Histopathology Flashcards
1
Q
Takayasus arteritis
A
Large vessel vasculitis
Pulseless, bruits and claudication
2
Q
Temporal arteritis
A
Tender scalp and headache
Large vessel vasculitis
3
Q
Granulomatosis transmural inflammation, giant calls and skip lesions on biopsy of a large vessel
A
Temporal arteritis
4
Q
Corkscrew appearance on angiogram
A
Beurger’s disease
5
Q
Polyarteritis nodosa
A
Renal involvement and micro-aneurysm
Medium vessel vasculitis
6
Q
Pulmonary haemorrhage and cresenteric glomerulonephritis
A
Wegener’s granulomatosis
7
Q
CANCA
A
Wegener’s granulomatosis
8
Q
Asthma and eosinophilia with pANCA
A
Churg Strauss
9
Q
Microscopic polyangitis
A
Pulmonary renal syndrome = pulmonary haemorrhage and glomerulonephritis
10
Q
pANCA (2)
A
Churg Strauss
Microscopic polyangitis
11
Q
Abdominal pain, glomerulonephritis and a purpuric rash
A
Hennoch-Schonlein Purpura
12
Q
Antibody type mediating HSP
A
IgA
13
Q
Nephrotic syndrome, cardiomegaly and hepatosplenomegaly
A
Amyloidosis
14
Q
Test for amyloidosis
A
Congo red stain showing apple green birefringence (due to the beta pleated sheet conformation)
15
Q
Non-caseating granulomas
A
Sarcoidosis
16
Q
Cause of the non-caseating granulomas in sarcoidosis
A
Schauman and asteroid bodies
17
Q
Fine nodular shadowing and bilateral hilar lymphadenopathy is indicative of what disease process
A
Sarcoidosis (pulmonary infiltrates cause the fine nodular shadowing)
18
Q
Painless rubbery lymphadenopathy with high Ca, high ESR and raised ACE levels
A
Sarcoidosis
NB: is a diagnosis of exclusion
19
Q
Basal ganglia stroke in a patient with known hypertension and Charcot-Bouchard microaneurysms
A
Intraparenchymal haemorrhage
20
Q
Thunderclap headache
A
Subdural haemorrhage
21
Q
What do polycystic kidneys put you at increased risk of?
A
Berry aneurysms and therefore subarachnoid haemorrhage
22
Q
Lucid interval before a LoC
A
Extradural haemorrhage
23
Q
An elderly, alcoholic with a fall and a blow to the head is at increased risk of what?
A
Subdural haemorrhage
24
Q
CSF showing - high lymphocytes, low glucose and high protein. Fibrin webs are also visualised
A
Tb meningitis
25
Causes of bacterial meningitis in a neonate (3)
E. coli
Listeria
Group B strep
26
Causes of bacterial meningitis in a young adult (2)
Strep. Pneumoniae
| N. Meningitidis
27
Causes of viral meningitis in a neonate (4)
HIV
Mumps
Coxsackie
Echovirus
28
Causes of viral encephalitis (2)
HSV1
| Rabies
29
Brain tumour type seen in neurofibromatosis II
Meningioma
30
Ventricular tumour and hydrocephalus
Ependymoma
31
Indolent brain tumour in a child
Pilocytic astrocytoma
32
Soft, gelatinous and calcified brain tumour
Oligodendroma
33
CT shows generalised brain atrophy - widened sulci, narrowed gyri and enlarged ventricles
Alzheimer's Disease
34
Treatments for Alzheimer's disease (3)
Anti-cholinesterases
nAChR agonists
Glutamate antagonists
35
Pathological protein in Lewy body dementia (2)
Alpha synuclein and ubiquitin
36
What is a Lewy body
Alpha synuclein inclusions
37
Myelin Basic Protein and proteo-lipid protein as markers for what?
Multiple Sclerosis
38
Shy Drager
Autonomic dysfunction
39
Three features of multi-system atrophy
Autonomic dysfunction
Striatonigral involvement --> movement difficulty
Olivopontocerebellar --> balance and co-ordination difficulty
40
Three types of pathology underlying nephrotic syndrome
Minimal change disease
Membranous glomerular disease
Focal segmental glomerulosclerosis
41
Three features of nephrotic syndrome
Oedema
Hypoalbuminaemia
Proteinuria >3g/24h
42
Child with nephrotic syndrome. Electron microscopy shows loss of podocyte foot processes
Minimal change disease
43
What treatment do you give to children with minimal change disease and what percent respond?
90% respond to steroids
44
Nephrotic syndrome with diffuse GBM thickening and spiked subepithelial deposits of Ig and complement along the entire GBM.
Membranous glomerular disease
45
What percent of membranous glomerular disease progress to ESRF
40%
46
Nephrotic syndrome with segmental glomerular consolidation, hyalinosis and scars containing Ig and complement
Focal segmental glomerulosclerosis
47
What % of focal segmental glomerulosclerosis respond to steroids
50%
48
Kimmelsteil Wilson nodules (mesangial matrix) and diffuse GBM thickening is seen in what?
