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My Year 5 Pathology > Histopathology > Flashcards

Histopathology Flashcards

1
Q

Give 4 important components of Cirrhosis

A
  1. whole liver involved
  2. fibrosis
  3. nodules of regenerating hepatocytes
  4. distortion of vascular architecture: intra/extra hepatic shunting of blood
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2
Q

what are the 6 types of liver cell?

A
  1. hepatocyte
  2. blood vessels
  3. kuppfer cells
  4. stellate cells
  5. bile ducts
  6. endothelial cells
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3
Q

what are the 3 main complications of liver cirrhosis

A
  1. portal hypertension
  2. hepatic encephalopathy
  3. liver cell cancer
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4
Q

What is the histopathology of actute hepatitis?

A

Spotty necrosis

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5
Q

Which types of viral hepatiti can cause chronic hepatitis?

A

B, C, D (the chronic viruses)

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6
Q

What are the 3 causes of chronic hepatitis

A

viral, drugs, autoimmune

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7
Q

What is a classic example of a drug which can cause chronic hepatitis?

A

Isoniazid

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8
Q

In chronic hepatitis, what is the difference between grade and stage?

A

GRADE = how much inflammation is there

STAGE = how much fibrosis

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9
Q

What is the more recent and accurate name for piecemeal necrosis?

A

interface hepatitis

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10
Q

What is interface hepatitis?

A

(aka piecemeal necrosis) is a process of inflammation and erosion of the hepatic parenchyma at its junction with portal tracts or fibrous septa

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11
Q

What are the hallmarks of alcoholic hepatitis?

A

Hepathcyte ballooning and necrosis due to accumulation of fat, water and proteins

Mallory-Denk bodies

Large fibrotic liver

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12
Q

What is the proper name for accumulation of fat droplets in hepatocytes?

A

Steatosis

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13
Q

What are the 2 types of non-alcoholic fatty liver disease?

A
  1. simple steatosis: fatty infiltration and is fairly benign
  2. NASH: non-alcoholic steatohepatitis: steatosis and inflammation - can progress to cirrhosis
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14
Q

What is the most common cause of chronic liver disease in the west?

A

NAFLD

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15
Q

What is the diagnostic feature of primary biliary cholangitis?

A

anti-mitochondrial antibodies

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16
Q

What autoimmune condition is primary sclerosing cholangitis associated with?

A

ulcerative colitis

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17
Q

what does PSC increase the risk of?

A

cholangiocarcinoma

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18
Q

what is the gold standard for diagnosis of PSC?

A

ERCP - endoscopic retrograde cholangiopancreatography - shows beading of bile ducts (multifocl strictures)

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19
Q

what condition are Kayser-Fleischer rings associated with?

A

Wilson’s disease (COPPER ACCUMULATION)

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20
Q

What genetic condition associated with liver damage, diabetes and skin pigmentation?

A

Haemochromatosis - accumulation of iron due to genetic mutation causing increased gut absorption of iron resulting in build up over the years/ aka bronzed diabetes

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21
Q

What is haemosiderosis

A

Accumulation of iron in macrophages due to blood transfusions - not damaging to liver

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22
Q

A rhodanine stain of a liver sample comes up positive - what condition does this suggest?

A

Wilson’s disease

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23
Q

what is the toxic byprouct of paraceamol

A

Napqui

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24
Q

give 2 specific and 2 general causes of hepatic granulomas?

A

specific to the liver: PBC and drugs

general: TB and sarcoid

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25
Q

Is alcoholic cirrhosis macro or micronodular

A

Micronodular

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26
Q

is viral liver hepatitis micro or macronodular

A

macronodular

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27
Q

Which of these is the commonest liver cell cancer seen in the west?

a) liver cell carcinoma
b) cholangiocarcinoma
c) metastatic adenocarcinoma

A

metastatic adeonocarcinoma - metastatic cancers are really common!

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28
Q

Which of these is not associated with fatty change in the liver?

a) diabetes
b) Hep B
c) Hep C
d) alcohol

A

B) Hep B –> because hep C can cause fat in the liver

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29
Q

which of these is not associated with genetic haemochromatosis

a) cirrhosis
b) diabetes
c) kayser-fleisher ring
d) myocardial damage

A

c) kayser-fleisher rings - these are associated with Wilsons disease

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30
Q

What are 3 types of benign liver cancers

A
  1. liver cell adenoma
  2. bile duct adenoma
    3 haemangioma
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31
Q

What type of bullous disease is characterised by IgG antibodies and C3 binding to hemidesmosomes of the basement membrane, resulting in subepidermal bull?

