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Marina Pathology > Histopathology (MedEd) > Flashcards

Histopathology (MedEd) Flashcards

1
Q

what’s the difference between erosion & ulcer?

A

Both are loss of surface epithelium but in erosion it’s beyond the muscularis mucosae

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2
Q

difference between acute & chronic ulcers:

A

fibrosis in chronic ulcers

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3
Q

define dysplasia and give example

A

Cytological and histological features of malignancy but basement membrane intact

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4
Q

define metaplasia and give example

A

Change in one mature cell type for another
mature cell type (Reversible)

eg Barrett’s oesophagus (squamous epithelium to columnar epithelium)

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5
Q

what are 2 features of dysplasia?

A

-Mitotic figures
-Raised nuclear : cytoplasmic ratio

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6
Q

Difference in histology of adenocarcinoma and squamous cell carcinoma:

A

Adenocarcinoma
1. Gland forming
2. Mucin secreting

Squamous cell carcinoma
1. Make keratin (even in non-keratinised tissues)
2. Inter-cellular bridges

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7
Q

Difference between necrosis & apoptosis:

A

Necrosis
-Represents energy failure
-Non-energy dependent cell death
-Cell lysis due to loss of electro-ionic potential
-Pathological

Apoptosis
-Planned, energy dependent exit strategy
-Cell contents are not released

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8
Q

What histopathological description is given to cells that have lost their intercellular connections between neighbouring cells?

An example could be the loss of desmosomal connections in pemphigus vulgaris.

A

Acantholysis

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9
Q

what is the term for nuclei in S. corneum – thickening of skin when scratching it?

A

parakeratosis

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10
Q

what is the term for ↑ in S. spinosum

A

Acanthosis

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11
Q

what is the term for intercellular oedema between keratinocytes?

A

spongiosis

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12
Q

what is the term for the linear pattern of melanocyte proliferation within epidermal basal cell layer (reactive or neoplastic)

A

Lentiginous

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13
Q

what are the layers of the epithelium? mnemonic?

A

Corn Lovers Grow Some Bales
* Corneum
* Lucidum
* Granulosum
* spinosum
* basale

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14
Q

difference between bullous pemphigoid vs pemphigus vulgaris

A

Bullous pemphigoiD=Deep
pemphigus vulgariS= superficial

-Both IgG antibodies

-Pemphigus vulgaris: IgG Abs bind to desmosome proteins 1,3
-mucosal involvement

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15
Q

What is the typical chemotherapy regime used for non-resectable pancreatic cancer?

A

Management is generally palliative chemotherapy (FOLFIRINOX ie 5-FU: 5-fluorouracil based) or surgical Whipple’s procedure if curative intent

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16
Q

A 60 year old man has suffered from atrial fibrillation since his early 30s. He has undergone multiple failed cardioversions, the most recent of which was 10 years ago. Since then his symptoms have been well controlled with bisoprolol 10mg OD. His heart sounds are normal.

He says he has had high blood pressure for “years”.

His ECG is normal other than an irregularly irregular rhythm and large, bifid p waves.

What is the most likely abnormality that will be found on his echocardiogram to explain his permanent atrial fibrillation and poor success at cardioversion?

A

dilated left atrium

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17
Q

What liver enzyme may also be found in the heart and may rise in acute myocardial infarction?

A

Aspartate Aminotransferase (Hepatocytes + Heart + Muscle)

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18
Q

what are 5 types of nephritic syndrome?

A

BADPG
● Berger disease (IgA nephropathy: 1-2 days after strep pyogenes)
● Alport’s syndrome (aka Hereditary nephritis)
●Diffuse proliferative ( Rapidly progressive) glomerulonephritis in SLE
●Post-infectious (aka Post-streptococcal)
●Goodpasture syndrome

● Thin basement membrane disease (aka Benign familial haematuria)
● wegener’s granulomatosis: granulomatosis with polyangitis
●Henoch-schonlein purpura (HSP)
● Haemolytic uraemic syndrome

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19
Q

What is the typical inheritance pattern of hereditary haemochromatosis?

A

autosomal recessive

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20
Q

Complications of hereditary haemochromatosis (mnemonic)

A

HaemoChromatosis Can Cause Deposits Anywhere)
o Hypogonadism
o Cancer (hepatocellular)
o Cirrhosis
o Cardiomyopathy
o Diabetes mellitus
o Arthropathy

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21
Q

What liver enzyme may be measured in the blood and, if raised to a level >10x the upper limit of normal is suggestive of viral hepatitis?

