Path - Histopathology Flashcards
Which of the following is true of bullous pemphigoid?
A. It is indicated by the presence of Wickham’s striae in the buccal cavity
B. Bullae can be found on the extensor serfaces
C. It is an auto-inflammatory condition present in older patients
D. Tense bullae are produced
E. It is a Type III hypersensitivity reaction
D. Tense bullae are produced
Bullous pemphigoid is an autoimmune condition present in elderly patients characterised by the formation of tense bullae formed on the flexural surfaces. It is characterised as a type II hypersensitivity reaction as it is mediated by IgG against desmosomes (as are all pemphigus types). Wickham’s striae are a sign of lichen planus.
Which of the following conditions would cause mitotically active melanocytes to be seen on histopathology?
A. Squamous cell carcinoma B. Pregnancy C. Basal cell carcinoma D. Psoriasis E. This is a normal finding
B. Pregnancy
Mitotically-active melanocytes are usually a sign of melanoma. A notable exception is when this appearance is noted in a pregnant patient, as this is normal.
In melanoma, upwards migration of melanocytes towards the epidermis will be seen, and melanocytes will fail to decrease in size as they migrate.
Where does damage occur in pemphigus vulgaris?
A. The basement membrane B. Between keratinocytes in the epidermis C. The surface of the epidermis D. Between the dermis and epidermis E. Subcorneal layer of epidermis
B. Between keratinocytes in the epidermis
Pemphigus is caused by antibodies against desmosomes. The type of desmosomes targeted determines which type of pemphigus will arise.
Match the appearances on immunofluorescence with the disease they are each most associated with
A. Homogenous
B. Speckled
C. Centromere pattern
D. Nucleolar pattern
- Diffuse cutaneous systemic sclerosis
- Limited cutaneous systemic sclerosis
- Mixed connective tissue disease
- SLE
A. Homogenous - 4. SLE
B. Speckled - 3. Mixed connective tissue disease
C. Centromere pattern - 2. Limited cutaneous systemic sclerosis
D. Nucleolar pattern - 1. Diffuse cutaneous systemic sclerosis
NB: None of these patterns are 100% specific e.g. SLE can give almost any of these appearances on immunofluorescence.
Homogenous pattern indicates Anti-dsDNA
Speckled pattern indicates Anti-Ro, La, and Sm
Nucleolar pattern indicates ANti-SCL70 (anti-topoisomerase)
A kidney biopsy shows thickened glomerular capillary loops (a wire loop appearance)
Which disease is this suggestive of?
A. SLE B. Scleroderma C. Sarcoidosis D. Goodpasture's disease E. GPA
A. SLE
The wire loop appearance is the classic appearance of lupus nephritis, and is caused by immune complex deposition in the glomerular capillary loops causing thickening.
Which vessels are most often affected by polyarteritis nodosa?
A. Coronary arteries B. Temporal and retinal arteries C. The aorta and its branches D. Renal and mesenteric arteries E. Vessels in the kidneys, lungs, and upper respiratory tract
D. Renal and mesenteric arteries
Polyarteritis nodosa is a necrotising arteritis affecting medium vessels. It most often affects the renal and mesenteric arteries, and causes a series of aneurysms in close proximity, creating the ‘rosary beads’ appearance on angiography. It is classically associated with hepatitis B infection.
What is the most common form of thyroid cancer?
Papillary
Though thyroid carcinomas are rare, within that group papillary thyroid cancer is the most common. They are especially associated with radiation exposure.
What form of thyroid cancer arises from parafollicular ‘C cells’?
Medullary
Medullary carcinoma makes up 5% of thyroid carcinomas. 80% are spontaneous, but 20% are associated with a MEN syndrome.
What is the most common type of adenoma?
A, Gonadotrophin-secreting B. ACTH-secreting C. Non-functioning D. Prolactinoma E. TSH-secreting
D. Prolactinoma
Prolactinomas make up 20-30% of pituitary adenomas, with the next most common adenoma being a non-functioning one.
Muscle weakness, hypertension, and congestive cardiac failure are all possible complications of adenomas secreting which hormone?
A. Somatotrophin B. Prolactin C. Somatostatin D. Gonadotrophin E. TSH
A. Somatotrophin
Muscle weakness, hypertension, T2DM, and congestive cardiac failure are all potential complications of acromegaly which is caused by excess somatotrophin (a.k.a. growth hormone).
What is the most common cause of goitre worldwide?
A. Iodine deficiency B. Hashimoto's thyroiditis C. Toxic multinodular goitre D. Graves' disease E. Papillary thyroid cancer
A. Iodine deficiency
Although very rare in the west because of iodine-fortified food, iodine deficiency is very common in parts of the developing world and so is still the commonest cause of goitre.
Which of the following statements about thyroid nodules is false?
A. Solitary nodules are more often neoplastic than multiple nodules
B. Solid nodules are more likely to be neoplastic than cystic nodules
C. Nodules in younger patients are more likely to be neoplastic than those in older patients
D. Nodules in females are more likely to be neoplastic than those in males
E. Nodules that don’t take up radio-labelled iodine (cold) are more commonly neoplastic than hot nodules
D. Nodules in females are more likely to be neoplastic than those in males
What findings on microscopy would suggest a papillary thyroid carcinoma?
Optically clear nuclei, intranuclear inclusions, and psamomma bodies
DIagnosis of papillary carcinoma does not necessarily focus on the overall architecture, as the classic papillary shape may not be present. Instead the cell morphology is analysed.
The nuclei in papillary thyroid carcinomas are visibly empty, hence ‘optically clear nuclei’ is a sign.
Psamomma bodies are round foci of calcification that appear in many cancers, but the only thyroid cancer they appear in is papillary.
Which of the following is not a complication of primary hyperparathyroidism?
A. Depression B. Pancreatitis C. Osteitis fibrosa cystica D. Depression E. Tetany
E. Tetany
All the other options are complications of hypercalcaemia, whereas tetany results from hypocalcaemia. Hyperparathyroidism causes hypercalcaemia as the excess PTH increases serum calcium beyond normal limits.In 80-90% of cases, primary hyperparathyroidism is caused by an adenoma, with 10-20% of cases being due to generalised parathyroid hyperplasia (which can be part of a MEN syndrome). Parathyroid carcinoma accounts for <1% of hyperparathyroidism cases.
Hyperparathyroidism may also be secondary, in which case chronic kidney disease is the most common cause, leading to insufficient 25-hydroxycholecalciferol hydroxylation (low active vitamin D).
Which pathogens are particularly associated with pelvic inflammatory disease after a woman has undergone a TOP?
A. B. C. D. E.
A.
