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MedEd Path > MedEd Histo 1 > Flashcards

MedEd Histo 1 Flashcards

1
Q

what is the MoA by which HPV causes cervical cancer

A

inhibiting tumour suppressor genes by encoding e6 and e7 proteins

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2
Q

which HPVs cause cervical cancer

A

16 and 18

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3
Q

31F with abdo pain once a month for several days. No IMB, not sexually active, not on contraceptives. USS abdo shows unilateral hypoechoic mass on L ovary. Dx?

A

follicular cyst

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4
Q

what does any hypoechoic mass on USS suggest

A

a cyst

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5
Q

define hyperplasia

A

increased number of cells

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6
Q

define hypertrophy

A

increased size of cells

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7
Q

define metaplasia

A

reversible change from one cell type to another

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8
Q

define dysplasia

A

reduced differentiation of cells with INTACT BM

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9
Q

define neoplasia

A

uncontrolled abnormal growth of cells and tissues

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10
Q

what makes up the vulva

A

vaginal opening
labia minora
labia majora
clitoris

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11
Q

what cells line the vulva

A

squamous epithelium

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12
Q

what are risk factors for usual type VIN (vulval intraepithelial neoplasia)

A

HPV 16/18
smoking
immunosuppression

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13
Q

what are the risk factors of getting differentiated type VIN

A

lichen sclerosis

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14
Q

what is a potential complication of differentiated type VIN

A

progression to SCC

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15
Q

2 features of epithelial neoplasia

A

proliferation of epithelial cells
thickening of epithelium

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16
Q

how is VIN graded

A

1 to 3

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17
Q

what is VIN 1-3

A

1 = 1/3rd from bottom
2 = 2/3rd from bottom
3 = full thickness of epithelium

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18
Q

2 types of VIN

A

usual type
differentiated type

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19
Q

the most common type of vulval cancer is ____ which accounts for ____%

A

squamous cell carcinoma
95%

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20
Q

other than SCC, what other type of cancer can occur in the vulva

A

adenocarcinoma (clear cell) 5%

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21
Q

what differentiates VIN from vulval cancer

A

vulval cancer invades through basement membrane

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22
Q

Sx of vulval cancer

A

visible, painless lesion
may be ulcerated
difficulty urinating
itching, irritation
FLAWS

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23
Q

who gets SCC of vulva

A

older women with lichen sclerosis

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24
Q

who gets clear cell adenocarcinoma of vulva

A

teenagers on COCP

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25
Q

what cells line the endocervix

A

columnar epithelium

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26
Q

what cells line the ectocervix

A

squamous epithelium

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27
Q

where is the endocervix vs ectocervix

A

endocervix is higher up, closer to uterus
ectocervix is lower down, continuous with vagina

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28
Q

where is the transformation zone

A

in between endo and ecto cervix

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29
Q

which area of cervix is vulnerable to cancer / infection and why

A

transformational zone
high cell turnover

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30
Q

what are CIN 1-3

A

1 = bottom 1/3rd
2 = bottom 2/3rd
3 = full thickness of epithelium

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31
Q

CIN and VIN are examples of what

A

dysplasia

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32
Q

are CIN and VIN cancer? why?

A

NO - they do not invade basement membrane

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33
Q

2 types of cervical cancer with %

A

SCC 80%
adneocarcinoma 20%

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34
Q

where does adenocarcinoma come from in cervix

A

endocervix (columnar cells)

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35
Q

RFs for cervical cancer

A

HPV infection - 16 and 18
COCP
immunosuppression
smoking
high parity

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36
Q

3 stages of HPV infection with cervix

A

latent
activated
cytological and histological changes

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37
Q

what % of people clear a HPV infection

A

80%

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38
Q

what does the e6 protein encoded by HPV inactivate

A

p53

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39
Q

what does the e7 protein encoded by HPV inactivate

A

retinoblastoma gene (Rb)

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40
Q

who is offered cervical screening and when

A

25 to 49 every 3 years
50 to 64 every 5 years

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41
Q

when is colposcopy offered

A

if cytology abnormal or 3 + HPVs in a row

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42
Q

where is the endometrium

A

top layer of the uterine wall, above myometrium

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43
Q

what is the main cancer type of endometrium

A

adenocarcinoma 90%

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44
Q

what is the benign tumour of the myometrium

A

fibroids (aka leiomyoma)

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45
Q

__% of women over ___ years old get fibroids

A

40% over 40

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46
Q

what are fibroids dependent on

A

oestrogen

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47
Q

when do fibroids get bigger / smaller

A

bigger in preg
smaller post menopause

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48
Q

what do fibroids look like macroscopically

A

large white, well circumscribed ball within endometrium

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49
Q

what do fibroids look like microscopically

A

bundles of purple smooth muscle cells
** key exam Q

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50
Q

what is endometriosis

A

presence of endometrial tissue outside endometrium

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51
Q

what causes endometriosis

A

vascular / lymphatic retrograde dissemination of endometrial cells

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52
Q

what is the presence of endometrial cells within the myometrium called

A

adenomyosis

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53
Q

buzzword for endometriosis appearance macroscopically

A

powder burns
(red-blue or brown vesicles)