A

ALT (alanine aminotransferase)

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22
Q

What tumour marker is associated with pancreatic cancer?

A

Carbohydrate Antigen 19-9 (CA 19-9)

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23
Q

What is the minimum random plasma glucose level (in mmol/L) that is required to diagnose diabetes in a symptomatic individual?

A

11.1

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24
Q

Which enzyme, synthesised by the pancreas, is most sensitive for the diagnosis of pancreatitis?

A

lipase

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25
Q

What is the main hormone produced by delta cells in the pancreas?

A

Delta cells: Produce somatostatin. Exhiibts a paracrine effect on alpha and beta cells, reducing secretion of glucagon and insulin

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26
Q

What histochemical stain would reveal the presence of iron in a liver biopsy with a patient with haemachromatosis?

A

Prussian blue

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27
Q

What histochemical stain would reveal the presence of melanin?

A

fontana

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28
Q

What is the inheritance pattern of Wilson’s disease?

A

autosomal recessive

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29
Q

What histochemical stain would reveal the presence of copper in a liver biopsy with a patient with Wilson’s disease?

A

Rhodanine

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30
Q

A 42 year old woman with Type 1 Diabetes Mellitus is investigated for fatigue and pruritus.

She has an elevated serum ALP and an elevated anti mitochondrial antibody titre.

An ultrasound of the biliary tree shows no gross dilatation.

What is the likely diagnosis?

A

primary biliary cirrhosis

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31
Q

What is the first line treatment for severe haemachromatosis?

A

therapeutic phlebotomy (venesection)

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32
Q

triad of nephrotic syndrome:

A
  1. hypoalbuminaemia
  2. proteinuria
  3. oedema
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33
Q

electron microscopy of minimal change disease?

A

loss of foot processes

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34
Q

what is seen in light and electron microscopy of membranous glomerulonephropathy:

A

light: diffuse BM thickening
electron: spikey immune complex deposits
immunofluorescence:

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35
Q

triad of nephritis syndrome:

A
  1. hypertension
  2. haematuria
  3. peripheral oedema
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36
Q

investigations for post-streptoccus

A

ASOT titre ↑, C3 ↓

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37
Q

alport syndrome triad;

A

Nephritic syndrome + sensorineural deafness + eye disorders (lens dislocation,
cataracts): kidneys, ears, eyes

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38
Q

what inheritance is Alport syndrome

A

X-linked

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39
Q

casts in ATN vs acute interstitial nephritis:

A

ATN: brown cast
acute interstitial nephritis: white casts

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40
Q

symptoms of polycystic kidney disease:

A

MISSHAPES
Abdominal Mass
o Infected cysts & increased BP
o Stones
o Systolic hypertension
o Haematuria
o Aneurysms (Berry)/subarachnoid haemorrhage
o Polyuria & nocturia
o Extra-renal cysts e.g. liver(most common extrarenal manifestation) ovaries, pancreas, seminal vesicles
o Systolic murmur – due to mitral valve prolapse

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41
Q

lupus nephritis renal histology:

A

‘wire loop capillaries’ & lumpy-bumpy granular fashion.

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42
Q

Abs to phospholipase A2 receptor associated with which glomerulonephritis?

A

membranous

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43
Q

Goodpasture Ab:

A

Anti GBM membranes

44
Q

characteristic histological finding in kidney of a patient with multiple myeloma:

A

Amyloid deposition (AL amyloidosis)

45
Q

40 yr old with massive proteinuria. Renal biopsy=wire loop capillaries, immune complex deposition and sclerosis >95% of sample

A

end stage (advanced sclerosis), vs mesangial =early stage

46
Q
A

(muddy) brown

47
Q
A

acute tubular necrosis

48
Q
A

acute tubular necrosis

49
Q

functional unit of kidney

A

nephron

50
Q

functional unit of liver

A

sinusoid

51
Q

zones of liver

A

zone 1: most oxygenated
zone 3: least oxygenated
form portal triad–> central veins

52
Q

acute hepatitis pattern of inflammation:

A

spotty necrosis

53
Q

causes of chronic hepatitis:

