosomiasisIn UK:

231
Q

Name 2 malignant epidermal cutaneous neoplasms

A

Squamous cell carcinoma

Basal cell carcinoma

232
Q

Which bones are affected in Enchondroma?

A

Hands 43%

233
Q

Normal O2 range

A

10 - 13 kPa

234
Q

What is the biochem of HyperPTH?

A

Increased Ca
Decreased or normal PO4
Increased or normal ALP

235
Q

What can cause hypovolaemia hyponatremia?

A

1) Diarrhoea
2) Vomitting
3) Diuretics
4) Salt losing nephropathy

236
Q

Define: Stevens Johnson Syndrome (SJS)

A

a form of toxic epidermal necrolysis, is a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes.

237
Q

What can cause hypervolaemia hyponatremia?

A

Fluid overloaded:

1) Cardiac failure
2) nephrotic syndrome
3) Cirrhosis

238
Q

Complications of acute renal failure are:

A 
Metabolic acidosis
Hyperkalaemia
Fluid overload
HTN
low calcium
Uraemia
239
Q

What is the prognosis of CIN?

A

60 - 90% of CIN 1 reverts to normal over 10 - 23 months

30% of CIN 3 progress to cervical cancer over 10 years

240
Q

Describe the pathophys of Dermatitis herpetiformis:

A

Associated with coeliac

IgA Abs bind to BM –> subepidermal bulla

241
Q

What can cause euvolaemia hyponatremia?

A

1) Hypothyroidism
2) Adrenal insufficiency
3) SIADH

242
Q

Define dermatitis/eczema:

A

Interchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashes

243
Q

How are vasculitides categorised?

A

Large Vessel
Medium vessel
Small vessel

244
Q

What is the main difference between gout and pseudogout?

A

Pseudogout is caused by calcium pyrophosphate dihydrate (CPPD) crystals, and gout is caused by sodium urate crystals.

245
Q

What is the histology of Dermatitis herpetiformis?

A

Microabscesses which combine to form subepidermal bullae

Neutophil & igA deposits at tips of dermal papillae.

246
Q

Define pemphigoid:

A

is a rare skin condition that causes large, fluid-filled blisters.
The blisters develop on areas of skin that often flex — such as the lower abdomen, upper thighs or armpits.
Bullous pemphigoid is most common in people older than age 60.

247
Q

Normal range of Na

A

135 - 145 mmol/l

248
Q

What are the risks factors for Pagets disease?

A

> 50 years

Caucasian

249
Q

Define erythema multiforme

A

Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus (HSV). It presents with a skin eruption characterised by a typical target lesion. There may be mucous membrane involvement.

250
Q

What are the X-ray changes in osteomyelitis?

A

Lytic destruction of bone ~10days after onset

251
Q

HUS pathophysiology

A

Usually affects children
Usually associated with diarrhoea caused by E.coli (outbreaks caused by children visiting petting zoos)
can be non-diarrhoea associated due to abnormal proteins in complement pathway/endothelium - can be familial

Thrombi confined to kidneys
Usually involves renal failure

252
Q

Define aphasia

A

A language disorder. May be expressive or receptive

253
Q

What do you know about cervical carcinoma?

A

Usually arises from CIN
Most commonly squamous cell carcinoma (70-80%) but ~20% are adenocarcinomas, adenosquamous carcinomas and others
Invasion through the basement membrane marks the change from CIN to carcinoma

254
Q

What is the treatment for invasive?

A 
Tamoxifen = mixed agnoist/antagonists of oestrogen at its receptor
Herceptin/trastuzumab = monoclonal Ig to HER2 (direct toxic effect on myocardium, must monitor LVEF)
255
Q

What disease features are seen in osteoporosis?

A

Decreased bone mass

DEXA scan: Tscore >2.5 SD below normal (1-2.5 = osteopaenia)

256
Q

Which X-ray changes can be seen in Enchondroma?

A

Lytic lesion
Cotton wool calcification
Expansile
O ring sign

257
Q

Define invasive ductal:

A

carcinoma that cannot be subclassified into another group. Most common

258
Q

What is the management of long term gout?

A

Allopurinol

Conservative: lower ETOH and purine intake e.g. sardines and liver

259
Q

How is endometrial carcinoma staged?

A

FIGO system:
stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer)
stage I: confined to the organ of origin
stage II: invasion of surrounding organs or tissue
stage III: spread to distant nodes or tissue within the pelvis
stage IV: distant metastasis(es)

260
Q

What is the histology of HyperPTH?

A

Osteitis fibrosa cystica (marrow fibrosis + cysts - aka brown tumour)

261
Q

Characteristics of Basal cell carcinoma:

A

AKA rodent ulcer
Slow growing tumour
Rarely metastatic but locally destructive
Pearly surface, often with telangiectasia

262
Q

What is triple assessment?

A

Examination
Radiological examination (mammography/USS/MRI)
FNA & Cytology

263
Q

Describe lobular carcinomas in situ:

A

ALWAYS an incidental finding in biopsy as no microcalcifications or stromal reactiosn
20-40% bilateral
Cells lack adhesion protein E-cadherin
Risk factor for subsequent invasive breast carcinoma

264
Q

What can cause osteoporosis

A

Mostly age related
Post-menopause in women
Secondary to systemic disease/drugs

265
Q

What pathological protein(s) (misfolded) is associated withfrontotemporal dementia linked to Chr 17?

A

Tau

266
Q

How is hereditary nephritis caused?