A

Pemphigoid

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32
Q

Which type of bullous disease is characterised by IgG antibodies binding to the desmosoml proteins causing intraepidermal bulla?

A

Pemphigus vulgaris

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33
Q

Which type of bullous disease affects both the skin AMD mucous membranes?

A

Pemphigus

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34
Q

which antibodies are involved in the autoimmune pemphigus vulgaris and pemphigoid diseases?

A

IgG

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35
Q

what are the specific antibodies which are produces in pemphigus foliaceus?

A

Desmoglein-1 (IgA)

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36
Q

What are the types of dermatitis?

A
  1. atopic
  2. contact
  3. seborrheic
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37
Q

What is the skin condition which can present in infants with a cradle cap, and is caused by a reaction to the yeast Malassezia?

A

Seborrheic dermatitis

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38
Q

Which surfaces of the body is eczema commonly affecting?

A

Flexor

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39
Q

Which surfaces of the body does psoriasis affect?

A

Extensor

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40
Q

What is the basic histopathological basis of psoriasis?

A
  • parakeratosis (rapid turnover of keratocytes) resulting in loss of the granular layer, causing thickening of the epidermis.
  • clubbing of the rete ridges.
  • Munro’s microabscesses (fill with neutrophils)
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41
Q

What type of hypersensitivity reaction is contact dermatitis?

A

Type IV (delayed hypersensitivity) - cell mediated - activated T cells release cytokines which activate macrophages or Tc cells which cause direct cellular damage

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42
Q

What other features other than skin changes are seen in psoriasis

A

Nails: pitting, onycholysis,

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43
Q

What is onycholysis?

A

Separation of the nail from the nail bed

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44
Q

What disease is characterized by itchy reddish-purple polygon-shaped skin lesions on the lower back, wrists, and ankles. It may also present with a burning sensation in the mouth, and a lattice-like network of white lines near sites of erosion

A

Lichen planus

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45
Q

In lichen planus, what is the a lattice-like network of white lines near sites of erosion called?

A

Wickman’s striae

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46
Q

In which condition do you see saw-tooth rete ridges and basal cell degeneration?

A

Lichen planus

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47
Q

What is the likely diagnosis: Rapid progression of painful, necrolytic, cutaneous ulcer with an irregular, violaceous and undermined border, biopsy shows abundance of inflammatory cells: neutrophils

A

Pyoderm gangrenosum

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48
Q

What type of hypersensitivity reaction is psoriasis?

A

Type IV T cell hypersensitivity reaction

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49
Q

What is a granuloma

A

A collection of activated histiocytes(macrophages)

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50
Q

What is the likely diagnosis: rough brown plaque, waxy, warty, “stuck on” appearance, in elderly patient - histo describes as proliferation of basal keratinocytes

A

Seborrhoeic keratosis

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51
Q

what is the likely diagnosis - 60 year old who spends a lot of time in spain, pearly white ridge, rolled edge, central ulceration,

A

BCC - basal cell carcinoma

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52
Q

Which of BCCs and SCCs can metastasise?

A

SCCs

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53
Q

The Breslow thickness is used to stage which cancer?

A

malignant melanoma

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54
Q

Which common skin cancer does not metastasise?

A

Basal cell carcinoma

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55
Q

What is the commonest cause of people going into acute renal failure?

A

Acute tubular injury/necrosis

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56
Q

what are 3 causes of crescentic glomerulonephritis?

A
  1. immune complex
  2. anti-GBM disease
  3. pauci-immune - associated with anti-neutrophil cytoplasm antibodies (ANCA)
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57
Q

what disease is diagnosed by immunochemistry showing linear deposition of IgG antibodies on the glomerular basement membrane?

A

Anti-GBM diease or goodpastures disease

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58
Q

What disease is characterised by cresentic glomerulonephritis and lung haemorrhage?

A

Goodpasture’s syndrome

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59
Q

what disease is associated with ANCA and glomerular necrosis?