A

Viruses (Hep B, C), drugs, PBC/PSC, wilson’s or haematochromatosis

54
Q

pattern of inflammation in chronic nephritis

A

piecemeal necrosis/interface hepatitis
-bridging fibrosis from portal triad–> central vein: signals evolution to cirrhosis

55
Q

micronodular causes:

A

alcohol

56
Q

macronodular causes:

A

everything else, not alcohol

57
Q

causes of acute hepatitis

A

Hep A, E or drugs

58
Q

most common malignancy in liver;

A

metastasis

59
Q

haemochromatosis inheritance pattern:

A

autosomal recessive

60
Q

a1 antitrypsin inheritance pattern:

A

autosomal dominant

61
Q

Wilson’s disease inheritance pattern:

A

autosomal recessive

62
Q

most common exam finding in pt with portal hypertension:

A

splenomegaly (other: oesophageal varices, caput medusae, jaundice)

63
Q
A

Answer: E. raised eosinophils
-schistosomiasis (parasitic infections); lake Malawi
-could also have deranged LFTs due to hepatomegaly

64
Q

eosinophils granules colour

A

red granules

65
Q
A

Answer: C : SCC

66
Q

what’s the cause of squamous cells in urine;

A

contamination

67
Q

oesophageal cancer most common types:

A

Adenocarcinoma is the most common type of cancer of the esophagus among White people
-squamous cell carcinoma is more common in African Americans

68
Q

most cancers in histo:

A

adenocarcinomas

69
Q

common transitional cell cancers (mnemonic)

A

KUB:
kidneys
-ureters/urinary tract
-bladder

70
Q
A

Answer: none (under 6 hours–> normal, CK-MB creatine kinase isoenzyme MB=normal)

71
Q

evolution of MI histological findings:

A
72
Q
A

Answer: D. AD mutation in DNA mismatch repair gene
HNPCC (lynch syndrome)

73
Q

FAP mutation/presentation:

A

AD mutation in APC gene, 100s/1000s polyps

74
Q
A

calcitonin

75
Q

MEN types (mnemonic)

A

3Ps–> 2Ps–> 1P

76
Q
A

Gleason score: 8
3 +5 =8

77
Q

what investigations can be done for wilson’s?

A

● ↓ serum caeruloplasmin
● ↓ serum copper
● ↑ urinary copper

78
Q

treatment for wilson’s

A

lifelong penicillamine (heavy metal antagonist)

79
Q

signs/symptoms of wilson’s

A

● Liver disease: acute hepatitis, fulminant liver failure or cirrhosis
● Neuro disease: parkinsonism, psychosis, dementia (basal ganglia involvement)
● Kayser Fleischer rings: copper deposits in Descemet’s membrane in cornea

80
Q

mutation in wilson’s

A

Mutated gene ATP7B (Chr 13): Encodes copper transporting ATPase expressed on canalicular membrane therefore → ↓biliary Cu excretion and deposition in liver, CNS, iris.

81
Q

Wegener’s granulomatosis triad:

A

1) necrotizing granlomatous inflammation of upper and/or lower respiratory tract
2) systemic or focal necrotizing vasculitis involving arteries and vein
3) focal segmental necrotizing crescentic gromerulonephritis.

82
Q

most common cause of nephrotic syndrome in adults (& associations):

A

FSGS: focal segmental glomerulosclerosis (associated with diabetes, obesity & HIV)

83
Q

2nd most common cause of nephrotic syndrome in adults

A

membranous glomerulonephritis

84
Q

What is the underlying precipitant of DIC?

A

Increased Exposure to Tissue Factor

85
Q

Which of the following is more associated with nephritic syndromes than nephrotic syndromes?

A. Proteinuria
B. Raised Creatinine
C. Oedema
D. Thrombosis
E. Onset in Childhood

A

B. Raised Creatinine (ie hypertension causing this)

86
Q

what defect in TTP:

A

antibodies against ADAMTS13 lead to long strands of VWF which
act like cheese wire in the blood vessels, cutting up RBCs.

87
Q

what does klebsiella typically cause/groups affected (mnemonic)

A

typical pneumonia (HADE): haemoptysis, alcoholics, diabetics, elderly.
-upper lobe cavitation, lung abscesses and empyemas
-negative rod, enterobacter

88
Q

What type of emphysema is associated with smoking ?

