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Joshua's Path > Histopathology > Flashcards

Histopathology Flashcards

1
Q

What happens when there is acute inflammation

A

neutrophil infiltration

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2
Q

what happens when there is chronic inflammation

A

Lymphocyte and plasma cell infiltration

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3
Q

What processes are eosinophilic

A

Allergic
parasitic
hodgkins lymphoma
sometimes myeloproliferative

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4
Q

eosinophilic oesaphagitis will give what sign

A

feline contractions

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5
Q

what types of process involve macrophages

A

late acute inflammation

chronic inflammation

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6
Q

What is a the cell origin of a carcinoma

A

epithelial cell
squamous- keratin, intercellular bridges
adeno-mucin secreting(mucin stain), glandular

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7
Q

What stain would one use for amyloid

A

congo red with apple green bifringence under polarised light

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8
Q

what stain would one use for iron

A

prussian blue

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9
Q

what does cytokeratin stain

A

epithelial cells

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10
Q

4 layers of the artery wall (outer to inner)

A

Tunica externa
tunica media
tunica interna
basement membrane

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11
Q

4 layers of the artery wall (outer to inner)

A

Tunica externa
tunica media
tunica interna
basement membrane

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12
Q

Name 4 modifiable risk factors for atherosclerosis

A

Diabetes mellitus, Hypercholesterolaemia, smoking, hypertenstion

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13
Q

~Name 3 non modifiable risk factors for atherosclerosis

A

Age, Gender(male), Fhx

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14
Q

Name 3 non modifiable risk factors for atherosclerosis

A

Age(40plus), Gender(male. Premenopausal women protected by hormones), Fhx

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15
Q

Give 4 features of a vulnerable plaque

A

clusters of inflammatory cells
thin cap
small amount of smooth muscle
lots of foam cells/lipid

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16
Q

likely contributors to rupture of a vulnerable plaque

A

stress - increased adrrenaline, vasocontriction to increase BP
getting up in a morning is a stressful event

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17
Q

Causes of acute pancreatitis, and how would you test for it?

A 
I GET SMASHED
Iatrogenic
Gall stones 50%
Ethanol 30%
Trauma
Steroids
Mumps
Autoimmune
Scorpian venom
Hypercalcaemia/hyperlipidaemia
ERCP
Drugs - thiazides

Serum amylase is raised transiently but serum lipase is much more sensitive

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18
Q

What is a pancreatic pseudocyst? how do you differentiate it from another tumour?

A

A pathalogical collection of fluid, rich in pancreatic enzymes and necrotic tissue lacks epithelial lining. - often associated with alcoholic pancreatitis. is a common complication of pancreatitis.

They are conected with the ducts.

It may have a riased amylase where a tumour may not and a lower viscosity where in a tumour may be raised

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19
Q

What are the common complications of acute pancreatitis?

A

Pseudocyst, abcess and haemorrhage(which has a 50% mortality rate)

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20
Q

What are the complications of chronic pancreatitis?

A

Pseudocyst, malabsorption, diabetes mellitus, cancer.

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21
Q

What are the causes of chronic pancreatitis

A

Haemochromatosis, alcoholism, CF, autoimmune, duct obstruction.

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22
Q

IgG4 sclerosing plasma cells

A

autoimmune pancreatitis

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23
Q

periductal inflammation is caused by what

A

obstruction.
may be due to stones or alochool

alcohol works by makind sphincter spasm and thicken secretions

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24
Q

What is seen on histology of acute and chronic pancreatitis?

A

Acute - Coagulative necrosiss

Chronic - fibrosis and loss of exocrine tissue. calcifications seen on xray. duct dilation with thick secretions.

Difference between them is the fibrosis which you get in chronic panc. and loss of acini and eventually endocrine cells too.

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25
Q

What is a rokitansky aschoff sinus

A

pseudodiverticulae of the gall bladder - associated with chronic cholecystitis

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26
Q

What is the most common type of pancreatic cancer

A

ductal adenocarcinoma - 85%
Rx - Smoking, diet, BMI, chronic pancreatitis, PanIN(k-ras mutation in 95%)

occurs at the head of the pancreas, appear gritty and grey - present earlier and therefore have a better prognosis.

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27
Q

Classical features of pancreatic cancer

A

painless jaundice.
weight loss and anorexia.
steattorhoea
diabetes

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28
Q

what is trousseaus SYNDROME

A

also known as trousseaus sign of malignancy.

recurrent superficial thrombophlebitis, often felt as a tender nodule.

associated with pancreas and lung cancer.

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29
Q

perilobular inflammation is caused by what?

A

due to acinar injury and is therefore associated with the other processes such as autoimmunity infection and drugs

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30
Q

Mucinous and serous cysts are what?

A

multilocular and unilocular respectively - panc ca

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31
Q

What is depositied in the kidneys in multiple myeloma?

A

amyloid light chain

amyloidosis causes AA chain - and sometimes in RA or TB too.

