Histopathology Flashcards
1
Q
Definition of closed fracture
A
Clean break with intact soft tissue
2
Q
Definition of comminuted fracture
A
Splintered bone with intact soft tissue
3
Q
Definition of compound fracture
A
Fracture site communicates with skin surface
4
Q
Stages of fracture repair
A
- Organisation of haematoma at # site (pro-callus)
- Formation of fibrocartilaginous callus
- Mineralisation of fibrocartilaginous callus
- Remodelling of bone along weightbearing lines
5
Q
Common sites for osteomyelitis in adults
A
Jaw
Vertebrae
Toe
6
Q
Features of osteomyeltis
A
General: Fever, Malaise, Leucocytosis, Chills
Local: Pain, Swelling, Redness
60% positive blood cultures
X-ray: mixed picture eventually lytic.
7
Q
Stages of Lyme Disease
A
Stage 1 - Early localised characterised by rash (90%) usually within 7-10 days and between 1 & 50cm diameter.
Often thigh, groin, axilla (earlobe in children)
Stage 2 - Early Disseminated affects many organs, musculoskeletal, heart, nervous system.
Stage 3- Late, persistent dominated by arthritis.
8
Q
Clinical features of rheumatoid arthritis
A
Mild anaemia Raised ESR RF+ve \+/- rheumaoid nodules extra-articular features
9
Q
Skin manifestations of rheumatoid arthritis
A
Pyoderma gangrenosum
Nodules
Ulcers (vasculitic)
10
Q
Components of Felty’s syndrome
A
RA
Neutropenia
Splenomegaly
11
Q
Eye manifestations of rheumatoid arthritis
A
Keratoconjunctivitis
Scleritis
Scleromalacia
Episcleritis
12
Q
Lung manifestations of rheumatoid arthritis
A
Fibrosing alveolitis
Obliterative bronchiolitis
Pleural effusion
Lung nodules
13
Q
Extra-articualr manifestations of RA
A
Skin manifestations: ulcers, pyoderma gangrenosum, nodules Lung manifestations e.g. fibrosis Eye inflammation and scleromalacia Sjogren syndrome Carpal tunnel and peripheral neuropathy Raynauds Osteoporosis Vasculitis Felty's Splenomegaly Amyloidosis Lymphadenopathy Systemic symptoms/signs: fever, malaise, fatigue, weight loss
14
Q
Rheumatoid arthritis affects small joints of the hands sparing the…
A
DIPJ
15
Q
Deformities seen in rheumatoid arthritis
A
Radial deviation of wrist Ulnar deviation of fingers Swan neck deformity of fingers Boutonniere deformity of fingers Z shaped thumb Swollen MP and PIP joints Dorsal subluxation of MP joints Atrophy of small hand muscles (Valleys)
16
Q
Stages (histological) in development of rheumatoid arthritis
A
- Unknown antigen reaches synovial membrane
- T cell proliferation associated with increased B cells and angiogenesis
- Chronic inflammation and inflammatory cytokines
- Pannus formation
- Cartilage and bone destruction
17
Q
Predominant inflammatory cell in the synovial space (in rheumatoid arthritis)
A
Neutrophil
18
Q
Joint most commonly affected by gout
A
Great toe
19
Q
When gout affects the big toe it is called
A
Podagra
20
Q
Causes (conditions) of pseudogout
A
Idiopathic Primary hyperparathyroidism Diabetes mellitus Hypothyroidism Wilsons disease Hereditary Low Mg Low phosphate Haemochromatosis
21
Q
Crystals found in pseudogout
A
Calcium pyrophosphate
22
Q
Birefringence: Gout is… Pseudogout is…
A
Gout: Negatively birefringent crystals
Pseudogout: Positively birefringent crystals
23
Q
First line treatment for acute gout
A
Potent NSAID e.g. 500mg BD naproxen
24
Q
Prophylaxis of pseudogout
A
Low dose colchicine (BD)
25
Treatment of pseudogout
Acute attack:
1 or 2 joints: Joint aspiration and intra-articular glucocorticoid (triamcinolone) injection
More than 2 joints: NSAIDs (first line) or colchicine
Prophylaxis: Colchicine
26
Prevention of gout
Acute attack: Potent NSAIDS e.g. naproxen (first line) or colchicine
Long term: allopurinol
Conservative: Reduced ETOH, and purine intake e.g. sardines, liver
27
Pseudogout crystal shape
Rhomboid
28
Medication used for pseudogout prophylaxis
Colchicine
29
A Brodie abscess is...
A subacute osteomyelitis that has been contained to a localised area and walled off by fibrous and granulation tissue.This is termed as Brodie's abscess.
30
Most common causative organism in osteomyelitis
Staph. aureus
31
Oesophagus layers
Epithelium: stratified squamous epithelium except the bottom part
Submucosa
Muscularis propria
32
Epithelial cell type in (most) of the oesophagus
Stratified squamous
33
What is the Z-line (oesophagus)
Columnar epithelium in the stomach, stratified squamous in the oesophagus. The transition between the 2 types is visible as a zig-zag line known as the Z-line. It is at the bottom of the oesophagus
34
Definition of ulceration in the GI tract
Erosion of the surface going beyond the muscularis mucosae.
35
What is Barrett's Oesophagus
AKA columnar lined oesophagus
Transformation of epithelial cells in the oesophagus from from stratified squamous epithelium to columnar epithelium
The columnar epithelium can be gastric type or intestinal type. Gastric type does not contain goblet cells. Intestinal type does.
Lose the sharp Z-line dividing white stratified squamous epithelium and red columnar epithelium.
In America for Barrett’s to be diagnosed the columnar epithelium must be intestinal type. In the UK this distinction is not made.
Barrett’s increased risk of cancer.
36
Squamous cell carcinomas produce...
Keratin
37
Adenocarcinomas produce...
Mucus
38
How does H.pylori cause lymphoma
H. pylori induces production of MALT (Mucosal Associated Lymphoid Tissue) in the stomach. A location where MALT is not normally found. If the drive on the proliferation of this lymphoid tissue continues for too long it can cause lymphoma in the stomach.
39
H pylori causes adenoma of the stomach due to
Inflammation which leads to metaplasia, which becomes dysplasia, which becomes adenocarcinoma
40
Which type of H.pylori is associated with more chronic infection?
Why?
cag-A-positive H. pylori
It has a needle like appendage that injects toxin into intracellular junctions separating the cells. It allows the bacteria to attach and colonise more easily and potentiates damage to the epithelium. It causes more inflammation.
