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Question 1

Dysplasia –> what is it + is it reversible?

Answer 1

• Disordered cell growth –> usually applied to epithelial cells
• dysplasia is potentially reversible if the stimulus is removed

Question 2

What might happen if dysplasia persists?

Answer 2

Dysplasia can progress to carcinoma in situ –> then to invasive carcinoma

Question 3

List 3 factors which mediate tumour invasion

Answer 3

• Loss of E-cadherin (epithelial cadherins) –> cell adhesion molecules
  (loss of cell-cell adhesion and cell junctions allows cells to invade surrounding tissues and migrate to distant sites)
• Secretion of proteinases - breaking down proteins into smaller polypeptides or single amino acids, and spurring the formation of new protein products
• Growth factor-driven migration

Question 4

What is neoplasm?

Answer 4

New growth which is clonal, unregulated, and irreversible
–> a neoplasm can be being or malignant

Question 5

Which malignant skin tumour does not usually metastasis?

Answer 5

BCC

Question 6

What are the cytological features of a malignant cell?

Answer 6

• High N-C ratio
• Dark, variably sized nuclei
• Irregular chromatin –> mixture of DNA and proteins
• Irregular nuclear membranes

Question 7

Name the malignant tumours which drive from the following 4 cell types?

• Epithelium
• Connective/mesenchymal tissue
• Lymphocytes
• Haematopoietic cells

Answer 7

• Epithelial cell –> carcinoma
• Connective/mesenchymal tissue –> sarcoma
• Lymphocytes –> lymphoma or leukaemia
• Haematopoietic cells –> leukaemia

Question 8

What does tumour grade mean?

Answer 8

How closely the tumour resembles the tissue of origin

Question 9

What is the tumour stage?

Answer 9

• T-stage –> size/depth of tumour
• N-stage –> spread to draining lymph nodes
• M stage –> systemic spread

Question 10

List the 3 routes by which tumours can spread

Answer 10

1. via lymphatics
2. via veins
3. transcoelomic –> body cavities (eg. pleural metastases)

Question 11

How do tumours evade the immune system?

Answer 11

• Selection of antigen negative clone
• Loss of MHC molecules
• Expression of immune suppression molecules

Question 12

Which molecular targets are used to try to control cancer?

Answer 12

Drugs which inhibit:
- receptor tyrosine kinases
- signal transducers
- cyclin-dependent kinases
- vascular endothelial growth factor
- immune checkpoints

Question 13

Type of epithelium found in a normal bronchus + if bronchial stem cells are damaged then what can be produced instead

Answer 13

• Normally columnar epithelial cells
• If bronchial stem cells damaged –> epithelium can produce squamous epithelial cells instead

Question 14

Green arrow?
Blue arrow?

Answer 14

• Green –> columnar epithelium
• Blue –> mature squamous epithelium (columnar epithelium has undergone squamous metaplasia)

Question 15

Answer 15

• white-greyish mass with black carbon deposits
• SCCs often show soft, friable areas of necrosis and this often causes central cavitation within the tumour

Question 16

Consequence of tumour arising in the bronchus

Answer 16

• Obstruction of the bronchial lumen can result in collapse of the lobe or lung, termed atelectasis
• If you block a bronchus, you can also cause build up of bronchial secretions behind the obstruction and this stasis predisposes to infection and this is called obstructive bronchopneumonia
• The repeated cycles of chronic inflammation caused by obstruction can also damage the elastin and smooth muscle of the bronchial wall causing permanent dilation which we call bronchiectasis

Question 17

Epithelial cells normally form coverings and linings but to invade malignant epithelial cells need to become mobile and acquire the ability to migrate. These abilities are normally seen in cells of mesenchymal origin and this change in behaviour seen in carcinoma is often referred to as…

Answer 17

epithelial-mesenchymal transition

Question 18

what does the basement membrane contain?

Answer 18

Type IV collagen

–> basement membrane contains laminin and type IV collagen

Question 19

Benign vs malignant tumours

Answer 19

.

Question 20

SNAIL and TWIST

Answer 20

• SNAIL –> transcription factor which can convert epithelial cells into migratory mesenchymal cells
  –> SNAIL genes act as survival factors and inducers of cell movement
• TWIST can silence e-cadherin expression and can promote epithelial to mesenchymal transformation

Question 21

_____ cleaves type IV collagen of epithelial and vascular basement membranes and stimulates the release of VEGF (vascular endothelial growth factor)

Answer 21

MMP-9 (Matrix metalloproteinase 9)

Question 22

Malignant cells vs benign cells

Answer 22

Question 23

What determines patient outcome in carcnioma?

Answer 23

Grade –> how closely the tumour resembles the tissue from which it arises –> how aggressive the tumour is likely to be

Question 24

The metastatic cascade

Answer 24

• Detachment of tumour cells from the neighbours
• Invasion of the connective tissue to reach lymphatics and blood vessels
• Intravasation into the lumen of vessels
• Evasion of host defence mechanisms –> such as natural killer cells and T lymphocytes
• Adherence to endothelium as a remote location
• Extravasation of the cells from the vessel lumen into the tissue
• Survival and growth in the new environment

Question 25

Antibiotic classes

Answer 25

Dr Matt and Dr Mike video:
https://www.youtube.com/watch?v=gqoqexfqoBM

https://www.youtube.com/watch?v=XJEHcpD1kC8

Question 26

Gram +ve vs gram -ve bacteria video

Answer 26

Dr Matt and Dr Mike video:
https://www.youtube.com/watch?v=PpqDBK1QQeQ

Question 27

Dermatomes + myotomes + plexuses (cervical, brachial, lumbosacral)

Answer 27

https://geekymedics.com/dermatomes-and-myotomes/

Question 28

SALTER HARRIS