They cause nephrOtic sydrome.

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32
Q

What forms the fibrous white cap of atherosclerosis

A

vascular smooth muscle cells

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33
Q

what are the 6 common causes of heart failure

A 
IHD
myocarditis
Arythmias
hypertension
valve disease
dilated cardiomyopathy
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34
Q

What are the mechnical complications of MI

A

Mechanical:
contractile dysfunction - loss of muscle - arytnmia - high mortality
Congestive cardiac failure - loss of ventricular function
Cardiac rupture of ventricle wall - typically seen at 4-5 days when get granulation tissue and before collagen is layed down.
can get ventricular aneurysm which leads to mural thrombos formation and stroke/ bowel infarct

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35
Q

What are the arythmia complications of MI

A

Arythmias:
VF usually occurs in the first 24 hours and is common cause of death
Other arythmia - AF, long QT

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36
Q

What are the pericardial complications of MI

A

Pericardial:
pericarditis
Effusion - and tamponade
Dresslers syndrome - immune mediated pericarditis on 2nd or 3rd day v painful fevers and effusion

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37
Q

who has the worst prognosis in MI

A

Women, old, previous MI and diabetics

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38
Q

What is dilated cardiomyopathy

A

loss of cardiac myocytes leading to systolic dysfunction

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39
Q

what is restrictive cardiomopathy

A

big atria with normal size ventricles and a loss of diastolic function due abnormal relaxation. no filling.

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40
Q

when would you see myocyte dissarray

A

Hypertrophic cardiomyopathy

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41
Q

what valve is typically affected by rheumatic fever

A

mitral valve - but may affect mitral AND aortic

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42
Q

What is the pathogenesis behind rheumatic fever

A

2-4 weeks post group A streptococcal infection, the cell mediated immunity antibodies cross react in what is known as antigenic mimicry with cardiac antigens causing a pancarditis

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43
Q

aschoff bodies

A

small giant cell granulomas - rheumatic fever

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44
Q

anitschkov myocytes

A

regenerating myocytes - rheumatic fever

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45
Q

Anti streptolysin o titre

A

rheumatic fever - with raised ESR

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46
Q

how do you treat rheumatic fever

A

Ben pen or erythromycin. steroids.

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47
Q

what would you see on a rheumative heart valve

A

small warty vegetations found along the lines of closure. verruccae

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48
Q

roth spots

A

infective endocarditis

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49
Q

name 5 obstructive respiratory disease processes

A 
Asthma
Chronic bronchitis
bronchiectasis
Emphysema
bronchiolitis - small airway disease
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50
Q

in what condition do you get centrolobular bullae

A

emphysema due to chronic smoking and is mainly in the upper airways.
alpha 1 antitrypsin deficiency cause panacinar bullae and is also in lower airway

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51
Q

what are heart failure cells

A

iron laiden macrophages that have mopped up blood

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52
Q

what happens to children who have hyaline membrane disease

A

go on to get bronchopulmonary dysplasia - scarring

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53
Q

curschmann’s spiral

A

asthma

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54
Q

charcot leyden crystals

A

asthma

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55
Q

codmans triangel

A

osteosarcoma

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56
Q

fluffy calcifications of the axial skeleton

A

chondrosarcoma - malignant chondrocytes - cartilage. occurs in over 40’s

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57
Q

t(11,22) translocation

A

ewings sarcoma - under 20’s

is a primative peripheral neuroectodermal tumour occuring in the diaphysis.

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58
Q

where do metaphysis diaphysis and epiphysis occur

A 
E
M
D
M
E
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59
Q

cd99+ve mic-2

A

ewing’s sarcoma - under 20’s

is a primitive peripheral neuroectodermal tumour occuring in the diaphysis.

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60
Q

5 causes of an eosinophilia

A 
asthma
parastitic infection
drug allergy
lymphomas
RA
polyarteritis
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61
Q

which tumours of lung occur centrally?

A

small cell and squamous cell

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62
Q

Which lung tumours occur peripherally

A

adenocarcinoma

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63
Q

What is the most common lung cancer?

A

squamous cell and is closely associated with smoking. however small cell is literally always a smoker.

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64
Q

what is the most common lung cancer for a non smoker

A

adenocarcinoma (20-30%) and often have a predilection for women.

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65
Q

What is the problem with bevacizumab

A

can cause fatal haemorrhage. VEGF monoclonal ab

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66
Q

What 2 things would you see on histology of a squamous cell lung carcinoma

A

keratinisation
intercellular pickles

Also associated with hypercalcaemia and cavitation.

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67
Q

What staging is used in Lung cancers

A 
TNM
T1 - less than 3cm
T2 - 3-7cm - partial atelectesis
T3 - >7cm - total lobe atelectasis, mediastinal pleura
T4 - mediastinal organs

N - which nodes involved 0-2
M - any mets? 0/1

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68
Q

What does ERCC1 - NSCLC predict

A

poor response to cisplatin

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69
Q

What does a Kras mutation mean in lung cancers

A

usually non response to TKIs

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70
Q

What does EML4 - ALK mean?