A

Pauci-immune crescetic GN

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60
Q

what antibodies is pauci-immune GN associated with?

A

Anti neutrophil cytoplasm antibodies (ANCA)

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61
Q

What does a Congo-red stain turning green under polarised light indicate?

A

presence of amyloidosis - causing nephrotic syndrome

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62
Q

What 4 things characterise nephrotic syndrome?

A
  1. Hypoalbuminaemia
  2. Proteinuria (>3.5g/day)
  3. Oedema
  4. Hyperlipidaemia
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63
Q

what pathogen causes diarrhoea associated haemolytic uraemic syndrome and why?

A

E. coli - the toxin it makes directly targets the renal endothelium

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64
Q

What are 3 examples of systemic diseases that can cause nephrotic syndrome?

A
  1. diabetes mellitus
  2. Amyloidosis
  3. SLE
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65
Q

What are the primary glomerular diseases that case nephrotic syndrome?

A
  1. minimal change disease
  2. focal and segmental glomerulosclerosis
  3. membranous glomerulonephritis
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66
Q

Which primary glomerular disease is seen most commonly in children?

A

Minimal change disease

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67
Q

what is the likely diagnosis and common treatment for a child with nephrotic syndrome

A

Minimal change disease

- respond to immunosuppression so a course of corticosteroids - prednisolone

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68
Q

What is the antibody responsible for primary membranous glomerulonepritis?

A

Autoantibodies to phospholipase A2 receptor - found on podocytes

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69
Q

what proportion of patients with IgA nephropathy progress to end stage renal disease?

A

30%

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70
Q

what is the most common cause of chronic kieny disease?

A

diabetes

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71
Q

what antibodies are commonly made in SLE?

A

ANA and anti ds-DNA

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72
Q

what cell forms the outer layer of the glomerular filtration barrier?

A

podocyte

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73
Q

to the nearest 10% what percentage of end stage renal disease is due to autosomal dominant polycystic disease?

A

10%

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74
Q

what type of amyloid is formed in patients with multiple myeloma?

A

AL

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75
Q

antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?

A

membranous glomerulonephritis

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76
Q

what type of epithelial cells is the oesophagus lines with

A

squamous

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77
Q

what is the Z line

A

gastro-oesophageal junction - transition from squamous to columnar epithelial cells

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78
Q

in the duodenum, what is the normal villous:crypt ratio?

A

2:1 – V:C

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79
Q

what is the key inflammatory cell involved in acute oesophagitis

A

neutrophil polymorph

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80
Q

what is the key difference between an acute and a chronic ulcer?

A

chronic ulcers have scarring and fibrosis at the base

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81
Q

what changes are seen in Barret’s oesophagus?

A

re-epithelialistion of the oesophagus with columnar epithelium, often with goblet cells

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82
Q

what is the key feature differentiating dysplasia from adenocarcinoma in the oesophagus

A

dysplasia = cytological, histological and genetic features of malignancy but NO INVASION - adenocarcinoma has invasion through the basement membrane

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83
Q

what is the commenest type of cancer in the oesophagus?

A

adenocarcinoma

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84
Q

what are the 2 types of cancer of the oesophagus and which is more common?

A

adenocarcinoma - (glandular - from dysplasia and invasion of columnar cells)

squamous cell carcinoma

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85
Q

what is a common infectious cause of acute gastritis?

A

H. pylori

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86
Q

what does a biopsy of the stomach showing the presence of lymphoid follicles indicate?

A

a current or previous infection with H. pylori

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87
Q

what does lymphoid tissue in the stomach increase the risk of?

A

Lymphomas - MALTomas

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88
Q

What is the increased risk of cancer with H pylori infection?

A

8X

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89
Q

what is the most common type of gastric cancer?

A

adenocarcinoma - either intestinal or diffuse type

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90
Q

Apart from H. pylori, which other pathogens must you consider when thinking about inflammation of the duodenum?