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54
Q

buzzword for endometriosis on ovaries

A

chocolate cysts
(endometriomas)

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55
Q

what does endometriosis look like microscopically

A

dark purple powder burns

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56
Q

2 main types of endometrial carcinoma with %

A

adenocarcinomas 80%
SCC 20%

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57
Q

2 types of endometrial adenocarcinoma

A

endometriod
non endometroid

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58
Q

who gets endometroid adenocarcinoma of endometrium

A

peri menopausal women

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59
Q

RF for endometroid adenocarcinoma of endometrium

A

increased lifetime oestrogen exposure

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60
Q

who gets non endometroid adenocarcinoma of endometrium

A

post menopausal women

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61
Q

3 types of endometroid adenocarcinoma of endometrium

A

secretory
endometroid
mucinous

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62
Q

3 types of non endometroid adenocarcinoma of endometrium

A

papillary
clear cell
serous

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63
Q

pnuemonic for remembering the 3 types of endometroid and 2 types of non endometroid adenocarcinoma of endometrium

A

Sarah eats meat, paul can’t stand it
Secretory
Endometroid
Mucinous

Papillary
Clear cell
Serous

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64
Q

are both types of adenocarcinoma of endometrium related to oestrogen exposure

A

NO - non endometroid is not, endometroid is

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65
Q

what mutation is present in >50% of endometroid adenocarcinoma of endometrium

A

PTEN (TSG)

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66
Q

what mutations are associated with non endometroid adenocarcinoma of endometrium

A

PTEN
P53
HER-2

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67
Q

3 key features of PID

A
  1. ascending infection from vagina/cervix into uterus/tubes
  2. inflammation
  3. adhesions
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68
Q

RUQ pain on a background of PID. Dx?

A

Fitz Hugh Curtis syndrome

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69
Q

what % of people get fitz hugh curtis

A

10%

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70
Q

what causes fitz hugh curtis Sx

A

peri hepatitis, but unknown aetiology

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71
Q

buzz word for fitz hugh curtis

A

violin strings (peri-hepatic lesions)

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72
Q

2 groups of causes of PID

A

ascending STI eg IUD
external contamination eg abortion / TOP

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73
Q

bacterial causes of ascending STI –> PID

A

n.gonorrhoea
c.trachomatis

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74
Q

bacterial causes of external contamination –> PID

A

s.aureus

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75
Q

2 other non bacterial causes of PID worldwide

A

TB
schistosomiasis

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76
Q

what is the leading cause of death from gynae cancer

A

ovarian cancer

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77
Q

peak incidence of ovarian cancer

A

75 to 84 years old

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78
Q

most common type of ovarian cancer

A

epithelial tumours 90%

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79
Q

3 types of cell in ovary

A

epithelial
germ
stroma

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80
Q

what are germ cells associated with

A

follicles

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81
Q

which cell type of ovary has the most tumours from it

A

epithelial

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82
Q

2 main types of physiological ovarian cysts

A

follicular
corpus luteum

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83
Q

what is the commonest type of physiological ovarian cyst

A

follicular

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84
Q

cause of follicular cysts

A

non rupture of dominant follicle
or
failure of atresia in non dominant follicle

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85
Q

progression of follicular cysts

A

regress after several menstrual cycles

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86
Q

who gets corpus luteum cysts

A

pregnant women

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87
Q

cause of corpus luteum cysts

A

corpus luteum doesn’t break down as its meant to, so fills with blood / fluid

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88
Q

how do corpus luteum cysts present

A

intraperitoneal bleeds

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89
Q

most common benign tumour of ovary

A

dermoid cyst (aka mature cystic teratoma)

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90
Q

what lines a dermoid cyst

A

epithelium

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91
Q

who gets dermoid cysts

A

women under 30
(most common benign ovarian tumour type in this group)

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92
Q

what are dermoid cysts associated with

A

ovarian torsion

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93
Q

buzzword with dermoid cyst

A

rokitanksky’s protuberance

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94
Q

most common malignant ovarian cancer in young women

A

dysgerminoma

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95
Q

Tx of dysgerminoma

A

radiotherapy

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96
Q

2 types of benign epithelial tumour of ovary

A

serous cystadenoma
mucinous cystadenoma

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97
Q

which is the most common benign epithelial tumour

A

serous cystadenoma

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98
Q

histology of serous cystadenoma (buzzwords)