A

no benefit from TKI

solid signet ring pattern

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71
Q

What kind of tumour is small cell carcinoma of the lung?

A

derived from neuroendocrine cells, and is therefore associated with ectopic ACTH secretion and lambert eaton syndrome.
it is highly metastatic and has poor prognosis despite being chemo sensitive

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72
Q

What is the name of the EGFR tyrosine kinase inhibitor

A

ertlotinib

used typically in adenocarcinoma of the lung

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73
Q

What would you see on histology of a small cell carcinoma

A

oat cell

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74
Q

What type of rash is seen in lyme disease

A

erythema migrans - NOT marginatum - this is rheumatic fever

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75
Q

What is aflotoxin

A

produced by aspergillus and causes hepatocellular carcinoma

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76
Q

What is one of the worse types of mesothelioma

A

sarcomatoid

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77
Q

what is virchows triad

A

stasis, vessel wall damage, hypercoaguable state

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78
Q

What are the sequelae of a PE

A

wedge shaped infarcts, if a large one greater than 60% of pulmonary bed occluded, can cause death.

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79
Q

what is for pulmonale

A

right heart failure as a result of pulmonary pathology e.g PE causing increased vascular resistance

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80
Q

What staging is used in Lung cancers

A 
TNM
T1 - less than 3cm
T2 - 3-7cm - partial atelectesis
T3 - >7cm - total lobe atelectasis, mediastinal pleura
T4 - mediastinal organs

N - which nodes involved 0-2
M - any mets? 0/1

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81
Q

What does ERCC1 - NSCLC predict

A

poor response to cisplatin

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82
Q

What does a Kras mutation mean in lung cancers

A

usually non response to TKIs

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83
Q

What does EML4 - ALK mean?

A

no benefit from TKI

solid signet ring pattern

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84
Q

How do you divide up pulmonary hypertension, and how is it defined?

A

Pre capilliary
capilliary
post capilliary
defined as >25mmhg at rest (pulmonary arterial pressure)

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85
Q

Which lung cancer is associated with RB1 mutation

A

small cell

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86
Q

which lung cancers are associated with p53 mutations

A

mainly squamous, and small cell

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87
Q

What are the risk factors for squamous cell carcinoma of the oesophagus

A

alcohol, smoking, plummer vinson syndrome, HPV

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88
Q

What would you see on histology of a SCC of the oesophagus

A

intercellular bridges and keratin.

found in middle 1/3 50% then 30% in lower and 20 in upper

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89
Q

How does an SCC of the oesophagus present

A

progressive dysphagia - solids then fluids, and then odynophagia.

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90
Q

where does h pylori tend to populate

A

antrum of the stomach

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91
Q

Histology of acute gastritis

A

neutrophils

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92
Q

Histology of chronic gastritis

A

lymphocytes and plasma cells

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93
Q

what is considered a gastric ulcer

A

when the muscularis mucosa has been breached and you are into submucosa

it can lead to intestinal metaplasia and therefore adenocarcinoma

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94
Q

which ulcer is better with food

A

duodenal - and milk
4 times more common than gastric ulcers due to stomach acid entering the duodenum. this can cause metaplasia (gastric)
it can cause iron deficiency anaemia

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95
Q

what is the triple therapy for H pylori

A

PPI, clarythromycin and amox/metro

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96
Q

Whcih HLA types predispose to coeliac disease?

A

HLA DQ2 DQ8

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97
Q

What is the main risk of untreated coeliac disease

A

10% get duodenal t cell lymphoma

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98
Q

What causes hirschsprungs disease and what is it associated with?

A

absence of ganglion cells in the myenteric plexus, 2% in downs patients

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99
Q

what does the histology of hirschsprungs disease show?

A

a rectal biopsy shows hypertrophied nerve fibres with no ganglia.

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100
Q

what is the treatment for hirschsprungs disease

A

remove the affected segment.

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101
Q

Where does ischemic colitis occur and why?

A

Occurs at the watershed areas such as the splenic flexure where SMA transitions to the IMA. and the rectosigmoid. arterial or venous occlusion

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102
Q

Peak age of Chrons

A

20’s

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103
Q

Peak age of UC

A

20-25

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104
Q

pathophysiology of chrons

A

Cobblestone appearance, skip lesions, transmural inflammation, non casseating granulomas, rosethorn and apthous ulcers.

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105
Q

extra - GI manifestations of IBD

A

Pyoderma gangrenosum, erythema nodosum, erythema multiforme, clubbing, uveitis. joint problems including ank spond,
PSC (UC>cd)

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106
Q

what is the main risk of UC

A

at 20-30 times risk of adenocarcinoma

toxic megacolon - dilation and perf

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107
Q

What is the twin concordence in IBD

A

50% in chrons, and 15% in UC

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108
Q

In which IBD is pain relieved on defecation

A

UC

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109
Q

What is carcinoid syndrome?

