Histopathology Flashcards
1
Q
What happens when there is acute inflammation
A
neutrophil infiltration
2
Q
what happens when there is chronic inflammation
A
Lymphocyte and plasma cell infiltration
3
Q
What processes are eosinophilic
A
Allergic
parasitic
hodgkins lymphoma
sometimes myeloproliferative
4
Q
eosinophilic oesaphagitis will give what sign
A
feline contractions
5
Q
what types of process involve macrophages
A
late acute inflammation
chronic inflammation
6
Q
What is a the cell origin of a carcinoma
A
epithelial cell
squamous- keratin, intercellular bridges
adeno-mucin secreting(mucin stain), glandular
7
Q
What stain would one use for amyloid
A
congo red with apple green bifringence under polarised light
8
Q
what stain would one use for iron
A
prussian blue
9
Q
what does cytokeratin stain
A
epithelial cells
10
Q
4 layers of the artery wall (outer to inner)
A
Tunica externa
tunica media
tunica interna
basement membrane
11
Q
4 layers of the artery wall (outer to inner)
A
Tunica externa
tunica media
tunica interna
basement membrane
12
Q
Name 4 modifiable risk factors for atherosclerosis
A
Diabetes mellitus, Hypercholesterolaemia, smoking, hypertenstion
13
Q
~Name 3 non modifiable risk factors for atherosclerosis
A
Age, Gender(male), Fhx
14
Q
Name 3 non modifiable risk factors for atherosclerosis
A
Age(40plus), Gender(male. Premenopausal women protected by hormones), Fhx
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
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
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
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
19
Q
What are the common complications of acute pancreatitis?
A
Pseudocyst, abcess and haemorrhage(which has a 50% mortality rate)
20
Q
What are the complications of chronic pancreatitis?
A
Pseudocyst, malabsorption, diabetes mellitus, cancer.
21
Q
What are the causes of chronic pancreatitis
A
Haemochromatosis, alcoholism, CF, autoimmune, duct obstruction.
22
Q
IgG4 sclerosing plasma cells
A
autoimmune pancreatitis
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
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.
25
What is a rokitansky aschoff sinus
pseudodiverticulae of the gall bladder - associated with chronic cholecystitis
26
What is the most common type of pancreatic cancer
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.
27
Classical features of pancreatic cancer
painless jaundice.
weight loss and anorexia.
steattorhoea
diabetes
28
what is trousseaus SYNDROME
also known as trousseaus sign of malignancy.
recurrent superficial thrombophlebitis, often felt as a tender nodule.
associated with pancreas and lung cancer.
29
perilobular inflammation is caused by what?
due to acinar injury and is therefore associated with the other processes such as autoimmunity infection and drugs
30
Mucinous and serous cysts are what?
multilocular and unilocular respectively - panc ca
31
What is depositied in the kidneys in multiple myeloma?
amyloid light chain
amyloidosis causes AA chain - and sometimes in RA or TB too.
They cause nephrOtic sydrome.
32
What forms the fibrous white cap of atherosclerosis
vascular smooth muscle cells
33
what are the 6 common causes of heart failure
```
IHD
myocarditis
Arythmias
hypertension
valve disease
dilated cardiomyopathy
```
34
What are the mechnical complications of MI
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
35
What are the arythmia complications of MI
Arythmias:
VF usually occurs in the first 24 hours and is common cause of death
Other arythmia - AF, long QT
36
What are the pericardial complications of MI
Pericardial:
pericarditis
Effusion - and tamponade
Dresslers syndrome - immune mediated pericarditis on 2nd or 3rd day v painful fevers and effusion
37
who has the worst prognosis in MI
Women, old, previous MI and diabetics
38
What is dilated cardiomyopathy
loss of cardiac myocytes leading to systolic dysfunction
39
what is restrictive cardiomopathy
big atria with normal size ventricles and a loss of diastolic function due abnormal relaxation. no filling.