41
Helicobacter infection increases the risk of gastric cancer ...fold
8-fold
42
H. pylori is gram...
Negative
43
Causes of gastritis
```
H. pylori
Drugs e.g. NSAIDs
CMV
Strongyloides (parasite)
IBD: Crohn's disease
```
44
Gastric cancer incidence high in which regions?
High incidence in Japan, Chile, Italy, China, Portugal, Russia
45
Gastric cancer
| More common in men or women?
Men
| 1.8:1 ratio
46
Most gastric cancers are which type?
Adenocarcinomas
47
Describe the 2 types of gastric adenocarcinoma
Intestinal type: well differentiated. More closely linked wit intestinal metaplasia. Large glands containing goblet cells producing mucus.
Diffuse types: poorly differentiated, single cells (signet ring cells) containing mucus, not forming glands. Linitis plastica refers to the appearance of the stomach, resembling an old leather water bottle.
48
Types of gastric cancer
```
Adenocarcinoma (95%)
Squamous cell carcinoma
Lymphoma (MALToma)
Gastrointestinal stromal tumours (GIST): sarcoma. Mostly benign. Common enough that a significant number are malignant.
Neuroendocrine tumours
```
49
Gastric MALToma/ lymphoma usually originates from which cells?
B cells in the marginal zone of the MALT
50
Pathogens causing duodenal ulceration
```
H. pylori
CMV
Cryptosporidiosis
Giardia lamblia
Whipples disease: caused by tropheryma whippelii
```
51
Giardia common in which country
Russia
52
Antibodies found in coeliac disease
Endomysial antibodies
| transglutaminase antibodies
53
MALToma associated with coeliac disease originates from which cells?
T cells
| (enteropathy associated T cell lymphoma
54
Coeliac disease produces which histological changes?
Flattening/atrophy of duodenal villi
Hyperplasia of duodenal crypts
Increased lymphocytes
55
Hirschprungs disease
Congenital disorder.
Absences of ganglionic cells in myenteric plexus
Distal colon fails to dilate
Causes constipation, abdominal distension, vomiting, ‘overflow’ diarrhoea
Loss of function in RET proto-oncogene Cr10 and others...
56
...% of people with Hirschprung's are male
80%
57
Gene associated with Hirschprung's
RET proto-oncogene
58
Treatment of Hirschprung's disease
Resection of affected part of colon (Distal)
59
Volvulus
Complete twisting of a loop of bowel at mesenteric base, around vascular pedicle
Leads to intestinal obstruction/infarction
In infants occurs in small bowel
Occurs in sigmoid colon in adults (common in elderly)
60
...% of diverticulae occur in the left colon
90%
61
Pathogenesis of pseudomembranous colitis
Proliferation of C.diff bacteria e.g. due to antibiotic use
Production of A and B toxins by the c.diff bacteria
Inflammatory response and formation of pseudomembrane composed of inflammatory debris and white cells
62
Distinctive clinical features of C.diff colitis
```
Significant diarrhoea
Fever
Abdominal pain
Recent antibiotic exposure
Foul smelling stool (distinctive smell)
```
63
Treatment of C.diff colitis
Metronidazole or vancomycin
VANCOMYCIN MUST BE ORAL
64
Common sites for ischaemic bowel
```
Splenuc flexure (SMA transition to IMA)
Rectosigmoid (IMA transition to internal iliac)
```
65
Clinical features of IBD
```
Diarrhoea +/- blood
Fever
Abdominal pain
Acute abdomen
Anaemia
Weight loss
Extra-intestinal manifestations
```
66
Peak age of Crohn's onset
Peak onset on teens/twenties
67
Histological features of Crohn's disease
```
Whole of GI tract can be affected (mouth to anus) – commonly found in the terminal ileum and the large bowel
‘Skip lesions’
Transmural inflammation – entire thickness of wall inflammed
Non-caseating granulomas (collections of macrophages)
Sinus/fistula formation
Fat wrapping’
Thick ‘rubber-hose’ like wall
Narrow lumen
‘cobblestone mucosa’
Linear ulcers
Fissures
abscesses
```
68
Extra-intestinal manifestations of Crohn's disease
```
Arthritis
Uveitis
Stomatitis/cheilitis
Skin lesions
Pyoderma gangrenosum
Erythema multiforme
Erythema nodosum
```
69
Peak age of onset of ulcerative colitis
20-25 years
70
Key histological features of ulcerative colitis
Involves rectum and colon in contiguous fashion.
May see mild ‘backwash ileitis’ and appendiceal involvement but small bowel and proximal GI tract not affected.
Inflammation confined to mucosa
Bowel wall normal thickness
Shallow ulcers
71
Complications of ulcerative colitis
Severe haemorrhage
Toxic megacolon
Adenocarcinoma (20-30 x risk)
72
Extra-intestinal manifestations of ulcerative colitis
```
Arthritis
Myositis
Uveitis/iritis
Erythema nodosum, pyoderma gangrenosum
Primary Sclerosing Cholangitis (5.5% in pancolitis)
```
73
1st line drug for Crohn's maintenance treatment
Mesalazine (or other 5-ASA)
74
1st line drug for ulcerative colitis maintenance treatment
Mesalazine (or other 5-ASA)
75
Two types of lower GI adenomas
Tubular
Villous
(can be a mixture of the two)
76
Histological features of (GI) tubular adenomas
Irregular, pseudo stratified, high nuclear to cytoplasmic ratio because they are dysplastic
77
Hamartomatous are seen in...
Peutz Jeghers
| Juvenile polyposis
78
Juvenile polyps are...
Focal malformations of the mucosa and lamina propria
Usually seen in children under 5 years
Can cause bleeding
79
Features of Peutz Jeghers
```
Multiple polyps (hamartomatous)
Mucocutaneous pigmentation
Freckles around mouth
Increased risk of intussusception
Increased risk of malignancy: GI (including pancreas), gonad, breast
```
80
Gene affected in familial adenomatous polyposis (FAP)
Chromosome 5q21, APC tumour suppressor gene
81
Familial adenomatous polyposis (FAP) average:
Age of onset
Number of polyps
25
| 1000
82
Familial adenomatous polyposis (FAP):
Minimum number of polyps
Mode of inheritance
100
| Autosomal dominant
83
Gardner syndrome is...
