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
2
Q
which HPVs cause cervical cancer
A
16 and 18
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
4
Q
what does any hypoechoic mass on USS suggest
A
a cyst
5
Q
define hyperplasia
A
increased number of cells
6
Q
define hypertrophy
A
increased size of cells
7
Q
define metaplasia
A
reversible change from one cell type to another
8
Q
define dysplasia
A
reduced differentiation of cells with INTACT BM
9
Q
define neoplasia
A
uncontrolled abnormal growth of cells and tissues
10
Q
what makes up the vulva
A
vaginal opening
labia minora
labia majora
clitoris
11
Q
what cells line the vulva
A
squamous epithelium
12
Q
what are risk factors for usual type VIN (vulval intraepithelial neoplasia)
A
HPV 16/18
smoking
immunosuppression
13
Q
what are the risk factors of getting differentiated type VIN
A
lichen sclerosis
14
Q
what is a potential complication of differentiated type VIN
A
progression to SCC
15
Q
2 features of epithelial neoplasia
A
proliferation of epithelial cells
thickening of epithelium
16
Q
how is VIN graded
A
1 to 3
17
Q
what is VIN 1-3
A
1 = 1/3rd from bottom
2 = 2/3rd from bottom
3 = full thickness of epithelium
18
Q
2 types of VIN
A
usual type
differentiated type
19
Q
the most common type of vulval cancer is ____ which accounts for ____%
A
squamous cell carcinoma
95%
20
Q
other than SCC, what other type of cancer can occur in the vulva
A
adenocarcinoma (clear cell) 5%
21
Q
what differentiates VIN from vulval cancer
A
vulval cancer invades through basement membrane
22
Q
Sx of vulval cancer
A
visible, painless lesion
may be ulcerated
difficulty urinating
itching, irritation
FLAWS
23
Q
who gets SCC of vulva
A
older women with lichen sclerosis
24
Q
who gets clear cell adenocarcinoma of vulva
A
teenagers on COCP
25
what cells line the endocervix
columnar epithelium
26
what cells line the ectocervix
squamous epithelium
27
where is the endocervix vs ectocervix
endocervix is higher up, closer to uterus
ectocervix is lower down, continuous with vagina
28
where is the transformation zone
in between endo and ecto cervix
29
which area of cervix is vulnerable to cancer / infection and why
transformational zone
high cell turnover
30
what are CIN 1-3
1 = bottom 1/3rd
2 = bottom 2/3rd
3 = full thickness of epithelium
31
CIN and VIN are examples of what
dysplasia
32
are CIN and VIN cancer? why?
NO - they do not invade basement membrane
33
2 types of cervical cancer with %
SCC 80%
adneocarcinoma 20%
34
where does adenocarcinoma come from in cervix
endocervix (columnar cells)
35
RFs for cervical cancer
HPV infection - 16 and 18
COCP
immunosuppression
smoking
high parity
36
3 stages of HPV infection with cervix
latent
activated
cytological and histological changes
37
what % of people clear a HPV infection
80%
38
what does the e6 protein encoded by HPV inactivate
p53
39
what does the e7 protein encoded by HPV inactivate
retinoblastoma gene (Rb)
40
who is offered cervical screening and when
25 to 49 every 3 years
50 to 64 every 5 years
41
when is colposcopy offered
if cytology abnormal or 3 + HPVs in a row
42
where is the endometrium
top layer of the uterine wall, above myometrium
43
what is the main cancer type of endometrium
adenocarcinoma 90%
44
what is the benign tumour of the myometrium
fibroids (aka leiomyoma)
45
__% of women over ___ years old get fibroids
40% over 40
46
what are fibroids dependent on
oestrogen
47
when do fibroids get bigger / smaller
bigger in preg
smaller post menopause
48
what do fibroids look like macroscopically
large white, well circumscribed ball within endometrium
49
what do fibroids look like microscopically
bundles of purple smooth muscle cells
** key exam Q
50
what is endometriosis
presence of endometrial tissue outside endometrium
