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PATH FACTS > PATH FACTS > Flashcards

PATH FACTS Flashcards

1
Q

MOST Common ovarian tumour

A

Serous (Mullerian epithelium)
associated with ascites
commonly bilateral

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2
Q

What are the three main ovarian cell types and the tumours arising from each?

A

Mullerian epithelium
- serous cystadenocarcinoma (MOST common)
- mucinous
- endometrioid
- Clear cell carcinoma - variant of
endometrioid
- Transitional cell tumour (BRENNER)
tumour (90% unilateral)
Germ cell
- Teratoma (dermoid)
- mature
- immature
- monodermal or highly
specialised
- Dysgerminoma
- Yolk sac tumour
- Choriocarcinoma
Sex-cord Stromal tumours
- Granulosa cell
- Fibroma, fibrothecoma, thecoma
- Sertoli-Leydig

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3
Q

MOST common BENIGN ovarian neoplasm.
What percentage is bilateral?

A

Dermoid
10-15%

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4
Q

Mature teratoma - DERMOID is occasionally associated with ?

1% undergo malignant transformation to ?

A

paraneoplastic syndrome
such as inflammatory limbic encephalitis

SCC

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5
Q

MOST common monodermal or specialised teratoma?

A

Struma ovarii and carcinoid
(ALWAYS unilateral)

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6
Q

What is STRUMAL CARCINOID?

A

combination of struma ovarii and carcinoid in the same ovary.

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7
Q

MOST common malignant ovarian GCT?
Whats the second MOST common

A

DYSGERMINOMA
ovarian counterpart of testicular seminoma
YOKL sac tumour

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8
Q

Which ovarian neoplasm is associated with endometrial hyperplasia and endometrial carcinoma

A

Adult type granulosa cell tumour

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9
Q

Fibromas are associated with ? when >6 cm +/- hydrothorax - which side

A

ascites
right side

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10
Q

What is Meigs syndrome?

A

ovarian tumour
hydrothorax
ascites

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11
Q

The disease is characterised by widespread deposition of collagen and other extracellular matrix proteins. This is believed to occur as a result of an abnormal immune response. Small vessels are involved early in the disease. This results in perivascular fibrosis and gradual luminal stenosis.

A

Scleroderma

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12
Q

All paragangliomas consist of two types of cells;

A

type I and type II. The main components are lobules or nests of chief cells (type I); these structures are known as Zellballen. They are surrounded by a single layer of sustentacular cells (type II).

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13
Q

The most common genetic cause of hereditary paragangliomas are mutations in

A

the succinate dehydrogenase (SDH) subunit (genes: SDHB, SDHD, SDHA or SDHAF2)

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14
Q

Uncommon sex cord stromal tumours include/.

A

HILUS cell tumour - pure leydig cell
rare, unilateral
lipid laden leydig cells
reinke crystalloids, produce testosterone
benign

pregnancy luteoma - rare and closely resembles corpus luteum, produces virilisation in pregnant patients and female infants

Gonadoblastoma - composed of sex cord and germ cells. Immature sertoli and granulosa cells. Co existent dysgerminoma in 50%

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15
Q

MOST common tumours that met to ovary?

A

BREAST and GI tract (colon, stomach, biliary, pancreas and appendiceal - pseudomyxoma peritonei)

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16
Q

Classic metastatic GI tumour involving the ovary?

A

KRUKENBERG TUMOUR signet ring appearance - bilateral mets of mucin producing cancer cells

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17
Q

MOST important predisposing condition for ectopic pregnancy?

A

PID
intrauterine contraceptive device increase 2x risk for ectopic

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18
Q

MOST common cause of hematosalpinx?

A

tubal pregnancy

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19
Q

what are the three types of twin placentas

A

dichorionic diamniotic
monochorionic diamniotic
monochorionic monoamniotic

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20
Q

What is the most common complication of monochorionic pregnancy ?

A

TTT syndrome

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21
Q

three types of abnormal placental implantation?

A

Placenta accreta - abnormal decidua
placenta increta
placenta percreta

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22
Q

2 types pf moles (trophoblastic disease) and how they develop

A

complete mole - 90% have 46 xx karyotype
fertilization of an egg that lost all its female chromosomes.
10% are from fertilization of an empty egg by 2 sperm - 46 xx and 46XY. No fetal parts. 2.5 % risk of choriocarcinoma
15% risk of persistent or invasive mole

Partial mole - fertilization of an egg with 2 sperm - karyotype is triploidy - 69 XXY or occasionally tetraploidy (92 XXXY)
FETAL tissue usually present
increased rik of persistent mole BUT NO association with CHORIOCARCINOMA

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23
Q

Malignant neoplasm of trophoblasts from pre normal or abnormal pregnancy

most common location of mets

A

CHORIOCARCINOMA
50% arise from complete hydatiform
25% from prev abortion
22% from normal pregnancy
rapidly invasive, mets widely and responds well to CHEMO

LUNGS (50%) cannon ball
Vagina -30-40%
brain>liver>bone>kidney

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24
Q

TWO serotypes of HSV and what they affect?

A

HSV - 1 perioral
HSV 2 - genital mucosa and skin

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25
Q

What is caused by the POXVIRUS?

