Pathology Flashcards
What is Septic Arthritis
Kocher criteriaof septic Arthritis
1. Non weight bearing on affected side
2. ESR > 40 mm/hr
3. Fever
4. WBC count of >12,000 mm3
Classic sign of Acute Mesenteric infarction
Sudden onset of abdominal pain followed by forceful evacuation are the classical presenting features of acute mesenteric infarction.
wherethe testes are implanted in Orchidopexy
Dartos fascia of scrotum
Hormone to check for recurrence after removal of athyroid gland
Thyroglobulin
Thyroid hormones
1 TPO
2 Ab to TSH receptors
- 100% in Hashimotoand 70% in Grave
- Only in Grave
Most likely GUT cancercaused by smoking is
TransitionalCell carcinoma of bladder
PauI bunneIl Test
The Paul Bunnell test is used to screen for Infectious Mononucleosis (IM), which is seen most commonly in adolescents and young adults. IM is caused by the Epstein-Barr virus.
Most lillely site for Mesenteric embolism
splenic flexure
Dominant feature of Acute on chronic mesenteric ischemia
Post prandial abdominal discomfort and weight los
which disease symptoms mimic Ischemic Colitis in chroonic phase
Acute on chronic Mesenteric Ischemia I
Os teopetrosis is also called
Marble bone disease
Microcalcifications occur in which, type of breest cancer
Comedo type DCIS
Early vs late hemolytic
reaction due to transfusion
Early due to 7 ABO incompatibility
Late due to in incompatibility
What is Berry sign
Enability to palpate carotid due to extensive thyromegaly
Which thyroid cancer is of neural crest origin
Medullary Carcinoma of thyroid is of neural crest origin.
Which thyroid cancer is associated with 2Asyndrome
Medullary Carcinoma
Lifrau meni syndrome is associated with which gene
p53 suppressor gene cdysfunction
Cowden disease and gene
PTEN is a tumour suppressor gene and loss of function mutations result in up regulation of the mTOR pathway.
FAP gene mutation
APC gene
Immature granulocytes and unleaded rbcs in blood with normal cbc
Metastatic carcinoma like myeloma, myelofibrosis not splenectomy
First line treatment for hypercalcemic crisis
Intravenous fluids which is 0.9 % saline
2nd line treatment for hypercalcemia
Calcitonin
Mithramycin
Which neck mass is common in glassblowers and wind instrument players
Laryngocele
What is ranula
Mucocele in floor of mouth in sublingual gland
Which neck swelling is due to failure in obliteration of 2nd brachial cleft
Brachial cyst
Bluish cyst in neck
Ranula
Neck swelling behind anterior border of sternocleidomastoid muscle
Brachial cyst
Brachial cyst aspirated feature
Opalescent fluid with cholesterol crystals
Pharyngeal pouch
Due to weakness in inferior constrictor muscle
Which is present in hepatitis vaccinated patient
Anti Hbs
Histologically Psammoma bodies are
Clusters of calcification
Features of hashimoto thyroiditis
In Middle Age females
HLA, DR5
microscopically it has Lymphocytes and plasma cells
superior thyroid artery should be ligatedat which part
superior thyroid artery should be ligated close to the glandas here it’s not very close to external laryngeal nerve
Why Strap musclesshould be divided at their upper end
Strap musclesshould be divided at upper end to avoid damage to ansa cervicalis which is at their lower end
Commonest thyroid malignancy
Papillary carcinoma
Commonest sub-type
haematogenous spread is of which thyroid tumor
Follicular
laterally located apparently ectopic thyroid tissue canbe which cancer
Papillary dueto its lymph spread
Diagnosis of follicular Carcinoma of Thyroid
all follicular FNA’s (THY 3f) will require at least a hemi thyroidectomy as cant be diagnosed on FNAC.
1
Worst prognosisof which thyroid carcinoma
Anaplastic
Which thyroid carcinoma appears as part of the MEN -2A disease spectrum.
Medullary carcinoma of thyroid
Which thyroid carcinoma is not responsive to radioiodine.
Medullary carcinoma are not derived primarily from thyroid cells they are not responsive to radioiodine.
which test is used in screening for disease recurrence of medullary Thyroid carcinoma
calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence
How follicular adenoma is differentiated from carcinoma
May appear macroscopically encapsulated, microscopically capsular invasion is seen. Without this finding the lesion is a follicular adenoma.
Orphan Annie Nuclei histology
Histologically tumour has papillary projections and pale empty nuclei
Most common in elderly females thyroid carcinoma
Anaplastic
Most common site of metastasis in thyroid Ca
Most common site of metastasis:Bone.