51
what causes endometriosis
vascular / lymphatic retrograde dissemination of endometrial cells
52
what is the presence of endometrial cells within the myometrium called
adenomyosis
53
buzzword for endometriosis appearance macroscopically
powder burns
(red-blue or brown vesicles)
54
buzzword for endometriosis on ovaries
chocolate cysts
(endometriomas)
55
what does endometriosis look like microscopically
dark purple powder burns
56
2 main types of endometrial carcinoma with %
adenocarcinomas 80%
SCC 20%
57
2 types of endometrial adenocarcinoma
endometriod
non endometroid
58
who gets endometroid adenocarcinoma of endometrium
peri menopausal women
59
RF for endometroid adenocarcinoma of endometrium
increased lifetime oestrogen exposure
60
who gets non endometroid adenocarcinoma of endometrium
post menopausal women
61
3 types of endometroid adenocarcinoma of endometrium
secretory
endometroid
mucinous
62
3 types of non endometroid adenocarcinoma of endometrium
papillary
clear cell
serous
63
pnuemonic for remembering the 3 types of endometroid and 2 types of non endometroid adenocarcinoma of endometrium
Sarah eats meat, paul can't stand it
Secretory
Endometroid
Mucinous
Papillary
Clear cell
Serous
64
are both types of adenocarcinoma of endometrium related to oestrogen exposure
NO - non endometroid is not, endometroid is
65
what mutation is present in >50% of endometroid adenocarcinoma of endometrium
PTEN (TSG)
66
what mutations are associated with non endometroid adenocarcinoma of endometrium
PTEN
P53
HER-2
67
3 key features of PID
1. ascending infection from vagina/cervix into uterus/tubes
2. inflammation
3. adhesions
68
RUQ pain on a background of PID. Dx?
Fitz Hugh Curtis syndrome
69
what % of people get fitz hugh curtis
10%
70
what causes fitz hugh curtis Sx
peri hepatitis, but unknown aetiology
71
buzz word for fitz hugh curtis
violin strings (peri-hepatic lesions)
72
2 groups of causes of PID
ascending STI eg IUD
external contamination eg abortion / TOP
73
bacterial causes of ascending STI --> PID
n.gonorrhoea
c.trachomatis
74
bacterial causes of external contamination --> PID
s.aureus
75
2 other non bacterial causes of PID worldwide
TB
schistosomiasis
76
what is the leading cause of death from gynae cancer
ovarian cancer
77
peak incidence of ovarian cancer
75 to 84 years old
78
most common type of ovarian cancer
epithelial tumours 90%
79
3 types of cell in ovary
epithelial
germ
stroma
80
what are germ cells associated with
follicles
81
which cell type of ovary has the most tumours from it
epithelial
82
2 main types of physiological ovarian cysts
follicular
corpus luteum
83
what is the commonest type of physiological ovarian cyst
follicular
84
cause of follicular cysts
non rupture of dominant follicle
or
failure of atresia in non dominant follicle
85
progression of follicular cysts
regress after several menstrual cycles
86
who gets corpus luteum cysts
pregnant women
87
cause of corpus luteum cysts
corpus luteum doesn't break down as its meant to, so fills with blood / fluid
88
how do corpus luteum cysts present
intraperitoneal bleeds
89
most common benign tumour of ovary
dermoid cyst (aka mature cystic teratoma)
90
what lines a dermoid cyst
epithelium
91
who gets dermoid cysts
women under 30
(most common benign ovarian tumour type in this group)
92
what are dermoid cysts associated with
ovarian torsion
93
buzzword with dermoid cyst
rokitanksky's protuberance
94
most common malignant ovarian cancer in young women
dysgerminoma
95
Tx of dysgerminoma
radiotherapy
96
2 types of benign epithelial tumour of ovary
serous cystadenoma
mucinous cystadenoma
97
which is the most common benign epithelial tumour
serous cystadenoma
98
histology of serous cystadenoma (buzzwords)