A

psammoma bodies
columnar epithelium

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99
Q

histology of mucinous cystadenoma

A

mucin secreting cells

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100
Q

what can mucinous cystadenoma cause

A

pseudomyxoma peritonei

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101
Q

usual size of mucinous cystadenoma

A

MASSIVE

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102
Q

2 types of malignant epithelial tumour

A

endometroid carcinoma
clear cell carcinoma

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103
Q

what does endometroid carcinoma co-exist with

A

endometrial cancer
endometriosis

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104
Q

what tumour marker is raised in endometroid carcinoma

A

ca125

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105
Q

histology of endometroid carcinoma

A

tubular glands

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106
Q

what are clear cell carcinomas associated with

A

endometrioma

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107
Q

histology of clear cell carcinoma (buzzwords)

A

clear cells
hobnail apperance

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108
Q

2 types of sex cord tumours

A

granulosa / thecal cell tumours
sertoli leydig cell tumours

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109
Q

what do granulosa / thecal cell tumours secrete

A

oestrogen

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110
Q

associations of granulosa / thecal cell tumours

A

PMB, IMB
endometrial / breast cancer
breast enlargement

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111
Q

what do sertoli leydig tumours secrete

A

androgens

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112
Q

associations of sertoli leydig tumours

A

virilisation, defeminisation, breast atrophy, hirsuitism, enlarged clitoris

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113
Q

histology of granulosa / thecal tumours (buzzword)

A

call-exner bodies

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114
Q

40 y/o nulliparous woman with BMI 32 presents with cyclical dysmenorrhoea and heavy menstrual bleeding. what will the biopsy show?

A

bundles of smooth muscle cells (fibroids)

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115
Q

a young woman presents to colposcopy clinic after abnormal smear showed reduced differentiation of squamous epi lining cervix. what name is given to this pathological process?

A

dysplasia

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116
Q

describe anatomy of the breast

A

lobules in clusters
ducts from lobules to nipple
lymph drainage from nipple to lobules

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117
Q

62F with microcalcifications found on mammography L breast. No lumps, palpable nodes, bleeding, inversion etc. No Sx. Dx?

A

ductal carcinoma in situ

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118
Q

single best prognostic indicator for breast cancer

A

lymph node involvement

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119
Q

buzzword for DCIS

A

microcalcifications

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120
Q

what other condition can have microcalcifications and how do they look

A

fibrocystic disease
distinct clusters of microcalcifications bilaterally

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121
Q

4 groups of breast lumps by cause

A

inflammatory
benign
proliferative (premalignant)
malignant

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122
Q

2 causes of inflammatory breast lumps

A

mastitis
fat necrosis

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123
Q

5 causes of proliferative premalignant breast lumps

A

intraductal papilloma
radial scar
usual epithelial hyperplasia
flat epithelial atypia
in situ lobular neoplasia

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124
Q

3 causes of benign breast lumps

A

fibroadenoma
fibrocystic disease
duct ectasia

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125
Q

3 causes of malignant breast lumps

A

ductal (in situ or invasive)
lobular (in situ or invasive)
Pagets

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126
Q

how is breast pathology Ix

A

TRIPLE ASSESSMENT
history & examination
imaging - USS or mammography
pathology - FNA or core biopsy.

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127
Q

who gets USS vs mammography

A

<35 = USS
>35 = mammography

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128
Q

what is the difference in sample collected from FNA and core biopsy

A

FNA = cells (useful if liquid sample eg cyst)
core = tissue (useful if solid sample)

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129
Q

5 codes of FNA showing results

A

c1 = inadequate sample
c2 = benign
c3 = atypia
c4 = suspicious of cancer
c5 = malignant

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130
Q

what can be assessed in core biopsy that can’t be assessed in FNA

A

architecture of tissue
basement membrane
cell - cell interaction

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131
Q

5 codes of core biopsy showing results

A

b1 = normal
b2 = benign
b3 = uncertain
b4 = suspicious of cancer
b5 = malignant

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132
Q

what does the suffix a or b to the core biopsy code indicate

A

b5a = DCIS
b5b = invasive carcinoma

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133
Q

PC of mastitis

A

erythematous, tender breast, fever, pain
+/- discharge

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134
Q

2 types of mastitis

A

lactational
non lactational

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135
Q

buzzwords of mastitis histology

A

abundance of neutrophils (inflammation)

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136
Q

Mx of mastitis

A

conservative - warm compress, analgesia, elevation, continue bilateral breastfeeding
if unresolved in 12-24hrs
- medical: oral Abx - flucloxacillin

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137
Q

most common organism causing mastitis

A

staph aureus

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138
Q

fluctuant swelling in breast, swinging fevers. Dx?