A

Molluscum contagiosum
4 types - MCV - 1 most prevalent
MCV-2 most often sexually transmitted

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26
Q

MAIN cause of bacterial vaginosis

A

Gardnerella vaginalis

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27
Q

Large flagelatted ovoid protozoan transmitted sexually - yellow frothy vaginal discharge or strawberry cervix

A

Trichomonas Vaginalis

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28
Q

Causes cervicitis but can ascend to uterus and tubes resulting in endometritis and salpingitis and cause of PID q

A

Chlamydia trachomatis

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29
Q

MOST common cause of PID

A

Neisseria Gonorrhoea

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30
Q

Lichen Sclerosis

A

marked THINNING of epidermis
NOT premalignant
increased RISK of SCC (keratinizing)

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31
Q

Lichen simplex chronicus (squamous cell hyperplasia)

A

marked THICKENING of the epidermis
NOT premalignant

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32
Q

Condylomata acuminata

A

BENIGN genital wart caused by LOW risk HPV - 6 and 11
NOT premalignant

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33
Q

Basaloid and warty carcinoma associated with

A

RELATED to High risk HPV - 16

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34
Q

Keratinizing SCC -

A

UNRELATED to HPV

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35
Q

EXTRAMAMMARY Pagets disease

A

NOT associated with underlying cancer

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36
Q

MOST vulvar cancers (70%) are NOT related to HPV but arise from background of

A

Lichen slcerosis or squamous cell hyperplasia (VIN)

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37
Q

These cysts are found long the LATERAL wall of the vagina and derived from WOlfian duct rests

A

Gartner duct cyst

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38
Q

Squamous cell carcinoma of the vagna arise from VIN and affects the upper vagina - posterior wall at junction of ectocervix
Lesions in lower 2/3rds mets to ?
Lesiosn in upper vagina spread to ?

A

inguinal nodes
regional iliac nodes

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39
Q

What is an uncommon vaginal tumour in infants/children < 5yrs - grapelike appearance - invades locally and causes death by penetration into peritoneal cavity or obstruction of urinary tract.

A

Embryonal rhabdomyosarcoma aka sarcoma botryoides

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40
Q

MOST common type of cervical cancer

Staging of cervical ca

A

Squamous cell carcinoma - 60% due to HPV 16, 10% due to HPV 18
second most common is adenocarcinoma

Stage 0 - carcinoma in situ
1 - confined to cervix
2 - extends beyond cervix but not into pelvic wall
3 - extends to pelvic wall
4 beyond the true pelvis or involving bladder or rectum

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41
Q

Site of endometriosis in descending order

A

Ovaries > uterine ligaments > rectovaginal septum > cul de sac > pelvis peritoneum > Serosa of SB and LB > appendix > mucosa of cervix > vagina and fallopian tubes > laparotomy scars

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42
Q

What are the three types of endometriosis?

A

Superficial peritoneal endometriosis
Ovarian endometriosis
Deep infiltrating endometriosis

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43
Q

Endometrial tissue within the uterine wall (myometrium)

A

Adenomyosis

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44
Q

What is the MOST common type of endometrial cancer?

A

Endometrioid endometrial ca - type I low grade
55-65yrs - 85-90% of cases
arises from endometrial hyperplasia and assoc with PTEN gene mutation
Other type is serous - Type 2 high grade
75yrs
arises from endometrial atrophy and assoc with TP53 mutation

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45
Q

Presents MOST commonly as large broad based endometrial polypoid growth that may prolapse through cervical os

A

Adenosarcoma

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46
Q

MOST common myometrial tumour

A

Leiomyoma (fibroid)
Benign smooth muscle neoplasm
Intramural, submucosal, subserosal

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47
Q

MOST common cause of cystitis?
in immunosupressed?
Haemorrhagic cystitic
Emphasematous cystitis

A

E.coli
Candida & cryptococcal agents
Adenovirus and BK virus
Clostridium perfringens

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48
Q

2 precursor lesions to invasive urothelial carcinoma

Risk factors

A

Non invasive papillary tumours
Flat non invasive papillary tumours

Smoking increased risk 3-8 x
exposure to aryl amines
schistosoma haematobium
long term analgesia
long term exposure to cyclophosphamide
irradiation

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49
Q

Hard penile plaques - deposition of collagen in connective tissue between CORPORA CAVERNOSA and TUNICA ALBUGINEA

A

Peyronie disease

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50
Q

Cryptorchidism - unilateral but bilateral in 25% - 3-5 x increased risk of testicular cancer

A

d

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51
Q

Which infections arise in the epididymis FIRST then spread to testis?

Which infections involve the testis first then spread to epididymis?

A

TB and Gonorrhea

Syphilis

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52
Q

Epididymitis and subsequent orchitis are commonly related to infections of the urinary tract - by age which is the most common organisms?
Childhood -
Male <35yrs sexually active
Male >35yrs

A

Childhood = GU abnormality and Gram - rods
<35yrs - C. trichomatis and N. gonorrhea
>35yrs = E.coli and pseudomonas

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53
Q

Systemic viral disease in school aged children - testicular involvement uncommon in this age group. Post puberty males orchitis occurs in 20-30% Acute interstitial orchitis develops 1 week after swelling of parotid glands

A

MUMPS

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54
Q

2 forms of testicular syphilis

A

Obliterative endarteritis
Granulomatous inflammation

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55
Q

Testicular torsion is usually due to

A

Bell clapper abnormalities

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56
Q

MOST common benign paratesticular tumour

A

Adenomatoid tumour

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57
Q

MOST common testicular tumour in 15-45yrs

A

GCT (95%) - MOST common type is seminoma (50%)
SPERMATOCYTIC seminoma >65yrs ***

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58
Q

MOST common malignant paratesticular tumour
children ?
adults?

A

Children = rhabdomyosarcoma
Adult = Liposarcoma

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59
Q

What condition is associated with 50x increased risk of mediastinal GCTs but they DO NOT develop testicular tumours?