40
when would you see myocyte dissarray
Hypertrophic cardiomyopathy
41
what valve is typically affected by rheumatic fever
mitral valve - but may affect mitral AND aortic
42
What is the pathogenesis behind rheumatic fever
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
43
aschoff bodies
small giant cell granulomas - rheumatic fever
44
anitschkov myocytes
regenerating myocytes - rheumatic fever
45
Anti streptolysin o titre
rheumatic fever - with raised ESR
46
how do you treat rheumatic fever
Ben pen or erythromycin. steroids.
47
what would you see on a rheumative heart valve
small warty vegetations found along the lines of closure. verruccae
48
roth spots
infective endocarditis
49
name 5 obstructive respiratory disease processes
```
Asthma
Chronic bronchitis
bronchiectasis
Emphysema
bronchiolitis - small airway disease
```
50
in what condition do you get centrolobular bullae
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
51
what are heart failure cells
iron laiden macrophages that have mopped up blood
52
what happens to children who have hyaline membrane disease
go on to get bronchopulmonary dysplasia - scarring
53
curschmann's spiral
asthma
54
charcot leyden crystals
asthma
55
codmans triangel
osteosarcoma
56
fluffy calcifications of the axial skeleton
chondrosarcoma - malignant chondrocytes - cartilage. occurs in over 40's
57
t(11,22) translocation
ewings sarcoma - under 20's
| is a primative peripheral neuroectodermal tumour occuring in the diaphysis.
58
where do metaphysis diaphysis and epiphysis occur
```
E
M
D
M
E
```
59
cd99+ve mic-2
ewing's sarcoma - under 20's
| is a primitive peripheral neuroectodermal tumour occuring in the diaphysis.
60
5 causes of an eosinophilia
```
asthma
parastitic infection
drug allergy
lymphomas
RA
polyarteritis
```
61
which tumours of lung occur centrally?
small cell and squamous cell
62
Which lung tumours occur peripherally
adenocarcinoma
63
What is the most common lung cancer?
squamous cell and is closely associated with smoking. however small cell is literally always a smoker.
64
what is the most common lung cancer for a non smoker
adenocarcinoma (20-30%) and often have a predilection for women.
65
What is the problem with bevacizumab
can cause fatal haemorrhage. VEGF monoclonal ab
66
What 2 things would you see on histology of a squamous cell lung carcinoma
keratinisation
intercellular pickles
Also associated with hypercalcaemia and cavitation.
67
What staging is used in Lung cancers
```
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
68
What does ERCC1 - NSCLC predict
poor response to cisplatin
69
What does a Kras mutation mean in lung cancers
usually non response to TKIs
70
What does EML4 - ALK mean?
no benefit from TKI
| solid signet ring pattern
71
What kind of tumour is small cell carcinoma of the lung?
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
72
What is the name of the EGFR tyrosine kinase inhibitor
ertlotinib
| used typically in adenocarcinoma of the lung
73
What would you see on histology of a small cell carcinoma
oat cell
74
What type of rash is seen in lyme disease
erythema migrans - NOT marginatum - this is rheumatic fever
75
What is aflotoxin
produced by aspergillus and causes hepatocellular carcinoma
76
What is one of the worse types of mesothelioma
sarcomatoid
77
what is virchows triad
stasis, vessel wall damage, hypercoaguable state
78
What are the sequelae of a PE
wedge shaped infarcts, if a large one greater than 60% of pulmonary bed occluded, can cause death.
79
what is for pulmonale
right heart failure as a result of pulmonary pathology e.g PE causing increased vascular resistance
80
What staging is used in Lung cancers
```
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
81
What does ERCC1 - NSCLC predict
poor response to cisplatin
82
What does a Kras mutation mean in lung cancers
usually non response to TKIs
83
What does EML4 - ALK mean?
no benefit from TKI
| solid signet ring pattern
84
How do you divide up pulmonary hypertension, and how is it defined?