A

breast abscess

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139
Q

Mx of breast abscess

A

IV ABx
incision and drainage

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140
Q

what is fat necrosis

A

inflammatory disease due to damaged adipose tissue

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141
Q

buzzwords for RFs for fat necrosis

A

trauma to breast ** key one
previous radiotherapy
unilateral underlying mass

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142
Q

what does fat necrosis look like microscopically

A

damaged fat lobules
large / irregular fat lobules

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143
Q

what are fibroadenomas

A

benign neoplasm of lobule with 2 components
- fibro (stromal)
- glandular (epithelial)

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144
Q

what does fibroadenoma look like microscopically

A

stromal proliferation

145
Q

what age group is fibroadenoma most common

A

20-40 year olds
(most common breast lump in this age group)

146
Q

what causes fibroadenoma and what does this mean in terms of sx/progression

A

oestrogen driven
- cyclical pain. regress during menopause

147
Q

buzzwords for fibroadenomas

A

breast mouse (mobile lump)

148
Q

what do fibroadenomas feel like

A

single 1-5cm, unilateral, spherical, well demarcated, firm/rubbery, painless, mobile mass

149
Q

Mx of fibroadenoma

A

<3cm - conservative
>3cm / ++ Sx - surgical excision

150
Q

what is phyllodes tumour

A

aggressive malignant fibroepithelial neoplasms arising from breast stroma ie MALIGNANT VERSION OF FIBROADENOMA

151
Q

how common is phyllodes tumour

A

very rare - 2 in every million

152
Q

who gets phyllodes tumours

A

women >50

153
Q

buzzwords for phyllodes tumour

A

artichoke apperance
frond like
branching

154
Q

buzzwords for phyllodes tumour

A

artichoke appearance
frond like
branching

155
Q

what is fibrocystic disease

A

fluid filled sacs in breast

156
Q

who gets fibrocystic disease

A

7% women !
peri menopausal women

157
Q

PC of fibrocystic disease

A

single or multiple lumps either uni or bilateral
cyclical pain

158
Q

O/E of fibrocystic disease

A

well demarcated
fluctuant
transilluminable
clear nipple discharge

159
Q

buzzword for fibrocystic disease

A

lumpiness

160
Q

red flags in fibrocystic disease

A

FNA blood stained
core biopsy shows complex cystic contents

161
Q

histology of fibrocystic disease

A

fluid filled cyst

162
Q

what is duct ectasia

A

blockage of milk ducts –> dilatation

163
Q

who gets duct ectasia

A

peri or post menopausal women

164
Q

buzzwords for duct ectasia

A

SMOKERS
sub / peri-areola mass
firm, thick yellow-green discharge

165
Q

histology of duct ectasia

A

duct dilatation
proteinaceous material inside the duct

166
Q

histology of nipple discharge from duct ectasia

A

contains macrophages and proteinaceous material

167
Q

what is intraductal papilloma

A

benign neoplasms growing within ducts of breast - well defined

168
Q

who gets intraductal papilloma

A

peri / post menopausal women

169
Q

2 types of intraductal papilloma

A

peripheral
central

170
Q

what is affected in peripheral intraductal papilloma

A

small ducts affected

171
Q

PC of peripheral intraductal papilloma

A

clinically silent
subareola mass

172
Q

what is affected in central intraductal papilloma

A

large ducts

173
Q

PC of central intraductal papilloma

A

bloody / clear nipple discharge

174
Q

what does histology of intraductal papilloma show

A

dilated ductule with papillary mass

175
Q

what is a radial scar

A

benign sclerosing lesion caused by impaired healing post-injury

176
Q

buzzwords for radial scar

A

central
fibrous
stellate area

177
Q

list 3 premalignant breast conditions

A

usual epithelial hyperplasia
flat epithelial atypia
in situ lobular neoplasia

178
Q

what is the increased breast cancer risk of usual epithelial hyperplasia

A

1-2x

179
Q

what is the increased risk of breast cancer of flat epithelial atypia

A

4x

180
Q

what is the increased risk of breast cancer of in situ lobular neoplasia

A

7 - 12x

181
Q

what are the sx of the pre malignant breast conditions

A

usually none

182
Q

RFs for breast cancer

A

genetics - BRCA1/2, FHx, Li Fraumeni syndrome
lifetime oestrogen exposure - early menarche, late menopause, nulliparity, late first child, COCP
lifestyle - alcohol, smoking, poor diet

183
Q

2 non invasive and 3 invasive breast cancers

A

non invasive = DCIS, LCIS
invasive = IDC, ILC, Pagets

184
Q

list the types of breast cancer from most to least common

A

IDC 85%
others:
ILC 10%
DCIS 3-5%
Pagets 2%
LCIS 1%

185
Q

buzzword for DCIS

A

microcalcifications (no Sx)

186
Q

how is LCIS Dx usually

A

incidentally

187
Q

histology of non invasive breast cancers

A

ducts filled with atypical epithelial cells

188
Q

histology buzzwords for ductal

A

big, pleomorphic cells

189
Q

histology buzzwords for invasive

A

cells in chains / single file

190
Q

histology buzzwords for tubular

A

well formed tubules

191
Q

histology buzzwords for mucinous

A

extracellular mucin

192
Q

how are breast cancers graded

A

nottingham scoring system

193
Q

criteria of nottingham grading system

A

nuclear pleomorphisms (/3)
tubule formation (/3)
mitotic activity (/3)

194
Q

what are the grades from the nottingham criteria and what do they mean

A

1 = well differentiated (<5)
2 = mod differentiated (6-7)
3 = poorly differentiated (8-9)

195
Q

what else are breast cancers screened for other than grade

A

ER,PR, HER2

196
Q

34F nulliparous has small lump in R breast. 2cm, spherical, mobile, painless. FH colon and breast cancer. Takes COCp, omeprazole, metformin. Best Ixs?