A

Paraneoplastic syndrome whereby there is production of 5-HT. enterochromaffin cell origin. usually found in bowel.

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110
Q

What are the symptoms of carcinoid syndrome

A

bronchoconstriction, flushing and diarrhoea

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111
Q

how do you test for and treat carcinoid syndrome

A

24hr urinary 5-HIAA main metabolite of serotonin

octreotide

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112
Q

what is an adenoma

A

bening dysplastic lesion - adenocarcinoma precursor

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113
Q

at what point do adenomas need surveillance?

A

3.4cm - 45% will become malignant.

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114
Q

what is the main gene involved in adenoma formation?

A

APC - people with FAP are born with a mutation in thi s gene.

others important mutations include Kras, p53, LOF

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115
Q

what are the systemic sequelae of a villous adenoma

A

hypoproteinemic hypokalaemia - leak protein and K

there are tubular types too which look likea row of test tubes

villous look like a little amoeba

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116
Q

What are the 3 layers of the GI mucosa

A

epithelieum
lamina propria
muscularis mucosa

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117
Q

what are the 3 layers below the mucosal layer of the GI tract

A

sub mucosa
muscularis propria
serosa

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118
Q

what is peutz jeugers syndrome

A

Characterised by hamartomatous polyps of the Gi tract often in the rectum and present with bleeding.
they also have pigmentation around the mouth (mucocutaneous)

increased risk of intuccusseption and malignancy

119
Q

What is a pseudopolyp

A

scar tissue from IBD, from granulation tissue in repeated cycles of ulceration.

120
Q

What type of cancer is colorectal cancer

A

98% are adenocarcinomas

121
Q

what are the clinical features of a cloretal cancer

A

Left sided: change in bowel habit and LLQ pain
Right sided: FE def anaemia, weight loss
monitor CEA

122
Q

What is Dukes staging?

A 
GI cancers (5yr surv)
A: confined to the mucosa (95)
B1 - in the muscularis propria without nodes (67)
B2: transmural without nodes (54)
C1: muscularis propria with nodes(43)
C2:transmural with nodes(23)
D distant mets(<10)
123
Q

where is the FAP gene

A

APC C5Q1 70% AD mutatoin

124
Q

What is the mutation in HNPCC

A

DNA mismatch repair gene - autosomal dominant

125
Q

what is secretin

A

Hormose released by s cells of the duodenum to stimulate pancreatic and liver enzyme reslease

126
Q

what is high blood pressure

A

140/90

127
Q

what is dislipidaemia

A

HDL <1 and a TG>2

128
Q

what is cck

A

cholecystokinin - released form I cells of the dudenum.

129
Q

what is the main symptom of a VIPoma

A

diarrhoea

130
Q

MEN1

A

PPP
Parathyroid hyperplasia
Pancreatic endocrine tumour
pituitary adenoma

131
Q

MEN2a

A

Parathyroid

132
Q

what is a lymphocytosis

A

too may tylphocytes

133
Q

what is the limiting plate

A

the border between the hepatocytes and the portal tract

134
Q

what are the causes of micronodular chirrosis

A

<3mm nodules with uniform liver involvement

alcoholic hepatitis and biliary tract disease, and haemochromatosis

135
Q

what are the causes of macro nodular cirrhosis

A

viral hepatitis, alpha 1 antitrypsin disease and wilsons disease

136
Q

what are the complications of cirrhosis

A

portal hypertension
hepatic encephalopathy
hepatocellular carcinoma

137
Q

spotty necrosis

A

acute hepatitis

138
Q

in liver pathology what does grade mean

A

severity of inflammation

139
Q

in liver pathology what does stage mean

A

extent of fibrosis

140
Q

what are the 3 types of alcoholic liver disease

A 
fatty liver (steatosis)(fully reversible)
alcoholic hepatitis (mallory bodies+hepatocyte ballooning)
alcoholic cirrhosis
141
Q

HLA DR3

A

autoimmune hepatitis

142
Q

what is the cause of NAFLD

A

insulin resistance i.e BMI and DM

143
Q

what is the cause of PBC

A

loss of MEDIUM SIZED bile ducts due to autoimmune destruction.
Anti- mitochondrial antibodies are positive in >90%

144
Q

what would be seen on PBC histology

A

bile duct loss with granulomas

145
Q

what would be seen on histology of PSC

A

Onion skin fibrosis and scarring. multifocal strictures of intra and extrahepatic bile ducts.

