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MRCS Past Questions Knowledge > Pathology > Flashcards

Pathology Flashcards

1
Q

What is a retrovirus?

A

inserts its own genetic code into cell’s DNA via reverse transcriptase and uses the cell to replicate itself
HIV

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2
Q

Pseudoaneurysm definition?

A

Contained only by tunica adventitia

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3
Q

Management of pseudoaneurysm?

A

A2E, compression, tourniquet if in right place, thrombin injection, stenting/repair

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4
Q

Complications of pseudoaneurysm?

A

Rupture, infection, distal thromboembolic events, local thrombosis

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5
Q

Definition of abscess?

A

pus surrounded by granulation tissue

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6
Q

Constituents of pus?

A

fluid and solid, dead and alive components. Bacteria, human cells, inflammatory cells, fibrin, water, plasma exudate

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7
Q

What causes a fever?

A

Present of pyrogen from microorganism, endotoxins/endotoxins
Cytokine activation
Prostogladin E2 release=> increase in hypothalamic set temperature point

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8
Q

Life span of WBCs?

A

1-3 days when in circulation?

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9
Q

What are neutrophils

A

inflammatory cell of acute inflammation, commonest granulocytes, type of leukocytes

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10
Q

Describe innate vs adaptive immunity?

A

Innate immune system
Macrophages/mast cells produce- Histamine, bradykinin, leukotrines, prostogladins
Neutrophils- produce TNF, IL1
Complement system- opsinisation, MAC complexes, recruit other inflamm cells
Classical-AbAg, lectin-bind to mannose and alternate- spontaneous
Adaptive immune system
Dendritic cells, b and t cells
APC
Activates CD4 and NKCs
Produce Abs=> phagocytosis

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11
Q

Describe Humoral vs cell mediated?

A

Humoral immunity- Ab mediated immunity
Complement activation, opsinisation, phagocytosis
Abs can lead to agglutination, phagocystosis, promote immune system
Cell mediated- cytotoxic t cell production, macrophage and NKC activation, cytokine release

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12
Q

Stages of inflammation?

A

vasodilation, increased vascular permeability, migration/chemotaxsis of neutrophils and phagocytosis

Rubor, dolor, tumour, calor

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13
Q

Stages of phagocytosis?

A

opsonisation by Abs, bacteria absorbed, lysosme fuse with vacuole and digest bacteria, excreted

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14
Q

Lining of the colon?

A

Mucosa
Submucosa
Muscalris propria
Serosa

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15
Q

What is endometriosis?

A

ells of the endometrial lining found outside the uterus- lead to ectopic bleeding, pain, cyclical, fibrosis and adhesions

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16
Q

How does endometriosis spread?

A

Retrograde menstruation is theory?

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17
Q

How to ensure complete resection intraoperatively of skin cancer?

A

Mohs microsurgery- intraop fresh frozen sections

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18
Q

How to treat BCC?

A

MDT
Avoid sun exposure
Search for mets
Excision biopsy, cryo, Mohs, DTx, topical flouracil

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19
Q

SqCC treatment options?

A

excision biopsy, cryo, 5-flouracil chemo cream, DTx, Chemo

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20
Q

What is MOHs?

A

Frozen section- sample placed in cryostat and thin slice taken for immediate pathological analysis, can be get more samples if needed

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21
Q

Things to look out for on biopsy report for skin Ca?

A

lark’s/breslows, grade, lymphovascular invasion, cell type, satellite lesions, immunohistochemistry

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22
Q

Types of Melanoma?

A

nodular, superfiscial, amelanoytic, lentigo maligna-elderly, acral melanoma- hands and palms

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23
Q

RFs for melanoma?

A

xeroderma pigmentosa, skin type, sun exposure, immunosuppression, radiotherapy

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24
Q

MRSA eradication therapy?

A

Unwell/infection- trust guidelines and IV vancomycin

Eradication-muciprocin for nose, chlorahexadine for ski

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25
Q

Pathophysiology of gallstone formation?

A

Due to raised cholesterol, haemolysis
Incomplete gall bladder emptying
Raised oestrogen leading to increased cholesterol

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26
Q

Types of nec fasc?

A

1- polymicrobial- staph and HIb
2- monomicrobial- GBS
3- clostridium
4- atypical- fungal infections

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27
Q

Commonest areas for GB Cancer to mets to?

A

Lymph nodes
Liver segments- 4/5
Stomach

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28
Q

Commonest cause of GB cancer and type?

A

Chronic inflam- stones/PBC

Adenocarcinoma

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29
Q

Complications of C.diff?

A 
Infection
Diarrhoea
Bloody diarrohea
Toxic megacolon and perf
Sepsis/AKI
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30
Q

Pathophysiology of pseudomembranous colitis?

A 
Abx leading to death of Normal gut flora
Overgrowth of c.diff
Produces exotoxins
Leads to inflammatory response
Fibrin and mucin production lead to pseudomembranes
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31
Q

Abx predisposed to c.diff

A

Ciprofloxacin
Clindamycin
Co-amox
Cephalasporins

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32
Q

Why perform MRCP?