A

X linked

Caused by a mutation in type IV collagen alpha 5 chain

267
Q

Membranous Glomerular disease

A

Affecting adults between 30 - 50 years
Caucasian
Caused by immune complex formation in the glomerulus by binding of antibodies to antigens in the GBM. The antigens may be part of the basement membrane, or deposited from elsewhere by the systemic circulation.
The immune complex serves as an activator that triggers a response from the C5b - C9 complements, which form a membrane attack complex (MAC) on the glomerular epithelial cells. This, in turn, stimulates release of proteases and oxidants by the mesangial and epithelial cells, damaging the capillary walls and causing them to become “leaky”.
Diffuse GBM thickening on light microscopy
Loss of podocyte foot processes
Ig and complment in granular deposists along entire GBM
Can be 1o or 2o to SLE, infection, drugs and malignancy

268
Q

What is the histology of pemphigoid?

A

Subepidermal bulla with eosinophils

Linear deposition of IgG along BM

269
Q

How are biopsy scored

A

Neoplastic lesions undergo core needle biopsy to confirm histological subtype and grading. Assessment of nuclear pleomorphism, tubule formation and mitotic activity.
Each gets a score /3, total score /9.
3-5/9 = grade 1/well differentiated
6-7/9 = grade 2/moderately differentiated
8-9/9 = grade 3/poorly differentiated

270
Q

Classification of lupus nephritis

A

Class I: minimal mesangial lupus nephritis - immune complexes but no structural alteration

Class II: mesangial proliferative lupus nephritis - immune complexes and mild/moder increase in mesangial matrix and cellularity

Class III: focal lupus nephritis - active swelling and proliferation in less than half the glomeruli

Class IV: Diffuse lupus nephritis - involvement of more than half the glomeruli

Class V: membranous lupus nephritis - subepitherlial immune complex deposition

Class VI: advanced sclerosising - complete sclerosis of >90% of the glomeruli.

271
Q

What is the pathophys of Henoch Schonlein purpura?

A

IgA mediated vasculitis

272
Q

What is the mechanism of ATI/ATN?

A

Damage to tubular epithelial cells –> Blockage of tubules by casts –> reduced flow and haemodynamic changes –> acute renal failure

273
Q

What are pagetoid cells?

A

buckshock appearance due to vertical growth in malignant melanoma

274
Q

Who is affected by gout?

A

Middle aged men]

275
Q

Where does atopic dermatitis effect older than infants?

A

Flexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopy

276
Q

What is Wickam’s striae

A

A fine white network on the surface of lesions in lichen planus

277
Q

What can happen to the coronary arteries in Kawasaki disease?

A

Aneurysm formation

278
Q

Signs/Symptoms of a TIAs are:

A

Symptoms last

279
Q

Polymyositis & dermatomyositis is associated with?

A

Underlying malignancy

280
Q

Define Bowen’s disease:

A

a very early form of skin cancer, which is easily curable. The main sign is a red, scaly patch on the skin. The abnormal growth takes place in the squamous cells – the outermost layer of skin – and Bowen’s disease is sometimes referred to as “squamous cell carcinoma in situ”.

281
Q

What antibody is positive in Microscopic polyangitis?

A

pANCA (anti-MPO)

282
Q

What is seen on X-ray for an osteoid osteoma?

A

Radiolucent nidus with sclerotic rim

283
Q

Symptoms of adenomyosis

A

Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods.
Deep dyspareunia

Globular uterus
Dysmenorrhoea (painful menstruation, typically involving abdominal cramps) is the major complaint

284
Q

Describe mucinous invasive breast cancer:

A

Mucinous carcinoma cells produce abundant quantities of extracellular mucin which dissects into surrounding stroma.

285
Q

What are the main subtypes of where ovarian carcinomas arise?

A

Epithelial (70%)
Germ Cell (20%)
Sex cord/stroma (10%)

286
Q

Normal ALT levels

A
287
Q

Who does Henoch Schonlein purpura effect?

A

children under 10

288
Q

Define ostemyelitis:

A

inflammation of bone or bone marrow, usually due to bacterial infection. Caused by haematogenous spread or local infection e.g. post trauma

289
Q

What are the main causes of CIN?

A

Infection by HPV 16 & 18

290
Q

Name 2 Traumatic haemorrhages

A

Extradural Haemorrhage

Subdural Haemorrhage

291
Q

Histology of malignant melanoma is:

A

atypical melanocytes
Initially grow horizontally in epidermis (radial growth phrase)
Then grow vertically into dermis (vertical growth phase)
Vertical growth produces buckshot appearance (=Pagetoid cells)

292
Q

What are the symptoms of dementia with lewy bodies?

A 
Psychological disturbances occur early
Day-to-day fluctuations in cognitive performance
Visual hallucinations
Spontaneous motor signs of Parkinsonism
Recurrent falls and syncope

This is pathologically indistinguishable from PD

293
Q

What is associated with a good prognosis

A

ER/PR receptor positive is associated with good prognosis because it predicts response to tamoxifen
HER 2 positive associated with bad prognosis

294
Q

How to diagnose HUS and TTP

A 
Low Haemaglobin
Low platelets
Signs of haemolysis (Increased bilirubin, increased reticulocytes, increased LDH)
Fragmented RBC's on blood smear
Coomb's test negative (as not AIHA)
295
Q

What are the symptoms of Henoch Schonlein purpura?

A

Palpable purpuric rash (lower limb extensors + buttocks)
Colicky abdo pain
Glomerulonephritis
Arthritis
Orchitis (inflammation of one or both of the testicles)

296
Q

What are the 3 theories of endometriosis

A

1) Regurgitant/implantation
2) Metaplastic
3) Vascular or lymphatic dissemination

297
Q

Clincial features of gout?

A

Swollen
red
Exquisitely painful joint
Tophus (s/c deposits of urate) is the pathognomonic lesion e.g. on pinna and hands

298
Q

Define dermatomyositis

A

an uncommon inflammatory disease marked by muscle weakness and a distinctive skin rash.

299
Q

Describe gynaecomastia:

A

Unilateral or bilateral enlargment of the male breast
Indicator of hyperoestrinism - alcohol, age, liver cirrhosis, functioning testicular tumour
Histology - epithelial hyperplasia, finger like projections into ducts

300
Q

What can cause gout?