A variant of FAP with extra intestinal features such as:
multiple osteomas of skull & mandible
epidermoid cysts
desmoid tumors
dental caries, unerrupted supernumery teeth
post-surgical mesenteric fibromatoses
84
Hereditary non-polyposis colorectal cancer features
Autosomal dominant mutation in DNA mismatch repair genes
Causes cancers in right colon (High frequency of carcinomas proximal to splenic flexure)
Causes few polyps
Fast progression to malignancy
Onset of colorectal cancer at an early age (under 50)
Poorly differentiated and mucinous carcinoma more frequent
Multiple synchronous cancers
Also associated with cancers of endometrium, ovary, small bowel, urinary system (including kidney)
85
Turcot syndrome is
Variant of Hereditary non-polyposis colorectal cancer (or FAP) also associated with brain cancers
86
Dukes staging of colon cancers
```
A = confined to wall of bowel
B = through wall of bowel (through muscularis propryia)
C = lymph node metastases
D = distant metastases
```
87
Causes of acute pancreatitis
```
Idiopathic
Gallstones
Ethanol
Trauma
Scorpion bite
Mumps/malignancy
Autoimmune
Steroids
Hypercalciamia/hyperlipidaemia/hyperparathyroidism
ERCP
Drugs (e.g. azathioprine, tetracycline, valproic acid, thiazide, co-trimoxazole)
```
```
Can be divided into 6 categories:
Obstruction of ducts
Metabolic/toxic
Poor blood supply (Shock and hypothermia)
Infection/inflammation
Autoimmine
Idiopathic
```
88
Effect of chronic pancreatitis on calcium
Causes hypocalcaemia
89
First pancreatic pro-enzyme activated in pancreatitis pathophysiology
Trypsinogen to trypsin
90
Pancreatic enzymes released from which cells
Acinar cells
91
How does gallstones cause pancreatitis
Stone lodged distal to merging of pancreatic and common bile ducts
Reflux of bile up pancreatic duct
Activation of trypsinogen to trypsin and then activation of ther pancreatic enzymes
92
How does alcohol (ethanol) cause pancreatitis
Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which can produce plugs which obstruct the smaller pancreatic ducts
93
Damage caused by release of lipases in pancreatitis
Fat necrosis: Fatty acids and glycerides bind with calcium and magnesium forming soaps seen as yellow/white foci.
94
Damage caused by release of elastases in pancreatitis
Damage to blood vessels and possible haemorrhagic pancreatitis
95
Damage caused by release of proteases in pancreatitis
Parenchymal destruction
96
Complications of acute pancreatitis
Pancreatic : pseudocyst, abscess
Gastrointestinal: UGI erosions, ileus, peritonitis
Systemic: shock, hypoglycaemia, hypocalcaemia
97
Pattern of injury in pancreatitis
Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with intrapancreatic, calcified stones with secondary dilatations
98
Complications of chronic pancreatitis
Malabsorption
Diabetes mellitus (it is the acini cells that are damaged not the islets of langerhans. Therefore a lot of pancreatitis is required to result in diabetes)
Pseudocyts
Carcinoma of the pancreas (?)
99
Pacreatic pseudocysts are lined by...
Fibrous tissue, granulation tissue, inflammatory cells
100
Most pancreatic carcinomas are...
Ductal
101
Types of cystic neoplasms
Serous
Mucinous
Intraductal Papillary Mucinous Neoplasm (IPMN)
102
Risk factors for pancreatic carcinoma
Smoking - doubles the risk (25% of cases)
BMI and dietary factors e.g. meat and fat
Chronic pancreatitis
Diabetes – doubles the risk (80% of cases)
Genetic e.g. Peutz-Jeghers syndrome (polyp with pigmentation around the buccal cavity and other areas)
Age (increases with age)
103
Components of the metabolic syndrome
```
Fasting hyperglycaemia
Hypertension
Central obesity
Dyslipidaemia
Microalbuminaemia
```
104
Clinical features of acute pancreatitis
Severe epigastric pain radiating to back relieved by sitting forward.
Vomiting
Raised amylase
Raised lipase
105
Pancreatic intraductal neoplasia can lead to...
| Mutation in which gene is commonly found in these lesions?
Ductal carcinoma
| K-ras (95% of cases)
106
Macroscopic appearance of ductal carcinoma (pancreas)
Gritty and grey
Invades adjacent structures
Tumours in the head present earlier and, therefore, tend to be smaller
107
Microscopic appearance of ductal carcinoma
Moderately differentiated
Glandular (adenocarcinoma)
Secretes mucin
Set in fibrous stroma
108
Most pancreatic ductal carcinomas are in the...
Head of the pancreas
| followed by, diffuse, then body, then tail
109
How and where does ductal pancreatic carcinoma spread
Direct: Bile ducts, duodenum
Lymphatic: Regional lymph nodes
Blood: Liver
Serosa: Peritoneum
110
2 main complications of ductal pancreatic cancer
Venous thrombosis: (they secrete mucin and once in the blood stream it activates the clotting cascade and forms thrombi in various parts of the body)
Chronic pancreatitis
111
Features of cystic pancreatic tumours
Usually multilocular
Contain serous or mucin secreting epithelium (cf. ovarian tumours)
Usually benign, mucinous tumours may be malignant
112
Appearance of neuroendocrine tumours (islet cell)
Circumscribed
Uniform cells
Cells arranged in nests/trabeculae with granular cytoplas,
113
Clinical features of ductal carcinoma of the pancreas
```
Older
Male
Weight loss (cachexia and anorexia)
Upper abdominal and back pain (chronic, persistent and severe)
Painless jaundice
Pruritus
Steatorrhoea
DM
Recurrent thrombophlebitis
Ascites
Abdominal mass
Virchow's node
Courvoursiers sign
```
Bloods: low Hb, raised Bili, raised Ca, positive CA19.9
114
What is courvoiser's sign
Courvoisier's law (or Courvoisier syndrome, or Courvoisier's sign or Courvoisier-Terrier's sign) states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.
Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen. This sign implicates possible malignancy of the gall bladder or pancreas and the swelling is unlikely due to gallstones
115
Pancreatic cancer tumour marker
CA19.9
116
Chemotherapy pancreatic cancer
5-FU
| Palliative
117
Pancreatic neuroendocrine are usually secretory or non-secretory?