A

Giardia lamblia
CMV
cryptosporidius
Whipples

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91
Q

how do you diagnose coeliacs disease

A

transglutaminase antibodies
endomysial antibodies
duodeal bopsy shoes villous atrophy (only if on a gluten diet at the time)

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92
Q

Histologically describe a MALToma

A

expansion of hte marginal zone with development of sheets of neoplastic small lymphoid cells

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93
Q

What kind of cells are involved in coeliac associated MALTomas in the duodenum

A

T cells (s opposed to B cells in normal gastric MALTomas)

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94
Q

True or false - most oesophageal and gastric cancers arise from pre-existing adenomas

A

False - metaplasia –> dysplasia pathway is most common

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95
Q

In a patient with coeliac disease on a diet containing gluten, what is the most likely histology

A

villous atrophy, with increased intra-epithelial lymphocytes

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96
Q

What are 4 complications of GORD

A
  1. haemorrhage
  2. stricture
  3. perforation
  4. Barrett’s oesophagus
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97
Q

What are 2 mjor examples of cancellous bones

A

pelvis and vertebrae

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98
Q

Which type of mone is more metabolically active: cancellous or cortical

A

cancellous

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99
Q

in suspected metabolic bone disease, where must a bone biopsy be obtained from

A

iliac crest

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100
Q

Re-epithelialisation by metaplastic columnar epithelium with goblet cells is called

A

intestinal metaplasia

101
Q

what is melena

A

black tarry stools with an offensive odour caused by an upper GI bleed

102
Q

What does a CLO test for?

A

H. pylori - “campylobacter like organism test”

103
Q

food and antacids relieve the pain of which type of ulcers?

104
Q

A 65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. Goblet cells are seen.

A

Barrett’s oesophagus

105
Q

what is the urea breath test used to diagnose?

A

H pylori - works based on how H. pylori converts urea to ammonia and CO2

106
Q

A 66 year old man complaining of epigastric pain undergoes an endoscopy. The mucosa appears reddened in the antrum of the stomach. 13C is detected on a urea breath test.

A

Gastric ulcer

107
Q

What is a rare diesease of the muscle of the lower esophageal body and the lower esophageal sphincter that prevents relaxation of the sphincter and an absence of contractions, or peristalsis, of the esophagus.

108
Q

A 30-year-old woman presents with haematemesis and diarrhoea. She has recurrent peptic ulceration and is taking omeprazole. Despite this, she has persistently high serum gastrin levels. Endoscopy shows a large 3cm actively bleeding ulcer in the duodenum.

A

Zollinger-Ellison syndrome

109
Q

A 50-year-old women presents with chest pain associated with regurgitation of solids and liquids equally, both occurring after swallowing. Diagnosis is confirmed by a characteristic ‘beak like’ tapering of the lower oesophagus on barium swallow and manometry shows failure of relaxation of the LOS.

110
Q

A 65-year-old woman presents with a 3 month history of anorexia, weight loss and epigastric pain. Blood tests reveal an iron deficiency anaemia. Endoscopy shows a thickened rigid gastric wall known as ‘leather bottle stomach’ indicating infiltration into all layers of the gastric wall. Numerous signet ring cells on biopsy diffusely infiltrate the mucosa.

A

Diffuse stomach carcinoma - adenocarcinoma

111
Q

A 45 year old woman presents with large tongue and swelling of the legs. She has a high BP and urine dipstick reveals protein +++.The tissue from renal biopsy stains with Congo red dye and shows apple green birefringence under polarised light

A

Renal amyloidosis

112
Q

A 28 year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum.

113
Q

A 55 year old woman presents with severe, unremitting headache with scalp tenderness. Her ESR and CRP are raised. A biopsy reveals giant cells.

A

Temporal arteritis

114
Q

delta-F508 mutation is a specific mutation for what?

A

Cystic Fibrosis

115
Q

What are the causes of pancreatitis?

A

GETSMASHED

Gallstones 
Ethanol (alcohol) 
Trauma 
Steroids 
Mumps 
Autoimmune (SLE) 
Scorpion sting 
Hypercalcaemia
ERCP 
Drugs
116
Q

What is the commonest cause of acute pancreatitis in the UK?

A

alcoholism

117
Q

39 year old lady suffers a sharp retrosternal chest pain which is worse on inspiration. The finding on auscultation is typical of this presentation.

A

pericarditis

118
Q

A 28 year old sportsman presents to A&E with severe chest pain and breathlessness. He has a history of asthma. There is a systolic murmur on examination.