A

Klinefelter syndrome

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60
Q

MOST common testicular tumour in infants up to age 3 yrs

A

YOLK sac tumour (endodermal sinus tumour)

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61
Q

Most testicular neoplasms spread via lymphatics - which nodes are 1st involved?

A

Retroperitoneal paraoartic lymph nodes with spread to mediastinum and supraclavicular nodes

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62
Q

What markers can be used to assess GCTs

A

AFP, hCG and lactate dehydrogenase

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63
Q

MOST common form of testicular neoplasms in men >60yrs

A

Non Hodgkin lymphoma
freq bilateral
subtype - diffuse large B cell > Burkitts > EBV

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64
Q

4 regions of the prostate?

A

peripheral - CARCINOMA
central
transitional _ BPH
periurethral

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65
Q

MOST common cause of prostatits

MOST Common form?

A

E.coli

Chronic abacterial prostatitis - aka chronic pelvic pain syndrome

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66
Q

PROSTATE cancer mets are typically?
most common locations

what grading system is used

A

OSTEOBLASTIC
lumbar spine > proximal femur > pelvis > thoracic spine > ribs

Gleason system - 5 grades

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67
Q

Prostate ca that shows > 25% mucinous secretions = ?

MOST aggressive prostate ca variant?

A

Colloid carcinoma

Small cell ca (neuroendocrine carcinoma)

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68
Q

MOST common benign parotid gland tumour ?

A

Pleomorphic adenoma followed by Warthin tumour

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69
Q

MOST common mesenchymal tumour of the abdomen

A

GIST > 50% occur in the stomach

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70
Q

Where does GIST tumour arise from

A

Interstitial cells of Cajal (or pacemaker cells)

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71
Q

What does Carney triad include

A

GIST
paraganglioma
pulmonary chondroma
primarily in females

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72
Q

What are the two subtypes of acute pancreatitis?

A

interstitial oedematous pancreatitis
the vast majority (90-95%)
most often referred to simply as “acute pancreatitis” or “uncomplicated pancreatitis”
5-10% will develop necrosis

necrotising pancreatitis
necrosis develops within the pancreas and/or peripancreatic tissue. tends to occur early, within the first 24-48 hours, 40% become infected within the 1st week

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73
Q

Risk Factors for pancreatitis

A

Cholelithiasis, alcohol
drugs, autoimmune, trauma, idiopathic/anatomic abnormality (pancreatic divisum), malignancy

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74
Q

4 complications of necrotising pancreatitis

A

Infection/abscess
pseudoaneurysm
spesis, organ damage

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75
Q

Idiopathic inflammatory bowel disease characterised by widespread discontinuous gastrointestinal tract inflammation. The terminal ileum and proximal colon are most often affected. Extraintestinal disease is common.

A

Crohns disease

Associations - coeliac disease: 3-4x increased risk

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76
Q

PSC is more common in which IBD?

A

UC

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77
Q

6 macroscopic features of Crohns disease

A

skip lesions, strictures, fissures, cobblestone appearance, apthous ulcres, transmural oedema, creeping fat

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78
Q

4 extraintestinal manifestations of crohns

A

sacroilitis, erythema nodosum (skin), uveitits (eyes) gallstones, renal calculi

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79
Q

Multicentric breast cancer ?
vs
metachronous breast cancer
vs
multifocal

A

multicentric = where there are two or more breast cancers separated by normal breast tissue (often taken as 5 cm of separation

metachronous = two breast cancers that occur in either breast in two different time periods.

multifocal = Multifocal breast cancer refers to two or more individual breast cancers diagnosed at the same time within the same quadrant of the same breast 1.

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80
Q

Malignant bone-forming tumours. Second most common primary bone tumour after multiple myeloma.
In children, they are considered the most common primary bone tumour Primary and secondary forms, as well as histologic types - conventional osteosarcoma is the most common.

A

OSTEOSARCOMA

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81
Q

Heterogeneous group of malignant cartilaginous tumours most commonly found in older patients. They can arise de novo or secondary from an existing benign cartilaginous neoplasm.

A

CHONDROSARCOMA

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82
Q

What site does HPV SCC usually affect in the upper aerodigestive tract?

A

Tonsils, base of tongue, soft palate, pharynx

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83
Q

Heterogeneous group of vascular lesions characterised by idiopathic, non-inflammatory, and non-atherosclerotic angiopathy of small and medium-sized arteries.

A

FMD - fibromuscular dysplasia

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84
Q

aganglionosis (absence of ganglion cells) in the distal colon and rectum. It affects cells both in the myenteric and submucosal plexuses

A

Hirschsprung disease

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85
Q

Carcinoma of the larynx is typically ?

Nondysplastic hyperplasia have almost no potential for malignant transformation. Lesions with dysplasia, malignant transformations is directly proportional to inital GRADE of dysplasia

A

SQUAMOUS CELL CARCINOMA
male, chronic smokers

86
Q

Characterised by progressive cardiac dilatation and contractile (systolic) dysfunction, usually with concomitant hypertrophy.
(heart is heavy and flabby and hypocontracting )

A

DCM - dilated cardiomyopathy
50% is familial

Takotsubo is a type of DCM - LV contractile dysfunction

87
Q

Myocardial hypertrophy, poorly complaint left ventricle muscle leading to poor diastolic filling.
(Heart is thick walled, heavy and hypercontracting). MAINLY diastolic dysfunction

A

Hypertrophic cardiomyopathy - key feature is massive myocardial hypertrophy without ventricular dilatation.
100% genetic
mutation in sarcomeric protein

88
Q

Classic feature seen in the septum of HCM?