psammoma bodies
columnar epithelium
99
histology of mucinous cystadenoma
mucin secreting cells
100
what can mucinous cystadenoma cause
pseudomyxoma peritonei
101
usual size of mucinous cystadenoma
MASSIVE
102
2 types of malignant epithelial tumour
endometroid carcinoma
clear cell carcinoma
103
what does endometroid carcinoma co-exist with
endometrial cancer
endometriosis
104
what tumour marker is raised in endometroid carcinoma
ca125
105
histology of endometroid carcinoma
tubular glands
106
what are clear cell carcinomas associated with
endometrioma
107
histology of clear cell carcinoma (buzzwords)
clear cells
hobnail apperance
108
2 types of sex cord tumours
granulosa / thecal cell tumours
sertoli leydig cell tumours
109
what do granulosa / thecal cell tumours secrete
oestrogen
110
associations of granulosa / thecal cell tumours
PMB, IMB
endometrial / breast cancer
breast enlargement
111
what do sertoli leydig tumours secrete
androgens
112
associations of sertoli leydig tumours
virilisation, defeminisation, breast atrophy, hirsuitism, enlarged clitoris
113
histology of granulosa / thecal tumours (buzzword)
call-exner bodies
114
40 y/o nulliparous woman with BMI 32 presents with cyclical dysmenorrhoea and heavy menstrual bleeding. what will the biopsy show?
bundles of smooth muscle cells (fibroids)
115
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?
dysplasia
116
describe anatomy of the breast
lobules in clusters
ducts from lobules to nipple
lymph drainage from nipple to lobules
117
62F with microcalcifications found on mammography L breast. No lumps, palpable nodes, bleeding, inversion etc. No Sx. Dx?
ductal carcinoma in situ
118
single best prognostic indicator for breast cancer
lymph node involvement
119
buzzword for DCIS
microcalcifications
120
what other condition can have microcalcifications and how do they look
fibrocystic disease
distinct clusters of microcalcifications bilaterally
121
4 groups of breast lumps by cause
inflammatory
benign
proliferative (premalignant)
malignant
122
2 causes of inflammatory breast lumps
mastitis
fat necrosis
123
5 causes of proliferative premalignant breast lumps
intraductal papilloma
radial scar
usual epithelial hyperplasia
flat epithelial atypia
in situ lobular neoplasia
124
3 causes of benign breast lumps
fibroadenoma
fibrocystic disease
duct ectasia
125
3 causes of malignant breast lumps
ductal (in situ or invasive)
lobular (in situ or invasive)
Pagets
126
how is breast pathology Ix
TRIPLE ASSESSMENT
history & examination
imaging - USS or mammography
pathology - FNA or core biopsy.
127
who gets USS vs mammography
<35 = USS
>35 = mammography
128
what is the difference in sample collected from FNA and core biopsy
FNA = cells (useful if liquid sample eg cyst)
core = tissue (useful if solid sample)
129
5 codes of FNA showing results
c1 = inadequate sample
c2 = benign
c3 = atypia
c4 = suspicious of cancer
c5 = malignant
130
what can be assessed in core biopsy that can't be assessed in FNA
architecture of tissue
basement membrane
cell - cell interaction
131
5 codes of core biopsy showing results
b1 = normal
b2 = benign
b3 = uncertain
b4 = suspicious of cancer
b5 = malignant
132
what does the suffix a or b to the core biopsy code indicate
b5a = DCIS
b5b = invasive carcinoma
133
PC of mastitis
erythematous, tender breast, fever, pain
+/- discharge
134
2 types of mastitis
lactational
non lactational
135
buzzwords of mastitis histology
abundance of neutrophils (inflammation)
136
Mx of mastitis
conservative - warm compress, analgesia, elevation, continue bilateral breastfeeding
if unresolved in 12-24hrs
- medical: oral Abx - flucloxacillin
137
most common organism causing mastitis
staph aureus
138
fluctuant swelling in breast, swinging fevers. Dx?