A

hypertrophic cardiomyopathy

119
Q

A 10 year old boy presents with skin rash and joint pain in his elbows and knees. His mother tells you that he recently had a sore throat. On examination he is found to have an ejection systolic murmur and a friction rub.

A

Acute rheumatic fever

120
Q

A 68 year old smoker presents with jaundice and worsening abdominal and back pain. Scratch marks are seen on his arms and legs. He has lost 5kg in 2 months. Ultrasound shows dilated intrahepatic bile ducts.

A

carcinoma head of the pancreas

121
Q

Around 10 % eventually get primary lymphoma (less often, carcinoma) of the gut if not properly treated. HLA B8 is linked with this.

A

coeliac disease

122
Q

A 66 year old man complaining of epigastric pain undergoes an endoscopy. The mucosa appears reddened in the antrum of the stomach. 13C is detected on a urea breath test.

123
Q

A 58 year old female presents with malnutrition. She complains of abdominal pain, weight loss and arthritis. She has steatorrhoea. A jejunal biopsy showed periodic acid-Schiff (PAS)-positive macrophages

A

Whipple’s disease

124
Q

A 45 year old woman presents with large tongue and swelling of the legs. She has a high BP and urine dipstick reveals protein +++.The tissue from renal biopsy stains with Congo red dye and shows apple green birefringence under polarised light

A

renal amyloidosis

125
Q

A 70 year old woman is referred to hospital with signs of peripheral oedema and hepatosplenomegaly. Hospital investigations demonstrate a degree of bone erosion and high levels of circulating kappa uniform light chain

A

Myeloma associated amyloidosis

126
Q

what type of amyloidosis is secondary to inflammatory conditions such as Chron’s disease or rheumatoid arthritis?

A

AA - reactive amyloidosis

127
Q

what is Hirschpring’s disease

A

Absence of ganglion cells in the myenteric plexus, resulting in distal colon failing to dilate - resulting in constipaition, abdo distention, overflow diarrhoea

128
Q

what condition is Hirschprung’s disease associated wth

A

Down’s syndrome

129
Q

How do you treat Hirschprung’s disease

A

biopsy to see absence of ganglion cells

and resection of affected area

130
Q

describe pancrwatic pseudocysts

A

lines with fibrous tissue (NO EPITHELIAL lining) - contain fluid rich in pancreatic enzymes or necrotic material
connect with pancreatic ducts

131
Q

What is the other common name for IgG4 disease

A

autoimmune pancreatitis

132
Q

wha tare the most common pancreatic tumours?

A

ductal carcinomas (85%)

133
Q

give the 4 risk factors for ductal carcinoma

A
  • smoking
  • BMI and dietary
  • chronic pancreatitis
  • DM
134
Q

What does ductal carcinoma arise from?

A

PANIN - pancreatic intraductal neoplasia

135
Q

what mutations are very common in ductal pancreatic carcinomas?

A

K-Ras (95%)

136
Q

which end of the pancreas must tumours be to cause jaundice?

A

The head - obstruct the bile duct

137
Q

what are 90% acute cholecystitis associated with?

A

gall stones

138
Q

What are Rokitansky-Aschoff sinuses?

A

Diverticula in the gall bladder (outpouchings) which can be related to chronic cholecystitis

139
Q

Gall bladder cancers are what type?

A

Adenocarcinomas

140
Q

What is the major disease associated with gall bladder cancer>

A

gallstones (90%)

141
Q

define pancreatitis

A

acute inflammation of the pancreas caused by aberrant release of . pancreatic enzymes - autodigestion

142
Q

what is the most common cause of acute pancreatitis? (and what %)

A

gall stones (50%)

143
Q

How to gallstones lead to pancreatitis?

A

obstruction leads to reflux of bile up the pancreatic duct, followed by damage to acini with release of proenzymes which then become activated

144
Q

what are the 3 different patterns of injury in acute pancreatitis

A
  1. periductal - necrosis of acinar cells near the ducts
  2. perilobular - necrosis at the edges of the lobules (due to poor blood supply)
  3. panlobular (develops from 1 and 2)
145
Q

how are pseudocysts structurally different to cysts?

A

pseudocysts lack an epithelial lining

146
Q

what is the most common cause of chronic pancreatitis?