A

Increased dietary purine intake (dairy + protein)
ETOH
Diuretics
inherited metabolic abnormalities

301
Q

Define systemic lupus erythematosus (SLE)

A

an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

302
Q

Describe the S. spinosum layer?

A

Cells linked by desmosomes

303
Q

What is the histopathology of ATI/ATN?

A

Necrosis of short segments of tubules

304
Q

How does rapidly progressive (crescentic) GN present

A

Presents as nephritic syndrome but:
Oliguria +
renal failure
are more pronounced

305
Q

Histology of keratoacanthoma:

A

Hard to differentiate from SCC

Atypia/dysplasia throughout epidermis, nuclear crowding and spreading through BM into dermis

306
Q

Focal Segmental Glomerulosclerosis (FSGS)

A

Leading cause of kidney failure in adults
Focal—only some of the glomeruli are involved (as opposed to diffuse), Segmental—only part of each glomerulus is involved (as opposed to global), Glomerulosclerosis—refers to scarring of the glomerulus
Most common in Afro-Carobbeans
Focal and segmental glomerular consolidation and scarring
Loss of podocyte foot processes on electron microscopy
1o but can be 2o to HIV nephropathy and obesity

307
Q

What are importnt predictors of stroke?

A

TIAs.

15% of 1st strokes are preceded by a TIATIAs.

308
Q

Management of a stroke is:

A

Aspirin +/- dipyridamole
Thrombolytics if less than 3 hours after event
+/- carotid endartectomy

Long term: treat HTN, decrease lipids, anticoagulate

309
Q

What is the difference between rickets and osteomalacia?

A

Osteomalacia (adults) and rickets (children) are caused by inadequate mineralisation of bone matrix. Vitamin D deficiency causes low calcium and phosphate, which lead to secondary hyperparathyroidism. Osteomalacia results from a loss of skeletal mass caused by inadequate mineralisation of the normal osteoid tissue after the closure of the growth plates. Rickets results from the same underlying process, occurring in children and adolescents before the growth plates have closed.

310
Q

Describe the pathophys of pemphigoid:

A

IgG Abs bind to hemidesmosomes of BM –> subepidermal bulla

Pemphigoid bullae are Deep

311
Q

Incidence + Presentation of Breast carcinomas:

A

Most common cancer in women, lifetime risk 1 in 8
age 75-80 years (younger in Afro-Caribbeans)
99% in women

Present with hard fixed lump, Pagets disease, peau d’orange, nipple retraction

312
Q

How is endometrial carcinoma subdivided?

A

Endometrioid - 80% (i.e. look similar to normal endometrial glands)
non-endometrioid - 20%

313
Q

Investigations fo TIA:

A

Carotid US

Ix for vascular risk: BP, FBC, ESR, U&E, glucose, lipids, CXR, ECG, carotid doppler

314
Q

What mutations are present in APCKD?

A

There is autosomal dominant inheritence.
85% due to mutations in PKD1 on chromosome 16 (encoding polycystin-1)
15% in PKD2 on chromosome 4 (encoding polycystin-2)

315
Q

What is the management of acute gout?

A

Colchicine

316
Q

What are the symptoms of hyperparathyroidism?

A

Hypercalcaemia: Moans, Stones, Bones, Groans

Depression/confusion
Renal stones
Bone pain and fractures
Constipation
Pancreatitis
POlyuria
Polydipsia
317
Q

Normal AST levels

A
318
Q

What is the histology of pemphigus?

A

Intraepidermal bulla
Netlike oattern of intercellular IgG deposits
Acantholysis

319
Q

What are the special features of Simple bone cyst?

A

Fluid filled unilocular

320
Q

What age are likely to get temporal arteritis?

A

Elderly

321
Q

What antibody is positive in Churg Strauss?

A

pANCA (anti-MPO)

322
Q

What is the end stage of neurodegenerative disease?

A

Dementia

323
Q

Name 4 Inflammatory breast conditions

A

Acute mastitis
Periductal mastitis
Mammary duct extasia
Fat necrosis

324
Q

What is the histology of osteosarcoma?

A

Malignant mesenchymal cells

ALP +ve

325
Q

Name 1 benign epidermal cutaneous neoplasm

A

Seborrhoeic keratosis

326
Q

Autobodies associated with Limited scleroderma CREST:

A

Anti-centromere

327
Q

Define Adenomyosis

A

Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Similar to endometriosis

328
Q

What can cause rickets?

A

Decreased Vit D

Decreased dietray Vit D,
decreased sunlight,
malabsoprtion of Vit D (GI causes)
genetic causes

329
Q

Define epithelial origin of ovarian carcinoma and name the subtyopes (4):

A

Derived from the surface of the epithelium that covers the ovary.
Can be benign, borderline or malignant serous

4 Types:
Serous
Mucinous
Endometrioid
Clear cell
330
Q

What is seen on immunofluorescence for 1o causes of Nephrotic syndrome

A

MC: No immune deposits

MG: Ig and complement in granular deposits along entire GBM

FSGS: Ig and complement in scarred areas

331
Q

Where does contact dermatitis commonly effect?

A

Ear lobes and neck (jewellery)
Wrist (leather watch straps)
Feet (shoes)

332
Q

Risk factors for breast carcinomas are:

A

Obesity
Tobacco
Alcohol
Race (Caucasian > Afro-Caribbean > Asian > Hispanic)
Family History
Advancing age
Hormone exposure - early menarche, late menopause, late 1st live birth (pregnancy –> terminal differentiation of milk-producing luminal cells, removing these from pool of potential cancer precursors), OCP/HRT
Susceptibility genes (12%) - BRCA1/BRCA2, also increased risk iof ovarian, prostate and pancreatic malignancy. BRCA mutations cause a lifetime risk of invasive breast carcinoma of up to 85%

333
Q

Which area does Giant cell affect most commonly?