I
which thyroid disease is One of the most common reasons for presentation
Multi nodular goitre
Toxic Goitre includes
3
Diffuse Goitre (Grave)
Toxic nodule
Toxic multinoduler goitre
Which drug causes hypothyroidism and is antipsychotic
Lithium
feature of anaplastic carcinoma
Marked local invasion is a feature of anaplastic carcinoma. These tumours are more common in elderly females.
IF extremely large goitre and no other issues apart from respiratory distress then it’s due to
Tracheo malacia
Post thyroidctomy hypocalcemia occurs after
first 2-5 post operative days.
Hurthle cell tumor
Type of follicular thyroid Ca
Have Oxyphil cells (eosinophilic granular cytoplasm as a result of accumulation of altered mitochondria.)
TSH level in hyperthyroidism
A TSH level of <0.5U/L suggests hyperthyroidism.
most sensitive test for diagnosing hyperthyroidism and hypo
Hyper : Free T3
Hypo : TSH
How primary hyperparathyroidism is diff from benign Familial hypocalciuric hypercalcemia
concordant biochemistry (urine calcium : creatinine clearance ratio <0.01-distinguished from primary hyperparathyroidism).
In primary hyperparathyroidism it’s >0.01
How long one should wait to treat tertiary hyperparathyroidism after renal transplant
Allow 12 months to elapse following transplant as many cases will resolve
When hyperthyroidism with increased PTH in which physiological condition
Where hyperthyroidism occurs secondary to pregnancy the TSH is typically elevated.
Which drug of breast Ca causes venous thromboembolism
Tamoxifen
Pneumonic for clinical features of digeorge syndrome
CATCH’:
Congenital heart defects
Abnormal facies
Thymic aplasia
Cleft palate
Hypoparathyroidism.
Diagnostic point of osteomalacia
Osteomalacia
low: calcium, phosphate
raised: alkaline phosphatase
C/F of rickets
rickets: knock-knee, bow leg, features of hypocalcaemia
C/F of osteomalacia
osteomalacia: bone pain, fractures, muscle tenderness, proximal myopathy
Xray findings of osteomalacia
x-ray: children - cupped, ragged metaphyseal surfaces;
adults - translucent bands (Looser’s zones or pseudofractures)
Most common cause of primary hyperparathyroidism
Most cases due to solitary adenoma (80%),
Which thyroid carcinoma cause distant metastasis and of what kind
Follicular carcinomas may metastasise haematogenously (often to bone)
Whichthyroid marker is only useful for followup of cancer
Thyro globulin
which Ab is present in both Hashimoto and Grave disease
Thyroid peroxidase (microsomal) antibodies
Which by causes tHypothyroidism
Lithium
Amiodarone
Sulfonylurea
Histology of Hashimoto Thyroiditis
Lymphocytic infiltrates and fibrosis are typically seen in Hashimotos thyroiditis.
ANA profile Ab
Anti Ro and La
Anti-centromere
Anti-Scl70
Anti-Ro and anti-La (associated with Sjögren syndrome)
•Anti-centromere (associated with CREST syndrome)
• Anti-Scl70 (associated with scleroderma)
Subacute(deQuervain)thyroiditis is caused by
Viral infections like EBV, mumps ,measles
Tinel sign is?
The Tinel sign is the tingling or prickling sensation elicited by the percussion of an injured nerve trunk at or distal to the site of the lesion.
Phalen test
The patient is asked to flex at the wrist and hold the position for up to a minute. A positive test elicits pain, paraesthesia, or numbness over median nerve distribution in the affected hand
Rx of hyperthyroid phase in Hashimoto’s thyroiditis
During the hyperthyroid phase of illness beta blockers may manage symptoms
Hashimoto thyroiditis is associated with which melegnancy
Thyroid lymphoma (Non Hodgkin’s B cell lymphoma
Which muscles is innervated by the cervical branch of the facial ner
The cervical branch of the facial nerve innervates platysma
Sick euthyroid syndrome
Sick euthyroid syndrome is most commonly seen in chronically ill patients or those with starvation. The thyroid function tests are often low and the patient clinically euthyroid.
Improve
Extra colonic diseases of Gardners syndrome
skull osteoma, thyroid cancer and epidermoid cysts
MOA of methimazole
Methimazole prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin
Most common liver tumor
Metastatic
Most common primary liver tumours
Hepatocellular carcinoma
main risk factor for cholangiocarcinoma
Primary sclerosing cholangitis is the main risk factor.
Most common cause of Hepatocellular Carcinoma
Most cases arise in cirrhotic livers or those with chronic hepatitis B infection,
Biopsy inHepatocellular carcinoma
Biopsy should be avoided as it seeds tumours cells through a resection plane.
