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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
Pathophysiology of gallstone formation?
Due to raised cholesterol, haemolysis Incomplete gall bladder emptying Raised oestrogen leading to increased cholesterol
26
Types of nec fasc?
1- polymicrobial- staph and HIb 2- monomicrobial- GBS 3- clostridium 4- atypical- fungal infections
27
Commonest areas for GB Cancer to mets to?
Lymph nodes Liver segments- 4/5 Stomach
28
Commonest cause of GB cancer and type?
Chronic inflam- stones/PBC | Adenocarcinoma
29
Complications of C.diff?
``` Infection Diarrhoea Bloody diarrohea Toxic megacolon and perf Sepsis/AKI ```
30
Pathophysiology of pseudomembranous colitis?
``` 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 ```
31
Abx predisposed to c.diff
Ciprofloxacin Clindamycin Co-amox Cephalasporins
32
Why perform MRCP?
``` Anatomy evaluation Trauma Stones Biliary leak Cancer/strictures ```
33
Bony tumour types?
Benign- osteochondroma, osteomas Malignant- Ewings, osteosarcoms, myeloma Mets
34
What to look for on follicular adenoma biopsy?
Thyroglobulin
35
Describe the process of abscess formation?
Acute inflam Necrotic centre Fibrotic surrounding Osmotic gradient
36
How to neutrophils reach an abscess?
Rolling Migration Extravasation Chemotaxsis
37
Necrosis vs apoptosis?
Energy dependent, abnormal/pathological cell death Apoptosis, energey independent cell detah
38
Constituents of pus?
dead and alive- fluid, solid components: water skin cells, plasma proteins, bacteria, inflammatory cells, fibrin
39
Describe the adenoma carcinoma sequence?
Sequence by which an adenoma transforms via gene mutations to a carcinoma. APC- TG kRAS- proto-oncogene p53- TSG
40
What are proto-oncogenes?
Encourage cellular proliferation | Precursors to oncogenes
41
Types of polyps? Most likely to become carcinoma? Commonest?
Benign- harmartomas, inflammatory, metaplastic | Malignant- Villous (most cancerous), tubovillous, tubular (commonest)
42
Extranintestinal manifestations of FAP?
``` Gardener's syndrome Osteomas Desmoid tumours Thyroid Ca Fibromas CHRPE (congenital hypertrophy of retinal pigment epithelium) ```
43
How to mets occur?
Angiogenesis, Lymphovascular invasion and migration through basement membrane Intravasation, circulation, extravasation Colonisation and survival
44
Difference between cytology and histology?
Cells vs tissue architecture Pleomorphism Mitosis Hyperchromatism Riaesed neuclear to cytoplasmic ration
45
Role of oestrogen?HER2 receptors in breast cancer?
Stimulate growth of cancer
46
Aetiology of Paget's disease of the breast?
DCIS
47
What is the action of anastrazole?
Aromatase inhibitor- | Blocks conversion of androgens to oestrogen
48
Definition of carcinoid tumour and syndrome presentation?
Neuroendocrine tumour of APUD cells Flushing, sweating, diarrhoea, abdo pain Once liver mets- serotonin in systemic circulation
49
Locations of carcinoid tumours?
Appendix, gastric, Small bowel, rectal, colonic
50
Investigations for carcinoid tumours?
``` Urinary 5-HIAA Chromogranin A Pancreatic polypeptide CT Whole body somatostatin receptor scintigram- if no primary found ```
51
Why do you get a weak arm in infective endocarditis?
Associated with brachial neuritis
52
Different types of paraneoplastic syndromes for Lung Ca?
Endocrine- ACTH, PTHrP, SIADH Neurological- LEMS, Dermatomyositis Dermatological- Acanthosis nigricans
53
What is FISH?
Flourescent In Situ Hybridisation | Looks for genetic defects
54
Aetiology of phimosis?
Idiopathic/congenital Balanitis Lichen scleorsis Penile Ca
55
Layers of penis? | Where does bleeding occur?
Skin Dartos Bucks Tunica albuginea Between dartos and bucks and bucks and albuginea
56
Aetiology of hypercalcaemia?
``` Cancer Sarcoid HyperPTH Paget's Hyperthyroidism- increased osteoclastic activity Myeloma Dehydration Familial hypocalciuric hypercalcemia ```
57
How does the body break down clots?
Plasminogen activates plamsin which does it
58
What to Tyrosine Kinase Inhibitros do?
Inhibit tyrosine kinase | Prevent phosphorylation of substances, prevent activation
59
Causes of coagulopathy?