A

Knee - epiphysis

334
Q

How is acute postinfectious GN diagnosed?

A

Haematuria (red cell casts)
Proteinuria
Oedema
HTN

Bloods: antistreptococcal antibody (ASOT) titre is raised, C3 decreased

Biopsy:
Light microscope - increased cellularity of glomeruli
Flurescence microscope - granular deposits of IgG and C3 in GBM
Electron microscope - Subendothelial humps

335
Q

Causes of nephritic syndrome

A

1) Acute postinfectious (post streptococcal) glomerulonephritis
2) IgA Nephropathy (berger disease)
3) Rapidly progressive (crescentic) GN
4) Hereditary nephritis (alports syndrome)
5) Thin basement membrane disease (benign familial haematuria)

336
Q

What is seen on X-ray for Pagets?

A

Mixed lytic and sclerotic

SKULL: Osteoporosis circumscripta
Cotton Wool

VERTEBRAE: Picture frame
Ivory vertebrae

PELVIS: Sclerosis and lucency

337
Q

How does acute postinfectious GN cause damage?

A

Glomerular damage is thought to be due to immune complex deposition
Occurs 1-3 weeks after streptococcal throat infection or impetigo (usually Group Aalpha-haemolytic strep = strep pyogenes)

338
Q

Name 3 types of bullous disease:

A

Dermatitis herpetiformis
Pemphigoid
Pemphigus

339
Q

Clinical symptoms of hyponatraemia are:

A

Nausea & vomiting

340
Q

What is the main clinical feature of scleroderma?

A

Skin fibrosis/hard skin

341
Q

Although polyarteritis nodosa can affect many organs, which does it spare?

A

Lungs

342
Q

Which X-ray changes can be seen in Simple bone cyst?

A

Lytic well defined

343
Q

Describe breast mice (fibroadenoma)

A

Most common benign tumour, from stroma, often multiple and bilateral
Occurs at any age within reporductive period (usually 20-20)
Epithelium responsive to hormones, therefore increase in size during pregnancy and calcify after menopause
Spherical, freely mobile, variable in size, rubbery
Overgrowth of collagenous mesenchyme
“shelling out” is curative

344
Q

Name two dermatological emergencies and describe why they are dangerous:

A

Stevens Johnson Syndrome - sheets of skin detachment 30% of body surface areaStevens Johnson Syndrome - sheets of skin detachment 30% of body surface areaStevens Johnson Syndrome - sheets of skin detachment 30% of body surface areaStevens Johnson Syndrome - sheets of skin detachment 30% of body surface areaStevens Johnson Syndrome - sheets of skin detachment 30% of body surface area

345
Q

What are the risks factors for Osteomalacia/rickets?

A 
Poor diet
Malabsorption
CLD (chronic liver disease)
CKD
lack of sunlight
346
Q

How is rapidly progressive (crescentic) GN caused?

A

Type 1: Goodpastures syndrome - HLA-DRB1 association
Type 2: SLE, IgA nephropathy, post infectious GN
Type 3: c-ANCA - Wegener’s granulomatosis
p-ANCA - microscopic polyangitis

347
Q

How does rapidly progressive (crescentic) GN present under fluorescence microscopy?

A

Type 1: Linear deposition of IgG in GBM

Type 2: Granular (lumpy bumpy) IgG immune complex deposition on GBM/mesangium

Type 3: Lack of/scanty significant immune complex deposition

348
Q

What are neoplastic lesions assessed for

A

Oestrogen receptors
progesterone receptors
HER2 receptors

349
Q

What areas are affected in TIAs?

A

Any
Characteristally embolic atherogenic debris from the carotid artery travels to the opthalmic branch of the internal carotid

350
Q

Describe the S. basale layer?

A

mitosis

cells bound to BM by hemidesmosomes

351
Q

Normal Alkaline Phosphatase (ALP)

A

30 - 150 iu/L

352
Q

Cerebral infection in a 1 month - 6 year old is most likely caused by:

A

Bacterial: Strep pneumoniae, Haemophilus influenza

353
Q

What can cause Hypokalaemia?

A

1) GI loss - D&V, drains
2) Renal loss - Hyperaldosterism, excess cortisol, increased sodium delivery to distal nephron, osmotic diuresis
3) Redistribution into cells - insulin, Beta-agonists, alkalosis
4) Rare causes - rare tubular acidosis type 1&2, hypomagnesaemia

354
Q

Characteristics of Squamous cell carcinoma (SCC):

A

When Bowens has spread to involve the dermis

Similar characteristics to Bowens but may ulcerate

355
Q

Which bones are affected in Fibrous dysplasia?

A

Femur

356
Q

Define viral encephalitis

A

inflammation of the brain caused by a virus.

357
Q

Define Squamous cell carcinoma (SCC):

A

the uncontrolled growth of abnormal cells in the skin outer squamous cells of the epidermis. It occurs as a result of keratinization of the epidermal cells and has the potential to metastasize to other regions of the body.

358
Q

Describe Phyllodes tumour

A

Arises from interlobular stroma with increased cellularity and mitoses.
Present >50 years as palpable mass
Low grade or high grade lesions
Mostly relatively benign, but can be aggressive therefore excised with wide local excision/mastectomy to limit local recurrence
Mets are very rare

359
Q

Which lobes are most marked in Alzheimer’s?

A

Temporal and frontal with loss of cholinergic neurones

360
Q

Which bones are affected in Osteochondroma?

