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Year 3 > Pathology > Flashcards

Pathology Flashcards

1
Q

What are lines of Zahn?

A

A feature of thrombi that occur particularly when formed in the heart or aorta.

Alternating layers of platelets and fibrin (pale) and RBCs (darker)

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2
Q

Which coronary artery usually supplies the SA node?

A 
Right coronary artery (60% of people)
Left circumflex (40% of people)
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3
Q

Which coronary artery usually supplies the AV node?

A

Right coronary artery (90%)

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4
Q

Which coronary artery is most commonly occluded?

A

Left anterior descending

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5
Q

Which microscopic features would you expect if a tumour is malignant?

A 
Abnormal mitotic figures
Abnormal nuclear membrane
Nuclear hyperchromasia
Prominent nucleoli
Enlarged pleomorphic nuclei
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6
Q

What is Verhoeff’s elastic stain/ Elastic Van Gieson stain used for?

A

This stains elastin black
Can be used when examining lung tumours microscopically
If part of the tumour lies beyond the elastin, the pleura is involved

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7
Q

Which type of lung cancer is usually a peripheral lesion that produces mucin?

A

Adenocarcinoma

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8
Q

What is the prognosis of lung adenocarcinoma if there are fewer glands?

A

Poorer

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9
Q

Which type of lung cancer is usually a central lesion with keratinisation, intercellular bridges and cavitation?

A

Squamous cell carcinoma

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10
Q

What is the most common type of lung cancer?

A

Adenocarcinoma (non small cell)

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11
Q

Which type of non small lung cancer has the strongest smoking association?

A

Squamous cell carcinoma

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12
Q

What are lepidic adenocarcinomas?

A

Subgroup of adenocarcinoma of lung
Divided into mucinous and non mucinous
Have growth around alveolar walls
May be considered insitu in some cases. Don’t usually have lymph/ vascular invasion, and no architectural disruption/ complexity.

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13
Q

What is the treatment of choice for small cell lung cancer?

A

Chemotherapy

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14
Q

Does emphysema cause haemoptysis?

A

NO

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15
Q

What percentage of lung cancers are treated by surgery?

A

15%

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16
Q

Which type of lung cancer is most associated with asbestos?

A

Non small cell carcinoma

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17
Q

Which type of lung cancer is most common in women and and non smokers?

A

Adenocarcinoma

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18
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma (75%)

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19
Q

What is the 5 year survival for lung cancer?

A

10%

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20
Q

What is used to assess the stage of melanoma?

A 
Breslow's thickness
Clark's scale
Microsatellites
Mitotic figures
Ulceration
Vascular invasion

(NOT SIZE OR DIAMETER)

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21
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma (75%)

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22
Q

Skin punch biopsies can be used for diagnosing which types of skin cancer?

A

Basal cell carncinoma

Squamous cell carcinoma

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23
Q

Which type of biopsy is used for diagnosing melanoma?

A

Excision biopsy

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24
Q

What are the most common variants of melanoma?

A

Superficial spreading

Nodular

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25
Q

Fat wrapping is a histological feature of which type of IBD?

A

Crohn’s

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26
Q

What are the histological features of Crohn’s?

A

Granulomas
Fat wrapping
Transmural lymphoid aggregates

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27
Q

Crypt abscesses and cryptitis, mucin depletion and loss of haustra are features of which condition?

A

UC

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28
Q

Which type of IBD has a stronger association with bowel cancer?

A

Ulcerative collitis

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29
Q

How does smoking affect the risk of Crohn’s?

A

Increases the risk

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30
Q

What surgery can be used in UC?

A

Subtotal colectomy with Terminal ileostomy or ileo anal pouch

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31
Q

What is the commonest type of colon cancer?

A

Adenocarcinoma

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32
Q

What TNM stage would a colon tumour which has invaded through the serosa be?

A

T4

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33
Q

An adenoma polyp increases the risk of _________

A

Colon cancer

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34
Q

What are poor prognostic indicators for colon adenocarcinoma?

A

Serosal invasion
Lymph node metastases
Vascular invasion

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35
Q

What are the vascular changes in acute inflammation?

A
  1. Arteriole vasodilation = increased capillary blood flow
  2. Increased permeability, increased blood viscosity
  3. Leukocyte margination
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36
Q

Ulcerative collitis is associated with which hepatobiliary condition?