Non-secretory
118
Types of secretory pancreatic endocrine tumour
Insulinoma
Gastrinoma: Zollinger-Ellison syndrome
VIPoma: secrete vasoactive intestinal peptide and cause diarrhoea (chronic watery with expected effects) RARE
Glucagonoma: causes necrolytic migrating erythema
119
Tumours in MEN 2A
Parathyroid
Thyroid
Phaeochromacytoma
120
Tumours in MEN 2B
Medullary thyroid
Phaeochromacytoma
Neuroma
(also marfanoid phenotype)
121
Commonest type of pancreatic endocrine secretory tumour
| Prognosis?
Insulinoma
| Not likely to metastasise
122
What are Rokitansky-Aschoff sinuses?
Pseudodiverticulae in the gallbladder wall.
| Not abnormal but associated with cholecystitis
123
Types pancreatic malformations
Ectopic pancreas: more common in stomach and small intestine
Pancreas divisum: failure of fusion of dorsal and ventral buds leading to increased risk of pancreatitis
Annular pancreas: second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. It can present with duodenal obstruction at approximately 1 year. However many cases will be asymptomatic.
124
Causes of increased epithelial lymphocytes in gut
```
Coeliac disease
Cows milk protein sensitivity
Drugs (NSAIDs)
IgA deficiency
Tropical sprue
Post infective malabsorption
Dermatitis herpetiformis
(lymphoma)
```
125
Causes of villous atrophy
```
Coeliac disease
Giardiasis (very rarely)
Tropical sprue
Crohn’s disease
Radiation/chemotherapy
Bacterial overgrowth
Nutritional deficiencies (b12 and folate, secondary to ability to synthesis new DNA)
Graft versus host disease
Microvillous inclusion disease (in children)
Common variable immunodeficiency
```
126
Complications of coeliac disease
```
Malabsorption
Osteomalacia and osteoporosis
Neurological disease
Epilepsy
Cerebral calcification
Lymphoma
Hyposplenism
```
127
Autoimmune and other conditions associated with coeliacs disease
Dermatitis herpetiformis (prevalence = 100%)
Type 1 diabetes mellitus (prevalence = 7%)
Autoimmune thyroid disease
Down’s syndrome
128
Neurosurgery:
| What is a Stereotactic biopsy?
I biopsy of an inoperable tumour.
Stereotactic neurosurgery involves mapping the brain in a three dimensional coordinate system. With the help of MRI and CT scans and 3D computer workstations, neurosurgeons are able to accurately target any area of the brain in stereotactic space (3D coordinate system). Stereotactic brain biopsy is a minimally invasive procedure that uses this technology to obtain samples of brain tissue for diagnostic purposes.
129
Neurosurgery:
| What is an open biopsy?
A biopsy of an inoperable but approachable tumour.
130
How to name a CNS tumour
Names derive from putative cell of origin
Differentiation
Descriptive
131
Grading of CNS tumours is based on...
Outcome: survival time
132
Grades of CNS tumour (and brief description of each)
Long-term survival / cured – Grade I
Cause death in more than 5 yrs – Grade II
Cause death within 5 yrs – Grade III
Cause death within 6 mo-1yr – Grade IV
133
WHO grading system for CNS tumours is only reliable for...
Diffuse astrocytomas and meningiomas
134
Most common type of primary CNS tumour in adults
Gliomas
135
Types of gliomas
Diffuse infiltration
Fibrillary, gemistocytic astrocytoma (all grades)
Oligodendroglioma (all grades)
Mixed oligo-astrocytoma
```
Compressive margins
Pilocytic astrocytoma
Pleomorphic xantoastrocytoma
Subependymal astrocytoma
-------------------------------------
Ganglioglioma
Ependymoma
```
136
Infiltrative gliomas: possible grades
2-4
137
Most aggressive form of glioma
Glioblastoma (GBM)
138
Types of glial cells
```
Glial cells are non neuronal cells. They include:
Oligodendrocytes
astrocytes
ependymal cells
Microglia,
```
In the peripheral nervous system glial cells include: Schwann cells and satellite cells.
139
80% of gliomas are which specific type?
Diffuse astrocytomas
140
Mutation of... is present in 80% of cases of diffuse astrocytomas
IDH1
141
Features of diffuse astrocytomas
Infiltrative
Most commonly in cerebral hemispheres but can be found elsewhere e.g. cewrebellum (10%) and brainstem (more common in children/young adults)
WHO grade 2, progressing in 5-7 years to grade 4 GBM
Most common in ages 30-40
Low vascularity but endothelial and capillary proliferation
No necrosis at core
IDH1 mutation in 80%
142
About ...% of glioblastomas develop from a lower grade astrocytoma
10%
143
Features of an oligodendroglioma
5% of all primary brain tumours
Almost exclusively in cerebral hemispheres – frontal lobe in 50-60% of cases
WHO grade II – Anaplastic WHO grade III – difficult grading
Presents with long history of neurological signs – seizure is more frequent
Extends to grey matter
Chemosensitive
Better prognosis than astrocytomas – resection is important
80% mutation of IDH1; 75% codeletion 1p19q; usually normal p53
144
Features of pilocytic astrocytoma
WHO grade I
Usually 1st and 2nd decade - 20% of CNS tumours below 14 years and 15% between 14-18 years
Often cerebellar, optic-hypothalamic, brain stem
Often cystic. Always contrast enhancement
They can disseminate in the subarachnoid space (es: follow nerve roots)
Compressive margins (never diffuse infiltration)
Always show marked nuclear atypia and vascular/endothelial proliferation
Very often Rosenthal fibres (eosinophilic/pink staining) and granular bodies
Hallmark: Piloid “hairy” cell
145
WHO definition of a medulloblastoma
A malignant, invasive embryonal tumour of the cerebellum with preferential manifestation in children, predominantly neuronal differentiation, and an inherent tendency to metastasize via CSF pathway
146
Features of a medulloblastoma
Rare (0.5 per 100,000 year, in children)
75% arise in the vermis in children and hemispheric in adults
Present with cerebellar signs, cranial hypertension
WHO grade IV
147
Medulloblastomas present with...
Cerebellar signs, cranial hypertension
148
Features of meningiomas
```
24-30% primary intracranial tumours
Incidental in up to 10% of post-mortem
Usually adults – rare in patients younger than 40 (more aggressive)
Focal symptoms (seizure, compression)
Any site of craniospinal axis
```
149
Grading of meningiomas based on histology (and projected outcome)
```
Grade I – benign
Grade II (atypical) – 20% of meningiomas; 40% recurrence
Grade III (anaplastic) – 1% of meningiomas; often lethal in 1 year
```
150
What is the virchow robin space?
| Why is important in CNS tumours?