Tumor markers in Cholangiocarcinoma
CA 19-9, CEA and CA 125 are often elevated
Hepatocellular carcinoma marker
a-fetoprotein is elevated in almost all cases
Commonest cause of amoebic liver disease
Entamoeba histiolytica
Congenital cause of unconjugated prehepatic hyper bili
Gilbert
Grigler_ Najjar
Jaundice level
> 35 umol /L
Most common benign tumours of mesenchymal origi
Haemangioma
Haemangioma on US
they are typically hyperechoic
Liverlesion caused by oral contraceptive
Liver cell adenoma
Mesenchymal hamartomas usually present in
Infants
Liver abscess major cause
Biliary sepsis is a major predisposing factor
Structures drained by the portal venous system form the second largest source
most common extra intestinal manifestation of amoebiasis
Liver abscess is the most common extra intestinal manifestation of amoebiasis
Amoebic abscess mostly occurs in which lobeof liver
Between 75 and 90% lesions occur in the right lobe
Aspirate of Amoebic abscess
1Aspiration yield sterile odourless fluid which has an anchovy paste consistency
wall of Hydatid cyst
The cyst wall is thick and has an external laminated hilar membrane and an internal enucleated germinal layer
Klatskin tumor
A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.
Black color GB stones
Pigment
Mixed stones of GB contains
More cholesterol
Multiple in number
Which GB stone is single vs multiple
Single: Cholesterol
Multiple: Mixed and Pigment
Gall stone ileus
due to fistula b/w GB and duo, stone get impacted at terminal ileal Level
Disease which affect enterohepatic circulation
Damage at terminal ileum suchas Crohn disease,int resection
Drugs causing GB stone
Estrogen
Clofibrate
The classical symptoms ofAcute cholecystitis
colicky right upper quadrant pain that occurs post prandially
sub total cholecystectomy criteria
IF problematic CaloT triangle
fistula between the gallbladder and duodenumin Gallstone iLeas in surgery
The fistula between the gallbladder and duodenum should not be interfered with.
CBD stone removal criteria
Small stones that measure less than 5mm may be safely left and most will pass spontaneously.
When not to surgically explore CBD
When stone is > 8mm
Acalculous cholecystitis infective causes
:Dueto infection with Ecoli, clostridia or rarely Salmonella
Rokitansky-Aschoff sinuses, or Luschka’s crypts
Glandular outpouchings formed by lining of mucosa extending into or through muscular coat of GB
GB doesn’t distend in which cystitis
GB doesn’t distend in Chronic Cholecystitis as it causes fibrosis of the wall
GB distend several times to its normal size in which disease
GB distend several times to its normal size due to lack of inflammation in Mucocele.
Strawberry gallbladder is
CholeSterolosis
Hematogenoas spread of Esophageal Ca. to
Lungss and liver
Common causes of Esophageal Ca
Diet defi of
1Vit A
2 Riboflavin
3. Zinc
High intaKe of tannic acid
Fungal contamination of food
Mostcommon cause of esophageal stasis
Lye strictures
most common cause of neck swellings
Reactive lymphadenopathy
Rubbery, painless lymphadenopathy in neck
Lymphoma
Pharyngeal pouch location
posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Branchial cyst
Branchial cyst Develop due to failure of obliteration of
second branchial cleft in embryonic development
Charcot’s triad of symptoms
pain, fever, jaundice)
Charcot’s triad of symptoms in
Cholangitis
Acalculus cholecystitis is caused by
Prolonged starvation / TPN
Hydatid cyst causes whichkind of ypersensitivity reaction
These cysts are allergens which precipitate atype 1 hypersensitivity reaction.
Hydatid cyst causes symptoms when
Size is >5mm
Acquired factor 12 deficiency causes prolonged clotting factor which type
Prolonged APTT
Apoptosis vS Necrosis of Kidney causes
Nephrotoxic stimuli such as aminoglycosides and radiological contrast media induce apoptosis.
Myoglobinuria and haemolysis result in necrosis
Post-operative renal failure is more likely to occur in patients who are
elderly, have peripheral vascular disease, high BMI, have COPD, receive vasopressors, are on nephrotoxic medication or undergo emergency surgery.
Which syndrome associated with hamartomas
Puetz jegher syndrome
Genetics of Peutz-Jeghers syndrome
Autosomal dominant
serine threonine kinase LKB1 or STK11 problem
Features of Peutz-Jeghers syndrome
Hamartomatous polyps in GI tract (mainly small bowel)
Pigmented lesions on lips, oral mucosa, face, palms and soles
Intestinal obstruction e.g. intussusception (which may lead to diagnosis)
Gastrointestinal bleeding
first line investigation for dysphagia
Endoscopy
Which tests to perform before fundoplication surgery for GERD
Ambulatory oesophageal pH and manometry studies
For diagnosis of pharyngeal pouch (or any other diverticulum) which test is performed
barium swallow studies can be performed
Urgent endoscopy criteria
With dysphagia
Aged ≥55yrs with weight loss plus
Upper abdominal pain
Reflux
Dyspepsia
Greenish nipple discharge
Duct ectasia
Green nipple discharge with normal USS
Best actions
Discharge and reassure
Duct ectasia
Galactorrhoea can be caused by
histamine receptor antagonists
What is galactorrh3a in post Parfums females
In postpartum females, this also includes milk production occurring 6-12 months after pregnancy and the cessation of breastfeeding
Which viral infection can cause galactorrhea
Varicella zoster
What type of hypersensitivity is tuberculosis?