A

disproportionate thickening of the ventricular septum relative to left ventricle free wall.

89
Q

What aneurysm is spherical outpouching involving only a portion of the vessle wall?

A

Saccular - generally 2- 20 mm

90
Q

Which aneurym involve diffuse, circumferential dilation of a long segmen

A

Fusiform

91
Q

Precursor lesion of GCTs is germ cell neoplasia in situ is found in 90% of testes with GCTs EXCEPT?

A

Spermatocytic tumour

92
Q

Non neoplastic cystic lesions assocaited with chronic otitis media?

A

CHOLESTEATOMA

93
Q

MOST prevelant form of sialadenitis = ?
MOST common viral cause of sialadenitis =?

Cause of bacterial sialadenitis = ?

A

Mucocele - often fnd on lower lip as a result of trauma, occur in all ages, fluctuant lower lip swelling with blue translucent hue
MUMPS -

S. aureus and strep viridans

94
Q

CYST that dissects through the connective tissue stroma connecting the two bellies of the mylohyoid muscle

A

Plunging ranula

95
Q

MOST common benign salivary gland tumours (top 3 )

A

Pleomorphic adenoma (rate of malignant transformation correlates with age of lesion - adenocarcinoma or undifferentiated and most aggressive)
Warthin tumour (M>F smoking risk factor) most unifocal - 10 % multifocal and 10% bilateral.
Oncocytoma

96
Q

MOST common malignant salivary gland tumours (top 3)

A

Mucoepidermoid carcinoma
Acinic cell carcinoma (mostly parotid gland)
Adenoid cystic carcinoma (minor salivary glands - particularly palatine - worse prognosis than when they occur in parotid) tend to invade perineural spaces.

97
Q

MOST common locations of salivary gland tumours in order

MALIGNANT potential of salivary glands are inversely proportional to gland size.

A

65-80% parotid gland (majority are benign)
10% submandibular (40% malignant)
remainder in minor salivary glands (50% malignant)

**70-90% of sublingual tumours are malignant. **

98
Q

WHAT are the three most common developmental anomalies of the lung?

A
  • Pulmonary hypoplasia
  • Foregut cyst (depending on wall structure they are classified as bronchogenic (most common - rarely connected to the tracheobronchial tree) esophageal or enteric.
  • pulmonary sequestration - NOT connected to the airways and has abnormal blood supply arising from aorta or branches.
99
Q

What are the 3 types of atelectasis

A
  • Resorption atelectasis - stems from obstruction of an airway
  • Compression atelectasis - tumour, fluid or air accumulates within pleural cavity
  • contraction atelectasis - fibrosis prevents full lung expansion
100
Q

2 types of pulmonary oedema?

A

cardiogenic and non-cardiogenic

101
Q

Characterised by abrupt onset of hypoxemia and bilateral pulmonary oedema in the absence of cardiac failure

A

ALI - acute lung injury

ARDS = sever ALI

102
Q

Chronic obstructive lung diseases include?

A

Chronic bronchitis - persistent cough with sputum production (3 months in 2 consecutive yrs).
Bronchiectasis
asthma
emphysema
small airways disease

103
Q

Irreversible enlargement of the airspaces DISTAL to the terminal bronchiole = ?

A

EMPHYSEMA

104
Q

WHAt are the 3 major types of emphysema? and which part of the airway does it affect

A

CENTRILOBULAR - most common form (>95%) mostly affects the upper lobes/apical - central or proximal parts of the acini affected (distal alveoli spared).
PANLOBULAR - assoc with A1-AT - uniformly enlarged from level of respiratory bronchiole to terminal blind alveoli. More common in lower lobes and anterior margins.
PARASEPTAL - Proximal acinus is normal - distal part involved.

105
Q

What index is used in chronic bronchitis and what does it measure?

A

Reid index - ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and the cartilage (normally 0.4)

106
Q

Compare and contrast Bronchitis with Emphysema

A

Bronchitis - 40-45yrs, lots of sputum, mild dyspnea, infection common, cor pulmonale common, increased airway resistance, blue bloater

Emphysema - 50-75yrs, scanty sputum, severe dyspnea, infection uncommon, normal or slightly increased airway resistance, pink puffer

107
Q

What are the types of asthma

A

Atopic asthma (MOST common form) - type I HS rxn - triggered by environmental allergens. Positive FHx is common - Eosinophilia and eosinophils, curschmann spirals and charcot layden crystals in sputum
Non-Atopic asthma - no allergen sensitization, Fhx less common, Virus infection is common trigger.
Drug-induced asthma - aspirin sensitive (uncommon) but occurs in people with recurrent rhinitis and nasal polyps.
Occupational asthma - triggered by fumes, organic and chemical dust, gases or other chemicals.

108
Q

ABPA frequently occurs in pts with asthma or CF and frequently leads to the development of bronchiectasis. it is a hyperimmune response to fungus?

A

Aspergillus fumigatus

109
Q

What are the major categories of chronic interstitial lung disease?

A

FIBROSING -
UIP
NSIP
COP - pathcy subpleural or peribronchial consolidation
Connective tissue disease
Pneumoconiosis
Drug rxns
Radiation pneumonitis

GRANULOMATOUS -
Sarcoid
Hypersensitivity pneumonitis (HSP)

SMOKING RELATED
DIP - Desquamative interstitial pneumonia
Resp bronchiolitis

OTHER -
LCH
PAP
LIP

110
Q

Progressive interstitial pulmonary fibrosis and respiratory failure
(rare <50yrs.)