breast abscess
139
Mx of breast abscess
IV ABx
incision and drainage
140
what is fat necrosis
inflammatory disease due to damaged adipose tissue
141
buzzwords for RFs for fat necrosis
trauma to breast ** key one
previous radiotherapy
unilateral underlying mass
142
what does fat necrosis look like microscopically
damaged fat lobules
large / irregular fat lobules
143
what are fibroadenomas
benign neoplasm of lobule with 2 components
- fibro (stromal)
- glandular (epithelial)
144
what does fibroadenoma look like microscopically
stromal proliferation
145
what age group is fibroadenoma most common
20-40 year olds
(most common breast lump in this age group)
146
what causes fibroadenoma and what does this mean in terms of sx/progression
oestrogen driven
- cyclical pain. regress during menopause
147
buzzwords for fibroadenomas
breast mouse (mobile lump)
148
what do fibroadenomas feel like
single 1-5cm, unilateral, spherical, well demarcated, firm/rubbery, painless, mobile mass
149
Mx of fibroadenoma
<3cm - conservative
>3cm / ++ Sx - surgical excision
150
what is phyllodes tumour
aggressive malignant fibroepithelial neoplasms arising from breast stroma ie MALIGNANT VERSION OF FIBROADENOMA
151
how common is phyllodes tumour
very rare - 2 in every million
152
who gets phyllodes tumours
women >50
153
buzzwords for phyllodes tumour
artichoke apperance
frond like
branching
154
buzzwords for phyllodes tumour
artichoke appearance
frond like
branching
155
what is fibrocystic disease
fluid filled sacs in breast
156
who gets fibrocystic disease
7% women !
peri menopausal women
157
PC of fibrocystic disease
single or multiple lumps either uni or bilateral
cyclical pain
158
O/E of fibrocystic disease
well demarcated
fluctuant
transilluminable
clear nipple discharge
159
buzzword for fibrocystic disease
lumpiness
160
red flags in fibrocystic disease
FNA blood stained
core biopsy shows complex cystic contents
161
histology of fibrocystic disease
fluid filled cyst
162
what is duct ectasia
blockage of milk ducts --> dilatation
163
who gets duct ectasia
peri or post menopausal women
164
buzzwords for duct ectasia
SMOKERS
sub / peri-areola mass
firm, thick yellow-green discharge
165
histology of duct ectasia
duct dilatation
proteinaceous material inside the duct
166
histology of nipple discharge from duct ectasia
contains macrophages and proteinaceous material
167
what is intraductal papilloma
benign neoplasms growing within ducts of breast - well defined
168
who gets intraductal papilloma
peri / post menopausal women
169
2 types of intraductal papilloma
peripheral
central
170
what is affected in peripheral intraductal papilloma
small ducts affected
171
PC of peripheral intraductal papilloma
clinically silent
subareola mass
172
what is affected in central intraductal papilloma
large ducts
173
PC of central intraductal papilloma
bloody / clear nipple discharge
174
what does histology of intraductal papilloma show
dilated ductule with papillary mass
175
what is a radial scar
benign sclerosing lesion caused by impaired healing post-injury
176
buzzwords for radial scar
central
fibrous
stellate area
177
list 3 premalignant breast conditions
usual epithelial hyperplasia
flat epithelial atypia
in situ lobular neoplasia
178
what is the increased breast cancer risk of usual epithelial hyperplasia
1-2x
179
what is the increased risk of breast cancer of flat epithelial atypia
4x
180
what is the increased risk of breast cancer of in situ lobular neoplasia
7 - 12x
181
what are the sx of the pre malignant breast conditions
usually none
182
RFs for breast cancer
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
2 non invasive and 3 invasive breast cancers
non invasive = DCIS, LCIS
invasive = IDC, ILC, Pagets
184
list the types of breast cancer from most to least common
IDC 85%
others:
ILC 10%
DCIS 3-5%
Pagets 2%
LCIS 1%
185
buzzword for DCIS
microcalcifications (no Sx)
186
how is LCIS Dx usually
incidentally
187
histology of non invasive breast cancers
ducts filled with atypical epithelial cells
188
histology buzzwords for ductal
big, pleomorphic cells
189
histology buzzwords for invasive
cells in chains / single file
190
histology buzzwords for tubular
well formed tubules
191
histology buzzwords for mucinous
extracellular mucin
192
how are breast cancers graded
nottingham scoring system
193
criteria of nottingham grading system
nuclear pleomorphisms (/3)
tubule formation (/3)
mitotic activity (/3)
194
what are the grades from the nottingham criteria and what do they mean
1 = well differentiated (<5)
2 = mod differentiated (6-7)
3 = poorly differentiated (8-9)
195
what else are breast cancers screened for other than grade
ER,PR, HER2
196
34F nulliparous has small lump in R breast. 2cm, spherical, mobile, painless. FH colon and breast cancer. Takes COCp, omeprazole, metformin. Best Ixs?