A

Long bones

Pelvis

361
Q

Normal CO2 range

A

4.7 - 6kPa

362
Q

Define Leiomyoma (fibroid)

A

a benign tumour of smooth muscle origin.A leiomyoma of the uterus is commonly called a fibroid.
It is the most common tumour of the female genital tract - occuring in 20% of women >35

363
Q

MS Buzzwords are:

A

Myelin basic protein

Proteo-lipid protein

364
Q

Describe chronic pyelonephritis and reflux nephropathy

A

Chronic inflammation and scarring of the parenchyma caused by recurrent and persistent bacterial infection

Can be due to:
Chronic obstruction - posterior uretheral valves, renal calculi
Urine reflux (=reflux nephropathy)
365
Q

Characteristics of actinic keratosis:

A

Rough
Sandpaper like
Scaly lesions on sun-exposed areas

366
Q

What disease features are seen in Pagets disease?

A

Both lytic and lerotic lesions

367
Q

Define osteoarthritis

A

degeneration of joint cartilage and the underlying bone, most common from middle age onward. It causes pain and stiffness, especially in the hip, knee, and thumb joints.

368
Q

What are the symptoms of Buergers?

A

Inflammation of arteries of extremities - tibial and radial
Pain
Ulceration of toes, feet, fingers

369
Q

Define Lupus Nephritis

A

Lupus nephritis is inflammation of the kidney that is caused by systemic lupus erythematous (SLE). Also called lupus, SLE is an autoimmune disease. With lupus, the body’s immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys.It is a type of glomerulonephritis in which the glomeruli become inflamed.

370
Q

Amyloidosis in 2o Nephrotic syndrome

A

Apple green birefringence with congo red stain
Patient may also have:
Chronic inflammation - rheumatoid, chronic infections (TB) causing AA protein deposition
Immunoglobulin light chain deposition - AL protein deposition from multiple myeloma

Clinical clues: Macroglossia, heart failure, hepatomegaly

371
Q

What do you know about dysgerminoma ovarian carcinoma?

A

Female counterpart of testicular seminoma

372
Q

Additional organ involvements with crescentic GN

A

Type 1: Lungs - pulmonary haemorrhage

Type 3: Vasculitis - particularly presenting as skin rashes or pulmonary haemorrhage

373
Q

What antibody is positive in Wegener’s granulomatosis?

A

cANCA (anti-PR3)

374
Q

Define dementia

A

A global impairment of cognitive function and personality without impairement of consciousness.
This impairement goes beyond what might be expected from normal ageing

Includes memory impairment and at least 1 cognitive disturbances (aphasia, agnosia, apraxia) or a disturbance in executive function

375
Q

Define Wegener’s granulomatosis:

A

inflammation of small arteries and veins (vasculitis) that classically involves the vessels supplying the tissues of the lungs, nasal passages (sinuses), and kidneys. Wegener’s granulomatosis usually affects young or middle-aged adults.

376
Q

Define Takayasu’s arteritis

A

an inflammatory disease of the large arteries. TA particularly affects the aorta, and the pulmonary artery.

BUZZWORD: Pulseless disease. Increased in Japanese womenan inflammatory disease of the large arteries. TA particularly affects the aorta, and the pulmonary artery.

377
Q

Melanocytic (i.e. from melanocytes) cutaneous neoplasms can be:

A

Benign - melanocytic nevi (=moles).

Malignant - melanoma

378
Q

Which organism causes osteomyelitis in children and where does it commonly affect?

A

Haemophilus influenza
Group B strep

Long bones

379
Q

What is the composition of bone?

A

80% compact/cortical

20 % anellous/spongy

380
Q

Define Pelvic Inflammatory Disease

A

inflammation of the female genital tract, accompanied by fever and lower abdominal pain. Infection ascends from vagina and cervix, up to the uterus and tubes, leading to inflammation (endometritis, salpingitis) and formation of adhesions.

381
Q

Histology of Squamous cell carcinoma (SCC):

A

Atypia/dysplasia throughout epidermis

nuclear crowding and spreading through BM into dermis

382
Q

What are the clinical features of Dermatitis herpetiformis?

A

Itchy vesicles on extensor surface of elbows and buttocks

383
Q

What are the symptoms of rickets?

A 
Bowing tibia
Bone pain
Frontal bossing
Rachitic rosary (expansion of the anterior rib ends at the costochondral junctions and is most frequently seen in rickets as nodularity at the costochondral junctions)
Pigeon chest
Delayed walking
384
Q

What is the biochem of Pagets disease?

A

Normal PO4

+++ increased ALP

385
Q

What are thrombotic microangioplasties characterised by?

A 
Thrombosis
Triad of:
- Microangiopathic haemolytic anaemia (MAHA)
- Thrombocytopenia
- Renal failure
386
Q

What are 2 thrombotic Microangiopathies?

A

1) Haemolytic Uraemic Syndrome (HUS)

2) Thrombotic Thrombocytopaenic Purpura (TTP)

387
Q

What is the histology of osteosarcoma?

A

Osteoclast-type multinucleate giant cells on background of spindle/ovoid cells

388
Q

What are the 2 main subtypes of Haemorrhage

A

Non Traumatic

Traumatic

389
Q

Defineadult polycystic kidney disease (APCKD)

A

a multisystemic and progressive disorder characterized by cyst formation and enlargement in the kidney and other organs (eg, liver, pancreas, spleen). It is autosomal dominant

390
Q

What is the name for increased S.corneum and therefore increased keratin?

A

Hyperkeratosis

391
Q

Define Buergers disease

A

a rare disease of the arteries and veins in the arms and legs. Blood vessels become inflamed, swell and can become blocked with thrombi eventually damaging or destroying skin tissues and may lead to infection and gangrene.

392
Q

What is the healing process of a fracture?

A

1) Organisation of haematoma (pro-callus)
2) Formation of fibrocartilaginous callus
3) Mineralisation of fibrocartilaginous callus
4) Remodelling of bone along weight bearing lines

393
Q

Where can fibroids occur?

A

Intramural
Submucosal
Subserosal

394
Q

What causes IgA nephropathy (berger disease)

A

Deposition of IgA immune complexes in the glomeruli
This is the most common GN worldwide
It can progress to ESRF

395
Q

What disease features are seen in Osteomalacia/rickets?