``` Liver dsyfunction- intrinsic/post hepatic Genetic- haemophilia, vWF deficiency Hypothermia DIC Trauma triad- acidosis/ hypothermia Hypocalcaemia ```
60
Post splenectomy Abx and vaccinations?
Pen V | Influenza, pneumococcl, meningicoccal
61
Difference between grouping and matching?
Grouping- ABO typing | Matching- trial transfusion check for platelet agglutination with proposed donor
62
What do you test for on blood transfusion?
Syphillis HIV Hep B and C CMV
63
What is a sequestrum and involucrum?
Processes in osteomyelitis Sequestrum- piece of devascularised bone, bacteria within are isolated from blood stream Involucrum- new bone walls of sequestrum
64
What is PVL staph?
Panton Valentine Leukocidin Staph A- exotoxin that kills lymphocytes
65
Risk factors for testicular Ca?
``` FHx Crypto Klitfelters HIV Infertility DTx Increased Oestrogen exposure ```
66
Risk for lymphoma?
``` Age Chemo/DTx EBV HHV8 Immunosuppresion Lupus and Sjorgens ```
67
Where does lymphoma mets to?
Liver lung bone | Lymphoid tissue
68
Types of Non seminomatous germ cell tumours of testicle?
Teratoma- young men Yolk sac Choriocarcinoma
69
Causes Complications Treatment of Cryptoorchidism?
Causes- FHx, Preterm, increased abdo pressure- gastroschisis/omphocele Complications- cancer, infertility, inguinal hernia, torsion Treatment- fix in place- can monitor for Ca, excision
70
Function of PTH?
Increase Ca reabsorption from kidneys, decrease Phosphate (therefore higher circulating free calcium) Increased osteoclastic activity Increased Vit D production
71
Gangrene definition and types?
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
What are pleural plaques?
Associated with asbestosis | Depositions of collagen and fibrin
73
Tests and stains for TB?
Ziel Niehlsen Acid fast gram - bacilli PCR Quanterferon gold Mantoux test
74
Other myocobacterium involved in immunocomprimised individuals?
Mycobacterium avium intracellulare
75
TB causes with hypersensitivity reaction?
Type 4- chronic
76
Commonest lymphoma | Owl eye appearance?
Commonest is NHL | Owl eyes= reed sternburg, Hodgkins lymphoma
77
What protein is deposited in TB?
AA amyloid
78
Inheritance pattern of PKD?
ARPKD- infantile, renal failure quickly, transplant needed ADPKD- 50-60yo, progressive CKD
79
Cells lining the bile duct?
Columnar epithelium
80
What is occuring if no urobiliogen in urine?
Obstructive jaundice
81
Why are bile salts reabsorbed?
Bile salts are recycled as the liver cannot synthesise enough bile salts to meet daily demand for fat digestion- 95%
82
Risk factors for nasopharyngeal carcinoma?
sian ethnicity, betel nuts, immunosuppresion, recurrent infections, local steroid use, EBV!!!!, workplace exposure- sawdust, smoking
83
DDx for nasal ulcer?
BCC/Sqc/ rhinitis/sarcoid/trauma/lymphoma
84
How is radiation dosing measured?
milisivert mSv
85
How to Dx C.diff? Conservative management options?
Stool antigen and toxin Colonscopy and biopsy Isolate Increased infection control precautions Alert Infection control team Vanc +- metronidazole Hospital policy
86
Causes of abscesses?
Causes of abscess- staph a, strep | Non bacterial abscess- HZV, VZV, fungi, ameoba
87
How long and at what temp can you store blood products?
RBCs 28 days at 4, platelets 48hrs at RTP, FFP/cryo- 1 year at -30o
88
How to test platelet function?
TEG | Platelet aggrometry
89
Malignant features of parotid lumps?
facial nerve palsy, rapid enlargement, lymph nodes, fixed
90
UC and crohn's macro/microscopic features?
UC features- submucosal inflam, continous, cryptal abscesses | Crohns features- transmural, skip, cobblestone appearances, fistulae, strictures, nonceseating granulomas
91
Why is B12/folate needed for RBCs?
haematopoiesis- needed for proliferation, for DNA synthesis, therefore macrocytosis and large and cannot divide
92
How to treat anaphylaxsis?
1:1000 0.5mg of adrenaline IM, chlorphenamine, hydrocortisone- ALS
93
Cytology grading?
``` C1- inadequate C2 benign C3 atypical C4 suspicious C5 malignant ```
94
Hypercalcaemia symptoms and signs? Complications?
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
Pathophysiology of atherosclerosis?
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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