Pathology Flashcards

1
Q

Coomb’s test: direct vs indirect (how it works)

A

Direct: detects antibodies bound to RBC surface antigens, indicating immune mediated attack on RBC

Indirect: detects antibodies against RBCs present in patient’s serum (used for antibody screening)

Either is positive if agglutination occurs

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2
Q

Trichomonas: how many flagellum and where?

A

4 anterior, 1 posterior

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3
Q

First line treatment for HMB

A

LNG IUS (mirena) levonorgestrel releasing intrauterine system

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4
Q

Percentage of those who get VZV that develop pneumonitis?

A

<1%

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5
Q

Percentage risk of endometrial cancer with Lynch syndrome

A

40-60%

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6
Q

Type of ovarian cancer that is associated with mismatch repair deficiency (MMRD)

A

Clear cell carcinoma of ovary (rare subtype of epithelial ovarian ca.)

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7
Q

Post CS- absorbable sutures, nodule in stitch line, type of cell for inflammation here

A

Giant cell (Langerhan)

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8
Q

Management of HIV in pregnancy re: medications/ timing of commencing based on viral load/ CD4 counts

A

All women not on HAART (highly active anti-retroviral therapy) should commence:
* As soon as they are able to do so in the second trimester where the baseline viral load ≤30,000 HIV RNA copies/mL;
* At the start of the second trimester, or as soon as possible thereafter, in women with a baseline viral load of 30,000–100,000 HIV RNA copies/mL;
* Within the first trimester if viral load >100,000 HIV RNA copies/mL and/or CD4 cell count is less than 200 cells/mm3.

All women should have commenced cART by week 24 of pregnancy.

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9
Q

Subtype of lichen planus that causes painful ulceration

A

Erosive lichen Planus

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10
Q

Cells of Brenner Tumour

A

Epithelial stromal tumour; transitional epithelial cells with longitudinal nuclear grooves (coffee bean nuclei), lying in abundant fibrous storm

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11
Q

Most common type of Fallopian tube cancer

A

Epithelial (serous adenocarcinoma)

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12
Q

What is a keratin pearl in a vulval ulcer suggestive of?

A

Squamous cell carcinoma (vulval cancer)

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13
Q

Pathophysiology of bacterial vaginosis (bacteria)

A

Variable degrees of depletion of protective Lactobacillus species. Marked increase in other organisms especially anaerobes: Gardnella vaginalis, Mobincullus, Atopobium vaginale, mycoplasma, bacteroides

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14
Q

General risks of anti-epileptic drugs during pregnancy?

A

Increased risk of teratogenicity 3x.
Associated with NTDs, cleft lip/ palate, cardiac defects, urogenital defects, neonatal coagulopathies

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15
Q

Which AED has the worst teratogenic profile?

A

Valproate

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16
Q

Which AEDs are in the FDA pregnancy category D?

A

Valproate, carbamazepine, phenytoin

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17
Q

Which AEDs are in the FDA pregnancy category C?

A

Lamotrigine, topiramate, vigabatrin

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18
Q

Which AEDs are in the FDA pregnancy category B?

A

Levetiracetam, gabapentin

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19
Q

Organism causing gonorrhoea (name and appearance)

A

Neisseria gonorrhoeae: gram negative intracellular diplococci

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20
Q

Most common tumour of female urethra

A

TCC

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21
Q

Pathophysiology of Grave’s disease

A

Autoantibodies to the thyrotropin receptor (TRAb) that activate the receptor, thereby stimulating thyroid hormone synthesis and secretion as well as thyroid growth

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22
Q

Most common cause of hyperprolactinaemia

A

Pituitary microadenoma

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23
Q

Fevers, headache, lymphadenopathy, CMV IgG positive, IgM negative

A

Previous CMV infection.

IgM antibodies are produced by the body first in response to a CMV infection. They can be detected in the blood within a week or two after the initial exposure. IgM levels (titers) rise for a short time, then decline and usually fall below detectable levels after a few months. IgM antibody levels rise again when latent CMV is reactivated.

IgG antibodies are produced several weeks after the initial CMV infection. IgG levels rise during the active infection, then stabilize as the CMV infection resolves and the virus becomes inactive. Once exposed to CMV, you will have some measurable amount of CMV IgG antibody in your blood for the rest of your life, which provides protection from getting another primary infection (immunity).