A

PSC

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37
Q

Anti mitochondrial antibodies are present in which condition?

A

PBC

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38
Q

PBC is more common in which age and gender?

A

Women aged 40-60years

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39
Q

What are the 2 main events in acute inflammation?

A
  1. Vascular changes (vasodilation, increased permeability)

2. Leukocyte migration

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40
Q

What are the 4 stages of leukocyte migration?

A
  1. Margination
  2. Rolling (selectins)
  3. Adhesion (integrins)
  4. Transmigration into extravascular space
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41
Q

What effect does histamine have?

A

Arteriole dilation

Increased permeability

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42
Q

What effect does bradykinin have?

A

Arteriole dilation

Increased permeability

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43
Q

What effect does Il-8 have?

A

Migration and activation of inflammatory cells

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44
Q

What is pus composed of?

A

Neutrophils
Bacteria
Necrotic cells

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45
Q

What type of diseases are usually associated with lymphocytes rather than neutrophils in acute inflammation?

A

Viral infections eg. Viral hepatitis, meningitis and myocarditis

Autoimmune hepatitis

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46
Q

What are the potential consequences of acute inflammation?

A
  1. Resolution
  2. Scarring/ fibrosis
  3. Progression to chronic inflammation
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47
Q

Which immune cells are involved in chronic inflammation?

A

Lymphocytes
Macrophages
Plasma cells

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48
Q

What is the role of CD4+ T cells in chronic inflammation?

A
  1. Secrete cytokines
  2. Activate effector cells (CD8+ and macrophages)
  3. Cooperate with B cells
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49
Q

In chronic inflammation eg. Chronic cholecystitis, muscle is replaced by ______________

A

Fibrous scarring

So loss of normal function

50
Q

What is the macroscopic appearance of a peptic ulcer?

A

Loss of mucosal folds
Flattening
Fibrous scarring of muscle

51
Q

What are the stages in the evolution of a gastric ulcer?

A

Necrosis
Acute inflammation
Healing
Scar

52
Q

Fibrous scarring in a chronic peptic ulcer can lead to complications such as _________

A
  1. Pyloric stenosis -> projectile vomit

2. Gastric haemorrhage

53
Q

What is the role of CD8+ T cells in chronic inflammation?

A

Effector cells: Kill by apoptosis, produce cytokines

54
Q

Which biologically active products do macrophages release?

A
  1. Proteases and toxins- tissue damage
  2. Cytokines and chemokines- activate and recruit other cells
  3. Growth factors- angiogenesis and fibrosis
  4. Collagenases- remodelling of connective tissue
55
Q

Which conditions have granulomas?

A

Infections- TB, Syphillis
Crohn’s
Sarcoidosis
Foreign body conditions eg. keratin, silica

56
Q

Which cells are mainly recruited in the immune response to TB?

A

T cells (delayed hypersensitivity)

57
Q

A ___________ is a subpleural lesion, often in the mid and lower zones of the lung caused by mycobacterium TB.

A

Ghon Focus

The centre of this undergoes necrosis mediated by TNF.

58
Q

Which cytokine mediations necrosis in the centre of a Ghon focus?

A

TNF released from T cells

59
Q

In Ulceratice Collitis, the damaged ulcerated tissue heals via __________

A

Regeneration

60
Q

If TB bacteria spread from the lungs via an infected lymph node into the pulmonary artery, this will cause _____________

A

Lung infection

61
Q

If TB bacteria spread from the lungs via the pulmonary vein, this will cause _____________

A

Systemic infection

62
Q

In Crohn’s disease, the damaged smooth muscle heals by _______

A

Fibrosis

63
Q

In Ulceratice Collitis, the damaged tissue heals via __________

A

Regeneration

64
Q

Which types of cells have labile (steady state) renewal?

A

Epithelial cells

Parenchyma of glands eg. liver, kidney

65
Q

Which cell types are permanent and non replacing?

A

Neurones

Cardiac muscle

66
Q

_______ is a decrease in size of an organ after development.

A

Atrophy

67
Q

_______ is a failure of a tissue or organ to reach normal size

A

Hypoplasia

68
Q

What is hyperplasia?