A

alcohol (80%)

147
Q

give 4 complications of chronic pancreatitis

A
  • diabetes mellitus
  • malabsorption
  • pseudocysts
  • ? carcinoma of the pancreas
148
Q

Autoimmune pancreatitis is characterised by large numbers of which cells?

A

IgG4 positive plasma cells

149
Q

Give 5 complications of diverticular disease

A
  1. obstruction
  2. inflammation (diverticulitis)
  3. pain
  4. perforation
  5. fistula
150
Q

which organism causes psuedomembranous colitis?

A

C. diff toxins

151
Q

how do you diagnose pseudomembranous colitis?

A
  • clinical picture (diarrhoea, fever, nausea following recent Ab use. esp. cephalosporins or fluoroquinolones)
  • Histology - shows massive inflammation of lower GI tract with sloughing
  • Stool assay - C. diff toxin
152
Q

Treatment for pseudomembranous colitis?

A

Metronidazole or Vancomycin

153
Q

What is dressler’s syndrome

A

Autoimmune reaction weeks-months post-MI, reaction to the damaged myocytes results in inflammation and causes pericarditis

154
Q

Which gene is most commoly mutated in HCM?

A

beta-MHC gene

Troponin T also often involved

155
Q

what do you see histologically in hypertrophic cardiomyopathy?>

A

Myocyte dysarray - which causes arrythmias

156
Q

Which valve is most ommonly affected in Rheumatic fever?

157
Q

what is commonly the causative organism in rheumatic fever?

158
Q

What are the Jones’ major criteria for Rheumatic fever?

A 
CASES 
Carditis 
Arthritis 
Sydenham's chorea 
Erythema marginarum 
Subcutaneous nodules
159
Q

WHat are examples of diffuse alveolar damage in adults and neonates?

A

adults: ARDS
neonates: Hyaline membrane disease of the newborn

160
Q

What is the resp condition associated with lack of surfactant in premature neonates?

A

Hyaline membrane disease of the newborn

161
Q

Which part of the lung does aspestososis tend to affec?

A

Lower lobes

162
Q

What is pneumoconiosis caused by?

A

Usually occupational - non-neoplastic lung reaction to inhalation of mineral dust/inorganic particles - often UPPER LOBE e.g. silicosis, coal worker.

163
Q

What histological features do you see in asthma

A

Curschmann’s spirrals and Charcot-Leyden crystals

164
Q

what is the definition of chronic bronchitis

A

chronic cough and production of sputum most days for 3+ months over 2+ consecutive years

165
Q

causes of amphysema

A
  • smoking

- alpha1-antitrypsin deficiency

166
Q

what is the definition of bronchiectasis?

A

permanent abnormal dilation of the bronchi

167
Q

What are congenital causes of bronchiectasis?

A

CF
primary ciliary dyskinesia
Young’s syndrome

168
Q

What triad of features are there in Toung’s syndrome?

A

Azoospermia
Rhinosinusitis
Bronchiectasis `

169
Q

What is the name of an infected pleural effusion?

170
Q

What is a granuloma?

A

Collection of histiocytes / macrophages +/- multinucleate giant cells

171
Q

What is the classic histological sign you see in end stage interstitial disease?

A

honey comb lung

172
Q

What non-infectious causes of granulomas are there in the lung

A

Sarcoid

  • Foreign body
  • occupational lung disease
173
Q

Infectious causes of lunggranulomas

A

TB

Fungal - cryptococcus, histo, aspergillus

174
Q

what is the proper name for farmer’s lung?

A

extrinsic allergic alveolitis

175
Q

What is “dusty lung”

A

Pneumoconiosis - permanent alteration to lung structure due to inhalation of INORGANIC dust, and the tissue reaction to its presence
e.g. coal workers lung, aspestososis, silicosis

176
Q

WHat is asbestososis associated with

A
  • pleural plaques
  • fine subpleural basal fibrosis with asbestos bodies in the tissue
  • increased risk of lung cancer
177
Q

WHat is nutmeg liver suggestive of?

A

RIght sided heart failure causing venous congestion of organs like the liver

178
Q

What are the types of non-small cell carcinoma?