Pre capilliary
capilliary
post capilliary
defined as >25mmhg at rest (pulmonary arterial pressure)
85
Which lung cancer is associated with RB1 mutation
small cell
86
which lung cancers are associated with p53 mutations
mainly squamous, and small cell
87
What are the risk factors for squamous cell carcinoma of the oesophagus
alcohol, smoking, plummer vinson syndrome, HPV
88
What would you see on histology of a SCC of the oesophagus
intercellular bridges and keratin.
found in middle 1/3 50% then 30% in lower and 20 in upper
89
How does an SCC of the oesophagus present
progressive dysphagia - solids then fluids, and then odynophagia.
90
where does h pylori tend to populate
antrum of the stomach
91
Histology of acute gastritis
neutrophils
92
Histology of chronic gastritis
lymphocytes and plasma cells
93
what is considered a gastric ulcer
when the muscularis mucosa has been breached and you are into submucosa
it can lead to intestinal metaplasia and therefore adenocarcinoma
94
which ulcer is better with food
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
95
what is the triple therapy for H pylori
PPI, clarythromycin and amox/metro
96
Whcih HLA types predispose to coeliac disease?
HLA DQ2 DQ8
97
What is the main risk of untreated coeliac disease
10% get duodenal t cell lymphoma
98
What causes hirschsprungs disease and what is it associated with?
absence of ganglion cells in the myenteric plexus, 2% in downs patients
99
what does the histology of hirschsprungs disease show?
a rectal biopsy shows hypertrophied nerve fibres with no ganglia.
100
what is the treatment for hirschsprungs disease
remove the affected segment.
101
Where does ischemic colitis occur and why?
Occurs at the watershed areas such as the splenic flexure where SMA transitions to the IMA. and the rectosigmoid. arterial or venous occlusion
102
Peak age of Chrons
20's
103
Peak age of UC
20-25
104
pathophysiology of chrons
Cobblestone appearance, skip lesions, transmural inflammation, non casseating granulomas, rosethorn and apthous ulcers.
105
extra - GI manifestations of IBD
Pyoderma gangrenosum, erythema nodosum, erythema multiforme, clubbing, uveitis. joint problems including ank spond,
PSC (UC>cd)
106
what is the main risk of UC
at 20-30 times risk of adenocarcinoma
toxic megacolon - dilation and perf
107
What is the twin concordence in IBD
50% in chrons, and 15% in UC
108
In which IBD is pain relieved on defecation
UC
109
What is carcinoid syndrome?
Paraneoplastic syndrome whereby there is production of 5-HT. enterochromaffin cell origin. usually found in bowel.
110
What are the symptoms of carcinoid syndrome
bronchoconstriction, flushing and diarrhoea
111
how do you test for and treat carcinoid syndrome
24hr urinary 5-HIAA main metabolite of serotonin
octreotide
112
what is an adenoma
bening dysplastic lesion - adenocarcinoma precursor
113
at what point do adenomas need surveillance?
3.4cm - 45% will become malignant.
114
what is the main gene involved in adenoma formation?
APC - people with FAP are born with a mutation in thi s gene.
others important mutations include Kras, p53, LOF
115
what are the systemic sequelae of a villous adenoma
hypoproteinemic hypokalaemia - leak protein and K
there are tubular types too which look likea row of test tubes
villous look like a little amoeba
116
What are the 3 layers of the GI mucosa
epithelieum
lamina propria
muscularis mucosa
117
what are the 3 layers below the mucosal layer of the GI tract
sub mucosa
muscularis propria
serosa
118
what is peutz jeugers syndrome
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
What is a pseudopolyp
scar tissue from IBD, from granulation tissue in repeated cycles of ulceration.
120
What type of cancer is colorectal cancer
98% are adenocarcinomas
121
what are the clinical features of a cloretal cancer
Left sided: change in bowel habit and LLQ pain
Right sided: FE def anaemia, weight loss
monitor CEA
122
What is Dukes staging?