146
Q

what are you more likely to get with primary sclerosing cholangitis

A

cholangiocarcinoma

147
Q

Is it true that men are more likely to get PBC and PSC

A

yes to PSC, but no to PBC - 10 times more in women

148
Q

where is the iron in haemochromatosis

A

Parenchyma of the liver. hepatocytes.

also in heart pancreas adrneals skin jonts pituitary

149
Q

what is the difference between haemosiderosis and haemochromatosis

A

haemosiderosis - iron in the macrophages and does not cause cirhosis or hepatititis

150
Q

what stain is used for copper

A

rhadanine

151
Q

what is seen on histology of wilsons disease

A

mallory bodies and fibrosis

leads to hepatitis, cirhosis and fulminant failure. also kayser fleisher rings

152
Q

what would you find on the histology of alpha 1 antitrypsin deficinecy

A

intracytoplasmic inclusions of A1AT and stain with periodic acid schiff

153
Q

what are the markers of autoimmune hepatitis

A

anti smooth muscle and ANA, anti actin and anti soluble liver antigen.

disease mediated by plasma cells -

154
Q

What are the causes of granulomas in the liver

A

specific - PBC and drugs

general - sarcoid and tb

155
Q

What is an endothelial cell tumour of the liver

A

haemangioma - very common

156
Q

What happens to the body of the stomach in pernicious anaemia

A

becomes atrophic and there is mucinous change - intenstinal metaplasia

157
Q

What carcinoma with h pylori?

A

adenocarcinoma - but also lymphoma.

158
Q

What paraneoplastic syndromes are associated with renal cell carcinomas

A

polycythaemia, hypercalcaeima, HTN, cushings, amyloid.

159
Q

What is the most common renal cancer and what mtation is it associated with

A

clear cell carcinoma - 3p loss von hippel lindau.

golden brown kidney with haemorrhagic areas

160
Q

What gener is associated with wilms tumours

A

WT1 - white/tan mass in kidney

161
Q

in what condition are you more likely to get angiomyolipomas of the kidney

A

tuberous sclerosis associated with gene TSC-2

162
Q

in what condition are you more likely to get angiomyolipomas of the kidney

A

tuberous sclerosis associated with gene TSC-2

163
Q

What are the risk factors associated with renal cell carcinomas

A 
obesity
hypertension
unnopposed oestrogen
VHL
smoking
heavy metals
CKD
164
Q

what is the most comon prostate cancer

A

adenocarcinoma - craggy prostate PSA high

165
Q

what causes BPH

A

dihydrotestosterone of stromal and epithelial cells creating large nodules

166
Q

how do you treat BPH

A

5 alpha reductase inhibitors - preenting testosterone to DHT. finasteride or dutaseride
alpha blockers are thought to be useful too such as doxazocin.

167
Q

Name 3 types of testicular malignancy

A

Seminoma - most common - radiosensitive - 30yr olds
terratoma - germ cell tumours occur in any age from infancy. often present with painless enlargement. chemosensitive
Lymphoma - old men, aggressive and poor prognosis.

168
Q

Name 2 benign neoplasms of the testis which are stromal (sex cord)

A

Leydig cell and sertoli cell tumours.

169
Q

What causes acute prostatitis

A

usually from a UTI - similar bacteria such as E.coli, enterococcus or staph.

170
Q

biggest risk factor for germ cell tumours of the testis?

A

cryptorchidism - or undescended testis

171
Q

what is the most common type of kidney stone

A

calcium oxalate

172
Q

what causes cystitis

A

infection - e.coli or proteus most common.

more at risk with bladder calculi
can cause ascending infection

173
Q

How does proteus increase likelihood of stone formation - mainly magnesium stone

A

proteus makes urine more alkaline by secreting urease, hydrolysing urea to ammonia. can become very large and cause a staghorn calculus

174
Q

What is the most common type of bladder cancer

A

transitional cell - invasive infiltraing or non ivaisve papillary

non invasive pappillary - often recurrent and occur at various points - carcinogen assocaited.

invasive just spread out

175
Q

what causes calcium stone

A

absorption of too much calcium from gut. underlying predisposition.

176
Q

What is a papillary adenoma

A

<5mm nodules of benign tumour

177
Q

what is an oncocytoma

A

benign tumour of renal epithemium

178
Q

What is an angiomyolipoma

A

benign mesenchymal tumour of renal cell - fat, smooth muscle and vessels shown in tuberous sclerosis

179
Q

What cancer is associated with schistosomiasis

A

Squamous cell carcinoma

180
Q

Adenocarcinoma of the bladder

A

intenstinal metaplasia associated

181
Q

What is the complication of lichen sclerosus of the penis

A

phimosis

182
Q

how is nephritic syndrome characterised

A

by red cell casts and haematuria(abnormal red cells)

183
Q

how much protein do you need in urine to count as nephrotic syndrome

A

3g in 24 hours

184
Q

what is the mesangium

A

connective tissue which supports the arterioles within bowmans space.

contaisn cells called mesangial cells which are like smooth muscle cells and they tether the corners of the capilliary loops to the mesangium.

185
Q

What are the layers of the cells involved in filtration

A

fenestrated epithelium
basement membrane - type 4 collagen
podocytes

186
Q

what type of immune complex depotision leads to nephrotic syndrome

A

subepithelial - in between podocyte and BM

187
Q

What is the most serious immune deposition

A

subendothelial - because they are in contact with cells of the blood and have the abiity to recruit large amounts of inflammation which is very damamgin to structure.