triple assessment - history, exam, USS breasts, core biopsy
197
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?
duct ectasia
198
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?
glioblastoma multiforme
199
8M has headaches worse AM, vomiting on waking. Quieter at school, struggles to concentrate. MRI shows 2x3cm lesion in parietal lobe. Dx?
pilocytic astrocytoma
200
define stroke
focal neurological deficit of presumed vascular origin that lasts more than 24hrs
201
define TIA
focal neurological defict of presumed vascular origin that resolves within 24hrs
202
2 types of stroke with %
ichaemic 80%
haemorrhagic 20%
203
causes of ischaemic stroke
atherosclerosis *** key
thromboembolic eg AF
DM
vasculitis
204
causes of haemorrhagic stroke
HTN *** key
AV malformation if <50
cavernous angiomas
SAH
205
the single most important RF for any strokes
HTN
206
what are cavernous angiomas
recurrent low pressure bleed
207
ischaemia vs infarction
ischaemia = lack of oxygen supply to tissue
infarction = death of tissue due to lack of oxygen supply
208
2 types of non traumatic haemorrhagic stroke
intraparenchymal
SAH
209
RF of intraparenchymal stroke
50% due to HTN
210
common site of intraparenchymal stroke
basal ganglia
211
RF of SAH
85% ruptured berry aneurysms
212
association of ruptured berry aneurysms
PCKD (bilateral abdo masses and FH)
213
common sites of SAHs
bifurcation of internal carotid
posterior communicating arteries
214
buzzword for SAH histology
hyperattenuation around circle of willis (can't usually see CoW but you can in SAH)
215
negative CT but high suspicion of SAH. Ix and results?
LP at 12hrs post event (up to 72hrs), to look for xanthochromia and oxyhaemoglobin
216
2 traumatic causes of hemorrhagic stroke
extradural haemorrhage
subdural haemorrhage
217
how do extra and subdural haemorrhages look on CT (buzzwords)
extra = lemon shape
sub = banana / crescent shape
218
what vessel ruptures in extra vs subdural haemorrhage
extra = middle meningeal artery
sub = bridging veins
219
Hx pre sub vs extra dural haemorrhage
extra = fracture of pterion due to punch to temple / RTA
sub = minor head trauma / falls
220
who gets subdural haemorrhages
alcoholics, anti coagulant users, elderly
221
single largest cause of death in under 45s
TBI
222
red flags of TBI
otorrhoea
rhinorrhoea
straw coloured fluid from nose / ears
battles sign
223
what is battles sign
bruise on mastoid
224
why is straw coloured fluid from nose / ears a red flag
its CSF leaking
225
what is diffuse axonal injury
shear tensile forces tearing axons apart in midline structures like corpus callosum / rostral brainstem / septum pellucidum
226
what does diffuse axonal injury cause
traumatic coma (most common cause)
227
what is a contusion
collisions between brain and skull
228
what is coup vs countercoup
coup = impact of brain on skull
countercoup = injury to opposite side of brain
229
most common cell in brain and most common primary brain cancer
astrocytes
astrocytoma
230
what does intra/extra axial mean
originating from within / outside the brain parenchyma
231
what cells / tissues are intra vs extra axial
intra = glia, neurones, neuroendocrine cells
extra = cranium, soft tissue, meninges, nerves
232
what is the commonest brain cancer
secondary mets
233
sources of brain mets
lung, skin, breast
234
RF of brain cancer
genetics - FH, NF T1/2, tuberous sclerosis
PMH - cancer, radiotherapy
235
grades of brain cancer
1 = benign
2 = >5yrs survival
3 = 1-5 years survival
4 = <1 year survival
236
staging vs grading
staging = how far tumour has spread
