Histopathology COPY Flashcards
Which of these options is a type of fracture?
(a) Extended
(b) Contracted
(c) Communal
(d) Confounding
(e) Comminuted
The correct answer is (e), comminuted.
A comminuted fracture is where there is splintered bone with intact soft tissue.
In children with osteomyelitis, what is the most common affected site?
(a) Vertebrae
(b) Long Bones
(c) Jaw
(d) Toe
(e) Pelvis
The correct answer is (b), long bones.
The most common site in children for osteomyelitis is the long bones, usually the metaphysis of that bone. Vertebrae, jaw (secondary to dental abscess) and toe (secondary to diabetic ulcer) are the common sites in adults.
What causative organism of osteomyelitis is associated with sickle cell disease?
(a) Klebsiella
(b) E. Coli
(c) Salmonella
(d) Staph. Aureus
(e) Pseudomonas
The correct answer is (c), salmonella.
Osteomyelitis caused by salmonella is associated with sickle cell disease. Of the others, pseudomonas is associated with IV drug users.
There are four stages in fracture repair. They are as follows:
- Organisation of haematoma at the fracture site (pro-callus).
- Formation of fibrocartilaginous callus
- Remodelling of bone along weight-bearing lines.
What is the third stage of fracture repair?
The third stage of fracture repair is mineralisation of the fibrcartilaginous callus.
Pott’s Disease is a skeletal deformity associated with osteomyelitis of the spine due to infection with what organism?
(a) Pseudomonas
(b) Mycobacterium Tuberculosis
(c) Klebsiella
(d) Staph. Aureus
(e) E. Coli
The correct answer is (b) Mycobacterium Tuberculosis.
Which of the following is NOT a feature of osteoarthritis?
(a) Fibrin deposition
(b) Cartilage degeneration
(c) Fissuring
(d) Abnormal matrix calcification
(e) Osteophytes
The correct answer is (a), fibrin deposition. This is a clinical feature of rheumatoid arthritis.
Rheumatoid factor forms immunocomplexes with which of the following?
(a) IgG
(b) IgM
(c) IgE
(d) C3
(e) C4
The correct answer is (a) IgG.
Rheumatoid factor mostly interacts with IgM but it forms immunocomplexes with IgG which may cause the extra-articular disease associated with rheumatoid arthritis.
In rheumatoid arthritis, on histology, you would see thinning of the synovial membrane. True or false?
False. Rheumatoid arthritis causes a proliferative synovitis which leads to thickening of the synovial membrane.
In gout, what percentage of the cases are primary?
a. 10%
b. 30 %
c. 50%
d. 70%
e. 90%
The correct answer is (e) 90% of gout cases are primary.
What is the name of the pathognomonic lesion found in Gout?
Tophus is the name of the pathognomonic lesion found in Gout.
Pseudogout of the knee is characterised by formation of what main type of crystal in the joint?
Calcium pyrophosphate crystals.
Calcium pyrophosphate crystals are what’s formed in pseudogout in the joints, particularly the knee. Calcium phosphate (hydroxyapatite) crystals can form in the knees and shoulders but the main pathological driving force in pseudogout of the knee is Calcium pyrophosphate crystal build up.
A 60 year old patient comes in complaining of “horrid skin lesions”. Bloods show an IgG antibody is to blame, and the histology on skin biopsy shows subdermal bulla with eosinophils. There is a linear deposition of IgG along the basement membrane.
What condition is this patient suffering from?
(a) Dermatitis herpetiformis
(b) Pemphigoid
(c) Pemphigus vulgaris
(d) Pemphigus foliaceus
(e) Discoid eczema
The correct answer is (b) Pemphigoid.
In Pemphigoid IgG antibodies bind to hemidesmosomes of basement membrane causing subepidermal bulla. Clinical features are large tense bullae on erythematous base, often in forearms, grown and axillae of the elderly. Bullae do not rupture as easily as pemphigus.
In Pemphigus vulgaris (c) the IgG antibodies bind to desmosomal proteins causing intraepidermal bulla. These bulla are easily ruptured and are found on skin and mucosal membranes. Under histology there are intrapeidermal bulla with a netlike pattern of intercellular IgG deposits.
Conversely, dermatitis herpetiformis (a) occurs when IgA antibodies bind to basement membrane, creating subepidermal bulla. This causes a clinical picture of itchy vesicles on extensor surfaces of elbows, buttocks. The histology is miceoabscesses which coalesce to form subepidermal bulla. there are neutrophil and IgA deposits at tips of dermal papillae.
Which of the following is not a cause of crescentic glomerulonephritis?
(a) Amyloidosis
(b) Immune complex deposition
(c) Anti-GBM disease
(d) Pauci-immune - associated with anti-neutrophil cytoplasm antibodies.