A
  • squamous cell
  • adenocarcinoma
  • large cell carcinoma
179
Q

what is the most common type of lung cancer

A

Squamous cell carcinoma (35%)

180
Q

In which type of lung cancer would you expect to see keratinisation?

A

squamous cell

181
Q

which type of lung cancer (adeno or squamous) is more likely to be in a peripheral location and present with mets?

A

Adenocarcinomas - 80% present with mets

Squamous cell Ca metastasise late and are located centrally

182
Q

which type of lung cancer is most common in women and non smokers?

A

adenocarcinomas

183
Q

Which type of lung cancer is associated with ACTH secretion

A

Small cell

184
Q

what mutations are common in small cell lung cancer?

A

p53 and RB1

185
Q

what drugs do some adenocarcinomas respond well to?

A

anti-EGFR e.g. Tarceva

186
Q

Which positive marker indicates a poor response to cisplatin chemo in non small cell large cell lung cancer

187
Q

What do kras mutations predict?

A

non response to EGFR therapy

188
Q

Which types of lung cancer sometime secrete PTH, causing hypercalcaemia?

A

Squamous cell

189
Q

Which types of lung cancer sometimes secrete ACTH or ADH?

A

Small cell

190
Q

45 year old woman presents with nipple retraction, pain and thick white nipple discharge. Cytology shows proteinaceous material andinflammatory cells. Diagnosis?

A

Duct Ectasia

191
Q

What cancers does BRCA1?BRCA2 gene increase risk of

A

breast
ovarian
pancreatic
prostate

192
Q

What aggroup of women are invited for mammogram screening?

A

47 to 73 invited every 3 years

193
Q

What are the risk factors for breast cancer?

A

Genetic susceptibilty- BRCA1/BRCA2 genes
Hormone exposure: early menarche late menopause, OCP, HRT, late childbirth
Age
Obesity
FHx Tobacco and alcohol

194
Q

What is the triple assessment

A

examintion, radiology (mammogram/uss) and cytology - fine needle aspiration

195
Q

What is the most common invasive breast cancer?

A

Invasive ductal carcinoma

196
Q

Which carcinoma in situ is associated with calcification

A

DCIS - ductal -

197
Q

Which receptors are breast neoplastic leasions checked for?

A

Eostrogen, progesterone and HER2

ER/PR and HER2

198
Q

What are positive ER and PR receptors indicative of in breast neoplastic?

A

Good prognosis as it means it is responsive to tamoxifen

199
Q

What is a positive HER2 indicative of?

A

bad prognosis

Can use Herceptin immunoglobulin

200
Q

What infection is Vulval intraepithelial carcinoma associated with?

201
Q

Which type of ovarian cancer is associated with psammoma bodies

A

Serous cystadenoma

202
Q

Ovarian cancer with classic hobnail histological appearance

A

Clear cell cancer (clear nail varnish on the ovaries)

203
Q

What do choriocarcinomas secrete?

204
Q

What is the difference between immature and mature ovarian teratomas?

A

Immature = malignant, solid, contains immature embryonal tissue - secreted AFP

Mature = dermoid cysts, contain mature tissues e.g. hair, teeth. Benign

205
Q

What type of cell are dermoid cysts derived from?

A

germ cells

206
Q

what types of ovarian tumours are associated with oligomenorrhoea, breast enlargement and breast/endometrial cancer?

A

Granulosa-Theca cell tumour - secrete oestrogen hence symptoms

Granny Theresa secreting female hormone

207
Q

what do sertoli-leydig ovarian tumours secrete

208
Q

Which types of HPV contribute to cervical dysplasia?

A

HPV 16 + 18

209
Q

What cell type is the most commmon type of cervical cancer

A

squamous cell carcinoma (70-80%)

210
Q

which surfaces are affected by psoriasis

A

Extensor (knees, elbows, scalp)

211
Q

what is koebner’s phenomenon

A

seen in derm ondition like psoriasis, vitilligo and molluscum - where lesions appear at sites of trauma e.g. from scrattching

212
Q

What is guttate psoriasis associated with

A

Weeks post strep throat

213
Q

which drugs can cause erythema multiforme?