A

IPF - histologic pattern is UIP

UIP pattern can also be seen in connective tissue disease, chronic HSP, asbestosis

NSIP is most often assoc with connective tissue diseases.

111
Q

Which autoimmune/connective tissue diseases most commonly involve the LUNG?

A

SLE
Rheum arthritis (30-40%)
scleroderma (NSIP pattern >UIP)
dermatomyositis-polymyositis
HISTOLOGY patterns varies and can include UIP, NSIP, OP and bronchiolitis

112
Q

When lung disease occurs in the setting of Rheum arthritis and pneumoconiosis its referred to as?

A

CAPLAN Syndrome

113
Q

Describes non neoplastic lung reactions to inhalation of mineral dusts encountered in the workplace, or disease induced by chemical fumes and vapors

A

PNEUMOCONIOSIS

114
Q

What mineral dusts cause pneumoconiosis -

A

Coal dust
Silica
Asbestos
Beryllium
Iron oxide
barium sulfate
Tin oxide

115
Q

Organic dusts that cause HSP

A

Moldy hay - farmers lung
Bagasse - bagassosis (manufacturing wallboard paper)
Bird droppings - bird breeders lung

116
Q

What is progressive massive fibrosis in the lungs? leads to?

A

Complicated coal workers pneumoconiosis (<10%)
Pulmonary dysfunction, pulmonary HTN, cor pulmonale

NO EVIDENCE that coal workers pneumoconiosis increases suscebtibility to TB nor cancer in absence of smoking

117
Q

Silica occurs in which two forms?
Which one is more fibrogenic

A

Crystalline and amorphous (biologically less active)
crystalline

118
Q

Silicosis is characterised by?

A

nodules in the hilar lymph nodes and upper zones of the lungs which coalesce into hard, collagenous scars. sometimes this sheets of calcification form in lymph nodes seen as eggshell calcification on xray.
Nodules (on polarised light) show weakly birefringent silicate particles.

119
Q

What is the most common delay time/onset of symptoms after exposure for silicosis?

A

10-30 yrs
accelerated (within 10 years)
rapid (weeks or months after intense exposure)

120
Q

Silicosis is associated with increased risk of what?

A

Susceptibility to TB and 2x increased risk of lung cancer.

121
Q

How is asbestos distinguished from other forms of diffuse interstitial fibrosis?>

A

presence of asbestos bodies. - which are golden brown fusiform or beaded rods with translucent centre that consists of asbestos fibres coated with iron containing proteinaceous material.

122
Q

What is the pattern of fibrosis in asbestos?

A

UIP

123
Q

Where does fibrosis begin in asbestos vs coal worker pneumoconiosis and silicosis?

A

Asbestos - begins around resp bronchioles and alveolar ducts
scarring may trap and narrow pulm arteries causing HTN and cor pulmonale

~Coal workers and silicosis - begins in lower lobes subpleurallly

124
Q

Where do pleural plaques form and what features do they have?

A

anterior and posterolateral aspects of the parietal pleura and over domes of diaphragm
Size and number DON’T correlate with level of exposure
NO identifiable asbestos bodies

125
Q

What other diseases develop in workers exposed to asbestoses?

A

Lung carcinoma and mesothelioma (pleural and peritoneal)

126
Q

Drug induced lung diseases include?

A

Bleomycin - pulm damage and fibrosis
Amiodarone - pneumonitis in 5-15%
ACEI - cough

127
Q

Radiation induced lung disease includes>?

A

HSP 1-6 months after irradiation in 3-44% of patients

128
Q

Sarcoidosis most commonly shows ?

A

BILATERAL hilar lymphadenopathy or parenchymal lung involvement
<40yrs
F>M
UNKNOWN CAUSE

129
Q

What other organs are commonly involved in Sarcoid other than lung? and findings?

A

Lymph nodes - hilar and mediastinal - can be calcified
Tonsillar granulomas
Spleen 75% of cases - overt splenomegaly only seen in 20%
Liver < spleen - but show scattered granulomas more in portal triads than parenchyma
Bone marrow - 20% - mostly seen in hands and feet radiologically - small circumscribed areas of bone resorption with the marrow cavity and diffuse reticulated pattern throughout the cavity with widening of shaft and new bone formation on the outer surface
skin - 25% - subcut nodules, erythematous plaques, resemble SLE, erythema nodosum
Eyes-25% iritis inflammation of lacrimal glands
heart and kidneys, CNS - neurosarcoid (5-15%), pituitary gland

130
Q

Combined uveoparotid involvement in sarcoid - bilateral sarcoid of the parotid glands, submaxillary and sublingual glands is called?

A

Mikulicz syndrome

131
Q

Pulmonary eosinophilia is divided into what categories

A

Acute eosinophilic pneumonia -
Secondary eosinophilia -
idiopathic chronic eosinophilic pneumonia - focal areas of consolidation mainly in the periphery of the lungs, interstitial fibrosis and organizing pneumonia are often present

132
Q

Characterized by large collection of macrophages in the air spaces of a current or former smoker.