A

triple assessment - history, exam, USS breasts, core biopsy

197
Q

55F with Beurger’s disease has swollen R breast, subareolar mass and green nipple discharge. Core biopsy shows dilated breast ducts, complex cellular proteinaceous material. Dx?

A

duct ectasia

198
Q

64M 2/12 Hx functional decline, change in personality, vomitting in AM. MRI brain shows lesion in parietal lobe with high mitotic activity, high cellularity and poor differentiation. Dx?

A

glioblastoma multiforme

199
Q

8M has headaches worse AM, vomiting on waking. Quieter at school, struggles to concentrate. MRI shows 2x3cm lesion in parietal lobe. Dx?

A

pilocytic astrocytoma

200
Q

define stroke

A

focal neurological deficit of presumed vascular origin that lasts more than 24hrs

201
Q

define TIA

A

focal neurological defict of presumed vascular origin that resolves within 24hrs

202
Q

2 types of stroke with %

A

ichaemic 80%
haemorrhagic 20%

203
Q

causes of ischaemic stroke

A

atherosclerosis *** key
thromboembolic eg AF
DM
vasculitis

204
Q

causes of haemorrhagic stroke

A

HTN *** key
AV malformation if <50
cavernous angiomas
SAH

205
Q

the single most important RF for any strokes

A

HTN

206
Q

what are cavernous angiomas

A

recurrent low pressure bleed

207
Q

ischaemia vs infarction

A

ischaemia = lack of oxygen supply to tissue
infarction = death of tissue due to lack of oxygen supply

208
Q

2 types of non traumatic haemorrhagic stroke

A

intraparenchymal
SAH

209
Q

RF of intraparenchymal stroke

A

50% due to HTN

210
Q

common site of intraparenchymal stroke

A

basal ganglia

211
Q

RF of SAH

A

85% ruptured berry aneurysms

212
Q

association of ruptured berry aneurysms

A

PCKD (bilateral abdo masses and FH)

213
Q

common sites of SAHs

A

bifurcation of internal carotid
posterior communicating arteries

214
Q

buzzword for SAH histology

A

hyperattenuation around circle of willis (can’t usually see CoW but you can in SAH)

215
Q

negative CT but high suspicion of SAH. Ix and results?

A

LP at 12hrs post event (up to 72hrs), to look for xanthochromia and oxyhaemoglobin

216
Q

2 traumatic causes of hemorrhagic stroke

A

extradural haemorrhage
subdural haemorrhage

217
Q

how do extra and subdural haemorrhages look on CT (buzzwords)

A

extra = lemon shape
sub = banana / crescent shape

218
Q

what vessel ruptures in extra vs subdural haemorrhage

A

extra = middle meningeal artery
sub = bridging veins

219
Q

Hx pre sub vs extra dural haemorrhage

A

extra = fracture of pterion due to punch to temple / RTA
sub = minor head trauma / falls

220
Q

who gets subdural haemorrhages

A

alcoholics, anti coagulant users, elderly

221
Q

single largest cause of death in under 45s

A

TBI

222
Q

red flags of TBI

A

otorrhoea
rhinorrhoea
straw coloured fluid from nose / ears
battles sign

223
Q

what is battles sign

A

bruise on mastoid

224
Q

why is straw coloured fluid from nose / ears a red flag

A

its CSF leaking

225
Q

what is diffuse axonal injury

A

shear tensile forces tearing axons apart in midline structures like corpus callosum / rostral brainstem / septum pellucidum

226
Q

what does diffuse axonal injury cause

A

traumatic coma (most common cause)

227
Q

what is a contusion

A

collisions between brain and skull

228
Q

what is coup vs countercoup

A

coup = impact of brain on skull
countercoup = injury to opposite side of brain

229
Q

most common cell in brain and most common primary brain cancer

A

astrocytes
astrocytoma

230
Q

what does intra/extra axial mean

A

originating from within / outside the brain parenchyma

231
Q

what cells / tissues are intra vs extra axial

A

intra = glia, neurones, neuroendocrine cells
extra = cranium, soft tissue, meninges, nerves

232
Q

what is the commonest brain cancer

A

secondary mets

233
Q

sources of brain mets

A

lung, skin, breast

234
Q

RF of brain cancer

A

genetics - FH, NF T1/2, tuberous sclerosis
PMH - cancer, radiotherapy

235
Q

grades of brain cancer

A

1 = benign
2 = >5yrs survival
3 = 1-5 years survival
4 = <1 year survival

236
Q

staging vs grading

A

staging = how far tumour has spread
grading = how differentiated the tumour cells are compared with native cell