(e) All of the above
The correct answer is (a) Amyloidosis.
Which of the following is not a feature of Hirschsprung’s disease?
(a) Absence of ganglion cells in myenteric plexus
(b) 50:50 split in gender
(c) Symptoms are constipation, abdominal distension, vomiting and ‘overflow’ diarrhoea.
(d) Associated with Down’s syndrome (2%)
(e) Genetic abnormality associated is RET proto-oncogene Cr10 + others.
The correct answer is (b) 50:50 split in gender.
Instead, 80% of Hirschsprung’s disease occurs in male patients.
Which of the follow is not an extraintestinal manifestation of Ulcerative colitis?
(a) Arthritis
(b) Myositis
(c) Uveitis
(d) Pyoderma gangrenosum
(e) Primary biliary cirrhosis
The correct answer is (e) Primary biliary cirrhosis.
Ulcerative colitis instead causes primary sclerosing cholangitis.
A 60 year old man undergoes an endoscopy wherein the surgeon notices a growth in his colon. The surgeon biopsies it and the histological results show a dark hyperchromatic, disorganised,pseudostratified epithelium with evidence of increased mitotic activity and disordered proliferation with no invasion through the basement membrane.
What is this growth likely to be?
(a) Hyperplastic polyp
(b) Peutz Jeghers polyp
(c) Tubular adenoma
(d) Adenocarcinoma
(e) Carcinoid tumour
The correct answer is (c) Tubular adenoma.
This tumour has all the excess epithelial proliferation and dysplastic signs of a tubular adenoma. It is not cancerous as it has not invaded through the basement membrane. It is a pre-cancerous state, that might progress to cancer later on.
20-30 percent of <40 year olds will have an adenoma, increasing to 40-50% prevalence after age 60.
Which of the following statements is true about the risk of a polyp becoming cancerous?
(a) Size of polyp is related to cancer risk, if a polyp is more than 2cm it has a 50% chance of becoming malignant.
(b) If the polyp is hamartomatous then it’s neoplastic, meaning it has the potential at a later stage to progress to cancer.
(c) If an adenoma has a high proportion of villous component it increases the risk of it becoming cancerous.
(d) Low degree of dysplastic change within polyp increases the risk of developing into cancer.
(e) Inflammatory “pseudo-polyps” are different to hyperplastic polyps in that hyperplastic polyps are neoplastic and can progress to cancer at a later stage.
The correct answer is (c) If an adenoma has a high proportion of villous component it increases the risk of it becoming cancerous.
The size of a polyp is a risk factor, however, if a polyp is >4cm approximately 45% have invasive malignancy so the numbers in (a) are incorrect.
Hamartomatous polyps (b) are non-neoplastic polyps that do not progress to cancer. Peutz Jeghers are a type of hamartomatous polyp, which are associated with an increased risk of bowel cancer, but it’s not due to the polyps themselves but the genetic syndrome that causes the polyps.
If there is a high degree of dysplastic change within a polyp it increases the risk of developing into cancer, not low like (d).
Both inflammatory pseudo-polyps and hyperplastic polyps are non-neoplastic so neither can progress to cancer, meaning (e) is also wrong.
Familial adenomatous polyposis is caused by a deletion of which of the following?
(a) 9:22
(b) 22q11
(c) 5q21
(d) 14q16
(e) 13:21
The correct answer is (c) 5q21. This is the APC tumour suppressor gene.
APC is an autosomal dominant condition where the average onset is 25 years old. The condition causes adenomatous polyps to form mostly colorectally. There’s a minimum of 100 polyps, average around 1000 polyps. Virtually 100% of these patients will develop cancer within 10-15 years.
55 year old alcoholic with a 40 pack year history has a biopsy taken from his pancreas after presenting with painless jaundice. Macroscopically the tissue is gritty and grey, and shows signs of invading adjacent structures. Microscopically it is made up of mucin secreting glands set in desmoplastic stroma.
What is this pathology and presentation indicative of?
(a) Ductal carcinoma
(b) Acinar carcinoma
(c) Serous cystadenocarcinoma
(d) Mucinous cystic neoplasm
(e) Islet cell tumour
The correct answer is (a) Ductal carcinoma.
This is the classic presentation, with two of the main risk factors of smoking and chronic pancreatitis observed, alongside painless jaundice which indicates a tumour of the head of the pancreas.
Both the macroscopic and microscopic findings are indicative of a ductal carcinoma. Desmoplastic is just a fancy word for fibrotic, which again indicates that this tumour arose against a background of chronic pancreatitis. 60% of duct carcinomas are found at the head of the pancreas.
An important complication of ductal carcinomas is venous thrombosis. This is due to the mucin production by the tumour subsequently entering the blood stream to cause thrombosis elsewhere.