grading = how differentiated the tumour cells are compared with native cell
237
3 types of astrocytoma with grade of each
pilocytic astrocytoma 1
diffuse glioma 2-3
glioblastoma multiforme 4
238
age range of the following astrocytomas:
- pilocytic astrocytoma
- diffuse glioma
- glioblastoma multiforme
- pilocytic astrocytoma = 0-20y/o
- diffuse glioma = 20 - 40 y/o
- glioblastoma multiforme = 50+
239
what is the most common aggressive primary tumour in adults
glioblastoma multiforme
240
prognosis of pilocytic astrocytoma
good
241
give location & histology buzzword of following brain cancer: meningioma
meninges / arachnoid cells
psammoma bodies
242
give location & buzzword of following brain cancer: medulloblastoma
cerebellum
children / squint / balance problems
243
give location & buzzword of following brain cancer: ependyoma
posterior fossa
tuberous sclerosis
244
give location & buzzword of following brain cancer: craniopharyngioma
pituitary sella
inferior bitemporal hemianopia
245
give location & buzzword of following brain cancer: pituitary tumour
pituitary sella
superior bitemporal hemianopia
246
Mx of primary brain tumour
surgical resection
radiotherapy
NOT chemo
247
why is chemo not used in primary brain tumours
most do not cross BBB
248
define dementia
global impairment of cognitive function and personality without impairment of consciousness
impairment goes beyond normal aging
249
5As of dementia
amnesia - memory
apraxia - functionality
aphasia - words
agnosia - recognising things
anomia - word recall
250
4 types of dementia in order of commonness
AD
vascular
lewy body
FTD
251
2 pathogenic theory of AD
accumulation of beta amyloid plaques
hyperphosphorylation of tau with neurofibrillary tangles
252
CT scan of AD
medial temporal lobes and hippocamus most affected
global atrophy
253
how is AD staged
BRAAK staging
254
buzzwords for vascular dementia
step wise deterioration
mini strokes
CVD RFs
255
buzzwords for LBD
visual hallucinations - little people / animals
fluctuating course
PD Sx
256
buzzwords for FTD
personality changes
disinhibition
overeating
emotional blunting
257
who gets FTD
younger pts 40-60
FHx of FTD
258
histology of FTD
lots of pick bodies (hyperphosphorylated tau)
259
pathophysiology of PD
depletion of dopaminergic neurons projecting from basal ganglia to substantia nigra
260
mutation and 3 locations of effect in PD
alpha synuclein mutation
accumulation of lewy bodies in nigrostriatal pathway --> PD
peripheral ganglia --> motor retardation
olfactory bulb --> anosmia
261
name 5 PD plus syndromes
vascular PD
drug induced PD
multiple system atrophy MSA
progressive supranuclear palsy PSP
corticobasal degeneration CBD
262
buzzword for vascular PD
PD + CVD RFs
263
buzzword for drug induced PD
PD + bilateral Sx
264
buzzword for MSA
PD + autonomic dysfunction
265
buzzword for PSP
PD + vertical gaze dysfunction
266
buzzword for CBD
PD + alien limb phenomenon
267
what is hydrocephalus
increased CSF within ventricles
268
describe flow of CSF in brain
made in choroid plexus in lateral ventricles
interventriclular foramen
3rd ventricle
through cerebral aqueduct
4th ventricle
subarachnoid space
reabsorbed in superior sagittal sinus
269
communicating vs non communicating hydrocephalus
non communicating = blockage in pathway
communicating = increased production / reduced absorption
270
triad of normal pressure hydrocephalus
gait disturbance
urinary retention
confusion
271
MRI of hydrocephalus
massive ventricles
272
sites of herniation in brain
subfalcine
transtentorial
tonsillar
273
76 y/o Dx with brain mets, where is the primary tumour most likely to have originated from?