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24
Q

Lung cancer, abdo pain, polyuria & hypercalcaemia

A

PTHrp produced by squamous cell lung cancer

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25
Risk of miscarriage with amniocentesis
1%
26
Abe for UTI contraindicated in 3rd trimester/ close to term
Nitrofurantoin (risk of neonatal haemolysis)
27
Arias Stella reaction
An Arias-Stella reaction is a common gynaecological histological finding in curettage specimens of gestational endometrium describing a non-neoplastic lesion that is easily confused with uterine malignancy. An Arias-Stella reaction is due to hormonal hyperstimulation causing atypical endometrial glandular cells associated with the presence of viable chorionic tissue It can present in normal physiologic conditions including pregnancy, postpartum and uterine abortion but is also associated with ectopic pregnancy, gestational trophoblastic disease, and uterine disease affecting the myometrium.
28
RMI
Combines ultrasound, menopausal status and ca125 RMI = (U) x (M) x Ca125 U- scores 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites, bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2 to 5) M- premenopausal = 1, post-menopausal = 3 (women without period for 1 year or age >50 and hysterectomy) If >200, discuss with gynaecological oncologist
29
How is melanoma prognosis assessed?
Breslow thickness (depth of lesion)
30
Which malaria parasite is the most dangerous?
P. falciparum And most prevalent on African continent
31
PCOS biochemical markers
Increased insulin, decreased SHBG, high testosterone, high LH/oestrogen/ FSH, high prolactin (in 40% -caused by high estradiol)
32
Features of neonatal herpes
Localized skin infection Encephalitis Disseminated herpes infection— the most dangerous type. The virus is spread throughout the body and can affect multiple organs, including the liver, brain, lungs, and kidney.
33
Pregnant woman contracted CMV in 2nd trimester. Risk of neonatal congenital infection?
30-40% in 1st/2nd trimester 40-70% in 3rd
34
Amsel's criteria for BV diagnosis
>=3 of: clue cells on wet microscopy, vaginal pH >4.5, amine odor when vaginal fluid is exposed to 10% potassium hydroxide, and abnormal vaginal discharge.
35
pH interpretation of FBS
>7.25 - Normal Repeat in 1h if CTG remains abnormal 7.21 to 7.24 - Borderline (repeat in 30 minutes) <7.2 - Abnormal (consider delivery)
36
Contraindications to FBS
Maternal infection e.g. HIV, HSV, hepatitis Known fetal coagulopathy Prematurity (<34 weeks) Acute fetal compromise
37
JVP Abnormalities & causes
Elevated JVP, normal waveform: - RHF, fluid overload, bradycardia Elevated JVP, no pulsation: - SVC obstruction Absent a-waves: - AF Paradoxical JVP (Kussmauls): - Pericardial constriction Large V wave, Absent X wave: - Tricuspid regurgitation Large A wave, slow Y descent: - Tricuspid stenosis
38
Types of necrosis and organs/ environments it occurs in
Coagulative: Kidney, heart, adrenals, hypoxic Liquefactive (Colliquative): Brain Fat: Pancreas Gangreous: GIT, peripheral limb Caseous (granulomatous): TB
39
Features of metaplasia and dysplasia & neoplasia
Metaplasia: - Reversible change of one differentiated cell type with another - Cervical metaplasia where glandular epithelium is replaced by stratified squamous epithelium Dysplasia: - Abnormal change to cellular size, shape and/ or organisation - Can progress to cancer - Anisocytosis (unequal cell size) - Poikilocytosis (abnormal cell shape) - Hyperchromatism (pigmentation) - Mitotic figures (increased cells currently dividing) Neoplasia (cancer) - Abnormal uncoordinated excess cell growth - Nuclear enlargement - Increased mitotic activity - Loss of differentiation (polarity) - Loss of cell cohesion - Self simulating acquired genetic alterations & activation of oncogenes/loss of TSG paracrine, exocrine, endocrine factor production
40
incidence of choriocarcinoma in UK
1 in 45,000 pregnancies
41