A

Decreased bone mineralization

396
Q

What is the HLA associated with scleroderma (limited & diffuse)?

A

HLA-DR5 & DRw8

397
Q

Define sex cord/stroma origin of ovarian carcinoma and name the subtyopes (3):

A

From sex cord or stroma of gonad
Can differentiaate toward female (granulosa and theca cells) or male (sertoli and leydig cells) structures

3 types:
Fibroma (from cells of ovarian stroma)
Granulosa-Theca cell tumour
Sertoli-Leydig cell tumour

398
Q

What are browns tumours

A

The brown tumor is a fibrotic, cystic bony change that arises in settings of excess osteoclast activity, such as hyperparathyroidism. These lesions are termed “Brown Tumors” due to the presence of old hemorrhage in the lesion.

399
Q

What is the osmolality in true hyponatraemia?

A

Low.
This can be distinguished using hydration status and urinary Na. (Low urinary Na shows the kidneys are still working). If urinary sodium is >20 then there is a problem with the kidneys i.e. diuretics, addisons, Salt-losing nephropathies, Acute Renal Failure, Chronic Renal Failure

400
Q

What pathological protein(s) (misfolded) is associated with dementia with lewy bodies?

A

Alpha-synuclein

Ubiquitin

401
Q

What is the pathogenic mechanism causing neurodegenerative disease?

A

Accumulation of misfolded proteins which may be intra- or extracellular

402
Q

Define tubulointerstitial nephritis

A

A group of renal inflammatory disorders that involve the tubules and intersitium

403
Q

What are the symptoms of temporal arteritis?

A

Scalp tenderness
Temporal headache
Jaw claudication
Blurred vision

404
Q

Signs & symptoms of endometriosis

A

Pelvic pain
Dsymenorrhoea
deep dyspareunia
Decreased fertility

405
Q

Which bones are affected in Osteoma?

A

Head + neck

406
Q

What investigations diagnose gout?

A

Negatively birefringent crystals

407
Q

Which joints are commonly affected in Gout?

A

Big toe - MTP (podagra)

Lower extremities e.g. knee

408
Q

Which X-ray changes can be seen in Fibrous dysplasia?

A

Soap bubble osteolysis

Shepherds crook deformity

409
Q

Nephritic syndrome is characterised by:

A

1) Haematuria (coca-cola urine)
2) Dysmporphic RBCs and red cell casts in urine

May also have:

3) Oliguria
4) Increased urea and creatinine
5) Hypertension
6) Proteinuria

410
Q

What are the nail changes associated with psoraisis?

A

Pitting
Onycholysis
Subungal Hyperkeratosis

(POSH)

411
Q

Define vulval carcinoma

A

Mainly squamous cell carcinoma

can arise from VIN or from other skin abnormalities (Paget’s of the vulva)

412
Q

What is the appearance of Ewing’s sarcoma on X-ray?

A

Onion skinning of perosteum

413
Q

Where does seborrhoeic dermatitis affect young adults?

A

Mild erythema
Fine scaling
Mildly pruritic

Affects; face, eyebrow, eyelid, anterior chest, external ear

414
Q

Describe Chronic interstitial nephritis/Analgesic nephropathy

A

Seen in the elderly with long-term analgesic consumption (NSAIDs/paracetamol)

Symptoms occur only in late disease: HTN, anaemia, proteinuria and haematuria

415
Q

What is the prognosis of 1o causes of Nephrotic syndrome ?

A

MC: 90% respond

MG: Poorly

FSGS: 50% respond

416
Q

What are the 3 types of tubulointerstitial nephritis?

A

1) Acute pyelonephritis
2) Chronic pyelonephritis & reflux nephropathy
3) Interstitial nephritis

417
Q

What is the management of Alzheimer’s?

A

Diagnosis is clinical, although PET and MRI may help
Senile plaques of beta-amyloid protein and neurofibrillary tangles of tau protein

Treatment is symptomatic: anti-cholinesterases, nAChR agonists, glutamate antagonists

418
Q

Define Temporal arteritis

A

the temporal arteries, which supply blood to the head and brain, become inflamed or damaged. It is also known as cranial arteritis or giant cell arteritis.

419
Q

Cerebral infection in a young adult/adolescent is most likely caused by:

A

Bacterial: N. meningitidis

Strep. Pneumoniae

420
Q

Cerebral infection in a neonate is most likely caused by:

A

Bacterial: GBS, E.coli, Listeria

Viral: Echovirus
Coxsackie’s
Mumps
HIV

421
Q

What are the clinical features of contact dermatitis?

A

Erythema
Swelling
Pruritis

422
Q

What is the name for a linear pattern of melanocyte proliferation within epidermal basal cell layer (can be reactive or neoplastic)?

A

Lentiginous

423
Q

How do 1o causes of Nephrotic syndrome respond to steroids?

A

MC:

424
Q

What can be seen in histology of Osteochondroma?

A

Cartilage capped bony outgrowth

425
Q

Define pseudogout:

A

a form of arthritis characterized by sudden, painful swelling in one or more of your joints.

426
Q

Define Munro’s microabscesses

A

Munro’s microabscess is an abscess (collection of neutrophils) in the stratum corneum of the epidermis due to the infiltration of neutrophils from papillary dermis into the epidermal stratum corneum.

427
Q

What is the most important prognostic factor in melanoma?

A

Breslow thickness

428
Q

TTP pathophysiology

A

Usually affects adults
Thrombi occur throughout circulation (esp in CNS)
Usually no renal failure
Neuro symptoms (headache, altered consciousness, seizures, coma)

429
Q

Describe Acute interstitial nephritis

A

A hypersensitivity reaction, usually to a drug e.g. Abx, NSAIDs, diuretics
Usually begins days after drug exposure

Presents with: fever
skin rash
haematuria
proteinuria
eosinophilia
430
Q

Name 5 malignant neoplastic breast conditions:

A 
Breast carcinoma
Carcinoma in situ (30%)
Invasibe breast carcinoma (80%)
Basal-like carcinoma
Phyllodes tumour
431
Q

Can fibroids be malignant?