188
Q

what mutation causes adult polycystic kidney diseas

A

PKD1 and PKD 2
AD - 10% of CKD are PCKD+ve
cysts cause pressure and result in loss of noral funtion

189
Q

Who gets aquired renal cysts

A
  • people with CKD
190
Q

Who gets aquired renal cysts

A
  • people with CKD and they have a risk of tranforming to carcinoma 7% at 10 years
191
Q

What is AKI

A

rapid loss of glomerular and tubular function. increased GFR and Creatinine and urea. HyperK. and acidosis.

192
Q

Acidosis and what derangement of potassium go hand in hand

A

hypERkalaemia -

193
Q

Acute glomerulonephritis is a cause of AKI, what are the others

A

Pre renal
renal
post rrenal

194
Q

What is the commonest cause of AKI

A

ATN - caused by ischemia

195
Q

what is the most common cause of CKD

A 
diabetes 20% 
glomerulonephritis - 15%
HTN and vascular disease - 15%
chronic pyelonephritis 10%
PCKD - 10%
196
Q

What are the causes of ATN

A

dehydration, bburns, septicaemia, drugs.

in this disease there is damage to the tubular epithelial cells. necrosis of short segments of tubule. causes leakage of fluid into surrounding interstitium and disrupts flow to other tubular cells aswell.

casts block the lumen.

197
Q

What is the difference between post strep glomerulonephritis and IgA nephropathy

A

Post strep GN - 2-3 weeks post group A alpha haemolytic strep. granular IgG deposits

IgA nephropathy - 1-2 days post URTI - frank haematuria.

198
Q

what is crescentic GN

A

a break in the glemrular luft causes leakage and recruitment of inflammatory cells into bowmans space.

they present like nephritis syndrome however oliguria and renal failure are much more common.

3 types : Anti GBM, immune complex, non imune (wegeners or p anca)

199
Q

What is lumpy bumpy deposition of immune complex

A

SLE, IgA nephropathy or post strep GN

200
Q

Alports syndrome

A

collagen type 4 (alpha 5 chain) x linked dominant mutation. causes nephritic syndrome, senorineural deafness

201
Q

Thin basement membrane disease

A

collagen type 4 (alpha 4 chain) AD defect.

normally asymptomatic haematuria. normal renal function.

202
Q

Causes of asytmptomatic haematuria

A

TCC
Thin basement membrane disease
alports syndrome
IgA nephropathy bergers

203
Q

kimmelsteil wilson nodules

A

secondary nephrotic syndrome due to diabetes.

diffuse basement membrane thickening which leads to microalbuminurea
proteinurea

204
Q

where is the deposition in post strep GN

A

subendothelial humps

205
Q

What are the 3 main causes of primary nephrotic syndrome

A

minimal change disease - kids - steroid sensitive
membranous glomerular disease
Focal segmental glomerulosclerosus (FSGS)

206
Q

what is the pathophysiology of minimal change disease

A

loss of podocyte foot process

207
Q

what is the pathophysiology of membranous glomerular disease

A

phospholipase a2 recepter autoantibodies cause Ig and compliment deposition in granuar form, with a thickening of the basememnt membrane, a loss of podocyte feet and subepithelial deposits

it may be secondary to SLE, infection, rugs, malig

the response to steroids is poor

208
Q

What is the pathophysiology behind FSGS

A

loss of podocyte foot, with areas of focal and segmental scarring. Ig and compliment in these areas

occurs in afro caribbean population and may be secondary to HIV

50% response to steroids

209
Q

what are the stages of lupus nephritis

A

stage 1 - mesangial - in the mesangium with no alteration to structure
stage 2 - mesangial proliferative - in the mesangium with some increase in mesangial cellularity
stage 3 - focal - active swelling and proliferation in less than half of the glomeruli
stage 4 - diffuse - active swelling and proliferation in more than half of the glomeruli
stage 5 - membranous - subepithelial complex deposition
stage 6 - advanced sclerosing - >90% of glomeruli completely sclrosed.

210
Q

What is the more common APCKD

A

PKD1 mutation 85% encoding polycystin 1

211
Q

what are the clinical features of APCKD

A

hamaturia, pain, UTI, ruptured cysts infection of cysts, haemoorhage of cysts.

212
Q

leukocytic casts

A

pyelonephritis

213
Q

reflux nephropathy

A

chronic scarring due to infections or blackages

214
Q

what are the sequelae of MAHAs

A

HUS - renal failure

TTP - seizures and neuro sx

215
Q

What is fitz hugh curtis syndrome

A

infection of the liver capsule from PID causing RUQ pain from perihepatitis.
gives violin string perihepatic adhesions.

216
Q

what are the complications of PID

A 
infertility
increased risk of ectopic - (scarring)
abcess
chronic pain
peritonitis
217
Q

what is salpingitis

A

infection of the fallopian tubes. often comes from the vagina and has repercussions including fusion and scarring, which lead to infertitlity and extopic risk. there is a risk of a hydrosalpynx.