Type IV
Delayed type
Levels of prolactin in prolactinoma
> 1000
Examples of type II hypersensitivity
TIMPAG
Autoimmune haemolytic anaemia
Pemphigus
Goodpasture’s
Transfusion reaction
ITP
Myasthenia gravis
Example of type 3 hypersensitivity
Serum sickness
SLE
Aspergillosis
Poststreptococcal glomerulonephritis
RA
Polyarteritis nodosa
Examples of type IV hypersensitivity
Graft versus host disease
Contact dermatitis
Tuberculin test
Microbial agents like TB
Example of type V hypersensitivity
TSH receptor antibody results in prolong hypersecretion of thyroid hormone
Tumors defying histogenetic classification are called
Anaplastic
Benign vs malignant features I don’t know
B: rarely ulcerates or undergo necrosis,
M: opposite
Carcinoma versus sarcoma
Carcinoma is a malignant epithelial neoplasm
Sarcoma is a malignant connective tissue neoplasm
Histopathologic features of malignancy
Abnormal tissue architecture
Coarse chromatin
Invasion of basement membrane*
Abnormal mitoses
Angiogenesis
De-differentiation
Areas of necrosis
Nuclear pleomorphism
Potent vasodilators during acute inflammation
histamine,
prostaglandins,
nitric oxide,
platelet activating factor,
complement C5a (and C3a) and
lysosomal compounds.
Serotonin function as a vasodilator versus vasoconstrictor
Intact and healthy tissues and vessels will respond to a serotonin infusion with vasodilation
In damag3d cells it acts as vasoconstrictor
What happens during exudative cellular phase of acute inflammmation
Adhesion of neutrophils
Neutrophils migration
Diapedesis
Neutrophils chemotaxis
Vascular phase of acute inflammation:
change in vessel calibre
increase vascular permeability
formation of fluid exudates
First response of vessel to injury
Vasoconstriction then dilation
What is triple response to jnjury
Flush: capillary dilation
Flare: arteriolar dilatation
Weal: zon3 of edema
Amount of protein in an exudate of acute inflammation
50g/L
Chemicals increasing leukocyte surface adhesion molecule expression versus
Chemicals increasing endothelial expression of adhesion molecules
C9mplement 5a, leukotriene B4, TNF
IL-1, Endotoxins, TNF
Chemicals responsible for neutrophil chemotaxis
Leukotriene B4
IL-8
Function of C5a
Neutrophils chemotaxis
Increase vascular permeability
Release of histamine from mast cells
Opsonization of bacteria and phagocytosis by macrophage is facild by which complements
C4b, 2a and 3b
Kindness system is activated by which factor
Factor XII
Kinin system
Prekallikrien>kallikrien by factorXII
Kinogen»_space; Bradykinin by Kallikrien
Which factor activate coagulation fibrinolytic and kinin system in acute inflammation
Factorc12
How lymphatic system helps in acute inflammation
Buy limiting extent of edema
Carry antigens to lymph nodes for recognition by lymphocytes
In TB where reactivation of disease occurs
Reactivation generally occurs in the apex of the lungs and may spread locally or to more distant sites
Regions of body affected by tuberculosis apart from lungs
Central nervous system
vertebral bodies
cervical lymph nodes
kidney
gastrointestinal tract
Tuberculosis in cervical lymph nodes is called
(scrofuloderma)
Risk factors for developing active tuberculosis include
silicosis
chronic renal failure
HIV positive
solid organ transplantation with immunosuppression
intravenous drug use
haematological malignancy
anti-TNF treatment
previous gastrectomy
Hadfield procedure
Total duct excision
Usually in periductal mastitis
Uncontrolled duct ectasia
Multiple duct pathology
When to perform
total duct excision
Vs
microdochectomy
In breast discharges
Multiple duct pathology
Vs
Single duct pathology
Van Gieson and Masson trichrome are histological staining methods for
identification of connective tissues.
Von Kossa technique is useful for identifying
tissue mineralisation.
Markers of carcinoid syndrome in blood
chromogranin A,
neuron-specific enolase (NSE),
substance P,
and
gastrin.