237
Q

3 types of astrocytoma with grade of each

A

pilocytic astrocytoma 1
diffuse glioma 2-3
glioblastoma multiforme 4

238
Q

age range of the following astrocytomas:
- pilocytic astrocytoma
- diffuse glioma
- glioblastoma multiforme

A
  • pilocytic astrocytoma = 0-20y/o
  • diffuse glioma = 20 - 40 y/o
  • glioblastoma multiforme = 50+
239
Q

what is the most common aggressive primary tumour in adults

A

glioblastoma multiforme

240
Q

prognosis of pilocytic astrocytoma

A

good

241
Q

give location & histology buzzword of following brain cancer: meningioma

A

meninges / arachnoid cells
psammoma bodies

242
Q

give location & buzzword of following brain cancer: medulloblastoma

A

cerebellum
children / squint / balance problems

243
Q

give location & buzzword of following brain cancer: ependyoma

A

posterior fossa
tuberous sclerosis

244
Q

give location & buzzword of following brain cancer: craniopharyngioma

A

pituitary sella
inferior bitemporal hemianopia

245
Q

give location & buzzword of following brain cancer: pituitary tumour

A

pituitary sella
superior bitemporal hemianopia

246
Q

Mx of primary brain tumour

A

surgical resection
radiotherapy
NOT chemo

247
Q

why is chemo not used in primary brain tumours

A

most do not cross BBB

248
Q

define dementia

A

global impairment of cognitive function and personality without impairment of consciousness
impairment goes beyond normal aging

249
Q

5As of dementia

A

amnesia - memory
apraxia - functionality
aphasia - words
agnosia - recognising things
anomia - word recall

250
Q

4 types of dementia in order of commonness

A

AD
vascular
lewy body
FTD

251
Q

2 pathogenic theory of AD

A

accumulation of beta amyloid plaques
hyperphosphorylation of tau with neurofibrillary tangles

252
Q

CT scan of AD

A

medial temporal lobes and hippocamus most affected
global atrophy

253
Q

how is AD staged

A

BRAAK staging

254
Q

buzzwords for vascular dementia

A

step wise deterioration
mini strokes
CVD RFs

255
Q

buzzwords for LBD

A

visual hallucinations - little people / animals
fluctuating course
PD Sx

256
Q

buzzwords for FTD

A

personality changes
disinhibition
overeating
emotional blunting

257
Q

who gets FTD

A

younger pts 40-60
FHx of FTD

258
Q

histology of FTD

A

lots of pick bodies (hyperphosphorylated tau)

259
Q

pathophysiology of PD

A

depletion of dopaminergic neurons projecting from basal ganglia to substantia nigra

260
Q

mutation and 3 locations of effect in PD

A

alpha synuclein mutation
accumulation of lewy bodies in nigrostriatal pathway –> PD
peripheral ganglia –> motor retardation
olfactory bulb –> anosmia

261
Q

name 5 PD plus syndromes

A

vascular PD
drug induced PD
multiple system atrophy MSA
progressive supranuclear palsy PSP
corticobasal degeneration CBD

262
Q

buzzword for vascular PD

A

PD + CVD RFs

263
Q

buzzword for drug induced PD

A

PD + bilateral Sx

264
Q

buzzword for MSA

A

PD + autonomic dysfunction

265
Q

buzzword for PSP

A

PD + vertical gaze dysfunction

266
Q

buzzword for CBD

A

PD + alien limb phenomenon

267
Q

what is hydrocephalus

A

increased CSF within ventricles

268
Q

describe flow of CSF in brain

A

made in choroid plexus in lateral ventricles
interventriclular foramen
3rd ventricle
through cerebral aqueduct
4th ventricle
subarachnoid space
reabsorbed in superior sagittal sinus

269
Q

communicating vs non communicating hydrocephalus

A

non communicating = blockage in pathway
communicating = increased production / reduced absorption

270
Q

triad of normal pressure hydrocephalus

A

gait disturbance
urinary retention
confusion

271
Q

MRI of hydrocephalus

A

massive ventricles

272
Q

sites of herniation in brain

A

subfalcine
transtentorial
tonsillar

273
Q

76 y/o Dx with brain mets, where is the primary tumour most likely to have originated from?

A

lung

274
Q

67M difficulty getting up from chair. O/E shuffling gait, cog wheel rigidity. Deficit in CN1. Accumulation of which protein is responsible for this presentation?