218
Q

what are the macroscopic signs of endometriosis

A

chocolate cysts and powder burns - red blue to brown nodules.

219
Q

3 types of leiomyoma

A

intramural, submucosal, subserosal

benign tumour of smooth muscle origin causing haevy bleeding and sometimes pain and pressure effects

220
Q

what are the complications of fibroids

A

red/carneous degeneration of pregnancy which is caused by venous thrombosis of the vessels within the tumour resulting in

very small chance of becoming cancerous - leiomyosarcoma but normally arise de novo and have a poor prognosis.

221
Q

what are the complications of fibroids

A

red/carneous degeneration of pregnancy which is caused by venous thrombosis of the vessels within the tumour resulting in

very small chance of becoming cancerous - leiomyosarcoma but normally arise de novo and have a poor prognosis.

222
Q

what is adenomysosis

A

implantation of endometrial tissue in the myometrium

223
Q

What are the 2 types of endometrial cancer

A

T1 - Endometriod 80%
related to unnoposed oestrogen and 85% of these are adenocarcinomas but may show some squamous differentionation.
RX. obesity and PCOS are big risk factors. tamoxifen. nulliparoty or early menarche.

T2 - Non - endometriod
papillary, serous or clear cell.

224
Q

which mutation is assocaited with serous non endometriod cancers

A

p53

225
Q

which mutation is associated with clear cell non endometriod cancers

A

PTEN

226
Q

which mutation is associated with adenocarcinoma endometriod cancers

A

PTEN, Pi3KCA, KRAS

227
Q

What is the FIGO staging in endometrial cancer

A

1 - confined to uterus
2 - cervix
3 local spread - adnexa nodes
4 distant spread

228
Q

what is the most common type of ovarian carcinoma

A

serous epithelial. mimics tubular epithelium - columnar
contains psammoma bodies commonly

BRCA, Kras, BRAF

229
Q

what are the 4 types of epithelial ovarian cancers

A

serous - psammoma
mucinous - no psammomo
endometriod - mimics endometrium - tubular glands
clear cell - hobnail appearance.

230
Q

How do you differentiate pagets disease of the nipple and eczema

A

Intraductal carcinoma - pagets affects the nipple first wheras eczema affects the areola first. pagets may have lumps or other skin changes associated with breast cancer age in 60’s aerage.

231
Q

what is fibrocystic change

A

fibroadenOSIS -
cystic change - small cysts form by lobular dilation. they contain fluid which is less proteinacious than duct ectasia

fibrosis - inflammation and scarring due to cyst rupture

Adenosis - increased number of acini per lobule

232
Q

what is mammary duct ectasia

A

occurs in perimenopausal women, dilation of the large ducts, may cause thick white/ green discharge and granulomatous inflammation.
may have a poorly defined palpable areolar mass.
need to do cytology as mammography mimics cancer.

233
Q

Which condition of the breast is closely associated with smoking and what would you expect to see on histology?

A

periductal mastitis - not associated with breast feeding and would show keratinising squamous epithelium extending deep into the nipple orifaces.

234
Q

what would be seen on fibroadenoma histology

A

benign overproliferation of stromal cells squishing the surrounding ducts.

235
Q

what is an intraductal papilloma

A

bloody discharge with no lump not seen on mammogram

benign papillary tumour arising in the ducts of the breast. may be central or perpheral.

236
Q

What is a radial scar?

A

central scarring surrounded by proliferating glandular tissue - looks the same as a cancer on mamogram and carries a small risk of malignant transformation due to it proliferating. excision.

237
Q

stellate pattern

A

radial scar?

238
Q

what type of breast cancer do you get with BRCA

A

invasive

239
Q

name 3 possible causes of a unilateral ptosis

A

Horners (myosis, ptosis, anyhdrosis)
Myasthenia gravis
3rd cranial nerve palsy -

240
Q

What is c-anca actually against?

A

proteinase 3

241
Q

what is p anca actually against

A

myeloperoxidase abs

242
Q

raised AFP

A

cholangiocarcionma or HCC

243
Q

where do berry aneurysms normally form and what do they predispose to

A

85% of subarachnoid haemorrhage and they usally occur at the internal carotid bifurcation

244
Q

How does an extradural haemorrhage present?

A

usually knock to the head and rupture of the Middle meningeal artery. They are lucid initially and then LOC.

245
Q

how does a subdural present?

A

slow venous bleed presents with slow decline, fluctuating conciousness

elderley or alcoholics

246
Q

AV malformation

A

high pressure bleed.