A

Increase in cell NUMBER due to hormonal or chemical stimuli

69
Q

What is hypertrophy?

A

Increase in cell SIZE due to mechanical stimuli

70
Q

Early cell injury is reversible and involves…

A

Na+ and water entry
Swelling
ER dilation

71
Q

Late cell injury is irreversible and involves…

A

Proteins denaturing
Nucleus shrinks, fragments and disappears
Enzymatic digestion of cell
Necrosis (4-12 hours after)

72
Q

_______ is programmed cell death which does not involve inflammation

A

Apoptosis

73
Q

In Barrett’s metaplasia, what happens to the oesophageal cells?

A

Stratified squamous replaced with simple columnar

Increased chance of malignancy

74
Q

What is “primary intention” in terms of skin healing?

A

Linear incision, 2 edges of open skin are close and wound can be closed with sutures, staples etc.

The healing of a clean wound without tissue loss. This is faster than healing by secondary intention.

75
Q

What is “secondary intention” in terms of skin healing?

A

Wounds created by trauma; loss of tissue so the wound is allowed to granulate
Epidermis grows from the bottom up
Healing process can be slow.

76
Q

What are the main stages of skin healing?

A
  1. Haemostasis: Clotting cascade
  2. Inflammation
  3. Proliferation (growth of new tissue): Fibroplasia and Granulation, Epithelialisation, Angiogenesis
  4. Maturation and remodeling
77
Q

What is granulation?

A

Formation of new tissue 2-5 days post wound formation

Rudimentary tissue that is stronger than the fibrin clot

Consists of blood vessels, fibroblasts, inflammatory cells, ECM components which are different in composition to normal ECM

78
Q

What is the role of fibroblasts in proliferation?

A

Proliferate into wound 2-3 days after injury
Produce collagen
Secrete growth factors
Contractile: help the wound to contract

79
Q

Scars are only ____% strong as the previous dermis

A

70-80%

80
Q

In order for the liver to heal, hepatocytes must be stimulated out of which phase of the cell cycle?

A

Quiescent G0 phase

81
Q

What are the consequences of liver cirrhosis?

A
  1. Portal hypertension: splenomegaly, porto-systemic shunt, ascites, oesophageal varicies
  2. Decreased Liver function: Jaundice, bleeding tendancy, thrombocytopenia, hepatic encephalopathy, gynaecomastia and palmar erythema, heptatocellular carcinoma
82
Q

What are the 2 ways that liver tissue can heal?

A
  1. Resolution- return back to normal

2. Repair- nodules and cirrhosis

83
Q

What happens to heart tissue when it is damaged?

A

No healing capacity

Inflammation, macrophages release cytokines eg. Il-6, fibroblasts produce MMPs

84
Q

What are the consequences of myocardial fibrosis?

A

Ventricular aneurysm
Contractil dysfunction
Arrhythmias
Pericarditis

85
Q

__________ is uncoordinated cell proliferation, which persists in the absence of stimuli

A

Neoplasia

86
Q

What are the potential consequences of benign neoplasia?

A 
Bleeding
Obstruction
Compression of other structures
Hormonal secretion
Progression to malignancy
87
Q

What is an in-situ neoplasia?

A

Uncoordinated cell proliferation which has not invaded the basement membrane
Pre-cancerous

88
Q

What are the 4 ways that malignant neoplasms can spread?`

A
  1. blood
  2. lymph
  3. secondary deposits in primary organ
  4. into cavities eg. pleura, peritoneum
89
Q

What is a paraneoplastic syndrome?

A

Signs and symptoms in cancer patient, not due to the local effects of cancer cells

Due to humoral factors secreted by the tumour eg. hormones, cytokines or immune responses against the tumour

90
Q

Compare the nuclear features of benign and malignant neoplasms.

A

BENIGN: Regular nuclear border, low mitotic activity, no hyperchromasia

MALIGNANT: Irregular nuclear border, high mitotic activity, hyperchromasia

91
Q

Compare the tumour shapes of benign vs malignant tumours.

A

BENIGN: Sessile, Polyp, Papillary

MALIGNANT: Fungating, ulcerated, annular

92
Q

What is an annular tumour?