A 
Anatomy evaluation
Trauma
Stones
Biliary leak
Cancer/strictures
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33
Q

Bony tumour types?

A

Benign- osteochondroma, osteomas
Malignant- Ewings, osteosarcoms, myeloma
Mets

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34
Q

What to look for on follicular adenoma biopsy?

A

Thyroglobulin

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35
Q

Describe the process of abscess formation?

A

Acute inflam
Necrotic centre
Fibrotic surrounding
Osmotic gradient

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36
Q

How to neutrophils reach an abscess?

A

Rolling
Migration
Extravasation
Chemotaxsis

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37
Q

Necrosis vs apoptosis?

A

Energy dependent, abnormal/pathological cell death

Apoptosis, energey independent cell detah

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38
Q

Constituents of pus?

A

dead and alive- fluid, solid components: water skin cells, plasma proteins, bacteria, inflammatory cells, fibrin

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39
Q

Describe the adenoma carcinoma sequence?

A

Sequence by which an adenoma transforms via gene mutations to a carcinoma.
APC- TG
kRAS- proto-oncogene
p53- TSG

40
Q

What are proto-oncogenes?

A

Encourage cellular proliferation

Precursors to oncogenes

41
Q

Types of polyps?
Most likely to become carcinoma?
Commonest?

A

Benign- harmartomas, inflammatory, metaplastic

Malignant- Villous (most cancerous), tubovillous, tubular (commonest)

42
Q

Extranintestinal manifestations of FAP?

A 
Gardener's syndrome
Osteomas
Desmoid tumours
Thyroid Ca
Fibromas
CHRPE (congenital hypertrophy of retinal pigment epithelium)
43
Q

How to mets occur?

A

Angiogenesis, Lymphovascular invasion and migration through basement membrane
Intravasation, circulation, extravasation
Colonisation and survival

44
Q

Difference between cytology and histology?

A

Cells vs tissue architecture

Pleomorphism
Mitosis
Hyperchromatism
Riaesed neuclear to cytoplasmic ration

45
Q

Role of oestrogen?HER2 receptors in breast cancer?

A

Stimulate growth of cancer

46
Q

Aetiology of Paget’s disease of the breast?

A

DCIS

47
Q

What is the action of anastrazole?

A

Aromatase inhibitor-

Blocks conversion of androgens to oestrogen

48
Q

Definition of carcinoid tumour and syndrome presentation?

A

Neuroendocrine tumour of APUD cells

Flushing, sweating, diarrhoea, abdo pain
Once liver mets- serotonin in systemic circulation

49
Q

Locations of carcinoid tumours?

A

Appendix, gastric, Small bowel, rectal, colonic

50
Q

Investigations for carcinoid tumours?

A 
Urinary 5-HIAA
Chromogranin A
Pancreatic polypeptide
CT
Whole body somatostatin receptor scintigram- if no primary found
51
Q

Why do you get a weak arm in infective endocarditis?

A

Associated with brachial neuritis

52
Q

Different types of paraneoplastic syndromes for Lung Ca?

A

Endocrine- ACTH, PTHrP, SIADH
Neurological- LEMS, Dermatomyositis
Dermatological- Acanthosis nigricans

53
Q

What is FISH?

A

Flourescent In Situ Hybridisation

Looks for genetic defects

54
Q

Aetiology of phimosis?

A

Idiopathic/congenital
Balanitis
Lichen scleorsis
Penile Ca

55
Q

Layers of penis?

Where does bleeding occur?

A

Skin
Dartos
Bucks
Tunica albuginea

Between dartos and bucks and bucks and albuginea

56
Q

Aetiology of hypercalcaemia?

A 
Cancer
Sarcoid
HyperPTH
Paget's
Hyperthyroidism- increased osteoclastic activity
Myeloma
Dehydration
Familial hypocalciuric hypercalcemia
57
Q

How does the body break down clots?

A

Plasminogen activates plamsin which does it

58
Q

What to Tyrosine Kinase Inhibitros do?

A

Inhibit tyrosine kinase

Prevent phosphorylation of substances, prevent activation

59
Q

Causes of coagulopathy?

A 
Liver dsyfunction- intrinsic/post hepatic
Genetic- haemophilia, vWF deficiency
Hypothermia
DIC
Trauma triad- acidosis/ hypothermia
Hypocalcaemia
60
Q

Post splenectomy Abx and vaccinations?

A

Pen V

Influenza, pneumococcl, meningicoccal

61
Q

Difference between grouping and matching?

A

Grouping- ABO typing

Matching- trial transfusion check for platelet agglutination with proposed donor

62
Q

What do you test for on blood transfusion?

A

Syphillis
HIV
Hep B and C
CMV

63
Q

What is a sequestrum and involucrum?

A

Processes in osteomyelitis

Sequestrum- piece of devascularised bone, bacteria within are isolated from blood stream

Involucrum- new bone walls of sequestrum

64
Q

What is PVL staph?