It is the immunological space between an artery and vein and the pia mater. It can be expanded by leucocytes.
Psueudoinvasion of meningiomas can occur along the space.
151
Commonest type of CNS tumour
Metastases/secondary
152
Tumours that most commonly metastasise to the CNS
Lung ca, melanoma, breast ca, renal ca and colon ca.
153
ICP is measured in mmHg and at rest, is normally...
| mmHg for a supine adult
7–15
154
CSF is produced by...
Choroid plexus: 70-80%
Ependyma and subarachnoid vessels
Parenchymal capillaries
155
Normal CSF volume is...
90-150ml
156
Types of hydrocephalus
Non-obstructive/communicating: reduced reabsorption
| Obstructive/non-communicating: Actual obstruction to flow of CSF
157
70-80% of strokes are which type?
Ischaemic
158
Embolic occlusion leading to stroke usually occurs in which vessels
Middle cerebral artery branches
159
Non-traumatic intraparenchymal haemorrhage most commonly occurs in...
Most common in basal ganglia
160
Risk factors for non-traumatic intraparenchymal haemorrhage
HTN (over 50% of bleeds)
Atherosclerosis
clotting disorders, neoplasms, amyloid, vasculitis, vascular malformations
161
Signs/symptoms of intraparenchymal haemorrhage
Raised intracranial pressure; severe headache, vomiting, rapid loss of consciousness; focal neurology
162
Cerebral AVMs present with... they become symtomatic between ages of...
Haemorrhage, seizures, headache, focal neurological deficits
20-50
(the risk if bleeding is around 1% annually but rises if bleed occurs. The risk of re-bleed is around 6% annually)
163
What is a cavernous angioma?
Well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces
(so basically a cavernous space filled with vessels)
164
Features of a cavernous angioma
Presents after 50
Has a few feeding vessels
Bleeds at low pressure
Present with headache, seizures, focal deficits, haemorrhage (similar to an AVM)
Angiography is usually NEGATIVE unlike AVM
Treatment is surgical
165
Types of brain herniation
Transtentorial (uncal gyral, mesial temporal) – medial temporal lobe compressed against the free margin of the tentorium cerebelli
Subfalcine (cingulate gyrus) – cingulate gyrus displaced under the falx cerebri
Tonsillar – cerebellar tonsils through the foramen magnum, this causes brain stem compression
166
Cause of most sub-arachnoid haemorrhages
Berry aneurism.
(In most of the 1% of people who have them they cause no problems.
Berry aneurisms tend to occur in the circle of willis at the junctions of the large vessels: most of them occur (80%) at the internal carotid artery bifurcation. The other 20% occur in the posterior circulation (vertibrobasilar circulation))
167
Common locations of berry aneurisms
Berry aneurisms tend to occur in the circle of willis at the junctions of the large vessels: most of them occur (80%) at the internal carotid artery bifurcation. The other 20% occur in the posterior circulation (vertibrobasilar circulation)
168
...% of people with berry aneurisms have multiple ones.
30%
169
Risk factors for berry aneurisms
Autosomal dominant polycystic kidney disease
```
(ADPKD)Ehlers-Danlos syndrome (type IV)
Marfan syndrome (controversial 3)
coarctation of aorta
bicuspid aortic valve
neurofibromatosis type 1 (NF1)
hereditary haemorrhagic telangiectasia
alpha 1 antitrypsin deficiency
cerebral arteriovenous malformation: a flow related aneurysm
fibromuscular dysplasia
```
170
% of people who die within days of a berry aneurism bleed
50% die within a few days, “Warning Bleed”
| Prognisis worse if rupture after a warning bleed
171
Components of GCS (just the responses tested)
```
eye response (max 4)
verbal response (max 5)
motor response (max 6)
```
172
Subdural bleeds are due to bleeding from which type of vessel?
Veins.
173
Most extradural bleeds originate from which vessels
Meningeal arteries,
174
Unique feature of prion diseases
Proteinaceous infection only. No DNA or RNA involved.
175
List prion diseases found in humans
Creutzfeldt-Jakob disease
Gerstmann-Straüssler-Sheinker syndrome
Kuru
Fatal familial insomnia
176
Features of new varian CJD
Sporadic neuropsychiatric disorder
| Patients
177
What is Gerstmann-Straüssler-Sheinker syndrome?
A familial version of CJD
178
Neuropathology of Alzheimer's disease
```
Extracellular plaques (protein deposition)
Neurofibrillary tangles (within neurons)
Cerebral amyloid angiopathy (CAA)
Neuronal loss (cerebral atrophy)
```
179
Key proteins in Alzheimer's disease
A-beta peptide.
| Tau
180
A-Beta peptide is part of which protein
Amyloid precursor protein
Notes: Role of APP unclear but is is physiological. The processing of the precursor protein can be amyloidogenic, in which case inact ABeta protein is released and can begin forming plaques.
181
Which form of tau is pathological
Hyperphosphororylated tau is the pathological form.
182
How is amyloid plaque formed in Alzheimer's disease
Amyloid precursor protein is processed. The processing of the precursor protein can be amyloidogenic, in which case inact ABeta protein is released. If a cell produces too much A beta it releases it, the A beta can then begin forming plaques.
183
Alzheimer's disease usually starts in which lobe?
Temporal (amnesia)
```
Then progresses to parietal (difficulty dressing)
Then frontal (personality changes)
The occipital (difficulty recognising people)
```
184
What is Braack staging used for?
Staging of alzheimer's disease according to progression of tau pathology.
Stages 1 to 6. Disease starts in anterior hippocampus, spreads to posterior hippocampus, then temporal cortex, then occipital cortex.
Staging of Parkinson's using alpha synuclein. Stages 1-6.
185
Key protein in Parkinson's disease
α-synuclein
Lewy bodies are immunopositive for this
186
Causes of parkinsonism
```
Idiopathic Parkinson’s disease
Drug-induced Parkinsonism
Multiple system atrophy
Progressive supranuclear palsy
Corticobasal degeneration
Vascular pseudoparkinsonism
Alzheimer’s changes
Fronto-temporal neurodegenerative disorders
20 other disorders
```
187
Features of Pick's disease
Fronto-temporal atrophy (problems with decision making)
Marked gliosis and neuronal loss
Balloon neurons
Tau positive Pick bodies
188
Neurodegenerative diseases where Tau is a major protein
Alzheimer's
Pick's disease
Progressive supranuclear palsy
Corticobasal degeneration
189
Neurodegenerative diseases where alpha synuclein is a major protein
Parkinson' disease
| Multiple system atrophy (affects glial cells)
190
The anterior pituitary secretes
```
Prolactin
ACTH
TSH
GH
FSH
LH
```
191
Pituitary adenomas are microadenomas if less than...