A

alpha synuclein (lewy bodies)

275
Q

describe parts of long bone

A

epiphysis - end of bone
metaphysis - contains growth plate
diaphysis - shaft
compact bone is very outer bit, middle is spongy bone, with medullary cavity in middle which makes RBCs

276
Q

describe anatomy of joint

A

2 bones meet, ends are covered in articular cartilage
synovial membrane lines outside of joint, with synovial fluid inside

277
Q

8M at endocrine clinic as he is 155cm tall, has irregular brown macules and patches on his back/torso. Difficulty walking and intermittent bone pain.
XR - bilateral shepherds crook deformity of femurs
Biopsy - trabecular chinese letter patterns
Dx?

A

mccune albright syndrome

278
Q

what is the most common malignant bone cancer in adults

A

osteosarcoma

279
Q

4 stages of healing after fracture

A

haematoma formation - periosteal proliferation
deposition of new bone - hyaline cartilage formation
mineralisation of new bone - primary and secondary bone form
remodelling - healed fracture

280
Q

XR features of osteoarthritis

A

loss of joint space
osteophytes
subchondral cysts
subchondral sclerosis

281
Q

what is osteoarthritis

A

degeneration of cartilage

282
Q

what is rheumatoid arthritis

A

chronic inflammation of synovium

283
Q

genetic predisposition to RA

A

HLA DR4
PADI 2&4 - increases citrullination of proteins
PTPN 2 - suppresses T cell activation

284
Q

5 steps of pathogenesis of RA

A

RF / anti CCP binds to Rs on synovial membrane
T / B cell proliferation, angiogenesis
release of inflam markers
pannus formation
cartilage and bone destruction

285
Q

5 histological features of RA

A

synovitis
proliferation of synviocytes
thickening of synovial membranes
inflammatory cell infiltrates
fibrin deposition

286
Q

what specific cells are present in RA

A

grimley - sockerhoff cells

287
Q

progression of osteomyelitis if untreated

A

1wk - irregular sub periosteal new bone formation (involucrum)
1-2wks - irregular lytic destruction
3-6wks - detachement of necrotic cortex (sequestra)

288
Q

gout vs pseudocout crystals appearance

A

gout = needle shaped, negatively birefringant
pseudogout = rhomboid shaped, positively birefringant

289
Q

buzzwords of gout XR

A

rat bite erosions

290
Q

buzzwords of pseudogout XR

A

white lines of chondrocalcinosis

291
Q

gout vs pseudogout crystals components

A

gout = monosodium urate
pseudogout = calcium pyrophosphate

292
Q

benign or malignant?
acute periosteal reaction

A

malignant (no reaction if benign)

293
Q

benign or malignant?
thick endosteal reaction

A

benign

294
Q

benign or malignant?
border between lesion and normal bone

A

malignant

295
Q

benign or malignant?
irregular bone formation

A

malignant (benign is regular bone formation)

296
Q

benign or malignant?
intraosseous

A

benign (malignant is extraosseous)

297
Q

benign or malignant?
irregular calcification

A

malignant (benign is regular)

298
Q

who gets osteosarcoma

A

adolescents

299
Q

where is most commonly affected by osteosarcoma

A

knee 60%

300
Q

buzzwords for histology of osteosarcoma

A

malignant mesenchymal cells
ALP +’ve
replacement of bone marrow with trabecular bone

301
Q

buzzwords for XR of osteosarcoma

A

elevated periosteum - codman’s triangle
sunburst appearance

302
Q

who gets chondrosarcomas

A

over 40s

303
Q

where does chondrosarcoma affect

A

axial skeleton
femur / tibia / pelvis

304
Q

histology buzzwords for condrosarcoma

A

malignant chondrocytes
(proliferation of cartilage)

305
Q

XR buzzwords for chondrosarcoma

A

lytic lesions with fluffy calcifications

306
Q

who gets ewing’s sarcoma

A

<20s

307
Q

where does ewing’s sarcoma affect

A

long bones
pelvis

308
Q

histology buzzwords of ewing’s sarcoma

A

sheets of small round cells

309
Q

XR buzzwords of ewing’s sarcoma

A

onion skinning of periosteum

310
Q

who gets giant cell

A

20-40yrs
F>M

311
Q

where does giant cell affect

A

knee epiphysis

312
Q

histology buzzwords of giant cell

A

soap bubble appearance
giant multi nucleate osteoclasts

313
Q

XR buzzwords of giant cell

A

lytic / lucent lesions right up to articular surface

314
Q

is giant cell malignant

A

borderline malignancy

315
Q

prognosis of ewing’s sarcoma

A

POOR - very malignant

316
Q

what is fibrous dysplasia

A

bone replaced with fibrous tissue so reduced density

317
Q

what is mccune albright syndrome triad

A

fibrous dysplasia
cafe au lait spots
precoccious puberty

318
Q

buzzwords for fibrous dysplasia

A

histology - chinese letters, tribecular
XR - soap bubble osteolysis, shepherds crook deformity

319
Q

50M publican has acutely painful big toe. what would aspirate under polarised light show?