```
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
where is the FAP gene
APC C5Q1 70% AD mutatoin
124
What is the mutation in HNPCC
DNA mismatch repair gene - autosomal dominant
125
what is secretin
Hormose released by s cells of the duodenum to stimulate pancreatic and liver enzyme reslease
126
what is high blood pressure
140/90
127
what is dislipidaemia
HDL <1 and a TG>2
128
what is cck
cholecystokinin - released form I cells of the dudenum.
129
what is the main symptom of a VIPoma
diarrhoea
130
MEN1
PPP
Parathyroid hyperplasia
Pancreatic endocrine tumour
pituitary adenoma
131
MEN2a
Parathyroid
132
what is a lymphocytosis
too may tylphocytes
133
what is the limiting plate
the border between the hepatocytes and the portal tract
134
what are the causes of micronodular chirrosis
<3mm nodules with uniform liver involvement
alcoholic hepatitis and biliary tract disease, and haemochromatosis
135
what are the causes of macro nodular cirrhosis
viral hepatitis, alpha 1 antitrypsin disease and wilsons disease
136
what are the complications of cirrhosis
portal hypertension
hepatic encephalopathy
hepatocellular carcinoma
137
spotty necrosis
acute hepatitis
138
in liver pathology what does grade mean
severity of inflammation
139
in liver pathology what does stage mean
extent of fibrosis
140
what are the 3 types of alcoholic liver disease
```
fatty liver (steatosis)(fully reversible)
alcoholic hepatitis (mallory bodies+hepatocyte ballooning)
alcoholic cirrhosis
```
141
HLA DR3
autoimmune hepatitis
142
what is the cause of NAFLD
insulin resistance i.e BMI and DM
143
what is the cause of PBC
loss of MEDIUM SIZED bile ducts due to autoimmune destruction.
Anti- mitochondrial antibodies are positive in >90%
144
what would be seen on PBC histology
bile duct loss with granulomas
145
what would be seen on histology of PSC
Onion skin fibrosis and scarring. multifocal strictures of intra and extrahepatic bile ducts.
146
what are you more likely to get with primary sclerosing cholangitis
cholangiocarcinoma
147
Is it true that men are more likely to get PBC and PSC
yes to PSC, but no to PBC - 10 times more in women
148
where is the iron in haemochromatosis
Parenchyma of the liver. hepatocytes.
| also in heart pancreas adrneals skin jonts pituitary
149
what is the difference between haemosiderosis and haemochromatosis
haemosiderosis - iron in the macrophages and does not cause cirhosis or hepatititis
150
what stain is used for copper
rhadanine
151
what is seen on histology of wilsons disease
mallory bodies and fibrosis
leads to hepatitis, cirhosis and fulminant failure. also kayser fleisher rings
152
what would you find on the histology of alpha 1 antitrypsin deficinecy
intracytoplasmic inclusions of A1AT and stain with periodic acid schiff
153
what are the markers of autoimmune hepatitis
anti smooth muscle and ANA, anti actin and anti soluble liver antigen.
disease mediated by plasma cells -
154
What are the causes of granulomas in the liver
specific - PBC and drugs
| general - sarcoid and tb
155
What is an endothelial cell tumour of the liver
haemangioma - very common
156
What happens to the body of the stomach in pernicious anaemia
becomes atrophic and there is mucinous change - intenstinal metaplasia
157
What carcinoma with h pylori?
adenocarcinoma - but also lymphoma.
158
What paraneoplastic syndromes are associated with renal cell carcinomas
polycythaemia, hypercalcaeima, HTN, cushings, amyloid.
159
What is the most common renal cancer and what mtation is it associated with
clear cell carcinoma - 3p loss von hippel lindau.
| golden brown kidney with haemorrhagic areas
160
What gener is associated with wilms tumours
WT1 - white/tan mass in kidney
161
in what condition are you more likely to get angiomyolipomas of the kidney
tuberous sclerosis associated with gene TSC-2
162
in what condition are you more likely to get angiomyolipomas of the kidney
tuberous sclerosis associated with gene TSC-2
163
What are the risk factors associated with renal cell carcinomas
```
obesity
hypertension
unnopposed oestrogen
VHL
smoking
heavy metals
CKD
```
164
what is the most comon prostate cancer
adenocarcinoma - craggy prostate PSA high
165
what causes BPH
dihydrotestosterone of stromal and epithelial cells creating large nodules
166
how do you treat BPH
5 alpha reductase inhibitors - preenting testosterone to DHT. finasteride or dutaseride
alpha blockers are thought to be useful too such as doxazocin.