1cm
192
Peak age of pituitary adenoma incidence
40-60 years
193
Clinical features of growth hormone adenomas
Prepubertal children - gigantism
Adults - acromegaly
Diabetes mellitus, muscle weakness, hypertension, congestive cardiac failure
Bitemporal hemianopia
194
What is Sheehan’s syndrome
Hypopituitarism caused by ischaemic necrosis following PPH (pituitary enlarges during pregnancy).
195
Most cases of hypopituitarism caused by...
Nonsecretory pituitary adenomas – compress the other cells that do produce hormones
196
Clinical manifestations of anterior pituitary hypofunction
Children - growth failure (pituitary dwarfism)
Gonadotrophin deficiency - amenorrhea and infertility in women. Decreased libido and impotence in men
TSH and ACTH deficiency - hypothyroidism and hypoadrenalism
Prolactin deficiency - failure of post-partum lactation
197
The posterior pituitary releases...
antidiuretic hormone (ADH) and oxytocin
198
Role of calcitonin
promotes absorption of calcium by the skeletal system
199
Calcitonin is synthesised by...
Thyroid contains a population of parafollicular or ‘C’ cells that synthesize calcitonin
200
Non-thyroid disease associated causes of thyrotoxicosis
```
Struma ovarii (ovarian teratoma with ectopic thyroid)
Factitious thyrotoxicosis (exogenous thyroid intake)
```
201
Most common cause of endogenous hyperthyroidism is...
Graves disease
202
Grave's disease triad
Thyrotoxicosis
Infiltrative ophthalmopathy with exophthalmos in up to 40%
Infiltrative dermopathy (pretibibial myxoedema) in a minority of cases
203
Most cases of thyroid carcinoma are...
Anaplastic
Follicular
Medullary or
Papillary
Papillary (75-85%)
Follicular (10-20%)
Medullary (5%)
Anaplastic (
204
Ionising radiation increases the risk of.... thyroid carcinomas
papillary
205
Histological features of papillary carcinoma
May have papillary architecture (but not all)
BUT diagnosis is based on nuclear features
Optically clear nuclei
Intranuclear inclusions
May be psammoma bodies (calcification)
206
Clinical features of papillary thyroid carcinomas
```
Nonfunctional
Present as painless mass in neck
May present with metastasis in cervical lymph node
May present with swollen lymph nodes
10 year survival up to 90%
```
207
```
Peak age of thyroid carcinoma incidence:
Papillary
Follicular
Anaplastic
Medullary
```
Any age
Middle age
Elderly patients
50-60
208
Histological features of follicular thyroid carcinoma
Follicular morphology
May be well demarcated with minimal invasion or clearly infiltrative
(spreads early)
209
Follicular thyroid carcinoma usually metastasises via bloodstream to..
Bone, liver, lungs
210
Histological features of medullary thyroid carcinoma
Neuroendocrine neoplasm derived from parafollicular C cells
| Calcitonin produced is broken down and deposited as amyloid. Congo red dye can be used to show amyloid
211
Medullary thyroid cancer is associated with MEN....
2
212
Which type of thyroid carcinoma usually causes death within a year?
Anaplastic
213
Parathyroid hyperplasia is associated with MEN...
1
214
Normal parathyroid gland is ...% fat
50
215
Clinical manifestations of hypoparathyroidism
Neuromuscular irritability - tingling, muscle spasms, tetany
Cardiac arrhythmias
Fits
Cataracts
216
Adrenal cortex contains.... cells
| Adrenal medulla contains... cells
Cortex – epithelial cells
| Medulla – neural cells
217
Zones of adrenal gland from outside to in
Zona glomerulosa
Zona fasciculata
Zona reticularis
Medulla
218
The adrenal medulla secretes
Adrenaline and noradrenaline
219
Zona glomerulosa (of adrenal gland) secretes
Aldosterone
220
Zona fasciculata (of adrenal gland) secretes
Glucocorticoids
221
Zona reticularis (of adrenal gland) secretes
Androgens and glucocorticoids
222
Most cases of Cushing's syndrome caused by
Most cases caused by administration of exogenous glucocorticoids
223
Effect of iatrogenic (administration of exogenous glucocorticoids) Cushing's syndrome on adrenals. Contrast with Cushing's disease
PCS – adrenals become hyper plastic (also with paraneoplastic cushings)
ICS – adrenal atropy
224
Most cases of primary hyperaldosteronism due to...
Bilateral adrenal hyperplasia
225
What is Waterhouse-Friderichson syndrome?
Adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection: Typically the pathogen is the meningococcus Neisseria meningitidis
226
3 Causes of acute adrenal insufficiency
Sudden withdrawal of corticosteroid therapy
Haemorrhage (neonates)
Sepsis with DIC (Waterhouse-Friderichson syndrome)
227
Features of adrenocortical carcinomas
Carcinomas
Rare
Usually large
More commonly associated with virilizing syndrome than adenoma
228
Phaeochromocytoma rule of 10s
10% arise in association with a familial syndrome inc. MEN 2A and 2B, von Hippel-Lindau disease and Sturge-Weber syndrome
10% are bilateral
10% are malignant
In addition 10% of catecholamine-secreting tumours arise outside the adrenal (paragangliomas)
229
What is Von Hippel-Lindau (VHL) disease?
Von Hippel-Lindau (VHL) disease is an inherited disorder causing multiple tumours, both benign and malignant, in the central nervous system (CNS) and viscera. The most common tumours are retinal and CNS haemangioblastomas, renal cell carcinoma (RCC), renal cysts and phaeochromocytoma.
230
Tumours associated with the MEN sydromes are more or less aggressive than sporadic tumours?
More aggressive
231
Dose of ACTH in short synacthen test
Describe test
250mcg
Measure cortisol + ACTH at start of test
Administer 250 micrograms synthetic ACTH by IM injection.
Check cortisol at 30 and 60 minutes.
232
Genes associated with polycystic kidney disease
PKD1
| PKD2
233
Renal failure due to PKD develops at what age?
Renal failure develops from 40-70 years
234
How is acute renal failure classified (what are the categories, and examples)?