A

needle shaped crystals, negatively birefringent

320
Q

45F pain in hands for 45 mins on waking. XR shows subluxation of joints, soft tissue swelling, erosions at joint margins. Proliferation of which cell is responsible for this?

A

synoviocytes (RA)

321
Q

layers of the skin

A

epidermis
dermis
subcut tissue

322
Q

5 layers of epidermis

A

stratum corneum
stratum granulosum
stratum spinosum
stratum basale

323
Q

pt has malignant melanoma, what factor determines worst prognosis?

A

depth (breslow thickness)

324
Q

87F multiple blisters on her arms. painful and burst when touched.
MCS of fluid - negative for microbes, crystals or blood.
skin biopsy - intraepidermial acantholysis. Dx?

A

pemphigus vulgaris

325
Q

2 theories of eczema pathogenesis

A

inside out theory - auotimmune IgE sensitisation
outside in theory - body reacts to allergens on skin surface

326
Q

gene mutation of eczema

A

filaggrin

327
Q

2 types of eczema and type of reaction of each

A

t1 hypersensitivity - atopic dermatitis
t4 hypersensitivity - contact dermatitis

328
Q

what cells are raised in eczema

A

eosinophils

329
Q

histology of eczema

A

thickening of epidermis
spongiosis - fluid collection in epidermis

330
Q

4 steps of psoriasis pathogenesis

A

t4 t cell hypersensitivity reaction within epidermis
t cell recruitment and release of inflamm cytokines
keratinocyte hyperproliferation
epidermal thickening

331
Q

3 buzzwords of psoriasis histology

A

parakeratosis
auspitz sign - rubbing causing bleeding
neutrophil recruitment

332
Q

2 buzzwords for guttate psoriasis

A

rain drop lesions
2 weeks post group A beta haemolytic strep throat infection

333
Q

which type of psoriasis is an emergency

A

erythrodermis / pustular

334
Q

which type of psoriasis forms at sites of trauma

A

koebner phenomenon

335
Q

how is bullous pemphigoid different to pemphigus vulgaris

A

bullous pemphigoid has bullae that are difficult to burst
pemphigus vulgaris has bullae that will burst on touch

336
Q

who / where does bullous pemphigoid affect

A

elderly people on flexures

337
Q

pathogenesis of bullous pemphigoid

A

IgG ABs and c3 bind to hemidesmosomes (adhesion molecules) in BM of epidermis
epidermis lifts off
fluid accumulates in space aka supepidermal bulla

338
Q

histology of bullous pemphigoid

A

eosinophilia
linear deposition of IgG along BM

339
Q

progression of pemphigus vulgaris

A

blisters that start in mouth and then spread around body

340
Q

pathogenesis of pemphigus vulgaris

A

IgG to desmoglein 1 &3 (adhesion molecules) between keratinocytes in stratum spinosum
–> acantholysis aka intraepidermal bulla

341
Q

who gets pemphigus foliaceus

A

elderly

342
Q

pathogenesis of pemphigus foliaceus

A

IgG against desmoglein in epidermis
detachment of superficial keratinocytes

343
Q

list skin cancers in order of how common they are

A

BCC 70%
SCC 20%
melanoma 10%

344
Q

RFs for skin cancer

A

UV exposure - long periods in sun, >6 sunburns, sunbeds
increasing age
exposure to ionising radiation / RT
type 1-2 skin
FH
immunosuppression
VAX - vitiligo, albinism, xoderma pigmentosum
FAMMM - familial atypical melaignant mole melanoma

345
Q

histology of BCC

A

basal cells in stratum basale - keratinocyte precursors
slow growing
locally invasive

346
Q

apperance of BCC

A

well defined, pearly rolled edges, shiny, fine telangectasia

347
Q

prognosis of BCC

A

excellent

348
Q

pre malignant version of BCC

A

nevoid BCC (gorlin-goltz syndrome)

349
Q

histology of SCC

A

epidermal keratinocytes
locally invasive, mod mets
Marjolin’s ulcer

350
Q

apperance of SCC

A

hyperkeratotic
crusting
ulcerated
rolled edges

351
Q

prognosis of SCC

A

okay

352
Q

premalignant SCC

A

solar / actinic keratosis
bowens disease (SCC in situ)

353
Q

4 types of melanoma

A

superficial spreading (90%)
nodular
lentigo meligna
acral lentiginous (soles / palms)

354
Q

apperance of melanoma

A

ABCDE
asymmetry, irregular border, colours >2, diameter >6mm, evolving)
breslows thickness !!

355
Q

prognosis of melanoma

A

bad

356
Q

pre malignant conditions of melanoma

A

melanocytic naevi
seborrhoeic keratosis

357
Q

14M has 6 months of intermittent erythematous, purple scaly plaques on flexures. white spots and splitting of nails. biopsy would show?

A

hyperparakeratosis

358
Q

most common type of malignant melanoma

A

superficial spreading

MedEd Path (10 decks)

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