lung
274
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?
alpha synuclein (lewy bodies)
275
describe parts of long bone
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
describe anatomy of joint
2 bones meet, ends are covered in articular cartilage
synovial membrane lines outside of joint, with synovial fluid inside
277
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?
mccune albright syndrome
278
what is the most common malignant bone cancer in adults
osteosarcoma
279
4 stages of healing after fracture
haematoma formation - periosteal proliferation
deposition of new bone - hyaline cartilage formation
mineralisation of new bone - primary and secondary bone form
remodelling - healed fracture
280
XR features of osteoarthritis
loss of joint space
osteophytes
subchondral cysts
subchondral sclerosis
281
what is osteoarthritis
degeneration of cartilage
282
what is rheumatoid arthritis
chronic inflammation of synovium
283
genetic predisposition to RA
HLA DR4
PADI 2&4 - increases citrullination of proteins
PTPN 2 - suppresses T cell activation
284
5 steps of pathogenesis of RA
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
5 histological features of RA
synovitis
proliferation of synviocytes
thickening of synovial membranes
inflammatory cell infiltrates
fibrin deposition
286
what specific cells are present in RA
grimley - sockerhoff cells
287
progression of osteomyelitis if untreated
1wk - irregular sub periosteal new bone formation (involucrum)
1-2wks - irregular lytic destruction
3-6wks - detachement of necrotic cortex (sequestra)
288
gout vs pseudocout crystals appearance
gout = needle shaped, negatively birefringant
pseudogout = rhomboid shaped, positively birefringant
289
buzzwords of gout XR
rat bite erosions
290
buzzwords of pseudogout XR
white lines of chondrocalcinosis
291
gout vs pseudogout crystals components
gout = monosodium urate
pseudogout = calcium pyrophosphate
292
benign or malignant?
acute periosteal reaction
malignant (no reaction if benign)
293
benign or malignant?
thick endosteal reaction
benign
294
benign or malignant?
border between lesion and normal bone
malignant
295
benign or malignant?
irregular bone formation
malignant (benign is regular bone formation)
296
benign or malignant?
intraosseous
benign (malignant is extraosseous)
297
benign or malignant?
irregular calcification
malignant (benign is regular)
298
who gets osteosarcoma
adolescents
299
where is most commonly affected by osteosarcoma
knee 60%
300
buzzwords for histology of osteosarcoma
malignant mesenchymal cells
ALP +'ve
replacement of bone marrow with trabecular bone
301
buzzwords for XR of osteosarcoma
elevated periosteum - codman's triangle
sunburst appearance
302
who gets chondrosarcomas
over 40s
303
where does chondrosarcoma affect
axial skeleton
femur / tibia / pelvis
304
histology buzzwords for condrosarcoma
malignant chondrocytes
(proliferation of cartilage)
305
XR buzzwords for chondrosarcoma
lytic lesions with fluffy calcifications
306
who gets ewing's sarcoma
<20s
307
where does ewing's sarcoma affect
long bones
pelvis
308
histology buzzwords of ewing's sarcoma
sheets of small round cells
309
XR buzzwords of ewing's sarcoma
onion skinning of periosteum
310
who gets giant cell
20-40yrs
F>M
311
where does giant cell affect
knee epiphysis
312
histology buzzwords of giant cell
soap bubble appearance
giant multi nucleate osteoclasts
313
XR buzzwords of giant cell
lytic / lucent lesions right up to articular surface
314
is giant cell malignant
borderline malignancy
315
prognosis of ewing's sarcoma
POOR - very malignant
316
what is fibrous dysplasia
bone replaced with fibrous tissue so reduced density
317
what is mccune albright syndrome triad
fibrous dysplasia
cafe au lait spots
precoccious puberty
318
buzzwords for fibrous dysplasia
histology - chinese letters, tribecular
XR - soap bubble osteolysis, shepherds crook deformity
319
50M publican has acutely painful big toe. what would aspirate under polarised light show?