A

Panton Valentine Leukocidin Staph A- exotoxin that kills lymphocytes

65
Q

Risk factors for testicular Ca?

A 
FHx
Crypto
Klitfelters
HIV
Infertility
DTx
Increased Oestrogen exposure
66
Q

Risk for lymphoma?

A 
Age
Chemo/DTx
EBV
HHV8
Immunosuppresion
Lupus and Sjorgens
67
Q

Where does lymphoma mets to?

A

Liver lung bone

Lymphoid tissue

68
Q

Types of Non seminomatous germ cell tumours of testicle?

A

Teratoma- young men
Yolk sac
Choriocarcinoma

69
Q

Causes
Complications
Treatment of Cryptoorchidism?

A

Causes- FHx, Preterm, increased abdo pressure- gastroschisis/omphocele
Complications- cancer, infertility, inguinal hernia, torsion
Treatment- fix in place- can monitor for Ca, excision

70
Q

Function of PTH?

A

Increase Ca reabsorption from kidneys, decrease Phosphate (therefore higher circulating free calcium)
Increased osteoclastic activity
Increased Vit D production

71
Q

Gangrene definition and types?

A

Tissue death due to infarction
Dry- 2o to poor arterial supply, dry, black, sharply demarcated
Wet- 2o to bacterial infection causing occlusion of venous return/ and less commonly arterial supply, wet, poor prognosis, smelly
Gas- subset of dry, caused by clostridium perfringens

72
Q

What are pleural plaques?

A

Associated with asbestosis

Depositions of collagen and fibrin

73
Q

Tests and stains for TB?

A

Ziel Niehlsen
Acid fast gram - bacilli

PCR
Quanterferon gold
Mantoux test

74
Q

Other myocobacterium involved in immunocomprimised individuals?

A

Mycobacterium avium intracellulare

75
Q

TB causes with hypersensitivity reaction?

A

Type 4- chronic

76
Q

Commonest lymphoma

Owl eye appearance?

A

Commonest is NHL

Owl eyes= reed sternburg, Hodgkins lymphoma

77
Q

What protein is deposited in TB?

A

AA amyloid

78
Q

Inheritance pattern of PKD?

A

ARPKD- infantile, renal failure quickly, transplant needed

ADPKD- 50-60yo, progressive CKD

79
Q

Cells lining the bile duct?

A

Columnar epithelium

80
Q

What is occuring if no urobiliogen in urine?

A

Obstructive jaundice

81
Q

Why are bile salts reabsorbed?

A

Bile salts are recycled as the liver cannot synthesise enough bile salts to meet daily demand for fat digestion- 95%

82
Q

Risk factors for nasopharyngeal carcinoma?

A

sian ethnicity, betel nuts, immunosuppresion, recurrent infections, local steroid use, EBV!!!!, workplace exposure- sawdust, smoking

83
Q

DDx for nasal ulcer?

A

BCC/Sqc/ rhinitis/sarcoid/trauma/lymphoma

84
Q

How is radiation dosing measured?

A

milisivert mSv

85
Q

How to Dx C.diff?

Conservative management options?

A

Stool antigen and toxin
Colonscopy and biopsy

Isolate
Increased infection control precautions
Alert Infection control team

Vanc +- metronidazole
Hospital policy

86
Q

Causes of abscesses?

A

Causes of abscess- staph a, strep

Non bacterial abscess- HZV, VZV, fungi, ameoba

87
Q

How long and at what temp can you store blood products?

A

RBCs 28 days at 4, platelets 48hrs at RTP, FFP/cryo- 1 year at -30o

88
Q

How to test platelet function?

A

TEG

Platelet aggrometry

89
Q

Malignant features of parotid lumps?

A

facial nerve palsy, rapid enlargement, lymph nodes, fixed

90
Q

UC and crohn’s macro/microscopic features?

A

UC features- submucosal inflam, continous, cryptal abscesses

Crohns features- transmural, skip, cobblestone appearances, fistulae, strictures, nonceseating granulomas

91
Q

Why is B12/folate needed for RBCs?

A

haematopoiesis- needed for proliferation, for DNA synthesis, therefore macrocytosis and large and cannot divide

92
Q

How to treat anaphylaxsis?

A

1:1000 0.5mg of adrenaline IM, chlorphenamine, hydrocortisone- ALS

93
Q

Cytology grading?

A 
C1- inadequate
C2 benign
C3 atypical
C4 suspicious
C5 malignant
94
Q

Hypercalcaemia symptoms and signs?

Complications?

A

Renal stones, bone pain, polyuria, abdominal pain (N/V/pancreatitis) and psychiatric features

Signs
Arrhythmias
Dehydration
Confusion

Complications
Arrythmias and syncope
Renal stones
Pancreatitis
Renal failure
95
Q

Pathophysiology of atherosclerosis?

A

Arterial wall dsyfunction/injury
Macrophage migration, formation of foam cells with lipid core (due to hypercholesterolaemia
Smooth muscle hyperproliferation to form a fibrous cap
Can rupture lead to thrombosis/emboli

MRCS Past Questions Knowledge (6 decks)

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