167
Name 3 types of testicular malignancy
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
Name 2 benign neoplasms of the testis which are stromal (sex cord)
Leydig cell and sertoli cell tumours.
169
What causes acute prostatitis
usually from a UTI - similar bacteria such as E.coli, enterococcus or staph.
170
biggest risk factor for germ cell tumours of the testis?
cryptorchidism - or undescended testis
171
what is the most common type of kidney stone
calcium oxalate
172
what causes cystitis
infection - e.coli or proteus most common.
more at risk with bladder calculi
can cause ascending infection
173
How does proteus increase likelihood of stone formation - mainly magnesium stone
proteus makes urine more alkaline by secreting urease, hydrolysing urea to ammonia. can become very large and cause a staghorn calculus
174
What is the most common type of bladder cancer
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
what causes calcium stone
absorption of too much calcium from gut. underlying predisposition.
176
What is a papillary adenoma
<5mm nodules of benign tumour
177
what is an oncocytoma
benign tumour of renal epithemium
178
What is an angiomyolipoma
benign mesenchymal tumour of renal cell - fat, smooth muscle and vessels shown in tuberous sclerosis
179
What cancer is associated with schistosomiasis
Squamous cell carcinoma
180
Adenocarcinoma of the bladder
intenstinal metaplasia associated
181
What is the complication of lichen sclerosus of the penis
phimosis
182
how is nephritic syndrome characterised
by red cell casts and haematuria(abnormal red cells)
183
how much protein do you need in urine to count as nephrotic syndrome
3g in 24 hours
184
what is the mesangium
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
What are the layers of the cells involved in filtration
fenestrated epithelium
basement membrane - type 4 collagen
podocytes
186
what type of immune complex depotision leads to nephrotic syndrome
subepithelial - in between podocyte and BM
187
What is the most serious immune deposition
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
what mutation causes adult polycystic kidney diseas
PKD1 and PKD 2
AD - 10% of CKD are PCKD+ve
cysts cause pressure and result in loss of noral funtion
189
Who gets aquired renal cysts
- people with CKD
190
Who gets aquired renal cysts
- people with CKD and they have a risk of tranforming to carcinoma 7% at 10 years
191
What is AKI
rapid loss of glomerular and tubular function. increased GFR and Creatinine and urea. HyperK. and acidosis.
192
Acidosis and what derangement of potassium go hand in hand
hypERkalaemia -
193
Acute glomerulonephritis is a cause of AKI, what are the others
Pre renal
renal
post rrenal
194
What is the commonest cause of AKI
ATN - caused by ischemia
195
what is the most common cause of CKD
```
diabetes 20%
glomerulonephritis - 15%
HTN and vascular disease - 15%
chronic pyelonephritis 10%
PCKD - 10%
```
196
What are the causes of ATN
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
What is the difference between post strep glomerulonephritis and IgA nephropathy
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
what is crescentic GN
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
What is lumpy bumpy deposition of immune complex
SLE, IgA nephropathy or post strep GN
200
Alports syndrome
collagen type 4 (alpha 5 chain) x linked dominant mutation. causes nephritic syndrome, senorineural deafness
201
Thin basement membrane disease
collagen type 4 (alpha 4 chain) AD defect.
| normally asymptomatic haematuria. normal renal function.