Urinary marker of carcinoid tumor
5 HIAA, which is a metabolite of serotonin
Common site of carcinoid tumor
mainly in the intestine (midgut-distal ileum/appendix)
Can occur in the rectum, bronchi
Site of carcinoid tumor other than gastrointestinal tract
Pancreas and lung
What valve issue in carcinoid
Pulmonary valve stenosis and tricuspid regurgitation causing dyspnoea
Tests for carcinoid syndrome
5-HIAA in a 24-hour urine collection
Somatostatin receptor scintigraphy
CT scan
Blood testing for chromogranin A
When to give Octreotide in patients with carcinoid tumor pre and post op
In the highest risk patients, octreotide can be started 24 hours prior to the operation and continued for 48 hours post-operatively.
Lynch syndrome/HNPCC features
locally advanced mucinous carcinoma
scanty polyps in the remaining colo
Right sided colonic Ca at young age
What type of gene is HNPCC vs APC
HNPCC: DNA mismatch repair gene
APC: Tumor suppressor gene
Lynch syndrome gene mutation
MSH2, MLH1, PMS2 and GTBP
Cowden disease diagnostic feature
Multiple intestinal hamartomas
Multiple trichilemmomas
Most common site of lynch syndrome
Colorectal>endometrial>gastric
Criteria for diagnosis of HNPCC
nemonic 3-2-1 for HNPCC.
3 individuals,
2 generations and
one must be younger than 50 yrs
At what cell count of T cells does candidiasis occur in AIDS
<200
pathological criteria carries the greatest prognostic weighting for malignant melajoma
Bristow thickness
Lesions >4 mm thick on breslow
Rx is
3 cm margin around the malignant melanoma
Example of primary chronic inflammation
TB
Suture material
Prosthetic materials like breast
Autoimmune conditions
Example of serous inflammation
Conjunctivitis
What is catarrhal inflammation
Hypersecretion of mucus in acute inflammation of a mucus membrane
How anemia is caused in acute pancreatitis
Loss of blood into exudates
A features of chronic inflammation
Usually primary but may follow acute
Granulomatous inflammation is a specific type
May be complicated by amyloidosis
Examples of primary chronic inflammation from foreign body endogenous materials
Foreign body reactions
endogenous material: necrotic bone, uric acid crystals
Name few diseases which cause primary chronic inflammation
Autoimmune diseases: hashimotos thyroiditis, chronic gastritus of pernicious anaemia, Rheumatoid arthritis
Granulomatus disease: crohn disease sarcoidosis
Ulcerative colitis
Tuberculosis, leprosy
Which kind of acute inflammation converts to chronic inflammation mostly
Suppurative inflammation type
Example of progression from acute inflammation to chronic
Inadequate drainage of pus like in chronic abscess of osteomyelitis or chronic Empyema thoracis
Foreign body reactions made develop into granuloma like suture material, wood, metal, glass, implanted prosthesis
Example of recurrent episodes of acute inflammation turning into chronic
Chronic cholecystitis due to gallstones
Microscopic appearance of chronic inflammation
Chronic ulceration
Chronic abscess
Caseating granulomatous inflammation
Thickening of hollow viscous
Fibrosis
How healing occurs in chronic information
By Fibrosis
What is diaphragm disease
When human of small bowl is divided into short compartments by circular membrane of mucosa and sub-mucosor
Cause of diaphragm disease
Long use OF NSAIDS
mostly in elderly females
Popcorns are present in which sub type of Hodgkin lymphoma
Nodular lymphocyte predominant
lymphohistiocytic (L-H) variant of Reed Sternberg cells
Popcorn cells
B Symptoms
10% weight loss, fever, night sweats
Which virus is associated with hodkin lymphoma
Ebstein bar virus specially to mixed cellularity lymphoma
Chronicle features of Hodgkin lymphoma
Cough, Pel Ebstein fever, haemoptysis, dyspnoea
B Symptoms - 10% weight loss, fever, night sweats
Which sub type of Hodgkin lymphoma has best prognosis
Nodular sclerosing has the best prognosis
Which features of hodgkin lymphoma attribute to worst prognosis
Lymphocyte depleted Hodgkins lymphoma,
advancing age,
male sex and
stage IV disease
apple green birefringence with polarised light in which disease
Amyloidosis
Which amyloidosis is a long-term complication of several chronic inflammatory disorders
Systemic AA amyloidosis
AL amyloidosis
results from extra-cellular deposition of fibril-forming monoclonal immunoglobulin light chains (most commonly of lambda isotype).