247
Q

22q12

A

Neurofibromatosis 2 - meningioma

248
Q

3q25

A

Von hippel lindau

249
Q

IDH1 mutation

A

oligodendroglioma most commonglial tumours: glioblastoma and astrocytoma most comon

250
Q

are glial tumours infiltrative or commpressive

A

80% infiltrate

251
Q

pilocytic astrocytoma

A

meaning hairy

compressive margins usually present erly in life , benign and slow growing

252
Q

Medullablastoma

A

grade 4 present in cerebellar vermis in kids but in the hemishphere in adults. cerebellar signs

253
Q

meningioma

A

outer layer and compressive

often incidental but may cause focal symptoms

254
Q

Where do oligodendrogliomas present?

A

frontal and always supratentorial. IDH1

255
Q

optic gliomas

A

NF1

256
Q

NF2

A

vestibulocochlear nerve affected. 8

257
Q

difference between sporadic and variant CJD

A

Variant young

sporadic OLd

Variant psych first - depresison

sporadic - rapid dementia and neuro signs

variant - tonsillar biopsy

sporadic csf 14,3,3

258
Q

codon 129 - MM

A

susceptibility to prion disease

MV and VV are chill

259
Q

Alzheimers brain protein deposits

A

beta amyloid and abnormaly agregated TAU

260
Q

alpha synuclein and ubiquitin

A

demntia with lewy bdoides

261
Q

proliferation of type 2 pneumocytes?

A

clara cells adenocarcinoma secreting cells

262
Q

What 3 things exhibit koebnerfication

A

psoriasis
lichen planus
vitiligo
(SLE)

263
Q

loosers zones

A

pseudofracures seen in osteomalacia

can be seen in pagets too

264
Q

browns tumour

A

no matrix - seen in primary hyperparathyroidism

265
Q

huge osteoclasts

A

pagets disease

266
Q

what goes orange on tetracycline labelling

A

bone which is vit d deficient and unminerilised

267
Q

bone resortpion in the phalanges

A

primary hyperparathroidsim

268
Q

loss of cancellous bone -

A

osteoporosis this is the same as thin TRABECULAE.

269
Q

mosaic pattern of lamellar bone

A

pagets

270
Q

pagets disease symptoms

A 
bone pain
head change of shape (osteoporosis circumscripta)
deafness
nerve compresion
micro fracturews
271
Q

cut ofs for osteopenia

A

dexa - betwwen 1 and 2.5 standard deviations below the mean

272
Q

what is pseudo vitamin d deficicney

A

due to loss of problems with 1 alpha hydroxylase in the kidney

273
Q

pseudogout crystals

A

calcium pyrophosphate

274
Q

langhans giant cells?

A

TB of the bone

275
Q

positive bofringence?

A

pseudgout

276
Q

negative bifringence

A

gout

277
Q

treatment for pseudogout

A

NSAIDS and intraarticular steroids

278
Q

treatment for gout

A

colchicine in acute, allopurinol long term

reduce intake of alchol and purine rich foods.

279
Q

common causes of osteomyelitis in children

A

haemophilus, group b strep? but normally staph in adults.

280
Q

testicular tumour secreting AFP

A

terratoma also secretes LDH and HCG is considered malignant after

281
Q

what is renal osteodystrophy

A

bone pain and disorders due to inability to maintain proper calcium and phosphate levels. question may say dialysis

282
Q

what cell sits in howships lacunae?

A

osteoclasts

283
Q

causes of restrictive pericarditis

A

Sarcoid
amyloid
radiation

284
Q

causes of dilated cardiomyopathy

A

Sarcoid
Haemochromatosis
Alcohol
Genetic

Myocarditis
Peripartum.

285
Q

What 4 things characterise chirossis

A

Hepatocyte necrosis
fibrosis and scarring
nodules of regenerating hepatocytes
change in liveer architecture which causes shunting and the hepatocytes dont see the blood.

286
Q

what is surrounding the nodules of regenrating hepatocytes

A

fibrous cuff

287
Q

what are the other markers of PBC

A

high alp, high cholesterol, high IGM

288
Q

what is auspitz sign?

A

bleeding on rubbing of psoriasis

289
Q

What is the diagnostic criteria fr nephritic syndrome

A

Red and white cell casts, haematuria

They may also have some protein in the urine but not enough to warrant it being nephrotic syndrome
oliguria is likely and may be more severe still in crescenteric glomerulonephritis

urea and creatinine are raised

they have hypertension

290
Q

What are the secondary causes of nephrotic syndrome

A

diabetes - kimmelsteil wilson nodules in the mesangial matrix

amyloid due to chronic inflammation

myeloma

291
Q

Which breast lesions calcify

A

DCIS - can be either pre or post menopausal

292
Q

Which breast cancers are bilateral

A

LCIS - 20-40% bilateral

these also are mainly in younger pre menopausal women

293
Q

What is the difference between a phylodes tumour and a fibroadenoma

A

similar but phylodes usually bigger than 5cm, and can have malignant potentiol and is usually found in older women, wheras fibroadenoma is usually young (20-30)

294
Q

which type of cancer usually presents with pagets disease of the breast?

A

IDC

also causes pea d;orange, tethering and pain.

Joshua's Path (9 decks)

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