A

Malignancy growing centripetally

Usually a colonic adenocarcinoma

93
Q

What is Dukes Stage A?

A

Colonic tumour invading no further than muscularis propria

94
Q

What is Dukes Stage B?

A

Colonic tumour invading beyond the muscularis propria, no lymph node involvement

95
Q

What is Dukes Stage C?

A

Colonic tumour invading beyond the muscularis propria, nodes involved

96
Q

What is Dukes Stage D?

A

Metastatic

97
Q

What is localised lymphadenopathy?

A

One lymph node region affected

98
Q

What is regional lymphadenopathy?

A

2 or more adjacent lymph node regions affected

99
Q

What is generalised lymphadenopathy?

A

2 or more non-continuous lymph node regions

OR

One node region plus splenomegaly

100
Q

What are the causes of lymphadenopathy?

A
  1. Leukocyte proliferation
  2. Leukocyte influx
  3. Neoplastic cell influx
  4. Abnormal phagocytosed substances eg. silicone
  5. Necrosis, pus
101
Q

Which drugs may cause lymphadenopathy?

A

Anticonvulsants eg. Phenytoin, Carbamazepine

Immunosuppressants eg. Methotrexate

102
Q

What are the features of malignant lymph nodes?

A 
Hard
Fixed
Round
Painless
Large
Forms aggregates
Fatty hilum not visible
103
Q

If pain is felt in an enlarged lymph node following alcohol consumption, which condition should be suspected?

A

Hogkin’s lymphoma

104
Q

What can cause cervical lymphadenopathy?

A 
Pharyngitis
Otitis
Dental abscess
TB
Atypical mycobacterial infection
Cancer: head, neck, thyroid, lyphoma
105
Q

_________ may cause a painless, non spreading cervical lymph node in children <5yrs

A

Atypical mycobacterial infection

106
Q

If an infraclavicular lymph node is enlarged, which condition should be suspected?

A

Hogkin’s lymphoma

107
Q

________ lymph nodes are not palpable and can be enlarged due to sarcoidosis, lymphoma or TB

A

Mediastinal

108
Q

What may be the consequences of mediastinal lymphadenopathy?

A

Superior Vena Cava syndrome (headaches, dilated chest veins)
Cough
Hiccups

109
Q

What are the consequences of SVC obstruction?

A 
Headaches
Feeling of fullness in face when bending over
Swelling in face, neck, chest
Dilated chest veins
SOB
Cough
110
Q

What are the most common causes of SVC syndrome?

A

Lung cancer- usually small cell

Non Hogkin’s lymphoma

111
Q

Axillary lymphadenopathy is usually _______ and can be caused by skin infection, tattoos, silicone

A

Benign

112
Q

What structures do the inguinal lymph nodes drain?

A

Men: Penis, scrotum (NOT TESTES)

Women: Vulva

Both: Anus, Perineum, lower abdominal wall

113
Q

If abdominal lymph nodes are enlarged, this is usually ________

A

Malignant

114
Q

What are the potential causes of large benign lymph nodes?

A
  1. Dermatopathic - node reaction to skin changes eg. eczema
  2. Silicone reaction
  3. Progressive transformation of germinal centres- linked to autoimmune disorders
  4. HIV
  5. TB
  6. Kikuchi disease
115
Q

What is Kikuchi disease?

A

Lymph node inflammation
Benign
Mimics lymphoma but is CD8+ instead of CD4+

116
Q

What are the 3 types of lymph node biopsy?

A
  1. Excision biopsy
  2. Core needle biopsy
  3. Fine needle aspiration
117
Q

What are the disadvantages of fine needle aspiration for biopsying lymph nodes?

A

Smear looses architecture of tissue
May miss focal lesion
Can’t exclude lymphoma
Can cause node necrosis

118
Q

Which lung cancer is most associated with hypercalcaemia?

A

Squamous cell carcinoma

119
Q

Which site in the body is the commonest site of metastases? Which tumours metastasize here?

A

Lung

Breast, colon, stomach, pancreas, kidney, melanoma, prostate

120
Q

Which genes must be expressed in NSCLC to allow prescription of targeted molecular therapies/ immunotherapy?

A

EGFR mutation
ALK translocation
ROS1 translocation
PD-L1 expression

Year 3 (22 decks)

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