most commonly affected sites by amyloidosis
kidney and heart
If myeloma or any monoclonal gammopathy then amyloidosis
Then amyloidosis can’t be from AL
As AL causes just asymptomatic ones
Sarcomas in which Lymphatic Metastasis is seen:
‘RACE For MS’
R: Rhabdomyosarcoma
A: Angiosarcoma
C: Clear cell sarcoma
E: Epithelial cell sarcoma
For: Fibrosarcoma
M: Malignant fibrous histiocytoma
S: Synovial cell sarcoma
Or
‘SCARE’
Synovial sarcoma
Clear cell sarcoma
Angiosarcoma
Rhabdomyosarcoma
Epithelioid sarcoma
Most common site of sarcoma metastasis
Lung
Malignant fibrous histiocytoma is now referred to as
undifferentiated pleomorphic sarcoma
Some features suspicious of sarcoma
Large >5cm soft tissue mass
Deep tissue location or intra muscular location
Rapid growth
Painful lump
Biopsy of a sarcoma
Never attempt blind biopsy always perform image guided by biopsy in such a way that the tract can be included in any resection in the future
Commonest type of Ewings sarcoma
femoral diaphysis
4 subtypes of Malignant Fibrous Histiocytoma
storiform-pleomorphic (70% cases), myxoid (less aggressive), giant cell and inflammatory
Callus visible on xray after how long from the injury
3 weeks
Bone tumors are mostly primary or sec
Secondary
Features of primary malignant bone tumor
Rare
Have bad prognosis
Affect patients in a younger age group
Genetic abnormality in Ewing sarcoma
genetic translocation of chromosomes 11 and 22
Most common bone tumor
Osteochondroma
Xray finding of Ewing sarcoma
Lytic lesion with periosteal reactions
Onion rings on x ray
Pediatric malignancy of bone
Ewing sarcoma
Treatment of Ewing sarcoma
Management is via adjuvant chemotherapy followed by surgical excision.
Human herpes virus 8 causes
Kaposi’s sarcoma
Human T-lymphotropic virus 1
Tropical spastic paraparesis
Adult T cell leukaemia
Human papillomavirus 16/18 causes
Cervical cancer
Anal cancer
Penile cancer
Vulval cancer
Oropharyneal cancer
Post transplant lymphoma occurs by
EBV
Nasopharyngeal carcinoma is caused by
EBV
MEN IIB includes
Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Hyperparathyroidism
Marfanoid appearance
MEN type IIa includes
Phaeochromocytoma
Medullary thyroid cancer (70%)
Hyperparathyroidism (60%)
Genetic of MEN 2
RET Oncogene on chromosome 10
Most common presentation of MEN 1
hypercalcaemia
Genetic of MEN 1
MENIN gene on chromosome 11
MEN 1 syndrome includes
Mnemonic ‘three P’s’:
Parathyroid (95%): Parathyroid adenoma
Pituitary (70%): Prolactinoma/ACTH/Growth Hormone secreting adenoma
Pancreas (50%): Islet cell tumours/Zollinger Ellison syndrome
also: Adrenal (adenoma) and thyroid (adenoma)
Sudden collapse and angioedema following exposure to latex
Which hypersensitivity
Type 1
CNS tissue has which kind of necrosis
Colliquative
Apoptosis occurs due to
activation of caspases triggered by the bcl-2 family or the binding of the FAS ligand to its receptor
Necrosis in arterioles in patients with hypertension
Fibrinoid
Black color ingangrene is due to
deposition of iron sulphide
Amorphous eosinophilic tissue in which necrosis
Caseous
Occurs in tissues with no supporting stroma
Colloiquative
In CNS
Nerve damage with no soft tissue injury what will be the rate of neuron growth
1 mm perday
Wallerian Degeneration begins
24-36 hours following injury
Wallerian Degeneration occurs in
Axonotmesis
Neurotmesis
Not in Neuropraxia
Difference between types of nerve injury
1 Neuropraxia
2 Axonotmesis
3 Neurotmesis
1 Only electrical conduction affected.
2 Only axon is affected with intact myelin
3 Both axon and myelin are affected
aneurysm screening programage limit
in all men aged 65 years.
Commonest cause of Abd aneurysm
Smoking and hypertension
Abdominal aortic aneurysm is associated with which type of connective tissue disorder
Marfan syndrome
When to perform surgery for aneurysm
Vs
When to perform urgent surgery
When size is >5.5 to 6 cm
If aneurysm is painful
Indications for surgery for abdominal aneurysm
Symptomatic aneurysms (80% annual mortality if untreated)
Increasing size above 5.5cm if asymptomatic
Rupture (100% mortality without surgery)
Most common rupture site of abdominal aneurysm
retroperitoneal 80%.
BP aim for abdominal aneurysm hematoma
100 mm
weeping, crusty lesion,areolar region is spared
Paget disease
Lab findings of antiphospholipid syndrome
Lupus anticoagulant may be present and the APTT is prolonged.
Features of antiphospholipid syndrome
thromboembolism and coagulation issues in a young woman
fetal loss, venous and arterial thrombosis and thrombocytopenia.