A

DIP - desquamative interstitial pneumonia
nearly ALL patients are SMOKERS
M=F (50’s)

133
Q

Marked by chronic inflammation and peribronchiolar fibrosis. Common in smokers. Characterised by presence of pigmented intraluminal macrophages within the first and second order respiratory bronchioles

A

RB-ILD

DIP often seen in the same lung

134
Q

Characterised by focal collections of langerhan cells (often plus eosinophils) - causes scarring and airway destruction giving appearance of irregular cystic spaces,

A

Pulmonary LCH

135
Q

Disease caused by defects in pulmonary macrophage function due to deficient granulocyte-macrophage colony-stimulating factor signaling. (GM-CSF) which results in accumulation of surfactant in the intra-alveolar and bronchiolar spaces,.
Characterised radiologically by ?

A

PAP
3 distinct classes - autoimmune, secondary and congenital

BILATERAL patchy asymmetric pulmonary opacifications

136
Q

Pulmonary embolus can be distinguished from a postmortem clot by?

A

presence of lines of Zahn in the thrombus

137
Q

Pulmonary infarct is classically ?
If infarct is caused by infected embolus it can cause ?

A

Haemorrhagic

Septic infarcts can turn into abscess

Patients with pulmonary embolus have a 30% chance of suffering a second embolus.

138
Q

Pulmonary artery HTN is defined as mean pulmonary artery pressure > than?

A

> or equal to 25 mmHg at rest

139
Q

ALL forms of pulmonary
HTN are associated with what?

A

Medial hypertrophy of the pulmonary musculature and elastic arteries and RV hypertrophy.

140
Q

What are plexiform lesions in Pulmonary HTN?

A

tuft of capillary formations preducing a network or web that spans the lumens of dilated thin walled small arteries and may extend outside the vessel. MOST prominent in idiopathic and familial pulm HTN and HIV

141
Q

Idiopathic (often inherited) pulm HTN is most common in women age 20-40

A
142
Q

this is a dramatic complication of some interstitial lung disorders.
This syndrome includes what disorders?

A

Diffuse pulmonary haemorrhage syndrome

Goodpasture syndrome
Idiopathic pulmonary hemosiderosis
vasculitis asspciated haemorrhage - includes (hypersensitivity angiitis, polyangitis with granulomatosis and SLE)

143
Q

This is a rare disorder characterised by intermittent, diffuse alveolar haemorrhage. Most occur in young children, productive cough, hemoptysis, anemia - associated with diffuse pulmonary infiltrates. Cause - UNKNOWN

A

Idiopathic pulmonary haemosiderosis

144
Q

Uncommon autoimmune disease in which kidney and lung injury are caused by circulating autoantibodies against the noncollagenous domain of alpha 3 chain of collagen IV. When only renal disease is caused its called?

The pathogenic antibodies cause destruction of the ?

A

Goodpasture syndrome

anti-glomerular basement membrane disease.

MOST occur in teens to 20’s
majority are active smokers

Basement membrane in renal glomeruli and pulmonary alveoli
giving rise to rapidly progressive glomerulinephritis and necrotizing haemorrhagic interstitial pneumonitis

145
Q

Autoimmune disease involving the upper respiratory tract and/or the lungs - haempoptysis is most common presentation.
TRANSBRONCHIAL lung Biopsy might provide the ONLY tissue available for DIAGNOSIS

A

Polyangiitis with granulomatosis

146
Q

What marker of inflammation is an acute pahse reactant produced in the liver but is more elevated in bacterial vs viral infections?

A

Procalcitonin

147
Q

What is the MOST common cause of community acquired pneumonia?

A

Strep pneumonia

148
Q

Which type of H. influenzae is most virulent?

A

Type b

149
Q

This bacteria causes bacterrial pneumonia in elderly, 2nd most common cause of acute exacerbation of COPD and MOST common cause of otitis media in children

A

Moraxella catarrhalis

150
Q

MOst common bacteria to cause abscesses or empyema following chest infection

A

Staph Aureus

151
Q

Most common bacteria to infect lungs of debilitated or malnourished esp chronic alcoholics - causes thick mucoid blood stained sputum

A

Klebsiella pneumoniae

152
Q

MOST common cause of hospital acquired infection, CF and immunocompromised patients. has propensity to invade blood vessels with extrapulmonary spread

A

Pseudomonas aeruginosa

153
Q

Causes Pontiac fever, agent of legionnaires disease, flourishes in artificial aquatic environments.

A

Legionella pneumophilia

154
Q

Infection particularly common among children and young adults. (spreads in schools, military camps/prisons)

A

Mycoplasma pneumoniae

155
Q

Patchy lung consolidation is known as

A

lobular bronchopneumonia

156
Q

What are the 4 stages of inflammatory response in pneumonia ?

A

congestion
red hepatization
grey hepatization
resolution

157
Q

What are the possible complications of pneumonia? (3)

A

tissue destruction and necrosis causing abscess
spread of infection to pleural cavity
bacteraemic dissemination to heart valves, pericardium, brain, kidneys

158
Q

Which influenzae virus is major cause of pandemic and epidemic influenzae infections?

A

Type A

159
Q

This infection is acquired by inhalation of dust particles from soil contaminated with bird or bat droppings that contain small spores

produce granulomas which become necrotic and can coalesce to produce areas of consolidation. yeast on histology

A

H. capsulatum (hitoplasmosis)

160
Q

soil inhabiting dimorphic fungus. what are the three forms

A

Blastomyces dermatitidis - 3 forms = pulmonary, disseminated and rare primary cutaneous form

161
Q

MOST common cancer worldwide and most common cause of cancer mortality worldwide

A

LUNG CARCINOMA

162
Q

Lung ca is broadly classified into ?

A

Small cell (15%) and
Non small cell types - includes adenocarcinoma (50%) and squamous cell carcinoma (20%).

Large cell carcinoma (2%)
Other (13%)

163
Q

Smoking + asbestos increases risk of lung ca by?