ALP/ phosphate/ PTH profile in the following: Myeloma Calcium Alkali Syndrome Sarcoidosis Hyperthyroidism Hyperparathyroidism Malignancy Vit D excess
Myeloma Normal ALP Normal/ high PO4 Normal/ high PTH Calcium Alkali Syndrome Normal ALP Normal/ high PO4 Low PTH Sarcoidosis Normal/high ALP Normal/ high PO4 Low PTH Hyperthyroidism Normal/high ALP Normal/ high PO4 Low PTH Hyperparathyroidism Normal/ high ALP Low PO4 High PTH Malignancy High ALP Normal/ low PO4 Variable PTH Vit D excess Low ALP High PO4 Low PTH
42
Which substance has been used as a tumour marker for granulosa cell tumour of the ovary?
Inhibin
43
Metabolic abnormality seen in congenital hypertrophic pyloric stenosis. When does it typically present?
Hypochloremic, hypokalemic metabolic alkalosis. Typically presents 4-8 weeks of age
44
Describe histological appearance of endometrium 1. In the proliferative/follicular phase 2. Soon after ovulation (early secretory) 3. Mid- secretory phase 4. Late secretory phase 5. In the menstrual phase
1. Round to tubular glands with even spacing between them. Pseudostratified columnar cells in glands. Increased mitoses, tubular glands, increased vessel coiling 2. Glands with subnuclear vacuolation in oedematous stroma. Mitoses present, but not as numerous as during proliferative phase 3. stromal oedema and luminal secretion 4. Decidualisation- periareterial stroma, increased spiral artery tortuosity, stromal granulocytes, no mitoses 5. Stromal breakdown, aggregates of stromal cells mixed with inflammatory cells and blood.
45
Types of fibroid degeneration
Red/ Carneous (most common in pregnancy): pain, fever, leucocytosis. Haemorrhagic appearance. Hyaline (most common- 60%): when the fibroid outgrows its blood supply. Ivolves presence of homogenous eosinophilic bands or plaques in the ECF, representing the accumulation of proteinaceous tissue. MRI: difficult to distinguish. T1: isointense, T2: hypo intense Cystic (4% of degen): extreme sequela of oedema. USS: hypoechooic or heterogeneous uterine mass with cystic areas. MRI: cystic areas with portions of high T2 signal. Myxoid (rare): filled with gelatinous material that can be difficult to distinguish from cystic.
46
Ectopic management
Expectant: Pain free & stable <35mm with no FH hCG <1500 IU/L Can return for F/U- hCG days 2, 4, 7, then weekly(should drop by >15% each time) Methotrexate: Pain free & stable <35mm with no FH hCG <5000 IU/L No IUP Can return for F/U- hCG measurement D4 and 7, then once per week until negative Surgical: Symptomatic/ clinically unstable Sixe >35mm or FH or ruptured
47
Polymorphic eruption of pregnancy vs pemphigoid gestationis
Both itchy rashes. Polymorphic eruption= itchy, bumpy rash in last 3 months of pregnancy, usually over abdomen. Clears with delivery. More common in first pregnancy, white eomen, high BMI, multiple pregnancy and male foetus. Pemphigoid gestationis (herpes gestationis)- itchy red rash. Autoimmune disease associated with IgG against hemidesmosomal proteins, BPAG2 & BP180, present in skin basement membrane. AutoAb to amniotic basement membrane may cross-react with skin BPAG2 leading to the immune response. Treatment (both): topical steroids and antihistamines, emollients.
48
Complete vs parțial molar pregnancy
Complete Diploid (46XX most common) Usually due to duplication of haploid sperm following fertilization of an empty ovum No fetal tissue Has the highest risk of malignancy (CM is15% vs. PM is 0.5%). Ultrasound: “snowstorm” diagnosis - Need for chemo afterwards is 15% Partial Triploid (e.g. 69 XXY) Two haploid paternal gene sets and 1 maternal haploid gene set (dispermic fertilization of an ovum) Evidence of fetus or RBCs Medical evacuation may be necessary if large fetal tissues - Need for chemo afterwards is 0.5%
49
Histological features of malignancy
Mitoses ↑nuclear: cytoplasm ratio Abnormal differentiation Disrupted architecture Breach of BM by malignant cells Metastasize
50
IOTA benign vs malignant USS rules