Rx of lead poisoning
Dimercaptosuccinic acid (DMSA)
D-penicillamine
EDTA
Dimercaprol
Clinical features of lead poisoning
abdominal pain
peripheral neuropathy (mainly motor)
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)
How to differentiate between intermittent porphyria vs lead poisoning
Blue line on gum margin in LP
Heme products in urine in AIP
Cbc of lead poisoning
red cell abnormalities including basophilic stippling and clover-leaf morphology
What may be seen making it sometimes difficult to differentiate lead poisoning from acute intermittent porphyria
Raised serum and urine levels of delta aminolaevulinic acid
Tumor arising from 4th ventricle and can grow through the foramina of Luschka and Magendie
Ependymoma
Adult vs pediatrics CNS tumor location
Most paediatric CNS tumours are infratentorial
Most adult CNS tumours are supratentorial
Which brain tumor can be treated with surgery and get cured
Meningioma
MC cell making giant cells
Macrophages
Most malignant CNS tumor
Glioblastoma multiforme
Most common CNS tumor in childhood
Medulloblastoma
Which sense is lost early in Acoustic neuroma
Corneal reflex
Recklinghausen’s disease has which neural tumor
Acoustic neuroma
Astrocytoma in children
In cerebellum
Benign
Can be excised completely
Most frequent sites affected by meningioma
Parasagittal region
Olfactory groove
Sphenoiid wing
Foramen magnum
Which tumor compress cerebral cortex at early stage and cause fits
Meningioma
Which brain tumors are radio resistant
Astrocytoma
Glioblastoma
Which bone type has better healing after fracture
Cancellous bone has better healing than compact
steroids, non steroidal anti inflammatory agents affect on bone healing
Decrease it
Location of dermoid tumor
midline of the neck, external angle of the eye and posterior to the pinna of the ear.
Desmoid cyst are associated with which
familial adenomatous polyposis coli syndrome
Graft vs host disease is caused due to which cell line
Lymphocytes
Transfusion related lung injury is due 5to which cell
Neutrophils
Mnemonic for transfusion reactions:
Mnemonic for transfusion reactions:
Got a bad unit
Graft vs. Host disease
Overload
Thrombocytopaenia
Alloimmunization
Blood pressure unstable
Acute haemolytic reaction
Delayed haemolytic reaction
Urticaria
Neutrophilia
Infection
Transfusion associated lung injury
Blood pressure compromise during transfusion is die to
IgA antibodies
most likely to arise from musculoaponeurotic structures?
Desmoid tumor
Beta-naphthalamine causes which Ca
Bladder Ca
If jaundice 2° stone then which test will show bleeding diathesis
PT
As cholestasis decreases production of vit l dependent factors 2,7,9 and 10
Macroscopic features of chronic inflammation
Ulcers
Fibrosis
Granulomatous process
Chronic inflammation usually occurs
Primar
Which type of diarrhoea in carcinoid syndrome
Secretary diarrhoea despite fasting
Pseudomyxoma peritoneii treatment
peritonectomy (Sugarbaker procedure) and heated intra peritoneal chemotherapy.
Pseudomyxoma Peritonei most commonly originates from which organ
Appendix
intra peritoneal chemotherapyin Pseudomyxoma Peritonei is dome by
Mitomycin C
Most common adverse event with Packed cell vs FFP
Packed cell: Pyrexia
FFP : Urticaria
Atrophy in muscle vs other organs
In muscle only the size is changes
In other organs size and cellularity both are changed
Neutrophil features
Lifespan of 1 to 3 days
ACTIONS: movement, opsonise microorganisms, phagocytosis & intracellular killing of microorganisms via aerobic (produce HYDROGEN PEROXIDE) & anaerobic mechanisms.
Neutrophil disorders include chronic granulomatous diseases: rare
Neutrophils produce what as a micocidal agent
Hydrogen peroxide not nitrogen
Nasopharyngeal Ca caused by which virus
EBV
Nasopharyngeal carcinoma
SCC
Mcommon in China
Symptoms of Nasopharyngeal carcinoma
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI
Which cranial nerve is affected in Nasopharyngeal carcinoma
III to VI
Rx of Nasopharyngeal Ca
1st line therapy is Radiotherapy
Organisms causing post splenectomy sepsis:
Streptococcus pneumoniae
Haemophilus influenzae
Meningococc
Postsplenectomy meds
Penicillin V 500mg BD or amoxicillin 250mg BD
Which age group has highest rate of post splenectomy sepsis
less than 16 years or greater than 50 years.