202
Causes of asytmptomatic haematuria
TCC
Thin basement membrane disease
alports syndrome
IgA nephropathy bergers
203
kimmelsteil wilson nodules
secondary nephrotic syndrome due to diabetes.
diffuse basement membrane thickening which leads to microalbuminurea
proteinurea
204
where is the deposition in post strep GN
subendothelial humps
205
What are the 3 main causes of primary nephrotic syndrome
minimal change disease - kids - steroid sensitive
membranous glomerular disease
Focal segmental glomerulosclerosus (FSGS)
206
what is the pathophysiology of minimal change disease
loss of podocyte foot process
207
what is the pathophysiology of membranous glomerular disease
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
What is the pathophysiology behind FSGS
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
what are the stages of lupus nephritis
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
What is the more common APCKD
PKD1 mutation 85% encoding polycystin 1
211
what are the clinical features of APCKD
hamaturia, pain, UTI, ruptured cysts infection of cysts, haemoorhage of cysts.
212
leukocytic casts
pyelonephritis
213
reflux nephropathy
chronic scarring due to infections or blackages
214
what are the sequelae of MAHAs
HUS - renal failure
| TTP - seizures and neuro sx
215
What is fitz hugh curtis syndrome
infection of the liver capsule from PID causing RUQ pain from perihepatitis.
gives violin string perihepatic adhesions.
216
what are the complications of PID
```
infertility
increased risk of ectopic - (scarring)
abcess
chronic pain
peritonitis
```
217
what is salpingitis
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
what are the macroscopic signs of endometriosis
chocolate cysts and powder burns - red blue to brown nodules.
219
3 types of leiomyoma
intramural, submucosal, subserosal
benign tumour of smooth muscle origin causing haevy bleeding and sometimes pain and pressure effects
220
what are the complications of fibroids
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
what are the complications of fibroids
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
what is adenomysosis
implantation of endometrial tissue in the myometrium
223
What are the 2 types of endometrial cancer
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
which mutation is assocaited with serous non endometriod cancers
p53
225
which mutation is associated with clear cell non endometriod cancers
PTEN
226
which mutation is associated with adenocarcinoma endometriod cancers
PTEN, Pi3KCA, KRAS
227
What is the FIGO staging in endometrial cancer
1 - confined to uterus
2 - cervix
3 local spread - adnexa nodes
4 distant spread
228
what is the most common type of ovarian carcinoma
serous epithelial. mimics tubular epithelium - columnar
contains psammoma bodies commonly
BRCA, Kras, BRAF
229
what are the 4 types of epithelial ovarian cancers
serous - psammoma
mucinous - no psammomo
endometriod - mimics endometrium - tubular glands
clear cell - hobnail appearance.
230
How do you differentiate pagets disease of the nipple and eczema
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
what is fibrocystic change
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
what is mammary duct ectasia
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
Which condition of the breast is closely associated with smoking and what would you expect to see on histology?
periductal mastitis - not associated with breast feeding and would show keratinising squamous epithelium extending deep into the nipple orifaces.
234
what would be seen on fibroadenoma histology
benign overproliferation of stromal cells squishing the surrounding ducts.
235
what is an intraductal papilloma
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
What is a radial scar?
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
stellate pattern
radial scar?
238
what type of breast cancer do you get with BRCA
invasive
239
name 3 possible causes of a unilateral ptosis
Horners (myosis, ptosis, anyhdrosis)
Myasthenia gravis
3rd cranial nerve palsy -
240
What is c-anca actually against?
proteinase 3
241
what is p anca actually against
myeloperoxidase abs
242
raised AFP
cholangiocarcionma or HCC
243
where do berry aneurysms normally form and what do they predispose to
85% of subarachnoid haemorrhage and they usally occur at the internal carotid bifurcation
244
How does an extradural haemorrhage present?
usually knock to the head and rupture of the Middle meningeal artery. They are lucid initially and then LOC.
245
how does a subdural present?
slow venous bleed presents with slow decline, fluctuating conciousness
elderley or alcoholics
246
AV malformation
high pressure bleed.