Diabetes
49
Features of nephritic syndrome (5)
```
Haematuria
RBC casts in urine
Hypertension
High urea and creatinine
Oliguria
```
50
Five types of nephritic syndrome
```
Acute post infectious GN
IgA nephropathy
Cresenteric (rapidly progressive) GN
Alports syndrome
Thin basement membrane disease
```
51
Granular IgG and C3 deposits in GBM with subendothelial humps in nephritic syndrome
Acute post infectious GN
52
High ASOT titre, low C3, nephritic syndrome and increased cellularity of glomeruli
Acute post infectious GN
53
What causes acute post-infectious GN
Post strep throat/impetigo
| Damage is caused by immune complex deposition
54
Frank haematuria 2 days after URTI
IgA nephropathy
55
granular IgA deposition and complement in the mesangium
IgA nephropathy - nephritic syndrome
56
Three types of cresenteric GN
Goodpastures - antiGBM antibody
Immune complex mediated - SLE/IgA
ANCA associated - Wegener's
57
Cresenteric glomerulonephritis with linear IgG deposition and lung involvement
Goodpastures
58
Cresenteric glomerulonephritis with granular deposition
Immune complex mediated ie SLE
59
Cresenteric glomerulonephritis with a lack of immune complex deposition visualised, vasculitis +/- pulmonary haemorrhage
ANCA associated - wegener's granulomatosis
60
Nephritic syndrome, sensorineural deafness and lens dislocation
Alports syndrome
61
Inheritance of alports syndrome
X linked
62
Deficit in Alports syndrome
IV collagen 5a chain
63
Microscopic haematuria and a mutation in IV collagen as a rare cause of nephritic syndrome
Thin basement membrane disease - common as autosomal dominant but rare cause of nephritic syndrome
64
Necrosis of short segments of the kidney tubules shortly after commencing gentamicin
Acute tubular necrosis
65
Four causes of tubulointerstitial nephritis
Acute pyelonephritis
Chronic pyelonephritis
Acute interstitial nephritis
Chronic interstitial nephritis
66
Fever, chills and renal angle tenderness with leukocytic casts in the urine.
Acute pyelonephritis
67
Most common causative agent for acute pyelonephritis
E. coli
68
Features of chronic pyelonephritis
Parenchyma scars due to recurrent infection
| Often on a picture of chronic obstruction ie posterior urethral valves/reflux nephropathy
69
What is the cause of acute interstitial nephritis
Hypersensitivity reaction often to drugs
70
How does someone with acute interstitial nephritis present?
Fever, rash, haematuria, eosinophilia and proteinuria
71
Elderly lady with long term analgesic use presents with anaemia, proteinuria and haematuria.
Chronic interstitial nephritis
72
What is the pathogenesis of thrombotic microangiopathies?
Widespread fibrin deposition in vessels --> platelet-fibrin thrombus --> platelet and RBC destruction --> thrombocytopenia and MAHA
73
Child with diarrhoea presents with pallor, jaundice and signs of deranged renal function
HUS - E coli caused
74
Low Hb, raised bilirubin, low platelets and raised reticulocytes with high LDH. Fragmented RBCs on blood smear and Coombs negative
TTP
75
Increased serum creatinine and urea, high potassium, low calcium and metabolic acidosis.
Acute renal failure
76
Define chronic renal failure
Progressive and irreversible loss of renal function
77
What are the different stages of kidney failure
1 Kidney damage but normal renal function
>90 GFR
2 Mildly impaired
60-89 GFR
3 Moderately impaired
30-59 GFR
4 Severely impaired
15-29 GFR
5 Renal failure <15 GFR
78
Inheritance of adult polycystic kidney disease
Autosomal dominant
| 85% PKD1 mutation - liver cysts
79
Six types of lupus nephritis
```
Minimal mesangial LN
Mesangial proliferative LN
Focal LN
Diffuse LN
Membranous LN
Advanced sclerosing LN
```
80
Minimal mesangial lupus nephritis
Immune complex deposition but no structural changes
81
Mesangial proliferative lupus nephritis
Increased mesangial matrix and increased cellularity
82
Focal Lupus Nephritis
Active swelling and proliferation of under 1/2 the glomeruli
83
Diffuse lupus nephritis
Over 1/2 the glomeruli involved with immune complex deposition
84
Membranous lupus nephritis
Subepithelial immune complex deposition
85
Advanced sclerosing lupus nephritis
Over 90%glomeruli sclerosed
86
Costovertebral pain
Renal cell carcinoma
87
"Powder burns" and "chocolate cysts"
Endometriosis
88
Adenomyosis
Ectopic endometrial tissue in the myometrium
Globular uterus
89
Staging for endometrial carcinoma
FIGO staging
90
What type of carcinoma are the majority of endometrial carcinomas?
Endometriod in 80% due to oestrogen excess of which 85% are adenocarcinomas
91
Elderly lady with endometrial atrophy and multiple metastases
Non-endometriod endometrial carcinoma - papillary, serous or clear cell.
92
HPV 16
Vulval intraepithelial neoplasia
93
Vulval intraepithelial neoplasia in a younger women is associated with what?
Warty/basiloid SCC
94
Vulval intraepithelial neoplasia in an older woman is associated with what?
Keratinising SCC with a increased risk of malignant transformation
95
Four types of epithelial ovarian carcinoma
Serous cystadenoma
Mucinous cystadenoma
Endometroid
Clear cell
96
What percentage of ovarian carcinomas are
A) epithelial
B) Germ cell
C) sex cord/stroma
A) 70%
B) 20%
C) 10%
97
Ovarian carcinoma in a woman of 35 which mimics tubal columnar epithelium and contains Psammoma bodies
Serous cystadenoma
98
Ovarian carcinoma which secretes both mucin and oestrogen
Mucinous cystadenoma
99
Ovarian carcinoma with histology showing clear cytoplasm and a hobnail appearance
Clear cell carcinoma
100
Ovarian cancer containing all three germ layers which secretes AFP
Teratoma
101
Three types of germ cell ovarian carcinoma
Dysgerminoma - testicular seminoma
Teratoma
Choriocarcinoma
102
Three types of sex cord/stromal ovarian carcinoma
Fibroma (Meir association)
Granulosa (E2 secreting = big breasts and irregular menstruation)
Sertoli-Leydig cell (androgen secretion = small breasts and virilisation)
103
HPV 16 and 18
CIN - cervical intraepithelial neoplasia