A

They are most often benign.
It is very rare to transform to malignant (leiomyosarcoma)
Leiomyosarcomas likely arise de novo and usually occur in post-menopausal women.

432
Q

What is the pathophysiology of thrombotic microangiopathies

A

widespread fibrin deposition in vessels -> formation of platelet-fibrin thrombi which damage passing platelets and RBC’s -> platelet and RBC destruction (i.e. thrombocytopenia and MAHA)

433
Q

What is the normal range of potassium

A

3.5 - 5.5 mmol/l

434
Q

What are the 4 layers of the Epidermis

A 
From top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basale
435
Q

Describe non-endometrioid endometrial carcinoma:

A

Include papillary, serous and clear cell.
Moore aggressive than endometrioid
Unrelated to oestrogen excess
Usually in elderly women with endometrial atrophy

436
Q

Define Basal cell carcinoma:

A

Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off.
Basal cell carcinoma often appears as a waxy bump, though it can take other forms. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as your face and neck.
Most basal cell carcinomas are thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight. Avoiding the sun and using sunscreen may help protect against basal cell carcinoma.

437
Q

Signs/Symptoms of a stroke are:

A 
Sudden onset
FAST
Numbness
Loss of vision
Dysphagia
438
Q

Which area does Ewing’s sarcoma affect most commonly?

A

Long bones

Pelvis

439
Q

What are the symptoms of osteoporosis?

A

Low impact fractures (hip - NOF, vertebrae, wrists - colles’)

Back pain

440
Q

What causes erythema multiforme?

A 
Infections (e.g. herpes simplex, mycoplasma)
Drug reactions (e.g. penicillin, salicylates, anti-malarials)
441
Q

What are the symptoms of Pagets disease?

A 
Bone pain
Microfractures
Nerve compression
Skull changes (increased head size)
Deafness
High output cardiac failure
442
Q

Risk factors of CIN are:

A 
Early age at first intercourse,
Multiple partners
Multiparity
Smoking
HIV
Immunosuppression
443
Q

Clinical features of APCKD

A

Haematuria
Flank pain
UTI

Clinical features are usually due to cyst complications such as cyst rupture, cyst infection and cyst haemorrhage

444
Q

Who is affected by pseudogout?

A

> 50 years

445
Q

What causes ATI/ATN?

A

Ischaemia - burns, septicaemia

Nephrotoxins - drugs (gentamicin, NSAIDs), radiographic contrast agents, myoglobin, heavy metals

446
Q

Causes of CRF

A 
Diabetes (19.5%)
Glomerulonephritis (15.3%)
HTN & Vascular disease (15%)
Reflux nephropathy (chronic pyelonephritis) (9.5%)
Polycystic kidney disease (9.4%)
447
Q

Describe VIN:

A

Similar to CIN
Dysplasia of epithelium; associated with HPV
Graded as VIN I, II and III
Progression to invasive disease is lower than for CIN (~5%)

448
Q

3 ways to characterise acute renal failure:

A

1) Pre-renal: Most common. Caused by renal hypo-perfusion e.g. hypovolaemia, sepsis, burns, acute pancreatitis and renal artery stenosis
2) Renal: Acute tubular necrosis is the most commenest cause but can also include acute glomerulonephritis and thrombotic microangiopathy
3) Post-renal: obstruction to urine flow as a result of stones, tumours (primary & secondary), prostatic hypertrophy and retroperitoneal fibrosis.

449
Q

How does the CSF look in pyogenic, TB and viral cerebral infection

A

Pyogenic: - often turbid (cloudy)
TB: - fibrin web
Viral: - usually clear

450
Q

Name 3 medium vessel vasculitides

A

Polyarteritis nodosa (PAN)
Kawasaki’s disease
Buerger’s disease (Thrombangitis obliterans)

451
Q

Define vulval intrapithelial neoplasia (VIN)

A

The term Vulvar intraepithelial neoplasia (VIN) refers to particular changes that can occur in the skin that covers the vulva. VIN is not cancer, and in some women it disappears without treatment.

452
Q

What can be seen in histology of Enchondroma?

A

Normal cartilage

453
Q

What is the biochem of Osteoporosis?

A

Normal Ca
Normal PO4
Normal ALP

454
Q

What are the 2 thrombotic microangiopathies?

A

1) Haemolytic uraemic syndrome

2) Thrombotic thrombocytopenic purpura

455
Q

What is the pathology of MS

A

MS plaques showing sharp margins of myelin loss

456
Q

Describe subdural haemorrhage

A

Prev history of minor traume –> damaged bridging veins with slow venous bleed
Often elderly/alcoholic
Associated with brain atrophy
Fluctuating consciousness

457
Q

Describe Subarachnoid haemorrhage

A

85% from ruptured berry aneurysms, most at internal bifurication
F>M
usually under 50 years of age
thunderclap headache, vomiting and LoC
Increased in PKD, Ehler’s Danlos and Aortic coarctation
Associated with vascular abnormalities including AV malformations, capillary telangiectasias, venous and cavernous angiomas, Ehlers Danlos

458
Q

What is the main difference between nephrotic and nephritic syndrome?

A

Nephrotic syndrome is characterized by only proteins moving into the urine. In contrast, Nephritic syndrome is characterized by having a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins (proteinuria) and red blood cells (hematuria) to pass into the urine. Both may involve hypoalbuminemia due to protein albumin moving from the blood to the urine.

459
Q

What is Nikolsky sign?

A

a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed.
In SJS and TEN this means there is prominent mucosal involvment

460
Q

What are the 5 different types of fracture?