needle shaped crystals, negatively birefringent
320
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?
synoviocytes (RA)
321
layers of the skin
epidermis
dermis
subcut tissue
322
5 layers of epidermis
stratum corneum
stratum granulosum
stratum spinosum
stratum basale
323
pt has malignant melanoma, what factor determines worst prognosis?
depth (breslow thickness)
324
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?
pemphigus vulgaris
325
2 theories of eczema pathogenesis
inside out theory - auotimmune IgE sensitisation
outside in theory - body reacts to allergens on skin surface
326
gene mutation of eczema
filaggrin
327
2 types of eczema and type of reaction of each
t1 hypersensitivity - atopic dermatitis
t4 hypersensitivity - contact dermatitis
328
what cells are raised in eczema
eosinophils
329
histology of eczema
thickening of epidermis
spongiosis - fluid collection in epidermis
330
4 steps of psoriasis pathogenesis
t4 t cell hypersensitivity reaction within epidermis
t cell recruitment and release of inflamm cytokines
keratinocyte hyperproliferation
epidermal thickening
331
3 buzzwords of psoriasis histology
parakeratosis
auspitz sign - rubbing causing bleeding
neutrophil recruitment
332
2 buzzwords for guttate psoriasis
rain drop lesions
2 weeks post group A beta haemolytic strep throat infection
333
which type of psoriasis is an emergency
erythrodermis / pustular
334
which type of psoriasis forms at sites of trauma
koebner phenomenon
335
how is bullous pemphigoid different to pemphigus vulgaris
bullous pemphigoid has bullae that are difficult to burst
pemphigus vulgaris has bullae that will burst on touch
336
who / where does bullous pemphigoid affect
elderly people on flexures
337
pathogenesis of bullous pemphigoid
IgG ABs and c3 bind to hemidesmosomes (adhesion molecules) in BM of epidermis
epidermis lifts off
fluid accumulates in space aka supepidermal bulla
338
histology of bullous pemphigoid
eosinophilia
linear deposition of IgG along BM
339
progression of pemphigus vulgaris
blisters that start in mouth and then spread around body
340
pathogenesis of pemphigus vulgaris
IgG to desmoglein 1 &3 (adhesion molecules) between keratinocytes in stratum spinosum
--> acantholysis aka intraepidermal bulla
341
who gets pemphigus foliaceus
elderly
342
pathogenesis of pemphigus foliaceus
IgG against desmoglein in epidermis
detachment of superficial keratinocytes
343
list skin cancers in order of how common they are
BCC 70%
SCC 20%
melanoma 10%
344
RFs for skin cancer
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
histology of BCC
basal cells in stratum basale - keratinocyte precursors
slow growing
locally invasive
346
apperance of BCC
well defined, pearly rolled edges, shiny, fine telangectasia
347
prognosis of BCC
excellent
348
pre malignant version of BCC
nevoid BCC (gorlin-goltz syndrome)
349
histology of SCC
epidermal keratinocytes
locally invasive, mod mets
Marjolin's ulcer
350
apperance of SCC
hyperkeratotic
crusting
ulcerated
rolled edges
351
prognosis of SCC
okay
352
premalignant SCC
solar / actinic keratosis
bowens disease (SCC in situ)
353
4 types of melanoma
superficial spreading (90%)
nodular
lentigo meligna
acral lentiginous (soles / palms)
354
apperance of melanoma
ABCDE
asymmetry, irregular border, colours >2, diameter >6mm, evolving)
breslows thickness !!
355
prognosis of melanoma
bad
356
pre malignant conditions of melanoma
melanocytic naevi
seborrhoeic keratosis
357
14M has 6 months of intermittent erythematous, purple scaly plaques on flexures. white spots and splitting of nails. biopsy would show?
hyperparakeratosis
358
most common type of malignant melanoma
superficial spreading