Which type of pneumococcal vaccine is offered to young children
Pconjugated vaccine (PCV
What is Hypersplenism
Splenomegaly associated with
•Any combination of anaemia, leucopenia or thrombocytopenia •Compensatory bone marrow hyperplasia
•Improvement after splenectomy
Primary splenism affects
Women
Massive splenomegaly is likely to be due to
Chronic myloid leukemia
Myelofibrosis
Lymphoma
Which storage disease causes splenomegaly
Gaucher’s Disease
If platelets above 1000 after splenectomy then what to do
No need to give anticoagulants
Antiplatelets such as aspirin can be given
What occurs absmoat immediately post splenectomy
Granulocytosis
When splenectomy is ofgreat risk
•In young especially < 2 years.
•When it happens 2’ to reticu lo endothelial than trauma.
Most common infection after splenectomy
Pneumococcal> H. influenza type B >N.meningitis
Which infection occurs after splenectomy due to dog bite
Capnocytophaga canimorsus
Other uncommon infections due to splenectomy
E.coli, Malaria, Babesiosis, capnocytophaga canimorsus
Why fatal sepsis is less after splenectomy from trauma
Due to splenosis means small multiple implants of splenic tissue auto transplantation
Vaccination after splenectomy
- Polyvalent pneumococcal vaccine PPV in adults while New Conjugate 7 valent vaccine for children undr 2.
- Hib vaccine.
Men C and Men ACWY( Latter for children under 2 years mostly).
Which vaccine is recommended annually after splenectomy
Influenza vaccine
Vaccination criteria due to planned versus emergency splenectomy
Planned: 2 weeks before or after surgery.
Emergency:Best after 14 days post surgery.
Glucaganoma is associated with
diarrhoea, weight loss and necrolytic migratory erythema.
Diagnosis of glucaganoma at which level
serum level of glucagon >1000pg/ml
Carcinoid tumor arise from
Enterochromaffin cells
How carcinoid syndrome is diagnos
5-Hydroxyindolaedcetic acid 5-HIAAmin urine
ARDS definition
The most up-to-date definition of acute respiratory distress syndrome is the Berlin Definition, which broadly consists of 4 key points:
Acute onset within 7 days
PaO2:FiO2 ratio <300 (with PEEP or CPAP >5cmH2O)
Bilateral infiltrates on CXR
Alveolar oedema not explained by fluid overload or cardiogenic causes
DALM lesion in ulcerative colitis
Rx?
Panproctocolectomy
If achalasia turns to malignancy it is
Squamous cell carcinoma
Post splenectomy causative organisms
Mnemonic used to remember some encapsulated pathogens is: ‘Even Some Super Killers Have Pretty Nice Big Capsules’
Escherichia coli, Streptococcus pneumoniae, Salmonella, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Neisseria meningitidis, Bacteroides fragilis, and the yeast Cryptococcus neoformans
Massive transfusion affects which coagulation factors
5 and 8
Classification of oncogenes
Growth factors e.g. Sis
Transcription factors e.g. Myc
Receptor tyrosine kinase e.g. RET
Cytoplasmic tyrosine kinase e.g. Src
Regulatory GTPases e.g. Ras
Schilling test used for
A Schilling test is also known as a Vitamin B12 absorption test
Vitamin required for collagen
Vit C
If increased flexibility then which collagen
III
Collagen loss in
Ehlers Danlos vs Osteogenesis imperfecta
E: 1 and 3
O: 1
Ehler Danlos patients are prone to
joint dislocations and pelvic organ prolapse.
Which symptoms during blood transfusion is the most common event of complication
Mild pyrexia during blood transfusion is the most common event and commonly occurs during transfusion.
GIST’s are derived from which cells
the interstitial pacemaker cells of Cajal
Genetics of GIST
The vast majority express CD117 which is a transmembrane tyrosine kinase receptor and in these there is a mutation of the c-KIT gene
Drug to give in GIST which is unresectable
Imatinib
pharyngeal pouch, what is the most appropriate investigation?
Upper GI endoscopy is contra indicated in pharyngeal pouch.
Organ sites that may metastasise (early) to the para-aortic lymph nodes:
Testis
Ovary
Uterine fundus
Infection with which of the following micro-organisms may result in a clinical picture resembling achalasia of the oesphagus?
Trypanosoma Cruzi may result in destruction of the ganglion cells of the myenteric plexus,
Which nerve can be damaged after temporal biopsy
Facial
Auriculotemporal
Histology of thyroid in hyper thyroidism
hyperplasia of acini, which are lined by high columnar epithelium
Vacuolated or empty acini
Scalloped appearance adjacent to thyrocytes
Which hyperthyroid disease will not react to meds
Toxic nodule as it’s autonomous
From where thyroid is produced in Toxic multinodualr goitre
In between the nodules
Not fromt the nodules themselves
Retinal and cerebellar haemangiomas are key features of
Von Hippel
Which type of HL is associated the most with EBV
Mixed cellularity
Non neoplastic polyps which don’t have cancer prognosis
Hamartamatous
Juvenile
Inflammatory
Lymphoid
Hyperplastic