Pre-renal
Failure of perfusion
Renal
Acute tubular injury
Acute glomerulonephritis
Thrombotic microangiopathy
Post-renal
Obstruction to urine flow
235
Why does acute renal tubular injury cause failure of glomerular filtration?
Blockage of tubules by casts
Leakage of fluid from tubules to interstitium reducing flow
Secondary haemodynamic changes
236
Glomerulonephritis sufficiently severe to cause renal failure is almost always associated with...
Glomerular crescents
237
Glomerulonephritis presents with...
Presents with oliguria with urine casts containing red and white blood cells
238
Acute glomerulonephritis
Acute inflammation of glomeruli leading to reduction in glomerular filtration
239
Crescentic glomerulonephritis is....
Rapidly progressing glomerulonephritis. It is characterised by a progressive rapidly deteriorating in kidney function
240
Causes of crescentic glomerulonephritis
Immune complex: SLE, IgA nephropathy, post-infectious GN
Anti-GBM disease
Pauci-immune – associated with anti-neutrophil cytoplasm antibodies (ANCA)
241
What is pauci-immune glomerulonephritis
A type of crescentic glomerulonephritis associated with ANCAs in which only scanty deposits of immunoglobulin and complement are present in glomeruli.
The ANCA anatibodies cause neutrophil activation which leads to glomerular necrosis. The condition also involves vasculitis in other organs e.g. lungs (haemorrhage).
It is associated with causes of vascular inflammation including Wegener granulomatosis and microscopic polyangitis
242
Brief pathogenesis of renal thrombotic microangiopathy
Red blood cells may become damaged by fibrin leading to haemolysis – microangiopathic haemolytic anaemia
Diarrhoea associated
Caused by bacterial gut infection – usually E. coli
Releases toxin that targets the renal endothelium
Non-diarrhoea associated
Often associated with abnormalities of proteins that control activation of the complement pathway on endothelium
May be familial
243
Nephrotic syndrome involves proteinuria above...
3.5g/24h
244
Features of nephrotic syndrome
Breakdown of selectivity of the glomerular filtration barrier leading to massive protein leak
Key features:
Proteinuria > 3.5g/day
Hypoalbuminaemia
Oedema
Also Hyperlipidaemia
245
Systemic causes of nephrotic syndrome
Diabetes mellitus
Amyloidosis
SLE
246
Local (primary glomerular disease) causes of nephrotic syndrome
Minimal change disease
Focal and segmental glomerulosclerosis
Membranous glomerulonephritis
247
How to test for amyloid deposits (histology)
Stains with Congo red stain and looks green under polarised light (apple green birefringence)
248
Commonest amyloid proteins in kidney
AL (amyloid light chains) derived from Ig light chains
| SAA: serum amyloid associated protein. Acute phase protein raised in certain chronic inflammatory conditions e.g. RA
249
80% of patients with AL (amyloid light chains) will have...
Multiple myeloma
250
Nephrotic syndrome: Histological changes of minimal change disease:
Electron microscopy
Light microscopy
immunofluorescence
Glomeruli look normal apart from loss of podocyte foot processes on electron microscopy
No changes on light microscopy
No immune deposits visible
251
Commonest cause of nephrotic syndrome in children is....
Minimal change disease
252
Which PRIMARY cause of nephrotic syndrome responds best to steroids...
Minimal change disease
253
Which PRIMARY cause of nephrotic syndrome responds least to steroids...
Membranous glomerular disease
254
Nephrotic syndrome: Histological changes of membranous glomerular disease
Electron microscopy
Light microscopy
Immunofluorescence
Light microscopy: Diffuse glomerular basement membrane thickening
Electron microscopy: Loss of podocyte foot processes and subepithelial deposits (spikey)
Immunofluorescence: Ig and complement in granular deposits along entire glomerular basement membrane
255
Nephrotic syndrome: Histological changes of focal segmental glomerularsclerosis
Electron microscopy
Light microscopy
Immunofluorescence
Electron microscopy: Loss of podocyte foot processes
Light microscopy: Focal and segmental glomerular consolidation and scarring. Hyalinosis.
Immunofluorescence: Ig and complement in scarred areas
256
Primary causes of membranous glomerulonephritis
Many associated with antibodies to phospholipase A2 receptor
257
Secondary causes of membranous glomerulonephritis
SLE
Infection
Drugs
Malignancy
258
Manifestations of thin basement membranes
Hereditary defect in type IV collagen
In most cases microscopic haematuria is the only consequence
259
Commonest form of glomerulonephritis worldwide is...
IgA nephropathy
260
Normal GFR is above...
90
261
```
Stages of chronic kidney disease. GFR in:
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
```
```
Stage 1: >90 (normal)
Stage 2: 60-89 (mild)
Stage 3: 30-59 (moderate)
Stage 4: 15-29 (severe)
Stage 5:
```
262
Top 5 causes of chronic renal failure
Diabetes (19.5%)
Glomerulonephritis (15.3%)
Hypertension & Vascular disease (15%)
Reflux nephropathy (chronic pyelonephritis) (9.5%)
Polycystic kidney disease (9.4%)
263
List 4 malignant bone tumours
Osteosarcoma
Chondrosarcoma
Ewing's sarcoma
Giant cell (borderline malignancy)
264
```
Features of osteosarcoma:
Age peak
Bone(s) commonly affected
Histology features
X ray appearance
```
Adolescence
Knee (60%)
Malignant, mesenchymal cells, ALP positive
Elevated periosteum (Codman's triangle), Sunburst appearance
265
```
Features of chondrosarcoma
Age peak
Bone(s) commonly affected
Histology features
X ray appearance
```
>40 years
Axial skeleton
Femur/ tibia/ pelvis
Malignant chondrocytes
Lytic lesion with fluffy calcification, axial skeleton
266
```
Features of Ewing's sarcoma
Age peak
Bone(s) commonly affected
Histology features
X ray appearance
```
267
Genetic mutation found in most cases of Ewing's sarcoma
Translocation 11:22 (which fuses the EWS gene of chromosome 22 to the FLI1 gene of chromosome 11)
268
Presentation of Ewing's sarcoma
Localized pain, swelling, and sporadic bone pain with variable intensity
Signs and symptoms of systemic inflammatory illness such as fever, anaemia and leucocytosis.