A 
SNAPP
Sulphonamides 
NSAIDS
Allopurinol 
Penicillin 
Phenytoin
214
Q

what is the skin disease linked to coeliac disease

A

Dermatitis herpetiformis

215
Q

what is the sqamous cell carcinoma in situ called

A

Bowen’s diseas

216
Q

describe a keratoacanthoma

A

rapidly growing dome shaped nodule which may cave crusty necrotic centre. Looks similr to SCC on histology, but benign and cler sponataneously

217
Q

Which is the most common type of malignant skin cancer that is often called the rodent ulcer?

A

Basal cell carcinoma (Rodents are common in the basement)

218
Q

Most common benign liver tumour?

A

Haemangioma

219
Q

Most common malignant liver tumour?

A

Mets from other prmary tumours

220
Q

most common cause of chronic liver disease in the west:

A

Non alcoholic fatty liver disease

221
Q

What antibodies are commonly involved in primary biliary cirrhosis (PBC)

A

anti-mitochondrial

222
Q

which type of cirrhosis do you find mallory bodies in the liver?

A

Alcoholic hepatitis

223
Q

which type of liver cirrhosis is associated wih IBD, especially UC, and is also linked to cholangiocarcinoma

A

Primary sclerosing cholangitis

224
Q

which gene is mutated in Wilson’s disease

225
Q

In which condition are mallory bodies most commonly seen

A

Alcoholic hepatitis - but also seen in alcoholic steatosis, alcoholic cirrhosis, Wilsons disease

226
Q

At which 3 points are kidney stones most likely to impact?

A
  1. from kidney to ureter - PUJ
  2. crossing brim of pelvic inlet- pelvic brim
  3. passage through wall of bladder - vesicoureteric junction
227
Q

what are the 2 most common types of renal calculi?

A
  1. calcium oxalate - 75%

2. triple stones (magnesum ammonium phosphate) - 15%

228
Q

which type of kidney stons are known to form large staghorn calculi?

A

Triple stones -magnesium ammoium phosphate

229
Q

what is the common childhood renal cancer characterised by lots of small round blue cells with areas of more differentiated epithelial and stromal components.

A

Wilm’s tumour - nephroblastoma

230
Q

what is used to estimate the prognosis of prostate cancer?

A

Gleason score - ranging from 6 (mild) to 10 (severe)

231
Q

what is the commonest cause of nephritic syndrome woldwide?

A

Berger’s disease - IgA nephropathy

232
Q

what is the most common pancreatic cancer

A

Ductal adenocarcinoma

233
Q

where do the majoirty of subarachnoid haemorrhages occur?

A

Bifurcation of the internal carotid (80%)

234
Q

what conditions is subarachnoid haemorrhage associated with

A

Polycystic kidneys
Ehlers danlos
coarctaton aorta

235
Q

signs of dementia

A

memory impairment
aphasia
apraxia
agnosia

236
Q

Agnosia means….

A

reduced ability to interpret sensory stimuli e.g. unable to recognise objects, smells, sounds

237
Q

apraxia means

A

reduced ability to perform learned motor tasks

238
Q

aphasia means

A

language disorder reduced ability to produce/understand speech (receptive/expressive)

239
Q

what is idiopathic parkinsons caused by

A

death of dopaminergic neurons in the substantia nigra causing reduced stimulation to the motor cortex

240
Q

what are the classic symptoms you see in parkinsons

A 
Tremor 
Rigidity 
Shuffling gait 
Akinesia 
Postural instability
241
Q

which mutated protein is involved in OD

A

alpha-synuclein

242
Q

What are the urate crystals like in gout

A

Needle like and negatively birefringant

243
Q

what are the calcium pyrophosphate crystals like in pseudogout?

A

rhomboid shaped and positively birefringant

244
Q

where are Heberden’s and Bouchard’s nodes?

A

Heberden’s = distal inter-phalangeal joint (DIPJ)

Bouchards = (PIPJ)

remember outer hebrides (far away - distal) and local butcher’s (proximal)

245
Q

which joint des RA spare?

246
Q

which lymphoma do you see panless lymphadenopathy, weight loss, pain ater drinking alcohol -

247
Q

What cells can you see in Hodgkins lymphoma

A

Reed-sternberg

248
Q

clinical features of multiple myeloma

A 
CRAB 
calcium high 
Renal failure 
Anaemia 
Bones

My Year 5 Pathology (5 decks)

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