Benign Unilocular cyst If solid components, largest solid <7mm Acoustic shadowing Smooth multilocular tumour with largest diameter <10cm No blood flow Malignant Irregular solid tumour Ascites At least 4 papillary structures Irregular multilocular solid tumour with largest diameter >10cm Very strong blood flow
51
Endometrial cancer - Type 1 vs Type 2 - Age at presentation - Prognosis - Most common spread - Staging & 5 year survival
Type 1 - Younger perimenopausal women with unopposed oestrogen - Risk factors include obesity, HRT, nulliparity, PCOS, early menses/ late menopause - Endometriod carcinoma (pre-malignant phase is atypical hyperplasia) Type 2 - Older post menopausal women - Non endometriosis (serous carcinoma) Typically present age 50-60 as PMB Most commonly spread to external iliac LN Staging: Stage 1 (85-90% 5Y survival) 1A: limited to uterus, invasion <1/2 myometrium 1B: limited to uterus, invasion >1/2 myometrium Stage 2 (65%) Cervical stromal invasion Stage 3 (45-60%) Invasion beyond uterus, but confined to pelvis 3A: invasion of uterine serosa, adnexa and peritoneal fluid 3B: Vaginal invasion 3C: Nodal involvement (C1= pelvic, C2 = para-aortic) Stage 4 (15%) Distant metastasis 4A: Invasion of mucosa of rectum/ bladder 4B: Distant including abominal mets or inguinal LN
52
Tumour markers in ovarian masses
Ca-125 LDH, AFP, HCG if <40 years with complex ovarian mass (germ cell tumours)
53
Types of primary ovarian ca. & tumour markers
Epithelial (85%) - Serous (75%)- psammoma bodies - Mucinous (CEA, TATI)L pseudomyxoma peritonei - Brenner's - Clear cell - Differentiated - Endometrioid - FIbroma Stromal (5%) - Sertoli-Leydig (testosterone secreting) - Thecofibroma - Granulosa (oestrogen secreting, inhibin A, 50% show Call-Exner bodies) Germ cell (5%)- 50% show Schiller-Duval bodies - Germinoma (yolk sac tumour) - Endodermal sinus tumour (secretes AFP and alpha anti-trypsin) - Choriocarcinoma - Teratoma - Embyronal E.G. Dysgerminoma (secretes LDH)
54
Benign ovarian masses Primary malignant ovarian masses Secondary malignant ovarian
Benign ovarian masses - Functional cysts - Serous cystadenoma - Mucinous cystadenoma - Mature teratoma (commonest ovarian tumour- 40%, bilateral in 10-15%) Primary malignant ovarian masses - Germ cell tumour - Epithelial carcinoma - Sex cord tumour Secondary malignant ovarian - Spread from breast/ GI/ peritoneal carcinoma - Krukenberg = ovarian ca from GI primary cancer, mucin-secreting signet ring cells.
55
Meig's syndrome
Ascites, pleural effusion and ovarian fibroma or thecoma (1% cases)
56
Ovarian cancer: - Staging & 5 year survival - Peak incidence - Common sites of spread
Stage 1 Limited to 1 or both ovaries 1A: involves 1 ovary, peritoneal washings negative 1B: involves both ovaries, peritoneal washings negative 1C: capsule ruptures, peritoneal washings positive Stage 2 Pelvic extensions 2A: implants on uterus 2B: implants on pelvic structure 2C: peritoneal washings positive Stage 3: peritoneal implants beyond pelvis or with extension to small bowel/ omentum 3A: microscopic implants 3B: Macroscopic implants <2cm 3C: Macroscopic implants >2cm Stage 4: distant mets 5 year survival for all stages is 35-45% Peak incidence 55-74y Commonly spreads to pelvic/ peritoneal cavity and para-aortic LN
57
CIN I to III
CIN I: dysplasia confined to basal 1/3 of squamous epithelium CIN II: dysplasia confined to basal 2/3 of squamous epithelium CIN III: full thickness epithelial dysplasia
58
What is the transition zone on the cervix? What is its clinical significance?
The region where the endocervical columnar epithelium has undergone squamous metaplasia and is bounded proximally by the new SQJ and distally by the original SQJ. TZ is where CIN occurs and needs to be sampled/ visualised by smear/ colposcopy
59
Cervical cancer staging
