Pathology

Question 1

Seminoma tumour marker

Answer 1

Placental alk phosphate

BetaHCG

Question 2

Uses of tumour markers (5)

Answer 2

Screening
Diagnosis 
Monitoring response to treatment
Monitor recurrence 
Severity of underlying disease

Question 3

Types of transplant

Answer 3

Autograft: from one part of body to another part

Isograft: transplant between two genetically identical individuals

Allograft: from one person to another who are not genetically identical

Xenograft: between species

Question 4

Cytological features of malignancy

Answer 4

1. Increased mitotic index
2. Hyperchromatism (dark nuclei due to more DNA)
3. Pleomorphism
4. Large nuclei (ie increased nucleus: cytoplasm ratio)

Question 5

Histological features of malignancy

Answer 5

1. Loss of normal tissue architecture
2. Invasion of basement membrane into nearby structures
3. Neovascularisation, necrosis and haemorrhage

Question 6

Congenital causes of melanoma

Answer 6

(XAG)
Xeroderma pigmentosum
Albinism
Giant congenital pigments naevus

Question 7

Acquired risk factors for melanoma

Answer 7

UV light exposure, childhood history of sunburn 
Redhead 
Fair skin
Tendency to freckle
High total number of naevi (>20)
Immunocompromised

Question 8

Four main types of melanoma

Answer 8

1. Superficial spreading (>70%)
2. Nodular
3. Acral (nail, palms, usually in black and Asian patients)
4. Amelanocytic

Question 9

Mechanism of action of PPI

Answer 9

Inhibits H/K ATPase in gastric parietal cells

Question 10

Factors that impede enterocutaneous fistula healing

Answer 10

F oreign body
R adiation
I nflammation/infection
E pithelilisation
N eoplasm
D istal obstruction 
S hort tract (<2cm)

Malnutrition
High Output

Question 11

Amyloidosis:

1. Definition
2. Microscopy findings
3. 3 types

Answer 11

1. Abnormal fibrillar protein in Extracellular space, Resistant to enzyme degradation
2. Microscopy: bright pink hyaline
   Congo red stain shows apple green birefringence under polarised light
3. AL- primary in myeloma and paraproteinaemia, clonal prolif of amyloidal monoclonal Ig
   AA - secondary to inflammatory conditions
   Familial - AD condition, mutation in transthyretin (transport protein produced by liver)

Question 12

Places where isolated amyloid deposits can be found (4)

Answer 12

PULA

Pituitary
Urinary tract
Larynx
Aorta

(Also brain in Alzheimer’s and CAA)

Question 13

Teratoma tumours markers

Answer 13

(ABC - Tetris, teratoma)

Alpha fetoprotein
Beta-HCG - can cause gynaecomastia
CEA

Question 14

Seminoma

Answer 14

30-40y/o
Lymphatic spread to paraaortic nodes
Radiosensitive
Monitor LDH
Placental ALP

Question 15

Teratoma & NSGCTs

Answer 15

20-30y/o
Haematogeous spread to lung, brain, liver
Chemo sensitive (platinum based chemo)
ABC (AFP, B-HGC, CEA)
Tissue formed from all 3 germ layers. Can be mature or immature, can contain malignant tissue from all layers

Question 16

Sickle cell anaemia

Pathology and complications

Answer 16

Autosomal recessive
Amino acid substitute (glutamate to valine), homozygous = trait.
3 main complications:

Thrombosis (cold, infection, dehydration predispose)
Aplastic crisis (parvovirus infection causes reduced BM production)
Sequestration (acute hepatosplenomegaly with liver failure)

(Increased infection risk due to small spleen from multiple thrombi)

Question 17

APC gene function

Answer 17

Facilitate beta catenin degradation. Beta catenin otherwise goes to nucleus and activates c-myc with transcription factors.
Crypt proliferation

Question 18

P53 action

Answer 18

Arrests cell cycle

Question 19

Mechanism of action of doxazocin

Answer 19

Alpha1-blocker

Relaxed internal bladder sphincter
Relaxes prostrate smooth muscle

Question 20

MEN 2 tumours

Genetic defect

Answer 20

(PAT)
Parathyroids hyperplasia/adenoma
Adrenal (phaeo)
Thyroid (medullary Ca)

RET Proto-oncogene, autosomal dominant

Question 21

MEN 1 tumours and genetics

Answer 21

Pituitary
Parathyroids 
Pancreas
(Adrenal hyperplasia)
(Thyroid hyperplasia)

MEN 1 gene, TSG, autosomal dominant

Question 22

Mechanism of calcium problems in chronic renal disease

Answer 22

1. Glomerular damage cause phosphate retention
2. Hyperphosphataemia inhibits calcium reabsorption
3. Reduced 1,25-dihydroxycholecalciferol production, further reduce gut reabsorption of calcium
4. Secondary and tertiary hyperparathyroidism mobilise calcium from bone
5. Renal osteodysteophy and ectopic calcification
   (Osteitis fibrosa cystica mainly from primary parathyroidism)

Question 23

PTH-rP secreting tumours

Answer 23

Lung SCC
RCC
Bladder TCC

Question 24

Commonest causes of hyperparathyroidism, and investigations

Answer 24

Single parathyroid adenoma (80%)
Diffuse hyperplasia
Carcinoma
(Primary, secondary, tertiary)

Ix: radioisotope scan (sestamibi), labelled with technetium-99m, persists longer in parathyroids, adenoma and carcinoma picked up.

Question 25

Cells seen in parathyroid adenoma

Answer 25

Chief cells (majority of parathyroid gland, secretes PTH)
Oxyphil cells (dark nuclei cells)

Question 26

What is necrosis

Answer 26

Premature unplanned cell death. 
Inflammation
No energy
Cells lyse
Always multiple cells within tissue

Question 27

Types of necrosis

CCF LFG

Answer 27

Coagulative (infarcts)
Caseous
Fibrinoid (vasculitis, PAN)

Liquefactive (brain infarct)
Fat
Gangrenous

Question 28

Acute inflammation

Answer 28

Vasodilation
Vascular permeability
Migration of leukocytes
Resolution, progression to chronic inflammation, scar, abscess

Histamine, bradykinin, serotonin, arachdonic acid breakdown, complement, cytokines

Question 29

Chronic inflammation

Answer 29

Active inflammation, tissue injury, tissue healing.
Lymphocytes, macrophages.
Longer chronicity

Question 30

Neoplasm definition

Answer 30

Growth exceeds surrounding tissue
Uncoordinated growth
Continues despite removal of stimulus