269
Presentation of osteosarcoma
Pain that may be worse at night
Pain in femur or immediately below the knee
Pathological fractures
270
Signs/symptoms of chondrosarcoma
Back or thigh pain
Sciatica
Bladder Symptoms
Unilateral oedema
271
Malignant bone tumours more common in middle age/older people
Chondrosarcoma
272
```
Features of Giant cell tumour of bone
Age peak
Bone(s) commonly affected
Histology features
X ray appearance
```
20-40 years (F>M)
Knee epiphysis
Osteoclast tyoe multinucleate giant cells on background of spindle/ovoid cells. Usually NOT malignant.
Lytic/lucent lesions right upto articular surface
273
What is osteosarcoma?
An osteosarcoma is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) and that exhibits osteoblastic differentiation and produces malignant osteoid
274
What is chondrosarcoma?
Chondrosarcoma is a cancer composed of cells derived from transformed cells that produce cartilage. Resistant to chemotherapy and radiotherapy.
275
What is Ewing's sarcoma?
A malignant small, round, blue cell tumor. It is a rare disease in which cancer cells are found in the bone or in soft tissue. The most common areas in which it occurs are the pelvis, the femur, the humerus, the ribs and clavicle (collar bone)
276
```
Features of osteoid osteoma (adolescent)
Bone affected
Special features
Histology
X ray
```
Tibia/femur
Small benign bone forming lesion, night pain releived by aspirin.
Normal bone
Radiolucent nidus with sclerotic rim
277
```
Features of osteoma (middle age)
Bone affected
Special features
Histology
X ray
```
Head and neck
```
Bony outgrowths attached to normal bone
Gardners syndrome (a subtype of FAP): multiple osteomas, GI polyps, and epidermoid cysts
```
Normal bone
Radiolucent nidus with sclerotic rim
278
```
Features of osteochondroma
Age affected
Bone affected
Special features
Histology
X ray
```
Adolescent (develop during skeletal growth and cease when the growth plates fuse at puberty)
Long bones
Cartilage capped bony outgrowth
Hereditary multiple exostoses: multiple exostoses (bony spurs), short stature, and bone deformities.
Cartilage capped bony outgrowth
Well defined bony protuberance from bone.
279
What is diaphyseal aclasis?
Hereditary multiple exostoses (HME or MHE), also known as diaphyseal aclasis, is a rare medical condition in which multiple bony spurs or lumps (also known as exostoses, or osteochondromas) develop on the bones of a child. HME is synonymous with multiple hereditary exostoses and multiple osteochondromatosis
280
```
Features of enchondroma
Age affected
Bone affected
Special features
Histology
X ray
```
Middle age
Hands
Benign tumours of cartilage.
Ollier's syndrome: multiple enchondromas
Maffuci's syndrome: multiple enchondromas and haemangiomas
Normal cartilage
Lytic lesion, cottom wool calcification, expansile, O ring sign.
281
What is Ollier's syndrome?
Multiple enchondromas
282
What is Maffuci's syndrome?
Multiple enchondromas and haemangiomas
283
```
Features of fibrous dysplasia
Age affected
Bone affected
Special features
Histology
X ray
```
Middle age (F>M)
Femur
A bit of bone is replaced by fibrous tissue.
Albright syndrome: polyostotic dysplasia, cafe au lait spots, precocious puberty.
Chines letters (misshapen bone trabeculae)
Soap bubble osteolysis
Shepherd's crook deformity
284
Features of sarcoidosis (by organ system)
Skin: Lupus pernio, erythema nodosum
CNS: Meningitis, cranial nerve lesions
Eyes: Uveitis, keratoconjunctivitis
Parotids: Bilateral enlargement
Lungs: BHL (bilateral hilar lymphadenopathy), fibrosis, lymphocytosis (CD4+ in BAL)
Liver: Hepatitis, cholestasis & cirrhosis
285
3 key lab features of sarcoidosis
Hypergammaglobulinaemia
Raised ACE
Hypercalcaemia (due to Vit D hydroxylation by activated macrophages)
286
Clinical features of Kawasaki's disease
```
Fever
Erythema of palms & soles, desquamation
Conjunctivitis
Lymphadenopathy
Coronary arteries may be affected (MI)
otherwise disease is self limiting
```
287
Features of polyarteritis nodosa
```
Necrotising arteritis
Polymorphs, lymphocytes, eosinophils
Arteritis is focal and sharply demarcated
Heals by fibrosis
More often renal and mesenteric arteries
```
Nodular appearance on angiography (small aneurysms
288
Polyarteritis nodosa usually happens in which arteries?
renal and mesenteric arteries
289
Cause of histological ‘Onion skin’appearance in scleroderma skin histology
Intimal thickening of small arteries
290
What is dyskaryosis
Abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin. May be followed by the development of a malignant neoplasm.
291
Cell type in the ectocervix
The ectocervix is covered with nonkeratinized stratified squamous epithelium
292
Precancerous changes in the ectocervix squamous cells is known as
Cervical intraepithelial neoplasia, CIN
293
Grades of cervical intraepithelial neoplasia
| Importance
CIN1
CIN2
CIN3
The risk of developing cancer is related to the grade of CIN. Most cases of CIN1 will go back to normal without any treatment.
CIN2 and CIN3 may develop into cancer in some cases, if left untreated
294
Cervical Glandular Intraepithelial Neoplasia is
Pre-cancerous change involving the inner glandular cells of the cervix.
295
Women of what ages are invited for cervical screening
25-65
296
Cervical screening is repeated every ... years
3-5
297
NHS cervical screening programme triage system
Low grade and borderline abnormalities have a HR-HPV test.
If HR-HPV positive – refer to colposcopy
If HR-HPV negative – routine recall
High grade abnormalities refer to colposcopy – no HR-HPV test
298
90% of genital warts caused by which HPV subtypes?
6 and 11
299
HPV subtype that cause most cervical cancers
16 and 18
| Approx 70% of cervical cancers
300
Effect of smoking on HPV
Smoking can make clearing HPV from the body less effective and can make clearance of minor smear abnormalities slower and less efficient
301
General uses of fine needle aspirations (cytology)
```
Immediate on site evaluation
Primary diagnosis
Rules out other diagnoses
Staging
Post adjuvant therapy staging
Differentiate a new primary from recurrence
```
302
Advantages of cytology fine needle aspiration
```
Accurate
Quick
Acceptable to patient
Rapid turnaround time
Organised into fast access clinics run by cytopathologists for aspiration of palpable swellings
```
Cheap
Triage material for ancillary tests
On-site diagnosis allows immediate patient management