A

centriacinar emphysema

89
Q

What is the commonest cause of constrictive pericarditis in the developing world?

A

tuberculosis (vs developed: world. In the developed world, the most common cause of constrictive pericarditis is idiopathic or post-cardiac surgery. In some cases, radiation therapy or autoimmune diseases, such as lupus, may also cause constrictive pericarditis.)

90
Q

What is the commonest cause of portal vein thrombosis?

A

Liver Cirrhosis (other causes=malignant, abdominal infection, IBD & inherited hypercoagulable states)

91
Q

A dysgerminoma is a type of tumour that affects the ovary. What is the equivalent tumour type in the testes?

A

seminoma

92
Q

Intestinal metaplasia in Barrett’s (columnar-lined) oesophagus is most commonly due to the presence of which cell?

A

Goblet cell

93
Q

Commonest histological type of primary malignant breast cancer?

A

invasive ductal carcinoma (IDC)

94
Q

What is the commonest cause of myocarditis?

A

– viral infections (coxsackievirus most common).
Other viral causes include adenovirus, cytomegalovirus, Epstein-Barr virus, parvovirus B19, and human herpesvirus 6. Bacterial, fungal, and parasitic infections, as well as autoimmune and idiopathic causes, can also lead to myocarditis.

95
Q

Which virus characteristically causes encephalitis involving the temporal lobes?

A

Herpes simplex 1 (HSV1=encephalitis); also causes herpes labialis vs HS2: meningitis and genital herpes

96
Q

restrictive vs obstructive impairment on spirometry causes

A
97
Q

sarcoidosis extra-pulmonary manifestations:

A

hypercalcaemia due to ectopic 1a hydroxylase release by activated macrophages
-lymph nodes: lymphadenopathy, painless & rubbery
-skin: erythema nodosum
-eyes: anterior uveitis
-Heerfordt syndrome, or uveoparotid fever, occurs in 10% of cases and consists of a triad of parotid enlargement, uveitis, and seventh cranial nerve palsy
-ACE increased
-ESR increased
-Transbronchial biopsy: non-caseating granuloma
-Spirometry-restrictive pattern

98
Q

erythema nodosum causes:

A
99
Q

Heerfordt syndrome triad. seen in:

A

AKA: uveoparotid fever
- triad of parotid enlargement, uveitis, and seventh cranial nerve (facial) palsy
-sarcoidosis

100
Q

What active enzyme in sarcoidosis patients causes hypercalcaemia

A

1 alpha hydroxylase
-This enzyme is produced by macrophages in the granulomas of sarcoidosis patients and converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, the active form of vitamin D. The excess production of 1,25-dihydroxyvitamin D leads to increased calcium absorption from the gut and bone resorption, resulting in hypercalcaemia.

101
Q

what vasculitides is associated with anti-proteinase 3?

A

Wegeners glomerulonephritis (Granulomatosis with polyangiitis: GPA)

102
Q

what drugs/conditions can cause erythema multiforme (mnemonic) ?

A

SNAPP:
○Sulphonamides
○ NSAIDs
○ Allopurinol
○ Penicillin
○ Phenytoin

103
Q

encephalitis symptoms, common cause and management

A
  • Sx: confusion, fluctuating consciousness
  • Most commonly caused by HSV1
  • Rx: IV acyclovir
104
Q

encephalitis & paraneoplastic syndrome

A

Therefore, it is important to screen for cancer in patients whom you suspect may have an underlying tumour.

Particular associations:

  1. Anti-Hu: Small cell lung cancer
  2. NMDA receptor antibodies: Ovarian teratoma
  3. Anti-Yo: breast and ovarian tumours
105
Q

A 30 year old woman has experienced a week of progressive retro ocular pain with a loss of visual acuity in the right eye. She does not wear glasses. There is a family history of Type 1 Diabetes.

On examination, there is a right relative afferent pupillary defect with reduced visual acuity. Fundoscopy and intraocular pressure is normal.

What investigation would be diagnostic?

A

An MRI Brain and Optic Nerves would be the best investigation to diagnose this patient because they are experiencing retro ocular pain with a loss of visual acuity in one eye, which could indicate optic neuritis, a common symptom of multiple sclerosis. The family history of Type 1 Diabetes may also increase the risk of developing optic neuritis.

Marina Pathology (5 decks)

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