247
22q12
Neurofibromatosis 2 - meningioma
248
3q25
Von hippel lindau
249
IDH1 mutation
oligodendroglioma most commonglial tumours: glioblastoma and astrocytoma most comon
250
are glial tumours infiltrative or commpressive
80% infiltrate
251
pilocytic astrocytoma
meaning hairy
| compressive margins usually present erly in life , benign and slow growing
252
Medullablastoma
grade 4 present in cerebellar vermis in kids but in the hemishphere in adults. cerebellar signs
253
meningioma
outer layer and compressive
| often incidental but may cause focal symptoms
254
Where do oligodendrogliomas present?
frontal and always supratentorial. IDH1
255
optic gliomas
NF1
256
NF2
vestibulocochlear nerve affected. 8
257
difference between sporadic and variant CJD
Variant young
sporadic OLd
Variant psych first - depresison
sporadic - rapid dementia and neuro signs
variant - tonsillar biopsy
sporadic csf 14,3,3
258
codon 129 - MM
susceptibility to prion disease
MV and VV are chill
259
Alzheimers brain protein deposits
beta amyloid and abnormaly agregated TAU
260
alpha synuclein and ubiquitin
demntia with lewy bdoides
261
proliferation of type 2 pneumocytes?
clara cells adenocarcinoma secreting cells
262
What 3 things exhibit koebnerfication
psoriasis
lichen planus
vitiligo
(SLE)
263
loosers zones
pseudofracures seen in osteomalacia
can be seen in pagets too
264
browns tumour
no matrix - seen in primary hyperparathyroidism
265
huge osteoclasts
pagets disease
266
what goes orange on tetracycline labelling
bone which is vit d deficient and unminerilised
267
bone resortpion in the phalanges
primary hyperparathroidsim
268
loss of cancellous bone -
osteoporosis this is the same as thin TRABECULAE.
269
mosaic pattern of lamellar bone
pagets
270
pagets disease symptoms
```
bone pain
head change of shape (osteoporosis circumscripta)
deafness
nerve compresion
micro fracturews
```
271
cut ofs for osteopenia
dexa - betwwen 1 and 2.5 standard deviations below the mean
272
what is pseudo vitamin d deficicney
due to loss of problems with 1 alpha hydroxylase in the kidney
273
pseudogout crystals
calcium pyrophosphate
274
langhans giant cells?
TB of the bone
275
positive bofringence?
pseudgout
276
negative bifringence
gout
277
treatment for pseudogout
NSAIDS and intraarticular steroids
278
treatment for gout
colchicine in acute, allopurinol long term
| reduce intake of alchol and purine rich foods.
279
common causes of osteomyelitis in children
haemophilus, group b strep? but normally staph in adults.
280
testicular tumour secreting AFP
terratoma also secretes LDH and HCG is considered malignant after
281
what is renal osteodystrophy
bone pain and disorders due to inability to maintain proper calcium and phosphate levels. question may say dialysis
282
what cell sits in howships lacunae?
osteoclasts
283
causes of restrictive pericarditis
Sarcoid
amyloid
radiation
284
causes of dilated cardiomyopathy
Sarcoid
Haemochromatosis
Alcohol
Genetic
Myocarditis
Peripartum.
285
What 4 things characterise chirossis
Hepatocyte necrosis
fibrosis and scarring
nodules of regenerating hepatocytes
change in liveer architecture which causes shunting and the hepatocytes dont see the blood.
286
what is surrounding the nodules of regenrating hepatocytes
fibrous cuff
287
what are the other markers of PBC
high alp, high cholesterol, high IGM
288
what is auspitz sign?
bleeding on rubbing of psoriasis
289
What is the diagnostic criteria fr nephritic syndrome
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
What are the secondary causes of nephrotic syndrome
diabetes - kimmelsteil wilson nodules in the mesangial matrix
amyloid due to chronic inflammation
myeloma
291
Which breast lesions calcify
DCIS - can be either pre or post menopausal
292
Which breast cancers are bilateral
LCIS - 20-40% bilateral
| these also are mainly in younger pre menopausal women
293
What is the difference between a phylodes tumour and a fibroadenoma
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
which type of cancer usually presents with pagets disease of the breast?
IDC
| also causes pea d;orange, tethering and pain.