A

55 x

164
Q

MOST common subtype of lung cancer in non smokers/women?

cancers in non smokers are more likely to have what mutation? and almost never have what mutation?

A

Adenocarcinoma (peripheral) - MOST common subtype overall

EGFR mutations
KRAS mutations

165
Q

Which subtype of lung ca is highly associated with smoking?

A

Squamous cell carcinoma (central)

166
Q

Which subtype of lung ca is ALWAYS related to smoking and has highest mutational burden (more common in men)

A

Small cell carcinoma (major bronchi or periphery of lung)
almost all are metatstatic at presentation - treated with CHEMO

167
Q

What are the 4 types of precursor lesions for lung ca

A

atypical adenomatous hyperplasia
adenocarcinoma in situ
squamous dysplasia and carcinoma in situ
diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

168
Q

Histologic types of adenocarcinoma (lung)

A

Lepidic
Acinar
Micropapillary
Papillary
Solid
Invasive mucinous adenocarcinoma
Minimally invasive adenocarcinoma (nonmucinous and mucinous)

169
Q

Histologic types of Squamous cell carcinoma (lung)

A

Keratinizing
nonkeratinizing
basaloid

170
Q

Histologic types of neuroendocrine tumours (lung)

A

small cell carcinoma
combined small cell carcinoma
large cell neuroendocrine carcinoma
combined large cell neuroendocrine carcinoma
carcinoid - typical and atypical

171
Q

Other uncommon Histologic types (lung)

A

large cell carcinoma
adenosquamous carcinoma
sarcomatoid carcinoma

172
Q

Apical lung cancers tend to invade the neural structures aroudn the trachea including the cervical sympathetic plexus producing horners syndrome on same side as lesion. These tumours are aka?

A

Pancoast tumours

173
Q

What paraneoplastic syndromes is associated with lung carcinoma ?

A

Inappropriate ADH secretion (induces hyponatraemia)
Cushings syndrome - ACTH
Hypercalcaemia - parathyroid
Calcitonin - hypocalcaemia
Gonadotrophins - gynaecomastia
Serotonin and bradykinin - carcinoid syndrome

174
Q

Which lung cancer predominantly produces
ACTH and ADH?
hypercalcaemia

A

Small cell carcinoma
squamous cell carcinoma

175
Q

Other systemic manifestations of lung ca include

A

Lambert -eaton myasthenic syndrome
peripheral neuropathy
acanthosis nigricans
trousseau syndrome
hypertrophic pulmonary osteoarthropathy

176
Q

This lung tumour can arise centrally or peripherally. rarely exceed 3-4 cm. most confined to mainstem bronchi. commonly project into lumen of bronchus. can penetrate wall and fan out into peribronchial tissues.

what classic syndrome can it produce?

A

bronchial carcinoid

carcinoid syndrome - intermittent attacks of diarrhoea, flushing and cyanosis

177
Q

Common lesion usually discovered incidentally - round radio-opaque coin lesion in CXR. most are solitary 3-4 cm well circumscribed

A

pulmonary hamartoma

178
Q

pulmonary disorder that primarily affects young women of childbearing age. characterised by proliferation or perivascular epithelioid cells that express markers of both melanocytes and smooth muscle cells. Leads to cystic emphysematous like dilation of terminal airspaces, thickening of the interstitium and obstruction of lymphatic vessels. only lung transplant is curative

A

Lymphangioleiomyomatosis

179
Q

rare tumour more common in children
round well defined peripheral mass +/- calcs

A

inflammatory myofibroblastic tumour

180
Q

inhertited disorder of ion transport that affects fluid secretion in exocrine glands and in the epithelial lining of the respiratory, gastrointestinal and reproductive tracts

A

Cystic fibrosis- MOST common lethal genetic disease that affects caucasian populations

181
Q

What is the primary defect in CF

A

abnormal transport of chloride and bicarbonate ions mediated by an anion channel encoded by the CFTR gene on chromosome 7q31.2

182
Q

80% of CF patients are colonized by ? by the age of 20

A

Pseudomonas Aeruginosa

183
Q

Peripheral nerve sheath neoplasms (benign and malignant) are composed of cells that show what?
what are the three common types?

A

Schwann cell differentiation

schwannoma, neurofibroma and malignant peripheral nerve sheath tumour.

184
Q

What are the unique features of PNST - association with what syndromes.
MPNST in context of NF1 are thought to arise from ?

A

NF1 and NF2
malignant transformation of benign plexiform neurofibroma

185
Q

Benign tumour that exhibit Schwann cell differentiation and often arise directly from peripheral nerves
assoc with which syndrome and chromosome

A

Schwannoma

NF2 - chromosome 22
Loss of NF2 gene (merlin) = finding in all schwannomas

186
Q

benign nerve sheath tumors where neoplastic schwann cells are admixed with perineural -like cells, fibroblasts, mast cells and CD34+ spindle cells.

A

neurofibromas

186
Q

most intracranial schwannomas occur where? and affect which nerve?

A

CPA
vestibular branch of 8th nerve

187
Q

Only Schwann cells in neurofibroma show complete loss of ? gene

A

NF1 (neurofibromin)

188
Q

these tumours grow within and expand nerve fascicles, entrapping associated axons.

A

plexiform neurofibroma

189
Q

Allergic fungal sinusitis is an allergic reaction to ?

Expansion, and even erosion (20%), of the sinuses is characteristic.

Commonly implicated fungi are: ?