A 
Simple
Compound
Greenstick
Comminuted
Impacted
461
Q

Which renal diseases effect the Blood vessels?

A

1) Thrombotic microangiopathies

462
Q

How is hyponatremia classified?

A

1) Hypervolaemia
2) Euvolaemia hyponatremia
3) Hypovolaemia hyponatremia

463
Q

What is seen on X-ray for HyperPTH?

A

Browns tumours
Salt and pepper skull
Subperiosteal bone resorption in phalanges

464
Q

Define Multiple System Atrophy

A

Degenerative neurological disorder that can present in a very similar manor to Parkinsons but shows a porr response to Parkinsons medication

465
Q

What is the appearance of osteosarcoma on X-ray?

A 
Elevated peristeum (codmans triangle)
Sunburst appearance
466
Q

Common presentation of TB

A

1) Cough +/- Haemoptysis
2) Fever
3) Night sweats
4) Weight loss
5) Malaise

467
Q

What is the name for an increase in S. spinosum?

A

Acanthosis

468
Q

Which X-ray changes can be seen in Osteochondroma?

A

Well defined bony protuberance from bone

469
Q

What disease features are seen in Primary hyperparathyroidism?

A

Bone changes of osteitis fibrosa cystica

470
Q

What are salt and pepper skulls?

A

Salt and pepper sign of the calvaria refers to multiple tiny hyperlucent areas in the skull vault caused by resorption of trabecular bone in hyperparathyroidism. There is loss of definition between the inner and outer tables of the skull and a ground-glass appearance as well as spotty deossification.

471
Q

What are the 3 areas of the nephron upon which renal disease can be classified?

A

1) Glomerulus
2) Tubules & Interstitium
3) Blood vessels

472
Q

What can cause primary hyperparathyroidism?

A

Parathyroid adenoma
MEN
Carcinoma
Hyperplasia

473
Q

Define Dermatitis herpetiformis:

A

a skin manifestation of celiac disease. Extremely itchy bumps or blisters appear on both sides of the body, most often on the forearms near the elbows, as well as on knees and buttocks.

474
Q

What is seborrhoeic dermatitis (dandruff)?

A

Inflammatory reaction to yeast - Malassezia

475
Q

Define infarction

A

An area of tissue death due to lack of oxygen.

Accounts for 70-80% of strokes

476
Q

Define nephritic syndrome

A

A manifestation of glomerular inflammation (i.e. glomerulonephritis)

477
Q

What are ivory vertebrae

A

The term ivory vertebra refers to a single sclerotic vertebra, that stands out due to its very dense white appearances, like the ivory tusks of an elephant. Often seen in pagets

478
Q

What are the 5 “p’s” describing lichen planus lesions?

A 
Pruritic
Purple
Polygonal
Papules
Plaques

They also have a mother of pearl sheen

479
Q

What is seen on X-ray for Osteoporosis?

A

Usually nothing

480
Q

What pathological protein(s) (misfolded) is associated with Corticobasal degeneration?

A

Tau

481
Q

What is the name for nuclei in S. corneum

A

Parakeratosis

482
Q

Which organism causes osteomyelitis in Adults and where does it commonly affect?

A

S. Aureus.

Vertebrae, jaw (2ndary to dental abscess) and toes (2ndary to diabetic skin ulcer)

483
Q

What pathological protein(s) (misfolded) is associated with Picks disease?

A

Tau

484
Q

Signs & symptoms of uraemia in CKF

A

Fatigue
Itching
Anorexia
Confusion - if severe

485
Q

If you suspect bacterial meningitis, what should you do?

A

Immediately treat with IV Abx

Then conform with lumbar puncture and blood culture

486
Q

How can benign melanocytic nevi (moles) be classified?

A

Junctional
Compound
Intradermal

487
Q

What is Auspitz’ sign?

A

Rubbing of psoriasis plaques to cause pin-point bleeding

488
Q

What is a risk factor for Buergers disease?

A

Heavy smokers

Men

489
Q

DefineHemolytic uremic syndrome (HUS)

A

Hemolytic uremic syndrome (HUS) is a condition that results from the abnormal premature destruction of red blood cells. it ischaracterized by hemolytic anemia (anemia caused by destruction of red blood cells), acute kidney failure (uremia), and a low platelet count (thrombocytopenia).

490
Q

Describe the S. granulosum layer?

A

Nuclei disintegrated

491
Q

What are 5 metabolic bone diseases?

A 
Pagets disease
Renal Osteodystrophy
Osteoporosis
Osteomalacia/rickets
Hyperparathyroidism (primary)
492
Q

Define bullous disease:

A

any disease marked by eruptions of blisters, or bullae, filled with fluid, on the skin or mucous membranes.

493
Q

What are the signs/symptoms of meningism?

A

Headache
Stiff neck
Photophobia
+ve Kernig’s sign

494
Q

Define Acute Tubular Injury/Necrosis (ATI/ATN)

A

A severe form of acute renal failure that develops in people with severe illnesses (such as sepsis) or with very low blood pressure. Patients may need dialysis.
Most common cause of acute renal failure

495
Q

What is cancellous/spongy bone important for?

A

Calcium metabolism, found especially in the vertebra and pelvis

496
Q

What pathological protein(s) (misfolded) is associated with alzheimers disease?

A

Tau

Beta-amyloid

497
Q

What can cause SJS and TEN?

A

Commonly drugs e.g. Sulfonamide Abx and anticonvulsants

498
Q

Buzzwords for a pilocytic astrocytoma are:

A

Indolent

Childhood

499
Q

What and where is the classic lesion for erythema multiforme?

A

Annular target lesions on the hands and feet

500
Q

What are the 2 forms of carcinoma in situ?

A

Lobular (LCIS)

Ductal (DCIS)

Year 5 Histopath (17 decks)

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