Stage I Limited to cervix 1A1: depth <3mm, length <7mm 1A2: depth 3-5mm, length <7mm 1B1: lesion <4cm 1B2: lesion >4cm Stage 2 Invades beyond uterus, but not to pelvic wall or lower 1/3 of vagina 2A: without parametrial invasion 2B: with parametrial invasion Stage 3 Extends to pelvic side wall or lower 1/3 vagina or hydronephrosis Stage 4 Extends beyond true pelvis 4A: invades mucosa of bladder and rectum 4B: distant mets
60
Features of TB on endometrial biopsy
Focal areas of ulceration, caseous necrosis and haemorrhage
61
Two most common cancers associated with endometriosis
Clear cell carcinoma Endometriod carcinoma
62
Cell death associated with cytoplasmic blebbing
Apoptosis
63
Best way to detect receptor status in breast ca.?
Immuno-histochemistry (using Abs against the different receptors)
64
Wound healing
1. inflammatory phase - Lasts 2-3d - Local vasoconstriction - Thrombus formation and fibrin mesh - Platelets line the damaged endothelium and release ADP/ PDGF/ cytokines/ histamine/ 5HT/ prostaglandins - ADP causes thrombus aggregation - Cytokines attract lymphocytes and macrophages 2. Proliferative phase - d3- week 3 - Increased fibroblast activity produces collagenase type 3 and ground substance - Angiogenesis - Re-epithelialisation of wound surface - Formation of granulation tissue 3. Remodelling - Maturation of collagen (type 1 replaces type 3) - Decrease in wound vascularity - Wound contraction
65
Process of healing by primary intention
NOT an acute inflammatory reaction - Fibrin rich haematoma develops - Neutrophils appear at the margins within 24h and move towards fibrin clot - Movement of epithelial cells from wound edge deposit a basement membrane in 24-48h - Macrophages replace neutrophils by D3 - Granulation tissue invasion - Neovascularisation (max D5) - Fibroblast proliferation at week 2 - Scar is devoid of inflammatory cells by week 4
66
Cells that dominate in acute inflammation in first 24h, then 48h
Neutrophils dominate in first 6-24h Largely replaced by monocytes in 24-48h
67
What is a tamm-horsfall protein?
A major protein in normal urine and the primary component of waxy nephron casts (common in ATN). It is secreted by renal tubular epithelial cells.
68
What is clear cell adenocarcinoma of the vagina/ cervix? Who is at risk? What else are they at risk of?
Rare cancer of vagina/ cervix Daughters of women treated with diethylstilbestrol during pregnancy (used to prevent miscarriages- non-steroidal oestrogen medication) Also at risk of vaginal adenosis (presence of glandular epithelium in vagina)
69
Which is the most common non-epithelial vaginal cancer?
Rhabdomyosarcoma
70
What is the risk of developing SCC in vulval lichen sclerosis?
<5%
71
What is Paget's disease of the vulva?
Adenocarcinoma in situ
72
Most common solid benign tumour of ovary
Fibroma
73
Most common benign epithelial ovarian tumour
Serous cyst adenoma
74
Proportion of Brenner tumours of the ovary that are malignant
5%
75
What type of gene is BRCA 1/2
Tumour suppressor genes
76
Histology of fibroma
Characterised by spindle cells with central nucleus and no nuclear atypia Fibromas with > 3 mitoses per 10 high power fields are considered fibrosarcomas
77
What type of necrosis is ATN?
Coagulative
78
Most common site for vulval cancer
Labia majora
79
What type of antibodies is lichen planus associated with? Typical features of lichen sclerosis including histology?
Extracellular matrix protein-I antibodies (60-80%) Smooth porcelain-white plaques on the vulva. Peri-anal skin involvement. Narrowing of Introits Hyperkeratosis Fissuring *doesn't typically involve vaginal mucosa* Histology - Atrophy of epidermis - Hyperkeratosis - Loss of normal rete ridge pattern in epidermis - Lymphocytic infiltrate in dermal-epidermal junction
80
What type of antibodies is lichen planus associated with?
anti-basement membrane antibodies
81
4 main groups of Lichen Simplex
Underlying dermatoses Systemic conditions Environmental factors Psychiatric disorders
81
Probability of sarcomatous change occurring in a fibroid
1 in 500
82
Size differentiation between micro and macroprolactinoma
10mm diameter