A

aerosolised environmental fungi (type 1, IgE-mediated hypersensitivity reaction).

dematiaceous (pigmented) fungi: Bipolaris, Curvularia, Alternaria

hyaline moulds: Aspergillus, Fusarium

190
Q

Where does the infection start in acute invasive fungal sinusitis and which fungal agents are implicated?

A

Infection is believed to originate in the nasal cavity (most often the middle turbinate) with subsequent spread to the paranasal sinuses

Several fungal agents are implicated, including:

Aspergillus spp: typically in neutropenic patients

Zygomycetes: usually in diabetic patients

The infection can spread rapidly from the sinuses via vascular invasion and bony erosion, potentially leading to an extension to the orbit, brain, cavernous sinus or carotid arteries

191
Q

Granulomatous invasive fungal rhinosinusitis is usually confirmed on the basis of clinical and histopathologic findings where there is non-caseating granuloma formation and fibrosis. It is usually caused by ?

A

Aspergillus flavus.

192
Q

What are the two types of Choanal atresia?

A

Structurally there are two main types:

osseous: ~90% 2

membranous: ~10%

General pathogenesis includes:

teratogenic effects caused by early pregnancy use of antithyroid drugs

193
Q

How are sinonasal polyps formed?

A

Polyps are formed by the influx of fluid into the lamina propria of the sinonasal Schneiderian mucosa

194
Q

What causes antrochoanal polyps ?

A

exact aetiology is not known, but it is thought that infection may be a common causative association. Chronic sinusitis is present in ~25% of patients 7 but a causal relationship has not been firmly established.

Pathologically, antrochoanal polyps are identical to other inflammatory polyps. However, unlike other polyps, they usually have a narrow stalk arising from the maxillary sinus

195
Q

Most commonly bacteria that causes tonsilitis?

A

(group A beta-haemolytic Streptococci) but may also be due to viral infections (herpes virus, cytomegalovirus, adenovirus)

196
Q

What are the common causes of epiglottitis?

A

Haemophilus influenzae type B used to be the most common responsible organism but group A beta-haemolytic Streptococci is becoming more common due to Haemophilus influenzae type B vaccinations.

Causes of epiglottitis include inflammatory and infective, including atypical infections such as TB.

Epiglottitis can be caused by direct extension of infection from other adjacent head and neck regions, such as dental infection, tonsillitis, laryngopyocele and skin cellulitis.

Inflammatory causes include sarcoidosis. Sarcoidosis associated epiglottitis is usually limited to the supraglottic larynx with sparing of the true vocal cords (as they have a sparse lymphatic system) .

197
Q

Organisms that cause retropharyngeal abscess

A

group A Streptococcus

S. aureus

H. influenzae

198
Q

What are the two types of ranula’s?

A

simple ranula: confined to the sublingual space

plunging ranula (also known as diving ranula or cervical ranula): extends into the submandibular space

Whether simple or of the diving/plunging type, most ranulas have no epithelial lining and are simply pseudocysts lined by a condensation of connective tissue at the periphery of the collection, formed in response to the inflammatory effect of the salivary secretions. Where there is no history of previous infection or haemorrhage, they tend to be thin-walled, unilocular, homogeneous cystic lesion.

The fluid within a ranula closely resembles that of the normal secretions of the sublingual glands

199
Q

Neurologic dysfunction resulting in vocal cord paralysis most common localises to which nerve?

In comparison, injury to the superior laryngeal nerve, which supplies only the cricothyroid muscle, causes subtle changes in voice and is less clinically significant.

Unilateral involvement is much more common than bilateral involvement

Which side is more commonly affected?

A

the recurrent laryngeal nerve, but can also be due to upstream lesions affecting the vagus nerve (from which the recurrent laryngeal nerve branches off) or the brain. Injury to the recurrent laryngeal nerve affects motor function of most of the intrinsic laryngeal muscles (posterior cricoarytenoid, lateral cricoarytenoid, transverse arytenoid, oblique arytenoid, and thyroarytenoid).

The left side is most commonly affected, likely because the longer course of the left recurrent laryngeal nerve presents greater opportunity for injury.

200
Q

Acute sialadenitis is most commonly caused by an ascending bacterial infection

A

with Staphylococcus aureus or Streptococcus viridans being the most common organisms.

Other causes of acute sialadenitis include dehydration, immunosuppression, iatrogenic (drug-induced) and rarely haematogenous spread. Rarely sialadenitis may be secondary to an obstructive salivary duct carcinoma.

201
Q

Epidemic parotitis is associated with ? virus, occurs mostly in children and is usually bilateral

A

Mumps

202
Q

What are the three histologic types of pleomorphic adenoma?

which one is the most common?

A

Three histological types have been described:

myxoid (hypocellular): most common, highest rate of recurrence

cellular

classic

203
Q

What is the cause of sialocele’s?

A

They tend to be post-traumatic or iatrogenic in nature. The proposed mechanisms include laceration of the salivary gland duct or ductal stenosis with subsequent dilatation.

204
Q

Adenoid cystic carcinomas aridses where?

How do they spread?

A

Adenoid cystic carcinomas arise more commonly in the minor salivary glands (~55%) than in the major salivary glands. They are the most common sinonasal tumours of salivary origin. They are locally aggressive with a propensity for perineural spread.

205
Q

Mucoepidermoid carcinomas

A

the tumours are composed of a mixture of:

mucus-secreting cells (muco-)

squamous cells (-epidermoid)

lymphoid infiltrate often also present

206
Q
A
207
Q
A
208
Q
A
209
Q
A

PATH FACTS (1 decks)

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